From 265195313c51f339c2c9e0070af328f962d660fd Mon Sep 17 00:00:00 2001
From: turtle89431 <turtle89431@gmail.com>
Date: Tue, 5 May 2026 00:30:06 -0700
Subject: [PATCH] Scrape wikipedia-science: 801 new, 2597 updated, 3478 total
 (kb-cron)

---
 _index.db                                     |  Bin 49795072 -> 51396608 bytes
 .../wiki/Abrasion_collar-0.md                 |   35 +
 data/en.wikipedia.org/wiki/Absolute_risk-0.md |   25 +
 data/en.wikipedia.org/wiki/Acholia-0.md       |   33 +
 .../en.wikipedia.org/wiki/Active_placebo-0.md |   26 +
 .../wiki/Acute_(medicine)-0.md                |   29 +
 data/en.wikipedia.org/wiki/Acute_abdomen-0.md |   35 +
 .../wiki/Acute_pericarditis-0.md              |   29 +
 .../wiki/Acute_pericarditis-1.md              |   42 +
 .../wiki/Acute_pericarditis-2.md              |   36 +
 .../wiki/Adherence_(medicine)-0.md            |   34 +
 .../wiki/Adherence_(medicine)-1.md            |   34 +
 .../wiki/Adherence_(medicine)-2.md            |   82 ++
 .../wiki/Adherence_(medicine)-3.md            |   52 +
 .../wiki/Adherence_(medicine)-4.md            |   40 +
 .../wiki/Adhesion_(medicine)-0.md             |   46 +
 .../wiki/Adhesion_(medicine)-1.md             |   27 +
 .../en.wikipedia.org/wiki/Admission_note-0.md |  142 ++
 .../wiki/Adrenergic_storm-0.md                |   28 +
 .../wiki/Adrenergic_storm-1.md                |   27 +
 .../en.wikipedia.org/wiki/Adverse_effect-0.md |   38 +
 .../en.wikipedia.org/wiki/Adverse_effect-1.md |   29 +
 .../en.wikipedia.org/wiki/Adverse_effect-2.md |   58 +
 .../wiki/Adverse_outcome_pathway-0.md         |   42 +
 data/en.wikipedia.org/wiki/Age_of_onset-0.md  |   27 +
 data/en.wikipedia.org/wiki/Agenesis-0.md      |   37 +
 data/en.wikipedia.org/wiki/Agnosia-0.md       |   46 +
 data/en.wikipedia.org/wiki/Agnosia-1.md       |   41 +
 data/en.wikipedia.org/wiki/Agonist-0.md       |   65 +
 .../wiki/Allopathic_medicine-0.md             |   18 +
 .../wiki/Allopathic_medicine-1.md             |   33 +
 .../wiki/Allow_natural_death-0.md             |   33 +
 .../wiki/Allow_natural_death-1.md             |   27 +
 data/en.wikipedia.org/wiki/Ambulatory-0.md    |   35 +
 .../wiki/Anatomical_terminology-0.md          |    2 +-
 .../wiki/Anatomical_terminology-1.md          |    2 +-
 .../wiki/Anatomical_terminology-2.md          |    2 +-
 .../wiki/Anatomical_terminology-3.md          |    2 +-
 .../wiki/Anatomical_terms_of_location-0.md    |   50 +
 .../wiki/Anatomical_terms_of_location-1.md    |   49 +
 .../wiki/Anatomical_terms_of_location-2.md    |   47 +
 .../wiki/Anatomical_terms_of_location-3.md    |   34 +
 .../wiki/Anatomical_terms_of_location-4.md    |   42 +
 .../wiki/Anginal_equivalent-0.md              |   14 +
 data/en.wikipedia.org/wiki/Anisomastia-0.md   |   22 +
 data/en.wikipedia.org/wiki/Anophthalmia-0.md  |   64 +
 data/en.wikipedia.org/wiki/Anophthalmia-1.md  |   30 +
 data/en.wikipedia.org/wiki/Aplasia-0.md       |   76 ++
 .../wiki/Arrested_development-0.md            |   16 +
 .../wiki/Assessment_and_plan-0.md             |   27 +
 data/en.wikipedia.org/wiki/Asymptomatic-0.md  |   44 +
 .../wiki/Asymptomatic_carrier-0.md            |   38 +
 .../wiki/Asymptomatic_carrier-1.md            |   45 +
 data/en.wikipedia.org/wiki/Atresia-0.md       |   55 +
 data/en.wikipedia.org/wiki/Atresia-1.md       |   21 +
 data/en.wikipedia.org/wiki/Atypia-0.md        |   45 +
 .../wiki/Auditory_agnosia-0.md                |   13 +
 .../wiki/Auditory_agnosia-1.md                |   21 +
 .../wiki/Auditory_agnosia-2.md                |   18 +
 .../wiki/Auditory_agnosia-3.md                |   21 +
 .../wiki/Auditory_agnosia-4.md                |   26 +
 .../en.wikipedia.org/wiki/Aura_(symptom)-0.md |   85 ++
 .../en.wikipedia.org/wiki/Autoamputation-0.md |   27 +
 .../wiki/Autonomic_dysreflexia-0.md           |   40 +
 .../wiki/Autonomic_dysreflexia-1.md           |   40 +
 .../wiki/Autonomic_dysreflexia-2.md           |   19 +
 data/en.wikipedia.org/wiki/Azygos-0.md        |   17 +
 .../wiki/B_type_inclusion-0.md                |   20 +
 .../wiki/Ballard_Maturational_Assessment-0.md |   42 +
 data/en.wikipedia.org/wiki/Benign_tumor-0.md  |   33 +
 data/en.wikipedia.org/wiki/Benign_tumor-1.md  |   42 +
 data/en.wikipedia.org/wiki/Benign_tumor-2.md  |   21 +
 .../wiki/Bethesda_system-0.md                 |   75 ++
 .../wiki/Biliary_microlithiasis-0.md          |   32 +
 .../wiki/Biliary_pseudolithiasis-0.md         |   23 +
 .../en.wikipedia.org/wiki/Biliary_sludge-0.md |   53 +
 data/en.wikipedia.org/wiki/Biotrauma-0.md     |   14 +
 .../wiki/Bleb_(medicine)-0.md                 |   23 +
 data/en.wikipedia.org/wiki/Body_fluid-0.md    |   52 +
 .../wiki/Body_image_(neuroscience)-0.md       |   41 +
 .../wiki/Body_image_(neuroscience)-1.md       |   26 +
 .../wiki/Bogart–Bacall_syndrome-0.md          |   51 +
 .../wiki/Bogart–Bacall_syndrome-1.md          |   27 +
 .../en.wikipedia.org/wiki/Breast_atrophy-0.md |   24 +
 .../Brief_resolved_unexplained_event-0.md     |   52 +
 .../Brief_resolved_unexplained_event-1.md     |   20 +
 data/en.wikipedia.org/wiki/Calcinosis-0.md    |   43 +
 .../wiki/Calculus_(medicine)-0.md             |  108 ++
 data/en.wikipedia.org/wiki/Cardiac_shunt-0.md |  199 +++
 .../wiki/Carnoy's_solution-0.md               |   28 +
 .../wiki/Case_presentation-0.md               |   40 +
 data/en.wikipedia.org/wiki/Case_report-0.md   |   75 ++
 .../en.wikipedia.org/wiki/Cause_of_death-0.md |   42 +
 .../wiki/Central_venous_pressure-0.md         |   59 +
 .../wiki/Cerebellar_degeneration-0.md         |   51 +
 .../wiki/Cerebellar_degeneration-1.md         |   25 +
 .../wiki/Cerebral_perfusion_pressure-0.md     |  220 ++++
 .../wiki/Cervical_conization-0.md             |   30 +
 .../wiki/Cervical_conization-1.md             |   23 +
 .../wiki/Cervical_dislocation-0.md            |   28 +
 .../wiki/Chain_of_survival-0.md               |   28 +
 .../wiki/Chain_of_survival-1.md               |   33 +
 data/en.wikipedia.org/wiki/Cheesewiring-0.md  |   55 +
 .../wiki/Chemoprophylaxis-0.md                |   33 +
 .../wiki/Chief_complaint-0.md                 |   29 +
 ...Healthcare_Needs_in_the_United_States-0.md |   64 +
 ...Healthcare_Needs_in_the_United_States-1.md |   41 +
 ...Healthcare_Needs_in_the_United_States-2.md |   27 +
 data/en.wikipedia.org/wiki/Chronic_care-0.md  |   46 +
 .../wiki/Chronic_condition-0.md               |   62 +
 .../wiki/Chronic_condition-1.md               |   19 +
 .../wiki/Chronic_condition-2.md               |   23 +
 .../wiki/Chronic_condition-3.md               |   24 +
 .../wiki/Chronic_condition-4.md               |   26 +
 .../wiki/Chronic_condition-5.md               |   47 +
 .../wiki/Clinical_formulation-0.md            |   49 +
 .../wiki/Clinical_pathway-0.md                |   70 +
 .../wiki/Clinical_research_center-0.md        |   24 +
 .../wiki/Clinical_supervision-0.md            |   19 +
 .../wiki/Clinical_supervision-1.md            |   41 +
 data/en.wikipedia.org/wiki/Clinophilia-0.md   |   28 +
 data/en.wikipedia.org/wiki/Cluttering-0.md    |   75 ++
 .../wiki/Combination_therapy-0.md             |   44 +
 data/en.wikipedia.org/wiki/Communicans-0.md   |   16 +
 .../wiki/Complication_(medicine)-0.md         |   40 +
 .../wiki/Complication_(medicine)-1.md         |   39 +
 .../wiki/Complication_(medicine)-2.md         |   45 +
 .../Computerized_physician_order_entry-0.md   |   72 ++
 .../Computerized_physician_order_entry-1.md   |   21 +
 .../Computerized_physician_order_entry-2.md   |   32 +
 .../wiki/Conservative_treatment-0.md          |   31 +
 .../wiki/Contraindication-0.md                |   29 +
 data/en.wikipedia.org/wiki/Convulsion-0.md    |   67 +
 .../wiki/Corpulence_index-0.md                |  171 +++
 data/en.wikipedia.org/wiki/Cosmesis-0.md      |   19 +
 .../wiki/Counterstimulation-0.md              |   24 +
 .../wiki/Course_(medicine)-0.md               |   25 +
 .../wiki/Craniocervical_instability-0.md      |   66 +
 .../wiki/Culture_conversion-0.md              |   14 +
 data/en.wikipedia.org/wiki/Cure-0.md          |  146 +++
 .../wiki/Dead_on_arrival-0.md                 |   45 +
 .../wiki/Dead_space_(physiology)-0.md         |  302 +++++
 .../wiki/Dead_space_(physiology)-1.md         |   49 +
 .../wiki/Death_by_misadventure-0.md           |   26 +
 .../en.wikipedia.org/wiki/Decompensation-0.md |   30 +
 .../wiki/Deficiency_(medicine)-0.md           |   39 +
 .../wiki/Degeneration_(medicine)-0.md         |   26 +
 .../wiki/Dense_breast_tissue-0.md             |   28 +
 .../wiki/Dense_breast_tissue-1.md             |   25 +
 .../wiki/Dental_abrasion-0.md                 |   32 +
 .../wiki/Dental_abrasion-1.md                 |   61 +
 ...tomandibular_sensorimotor_dysfunction-0.md |   60 +
 ...tomandibular_sensorimotor_dysfunction-1.md |   52 +
 .../wiki/Depression_(physiology)-0.md         |   18 +
 ...pmental_origins_of_health_and_disease-0.md |   28 +
 ...pmental_origins_of_health_and_disease-1.md |   30 +
 ...pmental_origins_of_health_and_disease-2.md |   21 +
 ...pmental_origins_of_health_and_disease-3.md |   21 +
 .../wiki/Diadochokinesia-0.md                 |   24 +
 data/en.wikipedia.org/wiki/Diagnosis-0.md     |   71 +
 .../wiki/Diagnosis-related_group-0.md         |   42 +
 .../wiki/Diagnosis-related_group-1.md         |   56 +
 .../wiki/Diagnosis_of_exclusion-0.md          |   42 +
 .../wiki/Diagnostic_greed-0.md                |   25 +
 .../wiki/Diastasis_(physiology)-0.md          |   19 +
 .../wiki/Diathesis_(medicine)-0.md            |   30 +
 .../wiki/Differential_diagnosis-0.md          |  109 ++
 .../wiki/Differential_diagnosis-1.md          |  216 ++++
 .../wiki/Differential_diagnosis-2.md          |  783 +++++++++++
 .../wiki/Differential_diagnosis-3.md          |  156 +++
 .../wiki/Differential_diagnosis-4.md          |  317 +++++
 .../wiki/Differential_diagnosis-5.md          |   42 +
 data/en.wikipedia.org/wiki/Disease-0.md       |   19 +
 data/en.wikipedia.org/wiki/Disease-1.md       |   29 +
 data/en.wikipedia.org/wiki/Disease-2.md       |   18 +
 data/en.wikipedia.org/wiki/Disease-3.md       |   58 +
 data/en.wikipedia.org/wiki/Disease-4.md       |   41 +
 data/en.wikipedia.org/wiki/Disease-5.md       |   21 +
 data/en.wikipedia.org/wiki/Disease-6.md       |   39 +
 .../wiki/Disease-modifying_treatment-0.md     |   19 +
 .../wiki/Disease_registry-0.md                |   57 +
 .../wiki/Disease_registry-1.md                |   24 +
 .../wiki/Disease_theory_of_alcoholism-0.md    |   28 +
 .../wiki/Disease_theory_of_alcoholism-1.md    |   17 +
 .../wiki/Disease_theory_of_alcoholism-2.md    |   23 +
 .../wiki/Disease_theory_of_alcoholism-3.md    |   33 +
 .../wiki/Disseminated_disease-0.md            |   28 +
 .../wiki/Distress_(medicine)-0.md             |   31 +
 data/en.wikipedia.org/wiki/Divaricate-0.md    |   24 +
 data/en.wikipedia.org/wiki/Diverticulum-0.md  |   72 ++
 .../wiki/Dose_area_product-0.md               |   60 +
 data/en.wikipedia.org/wiki/Drop_attack-0.md   |   20 +
 data/en.wikipedia.org/wiki/Dyscopia-0.md      |   37 +
 data/en.wikipedia.org/wiki/Dyscrasia-0.md     |   32 +
 .../wiki/Dysdiadochokinesia-0.md              |   83 ++
 data/en.wikipedia.org/wiki/Dystrophy-0.md     |   31 +
 data/en.wikipedia.org/wiki/E-patient-0.md     |   61 +
 data/en.wikipedia.org/wiki/ESKAPE-0.md        |   21 +
 data/en.wikipedia.org/wiki/ESKAPE-1.md        |   43 +
 .../wiki/Early_pregnancy_loss-0.md            |   29 +
 data/en.wikipedia.org/wiki/Ebullism-0.md      |   30 +
 data/en.wikipedia.org/wiki/Ebullism-1.md      |   39 +
 .../wiki/Economic_credentialing-0.md          |   17 +
 data/en.wikipedia.org/wiki/Efficacy-0.md      |   53 +
 .../wiki/Elective_surgery-0.md                |   60 +
 .../wiki/Electronic_prescribing-0.md          |   64 +
 .../wiki/Electronic_prescribing-1.md          |   29 +
 .../wiki/Electronic_prescribing-2.md          |   26 +
 .../wiki/Electronic_prescribing-3.md          |   36 +
 .../wiki/Electronic_prescribing-4.md          |   43 +
 .../wiki/Electronic_visit_verification-0.md   |   38 +
 data/en.wikipedia.org/wiki/Electuary-0.md     |   31 +
 data/en.wikipedia.org/wiki/Empyema-0.md       |   40 +
 .../wiki/End_organ_damage-0.md                |  108 ++
 .../wiki/End_organ_damage-1.md                |   26 +
 .../wiki/Endaural_phenomena-0.md              |   19 +
 .../wiki/Endogenous_agonist-0.md              |   15 +
 data/en.wikipedia.org/wiki/Endotype-0.md      |   37 +
 .../wiki/Engel_classification-0.md            |   41 +
 data/en.wikipedia.org/wiki/Epiphenomenon-0.md |   46 +
 data/en.wikipedia.org/wiki/Equianalgesic-0.md |   58 +
 data/en.wikipedia.org/wiki/Exacerbation-0.md  |   18 +
 .../wiki/Excavation_(medicine)-0.md           |   29 +
 .../wiki/Exercise_capacity-0.md               |   14 +
 .../wiki/Extracorporeal_procedure-0.md        |   58 +
 data/en.wikipedia.org/wiki/Extravasation-0.md |   46 +
 .../wiki/Extravasation_(intravenous)-0.md     |   67 +
 data/en.wikipedia.org/wiki/FRAX-0.md          |   53 +
 .../wiki/Family_history_(medicine)-0.md       |   42 +
 data/en.wikipedia.org/wiki/Fascia-0.md        |   51 +
 data/en.wikipedia.org/wiki/Fascia-1.md        |   42 +
 data/en.wikipedia.org/wiki/Fibrosis-0.md      |   79 ++
 .../wiki/Five-year_survival_rate-0.md         |   35 +
 data/en.wikipedia.org/wiki/Fomite-0.md        |   28 +
 data/en.wikipedia.org/wiki/Fomite-1.md        |   41 +
 data/en.wikipedia.org/wiki/Fremitus-0.md      |   59 +
 data/en.wikipedia.org/wiki/Fulminant-0.md     |   33 +
 .../wiki/Functional_disorder-0.md             |   35 +
 .../wiki/Functional_disorder-1.md             |   28 +
 .../wiki/Functional_disorder-2.md             |   24 +
 .../wiki/Functional_disorder-3.md             |   27 +
 .../wiki/Functional_symptom-0.md              |   38 +
 data/en.wikipedia.org/wiki/Gliosis-0.md       |   36 +
 data/en.wikipedia.org/wiki/Gliosis-1.md       |   23 +
 data/en.wikipedia.org/wiki/Gliosis-2.md       |   31 +
 data/en.wikipedia.org/wiki/Gliosis-3.md       |   19 +
 .../wiki/HEENT_examination-0.md               |   29 +
 data/en.wikipedia.org/wiki/HIV_remission-0.md |   42 +
 .../wiki/Habit-tic_deformity-0.md             |   26 +
 .../wiki/Head-twitch_response-0.md            |   22 +
 .../wiki/Head-twitch_response-1.md            |   22 +
 .../wiki/Head-twitch_response-2.md            |   26 +
 .../wiki/Head-twitch_response-3.md            |   24 +
 .../wiki/Head-twitch_response-4.md            |   29 +
 .../wiki/Health_Sciences_Descriptors-0.md     |   28 +
 .../wiki/Health_assessment-0.md               |   34 +
 .../Healthcare_error_proliferation_model-0.md |   46 +
 .../wiki/Healthcare_proxy-0.md                |   72 ++
 data/en.wikipedia.org/wiki/Herd_immunity-0.md |   28 +
 data/en.wikipedia.org/wiki/Herd_immunity-1.md |  119 ++
 data/en.wikipedia.org/wiki/Herd_immunity-2.md |  102 ++
 data/en.wikipedia.org/wiki/Herd_immunity-3.md |   41 +
 .../wiki/Hickam's_dictum-0.md                 |   26 +
 .../wiki/History_of_the_present_illness-0.md  |   33 +
 .../wiki/Homicidal_ideation-0.md              |   54 +
 .../wiki/Hospital_emergency_codes-0.md        |  153 +++
 .../wiki/Hospital_emergency_codes-1.md        |   48 +
 .../wiki/Hospital_emergency_codes-2.md        |   54 +
 data/en.wikipedia.org/wiki/Host_factor-0.md   |   32 +
 .../wiki/Human_body_temperature-0.md          |   31 +
 .../wiki/Human_body_temperature-1.md          |   44 +
 .../wiki/Human_body_temperature-2.md          |   41 +
 .../wiki/Human_body_temperature-3.md          |   33 +
 .../wiki/Human_equivalent-0.md                |   32 +
 data/en.wikipedia.org/wiki/Hyperkatifeia-0.md |   15 +
 data/en.wikipedia.org/wiki/Hypoplasia-0.md    |   38 +
 .../wiki/Idiopathic_disease-0.md              |   55 +
 data/en.wikipedia.org/wiki/Idiosyncrasy-0.md  |   59 +
 .../wiki/Idiosyncratic_drug_reaction-0.md     |   29 +
 .../wiki/Imaging_biomarker-0.md               |   25 +
 .../wiki/Imaging_biomarker-1.md               |   33 +
 .../wiki/Immune_dysregulation-0.md            |   32 +
 .../wiki/Immune_dysregulation-1.md            |   15 +
 .../wiki/Immune_dysregulation-2.md            |   15 +
 .../wiki/Implementability_(medicine)-0.md     |   18 +
 .../wiki/Incidental_medical_findings-0.md     |   30 +
 .../wiki/Indication_(medicine)-0.md           |   27 +
 .../wiki/Indication_(medicine)-1.md           |   23 +
 .../wiki/Indirect_agonist-0.md                |   28 +
 .../wiki/Individualized_medicine-0.md         |   35 +
 .../wiki/Ineffective_erythropoiesis-0.md      |   29 +
 .../wiki/Infiltration_(medical)-0.md          |   45 +
 .../wiki/Insufflation_(medicine)-0.md         |   58 +
 .../wiki/Insult_(medical)-0.md                |   15 +
 .../wiki/Integumentary_system-0.md            |   36 +
 .../wiki/Integumentary_system-1.md            |   40 +
 ...gy_Standards_Development_Organisation-0.md |   51 +
 .../en.wikipedia.org/wiki/Intertriginous-0.md |   22 +
 .../en.wikipedia.org/wiki/Intracorporeal-0.md |   37 +
 .../wiki/Involution_(medicine)-0.md           |   33 +
 data/en.wikipedia.org/wiki/Ketolysis-0.md     |   21 +
 .../wiki/Kissing_contusion-0.md               |   14 +
 .../wiki/Lateral_flow_test-0.md               |   42 +
 .../wiki/Lateral_flow_test-1.md               |   37 +
 .../wiki/Lateral_flow_test-2.md               |   30 +
 .../wiki/Left_without_being_seen-0.md         |   14 +
 .../en.wikipedia.org/wiki/Length_of_stay-0.md |   29 +
 .../wiki/Lightwood's_law-0.md                 |   15 +
 ...t_of_biological_development_disorders-0.md |   18 +
 .../List_of_bones_of_the_human_skeleton-0.md  |  159 +++
 .../wiki/List_of_medical_abbreviations-0.md   |   84 ++
 .../List_of_medical_roots_and_affixes-0.md    |  120 ++
 ...of_skeletal_muscles_of_the_human_body-0.md |   61 +
 .../wiki/Mathematical_proof-0.md              |   30 +
 .../wiki/Mathematical_proof-1.md              |  243 ++++
 .../wiki/Mathematical_proof-2.md              |  358 ++++++
 .../wiki/Mathematical_proof-3.md              |   57 +
 .../wiki/Medical_terminology-0.md             |   42 +
 .../wiki/Medical_terminology-1.md             |   33 +
 .../wiki/Medical_terminology-10.md            |   26 +
 .../wiki/Medical_terminology-11.md            |   43 +
 .../wiki/Medical_terminology-2.md             |   38 +
 .../wiki/Medical_terminology-3.md             |   49 +
 .../wiki/Medical_terminology-4.md             |   42 +
 .../wiki/Medical_terminology-5.md             |   60 +
 .../wiki/Medical_terminology-6.md             |   46 +
 .../wiki/Medical_terminology-7.md             |   33 +
 .../wiki/Medical_terminology-8.md             |   55 +
 .../wiki/Medical_terminology-9.md             |  100 ++
 .../wiki/Modulo_(mathematics)-0.md            |  164 +++
 .../wiki/Necessity_and_sufficiency-0.md       |   69 +
 .../wiki/Necessity_and_sufficiency-1.md       |  123 ++
 .../wiki/Necessity_and_sufficiency-2.md       |  145 +++
 .../wiki/Null_(mathematics)-0.md              |   22 +
 data/en.wikipedia.org/wiki/Of_the_form-0.md   |   28 +
 .../wiki/Order_(mathematics)-0.md             |  101 ++
 data/en.wikipedia.org/wiki/Orthomorphism-0.md |   14 +
 data/en.wikipedia.org/wiki/Parameter-0.md     |  193 +++
 data/en.wikipedia.org/wiki/Parameter-1.md     |  165 +++
 data/en.wikipedia.org/wiki/Parameter-2.md     |  111 ++
 data/en.wikipedia.org/wiki/Parameter-3.md     |   35 +
 .../wiki/Parameter_space-0.md                 |  213 +++
 .../wiki/Parametric_family-0.md               |   78 ++
 .../wiki/Parts-per_notation-0.md              |   36 +
 .../wiki/Parts-per_notation-1.md              |   57 +
 .../wiki/Pathological_(mathematics)-0.md      |   39 +
 .../wiki/Pathological_(mathematics)-1.md      |  155 +++
 .../wiki/Pathological_(mathematics)-2.md      |  155 +++
 .../wiki/Percentage_point-0.md                |   36 +
 data/en.wikipedia.org/wiki/Pointwise-0.md     |  398 ++++++
 data/en.wikipedia.org/wiki/Porism-0.md        |   34 +
 data/en.wikipedia.org/wiki/Porism-1.md        |   35 +
 ...wer,_root-power,_and_field_quantities-0.md |   30 +
 .../wiki/Projection_(mathematics)-0.md        |   43 +
 .../wiki/Projection_(mathematics)-1.md        |  124 ++
 .../wiki/Proportion_(mathematics)-0.md        |  475 +++++++
 .../wiki/Proportionality_(mathematics)-0.md   |  237 ++++
 .../wiki/Purulent_pericarditis-0.md           |   56 +
 data/en.wikipedia.org/wiki/Q.E.D.-0.md        |  109 ++
 .../wiki/Quadrature_(mathematics)-0.md        |   75 ++
 .../wiki/Qualitative_property-0.md            |   44 +
 .../wiki/Reduction_(mathematics)-0.md         |  408 ++++++
 .../wiki/Resilience_(mathematics)-0.md        |   97 ++
 .../wiki/Rigidity_(mathematics)-0.md          |  425 ++++++
 data/en.wikipedia.org/wiki/Scope_(logic)-0.md |  315 +++++
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diff --git a/data/en.wikipedia.org/wiki/Abrasion_collar-0.md b/data/en.wikipedia.org/wiki/Abrasion_collar-0.md
new file mode 100644
index 000000000..30254b64d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Abrasion_collar-0.md
@@ -0,0 +1,35 @@
+---
+title: "Abrasion collar"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Abrasion_collar"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:38.336536+00:00"
+instance: "kb-cron"
+---
+
+An abrasion collar, also known as an abrasion ring or abrasion rim, is a narrow ring of stretched, abraded skin immediately surrounding projectile wounds, such as gunshot wounds. It is most commonly associated with entrance wounds and is a mechanical defect due to a projectile's penetration through the skin. It is caused by a temporary over-stretching of the skin surrounding the projectile's point of penetration. Like all skin abrasions, the abrasion collar tends to dry out due to scraping away of the skin's outer layers and the collapse and dehydration of the underlying cells; it therefore becomes easier to discern with time. This defect is most often seen around rifled firearm entrance wounds due to the striations or grooves in the bullet's surface caused by the rifling on the inside of the weapon's barrel; however, certain other high-velocity projectile wounds can also have the same effect.
+An abrasion collar is usually found in association with a contusion collar of bruising caused by damaged blood vessels in the skin by hydrostatic forces from the bullet's entry. An abrasion rim defect is also possible in firearm exit wounds under certain circumstances, such as if the skin at the exit was crushed between the outgoing bullet and an unyielding object pressed against the skin over the exit site, or if the projectile exits at an extreme angle. Careful examination of the wound under magnification may show signs of everted (outward-turned) edges characteristic of an exit wound. Multiple projectiles impacting in close proximity together, such as in a close-range shotgun blast, will usually still produce an abrasion rim or artefact, though the wound will likely be irregular in shape.
+
+
+== Factors and characteristics ==
+
+
+=== Bullet wipe ===
+In the case of gunshot wounds from unjacketed lead alloy bullets or dirty bullets, a phenomenon known as bullet wipe may be observed, which forms a ring of greasy residue known as a grease or dirt collar that overlays the abrasion collar and is caused by deposits on the skin's surface. Generally, these deposits contain lead from the unjacketed projectile or oil from inside the weapon's barrel, but they may simply be dirty. Studies using high-speed photography have shown that bullet wipe is caused only by the head of the bullet—instead of the body—because the skin recoils away from the bullet as it penetrates due to the force of entry.
+
+
+=== Angle of trajectory ===
+The bullet's angle of trajectory at the point where it penetrates the skin can influence the shape of the abrasion collar. This can be used by forensic pathologists in discerning an approximate angle of entry and is important in investigations of gunshot wound victims, where evidence of the gunshot's origin is necessary to determine whether the death was homicidal, suicidal, or accidental. Generally, if the bullet impacts at an angle perpendicular to the skin surface, the abrasion collar will be symmetrical, concentric, round, and evenly-shaped. As the angle between the trajectory and the skin surface decreases, the abrasion collar becomes more distorted and often more distinct at the point of entry, having a semi-lunar or "half-moon" shape with the broadest width pointing in the direction of the gunshot's origin. This is caused by the exterior of the bullet contacting and scraping over the skin's surface for a certain distance before penetrating the skin.
+
+
+=== Bullet shape and velocity ===
+The bullet shape influences the size of the abrasion collar. High velocity bullets with pointed, narrow, or spitzer tips, such as rifle rounds, and full metal jacket bullets are less likely to produce abrasion collars compared to lower-velocity, semi-jacketed civilian bullets, such as bullets fired from handguns, which have rounded noses.
+If the wound is caused by a high-velocity rifle bullet, the abrasion collar may be smaller, but it may have minute tears in the surface of the skin surrounding the wound entrance. This is because the skin is not capable of stretching quickly enough if the bullet's velocity is too high. If the wound is made over bone, such as a head wound in the scalp, the abrasion collar may not be round at all; it instead becomes stellate or "star-shaped" with ragged and torn edges caused by the skin over-stretching and tearing. In the case of skull entrance wounds, the skin that includes the abrasion collar may be torn away because the underlying tissue is unable to flex away from the force of the bullet's entry.
+
+
+=== Wound distortions ===
+Towards the end of a bullet's effective range, it tends to lose axial stability and will begin to yaw or even tumble end-over-end. This means it may impact the skin while travelling sideways, and the resulting wound may be distorted, irregular in shape, or even slit-like, such that it does not resemble a conventional entrance wound. In this case, an abrasion artefact may be absent. Similarly misshapen wounds can be caused by the distortion of the bullet if it hits an intermediate object (including another part of the victim's own body, in what is known as a re-entrant wound) before penetrating the skin surface. However, careful examination of the wound under magnification may show the inverted wound edges and signs of an irregularly-shaped abrasion rim characteristic of entry wounds. 
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Absolute_risk-0.md b/data/en.wikipedia.org/wiki/Absolute_risk-0.md
new file mode 100644
index 000000000..c5edfa0ca
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Absolute_risk-0.md
@@ -0,0 +1,25 @@
+---
+title: "Absolute risk"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Absolute_risk"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:39.613272+00:00"
+instance: "kb-cron"
+---
+
+Absolute risk (or AR) is the probability or chance of an event. It is usually used for the number of events (such as a disease) that occurred in a group, divided by the number of people in that group.
+Absolute risk is one of the most understandable ways of communicating health risks to the general public.
+In difference to absolute risk, the relative risk (RR) is the ratio of the probability of an outcome in an exposed group to the probability of the outcome in an unexposed group.
+
+
+== See also ==
+Absolute risk reduction
+Relative risk reduction
+
+
+== References ==
+
+
+== Further reading ==
+Woloshin, Steven; Schwartz, Lisa M.; Welch, H. Gilbert (2008). Know Your Chances: Understanding Health Statistics. Berkeley (CA): University of California Press. PMID 23469386.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Acholia-0.md b/data/en.wikipedia.org/wiki/Acholia-0.md
new file mode 100644
index 000000000..82be54ad6
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Acholia-0.md
@@ -0,0 +1,33 @@
+---
+title: "Acholia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Acholia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:40.769428+00:00"
+instance: "kb-cron"
+---
+
+Acholia is pale feces, due to lack of bile which results in the normal brown colour. It is a sign of reduced conjugated bilirubin into the bowel, as a result of a problem in the liver itself or in the biliary tree.
+
+
+== Signs and symptoms ==
+Acholia results in pale feces.
+
+
+== Cause ==
+A condition in which little or no bile is secreted or the flow of bile into the digestive tract is obstructed. The acholia is a sign of many diseases, such as hepatitis.
+
+
+== Etymology ==
+Ancient Greek: a + chole (without bile).
+
+
+== See also ==
+Choluria
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Active_placebo-0.md b/data/en.wikipedia.org/wiki/Active_placebo-0.md
new file mode 100644
index 000000000..44535d2c4
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Active_placebo-0.md
@@ -0,0 +1,26 @@
+---
+title: "Active placebo"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Active_placebo"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:41.989643+00:00"
+instance: "kb-cron"
+---
+
+An active placebo is a placebo that produces noticeable side effects that may convince the person being treated that they are receiving a legitimate treatment, rather than an inert placebo.
+
+
+== Nomenclature ==
+According to a 1965 paper, the term "concealed placebo" (German: Kaschiertes Placebo) was suggested in a 1959 paper published in German.
+
+
+== Example ==
+An example of an active placebo is the 1964 work of Shader and colleagues who used a combination of low-dose phenobarbital plus atropine to mimic the sedation and dry mouth produced by phenothiazines.
+Morphine and gabapentin are painkillers with the common side effects of sleepiness and dizziness. In a 2005 study assessing the effects of these painkillers on neuropathic pain, lorazepam was chosen as an active placebo because it is not a painkiller but it does cause sleepiness and can cause dizziness.
+Testing from the late 1950s onwards on narcotic analgesics like morphine also has used dicyclomine as an active placebo, and on some occasions it was reported to cause the Straub mouse tail reaction, as do most narcotics. Clonidine is now finding more use as an active placebo for narcotics.
+
+
+== References ==
+
+Shader, R. I.; Cohler, J.; Elashoff, R.; Grinspoon, L. (October 1964). "Phenobarbital and atropine in combination, an active control substance for phenothiazine research". Journal of Psychiatric Research. 2 (3): 169–183. doi:10.1016/0022-3956(64)90018-4. PMID 14242375. Retrieved 7 September 2020.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Acute_(medicine)-0.md b/data/en.wikipedia.org/wiki/Acute_(medicine)-0.md
new file mode 100644
index 000000000..1f8070550
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Acute_(medicine)-0.md
@@ -0,0 +1,29 @@
+---
+title: "Acute (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Acute_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:43.224820+00:00"
+instance: "kb-cron"
+---
+
+In medicine, describing a disease as acute denotes that it is of recent onset; it occasionally denotes a short duration. The quantification of how much time constitutes "short" and "recent" varies by disease and by context, but the core denotation of "acute" is always qualitatively in contrast with "chronic", which denotes long-lasting disease (for example, in acute leukaemia and chronic leukaemia). 
+In the context of the mass noun "acute disease", it refers to the acute phase (that is, a short course) of any disease entity. For example, in an article on ulcerative enteritis in poultry, the author says, "in acute disease there may be increased mortality without any obvious signs", referring to the acute form or phase of ulcerative enteritis.
+
+
+== Meaning variations ==
+A mild stubbed toe is an acute injury. Similarly, many acute upper respiratory infections and acute gastroenteritis cases in adults are mild and usually resolve within a few days or weeks.
+The term "acute" is also included in the definition of several diseases, such as severe acute respiratory syndrome, acute leukaemia, acute myocardial infarction, and acute hepatitis. This is often to distinguish diseases from their chronic forms, such as chronic leukaemia, or to highlight the sudden onset of the disease, such as acute myocardial infarct.
+
+
+=== Related terminology ===
+Related terms include:
+
+
+== Acute care ==
+Acute care is the early and specialist management of adult patients who have a wide range of medical conditions requiring urgent or emergency care usually within 48 hours of admission or referral from other specialties.
+Acute hospitals are those intended for short-term medical and/or surgical treatment and care which is a medical speciality of acute medicine, as often primary care is not positioned to assume this role.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Acute_abdomen-0.md b/data/en.wikipedia.org/wiki/Acute_abdomen-0.md
new file mode 100644
index 000000000..4034245fd
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Acute_abdomen-0.md
@@ -0,0 +1,35 @@
+---
+title: "Acute abdomen"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Acute_abdomen"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:44.430078+00:00"
+instance: "kb-cron"
+---
+
+An acute abdomen refers to a sudden, severe abdominal pain. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment.
+
+
+== Differential diagnosis ==
+Common causes of an acute abdomen include a gastrointestinal perforation, peptic ulcer disease, mesenteric ischemia, acute cholecystitis, appendicitis, diverticulitis, pancreatitis, and an abdominal hemorrhage. However, this is a non-exhaustive list and other less common causes may also lead to an acute abdomen. In pregnant patient, a tubo-ovarian abscess, ruptured ovarian cyst or a ruptured ectopic pregnancy are common causes of an acute abdomen.
+
+
+=== Ischemic acute abdomen ===
+Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries (SMA and IMA respectively), both of which are direct branches of the aorta.
+Clinically, patients present with diffuse abdominal pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema. Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.
+
+
+== Diagnosis ==
+Traditionally, the use of opiates or other pain medications in patients with an acute abdomen has been discouraged before the clinical examination because of the concern that pain medications may mask the signs and symptoms of the condition and therefore may lead to a delay in diagnosis. However, the scientific literature has shown that early administration of pain medications, including opiates, in those with acute abdomen does not lead to delayed diagnosis, delayed treatment or errors in management (the incorrect surgical treatment administered or performing un-necessary surgery). In a meta-analysis of those with acute appendicitis, early administration of opiates was found to alter treatment approach (with a slightly higher rate of appendectomy in those who received opiates) but diagnostic accuracy and surgical outcomes were unaffected by pain medication use. Clinical guidelines also recommend early analgesic use before a cause is established.
+Medical imaging aids in the diagnosis of potential causes of an acute abdomen. A CT scan or ultrasound of the abdomen and pelvis are the preferred imaging modalities in the evaluate of an acute abdomen. The use of radiocontrast agents with CT scans improve diagnostic accuracy. Some authors advocate for the use of CT angiography with contrast of the abdomen and pelvis as the preferred imaging modality. An ultrasound is the preferred imaging modality in pregnant patients as CT scans expose the fetus to ionizing radiation which may lead to adverse pregnancy outcomes. An abdominal x-ray may show free air in the abdominal cavity due to a perforation in the gastrointestinal tract. However, abdominal x-ray is not recommended as part of the diagnostic evaluation in acute abdomen due to its low sensitivity and specificity. Delays in medical imaging acquisition and interpretation greater than 2 hours are associated with an increased risk of complications and death.
+
+
+== Society and culture ==
+In a population based study of Medicare patients in the United States, Black patients who were admitted to the hospital for an acute abdomen requiring general surgery consultation were 14% less likely to receive surgical consultation as compared to White patients. These racial disparities in care persisted (with an 11% difference) when socioeconomic factors were standardized. In another population based study in the United States, Black patients and patients from other racial minority groups were 22-30% less likely to receive pain medication for an acute abdomen as compared to White patients.
+
+
+== References ==
+
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/Acute_pericarditis-0.md b/data/en.wikipedia.org/wiki/Acute_pericarditis-0.md
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+---
+title: "Acute pericarditis"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Acute_pericarditis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:45.765948+00:00"
+instance: "kb-cron"
+---
+
+Acute pericarditis is a type of pericarditis (inflammation of the sac surrounding the heart, the pericardium) usually lasting less than 4 to 6 weeks. It is the most common condition affecting the pericardium.
+
+== Signs and symptoms ==
+
+Chest pain is one of the common symptoms of acute pericarditis. It is usually of sudden onset, occurring in the anterior chest and often has a sharp quality that worsens with breathing in or coughing, due to inflammation of the pleural surface at the same time. The pain may be reduced with sitting up and leaning forward while worsened with lying down, and also may radiate to the back, to one or both trapezius ridges. However, the pain can also be dull and steady, resembling the chest pain in an acute myocardial infarction. As with any chest pain, other causes must also be ruled out, such as GERD, pulmonary embolism, muscular pain, etc.
+A pericardial friction rub is a very specific sign of acute pericarditis, meaning the presence of this sign invariably indicates presence of disease. However, absence of this sign does not rule out disease. This rub can be best heard by the diaphragm of the stethoscope at the left sternal border arising as a squeaky or scratching sound, resembling the sound of leather rubbing against each other. This sound should be distinguished from the sound of a murmur, which is similar but sounds more like a "swish" sound than a scratching sound. The pericardial rub is said to be generated from the friction generated by the two inflamed layers of the pericardium; however, even a large pericardial effusion does not necessarily present a rub. The rub is best heard during the maximal movement of the heart within the pericardial sac, namely, during atrial systole, ventricular systole, and the filling phase of early ventricular diastole.
+Fever may be present since this is an inflammatory process.
+
+== Causes ==
+There are several causes of acute pericarditis. In developed nations, the cause of most (80–90%) cases of acute pericarditis is unknown but a viral cause is suspected in the majority of such cases. The other 10–20% of acute pericarditis cases have various causes including connective tissue diseases (e.g., systemic lupus erythematosus), cancer, or involve an inflammatory reaction of the pericardium following trauma to the heart such as after a heart attack such as Dressler's syndrome. Familial Mediterranean fever and TNF receptor associated periodic syndrome are rare inherited autoimmune diseases capable of causing recurring episodes of acute pericarditis.
+
+== Pathophysiology ==
+Acute pericarditis is an over-arching term to describe a set of clinical symptoms and findings associated with inflammation of the pericardium. The initial triggering event is variable and depends on the underlying etiology. In general, an inflammatory stimulus (virus, idiopathic, radiation, surgery) results in an injury that activates the immune system of the body. A structure known as the inflammasome (a large molecule cellular structure) begins to activate other smaller inflammatory molecules known as cytokines that eventually attack and damage the mesothelial cells of the pericardium. The differentiation in symptoms and presentation may depend on the patient-level variation of the adaptive and innate immune system. If a patient has adequate mechanisms to turn off pro-inflammatory processes, the acute pericarditis may not progress. If immune system is not regulated as well and is allowed to continue activating the inflammasome to damage the mesothelial cells, this may lead to the inflammation of the pericardium. The goal of medical treatment for this condition is to turn off or regulate the patients inflammatory system. 
+
+== Diagnosis ==
+
+For acute pericarditis to formally be diagnosed, two or more of the following criteria must be present: chest pain consistent with a diagnosis of acute pericarditis (sharp chest pain worsened by breathing in or a cough), a pericardial friction rub, a pericardial effusion, and changes on electrocardiogram (ECG) consistent with acute pericarditis.
+A complete blood count may show an elevated white count and a serum C-reactive protein may be elevated. Acute pericarditis is associated with a modest increase in serum creatine kinase MB (CK-MB). and cardiac troponin I (cTnI), both of which are also markers for injury to the muscular layer of the heart. Therefore, it is imperative to also rule out acute myocardial infarction in the face of these biomarkers. The elevation of these substances may occur when inflammation of the heart's muscular layer in addition to acute pericarditis. Also, ST elevation on EKG (see below) is more common in those patients with a cTnI > 1.5 μg/L. Coronary angiography in those patients should indicate normal vascular perfusion. Troponin levels increase in 35-50% of people with pericarditis.
+Electrocardiogram (ECG) changes in acute pericarditis mainly indicates inflammation of the epicardium (the layer directly surrounding the heart), since the fibrous pericardium is electrically inert. For example, in uremia, there is no inflammation in the epicardium, only fibrin deposition, and therefore the EKG in uremic pericarditis will be normal. Typical EKG changes in acute pericarditis includes
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+---
+title: "Acute pericarditis"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Acute_pericarditis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:45.765948+00:00"
+instance: "kb-cron"
+---
+
+stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1. Elevation of PR segment in aVR and depression of PR in other leads especially left heart V5, V6 leads indicates atrial injury.
+stage 2 -- normalization of ST and PR deviations
+stage 3 -- diffuse T wave inversions (may not be present in all patients)
+stage 4 -- EKG becomes normal OR T waves may be indefinitely inverted
+The two most common clinical conditions where ECG findings may mimic pericarditis are acute myocardial infarction (AMI) and generalized early repolarization. As opposed to pericarditis, AMI usually causes localized convex ST-elevation usually associated with reciprocal ST-depression which may also be frequently accompanied by Q-waves, T-wave inversions (while ST is still elevated unlike pericarditis), arrhythmias and conduction abnormalities. In AMI, PR-depressions are rarely present. Early repolarization usually occurs in young males (age <40 years) and ECG changes are characterized by terminal R-S slurring, temporal stability of ST-deviations and J-height/ T-amplitude ratio in V5 and V6 of <25% as opposed to pericarditis where terminal R-S slurring is very uncommon and J-height/ T-amplitude ratio is ≥ 25%. Very rarely, ECG changes in hypothermia may mimic pericarditis, however differentiation can be helpful by a detailed history and presence of an Osborne wave in hypothermia.
+Another important diagnostic electrocardiographic sign in acute pericarditis is the Spodick sign. It signifies to the PR-depressions in a usual (but not always) association with downsloping TP segment in patients with acute pericarditis and is present in up to 80% of the patients affected with acute pericarditis. The sign is often best visualized in lead II and lateral precordial leads. In addition, Spodick's sign may also serve as an important distinguishing electrocardiographic tool between the acute pericarditis and acute coronary syndrome. The presence of a classical Spodick's sign is often a giveaway to the diagnosis.
+Rarely, electrical alternans may be seen, depending on the size of the effusion.
+A chest x-ray is usually normal in acute pericarditis but can reveal the presence of an enlarged heart if a pericardial effusion is present and is greater than 200 mL in volume. Conversely, patients with unexplained new onset cardiomegaly should always be worked up for acute pericarditis.
+An echocardiogram is typically normal in acute pericarditis but can reveal pericardial effusion, the presence of which supports the diagnosis, although its absence does not exclude the diagnosis.
+
+== Differential Diagnoses ==
+There are many causes of acute pericarditis, so the first step in differentiating is taking a good patient history to determine likely and unlikely causes of acute pericarditis. To diagnose acute idiopathic pericarditis, one must rule out all other causes of acute pericarditis (diagnosis of exclusion).
+Common diagnoses to rule out when considering acute idiopathic pericarditis include the following:
+Pericarditis secondary to post-cardiac injury: Differentiate this from acute idiopathic pericarditis by timing. If the pericarditis results a few days or weeks post acute myocardial infarction, trauma to the chest wall, cardiac surgery or other cardiac perforation causes pericarditis secondary to post-cardiac injury is most likely the diagnosis.
+Pericarditis secondary autoimmune disease: Differentiate idiopathic pericarditis from common autoimmune diseases that present with pericarditis as just one of many complications. This list includes, systemic lupus erythematosus, rheumatoid arthritis, scleroderma, dermatomyositis, polymyositis, mixed connective tissue disease, vasculitis, Inflammatory bowel disease, sarcoidosis, Behçet's disease, Still disease, Immunoglobulin G4-related diseases, Erheim-Chester disease, polyarteritis nodosa, etc. Can be done by evaluating labs such as ANA, ESR, anti-rheumatoid factor, Anti-SSA/Ro, Anti-SSB/La, and p-ANCA/c-ANCA and so on
+Pericarditis secondary to drug toxicity: Pericarditis can result from the following medications: Procainamide, isoniazid, hydralazine, and cyclosporine.
+Pericarditis secondary to metabolic derangements: Differentiate pericarditis from causes resulting from both excretion of waste, such as uremia (dialysis associated) as well as from endocrine function including hyperthyroidism, hypothyroidism, cholesterol and anorexia. This can be obtained from a basic CMP, TSH and T4 levels.
+Pericarditis secondary to infection: Differentiate between viral, bacterial, fungal, and/or protozoal. Evaluate if the patient has a fever, chills, septicemia or any other evidence of infection.
+Pericarditis secondary to malignancy: Differentiate the result of acute pericarditis arising from invasion/activation of the immune system from a tumor such as malignant melanoma, lymphoma, leukemia, or solid tumors. If a pericardial effusion is present, malignant cells are often found in the pericardial fluid.
+
+== Treatment ==
+Patients with uncomplicated acute pericarditis can generally be treated and followed up in an outpatient clinic. However, those with high risk factors for developing complications (see above) will need to be admitted to an inpatient service, most likely an ICU setting. High risk patients include the following:
+
+subacute onset
+high fever (> 100.4 F/38 C) and leukocytosis
+development of cardiac tamponade
+large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
+immunocompromised
+history of oral anticoagulation therapy
+acute trauma
+failure to respond to seven days of NSAID treatment
+Pericardiocentesis is a procedure whereby the fluid in a pericardial effusion is removed through a needle. It is performed under the following conditions:
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+---
+title: "Acute pericarditis"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Acute_pericarditis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:45.765948+00:00"
+instance: "kb-cron"
+---
+
+presence of moderate or severe cardiac tamponade
+diagnostic purpose for suspected purulent, tuberculosis, or neoplastic pericarditis
+persistent symptomatic pericardial effusion
+NSAIDs in viral or idiopathic pericarditis. In patients with underlying causes other than viral, the specific etiology should be treated. With idiopathic or viral pericarditis, NSAID is the mainstay treatment. Goal of therapy is to reduce pain and inflammation. The course of the disease may not be affected. The preferred NSAID is ibuprofen because of rare side effects, better effect on coronary flow, and larger dose range. Depending on severity, dosing is between 300 and 800 mg every 6–8 hours for days or weeks as needed. An alternative protocol is aspirin 800 mg every 6–8 hours. Dose tapering of NSAIDs may be needed. In pericarditis following acute myocardial infarction, NSAIDs other than aspirin should be avoided since they can impair scar formation. As with all NSAID use, GI protection should be engaged. Failure to respond to NSAIDs within one week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) likely indicates that a cause other than viral or idiopathic is in process.
+Colchicine, which has been essential to treat recurrent pericarditis, has been supported for routine use in acute pericarditis by recent prospective studies. Colchicine can be given 0.6 mg twice a day (0.6 mg daily for patients <70 kg) for 3 months following an acute attack. It should be considered in all patients with acute pericarditis, preferably in combination with a short-course of NSAIDs. For patients with a first episode of acute idiopathic or viral pericarditis, they should be treated with an NSAID plus colchicine 1–2 mg on first day followed by 0.5 daily or twice daily for three months. It should be avoided or used with caution in patients with severe chronic kidney disease, hepatobiliary dysfunction, blood dyscrasias, and gastrointestinal motility disorders.
+Corticosteroids are usually used in those cases that are clearly refractory to NSAIDs and colchicine and a specific cause has not been found. Systemic corticosteroids are usually reserved for those with autoimmune disease.
+
+== Clinical Complications ==
+Clinical complications of acute pericarditis may vary between:
+
+Acute and recurrent pericarditis
+Pericardial effusion without major hemodynamic compromise
+Cardiac tamponade
+Constrictive pericarditis
+Effusive-constrictive pericarditis
+
+== Prognosis ==
+One of the most feared complications of acute pericarditis is cardiac tamponade. Cardiac tamponade is accumulation of enough fluid in the pericardial space --- pericardial effusion --- to cause serious obstruction to the inflow of blood to the heart. Signs of cardiac tamponade include distended neck veins, muffled heart sounds when listening with a stethoscope, and low blood pressure (together known as Beck's triad). This condition can be fatal if not immediately treated.
+Another longer term complication of pericarditis, if it recurs over a longer period of time (normally more than 3 months), is progression to constrictive pericarditis. Recent studies have shown this to be an uncommon complication. The definitive treatment for constrictive pericarditis is pericardial stripping, which is a surgical procedure where the entire pericardium is peeled away from the heart.
+
+== References ==
+
+== Further reading ==
+Chugh, S. N. (2014-05-14). Textbook of Clinical Electrocardiography. Jaypee Brothers Publishers. ISBN 9789350906088.
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/Adherence_(medicine)-0.md b/data/en.wikipedia.org/wiki/Adherence_(medicine)-0.md
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+---
+title: "Adherence (medicine)"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Adherence_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:48.247796+00:00"
+instance: "kb-cron"
+---
+
+In medicine, patient adherence describes the degree to which a person correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to other situations such as medical device use, self care, self-directed exercises, therapy sessions, or medical follow-up visits. Patient compliance and patient adherence may be used interchangeably but adherence emphasizes the role of the patient in decision-making and factors that influence the ability to follow instructions. Concordance is the process by which a patient and clinician make decisions together about treatment. Differences in terminology reflect regional variation, deliberate distinctions, and the preferences of various groups and organizations.
+Both patient and health-care provider affect adherence, and a positive physician-patient relationship is the most important factor in improving compliance. Access to care plays a role in patient adherence, whereby greater wait times to access care contributing to greater absenteeism. The cost of prescription medication and potential side effects also play a role.
+Worldwide, non-compliance is a major obstacle to the effective delivery of health care. 2003 estimates from the World Health Organization indicated that only about 50% of patients with chronic diseases living in developed countries follow treatment recommendations with particularly low rates of adherence to therapies for asthma, diabetes, and hypertension. Major barriers to compliance are thought to include the complexity of modern medication regimens, poor health literacy and not understanding treatment benefits, the occurrence of undiscussed side effects, poor treatment satisfaction, cost of prescription medicine, and poor communication or lack of trust between a patient and his or her health-care provider. Efforts to improve compliance have been aimed at simplifying medication packaging, providing effective medication reminders, improving patient education, and limiting the number of medications prescribed simultaneously. Studies show a great variation in terms of characteristics and effects of interventions to improve medicine adherence. It is still unclear how adherence can consistently be improved in order to promote clinically important effects.
+
+== Terminology ==
+In medicine, compliance describes the degree to which a patient correctly follows medical advice. Most commonly, it refers to medication or drug compliance, but it can also apply to medical device use, self care, self-directed exercises, or therapy sessions. Both patient and health-care provider affect compliance, and a positive physician-patient relationship is the most important factor in improving compliance.
+As of 2003, US health care professionals more commonly used the term "adherence" to a regimen rather than "compliance", because it has been thought to reflect better the diverse reasons for patients not following treatment directions in part or in full. Additionally, the term adherence includes the ability of the patient to take medications as prescribed by their physician with regards to the correct drug, dose, route, timing, and frequency. It has been noted that compliance may only refer to passively following orders. The term adherence is often used to imply a collaborative approach to decision-making and treatment between a patient and clinician.
+The term concordance has been used in the United Kingdom to involve a patient in the treatment process to improve compliance, and refers to a 2003 NHS initiative. In this context, the patient is informed about their condition and treatment options, involved in the decision as to which course of action to take, and partially responsible for monitoring and reporting back to the team. Informed intentional non-adherence is when the patient, after understanding the risks and benefits, chooses not to take the treatment.
+As of 2005, the preferred terminology remained a matter of debate. As of 2007, concordance has been used to refer specifically to patient adherence to a treatment regimen which the physician sets up collaboratively with the patient, to differentiate it from adherence to a physician-only prescribed treatment regimen. Despite the ongoing debate, adherence has been the preferred term for the World Health Organization, The American Pharmacists Association, and the U.S. National Institutes of Health Adherence Research Network. The Medical Subject Headings of the United States National Library of Medicine defines various terms with the words adherence and compliance. Patient Compliance and Medication Adherence are distinguished under the MeSH tree of Treatment Adherence and Compliance.
+
+== Adherence factors ==
+In 2003 WHO estimated that half of those for whom long term treatment regimens are prescribed do not follow them as directed.
+In general, adherence is higher in diseases where people see a greater health threat, such as HIV/AIDS and cancer, and it is lower for chronic conditions such as hypertension, asthma or diabetes.
+Factors can be categorized on 3 levels: individual, cultural and healthcare system level.
+
+=== Individual factors ===
+Depressive symptoms and perceived discrimination have been correlated with poor adherence.
+
+=== Side effects ===
+Negative side effects of a medicine can influence adherence.
+
+=== Socioeconomic status ===
+Medication adherence rates are typically lower with lower socioeconomic status, increased stress related to difficult life circumstances.
+Poverty is associated with Low levels of literacy and numeracy. Adults in more deprived areas, such as the North East of England, performed at a lower level than those in less deprived areas such as the South East. Local authority tenants and those in poor health were particularly likely to lack basic skills.
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+---
+title: "Adherence (medicine)"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Adherence_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:48.247796+00:00"
+instance: "kb-cron"
+---
+
+=== Literacy ===
+In 1999 one fifth of UK adults, nearly seven million people, had problems with basic skills, especially functional literacy and functional numeracy, described as: "The ability to read, write and speak in English, and to use mathematics at a level necessary to function at work and in society in general." This made it impossible for them to effectively take medication, read labels, follow drug regimes, and find out more.
+In 2003, 20% of adults in the UK had a long-standing illness or disability and a national study for the UK Department of Health, found more than one-third of people with poor or very poor health had literary skills of Entry Level 3 or below.
+A study of the relationship of literacy to asthma knowledge revealed that only 31% of asthma patients with a reading level of a ten-year-old knew they needed to see the doctors, even when they were not having an asthma attack, compared to 90% with a high school graduate reading level.
+
+=== Treatment cost ===
+In 2013 the US National Community Pharmacists Association sampled for one month 1,020 Americans above age 40 for with an ongoing prescription to take medication for a chronic condition and gave a grade C+ on adherence. In 2009, this contributed to an estimated cost of $290 billion annually. In 2012, increase in patient medication cost share was found to be associated with low adherence to medication.
+The United States is among the countries with the highest prices of prescription drugs mainly attributed to the government's lack of negotiating lower prices with monopolies in the pharmaceutical industry especially with brand name drugs. In order to manage medication costs, many US patients on long term therapies fail to fill their prescription, skip or reduce doses. According to a Kaiser Family Foundation survey in 2015, about three quarters (73%) of the public think drug prices are unreasonable and blame pharmaceutical companies for setting prices so high. In the same report, half of the public reported that they are taking prescription drugs and a "quarter (25%) of those currently taking prescription medicine report they or a family member have not filled a prescription in the past 12 months due to cost, and 18 percent report cutting pills in half or skipping doses". In a 2009 comparison to Canada, only 8% of adults reported to have skipped their doses or not filling their prescriptions due to the cost of their prescribed medications.
+
+=== Health literacy ===
+Cost and poor understanding of the directions for the treatment, referred to as 'health literacy' have been known to be major barriers to treatment adherence. Misinformation from the internet and social media can also lead to a delay or lack of compliance in following medical advice.
+
+=== Age ===
+The recent National Service Framework on the care of older people highlighted the importance of taking and effectively managing medicines in the elderly. Elderly individuals may face challenges, including multiple medications with frequent dosing, and potentially decreased dexterity or cognitive functioning. Patient knowledge is also a factor.
+In 1999 Cline et al. identified several gaps in knowledge about medication in elderly patients discharged from hospital. Despite receiving written and verbal information, 27% of older people discharged after heart failure were classed as non-adherent within 30 days. Half the patients surveyed could not recall the dose of the medication that they were prescribed and nearly two-thirds did not know what time of day to take them. A 2001 study by Barat et al. evaluated the medical knowledge and factors of adherence in a population of 75-year-olds living at home. They found that 40% of elderly patients do not know the purpose of their regimen and only 20% knew the consequences of non-adherence. Comprehension, polypharmacy, living arrangement, multiple doctors, and use of compliance aids was correlated with adherence.
+In children with asthma, self-management compliance is critical and co-morbidities have been noted to affect outcomes; in 2013 it has been suggested that electronic monitoring may help adherence.
+
+=== Ethnicity ===
+People of different ethnic backgrounds have unique adherence issues through, for example, limited English language proficiency, their cultural belief system rooted in historical experience (Tuskegee experiment), resulting in medical mistrust. There are few published studies on adherence in medicine taking in ethnic minority communities. Ethnicity and culture influence some health-determining behaviour, such as participation in health screening programmes and attendance at follow-up appointments.
+Ethnic groups differ in their attitudes, values, culture and beliefs about health and illness, particularly with preventive treatments and medication for asymptomatic conditions. Additionally, some cultures fatalistically attribute their good or poor health to their god(s), and attach less importance to self-care than others. Complementary and alternative medicine may be taken with or instead of the prescribed medications especially in Mexican American and Vietnamese people.
+Studies have shown that black patients and those with non-private insurance are more likely to be labeled as non-adherent. An increased risk for non adherence was observed even after controlling for  A1c, and socioeconomic factors.
+
+=== Prescription fill rates ===
+Not all patients will fill the prescription at a pharmacy. In a 2010 U.S. study, 20–30% of prescriptions were never filled at the pharmacy. Reasons people do not fill prescriptions include the cost of the medication, A US nationwide survey of 1,010 adults in 2001 found that 22% chose not to fill prescriptions because of the price, which is similar to the 20–30% overall rate of unfilled prescriptions. Other factors are doubting the need for medication, or preference for self-care measures other than medication. Convenience, side effects and lack of demonstrated benefit are also factors.
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+---
+title: "Adherence (medicine)"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Adherence_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:48.247796+00:00"
+instance: "kb-cron"
+---
+
+==== Medication Possession Ratio ====
+Prescription medical claims records can be used to estimate medication adherence based on fill rate. Patients can be routinely defined as being 'Adherent Patients' if the amount of medication furnished is at least 80% based on days' supply of medication divided by the number of days patient should be consuming the medication. This percentage is called the medication possession ratio (MPR). 2013 work has suggested that a medication possession ratio of 90% or above may be a better threshold for deeming consumption as 'Adherent'.
+Two forms of MPR can be calculated, fixed and variable. Calculating either is relatively straightforward, for Variable MPR (VMPR) it is calculated as the number of days' supply divided by the number of elapsed days including the last prescription.
+
+  
+    
+      
+        V
+        M
+        P
+        R
+        =
+        
+          
+            
+              All days' supply
+              Elapsed days (inclusive of last prescription)
+            
+          
+        
+      
+    
+    {\displaystyle VMPR={\dfrac {\text{All days' supply}}{\text{Elapsed days (inclusive of last prescription)}}}}
+  
+
+For the Fixed MPR (FMPR) the calculation is similar but the denominator is the number of days in a year whilst the numerator is constrained to be the number of days' supply within the year that the patient has been prescribed.
+
+  
+    
+      
+        F
+        M
+        P
+        R
+        =
+        
+          
+            
+              
+                
+                  All days' supply
+                
+                ≤
+                365
+              
+              365
+            
+          
+        
+      
+    
+    {\displaystyle FMPR={\dfrac {{\text{All days' supply}}\leq 365}{365}}}
+  
+
+For medication in tablet form it is relatively straightforward to calculate the number of days' supply based on a prescription. Some medications are less straightforward though because a prescription of a given number of doses may have a variable number of days' supply because the number of doses to be taken per day varies, for example with preventative corticosteroid inhalers prescribed for asthma where the number of inhalations to be taken daily may vary between individuals based on the severity of the disease.
+
+=== Contextual factors ===
+Contextual factors along with intrapersonal circumstances such as mental states affect decisions. They can accurately predict decisions where most contextual information is identified. General compliance with recommendations to follow isolation is influenced beliefs such as taking health precaution to be protected against infection, perceived vulnerability, getting COVID-19 and trust in the government. Mobility reduction, compliance with quarantine regulations in European regions where level of trust in policymakers is high can influence whether one complies with isolation rules. In addition, perceived infectiousness of COVID-19 is a strong predictor of rule compliance such that the more contagious people think COVID-19 is, the less willing social distancing measures are taken, while the sense of duty and fear of the virus contribute to staying at home. People might not leave their homes due to trusting regulations to be effective or placing it in a higher power such that individuals who trust others demonstrate more compliance than those who do not. Compliant individuals see protective measures as effective, while non-compliant people see them as problematic.
+
+=== Course completion ===
+Once started, patients seldom follow treatment regimens as directed, and seldom complete the course of treatment. In respect of hypertension, 50% of patients completely drop out of care within a year of diagnosis. Persistence with first-line single antihypertensive drugs is extremely low during the first year of treatment. As far as lipid-lowering treatment is concerned, only one third of patients are compliant with at least 90% of their treatment. Intensification of patient care interventions (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) improves patient adherence rates to lipid-lowering medicines, as well as total cholesterol and LDL-cholesterol levels.
+The World Health Organization (WHO) estimated in 2003 that only 50% of people complete long-term therapy for chronic illnesses as they were prescribed, which puts patient health at risk. For example, in 2002 statin compliance dropped to between 25 and 40% after two years of treatment, with patients taking statins for what they perceive to be preventative reasons being unusually poor compliers.
+A wide variety of packaging approaches have been proposed to help patients complete prescribed treatments. These approaches include formats that increase the ease of remembering the dosage regimen as well as different labels for increasing patient understanding of directions. For example, medications are sometimes packed with reminder systems for the day and/or time of the week to take the medicine. Some evidence shows that reminder packaging may improve clinical outcomes such as blood pressure.
+A not-for-profit organisation called the Healthcare Compliance Packaging Council of Europe] (HCPC-Europe) was set up between the pharmaceutical industry, the packaging industry with representatives of European patients organisations. The mission of HCPC-Europe is to assist and to educate the healthcare sector in the improvement of patient compliance through the use of packaging solutions. A variety of packaging solutions have been developed by this collaboration.
+
+== World Health Organization Barriers to Adherence ==
+The World Health Organization (WHO) groups barriers to medication adherence into five categories; health care team and system-related factors, social and economic factors, condition-related factors, therapy-related factors, and patient-related factors. Common barriers include:
+
+== Improving adherence rates ==
+
+=== Role of health care providers ===
+Health care providers play a great role in improving adherence issues. Providers can improve patient interactions through motivational interviewing and active listening. Health care providers should work with patients to devise a plan that is meaningful for the patient's needs. A relationship that offers trust, cooperation, and mutual responsibility can greatly improve the connection between provider and patient for a positive impact. The wording that health care professionals take when sharing health advice may have an impact on adherence and health behaviours, however, further research is needed to understand if positive framing (e.g., the chance of surviving is improved if you go for screening) versus negative framing (e.g., the chance of dying is higher if you do not go for screening) is more effective for specific conditions.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Adherence_(medicine)-3.md b/data/en.wikipedia.org/wiki/Adherence_(medicine)-3.md
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+---
+title: "Adherence (medicine)"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Adherence_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:48.247796+00:00"
+instance: "kb-cron"
+---
+
+=== Technology ===
+In 2012 it was predicted that as telemedicine technology improves, physicians will have better capabilities to remotely monitor patients in real-time and to communicate recommendations and medication adjustments using personal mobile devices, such as smartphones, rather than waiting until the next office visit.
+Medication Event Monitoring Systems (MEMS), as in the form of smart medicine bottle tops, smart pharmacy vials or smart blister packages as used in clinical trials and other applications where exact compliance data are required, work without any patient input, and record the time and date the bottle or vial was accessed, or the medication removed from a blister package. The data can be read via proprietary readers, or NFC enabled devices, such as smartphones or tablets. A 2009 study stated that such devices can help improve adherence. More recently a 2016 scoping review suggested that in comparison to MEMS, median mediction adherence was grossly overestimated by 17% using self-report, by 8% using pill count and by 6% using rating as alternative methods for measuring medication adherence.
+The effectiveness of two-way email communication between health care professionals and their patients has not been adequately assessed.
+
+==== Mobile phones ====
+As of 2019, 5.15 billion people, which equates to 67% of the global population, have a mobile device and this number is growing. Mobile phones have been used in healthcare and has fostered its own term, mHealth. They have also played a role in improving adherence to medication. For example, text messaging has been used to remind patients to take medication in patients with chronic conditions such as asthma and hypertension. Other examples include the use of smartphones for synchronous and asynchronous Video Observed Therapy (VOT) as a replacement for the currently resource intensive standard of Directly Observed Therapy (DOT) (recommended by the WHO) for Tuberculosis management. Other mHealth interventions for improving adherence to medication include smartphone applications, voice recognition in interactive phone calls and Telepharmacy. Some results show that the use of mHealth improves adherence to medication and is cost-effective, though some reviews report mixed results. Studies show that using mHealth to improve adherence to medication is feasible and accepted by patients. Specific mobile applications might also support adherence. mHealth interventions have also been used alongside other telehealth interventions such as wearable wireless pill sensors, smart pillboxes and smart inhalers
+
+=== Forms of medication ===
+Depot injections need to be taken less regularly than other forms of medication and a medical professional is involved in the administration of drugs so can increase compliance. Depot's are used for oral contraceptive pill and antipsychotic medication used to treat schizophrenia and bipolar disorder.
+
+=== Coercion ===
+Sometimes drugs are given involuntarily to ensure compliance. This can occur if an individual has been involuntarily committed or are subjected to an outpatient commitment order, where failure to take medication will result in detention and involuntary administration of treatment. This can also occur if a patient is not deemed to have mental capacity to consent to treatment in an informed way.
+
+== Health and disease management ==
+A WHO study estimates that only 50% of patients with chronic diseases in developed countries follow treatment recommendations.
+Asthma non-compliance (28–70% worldwide) increases the risk of severe asthma attacks requiring preventable ER visits and hospitalisations; compliance issues with asthma can be caused by a variety of reasons including: difficult inhaler use, side effects of medications, and cost of the treatment.
+
+=== Cancer ===
+200,000 new cases of cancer are diagnosed each year in the UK. One in three adults in the UK will develop cancer that can be life-threatening, and 120,000 people will be killed by their cancer each year. This accounts for 25% of all deaths in the UK. However while 90% of cancer pain can be effectively treated, only 40% of patients adhere to their medicines due to poor understanding.
+Results of a recent (2016) systematic review found a large proportion of patients struggle to take their oral antineoplastic medications as prescribed. This presents opportunities and challenges for patient education, reviewing and documenting treatment plans, and patient monitoring, especially with the increase in patient cancer treatments at home.
+The reasons for non-adherence have been given by patients as follows:
+
+The poor quality of information available to them about their treatment
+A lack of knowledge as to how to raise concerns whilst on medication
+Concerns about unwanted effects
+Issues about remembering to take medication
+Partridge et al (2002) identified evidence to show that adherence rates in cancer treatment are variable, and sometimes surprisingly poor. The following table is a summary of their findings:
+
+Medication event monitoring system - a medication dispenser containing a microchip that records when the container is opened and from Partridge et al (2002)
+In 1998, trials evaluating Tamoxifen as a preventative agent have shown dropout rates of around one-third:
+
+36% in the Royal Marsden Tamoxifen Chemoprevention Study of 1998
+29% in the National Surgical Adjuvant Breast and Bowel Project of 1998
+In March 1999, the "Adherence in the International Breast Cancer Intervention Study" evaluating the effect of a daily dose of Tamoxifen for five years in at-risk women aged 35–70 years was 
+
+90% after one year
+83% after two years
+74% after four years
+
+=== Diabetes ===
+Patients with diabetes are at high risk of developing coronary heart disease and usually have related conditions that make their treatment regimens even more complex, such as hypertension, obesity and depression which are also characterised by poor rates of adherence.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Adherence_(medicine)-4.md b/data/en.wikipedia.org/wiki/Adherence_(medicine)-4.md
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+---
+title: "Adherence (medicine)"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Adherence_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:48.247796+00:00"
+instance: "kb-cron"
+---
+
+Diabetes non-compliance is 98% in US and the principal cause of complications related to diabetes including nerve damage and kidney failure.
+Among patients with Type 2 Diabetes, adherence was found in less than one third of those prescribed sulphonylureas and/or metformin. Patients taking both drugs achieve only 13% adherence.
+Other aspects that drive medicine adherence rates is the idea of perceived self-efficacy and risk assessment in managing diabetes symptoms and decision making surrounding rigorous medication regiments. Perceived control and self-efficacy not only significantly correlate with each other, but also with diabetes distress psychological symptoms and have been directly related to better medication adherence outcomes. Various external factors also impact diabetic patients' self-management behaviors including health-related knowledge/beliefs, problem-solving skills, and self-regulatory skills, which all impact perceived control over diabetic symptoms.
+Additionally, it is crucial to understand the decision-making processes that drive diabetics in their choices surrounding risks of not adhering to their medication. While patient decision aids (PtDAs), sets of tools used to help individuals engage with their clinicians in making decisions about their healthcare options, have been useful in decreasing decisional conflict, improving transfer of diabetes treatment knowledge, and achieving greater risk perception for disease complications, their efficacy in medication adherence has been less substantial. Therefore, the risk perception and decision-making processes surrounding diabetes medication adherence are multi-faceted and complex with socioeconomic implications as well. For example, immigrant health disparities in diabetic outcomes have been associated with a lower risk perception amongst foreign-born adults in the United States compared to their native-born counterparts, which leads to fewer protective lifestyle and treatment changes crucial for combatting diabetes. Additionally, variations in patients' perceptions of time (i.e. taking rigorous, costly medication in the present for abstract beneficial future outcomes can conflict with patients' preferences for immediate versus delayed gratification) may also present severe consequences for adherence as diabetes medication often requires systematic, routine administration.
+
+=== Hypertension ===
+Hypertension non-compliance (93% in US, 70% in UK) is the main cause of uncontrolled hypertension-associated heart attack and stroke.
+In 1975, only about 50% took at least 80% of their prescribed anti-hypertensive medications.
+As a result of poor compliance, 75% of patients with a diagnosis of hypertension do not achieve optimum blood-pressure control.
+
+=== Mental illness ===
+A 2003 review found that 41–59% of patients prescribed antipsychotics took the medication prescribed to them infrequently or not at all. Sometimes non-adherence is due to lack of insight, but psychotic disorders can be episodic and antipsychotics are then use prophylactically to reduce the likelihood of relapse rather than treat symptoms and in some cases individuals will have no further episodes despite not using antipsychotics.  A 2006 review investigated the effects of compliance therapy for schizophrenia: and found no clear evidence to suggest that compliance therapy was beneficial for people with schizophrenia and related syndromes.
+
+=== Rheumatoid arthritis ===
+A longitudinal study has shown that adherence with treatment about 60%. The predictors of adherence were found to be more of psychological, communication and logistic nature rather than sociodemographic or clinical factors. The following factors were identified as independent predictors of adherence:
+
+the type of treatment prescribed
+agreement on treatment
+having received information on treatment adaptation
+clinician perception of patient trust
+
+== See also ==
+Drug withdrawal
+Patient participation
+
+== References ==
+
+== External links ==
+Adherence to long-term therapies, a report from the World Health Organization
+Technology report on NFC enabled smart medication packages
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Adhesion_(medicine)-0.md b/data/en.wikipedia.org/wiki/Adhesion_(medicine)-0.md
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+---
+title: "Adhesion (medicine)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Adhesion_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:49.521012+00:00"
+instance: "kb-cron"
+---
+
+Adhesions are fibrous bands that form between tissues and organs, often as a result of irritation of internal surfaces during surgery, infections or trauma. They may be thought of as internal scar tissue that connects tissues not normally connected.
+
+== Pathophysiology ==
+Adhesions form as a natural part of the body's healing process after surgery in a similar way that a scar forms. The term "adhesion" is applied when the scar extends from within one tissue across to another, usually across a virtual space such as the peritoneal cavity. Adhesion formation post-surgery typically occurs when two injured surfaces are close to one another. According to the "classical paradigm" of adhesion formation, the pathogenesis starts with inflammation and activation of the coagulation system which causes fibrin deposits onto the damaged tissues. 
+The fibrin then connects the two adjacent structures where damage of the tissues occurred. The fibrin acts like a glue to seal the injury and builds the fledgling adhesion, said at this point to be "fibrinous." In body cavities such as the peritoneal, pericardial, and synovial cavities, a family of fibrinolytic enzymes may act to limit the extent of the initial fibrinous adhesion, and may even dissolve it. In many cases, the production or activity of these enzymes are compromised because of inflammation following injury or infection, however, and the fibrinous adhesion persists. A more recent study suggested that the formation of "fibrinous" adhesions is preceded by the aggregation of cavity macrophages that may act like extravascular platelets in the abdominal cavity.
+If this is allowed to happen, tissue repair cells such as macrophages, fibroblasts, and blood vessel cells penetrate into the fibrinous adhesion and lay down collagen and other matrix substances to form a permanent fibrous adhesion. In 2002, Giuseppe Martucciello's research group showed a possible role could be played by microscopic foreign bodies (FB) inadvertently contaminating the operative field during surgery. These data suggested that two different stimuli are necessary for adhesion formation: a direct lesion of the mesothelial layers and a solid substrate foreign body (FB).
+While some adhesions do not cause problems, others may prevent muscle, nerve and other tissues and organs from moving freely, sometimes causing organs to become twisted or pulled from their normal positions.
+
+== Regions affected ==
+
+=== Adhesive capsulitis ===
+In the case of adhesive capsulitis of the shoulder (also known as frozen shoulder), adhesions grow between the shoulder joint surfaces, restricting motion.
+
+=== Abdominal adhesions ===
+Abdominal adhesions (or intra-abdominal adhesions) are most commonly caused by abdominal surgical procedures. The adhesions start to form within hours of surgery and may cause internal organs to attach to the surgical site or to other organs in the abdominal cavity. Adhesion-related twisting and pulling of internal organs may result in complications such as  abdominal pain or intestinal obstruction.
+Small bowel obstruction (SBO) is a significant consequence of post-surgical adhesions. A SBO may be caused when an adhesion pulls or kinks the small intestine and prevents the flow of content through the digestive tract. Obstruction may occur 20 years or more after the initial surgical procedure, if a previously benign adhesion allows the small bowel to twist spontaneously around itself and obstruct. Without immediate medical attention, SBO is an emergent, possibly fatal, condition.
+According to statistics provided by the National Hospital Discharge Survey, approximately 2,000 people die every year in the US from obstruction due to adhesions. Depending on the severity of the obstruction, a partial obstruction may relieve itself with conservative medical intervention. Many obstructive events require surgery, however, to loosen or dissolve the offending adhesion(s) or to resect the affected small intestine.
+
+=== Pelvic adhesions ===
+Pelvic adhesions are a form of abdominal adhesions in the pelvis. In women they typically affect reproductive organs and thus are of concern in reproduction or as a cause of chronic pelvic pain. Other than surgery, endometriosis and pelvic inflammatory disease are typical causes.
+Surgery inside the uterine cavity (e.g., suction dilation and curettage, myomectomy, endometrial ablation) may result in Asherman's syndrome (also known as intrauterine adhesions, intra uterine synechiae), a cause of infertility.
+The impairment of reproductive performance from adhesions may happen through many mechanisms, all of which usually stem from the distortion of the normal tubo-ovarian relationship. This distortion may prevent an ovum from traveling to the fimbriated end of the fallopian tube.
+A meta-analysis in 2012 came to the conclusion that there is only little evidence for the surgical principle that using less invasive techniques, introducing fewer foreign bodies, or causing less ischemia reduces the extent and severity of adhesions in pelvic surgery.
+
+=== Pericardial adhesions ===
+Adhesions forming between the heart and the sternum after cardiac surgery place the heart at risk of catastrophic injury during re-entry for a subsequent procedure.
+
+=== Peridural adhesions ===
+Adhesions and scarring as epidural fibrosis may occur after spinal surgery that restricts the free movement of nerve roots, causing tethering and leading to pain.
+
+=== Peritendinous adhesions ===
+Adhesions and scarring occurring around tendons after hand surgery restrict the gliding of tendons in their sheaths and compromise digital mobility.
+
+== Association with surgical procedures ==
+Applying adhesion barriers during surgery may help to prevent the formation of adhesions. There are two methods that are approved by the U.S. Food and Drug Administration (FDA) for adhesion prevention: Intercede and Seprafilm. One study found that Seprafilm is twice as effective at preventing adhesion formation when compared to just surgical technique alone. Surgical humidification therapy may also minimise the incidence of adhesion formation. Laparoscopic surgery has a reduced risk for creating adhesions. Steps may be taken during surgery to help prevent adhesions such as handling tissues and organs gently, using starch-free and latex-free gloves, not allowing tissues to dry out, and shortening surgery time.
+An unfortunate fact is, that adhesions are unavoidable in surgery and a treatment for adhesions is more surgery. Besides intestinal obstructions caused by adhesions that may be seen in an X-ray, there are no diagnostic tests available to accurately diagnose an adhesion.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Adhesion_(medicine)-1.md b/data/en.wikipedia.org/wiki/Adhesion_(medicine)-1.md
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@@ -0,0 +1,27 @@
+---
+title: "Adhesion (medicine)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Adhesion_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:49.521012+00:00"
+instance: "kb-cron"
+---
+
+=== Abdominal surgery ===
+A study showed that more than 90% of people develop adhesions following open abdominal surgery and that 55–100% of women develop adhesions following pelvic surgery. Adhesions from prior abdominal or pelvic surgery may obscure visibility and access at subsequent abdominal or pelvic surgery. In a very large study (29,790 participants) published in British medical journal The Lancet, 35% of patients who underwent open abdominal or pelvic surgery were readmitted to the hospital an average of two times after their surgery, due to adhesion-related or adhesion-suspected complications. Over 22% of all readmissions occurred in the first year after the initial surgery. Adhesion-related complexity at reoperation adds significant risk to subsequent surgical procedures.
+Certain organs and structures in the body are more prone to adhesion formation than others. The omentum is particularly susceptible to adhesion formation; one study found that 92% of post-operative adhesions were found in the omentum. It appears that the omentum is the chief organ responsible for "spontaneous" adhesion formation (i.e. no prior history of surgery). In another study, 100% of spontaneous adhesion formations were associated with the omentum.
+One method to reduce the formation of adhesions following abdominal surgery is hydroflotation, in which the organs are separated from one another by being floated in a solution.
+
+=== Carpal tunnel surgery ===
+The long-term use of a wrist splint during recovery from carpal tunnel surgery may cause adhesion formation. For that reason, it is advised that wrist splints be used only for short-term protection in work environments, but otherwise, splints do not improve grip strength, lateral pinch strength, or bowstringing. Beyond adhesion they also may cause stiffness or flexibility problems.
+
+== Types ==
+There are three general types of adhesions: filmy, vascular, and cohesive, however, their pathophysiology is similar. Filmy adhesions usually do not pose problems. Vascular adhesions are problematic.
+
+== References ==
+
+== External links ==
+
+eMedicineHealth: Adhesions, General and After Surgery
+Smith, Orla M., Getting adhesions unstuck, Science, November 30, 2018, volume 362, issue 6418, pp. 1014-1016
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Admission_note-0.md b/data/en.wikipedia.org/wiki/Admission_note-0.md
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+++ b/data/en.wikipedia.org/wiki/Admission_note-0.md
@@ -0,0 +1,142 @@
+---
+title: "Admission note"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Admission_note"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:50.831652+00:00"
+instance: "kb-cron"
+---
+
+An admission note is part of a medical record that documents the patient's status (including history and physical examination findings), reasons why the patient is being admitted for inpatient care to a hospital or other facility, and the initial instructions for that patient's care.
+
+
+== Purpose ==
+Admission notes document the reasons why a patient is being admitted for inpatient care to a hospital or other facility, the patient's baseline status, and the initial instructions for that patient's care.  Health care professionals use them to record a patient's baseline status and may write additional on-service notes, progress notes (SOAP notes), preoperative notes, operative notes, postoperative notes, procedure notes, delivery notes, postpartum notes, and discharge notes. These notes constitute a large part of the medical record. Medical students often develop their clinical reasoning skills by writing admission notes. The traditional, rational definition of being admitted usually involves spending an overnight in the hospital. This definition is sometimes stretched in the U.S. medical billing industry, where hospital corporations may blur the definitions of "admission" and "observation" because of reimbursement rules under which healthcare payors pay less for the care if an "admission" was involved.
+
+
+== Components ==
+An admission note may sometimes be incorrectly referred to as an HPI (history of present illness) or H and P (history and physical), which include only portions of an admission note.
+An admission note can include the following sections:
+
+
+== Outline ==
+Not every admission note explicitly discusses every item listed below, however, the ideal admission note would include:
+
+
+=== Header ===
+Patient identifying information (maybe located separately)
+name
+ID number
+chart number
+room number
+date of birth
+attending physician
+sex
+admission date
+Date
+Time
+Service
+
+
+=== Chief complaint (CC) ===
+
+Typically one sentence including
+
+age
+race
+sex
+presenting complaint
+example: "34 yo white male with right-sided weakness and slurred speech."
+
+
+=== History of present illness (HPI) ===
+
+statement of health status
+detailed description of chief complaint
+positive and negative symptoms related to the chief complaint based on the differential diagnosis the health care provider has developed.
+emergency actions taken and patient responses if relevant
+
+
+=== Allergies ===
+
+first antigen and response
+second antigen and response
+etc.
+
+
+=== Past medical history (PMHx) ===
+List of the patient's on-going medical problems. Chronic problems should be addressed as to whether or not they are well controlled or uncontrolled. Include dates of pertinent items.
+
+
+=== Past surgical history (PSurgHx, PSxHx) ===
+List of surgeries in the past with dates of pertinent items.
+
+
+=== Family history (FmHx) ===
+
+Health or cause of death for:
+
+Parents
+Siblings
+Children
+Spouse
+
+
+=== Social history (SocHx) ===
+
+In medicine, a social history is a portion of the admission note addressing familial, occupational, and recreational aspects of the patient's personal life that have the potential to be clinically significant.
+
+
+=== Medications ===
+
+for each: generic name - amount - rate
+medications on arrival (aspirin, Goody's medicated powder, herbal remedies, prescriptions, etc.)
+medications on transfer
+
+
+=== Review of systems (ROS) ===
+
+General
+Head
+Eyes
+Ears
+Nose and sinuses
+Throat, mouth, and neck
+Breasts
+Cardiovascular system
+Respiratory system
+Gastrointestinal system
+Urinary system
+Genital system
+Vascular system
+Musculoskeletal system
+Nervous system
+Psychiatric
+Hematologic system
+Endocrine system
+
+
+=== Physical exam ===
+
+Physical examination or clinical examination is the process by which a health care provider investigates the body of a patient for signs of disease.
+
+
+=== Labs ===
+e.g.: electrolytes, arterial blood gases, liver function tests, etc.
+
+
+=== Diagnostics ===
+e.g.: EKG, CXR, CT, MRI
+
+
+=== Assessment and plan ===
+
+Assessment includes a discussion of the differential diagnosis and supporting history and exam findings.
+
+
+== References ==
+
+
+== See also ==
+Admitting privileges
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Adrenergic_storm-0.md b/data/en.wikipedia.org/wiki/Adrenergic_storm-0.md
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@@ -0,0 +1,28 @@
+---
+title: "Adrenergic storm"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Adrenergic_storm"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:52.151132+00:00"
+instance: "kb-cron"
+---
+
+An adrenergic storm is a sudden and dramatic increase in serum levels of the catecholamines adrenaline and noradrenaline (also known as epinephrine and norepinephrine respectively), with a less significant increase in dopamine transmission. It is a life-threatening condition because of extreme tachycardia and hypertension, and is especially dire for those with prior heart problems. If treatment is prompt, prognosis is good; typically large amounts of diazepam or other benzodiazepines are administered alongside beta blockers. Beta blockers are contraindicated in some patients, so other antihypertensive medication such as clonidine may be used.
+Antipsychotics are also used to treat the most severe psychiatric reactions such as psychosis, paranoia or terror, after their use was formerly discouraged because of their potential to prolong the QT interval; however, more recent research performed since 2019 has revealed that this and other severe side effects are rare and their occurrence does not warrant banning antipsychotics from the treatment of adrenergic crises for which they can be extremely useful.
+Adrenergic storms are usually caused by overdoses of stimulants, especially cocaine or methamphetamine, or eating foods high in tyramine while taking monoamine oxidase inhibitors. A subarachnoid hemorrhage can also cause an adrenergic storm. A catecholamine storm is part of the normal course of rabies infection, and is responsible for the severe feelings of agitation, terror, and dysautonomia present in the pre-coma stage of the disease.
+
+== Signs and symptoms ==
+The behavioral symptoms are similar to those of an amphetamine, cocaine, or caffeine overdose. Overstimulation of the central nervous system results in a state of hyperkinetic movement and unpredictable mental status including mania, rage and suicidal behavior; hyperthermia is also prominently present. Delirium can also be present but rarely.
+Physical symptoms are more serious and include heart arrhythmias as well as outright heart attack or stroke in people who are at risk of coronary disease. Breathing is rapid and shallow while both pulse and blood pressure are dangerously elevated.
+Other complications would include rhabdomyolysis, a breakdown of the voluntary muscles because of the excessive physical movement, causing the components of the muscle, most notably myoglobin, to be released into the bloodstream and then clog the kidneys, causing renal failure. In all, rhabdomyolysis is especially common in adrenergic storms caused by the use of stimulant drugs, most notably those of the phenethylamines such as cathinones or amphetamines.
+
+== Causes ==
+There are several known causes of adrenergic storms; in the United States, cocaine overdose is the leading cause. Any stimulant drug has the capacity to cause this syndrome if taken in sufficient doses, but even non-psychotropic drugs can very rarely provoke a reaction.
+Monoamine oxidase inhibitors (MAOIs) are a class of drugs that inhibit the enzyme monoamine oxidase. This enzyme is responsible for breaking down many compounds; basically, anything with a primary amine moiety is likely to be oxidized by monoamine oxidase. An important substrate of the enzyme MAO is tyramine. MAOIs inhibit the enzyme either reversibly, in which MAO is inhibited only until the drug is cleared from the system, or irreversibly, in which the substrate binds permanently to the enzyme, rendering it inactive and effectively destroying it. Irreversible MAOIs are potentially more dangerous, because the body takes about two weeks to regenerate MAO enzymes to functional levels. Two subtypes of MAO exist: MAO-A and MAO-B; this is relevant to adrenergic storms, as there are significant differences between the two types, such as their differential expression throughout the body, and range of substrates. While both MAO-A and MAO-B metabolize tyramine, only MAO-A is present in the gastrointestinal tract and singularly metabolizes the majority of consumed tyramine. (The small portion normally passing into circulation is mostly degraded in the liver where both MAO types act.)
+Subarachnoid hemorrhage is an extremely serious condition in which a neural membrane is breached and the brain itself is compromised. The onset is sudden, described as "the worst headache of one's life," and many grave symptoms follow. Adrenergic storm is often present among these symptoms, and is responsible for some of the dangers, both long-term and short, of subarachnoid hemorrhage adrenergic storm, through a complex cascade of processes starting with the movement of subarachnoid blood into the brain. Apparently, as the intracranial pressure increases, the brain is squeezed and catecholamines are forced out of their vesicles into the synapses and extracellular space.
+
+=== Rare causes ===
+Rarely, a pheochromocytoma (tumor of the medullar tissue of the adrenal glands, which are located anterior to the kidney), may result in an adrenergic storm. This type of tumor is not common to begin with, and furthermore, the subtype that can cause massive adrenaline release is rarer still. Patients with pheochromocytoma can unexpectedly fly into a rage or sink into trembling fear, possibly dangerous to themselves and others as their judgment is impaired, their senses and pain threshold are heightened, and the level of the adrenaline in their bloodstream is more than most people ever experience; pheochromocytoma can, very rarely, kill by internal adrenaline overdose. But overall, adrenergic storm is an uncommon but certainly not rare phenomenon associated with the also uncommon condition of pheochromocytoma.
+
+== Diagnosis ==
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+---
+title: "Adrenergic storm"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Adrenergic_storm"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:52.151132+00:00"
+instance: "kb-cron"
+---
+
+=== Differential diagnosis ===
+Because the adrenergic storm overlaps with so many other similar conditions, such as hypertensive crises, stimulant intoxication or overdose, or even panic attack, and because the treatments for these overlapping conditions are largely alike, it is not necessary to obtain a differential and definitive diagnosis before initiating treatment. However, analysis of the patient's medical history, checked against the possible causes of the adrenergic storm such as those above, should be done, because some adrenergic storms can be caused by serious underlying conditions. If a patient has an adrenergic storm and all or most of the other factors are ruled out, the adrenergic storm could lead to the discovery of a pheochromocytoma, which can become malignant. However, not all cases of adrenergic storm have an identifiable cause.
+Serotonin syndrome, in which an excess of serotonin in the synapses causes a similar crisis of hypertension and mental confusion, could be confused with an adrenergic storm. Serotonin, being a tryptamine (non-catecholamine) involved in higher brain functions, can cause dangerous hypertension and tachycardia from its effects on the sympathetic nervous system. Symptoms caused by excessive adrenergic signalling can occur alongside those of serotonergic signalling. Abnormal echocardiograms or chest pain are indicative of adrenergic storm. On the other hand, uncontrollable slow, rhythmic, or jerky movements, contractions and tension—often in every part of the body, dangerously high fever, eye rolling, and bruxism are more indicative of serotonin syndrome.
+
+== Treatment ==
+If there is evidence of overdose or it is suspected, the patient should be given gastric lavage, activated charcoal, or both; this could make the difference between life and death in a close situation. It can however aggravate the patient which should be taken into account.
+The first-line treatments are diazepam and a non-selective beta blocker; other antihypertensive drugs may also be used. It is important to note that not all benzodiazepines and beta blockers are safe to use in an adrenergic storm; for instance, alprazolam and propranolol; alprazolam weakly agonizes dopamine receptors and causes catecholamine release while propranolol mildly promotes some catecholamine release – each worsening the condition.
+Antipsychotics are also used to treat the psychiatric symptoms such as aggression, agitation, psychosis, paranoia, or anxiety. Originally, the use of antipsychotics was discouraged because of their potential to prolong the QT interval; however, newer research has revealed that their careful use does not carry the potential for any significant side effects and today their judicious use is encouraged.
+Adrenergic storms are often idiopathic in nature; however if there is an underlying condition, then that must be addressed after bringing the heart rate and blood pressure down.
+
+== See also ==
+Adrenal crisis
+Paroxysmal sympathetic hyperactivity
+Sympathomimetic drug
+Takotsubo cardiomyopathy
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Adverse_effect-0.md b/data/en.wikipedia.org/wiki/Adverse_effect-0.md
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+---
+title: "Adverse effect"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Adverse_effect"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:53.424672+00:00"
+instance: "kb-cron"
+---
+
+An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complication is similar to adverse effect, but the latter is typically used in pharmacological contexts, or when the negative effect is expected or common. If the negative effect results from an unsuitable or incorrect dosage or procedure, this is called a medical error and not an adverse effect. Adverse effects are sometimes referred to as "iatrogenic" because they are generated by a physician/treatment. Some adverse effects occur only when starting, increasing or discontinuing a treatment.
+Using a drug or other medical intervention which is contraindicated may increase the risk of adverse effects. Adverse effects may cause complications of a disease or procedure and negatively affect its prognosis. They may also lead to non-compliance with a treatment regimen. Adverse effects of medical treatment resulted in 142,000 deaths in 2013 up from 94,000 deaths in 1990 globally.
+The harmful outcome is usually indicated by some result such as morbidity, mortality, alteration in body weight, levels of enzymes, loss of function, or as a pathological change detected at the microscopic, macroscopic or physiological level. It may also be indicated by symptoms reported by a patient. Adverse effects may cause a reversible or irreversible change, including an increase or decrease in the susceptibility of the individual to other chemicals, foods, or procedures, such as drug interactions.
+
+== Classification ==
+In terms of drugs, adverse events may be defined as: "Any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have to have a causal relationship with this treatment."
+In clinical trials, a distinction
+is made between an adverse event and a serious adverse event. Generally, any event which causes death, permanent damage, birth defects, or requires hospitalization is considered a serious adverse event. The results of trials are often included in the labelling of the medication to provide information both for patients and the prescribing physicians.
+The term "life-threatening" in the context of a serious adverse event refers to an event in which the patient was at risk of death at the time of the event; it does not refer to an event which hypothetically might have caused death if it were more severe.
+
+== Reporting systems ==
+In many countries, adverse effects are required by law to be reported, researched in clinical trials and included into the patient information accompanying medical devices and drugs for sale to the public. Investigators in human clinical trials are obligated to report these events in clinical study reports. Research suggests that these events are often inadequately reported in publicly available reports. Because of the lack of these data and uncertainty about methods for synthesising them, individuals conducting systematic reviews and meta-analyses of therapeutic interventions often unknowingly overemphasise health benefit. To balance the overemphasis on benefit, scholars have called for more complete reporting of harm from clinical trials.
+
+=== United Kingdom ===
+The Yellow Card Scheme is a United Kingdom initiative run by the Medicines and Healthcare products Regulatory Agency (MHRA) and the Commission on Human Medicines (CHM) to gather information on adverse effects to medicines. This includes all licensed medicines, from medicines issued on prescription to medicines bought over the counter from a supermarket. The scheme also includes all herbal supplements and unlicensed medicines found in cosmetic treatments. Adverse drug reactions (ADRs) can be reported by a number of health care professionals including physicians, pharmacists and nurses, as well as patients.
+
+=== United States ===
+In the United States several reporting systems have been built, such as the Vaccine Adverse Event Reporting System (VAERS), the Manufacturer and User Facility Device Experience Database (MAUDE) and the Special Nutritionals Adverse Event Monitoring System. MedWatch is the main reporting center, operated by the Food and Drug Administration.
+
+=== Australia ===
+In Australia, adverse effect reporting is administered by the Adverse Drug Reactions Advisory Committee (ADRAC), a subcommittee of the Australian Drug Evaluation Committee (ADEC). Reporting is voluntary, and ADRAC requests healthcare professionals to report all adverse reactions to its current drugs of interest, and serious adverse reactions to any drug. ADRAC publishes the Australian Adverse Drug Reactions Bulletin every two months. The Government's Quality Use of Medicines program is tasked with acting on this reporting to reduce and minimize the number of preventable adverse effects each year.
+
+=== New Zealand ===
+Adverse reaction reporting is an important component of New Zealand's pharmacovigilance activities. The Centre for Adverse Reactions Monitoring (CARM) in Dunedin is New Zealand's national monitoring centre for adverse reactions. It collects and evaluates spontaneous reports of adverse reactions to medicines, vaccines, herbal products and dietary supplements from health professionals in New Zealand. Currently the CARM database holds over 80,000 reports and provides New Zealand-specific information on adverse reactions to these products, and serves to support clinical decision making when unusual symptoms are thought to be therapy related
+
+=== Canada ===
+In Canada, adverse reaction reporting is an important component of the surveillance of marketed health products conducted by the Health Products and Food Branch (HPFB) of Health Canada. Within HPFB, the Marketed Health Products Directorate leads the coordination and implementation of consistent monitoring practices with regards to assessment of signals and safety trends, and risk communications concerning regulated marketed health products.
+MHPD also works closely with international organizations to facilitate the sharing of information.  Adverse reaction reporting is mandatory for the industry and voluntary for consumers and health professionals.
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+---
+title: "Adverse effect"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Adverse_effect"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:53.424672+00:00"
+instance: "kb-cron"
+---
+
+=== Limitations ===
+In principle, medical professionals are required to report all adverse effects related to a specific form of therapy. In practice, it is at the discretion of the professional to determine whether a medical event is at all related to the therapy. As a result, routine adverse effects reporting often may not include long-term and subtle effects that may ultimately be attributed to a therapy.
+Part of the difficulty is identifying the source of a complaint. A headache in a patient taking medication for influenza may be caused by the underlying disease or may be an adverse effect of the treatment. In patients with end-stage cancer, death is a very likely outcome and whether the drug is the cause or a bystander is often difficult to discern.
+
+== By situation ==
+
+=== Medical procedures ===
+Surgery may have a number of undesirable or harmful effects, such as infection, hemorrhage, inflammation, scarring, loss of function, or changes in local blood flow. They can be reversible or irreversible, and a compromise must be found by the physician and the patient between the beneficial or life-saving consequences of surgery versus its adverse effects. For example, a limb may be lost to amputation in case of untreatable gangrene, but the patient's life is saved. Presently, one of the greatest advantages of minimally invasive surgery, such as laparoscopic surgery, is the reduction of adverse effects.
+Other nonsurgical physical procedures, such as high-intensity radiation therapy, may cause burns and alterations in the skin. In general, these therapies try to avoid damage to healthy tissues while maximizing the therapeutic effect.
+Vaccination may have adverse effects due to the nature of its biological preparation, sometimes using attenuated pathogens and toxins. Common adverse effects may be fever, malaise and local reactions in the vaccination site. Very rarely, there is a serious adverse effect, such as eczema vaccinatum, a severe, sometimes fatal complication which may result in persons who have eczema or atopic dermatitis.
+Diagnostic procedures may also have adverse effects, depending much on whether they are invasive, minimally invasive or noninvasive. For example, allergic reactions to radiocontrast materials often occur, and a colonoscopy may cause the perforation of the intestinal wall.
+
+=== Medications ===
+
+Adverse effects can occur as a collateral or side effect of many interventions, but they are particularly important in pharmacology, due to its wider, and sometimes uncontrollable, use by way of self-medication. Thus, responsible drug use becomes an important issue here. Adverse effects, like therapeutic effects of drugs, are a function of dosage or drug levels at the target organs, so they may be avoided or decreased by means of careful and precise pharmacokinetics, the change of drug levels in the organism in function of time after administration.
+Adverse effects may also be caused by drug interaction. This often occurs when patients fail to inform their physician and pharmacist of all the medications they are taking, including herbal and dietary supplements. The new medication may interact agonistically or antagonistically (potentiate or decrease the intended therapeutic effect), causing significant morbidity and mortality around the world. Drug-drug and food-drug interactions may occur, and so-called "natural drugs" used in alternative medicine can have dangerous adverse effects. For example, extracts of St John's wort (Hypericum perforatum), a phytotherapic used for treating mild depression are known to cause an increase in the cytochrome P450 enzymes responsible for the metabolism and elimination of many drugs, so patients taking it are likely to experience a reduction in blood levels of drugs they are taking for other purposes, such as cancer chemotherapeutic drugs, protease inhibitors for HIV and hormonal contraceptives.
+The scientific field of activity associated with drug safety is increasingly government-regulated, and is of major concern for the public, as well as to drug manufacturers. The distinction between adverse and nonadverse effects is a major undertaking when a new drug is developed and tested before marketing it. This is done in toxicity studies to determine the nonadverse effect level (NOAEL). These studies are used to define the dosage to be used in human testing (phase I), as well as to calculate the maximum admissible daily intake. Imperfections in clinical trials, such as insufficient number of patients or short duration, sometimes lead to public health disasters, such as those of fenfluramine (the so-called fen-phen episode), thalidomide and, more recently, of cerivastatin (Baycol, Lipobay) and rofecoxib (Vioxx), where drastic adverse effects were observed, such as teratogenesis, pulmonary hypertension, stroke, heart disease, neuropathy, and a significant number of deaths, causing the forced or voluntary withdrawal of the drug from the market.
+Most drugs have a large list of nonsevere or mild adverse effects which do not rule out continued usage. These effects, which have a widely variable incidence according to individual sensitivity, include nausea, dizziness, diarrhea, malaise, vomiting, headache, dermatitis, dry mouth, etc. These can be considered a form of pseudo-allergic reaction, as not all users experience these effects; many users experience none at all.
+The Medication Appropriateness Tool for Comorbid Health Conditions in Dementia (MATCH-D) warns that people with dementia are more likely to experience adverse effects, and that they are less likely to be able to reliably report symptoms.
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+---
+title: "Adverse effect"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Adverse_effect"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:53.424672+00:00"
+instance: "kb-cron"
+---
+
+==== Examples with specific medications ====
+Abortion, miscarriage or uterine hemorrhage associated with misoprostol (Cytotec), a labor-inducing drug (this is a case where the adverse effect has been used legally and illegally for performing abortions)
+Addiction to many sedatives and analgesics, such as diazepam, morphine, etc.
+Birth defects associated with thalidomide
+Bleeding of the intestine associated with aspirin therapy
+Cardiovascular disease associated with COX-2 inhibitors (i.e. Vioxx)
+Deafness and kidney failure associated with gentamicin (an antibiotic)
+Death, following sedation, in children using propofol (Diprivan)
+Depression or hepatic injury caused by interferon
+Diabetes caused by atypical antipsychotic medications (neuroleptic psychiatric drugs)
+Diarrhea caused by the use of orlistat (Xenical)
+Erectile dysfunction associated with many drugs, such as antidepressants
+Fever associated with vaccination
+Glaucoma associated with corticosteroid-based eye drops
+Hair loss and anemia may be caused by chemotherapy against cancer, leukemia, etc.
+Headache following spinal anaesthesia
+Hypertension in ephedrine users, which prompted FDA to remove the dietary supplement status of ephedra extracts
+Insomnia caused by stimulants, methylphenidate (Ritalin), Adderall, etc.
+Lactic acidosis associated with the use of stavudine (Zerit, for HIV therapy) or metformin (for diabetes)
+Mania caused by corticosteroids
+Liver damage from paracetamol
+Melasma and thrombosis associated with use of estrogen-containing hormonal contraception, such as the combined oral contraceptive pill
+Priapism associated with the use of sildenafil
+Rhabdomyolysis associated with statins (anticholesterol drugs)
+Seizures caused by withdrawal from benzodiazepines
+Drowsiness or increase in appetite due to antihistamine use. Some antihistamines are used in sleep aids explicitly because they cause drowsiness.
+Stroke or heart attack associated with sildenafil (Viagra), when used with nitroglycerin
+Suicide, increased tendency associated to the use of fluoxetine and other selective serotonin reuptake inhibitor (SSRI) antidepressants
+Tardive dyskinesia associated with use of metoclopramide and many antipsychotic medications
+
+== Controversies ==
+Sometimes, putative medical adverse effects are regarded as controversial and generate heated discussions in society and lawsuits against drug manufacturers. One example is the recent controversy as to whether autism was linked to the MMR vaccine (or to thiomersal, a mercury-based preservative used in some vaccines). No link has been found in several large studies, and despite removal of thimerosal from most early childhood vaccines beginning with those manufactured in 2003, the rate of autism has not decreased as would be expected if it had been the causative agent.
+Another instance is the potential adverse effects of silicone breast implants, which led to class actions brought by tens of thousands of plaintiffs against manufacturers of gel-based implants, due to allegations of damage to the immune system which have not yet been conclusively proven. In 1998, Dow Corning settled its remaining suits for $3.2 Billion and went into bankruptcy.
+Due to the exceedingly high impact on public health of widely used medications, such as hormonal contraception and hormone replacement therapy, which may affect millions of users, even marginal probabilities of adverse effects of a severe nature, such as breast cancer, have led to public outcry and changes in medical therapy, although its benefits largely surpassed the statistical risks.
+
+== See also ==
+
+== References ==
+
+== External links ==
+
+Patient Safety Network – includes a glossary and articles on adverse effects, drug reactions, medical error, iatrogenesis, among others.
+Australian Adverse Drug Reactions Bulletin – published bimonthly
+MedEffect Canada (Health Canada)
+Medication Errors—from the U.S. Food and Drug Administration.
+Medical Product Safety Information – MedWatch lists safety alerts for drugs, biologics, devices and dietary supplements, recalls, market withdrawals, public health advisories and links
+Medical Devices Safety National Library of Medicine (Medline Plus, useful lists of conventional drug and medical device articles and websites)
+When Medicine Hurts Instead of Helps – June 1998 report by the Alliance for Aging Research.
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diff --git a/data/en.wikipedia.org/wiki/Adverse_outcome_pathway-0.md b/data/en.wikipedia.org/wiki/Adverse_outcome_pathway-0.md
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+---
+title: "Adverse outcome pathway"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Adverse_outcome_pathway"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:55.006766+00:00"
+instance: "kb-cron"
+---
+
+An adverse outcome pathway (AOP) is structured representation of biological events leading to adverse effects  and is considered relevant to risk assessment. The AOP links in a linear way existing knowledge along one or more series of causally connected key events (KE) between two points — a molecular initiating event (MIE) and an adverse outcome (AO) that occur at a level of biological organization relevant to risk assessment. The linkage between the events is described by key event relationships (KER) that describe the causal relationships between the key events. 
+AOPs are important for expanding the use of mechanistic toxicological data for risk assessment and regulatory applications with recent applications in further disciplines such as climate science.
+
+
+== Background ==
+In 2012, the Organisation for Economic Co-operation and Development (OECD) launched a new programme on the development of adverse outcome pathways. A guidance document describes in detail how AOPs are to be developed, reviewed, agreed and published at the OECD level. The AOP development and reviewing workflow is intended to take place via a web-based IT management tool: the Adverse Outcome Pathway Knowledge Base (AOP-KB) which  is currently still under development. It is the wiki-based, user-friendly tool providing open-source interface for collaborative sharing of established AOPs and building new AOPs. 
+The AOP-KB gives the scientific community the possibility to enter, share and discuss their AOP-related knowledge at one central point of information.
+The AOP-KB allows for building AOPs by entering and then linking information about MIEs, KEs, AOs and  Chemical Initiators.
+Knowing that pathway elements are not necessarily unique to a single AOP, value is added to existing knowledge by facilitating the re-use of MIE, KE and AO information in multiple AOPs, which prevents redundancy and make the collective knowledge about those entities available in all AOPs in which they appear.
+The AOP-KB is a combination of individually developed applications, synchronised and orchestrated in a way that gives users the possibility to capture, review, browse and comment on AOPs shared by the AOP stakeholder community.
+The AOP-KB project is an Organisation for Economic Co-operation and Development  initiative, which is executed as close collaboration between the Joint Research Centre of European Commission, the United States Environmental Protection Agency and the  Engineer Research and Development Center of United States Army Corps of Engineers for the purpose of the Organisation for Economic Co-operation and Development's programme on the development of AOPs 
+The AOP has also been recently applied to better understand the effects of climate related stressors, further expanding the potential of AOPs to other scientific disciplines 
+More recent developments have focused on the analysis of AOP networks and the quantification of KERs with a view to developing mathematical models of AOPs, sometimes referred to as quantitative AOPs.
+Scientific workshops held for advancing the concept of AOP:
+
+2013
+January 23–25, Baltimore, USA  Building Shared Experience to Advance Practical Application of Pathway-Based Toxicology:Liver Toxicity Mode-of-Action
+2014
+March 2–7, Somma Lombardo, Italy Advancing Adverse Outcome Pathways (AOP) for Integrated Toxicology and Regulatory Applications 
+August 24, Prague, Czech Republic AOPs 101: The How and Why of Development and Use 
+September 3–5, Bethesda, USA Adverse Outcome Pathways: From Research to Regulation workshop held by NTP Interagency Center for the Evaluation of Alternative Toxicological Methods (NICEATM) and the Physicians Committee for Responsible Medicine. Materials from the workshop, including links to the plenary session videocasts and summaries of the breakout group discussions, are available on the NTP website
+
+
+== References ==
+
+
+== External links ==
+AOP KB Homepage
+OECD Adverse Outcome Pathways, Molecular Screening and Toxicogenomics Programme on the development of AOPs
+European Commission's Joint Research Centre
+Adverse Outcome Pathways: From Research to Regulation
+NTP Interagency Center for the Evaluation of Alternative Toxicological Methods
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diff --git a/data/en.wikipedia.org/wiki/Age_of_onset-0.md b/data/en.wikipedia.org/wiki/Age_of_onset-0.md
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+---
+title: "Age of onset"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Age_of_onset"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:56.198547+00:00"
+instance: "kb-cron"
+---
+
+The age of onset is the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder. For instance, the general age of onset for the spinal disease scoliosis is "10-15 years old," meaning that most people develop scoliosis when they are of age between ten and fifteen years.
+Diseases are often categorized by their age of onset as congenital, infantile, juvenile, or adult. Missed or delayed diagnosis often occurs if a disease that is typically diagnosed in juveniles (such as asthma) is present in adults, and vice versa (such as arthritis). Depending on the disease, ages of onset may impact features such as phenotype, as is the case in Parkinson's and Huntington's diseases. For example, the phenotype for juvenile Huntington's disease clearly differs from adult-onset Huntington's disease and late-onset Parkinson's exhibits more severe motor and non-motor phenotypes.
+
+
+== Causes ==
+Germ-line mutations are often at least in part the cause of disease onset at an earlier age. Though many germ-line mutations are deleterious, the genetic lens through which they may be viewed may provide insights to treatment, possibly through genetic counseling.
+In some cases, the age of onset may be the result of mutation accumulation. If this is the case, it could be helpful to consider ages of onset as a product of the hypotheses depicted in theories of aging. Even some mental health disorders, whose ages of onset have been found to be harder to define than physical illnesses may have a mutated component. The symptoms of standard mental disorders often start off non-specific. Pathological changes pertaining to disorders often become more detailed and less fickle before they can be defined in the American Psychiatric Association's DSM. The brain is a dynamic and complex system, it is constantly re-wiring itself and a major concern is what happens to the brain in earlier life that mirrors what occurs later in its psycho-pathological state. The typical onset of many mental disorders in late adolescence may reflect the critical development that happens at this time.
+
+
+== Theories of Aging ==
+The rate-of-living theory of aging states that senescence occurs because individuals accumulate damage to cells and tissues during cell division. This theory is not supported because its postulates that aging rate should be correlated with metabolic rate and organisms cannot evolve longer lifespans were not supported in trials. The rate-of-living theory may not be used to draw conclusions about age of onset based on this.
+There are two subsets to the evolutionary theory of aging: antagonistic pleiotropy hypothesis and the mutation accumulation hypothesis.
+The antagonistic pleiotropy hypothesis was tested by monitoring the age-1 gene in C. elegans. The age-1 gene plays a role in senescence; nematodes with mutations in this gene live up to 80% longer. Mutants in the age-1 gene for allele hx546 seem to be otherwise normal until placed under stressful conditions. Then, the carriers of the mutant gene appear to be at disadvantage—they do not lay eggs while being starved. This evidence supports antagonistic pleiotropy as a theory of aging, and therefore as an onset cause in some cases.
+The mutation accumulation hypothesis was tested by demonstrating how quickly deleterious mutations can accumulate in Musca domestica. Reed and Bryant demonstrated this by limiting the lifespan of the flies to a few days, which made late-life mutations invisible to selection since they occurred after reproduction. The lifespan of the flies was monitored by allowing them to carry out their complete lifespan every few generations, which was reported to decline substantially. Mutation accumulation is supported as a theory of aging, and therefore an onset cause in cases of diseases resulting from mutation accumulation.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Agenesis-0.md b/data/en.wikipedia.org/wiki/Agenesis-0.md
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+---
+title: "Agenesis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Agenesis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:57.418271+00:00"
+instance: "kb-cron"
+---
+
+In medicine, agenesis () refers to the failure of an organ to develop during embryonic growth and development due to the absence of primordial tissue. Many forms of agenesis are referred to by individual names, depending on the organ affected:
+
+Agenesis of the corpus callosum - failure in the development of the band of fibers connecting the cerebral hemispheres
+Renal agenesis - failure of one or both of the kidneys to develop
+Amelia - failure of the arms or legs to develop
+Penile agenesis - failure of penis to develop
+Müllerian agenesis - failure of the uterus and part of the vagina to develop
+Agenesis of the gallbladder - failure of the Gallbladder to develop. A person may not realize they have this condition unless they undergo surgery or medical imaging, since the gallbladder is neither externally visible nor essential.
+
+
+== Eye agenesis ==
+Eye agenesis is a medical condition in which people are born with no eyes.
+
+
+== Dental & oral agenesis ==
+Anodontia, absence of all primary or permanent teeth.
+Aglossia, absence of the tongue.
+Agnathia, absence of the jaw.
+Wisdom tooth agenesis - most adult humans have three molars (on each upper/lower left/right side), with the third being referred to as the wisdom tooth. But many people have less than the four total. Agenesis of wisdom teeth is a normal condition that can differ widely by population, ranging from practically zero in Tasmanian Aborigines to nearly 100% in indigenous Mexicans. (See research paper with world map showing prevalence.)
+
+
+== Ear agenesis ==
+Ear agenesis is a medical condition in which people are born without ears. 
+Because the middle and inner ears are necessary for hearing, people with complete agenesis of the ears are totally deaf. Minor agenesis that affects only the visible parts of the outer ear, which may be called microtia, typically produces cosmetic concerns and perhaps hearing impairment if the opening to the ear canal is blocked, but not deafness.
+
+
+== References ==
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+---
+title: "Agnosia"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:58.633985+00:00"
+instance: "kb-cron"
+---
+
+Agnosia is a neurological disorder characterized by an inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is neither defective nor is there any significant memory loss. It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream.  Agnosia affects only a single modality, such as vision or hearing. More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.
+
+== Types ==
+
+=== Visual agnosia ===
+Visual agnosia is a broad category that refers to a deficiency in the ability to recognize visual objects. Visual agnosia can be further subdivided into two different subtypes: apperceptive visual agnosia and associative visual agnosia.
+Individuals with apperceptive visual agnosia display the ability to see contours and outlines when shown an object, but they experience difficulty if asked to categorize objects. Apperceptive visual agnosia is associated with damage to one hemisphere, specifically damage to the posterior sections of the right hemisphere.
+In contrast, individuals with associative visual agnosia experience difficulty when asked to name objects. Associative agnosia is associated with damage to both the right and left hemispheres at the occipitotemporal border.  A specific form of associative visual agnosia is known as prosopagnosia.  Prosopagnosia is the inability to recognize faces.  For example, these individuals have difficulty recognizing friends, family and coworkers. However, individuals with prosopagnosia can recognize all other types of visual stimuli.
+
+=== Speech agnosia ===
+Speech agnosia, or auditory verbal agnosia, refers to "an inability to comprehend spoken words despite intact hearing, speech production and reading ability". Patients report that they hear sounds being produced, but that the sounds are fundamentally unrecognizable or untranslatable.
+
+EXAMINER: What did you eat for breakfast?
+PATIENT: Breakfast, breakfast, it sounds familiar but it doesn't speak to me. (Obler & Gjerlow 1999:45)
+Despite an inability to process what the speaker is saying, some patients have been reported to recognize certain characteristic information about the speaker's voice (such as being a man or woman).
+
+== Causes ==
+Agnosia can result from strokes, dementia, or other neurological disorders. It may also be trauma-induced by a head injury, brain infection, or hereditary.  Additionally, some forms of agnosia may be the result of developmental disorders. Damage causing agnosia usually occurs in either the occipital or parietal lobes of the brain.  Although one modality may be affected, cognitive abilities in other areas are preserved.
+Patients who experience dramatic recovery from blindness experience significant to total agnosia.
+The effect of damage to the superior temporal sulcus is consistent with several types of neurolinguistic deficiencies, and some contend that agnosia is one of them. The superior temporal sulcus is vital for speech comprehension because the region is highly involved with the lexical interface. According to the 1985 TRACE II Model, the lexical interface associates sound waves (phonemes) with morphological features to produce meaningful words. This association process is accomplished by lateral inhibition/excitement of certain words within an individual's lexicon (vocabulary). For instance, if an experimenter were to say DOG aloud, the utterance would activate and inhibit various words within the subjects lexical interface:
+
+DOG activates 3, and inhibits 0 letters in DOG. – +3
+DOG activates 2, and inhibits 1 letters in FOG. – +2
+DOG activates 1, and inhibits 2 letters in DAN. – +1
+The consistency of this model to agnosia is shown by evidence that bilateral lesions to the superior temporal sulcus produces 'pure word deafness' (Kussmaul, 1877), or as it is understood today, speech agnosia. Patients with pure word deafness demonstrate the inability to recognize and process speech sounds with normal auditory processing for non-speech sounds below the level of the cortex.
+
+== Diagnosis ==
+In order to assess an individual for agnosia, it must be verified that the individual does not have a loss of sensation, and that both their language abilities and intelligence are intact.  In order for an individual to be diagnosed with agnosia, they must only be experiencing a sensory deficit in a single modality.  To make a diagnosis, the distinction between apperceptive and associative agnosia must be made.  This distinction can be made by having the individual complete copying and matching tasks.  If the individual has a form of apperceptive agnosia they will not be able to match two stimuli that are identical in appearance.  In contrast, if an individual has a form of associative agnosia, they will not be able to match different examples of a stimulus.  For example, an individual who has been diagnosed with associative agnosia in the visual modality would not be able to match pictures of a laptop that is open with a laptop that is closed.
+
+=== Pure alexia ===
+
+Individuals with pure alexia usually have difficulty reading words as well as difficulty with identifying letters.  In order to assess whether an individual has pure alexia, tests of copying and recognition must be performed. An individual with pure alexia should be able to copy a set of words, and should be able to recognize letters.
+
+=== Prosopagnosia ===
+
+Individuals are usually shown pictures of human faces that may be familiar to them such as famous actors, singers, politicians or family members.  The pictures shown to the patient are selected to be age- and culture-appropriate.  The task involves the examiner asking the individual to name each face.  If the individual cannot name whose face appears in the picture, the examiner may ask a question that would help to recognize the face in the picture.
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+---
+title: "Agnosia"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:58.633985+00:00"
+instance: "kb-cron"
+---
+
+== Treatment ==
+For all practical purposes, there is no direct cure. Patients may improve if information is presented in other modalities than the damaged one. Different types of therapies can help to reverse the effects of agnosia. In some cases, occupational therapy or speech therapy can improve agnosia, depending on its cause.
+Initially many individuals with a form of agnosia are unaware of the extent to which they have either a perceptual or recognition deficit.  This may be caused by anosognosia, which is the lack of awareness of a deficit.  This lack of awareness usually leads to a form of denial and resistance to any form of help or treatment.  There are various methods that can be used which can help the individual recognize the impairment in perception or recognition that they may have.  A patient can be presented with a stimulus to the impaired modality only to help increase their awareness of their deficit.  Alternatively, a task can be broken down into its component parts so that the individual can see each part of the problem caused by the deficit.  Once the individual acknowledges their perceptual or recognition deficit, a form of treatment may be recommended.  There are various forms of treatment, such as compensatory strategies with alternate modalities, verbal strategies, alternate cues and organizational strategies.
+
+=== Verbal strategies ===
+Using verbal descriptions may be helpful for individuals with certain types of agnosia.  Individuals such as prosopagnosics may find it useful to listen to a description of their friend or family member and recognize them based on this description more easily than through visual cues.
+
+=== Alternate cues ===
+Alternate cues may be particularly useful to an individual with environmental agnosia or prosopagnosia.  Alternate cues for an individual with environmental agnosia may include color cues or tactile markers to symbolize a new room or to remember an area by.  Prosopagnosics may use alternate visual cues such as a scar on an individual's face or crooked teeth, or cues from other senses, like the sound of an individual's voice, in order to recognize the individual. Hair color and length can be helpful cues as well.
+
+=== Organizational strategies ===
+Organizational strategies may be extremely helpful for an individual with visual agnosia.  For example, organizing clothes according to different hangers provides tactile cues for the individual, making it easier to identify certain forms of clothing as opposed to relying solely on visual cues.
+
+=== Current research ===
+There are clinical trials being done to further research for treatments. The National Institute of Neurological Disorders and Stroke (NINDS) supports research for rare diseases like agnosia. Some organizations recruit for trials via ClincalTrials.gov and provide status updates on the trials.
+
+== History ==
+The term agnosia comes from the Ancient Greek ἀγνωσία (agnosia), 'ignorance, absence of knowledge'. It was introduced by Sigmund Freud in 1891: "For disturbances in the recognition of objects, which Finkelnburg classes as asymbolia, I should like to propose the term 'agnosia'." Prior to Freud's introduction of the term, some of the first ideas about agnosia came from Carl Wernicke, who created theories about receptive aphasia in 1874.  He noted that individuals with receptive aphasia did not possess the ability to understand speech or repeat words.  He believed that receptive aphasia was due to lesions of the posterior third of the left superior temporal gyrus.  Due to these lesions, Wernicke believed that individuals with receptive aphasia had a limited deafness for certain sounds and frequencies in speech.
+After Wernicke, came Kussmaul in 1877 who attempted to explain why auditory verbal agnosia, also known as word deafness, occurs.  Contrary to Wernicke's explanations, Kussmaul believed auditory verbal agnosia was the result of major destruction to the first left temporal gyrus.  Kussmaul also posited about the origins of alexia (acquired dyslexia) also known as word blindness.  He believed that word blindness was the result of lesions to the left angular and supramarginal gyri.
+Heinrich Lissauer shared his ideas about agnosia after Wernicke and Kussmaul. In 1890, he theorized that there were two ways in which object recognition impairment could occur.  One way in which impairment could occur was if there was damage to early perceptual processing or if there was damage to the actual object representation.  If the actual object representation was damaged, this would not allow the object to be stored in visual memory, and therefore the individual would not be able to recognize the object.  During the time of Wernicke, Kussmaul and Lissauer there was little known about the cerebral cortex.  Today, new neuroimaging techniques have made it possible to expand our knowledge of agnosia greatly.
+
+== See also ==
+Agnoiology – Study of ignorance
+Pyrrho – Greek philosopher and founder of Pyrrhonism (c.360-c.270 BC) who suspended judgement of the senses to attain freedom from disturbance
+
+== References ==
+
+== External links ==
+
+Types and brain areas
+Total Recall: Memory Requires More than the Sum of Its Parts Scientific American (accessdate 2007-06-05)
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diff --git a/data/en.wikipedia.org/wiki/Agonist-0.md b/data/en.wikipedia.org/wiki/Agonist-0.md
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+---
+title: "Agonist"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Agonist"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:59.888594+00:00"
+instance: "kb-cron"
+---
+
+An agonist is a chemical that activates a receptor to produce a biological response. Receptors are cellular proteins whose activation causes the cell to modify what it is currently doing. In contrast, an antagonist blocks the action of the agonist, while an inverse agonist causes an action opposite to that of the agonist.
+
+
+== Etymology ==
+The word originates from the Greek word ἀγωνιστής (agōnistēs), "contestant; champion; rival" < ἀγών (agōn), "contest, combat; exertion, struggle" < ἄγω (agō), "I lead, lead towards, conduct; drive."
+
+
+== Types of agonists ==
+Receptors can be activated by either endogenous agonists (such as hormones and neurotransmitters) or exogenous agonists (such as drugs), resulting in a biological response. A physiological agonist is a substance that creates the same bodily responses but does not bind to the same receptor.
+
+An endogenous agonist for a particular receptor is a compound naturally produced by the body that binds to and activates that receptor. For example, the endogenous agonist for serotonin receptors is serotonin, and the endogenous agonist for dopamine receptors is dopamine.
+Full agonists bind to and activate a receptor with the maximum response that an agonist can elicit at the receptor. One example of a drug that can act as a full agonist is isoproterenol, which mimics the action of adrenaline at β adrenoreceptors. Another example is morphine, which mimics the actions of endorphins at μ-opioid receptors throughout the central nervous system. However, a drug can act as a full agonist in some tissues and as a partial agonist in other tissues, depending upon the relative numbers of receptors and differences in receptor coupling.
+A co-agonist works with other co-agonists to produce the desired effect together. NMDA receptor activation requires the binding of both glutamate, glycine and D-serine co-agonists. Calcium can also act as a co-agonist at the IP3 receptor.
+A selective agonist is selective for a specific type of receptor. E.g. buspirone is a selective agonist for serotonin 5-HT1A.
+Partial agonists (such as buspirone, aripiprazole, buprenorphine, or norclozapine) also bind and activate a given receptor, but have only partial efficacy at the receptor relative to a full agonist, even at maximal receptor occupancy. Agents like buprenorphine are used to treat opiate dependence for this reason, as they produce milder effects on the opioid receptor with lower dependence and abuse potential.
+An inverse agonist is an agent that binds to the same receptor binding-site as an agonist for that receptor and inhibits the constitutive activity of the receptor. Inverse agonists exert the opposite pharmacological effect of a receptor agonist, not merely an absence of the agonist effect as seen with an antagonist. An example is the cannabinoid inverse agonist rimonabant.
+A superagonist is a term used by some to identify a compound that is capable of producing a greater response than the endogenous agonist for the target receptor. It might be argued that the endogenous agonist is simply a partial agonist in that tissue.
+An irreversible agonist is a type of agonist that binds permanently to a receptor through the formation of covalent bonds.
+A biased agonist is an agent that binds to a receptor without affecting the same signal transduction pathway. Oliceridine is a μ-opioid receptor agonist that has been described to be functionally selective towards G protein and away from β-arrestin2 pathways.
+New findings that broaden the conventional definition of pharmacology demonstrate that ligands can concurrently behave as agonist and antagonists at the same receptor, depending on effector pathways or tissue type. Terms that describe this phenomenon are "functional selectivity", "protean agonism", or selective receptor modulators.
+
+
+== Mechanism of action ==
+As mentioned above, agonists have the potential to bind in different locations and in different ways depending on the type of agonist and the type of receptor. The process of binding is unique to the receptor-agonist relationship, but binding induces a conformational change and activates the receptor. This conformational change is often the result of small changes in charge or changes in protein folding when the agonist is bound. Two examples that demonstrate this process are the muscarinic acetylcholine receptor and NMDA receptor and their respective agonists.
+
+For the muscarinic acetylcholine receptor, which is a G protein-coupled receptor (GPCR), the endogenous agonist is acetylcholine. The binding of this neurotransmitter causes the conformational changes that propagate a signal into the cell. The conformational changes are the primary effect of the agonist, and are related to the agonist's binding affinity and agonist efficacy. Other agonists that bind to this receptor will fall under one of the different categories of agonist mentioned above based on their specific binding affinity and efficacy.
+
+The NMDA receptor is an example of an alternate mechanism of action, as the NMDA receptor requires co-agonists for activation. Rather than simply requiring a single specific agonist, the NMDA receptor requires both the endogenous agonists, N-methyl-D-aspartate (NMDA) and glycine. These co-agonists are both required to induce the conformational change needed for the NMDA receptor to allow flow through the ion channel, in this case calcium. An aspect demonstrated by the NMDA receptor is that the mechanism or response of agonists can be blocked by a variety of chemical and biological factors. NMDA receptors specifically are blocked by a magnesium ion unless the cell is also experiencing depolarization.
+These differences show that agonists have unique mechanisms of action depending on the receptor activated and the response needed. The goal and process remains generally consistent however, with the primary mechanism of action requiring the binding of the agonist and the subsequent changes in conformation to cause the desired response at the receptor. This response as discussed above can vary from allowing flow of ions to activating a GPCR and transmitting a signal into the cell.
+
+
+== Activity ==
+
+
+=== Potency ===
+Potency is the amount of agonist needed to elicit a desired response. The potency of an agonist is inversely related to its half maximal effective concentration (EC50) value. The EC50 can be measured for a given agonist by determining the concentration of agonist needed to elicit half of the maximum biological response of the agonist. The EC50 value is useful for comparing the potency of drugs with similar efficacies producing physiologically similar effects.  The smaller the EC50 value, the greater the potency of the agonist, the lower the concentration of drug that is required to elicit the maximum biological response.
+
+
+=== Therapeutic index ===
+Therapeutic index is a measure of a drug's safety margin. When a drug is used therapeutically, it is important to understand the margin of safety that exists between the dose needed for the desired effect and the dose that produces unwanted and possibly dangerous side-effects (measured by the TD50, the dose that produces toxicity in 50% of individuals). This relationship, termed the therapeutic index, is defined as the ratio TD50:ED50. In general, the narrower this margin, the more likely it is that the drug will produce unwanted effects. The therapeutic index emphasizes the importance of the margin of safety, as distinct from the potency, in determining the usefulness of a drug.
+
+
+== See also ==
+Allosteric modulator
+Dose response curve
+Excitatory postsynaptic potential
+Functional selectivity
+Intrinsic activity
+Inverse agonist
+Mixed agonist/antagonist
+Receptor antagonist
+Receptor theory
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Allopathic_medicine-0.md b/data/en.wikipedia.org/wiki/Allopathic_medicine-0.md
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+---
+title: "Allopathic medicine"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Allopathic_medicine"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:01.122654+00:00"
+instance: "kb-cron"
+---
+
+Allopathic medicine, or allopathy, from Ancient Greek ἄλλος (állos), meaning "other", and πάθος (páthos), meaning "pain", is a label originally used derogatorily by 19th-century homeopaths to describe heroic medicine. In its current usage, the term generally refers to contemporary conventional medicine. However, there are regional variations in usage of the term. For example, in the United States the term is primarily used in contrast with osteopathic medicine, especially in the field of medical education; whereas in India the term is used to distinguish modern medicine from Siddha medicine, Ayurveda, homeopathy, Unani and other alternative and traditional medicine traditions, especially when comparing treatments and drugs.
+The terms were coined in 1810 by the creator of homeopathy, Samuel Hahnemann. Heroic medicine was the conventional European medicine of the time and did not rely on evidence of effectiveness. It was based on the belief that disease is caused by an imbalance of the four "humours" (blood, phlegm, yellow bile, and black bile) and sought to treat disease symptoms by correcting that imbalance, using "harsh and abusive" methods to induce symptoms seen as opposite to those of diseases rather than treating their underlying causes: disease was caused by an excess of one humour and thus would be treated with its "opposite".
+A study released by the World Health Organization (WHO) in 2001 defined allopathic medicine as "the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern medicine." The WHO used the term in a global study in order to differentiate Western medicine from traditional and alternative medicine, noting that in certain areas of the world "the legal standing of practitioners is equivalent to that of allopathic medicine" where practitioners can be separately certified in complementary/alternative medicine and Western medicine.
+The term allopathy was also used to describe anything that was not homeopathy. Kimball Atwood, an American medical researcher and alternative medicine critic, said the meaning implied by the label of allopathy has never been accepted by conventional medicine and is still considered pejorative. American health advocate and sceptic William T. Jarvis, stated that "although many modern therapies can be construed to conform to an allopathic rationale (e.g., using a laxative to relieve constipation), standard medicine has never paid allegiance to an allopathic principle" and that the label "allopath" was "considered highly derisive by regular medicine." Most modern science-based medical treatments (antibiotics, vaccines, and chemotherapeutics, for example) do not fit Hahnemann's definition of allopathy, as they seek to prevent illness or to alleviate an illness by eliminating its cause.
+
+== History ==
+The practice of medicine in both Europe and North America during the early 19th century is sometimes referred to as heroic medicine because of the extreme measures (such as bloodletting) sometimes employed in an effort to treat diseases. The term allopath was used by Hahnemann and other early homeopaths to highlight the difference they perceived between homeopathy and the "conventional" heroic medicine of their time. With the term allopathy (meaning "other than the disease"), Hahnemann intended to point out how physicians with conventional training employed therapeutic approaches that, in his view, merely treated symptoms and failed to address the disharmony produced by underlying disease. Homeopaths saw such symptomatic treatments as "opposites treating opposites" and believed these methods were harmful to patients.
+Practitioners of alternative medicine have used the term "allopathic medicine" to refer to the practice of conventional medicine in both Europe and the United States since the 19th century. In that century, the term allopath was used most often as a derogatory name for the practitioners of heroic medicine, a precursor to modern medicine that itself did not rely on evidence of effectiveness.
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+---
+title: "Allopathic medicine"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Allopathic_medicine"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:01.122654+00:00"
+instance: "kb-cron"
+---
+
+James Whorton discusses this historical pejorative usage: One form of verbal warfare used in retaliation by irregulars was the word "allopathy". ..."Allopathy" and "allopathic" were liberally employed as pejoratives by all irregular physicians of the nineteenth century, and the terms were considered highly offensive by those at whom they were directed. The generally uncomplaining acceptance of [the term] "allopathic medicine" by today's physicians is an indication of both a lack of awareness of the term's historical use and the recent thawing of relations between irregulars and allopaths.
+The controversy surrounding the term can be traced to its original usage during a heated 19th-century debate between practitioners of homeopathy and those they derisively referred to as "allopaths."
+Hahnemann used "allopathy" to refer to what he saw as a system of medicine that combats disease by using remedies that produce effects in a healthy subject that are different (hence the Greek root allo- "different") from the effects produced by the disease to be treated. The distinction comes from the use in homeopathy of substances that are meant to cause similar effects as the symptoms of a disease to treat patients (homeo - meaning "similar").
+As used by homeopaths, the term allopathy has always referred to the principle of treating disease by administering substances that produce other symptoms (when given to a healthy human) than the symptoms produced by a disease. For example, part of an allopathic treatment for fever may include the use of a drug which reduces the fever, while also including a drug (such as an antibiotic) that attacks the cause of the fever (such as a bacterial infection). A homeopathic treatment for fever, by contrast, is one that uses a diluted dosage of a substance that in an undiluted form would induce fever in a healthy person. These preparations are typically diluted so heavily that they no longer contain any actual molecules of the original substance. Hahnemann used this term to distinguish medicine as practiced in his time from his use of infinitesimally small (or nonexistent) doses of substances to treat the spiritual causes of illness.
+The Companion Encyclopedia of the History of Medicine states that "[Hahnemann] gave an all-embracing name to regular practice, calling it 'allopathy'. This term, however imprecise, was employed by his followers and other unorthodox movements to identify the prevailing methods as constituting nothing more than a competing 'school' of medicine, however dominant in terms of number of practitioner proponents and patients".
+Contrary to the present usage, Hahnemann reserved the term "allopathic medicine" to the practice of treating diseases by means of drugs inducing symptoms unrelated (i.e., neither similar nor opposite) to those of the disease. He called the practice of treating diseases by means of drugs producing symptoms opposite to those of the patient "enantiopathic" (from the Greek ἐνάντιος (enántios), meaning "opposite") or "antipathic medicine".
+
+== Current usage ==
+In the United States, the term is used in the modern era to differentiate between two types of US medical schools (both of which teach aspects of science-based medicine and neither of which teach homeopathy): Allopathic (granting the MD degree) and Osteopathic (granting the DO degree).
+In India the term is used principally to distinguish "Western medicine" from Ayurveda, especially when comparing treatments and drugs.
+A study released by the World Health Organization (WHO) in 2001 defined "allopathic medicine" as "the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern medicine." The WHO used the term in a global study in order to differentiate Western medicine from traditional medicine, and from complementary/alternative medicine, noting that in certain areas of the world “the legal standing of practitioners is equivalent to that of allopathic medicine” where practitioners are certified in both complementary/alternative medicine and Western medicine.
+As of 2004, use of the term remained common among homeopaths and had spread to other alternative medicine practices. Kimball Atwood, an American medical researcher and alternative medicine critic, said the meaning implied by the label of allopathy has never been accepted by conventional medicine and is still considered pejorative by some. American health educator and skeptic William T. Jarvis, stated in 2008 that "although many modern therapies can be construed to conform to an allopathic rationale (e.g., using a laxative to relieve constipation), standard medicine has never paid allegiance to an allopathic principle" and that the label "allopath" was "considered highly derisive by regular medicine".
+Most modern science-based medical treatments (antibiotics, vaccines, and chemotherapeutics, for example) do not fit Samuel Hahnemann's definition of allopathy, as they seek to prevent illness, or remove the cause of an illness by acting on the cause of disease.
+
+== See also ==
+Conservation medicine
+Ethnomedicine
+Evidence-based medicine
+
+== References ==
+
+== External links ==
+ The dictionary definition of allopathy at Wiktionary
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diff --git a/data/en.wikipedia.org/wiki/Allow_natural_death-0.md b/data/en.wikipedia.org/wiki/Allow_natural_death-0.md
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+---
+title: "Allow natural death"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Allow_natural_death"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:02.316918+00:00"
+instance: "kb-cron"
+---
+
+Allow Natural Death (AND) is a medical term defining the use of life-extending measures such as cardiopulmonary resuscitation (CPR). These orders emphasize patient comfort and pain management instead of life extension.  Currently, American medical communities utilize "do not resuscitate," (DNR) orders to define patients' medical wishes. Those who propose to replace DNR with AND posit that DNR orders are ambiguous and require complex understanding between several parties, while AND orders are clearer. Proponents of replacing DNR with AND believe that AND terminology is more ethically conscientious DNR terminology. Research has been conducted regarding participant preference for AND vs. DNR terminology. The ease with which the terminology change can be practically incorporated depends on many factors such as costs and staff reeducation.
+
+== DNR vs. AND ==
+DNR orders range in the extent of life-saving measures to be avoided, from solely prohibiting the use of resuscitation to prohibiting any action seen as life extending. Because there are many parties involved in a patient's end of life care - significant others, family, personal doctors, specialists and nurses - DNR orders are not always completely clear, leaving open possible violation of the patient's wishes.  DNR terminology was replaced in 2005 by the American Heart Association with Do Not Attempt Resuscitation (DNAR) in an effort to make clearer the meaning of the order. However, DNR remains the popularly understood and used term in the medical and layperson settings. AND is yet another phrase for similar orders, and implementing it involves a term change.
+Those who propose to replace DNR orders with AND orders posit that AND is less ambiguous, clearly instructing medical personnel to not use any artificial, life extending measures. This would be especially helpful in regards to emergency care, when medical personnel who are unfamiliar with the patient must decide what medical practices should be used. Pros are that AND increases clarity on meaning and the choice of life or death. AND orders also don't use negative wording that could be confusing to interpret. Furthermore, proponents of AND claim that because it contains "death" in the title it is more clear to the patient and family exactly what the patient is agreeing to. Critics of AND claim it is simply the replacement of one ambiguous term with another. Cons include that death can be vague and CPR isn't mentioned in the phrase. Just as DNR particulars vary, so too would AND particulars vary. Thus, they argue that change would be ineffective.
+
+== Ethics ==
+AND terminology represents an ideology of patient care that emphasizes bodily autonomy and respect of the individual. This is in contrast to the terminology associated with DNR, or "do not resuscitate," which has been criticized for placing emphasis on potential negative outcomes associated with hospitalization, i.e. the act of "not" resuscitating is a conscious decision to "not" engage in life-extending care. Proponents of AND argue that, by "allowing" natural death, the provider is, instead, consciously deciding to engage in care; although such care is not life-extending, this form of care respects the wishes of patients to die peacefully and without suffering.
+AND and DNR share similar ethical considerations with regards to end-of-life care. These considerations can involve the four main principles of biomedical ethics, including autonomy, beneficence, nonmaleficence, and justice. Autonomy can be thought of as a patient's right to self-determination and the right to decide what kind of care they should receive, which can be achieved through ANDs or DNRs. The principles of beneficence and nonmaleficence require that the healthcare providers are aware of their patient's AND and DNR statuses, and of their roles in that patient's end-of-life care. Lastly, the principle of justice refers to the obligation for healthcare providers to advocate for fair and appropriate treatment of their patients at the end of their lives, which requires abiding by the conditions expressed through AND and DNR.
+In the cases of attempted suicide or medical mismanagement, there are questions around the meaning of what a "natural" death is. It is argued that in these cases, physicians should have the capability to revoke a patient's DNR or AND, though a wide consensus has yet to be reached.
+
+== Studies and Outcomes ==
+Most studies regarding AND are surveys based on hypothetical situations and are given to specific groups. One study gave a scenario regarding loved ones to nurses, nursing students, and people with no nursing background. Each group rated how likely they were to agree to end of life care when DNR or AND was used. Participants were significantly more likely to agree to end of life care when AND was used.
+Another study found similar results when giving a scenario to 524 adults- end of life care was more accepted when AND was used.
+However, when patients with cancer were given a scenario about how much time they had left to live (1 year, 6 months, or 1 month), the results were different. In two studies conducted by the same authors, there was no significant difference in choosing end of life care when AND or DNR was used.
+Finally, an anonymous survey asked residents and doctors about their experience with end of life care after their hospital switched to using AND over DNR. A majority agreed that using AND improved discussions about end of life care and decreased the burden of decision making.
+
+== Future Directions ==
+There are barriers that exist in implementing "allow natural death". Some argue that costs will occur with the need to reeducate clinical staff and replace forms and edit electronic medical databases. People are looking into high-end care for when it comes to end of life decisions and AND can help provide more autonomy for patients.
+
+== See also ==
+Letting die
+Coup de grace
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+---
+title: "Allow natural death"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Allow_natural_death"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:02.316918+00:00"
+instance: "kb-cron"
+---
+
+== Bibliography ==
+Fan, S.-Y., Wang, Y.-W., & Lin, I.-M. (2018). Allow natural death versus do-not-resuscitate: Titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision. BMC Palliative Care, 17(1). https://doi.org/10.1186/s12904-018-0367-4.
+This is a peer-reviewed scientific journal, so it should be a reliable source. It covers the topic in some depth, so it's helpful in establishing notability.
+Miljković, M. D., Emuron, D., Rhodes, L., Abraham, J., & Miller, K. (2015). "allow natural death" versus "do not resuscitate": What do patients with advanced cancer choose? Journal of Palliative Medicine, 18(5), 457–460. https://doi.org/10.1089/jpm.2014.0369.
+This is a peer-reviewed scientific journal, so it should be a reliable source. It covers the topic in some depth, so it's helpful in establishing notability.
+Wittmann-Price, Ruth; Celia, Linda M. (Nov–Dec 2010). "Exploring perceptions of "do not resuscitate" and "allowing natural death" among physicians and nurses". Holistic Nursing Practice. 24 (6): 333–337.
+This is a peer-reviewed scientific journal, so it should be a reliable source. It is an observational study that was used to understand the differences in perception of the terms "allow natural death" and "do not resuscitate."
+Akdeniz, Melahat; Yardımcı, Bülent; Kavukcu, Ethem (2021). "Ethical considerations at the end-of-life care". SAGE open medicine. 9: 20503121211000918.
+This is a peer-reviewed review article, so it should be a reliable source. It covers ethical considerations of end-of-life care, so it's helpful in providing context to the discussion of "allowing natural death."
+Knox, C., Vereb, J.A. (2005). "Allow Natural Death: A More Humane Approach to Discussing End-of-Life Directives". Journal of Emergency Nursing. 31 (6): 560-561. PMID 16308044
+This is an history of AND vs. DNR and argues for use of AND in a reputable journal.
+Venneman, S. S., Narnor-Harris, P., Perish, M., Hamilton, M. (2007). ""Allow natural death" versus "do not resuscitate": three words that can change a life". Journal of Medical Ethics. 34 (1): 2-6.
+This is a quantitative survey study in the Journal of Medical Ethics, which is a reputable and relevant source.
+Robinson, C., Kolesar, S., Boyko, M., Berkowitz, J., Calam, B., Collins, M. (2012). "Awareness of do-not-resuscitate orders". Canadian Family Physician. 58 (4): 229-233. PMID 22611610
+This is a primary cross-sectional study in a peer-reviewed journal on patient awareness of DNR and how and when they would like to decide on how or whether to use one.
+
+== References ==
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+---
+title: "Ambulatory"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Ambulatory"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:03.561509+00:00"
+instance: "kb-cron"
+---
+
+The ambulatory (Latin: ambulatorium 'walking place') is the covered passage around a cloister or the processional way around the east end of a cathedral or large church and behind the high altar. The first ambulatory was in France in the 11th century but by the 13th century ambulatories had been introduced in England and many English cathedrals were extended to provide an ambulatory.
+The same feature is often found in Indian architecture and Buddhist architecture generally, especially in older periods. Ritual circumambulation or parikrama around a stupa or cult image is important in Buddhism and Hinduism. Often the whole building was circumambulated, often many times. The Buddhist chaitya hall always allowed a path for this, and the Durga temple, Aihole (7th or 8th century) is a famous Hindu example.
+
+The term is also used to describe a garden feature in the grounds of a country house. A typical example is the one shown, which stands in the grounds of Horton Court in Gloucestershire, England.
+
+
+== Medical term ==
+Ambulatory is also an adjective used to describe
+
+patients who can walk despite their illness or injury.
+outpatients generally including those needing a wheelchair.
+medical staff providing outpatient care (see Ambulatory care nursing, Ambulatist).
+medical procedures that do not ordinarily require an overnight stay in hospital (see Ambulatory care).
+Canes or other walking aids can be called ambulatory assistive devices.
+
+
+== See also ==
+List of architectural vaults
+Scarcella
+
+
+== References ==
+
+
+== External links ==
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+---
+title: "Anatomical terms of location"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Anatomical_terms_of_location"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:06.044970+00:00"
+instance: "kb-cron"
+---
+
+Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provides a definition of what is at the front ("anterior"), behind ("posterior") and so on. As part of defining and describing terms, the body is described through the use of anatomical planes and axes.
+The meaning of terms that are used can change depending on whether a vertebrate is a biped or a quadruped, due to the difference in the neuraxis, or if an invertebrate is  a non-bilaterian. A non-bilaterian has no anterior or posterior surface for example but can still have a descriptor used such as proximal or distal in relation to a body part that is nearest to, or furthest from its middle.
+International organisations have determined vocabularies that are often used as standards for subdisciplines of anatomy. For example, Terminologia Anatomica, Terminologia Neuroanatomica, and Terminologia Embryologica  for humans and Nomina Anatomica Veterinaria for animals. These allow parties that use anatomical terms, such as anatomists, veterinarians, and medical doctors, to have a standard set of terms to communicate clearly the position of a structure.
+
+== Introduction ==
+
+Standard anatomical terms of location have been developed, usually based on Latin and Greek words, to enable all biological and medical scientists, veterinarians, medical doctors and anatomists to precisely delineate and communicate information about animal bodies and their organs, even though the meaning of some of the terms often is context-sensitive. Much of this information has been standardised in internationally agreed vocabularies for humans (Terminologia Anatomica, Terminologia Neuroanatomica, and Terminologia Embryologica), with Nomina Anatomica Veterinaria and Nomina Embryologica Veterinaria used for animal anatomy.
+Different terms are used for those vertebrates that are bipedal and those that are quadrupedal. The reasoning is that the neuraxis, and therefore the standard anatomical position is different between the two groups. Unique terms are also used to describe invertebrates, because of their wider variety of shapes and symmetries.
+
+=== Standard anatomical position ===
+
+Because animals can change orientation with respect to their environment, and because appendages like limbs and tentacles can change position with respect to the main body, terms to describe position need to refer to an animal when it is in its standard anatomical position, even when its appendages are in another position. This helps to avoid confusion in terminology when referring to the same animal in different postures. In humans, this refers to the body in a standing position with arms at the side and palms facing forward. In quadrupeds this is an animal standing upright with all four feet on the ground and the head facing forward. For a fish this is belly down with neutral appendages.
+
+=== Planes ===
+
+Anatomical terms describe structures with relation to three main anatomical planes. Anatomical planes are useful in a number of fields including medical imaging, embryology, and the study of movement.
+The three main plane orientations are:
+
+The sagittal planes, also called the parasagittal planes or paramedian planes, are planes that divide the body into left and right.  The central one of these is the median plane, also called the midsagittal plane, which passes through the head, spinal cord, navel and, in many animals, the tail.
+The coronal plane or frontal plane divides the body into front and back parts. In quadrupeds this plane is termed the dorsal plane and divides the body into dorsal (towards the backbone) and ventral (towards the belly) parts.
+The transverse plane, also called the axial plane or horizontal plane, is perpendicular to the other two planes.
+Sagittal planes and transverse planes are used as anatomical lines to delineate bodily regions. There are several transverse planes with clinical relevance in the division of the torso into sections. They include the transpyloric plane, the subcostal plane,  and the transumbilical plane.
+
+=== Axes ===
+
+The three axes of a vertebrate, are formed in embryonic development  before and during the gastrulation stage. Distinct ends of the embryo are chosen, and the axis is named according to those directions. The three main axes of a bilaterally symmetrical animal that intersect at right angles, are the left-right, the craniocaudal, and the anteroposterior axes. 
+
+The left-right axis, also known as the horizontal or frontal axis
+The craniocaudal axis, also known as the rostrocaudal, longitudinal or cephalocaudal
+The anteroposterior axis, also known as the dorsoventral, or sagittal axis
+An organism that is round, or asymmetrical may have different axes.
+
+== Main terms ==
+
+=== Superior and inferior ===
+In the standard human anatomical position, superior (from Latin  super 'above') or cranial, describes something that is nearer to the head, and inferior (from Latin  inferus 'below') or caudal describes what is below, and nearer to the feet. Examples are the superior mediastinum, and inferior mediastinum. Neuroanatomy examples are the superior colliculus, and the inferior colliculus. In veterinary anatomy, the terms superior and inferior are not used except to describe the eye, eyelids, lips and inner ear, using instead dorsal and ventral.
+
+=== Anterior and posterior ===
+
+Anterior (from Latin  ante 'before') describes what is in front, and posterior (from Latin  post 'after') describes what is to the back of something. For example, for many fish the gill openings are posterior to the eyes and anterior to the tail.  In veterinary anatomy, these terms are reserved for some structures of the head, instead using cranial and caudal throughout the rest of the body.
\ No newline at end of file
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+---
+title: "Anatomical terms of location"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Anatomical_terms_of_location"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:06.044970+00:00"
+instance: "kb-cron"
+---
+
+=== Dorsal and ventral ===
+These two terms, used in veterinary anatomy, are also used in human anatomy mostly in neuroanatomy, and embryology, to describe something at the back (dorsal, posterior) or front (ventral, anterior) of an organ, or organism.
+The dorsal (from Latin  dorsum 'back') surface, (also dorsum) of an organism or organ, refers to the back, or upper side, such as in the human, the dorsum of the tongue, the dorsum of the hand, and the dorsum of the foot.  If talking about the skull, the dorsal side is the top.
+
+The ventral (from Latin  venter 'belly') surface refers to the front, or lower side, of an organism, or organ such as the undersurface of the tongue.
+In a fish, the dorsal fin is on the upper surface and its ventral fins (pelvic fins) are on the belly or undersurface.
+The terms are used in other contexts, for example in dorsal and ventral gun turrets on a bomber aircraft.
+
+=== Medial and lateral ===
+These terms describe how close something is to the median plane. Lateral (from Latin  lateralis 'to the side') describes something to the sides of an animal, as in "left lateral" and "right lateral". Medial (from Latin  medius 'middle') describes structures close to the median plane, or closer to the median plane than another structure. For example, in a human, the arms are lateral to the torso. The genitals are medial to the legs. Temporal has a similar meaning to lateral but is restricted to the head.
+The terms "left" and "right", or sinistral and dextral, refer to the halves of a bilaterally symmetrical body divided by the median plane.
+Terms derived from lateral include:
+
+Contralateral (from Latin  contra 'against'): on the side opposite to another structure. For example, the right arm and leg are controlled by the left, contralateral, side of the brain.
+Ipsilateral (from Latin  ipse 'same'): on the same side as another structure. For example, the left arm is ipsilateral to the left leg.
+Bilateral (from Latin  bis 'twice'): on both sides of the body. For example, bilateral orchiectomy means removal of testes on both sides of the body.
+Unilateral (from Latin  unus 'one') one-sided or single-sided: on one side of the body. For example, unilateral deafness is hearing impairment in one ear.
+Varus (from Latin 'bow-legged') and valgus (from Latin 'knock-kneed' ) are terms used to describe angulation or bowing  of a bone or joint within the coronal plane, where the distal portion deviates towards (varus) or away from (valgus) the midline.
+
+=== Proximal and distal ===
+
+The terms proximal (from Latin  proximus 'nearest') and distal (from Latin  distare 'to stand away from') are used to describe parts of a feature that are close to or distant from the main mass of the body, respectively. Thus the upper arm in humans is proximal and the hand is distal. The main mass is taken as the center, the chest, or the heart.
+"Proximal and distal" are frequently used when describing appendages, such as fins, tentacles, and limbs. Although the direction indicated by "proximal" and "distal" is always respectively towards or away from the point of attachment, a given structure can be either proximal or distal in relation to another point of reference. Thus the elbow is distal to a wound on the upper arm, but proximal to a wound on the lower arm.
+This terminology is also employed in molecular biology and therefore by extension is also used in chemistry, specifically referring to the atomic loci of molecules from the overall moiety of a given compound.
+
+=== Rostral, cranial, and caudal ===
+
+Specific terms exist to describe how close or far something is to the head or tail of an animal. To describe how close to the head of an animal something is, three distinct terms are used:
+
+Rostral (from Latin  rostrum 'beak, nose') describes something situated toward the oral or nasal region, or in the case of the brain, toward the tip of the frontal lobe.
+Cranial (from Greek  κρανίον 'skull') or cephalic (from Greek  κεφαλή 'head') describes how close something is to the head of an organism.
+Caudal (from Latin  cauda 'tail') describes how close something is to the trailing end of an organism.
+These terms are generally preferred in veterinary medicine and not used as often in human medicine. For example, in horses, the eyes are caudal to the nose and rostral to the back of the head.
+In humans, "cranial" and "cephalic" are used to refer to the skull, with "cranial" being used more commonly. The term "rostral" is rarely used in human gross anatomy and refers more to the front of the face than the superior aspect of the organism. But it is used in embryology, and neuroanatomy.  Similarly, the term "caudal" is used more in embryology and neuroanatomy, and only occasionally in human gross anatomy. The "rostrocaudal axis" refers to the curved line of the neuraxis from the forehead (rostral) towards the tail end (caudal).
+
+=== Central and peripheral ===
+Central and peripheral refer to the distance towards and away from the centre of something. That might be an organ, a region in the body, or an anatomical structure. For example, the central nervous system and the peripheral nervous systems.
+Central (from Latin  centralis) describes something at, or close to the centre.  For example, the great vessels run centrally through the body; many smaller vessels branch from these. 
+Peripheral (from Latin  peripheria, originally from Ancient Greek) describes something that is situated nearer to the body's surface, such as a peripheral nerve.
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+---
+title: "Anatomical terms of location"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Anatomical_terms_of_location"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:06.044970+00:00"
+instance: "kb-cron"
+---
+
+=== Superficial and deep ===
+These terms refer to the distance of a structure from the surface.
+Deep (from Old English) describes something further away from the surface of the organism. For example, the external oblique muscle of the abdomen is deep to the skin. "Deep" is one of the few anatomical terms of location derived from Old English rather than Latin – the anglicised Latin term would have been "profound" (from Latin  profundus 'due to depth').
+Superficial (from Latin  superficies 'surface') describes something near the outer surface of the organism. For example, in skin, the epidermis is superficial to the subcutis.
+
+=== Combined terms ===
+
+Many anatomical terms can be combined, either to indicate a position in two axes simultaneously or to indicate the direction of a movement relative to the body. For example, anterolateral indicates a position that is both anterior and lateral to the body axis (such as the bulk of the pectoralis major muscle), or to a named organ such as the anterolateral tibial tubercle. The term can also describe the direction and location of something that enters or courses through the body such as the anterolateral system in the spinal cord, and the anterolateral central arteries.  Another term anteromedial is used for example in the anteromedial central arteries.
+In the more internal brain and spinal cord of the central nervous system the terms dorsal and ventral and their combinations are often used in place of anterior and posterior. In these organs numerous references need to be used, and in the brain for example the prefrontal cortex has the divisions of the dorsomedial prefrontal cortex, and the dorsolateral prefrontal cortex.  And the dorsomedial region has subcompartments that make use of other terms such as the anterior cingulate cortex, and infralimbic cortex. Structures such as the anterior cingulate cortex may be divided anatomically based on cognitive (dorsal), and emotional (ventral) components.
+Proximodistal is the axis of an appendage such as an arm or a leg, taken from its tip at the distal part to where it joins the body at the proximal part.
+In radiology, various X-ray views uses terminology  based on where the X-ray beam enters and leaves the body, including the front to back view (anteroposterior), the back to front view (posteroanterior), and the side view (lateral). Combined terms were once generally hyphenated, but typically the hyphen is omitted.
+
+=== Modifiers ===
+
+Several terms are commonly seen and used as prefixes:
+
+Sub- (from Latin  sub 'preposition beneath, close to, nearly etc') is used to indicate something that is beneath, or something that is subordinate to or lesser than. For example, subcutaneous means beneath the skin.
+Hypo- (from Ancient Greek  ὑπό 'under') is used to indicate something that is beneath. For example, the hypoglossal nerve supplies the muscles beneath the tongue.
+Infra- (from Latin  infra 'under') is used to indicate something that is within or below. For example, the infraorbital nerve runs within the orbit.
+Inter- (from Latin  inter 'between') is used to indicate something that is between. For example, the intercostal muscles run between the ribs.
+Super- or Supra- (from Latin  super, supra 'above, on top of') is used to indicate something that is above something else. For example, the supraorbital ridges are above the eyes.
+Ab- (from Latin  ab 'away'), and ad- (from Latin  ad 'towards') are used to indicate that something is towards (ad-) or away from (ab-) something else. For example abduction and adduction refer to muscular movement away from, and towards the midline of the body, respectively.
+Other terms are used as suffixes, added to the end of words:
+
+-al (from Latin  al 'pertaining to, of the') For example femoral neck.
+-ad (from Latin  ad 'towards'), equivalent to '-ally', is a suffix creating the adverb form to indicate that something moves towards (-ad) something else. For example, "distad" means "in the distal direction," as in "arterial blood flows distad/distally." Further examples may include cephalad (towards the cephalic end), orad, craniad, and proximad. The terms "proximally" and "distally" are in more common use in human and veterinary anatomic textbooks, while "proximad" and "distad," are used commonly in insect anatomy.
+
+== Other terms and special cases ==
+
+=== Anatomical landmarks ===
+
+The location of anatomical structures can also be described in relation to different anatomical landmarks used in anatomy, surface anatomy, surgery, and radiology.
+Structures may be described as being at the level of a specific vertebra, depending on the section of the vertebral column the structure is at. The position is often abbreviated. For example, structures at the level of the fourth cervical vertebra may be abbreviated as "C4", at the level of the fourth thoracic vertebra "T4", and at the level of the third lumbar vertebra "L3". Because the sacrum and coccyx are fused, they are not often used to provide the location.
+References may also take origin from surface anatomy, made to landmarks that are on the skin or visible underneath. For example, structures may be described relative to the anterior superior iliac spine, the medial malleolus or the medial epicondyle.
+Anatomical lines are theoretical lines, using either horizontal transverse planes, or vertical sagittal  planes, used to describe anatomical location. For examples, the mid-clavicular line is used as part of the cardiac examination to feel the apex beat of the heart, and the axillary lines are reference lines for the underarm region. Other types of lines in anatomy include the curved nuchal lines on the occipital bone, and the gluteal lines on the ilium.
+
+=== Mouth and teeth ===
\ No newline at end of file
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+---
+title: "Anatomical terms of location"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Anatomical_terms_of_location"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:06.044970+00:00"
+instance: "kb-cron"
+---
+
+Special terms are used to describe the mouth and teeth. Fields such as osteology, paleontology and dentistry apply special terms of location to describe the mouth and teeth. This is because although teeth may be aligned with their main axes within the jaw, some different relationships require special terminology as well; for example, teeth also can be rotated, and in such contexts terms like "anterior" or "lateral" become ambiguous. For example, the terms "distal" and "proximal" (or "mesial") are used for surfaces of individual teeth relative to the midpoint of the dental arch, and "medial" and "lateral" are used in the standard sense relative to the median plane. Terms used to describe structures include "buccal" (from Latin  bucca 'cheek') and "palatal" (from Latin  palatum 'palate') referring to structures close to the cheek and hard palate respectively.
+
+=== Hands and feet ===
+
+Several anatomical terms are particular to the hands and feet. Additional terms may be used to avoid confusion when describing the surfaces of the hand and what is the "anterior" or "posterior" surface. The term "anterior", while anatomically correct, can be confusing when describing the palm of the hand; Similarly is "posterior", used to describe the back of the hand and arm. This confusion can arise because the forearm can pronate and supinate and flip the location of the hand. For improved clarity, the directional term palmar (from Latin  palma 'palm of the hand') is commonly used to describe the front of the hand, and dorsal is the back of the hand. The palmar fascia is palmar to the tendons of muscles which flex the fingers, and the dorsal venous arch is so named because it is on the dorsal side of the foot.
+In humans, volar can also be used synonymously with palmar to refer to the palm of the hand, and can also be used to refer to the sole of the foot. But palmar is used exclusively for the palm of the hand, and plantar is used exclusively for the sole of the foot. 
+Similarly, in the limbs for clarity, the sides are named after the bones. In the forearm, structures closer to the radius are radial, structures closer to the ulna are ulnar, and structures relating to both bones are referred to as radioulnar, such as the distal radioulnar joint. Similarly, in the lower leg, structures near the tibia (shinbone) are tibial and structures near the fibula are fibular (or peroneal).
+
+=== Rotational direction ===
+
+Anteversion and retroversion are complementary terms describing an anatomical structure that is rotated forwards (towards the front of the body) or backwards (towards the back of the body), relative to some other position. They are particularly used to describe the curvature of the uterus.
+
+Anteversion (from Latin  anteversus) describes an anatomical structure being tilted further forward than normal, whether pathologically or incidentally. For example, a person's uterus typically is anteverted, tilted slightly forward. A misaligned pelvis may be anteverted, that is to say tilted forward to some relevant degree.
+Retroversion (from Latin  retroversus) describes an anatomical structure tilted back away from something. An example is a retroverted uterus.
+
+=== Other directional terms ===
+Several other terms are also used to describe location. These terms are not used to form the fixed axes. Terms include:
+
+Axial (from Latin  axis 'axle'): around the central axis of the organism or the extremity. Two related terms, "abaxial" and "adaxial", refer to locations away from and toward the central axis of an organism, respectively
+Luminal (from Latin  lumen 'light, opening'): on the—hollow—inside of an organ's lumen (body cavity or tubular structure); adluminal is towards, abluminal is away from the lumen. Opposite to outermost (the adventitia, serosa, or the cavity's wall).
+Terminal (from Latin  terminus 'boundary or end') at the extremity of a usually projecting structure; forming the end of a structure such as an axon terminal.
+Visceral (from Latin  viscera 'internal organs'): associated with the innermost layer of an organ within the body. For example, the visceral pleura covering the lungs, contrasted with the parietal pleura lining the thoracic cavity.
+Parietal (from Latin  paries 'wall'): pertaining to the wall of a body cavity as the parietal pleura lining the thoracic cavity, contrasted with visceral pleura.
+Aboral (away from oral) is used to denote a location in an organism that is further from the mouth.
\ No newline at end of file
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+---
+title: "Anatomical terms of location"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Anatomical_terms_of_location"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:06.044970+00:00"
+instance: "kb-cron"
+---
+
+== Other animals ==
+Different terms are used because of different body plans in animals, whether animals stand on two or four legs, and whether an animal is symmetrical or asymmetrical. For example, as humans are bilaterally symmetrical, anatomical descriptions usually use the same terms as those for other vertebrates. However, the standard human anatomical position means that their anterior/posterior and ventral/dorsal directions are the same, so the inferior/superior directions are used due to longstanding tradition instead of cranial/caudal, which apply regardless of position, as in other species. The term "rostral" used to refer to the beak or nose in some animals is used less frequently in humans, with the exception of parts of the brain; while humans do not have a visible tail (the coccygeal vertebrae are present and commonly called the "tailbone") the term "caudal" that refers to the tail-end is also sometimes used in humans and animals without tails to refer to the hind part of the body. Flounder and other flatfish which lie on the seabed on their left or right side are asymmetric, with both eyes on the 'up' side, making anatomical nomenclature a challenge.
+Invertebrates have a large variety of body shapes that can present a problem when trying to apply standard directional terms. Depending on the organism, some terms are taken by analogy from vertebrate anatomy, and appropriate novel terms are applied as needed. Some such borrowed terms are widely applicable in most invertebrates; for example proximal, meaning "near" refers to the part of an appendage nearest to where it joins the body, and distal, meaning "standing away from" is used for the part furthest from the point of attachment. In all cases, the usage of terms is dependent on the body plan of the organism.
+
+=== Non-bilaterian organisms ===
+
+In non-bilaterian organisms with a changeable shape, such as amoeboid organisms, most directional terms are meaningless, since the shape of the organism is not constant and no distinct axes are fixed. Similarly, in radially symmetrical organisms, there is nothing to distinguish one line through the centre of the organism from any other. An indefinite number of triads of mutually perpendicular axes could be defined, but any such choice of axes would be useless, as nothing would distinguish a chosen triad from any others. In such organisms, only terms such as superficial and deep, or sometimes proximal and distal, are usefully descriptive.
+
+=== Elongated organisms ===
+
+In organisms that maintain a constant shape and have one dimension longer than the other, at least two directional terms can be used. The long or longitudinal axis is defined by points at the opposite ends of the organism. Similarly, a perpendicular transverse axis can be defined by points on opposite sides of the organism. There is typically no basis for the definition of a third axis. Usually such organisms are planktonic (free-swimming) protists, and are nearly always viewed on microscope slides, where they appear essentially two-dimensional. In some cases a third axis can be defined, particularly where a non-terminal cytostome or other unique structure is present.
+
+Some elongated protists have distinctive ends of the body. In such organisms, the end with a mouth (or equivalent structure, such as the cytostome in Paramecium or Stentor), or the end that usually points in the direction of the organism's locomotion (such as the end with the flagellum in Euglena), is normally designated as the anterior end. The opposite end then becomes the posterior end. Properly, this terminology would apply only to an organism that is always planktonic (not normally attached to a surface), although the term can also be applied to one that is sessile (normally attached to a surface).
+
+Organisms that are attached to a substrate, such as sponges and animal-like protists also have distinctive ends. The part of the organism attached to the substrate is usually referred to as the basal end (from Latin  basis 'support/foundation'), whereas the end furthest from the attachment is referred to as the apical end (from Latin  apex 'peak/tip').
+
+=== Radially symmetrical organisms ===
+Radially symmetrical organisms include those in the group Radiata –  primarily Cnidarians (jellyfish, sea anemones and corals, and the comb jellies). Adult echinoderms, such as starfish, sea urchins, sea cucumbers and others are also included, since they have a pentamerous symmetry having five discrete symmetric parts arranged around a central axis. Echinoderm larvae are not included, since they are bilaterally symmetrical. 
+Cnidarians  have an incomplete digestive system, meaning that one end of the organism has a mouth, the oral end (from Latin  ōrālis 'of the mouth'), and the opposite aboral end (from Latin  ab- 'away from') has no opening from the gut (coelenteron). They are radially symmetric around the oral-aboral axis. Having only the single distinctive axis, "lateral", "dorsal", and "ventral" have no meaning, and all can be replaced by the generic term peripheral (from Ancient Greek  περιφέρεια 'circumference'). Medial can be used, but in the case of radiates indicates the central point, rather than a central axis as in vertebrates. Thus, there are multiple possible radial axes and medio-peripheral (half-) axes.
+Comb jellies have a biradial symmetry about only two planes, a tentacular plane, and a pharyngeal plane.
+
+=== Spiders ===
+
+Special terms are used for spiders. Two such terms are useful in describing views of the legs and pedipalps of spiders, and other arachnids. Prolateral refers to the surface of a leg that is closest to the anterior end of an arachnid's body. Retrolateral refers to the surface of a leg that is closest to the posterior end of an arachnid's body. Most spiders have eight eyes in four pairs. All the eyes are on the carapace of the prosoma, and their sizes, shapes and locations are characteristic of various spider families and other taxa. Usually, the eyes are arranged in two roughly parallel, horizontal and symmetrical rows of eyes. Eyes are labelled according to their position as anterior and posterior lateral eyes (ALE) and (PLE); and anterior and posterior median eyes (AME) and (PME).
+
+== See also ==
+Body relative direction
+Chirality
+Geometric terms of location
+Reflection symmetry
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Anginal_equivalent-0.md b/data/en.wikipedia.org/wiki/Anginal_equivalent-0.md
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+---
+title: "Anginal equivalent"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Anginal_equivalent"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:07.251155+00:00"
+instance: "kb-cron"
+---
+
+An anginal equivalent is a symptom such as shortness of breath (dyspnea), diaphoresis (sweating), extreme fatigue, or pain at a site other than the chest, occurring in a patient at high cardiac risk. Anginal equivalents are considered to be symptoms of myocardial ischemia. Anginal equivalents are considered to have the same importance as angina pectoris in patients presenting with elevation of cardiac enzymes or certain EKG changes which are diagnostic of myocardial ischemia.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Anisomastia-0.md b/data/en.wikipedia.org/wiki/Anisomastia-0.md
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+---
+title: "Anisomastia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Anisomastia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:08.506878+00:00"
+instance: "kb-cron"
+---
+
+Anisomastia is a medical condition in which there is a severe asymmetry or unequalness in the size of the breasts, generally related to a difference in volume. In other words, when one of the breasts is much larger than the other. In contrast to anisomastia, a slight  asymmetry of the breasts is common. Anisomastia may be corrected by surgical breast augmentation or reduction.
+
+
+== See also ==
+Micromastia
+Breast hypertrophy
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Anophthalmia-0.md b/data/en.wikipedia.org/wiki/Anophthalmia-0.md
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+---
+title: "Anophthalmia"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Anophthalmia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:09.740164+00:00"
+instance: "kb-cron"
+---
+
+Anophthalmia (Greek: ἀνόφθαλμος, "without eye") is the medical term for the absence of one or both eyes. Both the globe and the ocular tissue are missing from the orbit. The absence of the eye will cause a small bony orbit, a constricted mucosal socket, short eyelids, reduced palpebral fissure and malar prominence. Genetic mutations, chromosomal abnormalities, and prenatal environment can all cause anophthalmia. Anophthalmia is an extremely rare disease and is mostly rooted in genetic abnormalities. It can also be associated with other syndromes.
+
+== Classifications ==
+There are three classifications for this condition:
+
+Primary anophthalmia is a complete absence of eye tissue due to a failure of the part of the brain that forms the eye.
+Secondary anophthalmia the eye starts to develop and for some reason stops, leaving the infant with only residual eye tissue or extremely small eyes which can only be seen under close examination.
+Degenerative anophthalmia the eye started to form and, for some reason, degenerated. One reason for this occurring could be a lack of blood supply to the eye.
+
+== Associations ==
+
+There are a few conditions that are associated with anophthalmia. These include:
+
+Trisomy 13
+Lenz syndrome
+Goldenhar-Gorlin syndrome
+Waardenburg syndrome
+Aside from these associative conditions, anophthalmia in only one eye tends to be associated with complications in the other eye. These risks include a higher chance of having glaucoma or a detached retina.
+
+== Causes ==
+
+=== SOX2 ===
+The most common genetic cause for anophthalmia is mutated SOX2 gene. Sox2 anophthalmia syndrome is caused by a mutation in the Sox2 gene that does not allow it to produce the Sox2 protein that regulates the activity of other genes by binding to certain regions of DNA. Without this Sox2 protein, the activity of genes that is important for the development of the eye is disrupted. Sox2 anophthalmia syndrome is an autosomal dominant inheritance, but the majority of patients who have Sox2 anophthalmia are the first in their family history to have this mutation. In certain cases, one parent will possess the mutated gene only in their egg or sperm cell and the offspring will inherit it through that. This is called germline mosaicism. There are at least 33 mutations in the Sox2 gene that have been known to cause anophthalmia. Some of these gene mutations will cause the Sox2 protein not to be formed, while other mutations will yield a non-functional version of this protein.
+
+=== RBP4 ===
+RBP4 has recently been linked to autosomal dominant form of anophthalmia. This form of anophthalmia has variable penetrance and a unique maternal inheritance effect that is rooted in pregnancy. Specifically, the disease only occurs when a mother and fetus both carry a RBP4 mutation which predisposes the fetus to vitamin A deficiency (a known environmental risk factor for anophthalmia) during pregnancy. If Vitamin A deficiency occurs during the first several months when the eye is developing, it may lead to anophthalmia. This form of anophthalmia is the first that may be intervened upon with vitamin A supplementation of retinyl esters during the first several months of pregnancy. This strategy exploits an RBP-independent pathway. Clinical research is underway. 
+
+=== Other influential genes ===
+SOX2 and RBP4 are not the only genes that can cause anophthalmia.  Other important genes include OTX2, CHX10 and RAX. Each of these genes are an important in retinal expression. Mutations in these genes can cause a failure of retinal differentiation. OTX2 is dominantly inherited. Mutation effects vary in severity, and can include microphthalmia. BMP4 is also linked to anophthalmia, as well as causing myopia and microphthalmia. It is dominantly inherited. BMP4 interacts with the Sonic hedgehog (SHH) pathway and can cause anophthalmia. Haploinsufficiency of PRR12 is also known to result in anophthalmia among other abnormalities.
+
+=== Environmental influence ===
+Many environmental conditions have also been known to cause anophthalmia. The strongest support for environmental causes has been studies where children have had gestational-acquired infections. These infections are typically viral. A few known pathogens that can cause anophthalmia are Toxoplasma, rubella, and certain strains of the influenza virus. Other known environmental conditions that have led to anophthalmia are maternal vitamin A deficiency, exposure to X-rays during gestation, solvent abuse, and exposure to thalidomide.
+
+=== Chromosome 14 ===
+An interstitial deletion of chromosome 14 has been known to occasionally be the source of anophthalmia. The deletion of this region of chromosome has also been associated with patients having a small tongue, and high arched palate, developmental and growth retardation, undescended testes with a micropenis, and hypothyroidism. The region that has been deleted is region q22.1-q22.3. This confirms that region 22 on chromosome 14 influences the development of the eye.
+
+== Prenatal diagnosis ==
+
+=== Ultrasounds ===
+Ultrasounds can be used to diagnose anophthalmia during gestation. Due to the resolution of the ultrasound, it is difficult to diagnose it until the second trimester. The earliest time to detect anophthalmia this way is approximately 20 weeks.
+
+=== Amniocentesis ===
+It is possible to diagnose prenatally with amniocentesis, but it may not show a correct negative result. Amniocentesis can only diagnose anophthalmia when there is a chromosomal abnormality. Chromosomal abnormalities are only a minority of cases of anophthalmia.
+
+== Postnatal diagnosis ==
+
+=== MRI/CT ===
+MRIs and CTs can be used to scan the brain and orbits. Radiologists use this to assess the internal structures of the globe, the optic nerve and extraocular muscles, and brain anatomy.
+
+=== Examination ===
+Physicians, specifically ophthalmologists, can examine the child and give a correct diagnosis. Some will do molecular genetics tests to see if the cause is linked with gene mutations.
+Genetic testing can include chromosomal microarray analysis, single-gene testing, or multigene-panel testing. Genomic testing including exome sequencing, genome sequencing, and mitochondrial sequencing may be considered if single-gene testing or use of a multigene panel fails to confirm a molecular diagnosis.
+
+== Treatments ==
\ No newline at end of file
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+---
+title: "Anophthalmia"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Anophthalmia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:09.740164+00:00"
+instance: "kb-cron"
+---
+
+=== Prosthetic eye ===
+Currently, there is not a treatment option for regaining vision by developing a new eye. There are, however, cosmetic options so the absence of the eye is not as noticeable. Typically, the child will need to go to an ocularist to have conformers fitted into the eye. Conformers are made of clear plastic and are fitted into the socket to promote socket growth and expansion. As the child's face grows and develops, the conformer will need to be changed. An expander may also be needed in anophthalmia to expand the socket that is present. The conformer is changed every few weeks the first two years of life. After that, a painted prosthetic eye can be fitted for the child's socket. The prosthetic eye can be cleaned with mild baby soap and water. Rubbing alcohol should be avoided because it may damage the prosthetic eye. Children need to be checked regularly to ensure the fit and size is appropriate.
+A Cochrane Review published in 2016 asked whether the type of material used to make the prosthetic eye affects the success of the operation. Prosthetic eyes can be made from two types of material; porous or non-porous material. "If the material is porous then the artificial eye can become integrated into the body because new blood vessels can grow into the material. If the material is non-porous, then the artificial eye remains separate from the rest of the body's tissue." After assessing three studies, the review concluded that there wasn't enough evidence to conclude which material was better.
+
+=== Cosmetic surgery ===
+If the proper actions are not taken to expand the orbit, many physical deformities can appear. It is important that if these deformities do appear, that surgery is not done until at least the first two years of life. Many people get eye surgery, such as upper eyelid ptosis surgery and lower eyelid tightening. These surgeries can restore the function of the surrounding structures like the eyelid in order to create the best appearance possible. This is more common with people who have degenerative anophthalmia.
+
+== Epidemiology ==
+Anophthalmia has been reported to be present in 3 out of every 100,000 births. Many instances of anophthalmia also occur with microphthalmia. A recent study in the UK indicated that anophthalmia and microphthalmia had a combined average of 1 in every 10,000 births. The annual rate of occurrence of anophthalmia/microphthalmia in the United States is about 780 children born/year. The most extensive epidemiological survey on this congenital malformation has been carried out by Dharmasena et al. and using English National Hospital Episode Statistics, they calculated the annual incidence of anophthalmia, microphthalmia and congenital malformations of orbit/lacrimal apparatus from 1999 to 2011. According to this study the incidence of congenital anophthalmia ranged from 2.4 (95% CI 1.3 to 4.0) per 100 000 infants in 1999 to 0.4 (0 to 1.3) in 2011.    Parents that already have a child who has anophthalmia have a 1 in 8 chance of having another child with anophthalmia. Approximately two-thirds of all cases of anophthalmia are determined to be of genetic basis. Anophthalmia is one of the leading causes of congenital blindness and accounts for 3–11% of blindness in children. Anophthalmia and microphthalmia together make up 1.7–1.8% of reconstructive surgical cases in laboratory of plastic surgery and ocular prostheses.
+
+== References ==
+
+== External links ==
+
+MAPS – Support group for parents with anophthalmic and microphthalmic children
+International Children's Anophthalmia and Microphthalmia Network (ICAN)
+Microphthalmia Anophthalmia & Coloboma Support (MACS) – Charity offering support and information for people affected by microphthalmia, anophthalmia, and coloboma
+National Eye Institute (NEI) – Resources
+GeneReviews/NCBI/NIH/UW entry on anophthalmia / microphthalmia
+NCBI/Molecular diagnosis of anophthalmia / microphthalmia
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diff --git a/data/en.wikipedia.org/wiki/Aplasia-0.md b/data/en.wikipedia.org/wiki/Aplasia-0.md
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+---
+title: "Aplasia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Aplasia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:11.073294+00:00"
+instance: "kb-cron"
+---
+
+Aplasia ( ; from Greek a, "not", "no" + plasis, "formation") is a birth defect where an organ or tissue is wholly or largely absent. It is caused by a defect in a developmental process.
+Aplastic anemia is the failure of the body to produce blood cells. It may occur at any time, and has multiple causes.
+
+
+== Types ==
+
+
+=== Pure red cell aplasia ===
+
+Pure red cell aplasia (PRCA) is caused by the selective destruction or inhibition of erythroid progenitor or precursor cells. It is characterized by anemia and reticulocytopenia and can be chronic or acute. Diamond–Blackfan anemia is a type of PRCA that occurs at birth. PRCA can be acquired as a primary disorder or as a result of another disorder. Immunosuppressive drugs, particularly corticosteroids, will usually result in a temporary or permanent remission. The final outcome is primarily determined by the underlying disorder.
+
+
+=== Aplasia cutis congenita ===
+
+Aplasia cutis congenita is a condition in which some or large portions of the skin is missing at birth.  The disorder is most commonly seen on the scalp, often as a solitary lesion without other abnormalities. The condition may be caused by epidermolysis bullosa, specific teratogens, or intrauterine infections, or it may be caused by chromosomal abnormalities, ectodermal dysplasias, or other malformation syndromes.
+
+
+=== Radial aplasia ===
+
+Radial aplasia is a condition in which the radius does not form. The radius runs from the elbow to the wrist, where the thumb is located. With radial aplasia, the arm can look misshapen and bent. The thumb could also be absent or shorter than usual.
+
+
+=== Sertoli cell-only syndrome ===
+
+Sertoli cell-only syndrome (SCOS), also known as germ cell aplasia, is defined by azoospermia where the testicular seminiferous tubules are lined solely with sertoli cells. Sertoli cells contribute to the formation of the blood-testis barrier and aid in sperm generation. These cells respond to follicle-stimulating hormone, which is secreted by the hypothalamus and aids in spermatogenesis.
+Men often learn they have Sertoli cell-only syndrome between the ages of 20 and 40 when they are checked for infertility and found to produce no sperm. Other signs and symptoms are uncommon, yet in some cases, an underlying cause of SCO syndrome, such as Klinefelter syndrome, may produce other symptoms.
+Most cases of SCO syndrome are idiopathic, however, causes may include deletions of genetic material on Y-chromosome regions, particularly the azoospermia factor area. Other factors include chemical or toxin exposure, previous exposure to radiation therapy, and a history of severe trauma. A testicular biopsy confirms the diagnosis of SCO syndrome. Although there is no effective treatment at the moment, assisted reproductive technology may help some men with SCO syndrome reproduce.
+
+
+=== Pulmonary aplasia ===
+
+Pulmonary aplasia is a rare congenital pathology characterized by the unilateral or bilateral absence of lung tissue. It is distinct from pulmonary agenesis, which, while similar, has a short-blind ending bronchus in aplasia. Because bilateral pulmonary aplasia is not feasible, it is usually unilateral. It is frequently associated with other congenital abnormalities, primarily cardiovascular, and has been shown to occur with the VACTERL syndrome.
+
+
+=== Thymic aplasia ===
+Thymic aplasia is a rare primary immunodeficiency with autosomal or X-linked recessive inheritance, characterized by thymus atrophy in the absence of other congenital abnormalities, profound T-cell deficiency, and normal or increased serum immunoglobulin levels. Patients present with chronic or recurring infections in infancy, such as candidiasis, skin, pulmonary, and urinary tract infections, chronic diarrhea, and failure to thrive.
+
+
+=== Optic nerve aplasia ===
+
+Optic nerve aplasia (ONA) is a congenital optic nerve anomaly defined as the absence of the optic nerve head, the retinal blood vessels, ganglion cells of the retina, and optic nerve fibers in an otherwise normal eye. Clinically, the condition is characterized by a lack of light perception, an afferent pupillary defect, and a fundus appearance of an absent optic nerve head and retinal vessels, as well as other ocular and nonocular abnormalities. Bilateral ONA has been linked to systemic anomalies, whereas unilateral ONA is seen in otherwise healthy people.
+
+
+=== Aplastic anemia ===
+
+Aplastic anemia is a bone marrow failure syndrome characterized by peripheral pancytopenia and bone marrow hypoplasia. Although the anemia is usually normocytic, mild macrocytosis can be seen in conjunction with stress erythropoiesis and raised fetal hemoglobin levels. Aplastic anemia patients present with symptoms related to a decrease in hematopoietic cell production in the bone marrow. The onset is gradual, and the first symptom is frequently anemia or bleeding, though a high temperature or infections may be present at the onset. The following are examples of specific manifestations:
+
+Anemia: Pallor, headache, palpitations, dyspnea, fatigue, or foot swelling
+Thrombocytopenia: Mucosal and gingival bleeding, as well as petechial rashes, may occur.
+Neutropenia: Can cause overt infections, recurring infections, or mouth and pharyngeal ulcers.
+The majority of cases of aplastic anemia are idiopathic, and seeking a possible cause is frequently unproductive.
+
+
+== Epidemiology ==
+Aplasia is a rare condition. Radial aplasia and pure red cell aplasia, particularly the acquired form of pure red cell aplasia, are the most common types. Radial aplasia affects about one in every 30,000 newborns. Radial ray deficiencies, such as radial aplasia, are one of the most common congenital arm disabilities. Congenital pure red cell aplasia is uncommon, with an estimated 5 to 7 cases per million births. The acquired form is more prevalent.
+
+
+== See also ==
+Atrophy
+Hyperplasia
+Hypoplasia
+Neoplasia
+List of biological development disorders
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Arrested_development-0.md b/data/en.wikipedia.org/wiki/Arrested_development-0.md
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+---
+title: "Arrested development"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Arrested_development"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:12.406155+00:00"
+instance: "kb-cron"
+---
+
+The term "arrested development" has had multiple meanings for over 200 years. In the field of medicine, the term "arrested development" was first used, circa 1835–1836, to mean a stoppage of physical development; the term continues to be used in the same way.
+In contrast, the UK's Mental Health Act 1983 used the term "arrested development" to characterize a form of mental disorder comprising severe mental impairment, resulting in a lack of intelligence. However, some researchers have objected to the notion that mental development can be "arrested" or stopped, preferring to consider mental status as continuing to develop in other ways. Consequently, the term "arrested development" is no longer used when referring to a developmental disorder in mental health.
+In anthropology and archaeology, the term "arrested development" means that a plateau of development in some sphere has been reached. Often it is a technological plateau such as the development of high temperature ceramics without glaze because of a lack of materials, or copper smelting without the development of bronze, because of a lack of tin.   Arrested development is key in the insight of self-domestication in the evolution of hominidae where it involves being in an environment that favors reduction in aggression, including interspecific and intraspecific antagonism, for survival, in favor of attitudes that favor living together in a group, social behavior, traits that favor the group as a whole to come to the front stage, elimination of bullies - individuals with an antisocial personality disorder.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Assessment_and_plan-0.md b/data/en.wikipedia.org/wiki/Assessment_and_plan-0.md
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+---
+title: "Assessment and plan"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Assessment_and_plan"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:13.697908+00:00"
+instance: "kb-cron"
+---
+
+The assessment and plan (abbreviated A/P" or A&P) is a component of an admission note.
+
+Assessment includes a discussion of the differential diagnosis and supporting history and exam findings.
+The plan is typically broken out by problem or system. Each problem should include:
+brief summary of the problem, perhaps including what has been done thus far
+orders for medications, labs, studies, procedures and surgeries to address the problem.
+problems are commonly derived from
+chief complaint
+history of present illness
+review of systems (rarely; these should have been picked up and incorporated as new chief complaints during the interview)
+physical exam (rarely; these should have been picked up and incorporated as new chief complaints during the exam)
+social history, including counseling for smoking, alcohol, and illicit drug use
+family history
+medications may indicate problems that need to be addressed in the treatment of the other problems, such as dyslipidemia controlled with a statin.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Asymptomatic-0.md b/data/en.wikipedia.org/wiki/Asymptomatic-0.md
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+---
+title: "Asymptomatic"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Asymptomatic"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:14.855425+00:00"
+instance: "kb-cron"
+---
+
+Asymptomatic (or clinically silent) is an adjective categorising the medical conditions (i.e., injuries or diseases) that patients carry but without experiencing their symptoms, despite an explicit diagnosis (e.g., a positive medical test).
+Pre-symptomatic is the adjective categorising the time periods during which the medical conditions are asymptomatic.
+Subclinical and paucisymptomatic are other adjectives categorising either the asymptomatic infections (i.e., subclinical infections), or the psychosomatic illnesses and mental disorders expressing a subset of symptoms but not the entire set an explicit medical diagnosis requires.  
+
+
+== Examples ==
+An example of an asymptomatic disease is cytomegalovirus (CMV) which is a member of the herpes virus family. "It is estimated that 1% of all newborns are infected with CMV, but the majority of infections are asymptomatic." (Knox, 1983; Kumar et al. 1984) In some diseases, the proportion of asymptomatic cases can be important. For example, in multiple sclerosis it is estimated that around 25% of the cases are asymptomatic, with these cases detected postmortem or just by coincidence (as incidental findings) while treating other diseases.
+
+
+== Importance ==
+Knowing that a condition is asymptomatic is important because:
+
+It may be contagious, and the contribution of asymptomatic and pre-symptomatic infections to the transmission level of a disease helps set the required control measures to keep it from spreading.
+It is not required that a person undergo treatment. It does not cause later medical problems such as high blood pressure and hyperlipidaemia.
+Be alert to possible problems: asymptomatic hypothyroidism makes a person vulnerable to Wernicke–Korsakoff syndrome or beri-beri following intravenous glucose.
+For some conditions, treatment during the asymptomatic phase is vital. If one waits until symptoms develop, it is too late for survival or to prevent damage.
+
+
+== Mental health ==
+Subclinical or subthreshold conditions are those for which the full diagnostic criteria are not met and have not been met in the past, although symptoms are present. This can mean that symptoms are not severe enough to merit a diagnosis, or that symptoms are severe but do not meet the criteria of a condition.
+
+
+== List ==
+These are conditions for which there is a sufficient number of documented individuals that are asymptomatic that it is clinically noted. For a complete list of asymptomatic infections see subclinical infection.
+
+Millions of women reported lack of symptoms during pregnancy until the point of childbirth or the beginning of labor and did not know they were pregnant. This phenomenon is known as cryptic pregnancies.
+
+
+== See also ==
+Symptomatic
+Subclinical infection
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Asymptomatic_carrier-0.md b/data/en.wikipedia.org/wiki/Asymptomatic_carrier-0.md
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+---
+title: "Asymptomatic carrier"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Asymptomatic_carrier"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:16.115969+00:00"
+instance: "kb-cron"
+---
+
+An asymptomatic carrier is a person or other organism that has become infected with a pathogen, but shows no signs or symptoms.
+Although unaffected by the pathogen, carriers can transmit it to others or develop symptoms in later stages of the disease. Asymptomatic carriers play a critical role in the transmission of common infectious diseases such as typhoid, HIV, C. difficile, influenzas, cholera, tuberculosis, and COVID-19, although the latter is often associated with "robust T-cell immunity" in more than a quarter of patients studied. While the mechanism of disease-carrying is still unknown, researchers have made progress towards understanding how certain pathogens can remain dormant in a human for a period of time. A better understanding of asymptomatic disease carriers is crucial to the fields of medicine and public health as they work towards mitigating the spread of common infectious diseases.
+
+== Types of asymptomatic carriers ==
+Asymptomatic carriers can be categorized by their current disease state.  When an individual transmits pathogens immediately following infection but prior to developing symptoms, they are known as an incubatory carrier. Humans are also capable of spreading disease following a period of illness. Typically thinking themselves cured of the disease, these individuals are known as convalescent carriers. Viral diseases such as hepatitis and poliomyelitis are frequently transmitted in this manner. "Healthy carriers" never exhibit signs or symptoms of the disease, yet are capable of infecting others, and are often considered to be the "classic" asymptomatic carriers.
+While the mechanism of disease carrying is still unknown, researchers have made progress towards understanding how certain pathogens can remain dormant in a human for a period of time.
+
+== Significance in disease transmission ==
+The limited information on the prevalence of asymptomatic carriers creates a considerable difficulty when planning public health initiatives. Given that disease surveillance is dependent on estimates for both the asymptomatic rates and symptomatic rates of disease, the lack of information on the prevalence of carriers can lead to insufficient initiatives for the mitigation of common public health concerns such as C. difficile or influenza.
+Researchers have expressed the desire to better predict transmission methods in order to determine the appropriate public health response.  For example, a disease with a known low asymptomatic rate may lead to increased surveillance of symptomatic cases, whereas a higher asymptomatic rate could lead to more aggressive methods such as travel bans and compulsory quarantines, since the number of infectious, asymptomatic cases would be unknown.
+
+== Possible explanations ==
+While an exact explanation for asymptomatic carriage is unknown, researchers have been dedicating their efforts towards understanding how specific bacteria thrive in human hosts in the hopes of determining a universal understanding of asymptomatic transmission.
+
+=== A biological mechanism utilizing Salmonella ===
+Numerous research publications have demonstrated how salmonella is able to remain in immune cells and alter their metabolic systems in order to further transmit the disease. Utilizing a closely related strand of bacterium (S. typhimurium), scientists have been able to create a mouse model that mimics the persistent salmonella cases seen in carriers of typhoid. Knowing that the bacterium can reside in mice for their entire lives, researchers have been able to determine that the bacterium tends to reside in macrophages. Further examination of the gut lymph nodes of the mice reveals that S. typhimurium changes the inflammatory response of the macrophages. Instead of eliciting an inflammatory response from the attack cells, the bacterium is able to convert them into an anti-inflammatory macrophage, allowing for optimal survival conditions. In the words of lead scientist Denise Monack, "It wasn't that inflammatory macrophages were invulnerable to infection, but rather that, having infected a macrophage, S. typhimurium was much more able to replicate in the anti-inflammatory type".
+Investigators have also found that the presence of peroxisome proliferator-activated receptors (PPARs) correlated to the presence of salmonella bacterium. PPARs, thought of as roaming genetic switches, are responsible for the fat metabolism needed to sustain anti-inflammatory macrophages in which S. typhimurium hides.
+
+== Asymptomatic bacteriuria ==
+Asymptomatic bacteriuria is a condition that typically impacts 3–5% of women, with the most vulnerable populations being the elderly and those diagnosed with diabetes.  Within the female population, the risk of bacteriuria increases with age. Escherichia coli is the most common organism found during urine analysis, though the variety of potentially infectious organisms is diverse and can include Enterobacteriaceae, Pseudomonas aeruginosa, Enterococcus species, and group B streptococcus. The Agency for Healthcare Research and Quality has issued a set of screening recommendations as well as offered some insight into the mechanism of bacteriuria. Results of the meta-analysis produced no clear explanation for asymptomatic carriage, but did yield new evidence that strengthened the support for screening for asymptomatic bacteriuria in pregnant women only.
+
+== Infectious diseases ==
+Asymptomatic carriers have furthered the spread of many infectious diseases. A common principle in epidemiology, the 80–20 rule, speculates that 80% of the disease transmission is conducted by only 20% of people in a population.
+
+=== Typhoid fever ===
+Typhoid fever is an ailment caused by the bacterium Salmonella enterica ser. Typhi. An individual can acquire this infection from consuming risky foods or drinks, or by consuming foods or drinks prepared by an infected individual. Those who recover from this infection can still carry the bacteria in their cells, and therefore be asymptomatic.
+
+==== Typhoid Mary ====
\ No newline at end of file
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+---
+title: "Asymptomatic carrier"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Asymptomatic_carrier"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:16.115969+00:00"
+instance: "kb-cron"
+---
+
+Mary Mallon, known as "Typhoid Mary", was an asymptomatic carrier of Salmonella enterica serovar typhi, the causative agent of typhoid fever. She was a cook for several families and soldiers in New York City during the late 1800s, and several cases of typhoid fever were traced to her by the Health Department. At the time, there was no way of eradicating the disease, and it was spread primarily through fecal-oral transmission. Most of Mary Mallon's transmission risk was thought to arise from her continued involvement in occupations involving food preparation and handling. New York City's public health officials initially sought to merely restrict her from such employment rather than permanently quarantining her. When she continued to be non-compliant, the Health Commission ordered that she be quarantined on one of the islands surrounding Manhattan. She remained there until her death.
+Despite appearing perfectly healthy, it is estimated that Mallon infected about 50 people before she was quarantined on North Brother Island. Scientists calculate that between 1% and 6% of individuals infected with Salmonella typhi become chronic, asymptomatic carriers like Mary.
+
+=== HIV ===
+
+HIV infection has a long period during which the person is asymptomatic. Although the host may not be experiencing symptoms, the virus can still be passed on to others. It is also possible for the infection to become symptomatic after this incubation period. Whether the host is showing symptoms or not, opportunistic infections can take advantage of the weakened immune system and cause further complications.
+
+=== Epstein–Barr virus ===
+Many carriers are infected with persistent viruses such as Epstein–Barr virus (EBV), a member of the herpes virus family. Studies show that about 95% of adults have antibodies against EBV, which means they were infected with the virus at some point in their life.
+
+=== Clostridioides difficile ===
+Clostridioides difficile has also been shown to be spread by asymptomatic carriers, and poses significant problems in home-care settings. Reports indicating that over 50% of long-term patients present with fecal contamination despite a lack of symptoms have led many hospitals to extend the period of contact precautions until discharge.
+
+=== Cholera ===
+For cholera the estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100.
+
+=== Chlamydia ===
+Chlamydia, an STI that affects both men and women, can also be asymptomatic in most individuals. Although the infection may not yield any obvious symptoms, it can still damage the reproductive system. If the infection goes unnoticed for a long time, infected individuals are at risk of developing pelvic inflammatory disease (PID). Like chlamydia, PID can also be asymptomatic.
+
+=== Poliomyelitis ===
+A small number of asymptomatic carriers of polio (referred to as chronic excretors) continue to produce active virus for years (or even decades) after their initial exposure to the oral Sabin vaccine. Carriers of the attenuated virus unintentionally spread the attenuated virus, inoculating others, giving them contact immunity; however some adults with weak immune systems have contracted paralytic polio from contact with recently immunized children. Carriers of virulent strains spread polio, increasing the difficulty of poliomyelitis eradication.
+
+=== Tuberculosis ===
+Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Active or symptomatic tuberculosis is spread from person to person through the air through bacterium spores that are released into the air following a cough or sneeze. Some individuals may be infected with the tuberculosis mycobacterium but never display symptoms. Called latent tuberculosis, these cases, while uncontagious, are particularly problematic from a public health perspective, since approximately 10% of those diagnosed with latent TB will go on to develop an active (and contagious) case.
+
+=== COVID-19 ===
+A 2021 paper estimated that at least 50% of SARS-CoV-2 infections were a result of exposure to asymptomatic carriers.
+
+== See also ==
+Vector (epidemiology)
+Viral load
+Virulence
+Jennie Barmore, "Typhoid Jennie"
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Atresia-0.md b/data/en.wikipedia.org/wiki/Atresia-0.md
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+---
+title: "Atresia"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Atresia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:18.542702+00:00"
+instance: "kb-cron"
+---
+
+Atresia is a condition in which an orifice or passage in the body is (usually abnormally) closed or absent.
+
+== Types ==
+
+=== Anotia ===
+
+Anotia is characterized by the complete absence of the ear and is extremely rare. This condition may affect one or both ears, though one missing ear is more common. Anotia is also linked to conductive hearing loss, a condition in which sound waves do not travel well through the ear and sound is not efficiently conducted from the outer ear canal to the eardrum. Anotia has no known cause. An associated syndrome, such as Treacher Collins or Goldenhar syndrome, may affect up to 40% of patients. Anotia is typically diagnosed through a physical examination at birth. Prenatal ultrasounds may help with early detection. Total ear reconstruction is the standard treatment for Anotia.
+
+=== Biliary atresia ===
+
+Biliary atresia (BA) is a rare disease marked by an unknown-origin biliary obstruction that manifests in the neonatal period. The classic clinical triad of Biliary atresia is acholic stools, and dark urine, jaundice, and hepatomegaly. The clinical manifestations are used to make the diagnosis, which is supported by liver ultrasonography, cholangiography, and a liver biopsy. The initial treatment is surgical, with the obliterated extrahepatic bile duct resected and a hepatoportoenterostomy created.
+
+=== Bronchial atresia ===
+
+Bronchial atresia is a rare congenital disease characterized by segmental or lobar emphysema and, in some cases, mucoid impaction. The exact cause of bronchial atresia is unknown; the lobar bronchi, subsegmental bronchi, and distal bronchioles develop in the fifth, sixth, and sixteenth weeks of fetal development, respectively. Bronchial atresia is frequently discovered incidentally because it is asymptomatic. Recurrent pulmonary infections are among the most frequent clinical manifestations in symptomatic patients. Because such benign disease frequently affects young patients, minimally invasive surgery, such as thoracoscopic surgery, is advised.
+
+=== Choanal atresia ===
+
+Choanal atresia (CA) is a rare but well-known condition marked by the anatomical closure of the posterior choanae in the nasal cavity. CA presents clinically in a variety of ways, ranging from acute airway obstruction to chronic recurrent sinusitis, depending on whether it is unilateral, bilateral, or paired with other coexisting airway abnormalities, as is common in individuals who have CHARGE syndrome and craniofacial anomalies. The initial clinical evaluation consists of inserting a six or eight Fr suction catheter through the nostrils, performing a methylene blue dye test, a cotton wisp test, and a laryngeal mirror test. In patients with proper nasal preparation, a CT of the sinuses with 2-5 mm cuts provides a definitive evaluation.
+
+=== Esophageal atresia ===
+
+Esophageal atresia (EA) is a rare congenital malformation characterized by a lack of continuity between the lower and upper esophageal pouches, often associated with tracheoesophageal fistula. Esophageal atresia with or without tracheoesophageal fistula (TEF) is the most common birth defect of the esophagus. The diagnosis of EA usually occurs within the first 24 hours of life, but it can be made antenatally or later. Although environmental effects and genetic factors have been documented, the causes of EA remain largely unknown. Treatment is surgical and includes reconstruction of the continuity of the esophagus or replacement by other organs.
+
+=== Follicular atresia ===
+
+Follicular atresia refers to the process in which a follicle fails to develop, thus preventing it from ovulating and releasing an egg. It is a normal, naturally occurring progression that occurs as mammalian ovaries age. Approximately 1% of mammalian follicles in ovaries undergo ovulation and the remaining 99% of follicles go through follicular atresia as they cycle through the growth phases. In summary, follicular atresia is a process that leads to the follicular loss and loss of oocytes, and any disturbance or loss of functionality of this process can lead to many other conditions.
+
+=== Imperforate anus ===
+
+Imperforate anus is a somewhat common anomaly, with a newborn incidence ranging from 1: 1500 to 1:5000. There have been isolated cases of imperforate anus, but this condition is more commonly found as one among numerous anomalies. Imperforate anus is usually not diagnosed until after birth. There is no need for immediate reconstructive anorectal surgery. However, prompt evaluation is critical, and urgent decompressive surgery may be required.
+
+=== Intestinal atresia ===
+
+With an incidence of 1 in 5,000 newborns, intestinal atresias are one of the most common causes of neonatal intestinal obstruction. The majority of cases are small intestinal atresia, while colonic atresias are uncommon. There have been two main etiologies proposed for intestinal atresia: the first is a lack of re-vacuolization of the solid cord stage of intestinal development, and the second is a late intrauterine mesenteric vascular accident. Prenatal ultrasonography is the most reliable way to diagnose intestinal artesia. Pre-operative management includes primary resuscitation, correction of dehydration, and correction of electrolyte abnormalities. Kimura's diamond-shaped duodeno-duodenostomy is the most common surgical treatment.
+
+=== Microtia ===
+
+Microtia is a congenital deformity where the auricle (external ear) is underdeveloped. A completely undeveloped pinna is referred to as anotia. Because microtia and anotia have the same origin, it can be referred to as microtia-anotia. Microtia can be unilateral (one side only) or bilateral (affecting both sides). Microtia occurs in 1 out of about 8,000–10,000 births. In unilateral microtia, the right ear is most commonly affected. It may occur as a complication of taking Accutane (isotretinoin) during pregnancy.
+
+=== Potter sequence ===
+
+Potter's sequence is a fatal sporadic and autosomal recessive disorder with an incidence of 1 in 4000 births. Babies born with this defect are either stillborn or die very soon after birth. It primarily affects male babies and is associated with severe oligohydramnios, polycystic kidney, bilateral renal agenesis, and obstructive uropathy during the middle gestational weeks. The main defect in Potter's sequence is renal failure. Premature birth, breech presentation, atypical facial appearance, and limb malformations are other distinguishing characteristics. In most infants, severe respiratory insufficiency results in death.
+
+=== Renal agenesis ===
\ No newline at end of file
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+---
+title: "Atresia"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Atresia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:18.542702+00:00"
+instance: "kb-cron"
+---
+
+Renal agenesis occurs when the ureteric bud doesn't fuse with the metanephric blastema during embryogenesis, leading to the nephron and, in some cases, the ureter being absent. Unilateral renal agenesis occurs in 1 in 1000 live births, in contrast bilateral renal agenesis occurs in 1 in 3000 to 4000 pregnancies. Unilateral renal agenesis has a very good prognosis, whereas bilateral renal agenesis has a high rate of perinatal mortality and morbidity due to the lack of amniotic fluid, resulting in lethal pulmonary hypoplasia. The diagnosis of renal agenesis is usually made during a midgestation anatomy ultrasound examination. A genetic syndrome or other anomalies are linked to approximately 30% of cases of renal agenesis.
+
+=== Tricuspid atresia ===
+
+Tricuspid atresia is a form of congenital heart disease whereby there is a complete absence of the tricuspid valve. Therefore, there is an absence of right atrioventricular connection. This leads to a hypoplastic (undersized) or absent right ventricle. This defect is contracted during prenatal development, when the heart does not finish developing. It causes the systemic circulation to be filled with relatively deoxygenated blood. The causes of tricuspid atresia are unknown.
+
+=== Vaginal atresia ===
+
+Vaginal atresia is a birth defect that causes uterovaginal outflow tract obstruction. It happens when the urogenital sinus fails to form the caudal portion of the vagina. Fibrous tissue replaces the caudal portion of the vagina. Vaginal atresia is thought to affect one in every 5000-10,000 live female births. The anomaly is frequently undetected until adolescence, when primary amenorrhea or abdominal pain caused by an obstructed uterovaginal tract leads to a diagnostic evaluation.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Atypia-0.md b/data/en.wikipedia.org/wiki/Atypia-0.md
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+---
+title: "Atypia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Atypia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:19.731619+00:00"
+instance: "kb-cron"
+---
+
+Atypia (from Greek, a + typos, without type; a condition of being irregular or nonstandard) is a histopathologic term for a structural abnormality in a cell, i.e. it is used to describe atypical cells.
+Atypia can be caused by infection or irritation. If, for example it were diagnosed in a Pap smear in the uterus it is more likely to be precancerous.
+The related concept of dysplasia refers to an abnormality of development, and includes abnormalities on larger, histopathologic scales.
+
+
+== Example features ==
+Features that constitute atypia have different definitions for different diseases, but often include the following nucleus abnormalities:
+
+Enlargement
+Pleomorphism
+Nuclear polychromasia, which means variability in nuclear chromatin content. Polychromasia otherwise refers to a disease of immature red blood cells.
+Numerous mitotic figures
+
+
+=== Examples for Barrett's esophagus ===
+In Barrett's esophagus, features that are classified as atypia but not as dysplasia are mainly:
+
+Nuclear stratification, wherein cell nuclei, which are normally located nearly at the same level between adjacent cells, are instead located at different levels.
+Crowding
+Hyperchromatism
+Prominent nucleoli
+
+
+== Prognosis ==
+It may or may not be a precancerous indication associated with later malignancy, but the level of appropriate concern is highly dependent on the context with which it is diagnosed.
+For example, already differentiated, specialised cells such as epithelia displaying "cellular atypia" are far less likely to become problematic (cancerous/malignant) than are myeloid progenitor cells of the immune system. The 'further back' in an already specialised, differentiated cell's lineage, the more problematic cellular atypia is likely to be. This is due to the conferring of such atypia to progeny-cells further down the lineage of that cell type.
+
+
+== See also ==
+
+Irregularity
+List of biological development disorders
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Auditory_agnosia-0.md b/data/en.wikipedia.org/wiki/Auditory_agnosia-0.md
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+---
+title: "Auditory agnosia"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Auditory_agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:21.081452+00:00"
+instance: "kb-cron"
+---
+
+Auditory agnosia is a form of agnosia that manifests itself primarily in the inability to recognize or differentiate between sounds. It is not a defect of the ear or "hearing", but rather a neurological inability of the brain to process sound meaning. While auditory agnosia impairs the understanding of sounds, other abilities such as reading, writing, and speaking are not hindered. It is caused by bilateral damage to the anterior superior temporal gyrus, which is part of the auditory pathway responsible for sound recognition, the auditory "what" pathway.
+Persons with auditory agnosia can physically hear the sounds and describe them using unrelated terms, but are unable to recognize them. They might describe the sound of some environmental sounds, such as a motor starting, as resembling a lion roaring, but would not be able to associate the sound with "car" or "engine", nor would they say that it was a lion creating the noise. All auditory agnosia patients read lips in order to enhance the speech comprehension.
+It is yet unclear whether auditory agnosia (also called general auditory agnosia) is a combination of milder disorders, such auditory verbal agnosia (pure word deafness), non-verbal auditory agnosia, amusia and word-meaning deafness, or a mild case of the more severe disorder, cerebral deafness. Typically, a person with auditory agnosia would be incapable of comprehending spoken language as well as environmental sounds. Some may say that the milder disorders are how auditory agnosia occurs. There are few cases where a person may not be able to understand spoken language. This is called verbal auditory agnosia or pure word deafness. Nonverbal auditory agnosia is diagnosed when a person's understanding of environmental sounds is inhibited. Combined, these two disorders portray auditory agnosia. The blurriness between the combination of these disorders may lead to discrepancies in reporting. As of 2014, 203 patients with auditory perceptual deficits due to CNS damage were reported in the medical literature, of which 183 diagnosed with general auditory agnosia or word deafness, 34 with cerebral deafness, 51 with non-verbal auditory agnosia-amusia and 8 word meaning deafness (for a list of patients see).
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diff --git a/data/en.wikipedia.org/wiki/Auditory_agnosia-1.md b/data/en.wikipedia.org/wiki/Auditory_agnosia-1.md
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+---
+title: "Auditory agnosia"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Auditory_agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:21.081452+00:00"
+instance: "kb-cron"
+---
+
+== History ==
+A relationship between hearing and the brain was first documented by Ambroise Paré, a 16th century battlefield doctor, who associated parietal lobe damage with acquired deafness (reported in Henschen, 1918). Systematic research into the manner in which the brain processes sounds, however, only began toward the end of the 19th century. In 1874, Wernicke was the first to ascribe to a brain region a role in auditory perception. Wernicke proposed that the impaired perception of language in his patients was due to losing the ability to register sound frequencies that are specific to spoken words (he also suggested that other aphasic symptoms, such as speaking, reading and writing errors occur because these speech specific frequencies are required for feedback). Wernicke localized the perception of spoken words to the posterior half of the left STG (superior temporal gyrus). Wernicke also distinguished between patients with auditory agnosia (which he labels as receptive aphasia) with patients who cannot detect sound at any frequency (which he labels as cortical deafness).
+In 1877, Kussmaul was the first to report auditory agnosia in a patient with intact hearing, speaking, and reading-writing abilities. This case-study led Kussmaul to propose of distinction between the word perception deficit and Wernicke's sensory aphasia. He coined the former disorder as "word deafness". Kussmaul also localized this disorder to the left STG. Wernicke interpreted Kussmaul's case as an incomplete variant of his sensory aphasia.
+In 1885, Lichtheim also reported of an auditory agnosia patient. This patient, in addition to word deafness, was impaired at recognizing environmental sounds and melodies. Based on this case study, as well as other aphasic patients, Lichtheim proposed that the language reception center receives afferents from upstream auditory and visual word recognition centers, and that damage to these regions results in word deafness or word blindness (i.e., alexia), respectively. Because the lesion of Lichtheim's auditory agnosia patient was sub-cortical deep to the posterior STG (superior temporal gyrus), Lichtheim renamed auditory agnosia as "sub-cortical speech deafness".
+The language model proposed by Wernicke and Lichtheim wasn't accepted at first. For example, in 1897 Bastian argued that, because aphasic patients can repeat single words, their deficit is in the extraction of meaning from words. He attributed both aphasia and auditory agnosia to damage in Lichtheim's auditory word center. He hypothesized that aphasia is the outcome of partial damage to the left auditory word center, whereas auditory agnosia is the result of complete damage to the same area. Bastian localized the auditory word center to the posterior MTG (middle temporal gyrus).
+Other opponents to the Wernicke-Lichtheim model were Sigmund Freud and Carl Freund. Freud (1891) suspected that the auditory deficits in aphasic patients was due to a secondary lesion to cochlea. This assertion was confirmed by Freund (1895), who reported two auditory agnosia patients with cochlear damage (although in a later autopsy, Freund reported also the presence of a tumor in the left STG in one of these patients). This argument, however, was refuted by Bonvicini (1905), who measured the hearing of an auditory agnosia patient with tuning forks, and confirmed intact pure tone perception. Similarly, Barrett's aphasic patient, who was incapable of comprehending speech, had intact hearing thresholds when examined with tuning forks and with a Galton whistle. The most adverse opponent to the model of Wernicke and Lichtheim was Marie (1906), who argued that all aphasic symptoms manifest because of a single lesion to the language reception center, and that other symptoms such as auditory disturbances or paraphasia are expressed because the lesion encompasses also sub-cortical motor or sensory regions.
+In the following years, increasing number of clinical reports validated the view that the right and left auditory cortices project to a language reception center located in the posterior half of the left STG, and thus established the Wernicke-Lichtheim model. This view was also consolidated by Geschwind (1965) who reported that, in humans, the left planum temporale is larger in the left hemisphere than on the right. Geschwind interpreted this asymmetry as anatomical verification for the role of left posterior STG in the perception of language.
+The Wernicke-Lichtheim-Geschwind model persisted throughout the 20th century. However, with the advent of MRI and its usage for lesion mapping, it was shown that this model is based on incorrect correlation between symptoms and lesions. Although this model is considered outdated, it is still widely mentioned in Psychology and medical textbooks, and consequently in medical reports of auditory agnosia patients. As will be mentioned below, based on cumulative evidence the process of sound recognition was recently shifted to the left and right anterior auditory cortices, instead of the left posterior auditory cortex.
+
+== Related disorders ==
+After auditory agnosia was first discovered, subsequent patients were diagnosed with different types of hearing impairments. In some reports, the deficit was restricted to spoken words, environmental sounds or music. In one case study, each of the three sound types (music, environmental sounds, speech) was also shown to recover independently (Mendez and Geehan, 1988-case 2). It is yet unclear whether general auditory agnosia is a combination of milder auditory disorders, or whether the source of this disorder is at an earlier auditory processing stage.
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+---
+title: "Auditory agnosia"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Auditory_agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:21.081452+00:00"
+instance: "kb-cron"
+---
+
+=== Cerebral deafness ===
+Cerebral deafness (also known as cortical deafness or central deafness) is a disorder characterized by complete deafness that is the result of damage to the central nervous system. The primary distinction between auditory agnosia and cerebral deafness is the ability to detect pure tones, as measured with pure tone audiometry. Using this test, auditory agnosia patients were often reported capable of detecting pure tones almost as good as healthy individuals, whereas cerebral deafness patients found this task almost impossible or they required very loud presentations of sounds (above 100 dB). In all reported cases, cerebral deafness was associated with bilateral temporal lobe lesions. A study  that compared the lesions of two cerebral deafness patients to an auditory agnosia patient concluded that cerebral deafness is the result of complete de-afferentation of the auditory cortices, whereas in auditory agnosia some thalamo-cortical fibers are spared. In most cases the disorder is transient and the symptoms mitigate into auditory agnosia (although chronic cases were reported). Similarly, a monkey study that ablated both auditory cortices of monkeys reported of deafness that lasted 1 week in all cases, and that was gradually mitigated into auditory agnosia in a period of 3–7 weeks.
+
+=== Pure word deafness ===
+Since the early days of aphasia research, the relationship between auditory agnosia and speech perception has been debated. Lichtheim (1885) proposed that auditory agnosia is the result of damage to a brain area dedicated to the perception of spoken words, and consequently renamed this disorder from 'word deafness' to 'pure word deafness'. The description of word deafness as being exclusively for words was adopted by the scientific community despite the patient reported by Lichtheim's who also had more general auditory deficits. Some researchers who surveyed the literature, however, argued against labeling this disorder as pure word deafness on the account that all patients reported impaired at perceiving spoken words were also noted with other auditory deficits or aphasic symptoms. In one review of the literature, Ulrich (1978) presented evidence for separation of word deafness from more general auditory agnosia, and suggested naming this disorder "linguistic auditory agnosia" (this name was later rephrased into "verbal auditory agnosia"). To contrast this disorder with auditory agnosia in which speech repetition is intact (word meaning deafness), the name "word sound deafness" and "phonemic deafness" (Kleist, 1962) were also proposed. Although some researchers argued against the purity of word deafness, some anecdotal cases with exclusive impaired perception of speech were documented. On several occasions, patients were reported to gradually transition from pure word deafness to general auditory agnosia/cerebral deafness or recovery from general auditory agnosia/cerebral deafness to pure word deafness.
+In a review of the auditory agnosia literature, Phillips and Farmer showed that patients with word deafness are impaired in their ability to discriminate gaps between click sounds as long as 15-50 milliseconds, which is consistent with the duration of phonemes. They also showed that patients with general auditory agnosia are impaired in their ability to discriminate gaps between click sounds as long as 100–300 milliseconds. The authors further showed that word deafness patients liken their auditory experience to hearing foreign language, whereas general auditory agnosia described speech as incomprehensible noise. Based on these findings, and because both word deafness and general auditory agnosia patients were reported to have very similar neuroanatomical damage (bilateral damage to the auditory cortices), the authors concluded that word deafness and general auditory agnosia is the same disorder, but with a different degree of severity.
+Pinard et al also suggested that pure word deafness and general auditory agnosia represent different degrees of the same disorder. They suggested that environmental sounds are spared in the mild cases because they are easier to perceive than speech parts. They argued that environmental sounds are more distinct than speech sounds because they are more varied in their duration and loudness. They also proposed that environmental sounds are easier to perceive because they are composed of a repetitive pattern (e.g., the bark of a dog or the siren of the ambulance).
+Auerbach et al considered word deafness and general auditory agnosia as two separate disorders, and labelled general auditory agnosia as pre-phonemic auditory agnosia and word deafness as post-phonemic auditory agnosia. They suggested that pre-phonemic auditory agnosia manifests because of general damage to the auditory cortex of both hemispheres, and that post-phonemic auditory agnosia manifests because of damage to a spoken word recognition center in the left hemisphere. A recent research on an epileptic patient supported this hypothesis. The patient undergone electro-stimulation to the anterior superior temporal gyrus, and demonstrated a transient loss of speech comprehension, while preserving intact perception of environmental sounds and music.
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+---
+title: "Auditory agnosia"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Auditory_agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:21.081452+00:00"
+instance: "kb-cron"
+---
+
+=== Non-verbal auditory agnosia ===
+The term auditory agnosia was originally coined by Sigmund Freud in 1891, to describe patients with selective impairment of environmental sounds. In a review of the auditory agnosia literature, Ulrich re-named this disorder as non-verbal auditory agnosia (although sound auditory agnosia and environmental sound auditory agnosia are also commonly used). This disorder is very rare and only 18 cases have been documented. In contradiction to pure word deafness and general auditory agnosia, this disorder is likely under-diagnosed because patients are often not aware of their disorder, and thus don't seek medical intervention.
+Throughout the 20th century, all reported non-verbal auditory agnosia patients had bilateral or right temporal lobe damage. For this reason, the right hemisphere was traditionally attributed with the perception of environmental sounds. However, Tanaka et al reported 8 patients with non-verbal auditory agnosia, 4 with right hemisphere lesions and 4 with left hemisphere lesions. Saygin et al also reported a patient with damage to the left auditory cortex.
+The underlying deficit in non-verbal auditory agnosia appears to be varied. Several patients were characterized by impaired discrimination of pitch whereas others reported with impaired discrimination of timbre and rhythm (discrimination of pitch was relatively preserved in one of these cases). In contrast, to patients with pure word deafness and general auditory agnosia, patients with non-verbal auditory agnosia were reported impaired at discriminating long gaps between click sounds, but impaired at short gaps. A possible neuroanatomical structure that relays longer sound duration was suggested by Tanaka et al. By comparing the lesions of two cortically deaf patients with the lesion of a word deafness patient, they proposed the existence of two thalamocortical pathways that inter-connect the MGN with the auditory cortex. They suggested that spoken words are relayed via a direct thalamocortical pathway that passes underneath the putamen, and that environmental sounds are relayed via a separate thalamocortical pathway that passes above the putamen near the parietal white matter.
+
+=== Amusia ===
+Auditory agnosia patients are often impaired in the discrimination of all sounds, including music. However, in two such patients music perception was spared and in one patient music perception was enhanced. The medical literature reports of 33 patients diagnosed with an exclusive deficit for the discrimination and recognition of musical segments (i.e., amusia). The damage in all these cases was localized to the right hemisphere or was bilateral. (with the exception of one case.) The damage in these cases tended to focus around the temporal pole. Consistently, removal of the anterior temporal lobe was also associated with loss of music perception, and recordings directly from the anterior auditory cortex revealed that in both hemispheres, music is perceived medially to speech. These findings therefore imply that the loss of music perception in auditory agnosia is because of damage to the medial anterior STG. In contrast to the association of amusia specific to recognition of melodies (amelodia) with the temporal pole, posterior STG damage was associated with loss of rhythm perception (arryhthmia). Conversely, in two patients rhythm perception was intact, while recognition/discrimination of musical segments was impaired. Amusia also dissociates in regard to enjoyment from music. In two reports, amusic patients, who weren't able to distinguish musical instruments, reported that they still enjoy listening to music. On the other hand, a patient with left hemispheric damage in the amygdala was reported to perceive, but not enjoy, music.
+
+=== Word meaning deafness / associative auditory agnosia ===
+In 1928, Kleist suggested that the etiology of word deafness could be due either to impaired perception of the sound (apperceptive auditory agnosia), or to impaired extraction of meaning from a sound (associative auditory agnosia). This hypothesis was first tested by Vignolo et al (1969), who examined unilateral stroke patients. They reported that patients with left hemisphere damage were impaired in matching environmental sounds with their corresponding pictures, whereas patients with right hemisphere damage were impaired in the discrimination of meaningless noise segments. The researchers then concluded that left hemispheric damage results in associative auditory agnosia, and right hemisphere damage results in apperceptive auditory agnosia. Although the conclusion reached by this study could be considered over-reaching, associative auditory agnosia could correspond with the disorder word meaning deafness.
+Patients with word meaning deafness are characterized by impaired speech recognition but intact repetition of speech and left hemisphere damage. These patients often repeat words in an attempt to extract its meaning (e.g., "Jar....Jar....what is a jar?"). In the first documented case, Bramwell (1897 - translated by Ellis, 1984) reported a patient, who in order to comprehend speech wrote what she heard and then read her own handwriting. Kohn and Friedman, and Symonds also reported word meaning deafness patients who are able to write to dictation. In at least 12 cases, patients with symptoms that correspond with word meaning deafness were diagnosed as auditory agnosia. Unlike most auditory agnosia patients, word meaning deafness patients are not impaired at discriminating gaps of click sounds. It is yet unclear whether word meaning deafness is also synonymous with the disorder deep dysphasia, in which patients cannot repeat nonsense words and produce semantic paraphasia during repetition of real words. Word meaning deafness is also often confused with transcortical sensory aphasia, but such patients differ from the latter by their ability to express themselves appropriately orally or in writing.
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diff --git a/data/en.wikipedia.org/wiki/Auditory_agnosia-4.md b/data/en.wikipedia.org/wiki/Auditory_agnosia-4.md
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+---
+title: "Auditory agnosia"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Auditory_agnosia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:21.081452+00:00"
+instance: "kb-cron"
+---
+
+== Neurological mechanism ==
+Auditory agnosia (with the exception of non-verbal auditory agnosia and amusia) is strongly dependent on damage to both hemispheres. The order of hemispheric damage is irrelevant to manifestation of symptoms, and years could take between the damage of the first hemisphere and the second hemisphere (after which the symptoms suddenly emerge). A study that compared lesion locations, reported that in all cases with bilateral hemispheric damage, at least in one side the lesion included Heschl's gyrus or its underlying white matter. A rare insight into the etiology of this disorder was reported in a study of an auditory agnosia patient with damage to the brainstem, instead of cortex. fMRI scanning of the patient revealed weak activation of the anterior Heschl's gyrus (area R) and anterior superior temporal gyrus. These brain areas are part of the auditory 'what' pathway, and are known from both human and monkey research to participate in the recognition of sounds.
+
+== See also ==
+Amusia
+Aphasia
+Apraxia
+Auditory verbal agnosia
+
+== References ==
+
+== Further reading ==
+Polster MR, Rose SB (February 1998). "Disorders of auditory processing: evidence for modularity in audition" (PDF). Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 34 (1): 47–65. doi:10.1016/S0010-9452(08)70736-6. PMID 9533993. S2CID 2717085.
+
+== External links ==
+Psychnet Definition
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Aura_(symptom)-0.md b/data/en.wikipedia.org/wiki/Aura_(symptom)-0.md
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+---
+title: "Aura (symptom)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Aura_(symptom)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:22.252744+00:00"
+instance: "kb-cron"
+---
+
+An aura is a perceptual disturbance experienced by some with epilepsy or migraine. An epileptic aura is a form of minor seizure.
+Epileptic and migraine auras are due to the involvement of specific areas of the brain, which are those that determine the symptoms of the aura. Therefore, if the visual area is affected, the aura will consist of visual symptoms, while if a tactile sensory one, then tactile sensory symptoms will occur.
+Epileptic auras are subjective sensory or psychic phenomena due to a focal seizure, i.e. a seizure that originates from that area of the brain responsible for the function which then expresses itself with the symptoms of the aura. It is important because it makes it clear where the alteration causing the seizure is located. An epileptic aura is in most cases followed by other manifestations of a seizure, for example a convulsion, since the epileptic discharge spreads to other parts of the brain. Rarely it remains isolated. Auras, when they occur, allow some people who have epilepsy time to prevent injury to themselves and/or others when they lose consciousness.
+
+
+== Migraine ==
+The aura of migraine is visual in the vast majority of cases, because dysfunction starts from the visual cortex. The aura is usually followed, after a time varying from minutes to an hour, by the migraine headache. However, the migraine aura can manifest itself in without being followed by headache. The aura can stay for the duration of the migraine; depending on the type of aura, it can leave the person disoriented and confused. It is common for people with migraines to experience more than one type of aura during the migraine. Some people have the same type of aura every time.
+Auras can also be confused with sudden onset of panic, panic attacks or anxiety attacks, which creates difficulties in diagnosis. The differential diagnosis of patients who experience symptoms of paresthesias, derealization, dizziness, chest pain, tremors, and palpitations can be challenging.
+
+
+== Seizures ==
+An epileptic aura is the consequence of the activation of functional cortex by abnormal neuronal discharge. In addition to being a warning sign for an impending seizure, the nature of an aura can give insight into the localization and lateralization of the seizure or migraine.
+The most common auras include motor, somatosensory, visual, and auditory symptoms. The activation in the brain during an aura can spread through multiple regions continuously or discontinuously, on the same side or to both sides.
+Auras are particularly common in focal seizures. If the motor cortex is involved in the overstimulation of neurons, motor auras can result. Likewise, somatosensory auras (such as tingling, numbness, and pain) can result if the somatosensory cortex is involved. When the primary somatosensory cortex is activated, more discrete parts on the opposite side of the body and the secondary somatosensory areas result in symptoms ipsilateral to the seizure focus.
+Visual auras can be simple or complex. Simple visual symptoms can include static, flashing, or moving lights/shapes/colors caused mostly by abnormal activity in the primary visual cortex. Complex visual auras can include people, scenes, and objects which results from stimulation of the temporo-occipital junction and is lateralized to one hemifield. Auditory auras can also be simple (ringing, buzzing) or complex (voices, music). Simple symptoms can occur from activation in the primary auditory cortex and complex symptoms from the temporo-occipital cortex at the location of the auditory association areas.
+
+
+== Examples ==
+
+An aura sensation can include one or a combination of the following:
+
+
+=== Visual changes ===
+Bright lights and blobs
+Zigzag lines
+Distortions in the size or shape of objects
+Vibrating visual field
+Scintillating scotoma
+Shimmering, pulsating patches, often curved
+Tunnel vision
+Scotoma
+Blind or dark spots
+Curtain like effect over one eye
+Slowly spreading spots
+Kaleidoscope effects
+Temporary blindness in one or both eyes
+Heightened sensitivity to light
+
+
+=== Auditory changes ===
+Hearing voices or sounds that do not exist: auditory hallucinations
+Modification of voices or sounds in the environment: buzzing, tremolo, amplitude modulation or other modulations
+Heightened sensitivity to hearing
+Vestibular dysfunction causing vertigo
+
+
+=== Other sensations ===
+Strange smells (phantosmia) or tastes (gustatory hallucinations)
+Heightened sensitivity to smell
+Synesthesia
+Déjà vu or jamais vu
+Cephalic aura, a perception of movement of the head or inside the head
+Abdominal aura, such as an epigastric rising sensation
+Nausea
+Numbness or tingling (paresthesia)
+Weakness on one side of the body (hemiparesis)
+Feelings of being separated from or floating above one's body (dissociation)
+Feeling of overheating and sudden perspiration
+Inability to speak (aphasia) or slurred speech
+
+
+== See also ==
+Focal seizure – Seizures which affect only one brain hemisphere
+Hallucination – Perception that only seems real
+Persistent aura without infarction
+Synesthesia – Neurological condition involving the crossing of senses
+CADASIL
+Retinal migraine – Medical condition of the eye
+Photopsia – Presence of perceived flashes of light in one's field of vision
+
+
+== References ==
+
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/Autoamputation-0.md b/data/en.wikipedia.org/wiki/Autoamputation-0.md
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+---
+title: "Autoamputation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Autoamputation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:23.447574+00:00"
+instance: "kb-cron"
+---
+
+Autoamputation is the spontaneous detachment (amputation) of an appendage or organ from the body. This is not to be confused with self-amputation, which is performed at will. It is usually due to destruction of the blood vessels feeding an extremity such as the finger tips. Once the vessels are destroyed, the tissue is starved of oxygen and dies, which is often followed by gangrene.
+Autoamputation is a feature of ainhum, cryoglobulinemia and thromboangiitis obliterans. In 1881, Thornton made the case of autoamputation.  Autoamputation could be the result of severe cases of certain chronic wounds, such as frostbite. These chronic wounds might be due to some vascular and pathogenic conditions like Buerger disease or Raynaud's phenomenon. Also, uncontrolled diabetes can predispose one to autoamputation. However, autoamputation has been described as spontaneous. Autoamputation has often been associated with fingers and toes but other parts of the body can suffer this condition as well. There have been reported cases of ovarian autoamputation in a newborn and also in a mature ovary of adults. Autoamputation has been reported to affect an infant of closely consanguineous parentage. Though autoamputation is often regarded as an acquired ailment, it could also be congenital. Chronic torsion or a delay in the diagnosis of acute adnexal torsion has been attributed as causes of acquired autoamputation.
+
+
+== Types of autoamputation ==
+Though its facts are being unraveled and analyzed, autoamputation can be categorized as acute, subacute or chronic. Acute autoamputation is characterized by tumor necrosis. This is accompanied by inadequate supply of blood to the heart and other body parts (ischemia) leading to the degeneration of the cells, a condition known as atrophy. Chronic or subacute autoamputation is evident in the attachment of the tumor to other cells surrounding it. There is a rare possibility of the tumor detaching itself from the pedicle. When this happens, it could be parasitic.
+
+
+== See also ==
+Autotomy
+
+
+== Notes ==
+
+
+== External links ==
+ Media related to Autoamputation at Wikimedia Commons
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diff --git a/data/en.wikipedia.org/wiki/Autonomic_dysreflexia-0.md b/data/en.wikipedia.org/wiki/Autonomic_dysreflexia-0.md
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@@ -0,0 +1,40 @@
+---
+title: "Autonomic dysreflexia"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Autonomic_dysreflexia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:24.727358+00:00"
+instance: "kb-cron"
+---
+
+Autonomic dysreflexia (AD) is a life-threatening medical emergency characterized by hypertension and cardiac arrhythmias.  This condition is sometimes referred to as autonomic hyperreflexia. Most cases of AD occur in individuals with spinal cord injuries. Lesions at or above the T6 spinal cord level are more frequently reported, although there are reports of AD in patients with lesions as low as T10. Guillain–Barré syndrome may also cause autonomic dysreflexia.
+Hypertension in AD may result in mild symptoms, such as sweating above the lesion level, goosebumps, blurred vision, or headache. Severe symptoms may result in life-threatening complications including seizure, intracranial bleeds (stroke), myocardial infarction, and retinal detachment.
+Both noxious and non-noxious stimuli can trigger AD. The result is stimulation and hyperactivity of the sympathetic nervous system.  The noxious stimuli activate a sympathetic surge that travels through intact peripheral nerves, resulting in systemic vasoconstriction below the level of the spinal cord lesion. The peripheral arterial vasoconstriction and hypertension activates the baroreceptors, resulting in a parasympathetic surge. This surge originates in the central nervous system to inhibit the sympathetic outflow. However, the parasympathetic signal is unable to transmit below the level of the spinal cord lesion to reduce elevated blood pressure. This can result in bradycardia, tachycardia, vasodilation, flushing, pupillary constriction and nasal stuffiness above the spinal lesion. Piloerection and pale, cool skin occur below the lesion due to the prevailing sympathetic outflow.
+The most common causes include bladder or bowel over-distension from urinary retention and fecal compaction. Other causes include pressure sores, extreme temperatures, fractures, undetected painful stimuli (such as a pebble in a shoe), sexual activity, and extreme spinal cord pain.
+Treating AD immediately involves removing or correcting the noxious stimuli. This entails sitting the patient upright, removing any constrictive clothing (including abdominal binders and support stockings), and rechecking blood pressure often. The inciting issue may require urinary catheterization or bowel disimpaction. If systolic blood pressure remains elevated (over 150 mm Hg) after these steps, fast-acting short-duration antihypertensives are considered, while other inciting causes must be investigated for the symptoms to resolve.
+Educating the patient, family, and caregivers about the avoidance of triggers and the cause, if known, is important in the prevention of AD. Since bladder and bowel are common causes, routine bladder and bowel programs and urological follow-up may help reduce the frequency and severity of attacks. These follow-ups may include cystoscopy/urodynamic studies.
+Prognosis of AD is generally good and mortality is rare, given that the trigger is identified and managed.
+
+== Signs and symptoms ==
+This condition is distinct and usually episodic. An elevation of 20 mm Hg over baseline systolic blood pressure, with a potential source below the neurological level of injury, meets the current definition of dysreflexia.
+Common presenting symptoms include:
+
+headache
+diaphoresis
+increased blood pressure
+facial erythema
+goosebumps
+nasal stuffiness
+a "feeling of doom" or apprehension
+blurred vision.
+
+=== Complications ===
+Autonomic dysreflexia can become chronic and recurrent. This often occurs in response to longstanding medical problems like soft tissue pressure injuries or hemorrhoids.
+Complications of severe acute hypertension can include seizures, pulmonary edema, myocardial infarction, or cerebral hemorrhage. Other organs that may be affected include the kidneys and retinas of the eyes. Long-term therapy to decrease blood pressure may include alpha blockers or calcium channel blockers.
+
+== Causes ==
+The first episode of autonomic dysreflexia may occur weeks to years after the spinal cord injury takes place. It may take place anytime after reflexes have returned following spinal shock. Most people at risk develop their first episode within the first year after the injury.
+There are many possible triggers of AD in patients who have had spinal cord injuries. The most common causative factor is bladder distention. Other causes include urinary tract infections, urinary retention, blocked catheters, constipation, hemorrhoids or fissures, skin damage, fractures, and sexual intercourse. It is important to note that not all noxious stimuli will cause AD. Some otherwise severe noxious stimuli, e.g. broken bones, may not result in AD, and may in fact even go unnoticed. In the absence of clear triggering factors, recurrent episodes of AD can be important signs that there is an underlying pathology in a patient that has not yet been discovered.
+
+== Mechanism ==
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diff --git a/data/en.wikipedia.org/wiki/Autonomic_dysreflexia-1.md b/data/en.wikipedia.org/wiki/Autonomic_dysreflexia-1.md
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+---
+title: "Autonomic dysreflexia"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Autonomic_dysreflexia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:24.727358+00:00"
+instance: "kb-cron"
+---
+
+The autonomic nervous system comprises the sympathetic, parasympathetic, and enteric nervous systems. The mechanism of autonomic dysreflexia has to do with the relationship of the sympathetic and parasympathetic systems.
+Supraspinal vasomotor neurons send projections to the intermediolateral cell column, which is composed of sympathetic preganglionic neurons (SPN) through the T1-L2 segments of the spinal cord. The supraspinal neurons act on the SPN and its tonic firing by modulating its action on the peripheral sympathetic chain ganglia and the adrenal medulla. The sympathetic ganglia act directly on the blood vessels they innervate throughout the body. This controls vessel diameter and resistance. The adrenal medulla indirectly controls the same action through the release of epinephrine and norepinephrine.
+In a patient with a spinal cord lesion, the descending autonomic pathways that are responsible for the supraspinal communication with the SPN are interrupted. This results in decreased sympathetic outflow below the level of the injury. In this circumstance, the SPN is controlled only by spinal influences.
+After a spinal injury, the decreased sympathetic outflow causes reduced blood pressure and sympathetic reflex. Eventually, synaptic reorganization and plasticity of the SPN develops into an overly sensitive state. Because of this, there is abnormal reflex activation of SPN due to afferent stimuli. Most commonly, bowel or bladder distension.
+Reflex activation then results in systemic vasoconstriction below the spinal cord disruption. This peripheral arterial vasoconstriction and hypertension activates the baroreceptors. There is a resultant parasympathetic surge originating in the central nervous system which inhibits the sympathetic outflow. This parasympathetic signal is unable to transmit below the level of the spinal cord lesion and there is a heightened sympathetic response. This results in vasodilation, flushing, pupillary constriction and nasal stuffiness above the spinal lesion. Below the lesion, piloerection, paleness, and cool skin occur due to the prevailing sympathetic outflow. This issue is much more prominent for lesions at or above the T6 level. This is because the splanchnic nerves emerge from the T5 level and below.
+
+== Diagnosis ==
+Autonomic dysreflexia is diagnosed by documenting an increase in systolic blood pressure greater than 20 to 30 mmHg. The associated symptoms vary from life-threatening to asymptomatic.
+An essential step to diagnosing AD is careful monitoring of blood pressure and other vital sign changes. Having knowledge of the patient's baseline blood pressure can be helpful in diagnosing AD. Especially in cases of patients with baseline hypotension since the condition may not be recognized unless compared with their baseline levels.
+Apart from the increased blood pressure, additional symptoms help differentiate AD from other conditions. These include sweating, spasms, erythema (more likely in upper extremities), headaches, and blurred vision. Older patients with very incomplete spinal cord injuries and systolic hypertension may be experiencing essential hypertension, not autonomic dysreflexia, if they lack additional symptoms.
+
+=== Differential Diagnoses ===
+Other diagnoses that should be considered due to similar presentation include: 
+
+Intracranial hemorrhage
+Ischemic stroke
+Hyperthyroidism
+Anxiety
+Essential hypertension
+Drug overdose
+
+== Treatment ==
+Initial management of autonomic dysreflexia includes measuring and monitoring blood pressure and sitting the patient upright to attempt to lower their blood pressure. It is also important to search for and correct the triggering stimuli. Tight clothing and pressure stockings should be removed. Catheterization of the bladder should be performed as well as evaluation for possible urinary tract infection (UTI). Indwelling catheters should be checked for obstruction. Relief of a blocked urinary catheter tube may resolve the problem. A rectal examination can be performed to clear the rectum of any possible stool impaction. If the noxious stimuli cannot be identified or the systolic blood pressure remains above 150 mmHg, then pharmacologic treatment may be needed. In this situation, the aim is to decrease the elevated intracranial pressure until further studies can identify the cause.
+Pharmacologic treatment will include antihypertensive medications. Options include sublingual or topical nitrates as well as oral hydralazine or clonidine. Ganglionic blockers can also be used to control sympathetic nervous system outflow. Epidural anesthesia has been demonstrated to be effective in reducing AD in women in labor. However, there is less evidence for its use in reducing AD during general surgical procedures.
+If the episode of AD is triggered by bowel or bladder irritants, topical analgesics such as lidocaine and bupivacaine are commonly used. Yet, their effectiveness in reducing AD remains inconclusive. Because bladder distension is a common trigger of AD, botulinum toxin used to treat bladder dysfunction in SCI patients may be effective in reducing attacks. Prophylactic use of medications has also been reported to prevent attacks. Some examples include nifedipine, prazosin, and terazosin.
+Patients with AD should have a card or file about their medical history in case they have an episode in public. This will help the individuals responding to the episode manage the situation by looking for common triggers. Patients with history of AD should also carry their medications for easy access in emergency scenarios.
+
+== Prognosis ==
+The prognosis of autonomic dysreflexia is generally good, given that the trigger is identified and managed. Attacks can be prevented by recognizing and avoiding triggering stimuli.
+Mortality is rare with AD, but morbidities such as stroke, retinal hemorrhage, and pulmonary edema if left untreated can be quite severe. The cause of autonomic dysreflexia itself can be life-threatening. There must be proper investigation and appropriate treatment of the inciting cause to prevent unnecessary morbidity and mortality.
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+---
+title: "Autonomic dysreflexia"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Autonomic_dysreflexia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:24.727358+00:00"
+instance: "kb-cron"
+---
+
+== Research directions ==
+Most future work on the topic of autonomic dysreflexia is directed at earlier detection and intervention. Overall, the goal of these research projects involves minimizing complications that result from late detection of autonomic dysreflexia. Some research is aimed at investigating the use of non-invasive sensors to track nerve activity to detect signs of AD. Other work has begun to look at the use of AI for this role, although it has been limited to rat models. Results from a study showed that AI can serve as another non-invasive tool in combination with sensors that track nerve activity. Future work of studies such as these includes using more sensors to track other variables for increasingly accurate results.
+Other work revolves around increasing the understanding of the mechanism behind AD. While it is understood that spinal cord injury results in inhibited parasympathetic surges and a heightened sympathetic response that can lead to AD, other details are yet to be defined. It is also understood that the renin-angiotensin system (RAS) plays a significant role in cardiovascular function in addition to the autonomic nervous system (ANS), which includes the sympathetic and parasympathetic systems. What remains to be studied is the degree to which a spinal cord injury affects the relationship between RAS and ANS. It also remains to be determined whether targeting the RAS system can help manage symptoms of AD.
+
+== References ==
+
+== Further reading ==
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Azygos-0.md b/data/en.wikipedia.org/wiki/Azygos-0.md
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+++ b/data/en.wikipedia.org/wiki/Azygos-0.md
@@ -0,0 +1,17 @@
+---
+title: "Azygos"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Azygos"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:25.966903+00:00"
+instance: "kb-cron"
+---
+
+Azygos (impar), from the Greek άζυξ, refers to an anatomical structure that is unpaired. This is relatively unusual, as most elements of anatomy reflect bilateral symmetry. Azygos may refer to:
+
+Azygos anterior cerebral artery
+Azygos artery of vagina
+Azygos lobe
+Azygos vein
+Ganglion impar
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diff --git a/data/en.wikipedia.org/wiki/B_type_inclusion-0.md b/data/en.wikipedia.org/wiki/B_type_inclusion-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/B_type_inclusion-0.md
@@ -0,0 +1,20 @@
+---
+title: "B type inclusion"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/B_type_inclusion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:27.133905+00:00"
+instance: "kb-cron"
+---
+
+B-type inclusions, formerly known as Guarnieri bodies  are cellular features found upon microscopic inspection of epithelial cells of individuals suspected of having poxvirus (e.g. smallpox or vaccinia). In cells stained with eosin, they appear as pink blobs in the cytoplasm of affected epithelial cells. The absence of Guarnieri bodies cannot be used as to rule out smallpox, however, as more sensitive test need to be performed.
+B-type inclusions are the sites of viral replication and are found in all poxvirus-infected cells, unlike A-type inclusions which are more strongly eosinophilic and only found in infections with certain poxviruses.
+They are named after the Italian physician Giuseppe Guarnieri.
+
+
+== References ==
+
+
+== Further reading ==
+GOODPASTURE EW (1959). "Cytoplasmic inclusions resembling Guarnieri bodies, and other phenomena induced by mutants of the virus of fowlpox". Am. J. Pathol. 35 (2): 213–31. PMC 1934859. PMID 13627123.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Ballard_Maturational_Assessment-0.md b/data/en.wikipedia.org/wiki/Ballard_Maturational_Assessment-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Ballard_Maturational_Assessment-0.md
@@ -0,0 +1,42 @@
+---
+title: "Ballard Maturational Assessment"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Ballard_Maturational_Assessment"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:28.282771+00:00"
+instance: "kb-cron"
+---
+
+The Ballard maturational assessment, Ballard score, or Ballard scale, is a gestational age assessment technique. It was devised by Dr. Jeanne L. Ballard, professor emeritus of the Department of Pediatrics, Obstetrics, and Gynecology at the University of Cincinnati College of Medicine. It was developed in 1979.
+The assessment scores various criteria, the sum of which is then extrapolated to the gestational age of the fetus. These criteria are divided into physical and neuromuscular criteria, which allows for the estimation of age in the range of 26 weeks to 44 weeks. The new Ballard score is an extension of the above to include extremely preterm babies, i.e., up to 20 weeks.
+The scoring relies on the intrauterine changes the fetus undergoes during maturation. Whereas the neuromuscular criteria depend mainly upon muscle tone, the physical scale relies on anatomical changes. Neonate fetuses (less than 37 weeks of age) are in a state of physiological hypotonia, and since muscle tone increases throughout the fetal growth period, it can be used to identify fetal maturation. 
+
+
+== Neuromuscular criteria ==
+Posture – score the infant's posture from flexed to extended
+Square window – assess the flexibility of the wrist 
+Arm recoil – measure the angle of recoil after extending arm
+Popliteal angle – measure the angle formed between knees during flexed extension
+Scarf sign – record the resistance while stretching the infant's arm across the chest
+Heel to ear – note the location of the heel when stretching the infant's leg toward the ear 
+
+
+== Physical criteria ==
+
+
+== Scoring system ==
+In the original Ballard score, each of the criteria is scored from 0 to 5. The scores were then ranged 5 to 50, with the corresponding gestational ages being 26 weeks and 44 weeks. A score increase of 5 advances the estimated age by 2 weeks. The new Ballard score allows scores of −1 for the criteria. The possible scores then range from −10 to 50, with the gestational range extending earlier to 20 weeks. 
+
+A simple formula to estimate age from the Ballard score is age = (2 * score + 120) / 5
+
+
+== See also ==
+Apgar score
+
+
+== References ==
+
+
+== External links ==
+BallardScore.com
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Benign_tumor-0.md b/data/en.wikipedia.org/wiki/Benign_tumor-0.md
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+++ b/data/en.wikipedia.org/wiki/Benign_tumor-0.md
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+---
+title: "Benign tumor"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Benign_tumor"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:29.480012+00:00"
+instance: "kb-cron"
+---
+
+A benign tumor is a mass of cells (tumor) that does not invade neighboring tissue or metastasize (spread throughout the body). Compared to malignant (cancerous) tumors, benign tumors generally have a slower growth rate. Benign tumors have relatively well differentiated cells. They are often surrounded by an outer surface (fibrous sheath of connective tissue) or stay contained within the epithelium. Common examples of benign tumors include moles and uterine fibroids.
+Some forms of benign tumors may be harmful to health. Benign tumor growth causes a mass effect that can compress neighboring tissues. This can lead to nerve damage, blood flow reduction (ischemia), tissue death (necrosis), or organ damage. The health effects of benign tumor growth may be more prominent if the tumor is contained within an enclosed space such as the cranium, respiratory tract, sinus, or bones. For example, unlike most benign tumors elsewhere in the body, benign brain tumors can be life-threatening. Tumors may exhibit behaviors characteristic of their cell type of origin; as an example, endocrine tumors such as thyroid adenomas and adrenocortical adenomas may overproduce certain hormones.
+The word benign means 'favourable, kind, fortunate, salutary, propitious'. However, a benign tumor is not benign in the usual sense; the name merely specifies that it is not "malignant", i.e. cancerous. While benign tumors usually do not pose a serious health risk, they can be harmful or fatal. Many types of benign tumors have the potential to become cancerous (malignant) through a process known as tumor progression. For this reason and other possible harms, some benign tumors are removed by surgery. When removed, benign tumors usually do not return. Exceptions to this rule may indicate malignant transformation.
+
+== Signs and symptoms ==
+Benign tumors are very diverse; they may be asymptomatic or may cause specific symptoms, depending on their anatomic location and tissue type. They grow outward, producing large, rounded masses which can cause what is known as a "mass effect". This growth can cause compression of local tissues or organs, leading to many effects, such as blockage of ducts, reduced blood flow (ischaemia), tissue death (necrosis) and nerve pain or damage. Some tumors also produce hormones that can lead to life-threatening situations. Insulinomas can produce large amounts of insulin, causing hypoglycemia. Pituitary adenomas can cause elevated levels of hormones such as growth hormone and insulin-like growth factor-1, which cause acromegaly; prolactin; ACTH and cortisol, which cause Cushing's disease; TSH, which causes hyperthyroidism; and FSH and LH. Bowel intussusception can occur with various benign colonic tumors. Cosmetic effects can be caused by tumors, especially those of the skin, possibly causing psychological or social discomfort for the person with the tumor. Vascular tissue tumors can bleed, in some cases leading to anemia.
+
+== Causes ==
+
+=== PTEN hamartoma syndrome ===
+PTEN hamartoma syndrome encompasses hamartomatous disorders characterized by genetic mutations in the PTEN tumor suppressor gene, including Cowden syndrome, Bannayan–Riley–Ruvalcaba syndrome, Proteus syndrome and Proteus-like syndrome. Absent or dysfunctional PTEN protein allows cells to over-proliferate, causing hamartomas. Cowden syndrome is an autosomal dominant genetic disorder characterized by multiple benign hamartomas (trichilemmomas and mucocutaneous papillomatous papules) as well as a predisposition for cancers of multiple organs including the breast and thyroid. Bannayan–Riley–Ruvalcaba syndrome is a congenital disorder characterized by hamartomatous intestinal polyposis, macrocephaly, lipomatosis, hemangiomatosis and glans penis macules. Proteus syndrome is characterized by nevi, asymmetric overgrowth of various body parts, adipose tissue dysregulation, cystadenomas, adenomas, vascular malformation.
+
+=== Familial adenomatous polyposis ===
+Familial adenomatous polyposis (FAP) is a familial cancer syndrome caused by mutations in the APC gene. In FAP, adenomatous polyps are present in the colon. The polyps progress into colon cancer unless removed. The APC gene is a tumor suppressor. Its protein product is involved in many cellular processes. Inactivation of the APC gene leads to the buildup of a protein called β-catenin. This protein activates two transcription factors: T-cell factor (TCF) and lymphoid enhancer factor (LEF). These factors cause the upregulation of many genes involved in cell proliferation, differentiation, migration and apoptosis (programmed cell death), causing the growth of benign tumors.
+
+=== Tuberous sclerosis complex ===
+Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disorder caused by mutations in the genes TSC1 and TSC2. TSC1 produces the protein hamartin. TSC2 produces the protein tuberin. This disorder presents with many benign hamartomatous tumors including angiofibromas, renal angiomyolipomas, and pulmonary lymphangiomyomatosis. Tuberin and hamartin inhibit the mTOR protein in normal cellular physiology. Inactivation of the TSC tumor suppressors causes an increase in mTOR activity. This leads to the activation of genes and the production of proteins that increase cell growth.
+
+=== Von Hippel–Lindau disease ===
+Von Hippel–Lindau disease is a dominantly inherited cancer syndrome that significantly increases the risk of various tumors. This includes benign hemangioblastomas and malignant pheochromocytomas, renal cell carcinomas, pancreatic endocrine tumors, and endolymphatic sac tumors. It is caused by genetic mutations in the Von Hippel–Lindau tumor suppressor gene. The VHL protein (pVHL) is involved in cellular signaling in oxygen starved (hypoxic) cells. One role of pVHL is to cause the cellular degradation of another protein, HIF1α. Dysfunctional pVHL leads to accumulation of HIF1α. This activates several genes responsible for the production of substances involved in cell growth and blood vessel production: VEGF, PDGFβ, TGFα and erythropoietin.
+
+=== Bone tumors ===
+Benign tumors of bone can be similar macroscopically and require a combination of a clinical history with cytogenetic, molecular, and radiologic tests for diagnosis. Three common forms of benign bone tumors with are giant cell tumor of bone, osteochondroma, and enchondroma; other forms of benign bone tumors exist but may be less prevalent.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Benign_tumor-1.md b/data/en.wikipedia.org/wiki/Benign_tumor-1.md
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+++ b/data/en.wikipedia.org/wiki/Benign_tumor-1.md
@@ -0,0 +1,42 @@
+---
+title: "Benign tumor"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Benign_tumor"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:29.480012+00:00"
+instance: "kb-cron"
+---
+
+==== Giant cell tumors ====
+Giant cell tumors of bone frequently occur in long bone epiphyses of the appendicular skeleton or the sacrum of the axial skeleton. Local growth can cause destruction of neighboring cortical bone and soft tissue, leading to pain and limiting range of motion. The characteristic radiologic finding of giant cell tumors of bone is a lytic lesion that does not have marginal sclerosis of bone. On histology, giant cells of fused osteoclasts are seen as a response to neoplastic mononucleated cells. Notably, giant cells are not unique among benign bone tumors to giant cell tumors of bone. Molecular characteristics of the neoplastic cells causing giant cell tumors of bone indicate an origin of pluripotent mesenchymal stem cells that adopt preosteoblastic markers. Cytogenetic causes of giant cell tumors of bone involve telomeres. Treatment involves surgical curettage with adjuvant bisphosphonates.
+
+==== Osteochondroma ====
+Osteochondromas form cartilage-capped projections of bone. Structures such as the marrow cavity and cortical bone of the osteochondroma are contiguous to those of the originating bone. Sites of origin often involve metaphyses of long bones. While many osteochondromas occur spontaneously, there are cases in which several osteochondromas can occur in the same individual; these may be linked to a genetic condition known as hereditary multiple osteochondromas. Osteochondroma appears on X-ray as a projecting mass that often points away from joints. These tumors stop growing with the closure of the parental bone's growth plates. Failure to stop growth can be indicative of transformation to malignant chondrosarcoma. Treatment is not indicated unless symptomatic. In that case, surgical excision is often curative.
+
+==== Enchondroma ====
+Enchondromas are benign tumors of hyaline cartilage. Within a bone, enchondromas are often found in metaphyses. They can be found in many types of bone, including small bones, long bones, and the axial skeleton. X-ray of enchondromas shows well-defined borders and a stippled appearance. Presentation of multiple enchondromas is consistent with multiple enchondromatosis (Ollier Disease). Treatment of enchondromas involves surgical curettage and grafting.
+
+=== Benign soft tissue tumors ===
+
+==== Lipomas ====
+Lipomas are benign, subcutaneous tumors of fat cells (adipocytes). They are usually painless, slow-growing, and mobile masses that can occur anywhere in the body where there are fat cells, but are typically found on the trunk and upper extremities. Although lipomas can develop at any age, they more commonly appear between the ages of 40 and 60. Lipomas affect about 1% of the population, with no documented sex bias, and about 1 in every 1000 people will have a lipoma within their lifetime. The cause of lipomas is not well defined. Genetic or inherited causes of lipomas play a role in around 2-3% of patients. In individuals with inherited familial syndromes such as Proteus syndrome or Familial multiple lipomatosis, it is common to see multiple lipomas across the body. These syndromes are also associated with specific symptoms and sub-populations. Mutations in chromosome 12 have been identified in around 65% of lipoma cases. Lipomas have also been shown to be increased in those with obesity, hyperlipidemia, and diabetes mellitus.
+Lipomas are usually diagnosed clinically, although imaging (ultrasound, computed tomography, or magnetic resonance imaging) may be utilized to assist with the diagnosis of lipomas in atypical locations. The main treatment for lipomas is surgical excision, after which the tumor is examined with histopathology to confirm the diagnosis. The prognosis for benign lipomas is excellent and recurrence after excision is rare, but may occur if the removal was incomplete.
+
+== Mechanism ==
+
+=== Benign vs malignant ===
+
+A tumor is classified as either benign or malignant based on its invasive potential. Benign tumors are non-invasive: They cannot invade adjacent tissues or metastasize (spread via metastasis). In contrast, malignant tumors are invasive or metastatic. For this reason, benign tumors are not classed as cancer. A benign tumor will grow in a contained area, usually a fibrous connective tissue capsule.
+The growth rates of benign and malignant tumors usually differ, with benign tumors growing more slowly than malignant tumors. However, cases of fast-growing benign tumors have been documented. Although benign tumors generally pose a lower health risk than malignant tumors, both can be life-threatening.
+Benign and malignant tumors differ in some general characteristics, but sometimes a benign tumor will exhibit some characteristics of a malignant tumor, or vice versa. For example, benign tumors are mostly well-differentiated, and malignant tumors are often undifferentiated. However, undifferentiated benign tumors can occur, as can differentiated malignant tumors. Certain malignant tumors, such as  basal-cell carcinomas, are mostly non-metastatic.
+
+=== Multistage carcinogenesis ===
+
+Tumors are formed by carcinogenesis, a process in which cellular alterations lead to the formation of cancer. Multistage carcinogenesis involves the sequential genetic or epigenetic changes to a cell's DNA, where each step produces a more advanced tumor. It consists of three stages: initiation, promotion and progression. Multiple mutations may occur per stage.
+Initiation is where the first genetic mutation occurs in a cell. Promotion is the clonal expansion (repeated division) of this transformed cell into a visible tumor that is usually benign. Following promotion, progression may take place where more genetic mutations are acquired in a sub-population of tumor cells. Progression changes the benign tumor into a malignant tumor.
+A prominent and well studied example of this phenomenon is the tubular adenoma, a common type of colon polyp which is an important precursor to colon cancer. The cells in tubular adenomas, like most tumors that frequently progress to cancer, show certain abnormalities of cell maturation and appearance collectively known as dysplasia. These cellular abnormalities are not seen in benign tumors that rarely or never turn cancerous, but are seen in other pre-cancerous tissue abnormalities which do not form discrete masses, such as pre-cancerous lesions of the uterine cervix.
+
+== Diagnosis ==
+
+=== Classification ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Benign_tumor-2.md b/data/en.wikipedia.org/wiki/Benign_tumor-2.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Benign_tumor-2.md
@@ -0,0 +1,21 @@
+---
+title: "Benign tumor"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Benign_tumor"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:29.480012+00:00"
+instance: "kb-cron"
+---
+
+Benign neoplasms are typically, but not always, composed of cells which bear a strong resemblance to a normal cell type in their organ of origin. These tumors are named for the cell or tissue type from which they originate. The suffix "-oma" (but not -carcinoma, -sarcoma, or -blastoma, which are generally cancers) is applied to indicate a benign tumor. For example, a lipoma is a common benign tumor of fat cells (lipocytes), and a chondroma is a benign tumor of cartilage-forming cells (chondrocytes). Adenomas are benign tumors of gland-forming cells, and are usually specified further by their cell or organ of origin, as in hepatic adenoma (a benign tumor of hepatocytes, or liver cells). Teratomas contain many cell types such as skin, nerve, brain and thyroid, among others, because they are derived from germ cells. Hamartomas are a group of benign tumors that have relatively normal cellular differentiation but exhibit disorganized tissue organization.
+Exceptions to the nomenclature rules exist for historical reasons. Malignant examples include melanoma (a skin cancer of pigmented melanocytes) and seminoma (a cancer of male reproductive cells).
+Not all benign growths are tumors. Skin tags, vocal chord polyps, and hyperplastic polyps of the colon are often called benign, but they are overgrowths of normal tissue rather than neoplasms.
+
+=== Imaging ===
+Radiography can be used to image a tumor and determine whether it is malignant. Smaller tumors are more likely benign. For example, regarding lung cancer, 80% of lung nodules less than 2 cm in diameter are benign. Most benign nodules are smoothed radiopaque densities with clear margins, but these are not exclusive signs of benign tumors.
+
+== Treatment ==
+Benign tumors typically need no treatment unless they cause problems such as seizures, discomfort or cosmetic concerns. Surgery is usually the most effective approach and is used to treat most benign tumors. In some cases, other treatments may be used. Adenomas of the rectum may be treated with sclerotherapy, in which chemicals are used to shrink blood vessels in order to cut off the blood supply. Most benign tumors do not respond to chemotherapy or radiation therapy, although there are exceptions; benign intercranial tumors are sometimes treated with radiation therapy and chemotherapy under certain circumstances. Radiation can also be used to treat hemangiomas in the rectum. Benign skin tumors are usually surgically resected but other treatments such as cryotherapy, curettage, electrodesiccation, laser therapy, dermabrasion, chemical peels and topical medication are used.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Bethesda_system-0.md b/data/en.wikipedia.org/wiki/Bethesda_system-0.md
new file mode 100644
index 000000000..af276e50a
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+++ b/data/en.wikipedia.org/wiki/Bethesda_system-0.md
@@ -0,0 +1,75 @@
+---
+title: "Bethesda system"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Bethesda_system"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:30.688221+00:00"
+instance: "kb-cron"
+---
+
+The Bethesda system (TBS), officially called The Bethesda System for Reporting Cervical Cytology, is a system for reporting cervical or vaginal cytologic diagnoses, used for reporting Pap smear results.  It was introduced in 1988 and revised in 1991, 2001, and 2014. The name comes from the location (Bethesda, Maryland) of the conference, sponsored by the National Institutes of Health, that established the system.
+Since 2010, the Bethesda system has been used for cytopathology of thyroid nodules, which is called The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC or BSRTC). Like TBS, it was the result of a conference sponsored by the NIH and is published in book editions (currently by Springer). Mentions of "the Bethesda system" without further specification usually refer to the cervical system, unless the thyroid context of a discussion is implicit.
+
+
+== Cervix ==
+Abnormal results include:
+
+Atypical squamous cells
+Atypical squamous cells of undetermined significance (ASC-US)
+Atypical squamous cells – cannot exclude HSIL (ASC-H)
+Low-grade squamous intraepithelial lesion (LGSIL or LSIL)
+High-grade squamous intraepithelial lesion (HGSIL or HSIL)
+Squamous cell carcinoma
+Atypical Glandular Cells not otherwise specified (AGC-NOS)
+Atypical Glandular Cells, suspicious for AIS or cancer (AGC-neoplastic)
+Adenocarcinoma in situ (AIS)
+The results are calculated differently following a Pap smear of the cervix.
+
+
+=== Squamous cell abnormalities ===
+
+
+==== LSIL: low-grade squamous intraepithelial lesion ====
+
+A low-grade squamous intraepithelial lesion (LSIL or LGSIL) indicates possible cervical dysplasia. LSIL usually indicates mild dysplasia (CIN 1), more than likely caused by a human papillomavirus infection. It is usually diagnosed following a Pap smear.
+CIN 1 is the most common and most benign form of cervical intraepithelial neoplasia and usually resolves spontaneously within two years. Because of this, LSIL results can be managed with a simple "watch and wait" philosophy. However, because there is a 12–16% chance of progression to more severe dysplasia, the physician may want to follow the results more aggressively by performing a colposcopy with biopsy. If the dysplasia progresses, treatment may be necessary. Treatment involves removal of the affected tissue, which can be accomplished by LEEP, cryosurgery, cone biopsy, or laser ablation.
+
+
+==== HSIL: high-grade squamous intraepithelial lesion ====
+
+High-grade squamous intraepithelial lesion (HSIL or HGSIL) indicates moderate or severe cervical intraepithelial neoplasia or carcinoma in situ.  It is usually diagnosed following a Pap test.  In some cases, these lesions can lead to invasive cervical cancer, if not followed appropriately.
+HSIL does not mean that cancer is present. Of all women with HSIL results, 2% or less have invasive cervical cancer at that time; however, about 20% would progress to having invasive cervical cancer without treatment. To combat this progression, HSIL is usually followed by an immediate colposcopy with biopsy to sample or remove the dysplastic tissue. This tissue is sent for pathology testing to assign a histologic classification that is more definitive than a Pap smear result (which is a cytologic finding). HSIL generally corresponds to the histological classification of CIN 2 or 3.
+HSIL treatment involves the removal or destruction of the affected cells, usually by LEEP. Other methods include cryotherapy, cautery, or laser ablation, but none are performed on pregnant women for fear of disrupting the pregnancy—the indication per 2006 American Society for Colposcopy and Cervical Pathology consensus guidelines being only invasive cancer.  Any of these procedures is 85% likely to cure the problem.
+
+
+=== Glandular cell abnormalities ===
+
+
+==== Adenocarcinoma ====
+
+Adenocarcinoma can arise from the endocervix, endometrium, and extrauterine sites.
+
+
+==== AGC ====
+AGC, formerly AGUS, is a term for atypical glandular cells of undetermined significance.  Renamed AGC to avoid confusion with ASCUS.
+The management of AGC is colposcopy with or without an endometrial biopsy.
+
+
+== Thyroid nodules ==
+The Bethesda System for Reporting Thyroid Cytopathology is the system used to report whether the thyroid cytological specimen is benign or malignant on fine-needle aspiration cytology (FNAC). It can be divided into six categories:
+
+Repeated FNAC is recommended for Category I, followed by clinical follow-up in Category II, repeat FNAC for Category III, and lobectomy for Category IV, near total-thyroidectomy/lobectomy for Category V, and near total thyroidectomy for Category VI. The risk of malignancy in a malignant FNAC report is 93.7% while for a suspicious FNAC report, it is 18.9%.
+
+
+== See also ==
+American Society for Clinical Pathology
+
+
+== References ==
+
+
+== External links ==
+ASCP: The Bethesda System Website Atlas
+Bethesda 2001 Workshop
+Bongiovanni, Massimo; Spitale, Alessandra; Faquin, William C.; Mazzucchelli, Luca; Baloch, Zubair W. (2012). "The Bethesda System for Reporting Thyroid Cytopathology: A Meta-Analysis". Acta Cytologica. 56 (4): 333–339. doi:10.1159/000339959. PMID 22846422. S2CID 14143335. Retrieved 24 November 2022.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Biliary_microlithiasis-0.md b/data/en.wikipedia.org/wiki/Biliary_microlithiasis-0.md
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@@ -0,0 +1,32 @@
+---
+title: "Biliary microlithiasis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Biliary_microlithiasis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:31.871930+00:00"
+instance: "kb-cron"
+---
+
+Biliary microlithiasis refers to the creation of small gallstones less than 3 mm in diameter in the biliary duct or gallbladder.
+It has been suggested as a cause of postcholecystectomy syndrome, or PCS, the symptoms of which include:
+
+Upset stomach, nausea, and vomiting.
+Gas, bloating, and diarrhea.
+Persistent pain in the upper right abdomen.
+
+
+== Diagnostics ==
+Biliary Microlithiasis may be detectable by ultrasound using a Rapid Patient Rotation Ultrasound Protocol
+Analysis of biliary sludge obtained through endoscopic retrograde cholangiopancreatography (ERCP)
+
+
+== Treatment ==
+Oral ursodeoxycholic acid can be used to dissolve these crystals.
+
+
+== See also ==
+Biliary sludge
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Biliary_pseudolithiasis-0.md b/data/en.wikipedia.org/wiki/Biliary_pseudolithiasis-0.md
new file mode 100644
index 000000000..79a7b60f0
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Biliary_pseudolithiasis-0.md
@@ -0,0 +1,23 @@
+---
+title: "Biliary pseudolithiasis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Biliary_pseudolithiasis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:33.115723+00:00"
+instance: "kb-cron"
+---
+
+Biliary pseudolithiasis is an unusual complication of ceftriaxone where the drug complexes with calcium and mimics gallstones. It is reversed when ceftriaxone administration is stopped. It was first described in 1988 by Schaad et al. as "reversible ceftriaxone-associated biliary pseudolithiasis". Ceftriaxone has been frequently associated with biliary sludge or biliary pseudolithiasis in subsequent reports. Ceftriaxone is excreted primarily through the urine, but also through the bile, up to 40% of its excretion, with concentrations in the bile 20-150 times higher than in the serum. It forms a calcium salt in the gallbladder, which can exceed its solubility and create precipitates that resemble gallstones on ultrasonography. The incidence of pseudolithiasis in children treated with ceftriaxone is up to 25%, but most patients are asymptomatic. Risk factors for biliary pseudolithiasis include age greater than 24 months, gram-negative sepsis, high doses of ceftriaxone, hypercalcemia, surgery, and decreased bile flow/increased ceftriaxone excretion in bile.  Conservative management with serial ultrasounds is recommended until the "stones" completely resolve. If associated with ceftriaxone, it resolves on average about 2 weeks after the ceftriaxone is stopped.
+
+
+== Ceftriaxone ==
+
+Ceftriaxone sold under the brand name Rocephin, is a third-generation cephalosporin antibiotic used for the treatment of a number of bacterial infections. These include middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhea, and pelvic inflammatory disease. It is also sometimes used before surgery and following a bite wound to try to prevent infection. Ceftriaxone can be given by injection into a vein or into a muscle.
+
+
+== See also ==
+Biliary sludge
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Biliary_sludge-0.md b/data/en.wikipedia.org/wiki/Biliary_sludge-0.md
new file mode 100644
index 000000000..9872f6259
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Biliary_sludge-0.md
@@ -0,0 +1,53 @@
+---
+title: "Biliary sludge"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Biliary_sludge"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:34.361744+00:00"
+instance: "kb-cron"
+---
+
+Biliary sludge refers to a viscous mixture of small particles derived from bile. These sediments consist of cholesterol crystals, calcium salts, calcium bilirubinate, mucin, and other materials.
+
+
+== Signs and symptoms ==
+
+
+=== Complications ===
+Biliary sludge may cause complications such as biliary colic, acute cholecystitis, acute cholangitis, and acute pancreatitis.
+
+
+== Cause ==
+Biliary sludge has been associated with pregnancy, rapid weight loss, total parenteral nutrition, drugs such as ceftriaxone and octreotide, solid organ transplantation, and gastric surgery. In many of these conditions, it is thought that the impairment in the contractility of the gallbladder leads to the formation of the sludge.
+
+
+== Pathophysiology ==
+The pathophysiology of biliary sludge formation is likely related to gallbladder dysmotility. It is presumed that because the gallbladder is unable to effectively empty, the biliary sludge can start to accumulate.
+
+
+== Diagnosis ==
+
+Biliary sludge is typically diagnosed by CT scan or transabdominal ultrasonography. Endoscopic ultrasonography is another more sensitive option. However, the gold standard is considered to be direct microscopy of aspirated gallbladder bile. This method is much more sensitive, although it is less practical.
+
+
+== Treatment ==
+For patients without symptoms, no treatment is recommended. If patients become symptomatic and/or develop complications, cholecystectomy is indicated. For those who are poor surgical candidates, endoscopic sphincterotomy may be performed to reduce the risk of developing pancreatitis.
+
+
+== Prognosis ==
+The clinical course of biliary sludge can do one of three things: (1) it can resolve completely, (2) wax and wane, or (3) progress to gallstones. If the biliary sludge has a cause (e.g. pregnancy), it oftentimes is resolved when the underlying cause is removed.
+
+
+== Epidemiology ==
+The prevalence of biliary sludge is low in the general population. It has been reported that the prevalence ranges from 0-0.20% in men and 0.18-0.27% in women. However, in patients with certain conditions, the prevalence may be higher.
+
+
+== See also ==
+Biliary microlithiasis
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Biotrauma-0.md b/data/en.wikipedia.org/wiki/Biotrauma-0.md
new file mode 100644
index 000000000..3f7dca986
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Biotrauma-0.md
@@ -0,0 +1,14 @@
+---
+title: "Biotrauma"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Biotrauma"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:36.815898+00:00"
+instance: "kb-cron"
+---
+
+Although the term has occasionally been used in other ways, in medical literature biotrauma is usually defined as a severe inflammatory response produced in the lungs of patients who breathe by means of a mechanical ventilator for a long period of time.  The term was coined in a 1998 paper by L. N. Tremblay and A. S. Slutsky, titled Ventilator-induced injury: from barotrauma to biotrauma.  The message of that paper was that barotrauma caused by pressure differentials is only one of several types of lung damage that a ventilator can produce.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Bleb_(medicine)-0.md b/data/en.wikipedia.org/wiki/Bleb_(medicine)-0.md
new file mode 100644
index 000000000..aca18cedb
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Bleb_(medicine)-0.md
@@ -0,0 +1,23 @@
+---
+title: "Bleb (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Bleb_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:38.141600+00:00"
+instance: "kb-cron"
+---
+
+In medicine, a bleb is a blister-like protrusion (often hemispherical) or vesicle filled with serous fluid. Blebs can form in a number of tissues by different pathologies, including frostbite and can "appear and disappear within a short time interval".
+In pathology, pulmonary blebs are small subpleural thin-walled air-containing spaces, not larger than 1-2 cm in diameter, found by the upper lobe of the lung, between the lung and the visceral pleura. Their walls are thin, being less than 1 mm thick. If they rupture, they allow air to escape into pleural space, resulting in a spontaneous pneumothorax and possibly a collapsed lung. Blebs can grow larger or join together to create a larger cyst, or bulla. There are usually no symptoms unless a pneumothorax occurs or the bulla grows very large. Blebs are usually associated with emphysema.
+In ophthalmology, blebs may be formed intentionally in the treatment of glaucoma. In such treatments, functional blebs facilitate the circulation of aqueous humor, the blockage of which will lead to increase in eye pressure. Use of collagen matrix wound modulation device such as ologen during glaucoma surgery is known to produce vascular and functional blebs, which are positively correlated with treatment success rate.
+In the lungs, a bleb is a collection of air within the layers of the visceral pleura.
+In breasts, a bleb is a milk blister (also known as blocked nipple pore, nipple blister, or "milk under the skin").
+
+
+== References ==
+
+
+== External links ==
+Medical definition
+Moorfields Bleb Grading System
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Body_fluid-0.md b/data/en.wikipedia.org/wiki/Body_fluid-0.md
new file mode 100644
index 000000000..57194661f
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Body_fluid-0.md
@@ -0,0 +1,52 @@
+---
+title: "Body fluid"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Body_fluid"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:39.339802+00:00"
+instance: "kb-cron"
+---
+
+Body fluids, bodily fluids, or biofluids, sometimes body liquids, are liquids within the body of an organism. In lean healthy adult men, the total body water is about 60% (60–67%) of the total body weight; it is usually slightly lower in women (52–55%). The exact percentage of fluid relative to body weight is inversely proportional to the percentage of body fat. A lean 70 kg (150 lb) man, for example, has about 42 (42–47) liters of water in his body.
+The total body of water is divided into fluid compartments, between the intracellular fluid compartment (also called space, or volume) and the extracellular fluid (ECF) compartment (space, volume) in a two-to-one ratio: 28 (28–32) liters are inside cells and 14 (14–15) liters are outside cells.
+The ECF compartment is divided into the interstitial fluid volume – the fluid outside both the cells and the blood vessels – and the intravascular volume (also called the vascular volume and blood plasma volume) – the fluid inside the blood vessels – in a three-to-one ratio: the interstitial fluid volume is about 12 liters; the vascular volume is about 4 liters.
+The interstitial fluid compartment is divided into the lymphatic fluid compartment – about 2/3, or 8 (6–10) liters, and the transcellular fluid compartment (the remaining 1/3, or about 4 liters).
+The vascular volume is divided into the venous volume and the arterial volume; and the arterial volume has a conceptually useful but unmeasurable subcompartment called the effective arterial blood volume.
+
+
+== Compartments by location ==
+intracellular fluid (ICF), which consist of cytosol and fluids in the cell nucleus
+Extracellular fluid
+Intravascular fluid (blood plasma)
+Interstitial fluid
+Lymphatic fluid (sometimes included in interstitial fluid)
+Transcellular fluid
+
+
+== Health ==
+
+
+=== Clinical samples ===
+Clinical samples are generally defined as non-infectious human or animal materials including blood, saliva, excreta, body tissue and tissue fluids, and also FDA-approved pharmaceuticals that are blood products.  In medical contexts, it is a specimen taken for diagnostic examination or evaluation, and for identification of disease or condition.
+
+
+== See also ==
+Basic reproduction number
+Blood-borne diseases
+Clinical pathology
+Humorism
+Hygiene
+Ritual cleanliness
+
+
+== References ==
+
+
+== Further reading ==
+Paul Spinrad. (1999) The RE/Search Guide to Bodily Fluids. Juno Books. ISBN 1-890451-04-5
+John Bourke. (1891) Scatalogic Rites of All Nations. Washington, D.C.: W.H. Lowdermilk.
+
+
+== External links ==
+De Luca LA, Menani JV, Johnson AK (2014). Neurobiology of Body Fluid Homeostasis: Transduction and Integration. Frontiers in Neuroscience. Boca Raton: CRC Press/Taylor & Francis. ISBN 9781466506930. PMID 24829987.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-0.md b/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-0.md
new file mode 100644
index 000000000..5067e9ad1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-0.md
@@ -0,0 +1,41 @@
+---
+title: "Body image (neuroscience)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Body_image_(neuroscience)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:40.513246+00:00"
+instance: "kb-cron"
+---
+
+Body image is a complex construct, often used in the clinical context of describing a patient's cognitive perception of their own body. The medical concept began with the work of the Austrian neuropsychiatrist and psychoanalyst Paul Schilder, described in his book The Image and Appearance of the Human Body first published in 1935. The term "body image" was officially introduced by Schilder himself and his widely used definition is: "body image is the picture of our own body we form in our mind, that is to say the way in which the body appears to ourselves". In research with the term "body image" we currently refer to a conscious mental representation of one's own body, which involves affects, attitudes, perceptual components and cognition. On the contrary, the term "body schema" was initially used to describe an unconscious body mental representation fundamental for action. Keizer and colleagues (2013) suggest the following definition: "[body schema is] an unconscious, sensorimotor, representation of the body that is invoked in action". In light of recent scientific developments regarding the multisensory integration of body sensations, the distinction between body image and body schema appears simplistic and probably no longer useful for scientific research and clinical purposes.
+
+== Harms ==
+Engaging in social comparisons, particularly upward comparisons to individuals perceived as superior, can negatively affect self-evaluations and body image. Research indicates that exposure to idealized media images, such as models embodying cultural beauty standards, often leads to unfavorable body-image outcomes. Specifically for women, who are more likely to engage in upward appearance comparisons. Individual differences play a crucial role in which appearance comparison tendencies occur. Identifying modifiable risk factors linked to appearance comparisons is crucial for reducing their frequency and preventing body dissatisfaction. The Identity Disruption Model suggests that early adverse experiences, such as abuse or neglect, can disrupt identity development, leading to low self-concept clarity and an increased tendency to compare oneself to others. 
+
+== Clinical significance ==
+In the clinical setting, body image disturbances are relatively frequent and involve both psychiatric and neurological disorders. Disturbances in the perception of one's body are present in psychiatric disorders such as:
+
+anorexia nervosa
+bulimia nervosa
+binge eating disorder
+psychotic spectrum disorders
+body dysmorphic disorder
+body integrity dysphoria (not included in DSM-5).
+Body image disorders are common in eating disorders and are referred to as "body image disturbance".
+
+=== Anorexia nervosa ===
+There are three aspects pertaining to body image distortion in those with Anorexia nervosa. The first is Perception; this refers to the way in which someone views their own body. This is where the EBA and FBA come into play. Both the Extrastriate Body Area (EBA) and the Fusiform Body Area (FBA) in the brain are involved in how we perceive our own bodies. Those with Anorexia nervosa present an impaired functioning in these two brain regions which accounts for their inability to correctly describe their body. The second aspect is Affect; how satisfied or dissatisfied one is with their body. The third and final component is Cognition which alludes to what someone thinks about their own body and how they mentally picture themselves. Both the Affect and Cognition components use the insula in the brain; it creates our sense of "self" and self-awareness. This means that the insula plays a role in how we feel (Affect) and think (Cognition) about ourselves.
+Furthermore, The Allocentric Lock Theory states that those with eating disorders, such as Anorexia nervosa, are incapable of retaining new and updated views on their own bodies, therefore are unable to precisely report on their current body.
+
+=== Bulimia nervosa ===
+Bulimia nervosa is a form of an eating disorder where one binge eats, and then forces themself to throw up in order to not gain weight. It can be caused by many things, such as stress, pressure, genetics, low self-esteem, obesity, and more. It is difficult to get diagnosed with as people tend to keep it to themselves, additionally, it is more common to get diagnosed with anorexia nervosa, so bulimia nervosa is often overlooked. 
+
+=== Binge eating disorder ===
+Binge eating disorder is a very serious form of eating disorder. Individuals with binge eating disorder often get the feeling of not being able to stop eating and eating much larger portions of food. Often after these binges, people with BED feel the need to cut back on their eating, but often this just results in more of the feeling to need to binge in the future. It can be caused by a number of things and is a lot of the time caused by a mix of things such as psychological things, environmental things, or biological things. 
+
+=== Psychotic spectrum disorders ===
+Psychotic spectrum disorder is a group of disorders that all have to do with psychosis. People with psychotic spectrum disorders often have trouble deciphering their thought which can lead to them being unable to tell what is real and what is fake. It is hard to define because each person who experiences it experiences it differently. There are many different types such as schizophrenia, schizophreniform disorder, delusional disorder, and many more. It is unknown for sure what causes psychotic spectrum disorders, but it is thought to be most likely a combination of genetics, brain development, traumas, and/or illnesses. 
+
+=== Body dysmorphia disorder ===
+Body dysmorphic disorder is a mental disorder in which a person hyper focuses on any possible flaws or defects that they see in themselves that in most cases aren't seen by others. It causes people that have it to care more and focus on body image and appearance. There's no known for sure cause of body dysmorphia, but like many other illnesses, it is most likely caused by a combination of things such as family history, negative experiences, and abnormal brain functions. 
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-1.md b/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-1.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Body_image_(neuroscience)-1.md
@@ -0,0 +1,26 @@
+---
+title: "Body image (neuroscience)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Body_image_(neuroscience)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:40.513246+00:00"
+instance: "kb-cron"
+---
+
+=== Body integrity disorder ===
+Body integrity dysphoria is a mental disorder in which a person gets the feeling that a certain part of their body no longer belongs on their body. People with this disorder know that the part is useful and healthy, but don't believe that they should be able to use it. It often causes people to try and get amputations or attempt to amputate themselves. There's no known cause of body integrity disorder, but it is thought to have to do with issues regarding the structure of the brain because multiple parts of the brain are involved in body perception.
+
+=== Measurements ===
+Attempts by researchers to measure variances in body image include the FAI index, developed in a 2014 study (Zaccagni 2014). The FAI (feel-status minus actual-status inconsistency) index is used to assess someone's weight perception. FAI scores range from -3 to +3: Negative FAI values mean weight status underestimation, positive FAI values mean weight status overestimation and a FAI score of 0 means a realistic perception of one's weight status. The study found that women tend to have positive FAI values (overestimating their weight) while men had negative FAI values (underestimating their weight). Further studies have used the FAI index to study body image among natives and immigrants in Italy and North Africa.
+Another study (Zaccagni 2020) developed a refined version of the FAI index, called the FAIFAT index. This index (feel-fat-status minus actual-fat-status inconsistency) was meant to address possible fat status perception inconsistencies by bioelectrical impedance analysis (BIA).
+
+== See also ==
+Body schema
+Gender dysphoria
+Mirror box
+Rubber hand illusion
+Body image—social concept
+
+== References ==
+13. Vartanian, L. R., Pinkus, R. T., & Fardouly, J. (2025). Self-concept clarity and appearance comparisons in everyday life. Body Image An International Journal of Research, 52
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-0.md b/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-0.md
@@ -0,0 +1,51 @@
+---
+title: "Bogart–Bacall syndrome"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Bogart–Bacall_syndrome"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:41.835054+00:00"
+instance: "kb-cron"
+---
+
+Bogart–Bacall syndrome (BBS) is a voice disorder that is caused by abuse or overuse of the vocal cords.
+
+People who speak or sing outside their normal vocal range can develop BBS; symptoms are chiefly an unusually deep or rough voice, or dysphonia, and vocal fatigue. The people most commonly affected are those who speak in a low-pitched voice, particularly if they have poor breath and vocal control. The syndrome can affect both men and women.
+In 1988, an article was published describing a discrete type of vocal dysfunction which results in men sounding like actor Humphrey Bogart and women sounding like actress Lauren Bacall; Bogart and Bacall were married to each other and made several films together. BBS is now the medical term for an ongoing hoarseness that often affects actors, singers or TV/radio voice workers who routinely speak in a very low pitch.
+Treatment usually involves voice therapy by a speech language pathologist.
+
+== Signs and symptoms ==
+Signs and symptoms of Bogart–Bacall Syndrome can appear differently depending on the vocal use of the individual. In singers, symptoms may appear more subtly due to their extreme sensitivity to small changes in the laryngeal mechanism and being able to control their laryngeal muscles more than the average person. This vocal control can compensate for irritation, weakness, or change in vibration patterns for the vocal folds. Signs and symptoms will vary on a case-by-case basis and will depend on vocal strain and the degree of daily use. Women are also more susceptible than men to experience heightened symptoms due to their increased likelihood of speaking at a lower pitch in professional settings.
+Signs and symptoms of Bogart–Bacall include the following:
+
+Vocal fatigue
+Unnaturally deep or rough voice
+Hoarseness
+Sore larynx (tightness or muscle aches in the throat)
+Sudden breaks or fading of the voice
+Loss of vocal range when singing
+Feeling the need to clear the throat often
+Experiencing loss of speech
+
+== Cause ==
+The cause of Bogart–Bacall syndrome is most commonly identified as abuse or overuse of the vocal cords. Individuals who speak or sing outside of their normal range can develop BBS over a long period of misuse. Individuals who develop this syndrome tend to speak or perform with poor breath support and laryngeal muscle tension. Causes include speech and communication disorders, throat conditions, and work-related conditions.
+Speech and communication disorders refers to issues involving language and related areas such as oral motor function. Some examples include expressive language disorder, receptive-expressive language disorder, phonologic disorder, and stuttering.
+Throat conditions can be any one of the following:
+
+Vocal cord paralysis
+Vocal cord polyps
+Laryngitis
+Achalasia
+Throat cancer
+Hypopharyngeal cancer
+Larynx cancer.
+Work-related conditions typically affect individuals whose professions require extensive use or overuse of their vocal cords. Some examples include news and television broadcasters, radio hosts, as well as singers or actors. Teachers may also be susceptible to BBS depending on their volume and how much they talk on a regular basis.
+
+== Mechanism ==
+There are many plausible reasons for how Bogart–Bacall and other vocal disorders occur, but it can not be determined for certain due to the many factors that play a role in speech production. Voice production requires the coordination of many muscles and other structures in the larynx. Many factors can cause the larynx to become tensed which changes the position of larynx. This affects the cartilaginous structures within the larynx leading to abnormal phonation. Bogart–Bacall refers to an unnaturally deep voice, so when lowering their voice, individuals may continue to speak even when the air in their lungs has been almost entirely expelled. Due to the effort exerted in lowering the pitch range, the muscles involved in respiration become tensed and strained along with speech.
+Bogart–Bacall syndrome is considered a secondary muscle tension dysphonia disorder, meaning that there is an abnormality in the voice box that causes the overuse of muscles to help produce your voice. This abnormality can be caused by an underlying medical reason or a physical exertion. By lowering vocal pitch, the larynx compresses the vocal folds which regulate air flow and production of the sounds used in speech which can cause damage to these muscles over time. Vocal fold lesions or nodules can cause changes in the vocal fold mucosa which leads to increased tension in the larynx, ultimately causing dysphonia.
+
+== Diagnosis ==
+A speech-language pathology evaluation with a focus on understanding the patient's vocal use history, as well as an examination of the throat and larynx should be conducted. This evaluation potentially involves imaging to visualize the vocal cords in order to identify areas that have been heavily stressed. Imaging options can include a laryngoscope, videostroboscopy, or laryngeal electromyography. Diagnosis of Bogart–Bacall can be difficult due to the variance in symptom presentation and vocal use.
+Videostroboscopy provides a magnified, slow-motion view of the vocal cords and larynx in action which allows professionals to see any abnormal movement. Videostroboscopy can be used to visualize any swelling of the vocal folds, irritation, or polyps and growth. Occasionally, redness or bumps can be seen on vocal cords which is useful in making a correct diagnosis.
+Laryngeal electromyography is a test that measures the electrical signals from the voice box muscles (laryngeal muscles) during speaking, breathing, and swallowing. This evaluation is to check if vocal issues are related to any one of the following: partial paralysis resulting in muscle weakness, paralysis resulting in loss of muscle function, and the functionality of the motor unit of the laryngeal muscles. Laryngeal electromyography plays an important role in determining whether or not a nerve problem is the cause of a vocal disorder.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-1.md b/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-1.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Bogart–Bacall_syndrome-1.md
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+---
+title: "Bogart–Bacall syndrome"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Bogart–Bacall_syndrome"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:41.835054+00:00"
+instance: "kb-cron"
+---
+
+== Prevention and treatment ==
+Prevention of Bogart–Bacall syndrome aims to target the two main symptoms of this disorder, dysphonia and vocal fatigue. Having effective posture allows a person to shift the tension between the muscles allowing free movement of the larynx without blockage leading to effective voice production. Improvement of breath control with a professional vocal coach is also important for individuals who may have work-related conditions that require continuous strain on the vocal cords and larynx.
+Speech therapy with a speech-language pathologist is a very common method of treatment to return speaking level to its normal pitch range. Consultation with a speech-language pathologist will determine what levels of rest, fluid, and performance corrections are needed for the vocal cords and larynx to sustain a healthy voice. If there is a particular underlying cause of the condition that can be treated with medication, this can be coupled with speech therapy as a form of treatment.
+Individuals with persistent symptoms after speech therapy may require more invasive treatment. Invasive treatment may require the removal of lesions, nodules, or masses on the vocal cords if visualized during diagnostic imaging. If the disorder is found to be nerve related through electromyography the nerve in question may need to be replaced or the vocal cords can be pushed together with a bulk injection or thyroplasty. A bulk injection involves adding a filler substance to the paralyzed vocal cord to have it vibrate closer to the functioning vocal cord. Thyroplasty involves the insertion of an implant against the paralyzed vocal cord moving it closer to the other vocal cord.
+
+== Prognosis ==
+Individuals with Bogart–Bacall syndrome that do not have an underlying condition are typically expected to make a vocal recovery through voice therapy. Having a form of muscle tension dysphonia go untreated, can cause further long-term disorders that require additional forms of treatment.
+
+== Epidemiology ==
+Bogart–Bacall syndrome can develop in individuals at any age. It is more likely to develop in individuals who work in voice performance which can range from singers, actors, teachers or radio and television broadcasters. Women are more likely than men to develop BBS due to the tendency of lowering their voices in a professional environment. This syndrome is also more prevalent in the 40–50-year-old-age group as their vocal cords thin. Vocal disorders are prevalent in roughly 10% of the population and can range from muscle tension dysphonia to speech and language disorders.
+
+== Research directions ==
+Further studies need to be conducted to further examine the long-term effects of Bogart–Bacall syndrome if left untreated. Studies that are currently ongoing aim to understand what the best course of treatment may be for individuals with muscle tension dysphonia, which includes individuals with Bogart–Bacall. It is currently understood that an interdisciplinary approach to target the causes such as poor breath support, overuse, and inappropriate intensity is most effective.
+Vocal disorders and misuse are currently being researched depending on work conditions and professions. A study based on over 1,200 teachers has indicated that voice disorders play a significant role in their profession. The study found that a substantial number of teachers have needed to take time off work or seek medical attention due to voice issues or to seek treatment. The study also found that women are more likely to develop these disorders over their male counterparts.
+There is more research available on vocal disorders and how they may be affected by additional lifestyle factors. A study was conducted to understand how reflux affected vocal disorders such as dysphonia in singers with bulimia. Singers tend to overuse their vocal cords which makes them very susceptible to a variety of vocal disorders. Dysphonia associated with bulimia has been linked to vocal fold edema and polypoid changes. The aim was to understand if bulimia was linked to laryngopharyngeal reflux as a plausible cause of dysphonia. In preliminary results, it was understood that reflux was the case in every singer with bulimia and dysphonia, indicating it may be a contributing factor to their vocal disorder.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Breast_atrophy-0.md b/data/en.wikipedia.org/wiki/Breast_atrophy-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Breast_atrophy-0.md
@@ -0,0 +1,24 @@
+---
+title: "Breast atrophy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Breast_atrophy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:43.043100+00:00"
+instance: "kb-cron"
+---
+
+Breast atrophy is the normal or spontaneous atrophy or shrinkage of the breasts.
+Breast atrophy commonly occurs in women during menopause when estrogen levels decrease. It can also be caused by hypoestrogenism and/or hyperandrogenism in women in general, such as in antiestrogen treatment for breast cancer, in polycystic ovary syndrome (PCOS), and in malnutrition such as that associated with eating disorders like anorexia nervosa or with chronic disease. It can also be an effect of weight loss.
+In the treatment of gynecomastia in males and macromastia in women, and in hormone replacement therapy (HRT) for trans men, breast atrophy may be a desired effect.
+
+
+== See also ==
+Mammoplasia
+Micromastia
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-0.md b/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-0.md
new file mode 100644
index 000000000..a95ea9633
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-0.md
@@ -0,0 +1,52 @@
+---
+title: "Brief resolved unexplained event"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Brief_resolved_unexplained_event"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:44.192552+00:00"
+instance: "kb-cron"
+---
+
+Brief resolved unexplained event (BRUE), previously apparent life-threatening event (ALTE), is a medical term in pediatrics that describes an event that occurs during infancy. The event is noted by an observer, typically the infant's caregiver. It is characterized by one or more concerning symptoms such as change in skin color, lack of breathing, weakness, or poor responsiveness. By definition, by the time they are assessed in a healthcare environment they must be back to normal without obvious explanation after the clinician takes the appropriate clinical history and physical examination.
+The American Academy of Pediatrics (AAP) clarified the use of both terms in a 2016 consensus statement that recommended the term BRUE be used whenever possible as it is more specifically defined. Thus, it is more useful for assessing risk of further events. The cause for BRUEs is often unknown, although some of the more common causes include gastroesophageal reflux, seizure, and child maltreatment.  Evaluation after an ALTE or BRUE is diagnostically important, as some events represent the first sign or symptom of an underlying medical condition.  In most cases, assuming the infants are otherwise healthy and no underlying medical issue is found, the infants who have a BRUE are unlikely to have a second event and have an even smaller risk of death.
+
+== Presentation ==
+A BRUE is a description of a self-limited episode. Usually a BRUE lasts for less than 1 minute. By definition, the episode must have resolved by the time the infant is evaluated by a medical professional. The caregiver may report observation of bluish skin discoloration, called cyanosis. Breathing abnormalities, such as lack of breathing, slow breathing, or irregular breathing may be noted. Differences in muscle tone, such as transient floppiness or rigidity can also be characterized as a BRUE. Changes in level of responsiveness such as abnormal eye contact or inability to interact can also fulfill the classification.
+A BRUE is a term used by a clinician to characterize an infant's self-limited episode witnessed by someone else. The AAP defines a BRUE as a sudden, brief episode that occurs to infants less than 1 year of age, lasts less than one minute, and resolves completely on its own prior to being evaluated by a health professional. The event must include at least one of the following:
+
+skin color change to blue (cyanosis) or pale (pallor)
+abnormal breathing
+muscle weakness
+decreased responsiveness
+
+== Causes ==
+Most infants who have a BRUE are never diagnosed with a definitive cause for the event. However, we use the literature on ALTEs, which is more extensive, to help explain the cause of a BRUE.  These causes may also be considered conditions that can be confused with a BRUE.
+
+=== Gastroesophageal reflux ===
+Vomiting or choking during feeding can trigger laryngospasm that leads to a BRUE or ALTE. This is a likely cause if the infant had vomiting or regurgitation just prior to the event, or if the event occurred while the infant was awake and lying down. In healthy infants with a suggestive GER event, no additional testing is typically done. In infants with repeated episodes of choking or repeated acute events, evaluation with a swallowing study can be helpful.
+
+=== Other causes ===
+Other causes that are less common include meningitis, urinary tract infection, breath-holding spells, congenital central hypoventilation syndrome, cancer, intracranial bleed, apnea of infancy, periodic breathing of infancy, choking, obstructive sleep apnea, factitious disorder imposed on another (formerly Munchausen syndrome).
+
+== Diagnosis ==
+Taking the history of the event is vital in the evaluation of a BRUE.  The first step is determining whether this is truly a BRUE by looking for presence of abnormal symptoms or vital signs.  If this is the case, then it cannot be labelled as a BRUE and the healthcare professional should treat accordingly.
+
+=== Low-risk infants ===
+The next step in evaluation is distinguishing whether this BRUE is low- or high-risk. The American Academy of Pediatrics classifies an infant as low risk if they have a BRUE and meet the following characteristics:
+
+infant is of age greater than 60 days
+gestational age greater than or equal to 32 weeks
+infant has had no prior BRUEs
+this BRUE did not occur in a cluster
+cardiopulmonary resuscitation (CPR) by a medical provider was not required
+no concerning features on history
+no concerning physical examination findings
+duration less than 20 seconds
+
+=== High-risk infants ===
+If the infant does not meet all of these criteria, the BRUE is considered high-risk, and more likely represents an underlying medical condition. Characteristics of the infant that make this more likely include history of similar events or clustering, history of unexpected death in a sibling, need for CPR by a trained medical professional, ongoing lethargy, suspicion for child abuse or maltreatment, or existence of genetic syndrome or congenital anomalies.
+
+== Management ==
+If the infant meets criteria for a low-risk BRUE and the clinician feels there are no concerning findings otherwise, treatment often involves simple short observation in the emergency department with pulse oximetry. For the cases where parents complain of specific symptoms at the time of the event, then follow-up testing may be done for the related conditions or diseases.  Other tests are not typically recommended for low-risk infants.
+For infants that have concerning features on history or physical, and are thus categorized as high-risk, further evaluation is warranted. This will vary greatly depending on the infants symptoms, but may include, urinalysis, complete blood count, imaging with chest x-ray, and laboratory screening for ingestion of medications or poisons.  Also, for infants in the high-risk category, clinicians should consider admission to the hospital for extended observation, depending on the benefits and risk of the case.  The course of the admission provides an opportunity to witness a second event to better characterize it and narrow the list of possible diagnoses.  The observation of infants at home with the help of medical devices after discharge is not recommended.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-1.md b/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-1.md
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index 000000000..466258d86
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Brief_resolved_unexplained_event-1.md
@@ -0,0 +1,20 @@
+---
+title: "Brief resolved unexplained event"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Brief_resolved_unexplained_event"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:44.192552+00:00"
+instance: "kb-cron"
+---
+
+== Prognosis ==
+The risk of death of patients who have a BRUE has been studied by using the literature about ALTEs, since this data is more abundant.  The studies concluded that there is no increased risk of death for these patients compared to the rest of the infant population.  As for the prognosis of these infants into adulthood, research still needs to be conducted to assess for any long-term health effects.
+
+== History ==
+In 1986, the National Institute of Health defined an apparent life-threatening event (ALTE) as an observed frightening event of an infant that includes at least one component of lack of breathing (apnea), skin color change (such as cyanosis), weakness, choking, or gagging. The term was invented to avoid previously used terms such as "near-miss SIDS" to dissociate the event from SIDS, a separate condition in infancy.  There had been literature discussion in the past about the increased risk of SIDS in these infants, but more recently the research has concluded that there is no direct relationship between an ALTE and SIDS. It also was defined as part of an attempt to characterize the different forms of apnea, or sudden lack of breathing, in infants.
+In 2016, the American Academy of Pediatrics (AAP) published a clinical practice guideling recommending the replacement of ALTE with a new term, brief resolved unexplained event (BRUE).  The guidelines state that the term ALTE is still applicable with key differences between ALTE and BRUE.  The biggest difference is whether the infant is symptomatic at time of presentation to a health professional.  If the infant is still showing symptoms, then the condition is termed an ALTE.  In order to be considered a BRUE, the infant should be completely asymptomatic at time of presentation, which is more common.  Because of this, a BRUE can also be considered as a subset of ALTE.  The term change was also recommended in large part due to the "life-threatening" suggestion from the older term.  The rate of death in infants following a BRUE has been studied and is relatively rare, about 1 in 800.
+
+== References ==
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Calcinosis-0.md b/data/en.wikipedia.org/wiki/Calcinosis-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Calcinosis-0.md
@@ -0,0 +1,43 @@
+---
+title: "Calcinosis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Calcinosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:45.452780+00:00"
+instance: "kb-cron"
+---
+
+Calcinosis is the formation of calcium deposits in any soft tissue. It is a rare condition that has many different causes. These range from infection and injury to systemic diseases like kidney failure.
+
+
+== Types ==
+
+
+=== Dystrophic calcification ===
+The most common type of calcinosis is dystrophic calcification. This type of calcification can occur as a response to any soft tissue damage, including that involved in implantation of medical devices.
+
+
+=== Metastatic calcification ===
+Metastatic calcification involves a systemic calcium excess imbalance, which can be caused by hypercalcemia, kidney failure, milk-alkali syndrome, lack or excess of other minerals, or other causes.
+
+
+=== Tumoral calcinosis ===
+The cause of the rare condition of tumoral calcinosis is not entirely understood. It is generally characterized by large, globular calcifications near joints.
+
+
+== See also ==
+Calcification
+Calcinosis cutis
+Dermatomyositis
+Fahr's syndrome
+Hyperphosphatemia
+Primrose syndrome
+Scleroderma
+
+
+== References ==
+
+
+== External links ==
+ Media related to Calcinosis at Wikimedia Commons
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Calculus_(medicine)-0.md b/data/en.wikipedia.org/wiki/Calculus_(medicine)-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Calculus_(medicine)-0.md
@@ -0,0 +1,108 @@
+---
+title: "Calculus (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Calculus_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:46.702674+00:00"
+instance: "kb-cron"
+---
+
+A calculus (pl.: calculi), often called a stone, is a concretion of material, usually mineral salts, that forms in an organ or duct of the body. Formation of calculi is known as lithiasis (). Stones can cause a number of medical conditions.
+Some common principles (below) apply to stones at any location, but for specifics see the particular stone type in question.
+Calculi are not to be confused with gastroliths, which are ingested rather than grown endogenously.
+
+
+== Types ==
+
+Calculi in the inner ear are called otoliths. Unlike other entries in this list, otoliths are not pathological but are a normal feature of the inner ear.
+Calculi in the urinary system are called urinary calculi and include kidney stones (also called renal calculi or nephroliths) and bladder stones (also called vesical calculi or cystoliths). They can have any of several compositions, including mixed. Principal compositions include oxalate and urate.
+Calculi in the prostate are called prostatic calculi.
+Calculi in the mammary gland are called breast microcalcifications or mammary microcalcifications.
+Calculi of the gallbladder and bile ducts are called gallstones and are primarily developed from bile salts and cholesterol derivatives.
+Calculi in the nasal passages (rhinoliths) are rare.
+Calculi in the gastrointestinal tract (enteroliths) can be enormous. Individual enteroliths weighing many pounds have been reported in horses.
+Calculi in the stomach are called gastric calculi (not to be confused with gastroliths which are exogenous in nature).
+Calculi in the salivary glands are called salivary calculi (sialoliths).
+Calculi in the tonsils are called tonsillar calculi (tonsilloliths).
+Calculi in the veins are called venous calculi (phleboliths).
+Calculi in the skin, such as in sweat glands, are not common but occasionally occur.
+Calculi in the navel are called omphaloliths.
+Calculi are usually asymptomatic, and large calculi may have required many years to grow to their large size.
+
+
+== Cause ==
+
+From an underlying abnormal excess of the mineral, e.g., with elevated levels of calcium (hypercalcaemia) that may cause kidney stones, dietary factors for gallstones.
+Local conditions at the site in question that promote their formation, e.g., local bacteria action (in kidney stones) or slower fluid flow rates, a possible explanation of the majority of salivary duct calculus occurring in the submandibular salivary gland.
+Enteroliths are a type of calculus found in the intestines of animals (mostly ruminants) and humans, and may be composed of inorganic or organic constituents.
+Bezoars are lumps of indigestible material in the stomach and/or intestines; most commonly, they consist of hair (in which case they are also known as hairballs). A bezoar may form the nidus of an enterolith.
+In kidney stones, calcium oxalate is the most common mineral type (see nephrolithiasis). Uric acid is the second most common mineral type, but an in vitro study showed uric acid stones and crystals can promote the formation of calcium oxalate stones.
+
+
+== Pathophysiology ==
+Stones can cause disease by several mechanisms:
+
+Irritation of nearby tissues, causing pain, swelling, and inflammation
+Obstruction of an opening or duct, interfering with normal flow and disrupting the function of the organ in question
+Predisposition to infection (often due to disruption of normal flow)
+A number of important medical conditions are caused by stones:
+
+Nephrolithiasis (kidney stones)
+Can cause hydronephrosis (swollen kidneys) and kidney failure
+Can predispose to pyelonephritis (kidney infections)
+Can progress to urolithiasis
+Urolithiasis (urinary bladder stones)
+Can progress to bladder outlet obstruction
+Cholelithiasis (gallstones)
+Can predispose to cholecystitis (gall bladder infections) and ascending cholangitis (biliary tree infection)
+Can progress to choledocholithiasis (gallstones in the bile duct) and gallstone pancreatitis (inflammation of the pancreas)
+Gastric calculi can cause colic, obstruction, torsion, and necrosis.
+
+
+== Diagnosis ==
+Diagnostic workup varies by the stone type, but in general:
+
+Clinical history and physical examination
+Imaging studies:
+Some stone types (mainly those with substantial calcium content) can be detected on X-ray and CT scan
+Many stone types can be detected by ultrasound
+Factors contributing to stone formation (as in #Etiology) are often tested:
+Laboratory testing can give levels of relevant substances in blood or urine
+Some stones can be directly recovered (at surgery, or when they leave the body spontaneously) and sent to a laboratory for analysis of content
+
+
+== Treatment ==
+Modification of predisposing factors can sometimes slow or reverse stone formation. Treatment varies by stone type, but, in general:
+
+Healthy diet and exercise (promotes flow of energy and nutrition)
+Drinking fluids (water and electrolytes like lemon juice, diluted vinegar e.g. in pickles, salad dressings, sauces, soups, shrubs cocktail)
+Surgery (lithotomy)
+Medication / antibiotics
+Extracorporeal shock wave lithotripsy (ESWL) for removal of calculi
+
+
+== History ==
+The earliest operation for curing stones is given in the Sushruta Samhita (6th century BCE). The operation involved exposure and going up through the floor of the bladder.
+The care of this disease was forbidden to the physicians that had taken the Hippocratic Oath because:
+
+There was a high probability of intraoperative and postoperative surgical complications like infection or bleeding
+The physicians would not perform surgery as in ancient cultures they were two different professions
+
+
+== Etymology ==
+The word comes from Latin calculus "small stone", from calx "limestone, lime", probably related to Greek χάλιξ chalix "small stone, pebble, rubble", which many trace to a Proto-Indo-European language root for "split, break up". Calculus was a term used for various kinds of stones. In the 18th century it came to be used for accidental or incidental mineral buildups in human and animal bodies, like kidney stones and minerals on teeth.
+
+
+== See also ==
+Bezoar
+Calculus (dental)
+Lithotomy
+
+
+== References ==
+
+
+== External links ==
+
+"The Little Treatise on the Medical Treatment of the Back and of Hemorrhoids" is a manuscript, from the 18th-century, in Arabic, which discusses the treatment of calculi
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cardiac_shunt-0.md b/data/en.wikipedia.org/wiki/Cardiac_shunt-0.md
new file mode 100644
index 000000000..afc199656
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cardiac_shunt-0.md
@@ -0,0 +1,199 @@
+---
+title: "Cardiac shunt"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cardiac_shunt"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:47.861966+00:00"
+instance: "kb-cron"
+---
+
+In cardiology, a cardiac shunt is a pattern of blood flow in the heart that deviates from the normal circuit of the circulatory system. It may be described as right-left, left-right or bidirectional, or as systemic-to-pulmonary or pulmonary-to-systemic. The direction may be controlled by left and/or right heart pressure, a biological or artificial heart valve or both. The presence of a shunt may also affect left and/or right heart pressure either beneficially or detrimentally.
+
+
+== Terminology ==
+
+The left and right sides of the heart are named from a dorsal view, i.e., looking at the heart from the back or from the perspective of the person whose heart it is. There are four chambers in a heart: an atrium (upper) and a ventricle (lower) on both the left and right sides. In mammals and birds, blood from the body goes to the right side of the heart first. Blood enters the upper right atrium, is pumped down to the right ventricle and from there to the lungs via the pulmonary artery. Blood going to the lungs is called the pulmonary circulation. When the blood returns to the heart from the lungs via the pulmonary vein, it goes to the left side of the heart, entering the upper left atrium. Blood is then pumped to the lower left ventricle and from there out of the heart to the body via the aorta. This is called the systemic circulation. A cardiac shunt is when blood follows a pattern that deviates from the systemic circulation, i.e., from the body to the right atrium, down to the right ventricle, to the lungs, from the lungs to the left atrium, down to the left ventricle and then out of the heart back to the systemic circulation.
+A left-to-right shunt is when blood from the left side of the heart goes to the right side of the heart. This can occur either through a hole in the ventricular or atrial septum that divides the left and the right heart or through a hole in the walls of the arteries leaving the heart, called great vessels. Left-to-right shunts occur when the systolic blood pressure in the left heart is higher than the right heart, which is the normal condition in birds and mammals.
+
+
+== Congenital shunts in humans ==
+The most common congenital heart defects (CHDs) which cause shunting are atrial septal defects (ASD), patent foramen ovale (PFO), ventricular septal defects (VSD), and patent ductus arteriosi (PDA). In isolation, these defects may be asymptomatic, or they may produce symptoms which can range from mild to severe, and which can either have an acute or a delayed onset. However, these shunts are often present in combination with other defects; in these cases, they may still be asymptomatic, mild or severe, acute or delayed, but they may also work to counteract the negative symptoms caused by another defect (as with d-Transposition of the great arteries).
+
+
+== Acquired shunts in human ==
+
+
+=== Biological ===
+Some acquired shunts are modifications of congenital ones: a balloon septostomy can enlarge a foramen ovale (if performed on a newborn), PFO or ASD; or prostaglandin can be administered to a newborn to prevent the ductus arteriosus from closing. Biological tissues may also be used to construct artificial passages.
+Evaluation can be done during a cardiac catheterization with a "shunt run" by taking blood samples from superior vena cava (SVC), inferior vena cava (IVC), right atrium, right ventricle, pulmonary artery, and system arterial. Abrupt increases in oxygen saturation support a left-to-right shunt and lower than normal systemic arterial oxygen saturation supports a right-to-left shunt.
+Samples from the SVC & IVC are used to calculate mixed venous oxygen saturation using the Flamm formula
+
+  
+    
+      
+        
+          S
+          
+            v
+          
+        
+        
+          O
+          
+            2
+          
+        
+        =
+        
+          
+            3
+            4
+          
+        
+        ×
+        S
+        V
+        C
+        +
+        
+          
+            1
+            4
+          
+        
+        ×
+        I
+        V
+        C
+      
+    
+    {\displaystyle S_{v}O_{2}={\frac {3}{4}}\times SVC+{\frac {1}{4}}\times IVC}
+  
+
+and Qp:Qs ratio
+
+  
+    
+      
+        Q
+        p
+        :
+        Q
+        s
+        =
+        
+          
+            change in oxygen concentration across the pulmonary circulation
+            change in oxygen concentration across the systemic circulation
+          
+        
+        =
+        
+          
+            
+              
+                P
+                
+                  V
+                
+              
+              −
+              
+                P
+                
+                  A
+                
+              
+            
+            
+              
+                S
+                
+                  A
+                
+              
+              −
+              
+                S
+                
+                  V
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle Qp:Qs={\frac {\text{change in oxygen concentration across the pulmonary circulation}}{\text{change in oxygen concentration across the systemic circulation}}}={\frac {P_{V}-P_{A}}{S_{A}-S_{V}}}}
+  
+
+where 
+  
+    
+      
+        
+          P
+          
+            V
+          
+        
+      
+    
+    {\displaystyle P_{V}}
+  
+ is the pulmonary vein, 
+  
+    
+      
+        
+          P
+          
+            A
+          
+        
+      
+    
+    {\displaystyle P_{A}}
+  
+ is the pulmonary artery, 
+  
+    
+      
+        
+          S
+          
+            A
+          
+        
+      
+    
+    {\displaystyle S_{A}}
+  
+ is the systemic arterial, and 
+  
+    
+      
+        
+          S
+          
+            V
+          
+        
+      
+    
+    {\displaystyle S_{V}}
+  
+ is the mixed-venous The Qp:Qs ratio is based upon the Fick principle and it is reduced to the above equation and eliminates the need to know cardiac output and hemoglobin concentration.
+
+
+=== Mechanical ===
+Mechanical shunts such as the Blalock-Taussig shunt are used in some cases of CHD to control blood flow or blood pressure.
+
+
+== Reptile ==
+
+All reptiles have the capacity for cardiac shunts.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Carnoy's_solution-0.md b/data/en.wikipedia.org/wiki/Carnoy's_solution-0.md
new file mode 100644
index 000000000..4e5ab9501
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Carnoy's_solution-0.md
@@ -0,0 +1,28 @@
+---
+title: "Carnoy's solution"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Carnoy's_solution"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:50.446534+00:00"
+instance: "kb-cron"
+---
+
+Carnoy's solution is a fixative composed of 60% ethanol, 30% chloroform and 10% glacial acetic acid, 1 gram of ferric chloride.
+Carnoy's solution is also the name of a different fixation composed of ethanol and glacial acetic acid (3:1).
+The invention of Carnoy's solution is attributed to Jean-Baptiste Carnoy, a pioneering 19th century cytologist.
+
+
+== Uses ==
+Some of the uses of Carnoy's solution are:
+
+Enhancing lymph node detection during dissection of cadavers.
+Immunohistochemical fixation and detection of NMDA receptors within the murine hippocampus.
+Applied directly following enucleation for the treatment of odontogenic keratocysts.
+Direct application following enucleation (Cuba) for certain kinds of unicystic ameloblastomas.  This appears to decrease the likelihood of recurrence over enucleation alone.  Protein coagulation is thought to limit uptake of these toxic materials by surrounding tissues, however it is this fact that limits its usefulness as a treatment agent in general.
+As a fixative for pap smear samples.
+As a fixative agent for both nuclear and mitochondrial DNA in various tissues.
+As a fixative agent to preserve mucus, useful for tissue preparation before staining with periodic acid-Schiff base.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Case_presentation-0.md b/data/en.wikipedia.org/wiki/Case_presentation-0.md
new file mode 100644
index 000000000..d401d569f
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Case_presentation-0.md
@@ -0,0 +1,40 @@
+---
+title: "Case presentation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Case_presentation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:51.626584+00:00"
+instance: "kb-cron"
+---
+
+A case presentation is a formal communication between health care professionals such as doctors and nurses regarding a patient's clinical information.
+Essential parts of a case presentation include:
+
+Identification
+Reason for consultation/admission
+Chief complaints (CC) - what made patients seek medical attention.
+History of present illness (HPI) - circumstances relating to chief complaints.
+Past medical history (PMHx)
+Past surgical history
+Current medications
+Allergies
+Family history (FHx)
+Social history (SocHx)
+Physical examination (PE)
+Laboratory results (Lab)
+Other investigations (imaging, biopsy etc.)
+Case summary and impression
+Management plans
+follow up in clinic or hospital
+Adherence of the patient to treatment
+success of the treatment or failure.
+causes of success or failure.
+
+
+== See also ==
+Case report
+Case series
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Case_report-0.md b/data/en.wikipedia.org/wiki/Case_report-0.md
new file mode 100644
index 000000000..addf36604
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Case_report-0.md
@@ -0,0 +1,75 @@
+---
+title: "Case report"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Case_report"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:52.887502+00:00"
+instance: "kb-cron"
+---
+
+In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurrence. Some case reports also contain a literature review of other reported cases. Case reports are professional narratives that provide feedback on clinical practice guidelines and offer a framework for early signals of effectiveness, adverse events, and cost. They can be shared for medical, scientific, or educational purposes.
+
+
+== Types ==
+Most case reports are on one of six topics:
+
+An unexpected association between diseases or symptoms.
+An unexpected event in the course of observing or treating a patient.
+Findings that shed new light on the possible pathogenesis of a disease or an adverse effect.
+Unique or rare features of a disease.
+Unique therapeutic approaches.
+A positional or quantitative variation of the anatomical structures.
+
+
+== Roles in research and education ==
+A case report is generally considered a type of anecdotal evidence.  Given their intrinsic methodological limitations, including lack of statistical sampling, case reports are placed at the bottom of the hierarchy of clinical evidence, together with case series. Nevertheless, case reports do have genuinely useful roles in medical research and evidence-based medicine. In particular, they have facilitated recognition of new diseases and adverse effects of treatments. For example, the recognition of the link between administration of thalidomide to mothers and malformations in their babies was triggered by a case report. Case reports have a role in pharmacovigilance. They can also help understand the clinical spectrum of rare diseases as well as unusual presentations of common diseases. They can help generate study hypotheses, including plausible mechanisms of disease. Case reports may also have a role to play in guiding the personalization of treatments in clinical practice.
+Proponents of case reports have outlined some particular advantages of the format. Case reports and series have a high sensitivity for detecting novelty and therefore remain one of the cornerstones of medical progress; they provide many new ideas in medicine. Whereas randomized clinical trials usually only inspect one variable or very few variables, rarely reflecting the full picture of a complicated medical situation, the case report can detail many different aspects of the patient's medical situation (e.g. patient history, physical examination, diagnosis, psychosocial aspects, follow up).
+Because typical, unremarkable cases are less likely to be published, use of case reports as scientific evidence must take into account publication bias. Some case reports also contain an extensive review of the relevant literature on the topic at-hand (and sometimes a systematic review of available evidence). Reports adopting this sort of approach can be identified by terms such as a "case report and review of the literature". Reports containing broader active research such as this might be considered case studies in the true definition of the term.
+Case reports can also play a relevant role in medical education by providing a structure for case-based learning.
+A particular attraction of case reports is the possibility of quick publication (with respect to more extensive studies such as randomized control trials), allowing them to act as a kind of rapid short communication between busy clinicians who may not have the time or resources to conduct large scale research.
+
+
+== Reporting guidelines ==
+The quality of the scientific reporting of case reports is variable, and sub-optimal reporting hinders the use of case reports to inform research design or help guide clinical practice. In response to these issues, reporting guidelines are under development to facilitate greater transparency and completeness in the provision of relevant information for individual cases. The CARE (i.e. CAse REport) guidelines include a reporting checklist that is listed on the EQUATOR Network, an international initiative aimed at promoting transparent and accurate reporting of health research studies to enhance the value and reliability of medical research literature. This 13-item checklist includes indications regarding the title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. An explanation and elaboration article (a manual for writing case reports following the CARE guidelines) was published in the Journal of Clinical Epidemiology in 2017.
+
+
+== Publishing ==
+
+Many international journals publish case reports, but they restrict the number that appear in the print run because this has an adverse effect on the journal's impact factor. Case reports are often published online, and there is often still a requirement for a subscription to access them. However, an increasing number of journals are devoted to publishing case reports alone, most of which are open access. The first of these to start publishing, in 2001, was Grand Rounds.
+There are a number of websites that allow patients to submit and share their own patient case reports with other people. PatientsLikeMe and Treatment Report are two such sites.
+
+
+== Use of terminology outside science ==
+The term is also used to describe non-scientific reports usually prepared for educational reasons.
+
+
+== Famous scientific case reports ==
+Sigmund Freud reported on numerous cases, including Anna O., Dora, Little Hans, Rat Man, and Wolf Man
+Frederick Treves reported on "The Elephant Man"
+Paul Broca reported on language impairment following left hemisphere lesions in the 1860s.
+Joseph Jules Dejerine reported on a case of pure alexia.
+William MacIntyre reported on a case of multiple myeloma (described in the 1840s).
+Christiaan Barnard described the world's first heart transplant as a case report
+W. G. McBride, Thalidomide Case Report (1961). The Lancet 2:1358.
+
+
+== See also ==
+Case series
+Case presentation
+
+
+== References ==
+
+Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T; et al. (2017). "CARE 2013 Explanation and Elaborations: Reporting Guidelines for Case Reports". Journal of Clinical Epidemiology. 89: 218–235. doi:10.1016/j.jclinepi.2017.04.026. PMID 28529185. S2CID 205846029.{{cite journal}}:  CS1 maint: multiple names: authors list (link)
+
+
+== Further reading ==
+Jamjoom, Aimun; Nikkar-Esfahani, Ali; Fitzgerald, J Edward (2010). "Writing a medical case report". BMJ. 340 b5274. doi:10.1136/sbmj.b5274. S2CID 164945175.
+Kidd, Michael; Hubbard, Charlotte (2007). "Introducing Journal of Medical Case Reports". Journal of Medical Case Reports. 1 (1): 1. doi:10.1186/1752-1947-1-1. ISSN 1752-1947. PMC 1839763. PMID 17411446.
+Richardson, Michael L.; Chew, Felix S. (2006). "Radiology Case Reports: a new peer-reviewed, open-access journal specializing in case reports". Radiology Case Reports. 1 (1): 1–3. doi:10.2484/rcr.v1i1.7. ISSN 1930-0433. PMC 4891400. PMID 27298670.
+"Talanow: A new interactive Radiology journal". Archived from the original on 2008-09-27.
+
+
+== External links ==
+Case reports – The CARE guidelines
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cause_of_death-0.md b/data/en.wikipedia.org/wiki/Cause_of_death-0.md
new file mode 100644
index 000000000..8bd767b16
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cause_of_death-0.md
@@ -0,0 +1,42 @@
+---
+title: "Cause of death"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cause_of_death"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:54.150733+00:00"
+instance: "kb-cron"
+---
+
+In law, medicine, and statistics, cause of death is an official determination of the conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. In rare cases, an autopsy needs to be performed by a pathologist. The cause of death is a specific disease or injury, in contrast to the manner of death, which is a small number of categories like "natural", "accident", "suicide", and "homicide", each with different legal implications.
+The standards for cause of death recording and reporting are set by WHO. All death certificates typically include a medical certificate of cause of death collecting information for disease prevention and health policy. The recommended international format for this certificate is established by the World Health Organization (WHO) and applies uniformly across member states. The World Health Organization's ICD-11 Reference Guide provides the authoritative specification for its design and completion. Extensive detail is also available in the format of a manual for medical certification.
+International Classification of Disease (ICD) codes are used to record manner and cause of death in a systematic way that makes it easy to compile statistics and more feasible to compare events across jurisdictions globally.
+
+
+== Accuracy concerns ==
+A study published in Preventing Chronic Disease found that only one-third of New York City resident physicians reported believing that the present system of documentation was accurate. Half reported the inability to record "what they felt to be the correct cause of death", citing reasons such as technical limitation and instruction to "put something else". Nearly four-fifths reported being unaware that determinations of "probable", "presumed", or "undetermined" could be made, and fewer than three percent reported ever updating a death certificate when conflicting lab results or other new information became available, and cardiovascular disease was indicated as "the most frequent diagnosis inaccurately reported".
+Causes of death are sometimes disputed by relatives or members of the public, particularly when some degree of uncertainty or ambiguity exists in relation to the cause of death. On occasion, such disputes may result from, or sometimes instigate, a conspiracy theory.
+Public perception of the relative risk of death by various causes is biased by personal experience and by media coverage. The phrase "hierarchy of death" is sometimes used to describe the factors that cause some deaths to get more attention than others.
+Though some opponents of abortion consider it a cause of death, conventionally medical authorities do not confer personhood on fetuses that are not viable outside the womb, and thus abortions are not reported as deaths in these statistics.
+
+
+== Aging ==
+
+Health departments discourage listing "old age" as the cause of death because doing so does not benefit public health or medical research. Aging is not a scientifically recognized cause of death; it is currently considered that there is always a more direct cause (although it may be unknown in certain cases and could be one of a number of aging-associated diseases). As an indirect or non-determinative factor, biological aging is the biggest contributor to deaths worldwide. It is estimated that of the roughly 150,000 people who die each day across the globe, about two thirds—100,000 per day—die of age-related causes. In industrialized nations the proportion is much higher, reaching 90%. In recent years, there have been official claims about a possibility of recognizing aging itself as a disease. If this would be so, the situation would change.
+
+
+== Emotional death ==
+There are also popular notions that someone can be "scared to death" or die of loneliness or heartbreak. Experiencing fear, extreme stress, or both can cause changes in the body that can, in turn, lead to death. For example, it is possible that overstimulation of the vagus nerve—which decreases heart rate in a mechanism related to the behavior of apparent death (also known as "playing dead" and "playing possum")—is the cause of documented cases of psychogenic death.  The flight or fight response to fear or stress has the opposite effect, increasing heart rate through stress hormones, and can cause cardiovascular problems (especially in those with pre-existing conditions).  This is the proposed mechanism for the observed increase in the death rate due to cardiac arrest after widely experienced acutely stressful events such as terrorism, military attacks, and natural disasters (even among those who are not in the affected area) and for documented deaths in muggings and other frightening events which caused no traumatic physical harm.  The proximal medical cause of death in these cases is likely to be recorded as cardiac failure or vagal inhibition (which also has other potential causes such as blows to certain parts of the body and nerve injuries).
+One specific condition observed to result from acute stress, takotsubo cardiomyopathy, is nicknamed "broken heart syndrome", but the stress need not be relationship-related and need not be negative.
+These syndrome couldn't easily be diagnosed because it has less phisical evidence, when there are several volatile organic compounds developed. that can easily cause air polllution or poisenous gas.
+
+
+== See also ==
+Death by misadventure
+List of causes of death by rate
+List of preventable causes of death
+Manner of death
+Proximate and ultimate causation
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Central_venous_pressure-0.md b/data/en.wikipedia.org/wiki/Central_venous_pressure-0.md
new file mode 100644
index 000000000..00a07ebc5
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Central_venous_pressure-0.md
@@ -0,0 +1,59 @@
+---
+title: "Central venous pressure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Central_venous_pressure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:55.347879+00:00"
+instance: "kb-cron"
+---
+
+Central venous pressure (CVP) is the blood pressure in the venae cavae, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system. CVP is often a good approximation of right atrial pressure (RAP), although the two terms are not identical, as a pressure differential can sometimes exist between the venae cavae and the right atrium. CVP and RAP can differ when arterial tone is altered. This can be graphically depicted as changes in the slope of the venous return (VR) plotted against right atrial pressure (where central venous pressure (CVP) increases, but right atrial pressure (RAP) stays the same; VR = CVP − RAP).
+CVP has been, and often still is, used as a surrogate for preload, and changes in CVP in response to infusions of intravenous fluid have been used to predict volume-responsiveness (i.e. whether more fluid will improve cardiac output). However, there is increasing evidence that CVP, whether as an absolute value or in terms of changes in response to fluid, does not correlate with ventricular volume (i.e. preload) or volume-responsiveness, and so should not be used to guide intravenous fluid therapy.  Nevertheless, CVP monitoring is a useful tool to guide hemodynamic therapy.  
+The cardiopulmonary baroreflex responds to an increase in CVP by decreasing systemic vascular resistance while increasing heart rate and ventricular contractility in dogs.
+
+
+== Measurement ==
+
+Normal CVP in patients can be measured from two points of reference:
+
+Sternum: 0–14 cm H2O
+Midaxillary line: 8–15 cm H2O
+CVP can be measured by connecting the patient's central venous catheter to a special infusion set which is connected to a small diameter water column. If the water column is calibrated properly the height of the column indicates the CVP.
+In most intensive care units, facilities are available to measure CVP continuously.
+Normal values vary between 4 and 12 cm H2O.
+
+
+== Factors affecting CVP ==
+Factors that increase CVP include:
+
+Cardiac tamponade
+Decreased cardiac output
+Forced exhalation
+Heart failure
+Hypervolemia
+Mechanical ventilation and the application of positive end-expiratory pressure (PEEP)
+Pleural effusion
+Pulmonary embolism
+Pulmonary hypertension
+Tension pneumothorax
+Factors that decrease CVP include:
+
+Deep inhalation
+Distributive shock
+Hypovolemia
+
+
+== See also ==
+Jugular venous pressure
+Pulmonary capillary wedge pressure
+
+
+== References ==
+
+
+== External links ==
+Venous function and central venous pressure: a physiologic story - a technical discussion of the more modern understanding of central venous pressure; this may well conflict with the sources below.
+Central Venous Pressure and Pulmonary Capillary Wedge Monitoring
+Cardiovascular Physiology
+Central+Venous+Pressure at the U.S. National Library of Medicine Medical Subject Headings (MeSH)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cerebellar_degeneration-0.md b/data/en.wikipedia.org/wiki/Cerebellar_degeneration-0.md
new file mode 100644
index 000000000..4cb35f1d8
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cerebellar_degeneration-0.md
@@ -0,0 +1,51 @@
+---
+title: "Cerebellar degeneration"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Cerebellar_degeneration"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:56.519839+00:00"
+instance: "kb-cron"
+---
+
+Cerebellar degeneration is a condition in which cerebellar cells, otherwise known as neurons, become damaged and progressively weaken in the cerebellum. There are two types of cerebellar degeneration; paraneoplastic cerebellar degeneration, and alcoholic or nutritional cerebellar degeneration. As the cerebellum contributes to the coordination and regulation of motor activities, as well as controlling equilibrium of the human body, any degeneration to this part of the organ can be life-threatening. Cerebellar degeneration can result in disorders in fine movement, posture, and motor learning in humans, due to a disturbance of the vestibular system. This condition may not only cause cerebellar damage on a temporary or permanent basis, but can also affect other tissues of the central nervous system, those including the cerebral cortex, spinal cord and the brainstem (made up of the medulla oblongata, midbrain, and pons).
+Cerebellar degeneration can be attributed to a plethora of hereditary and non-hereditary conditions. More commonly, cerebellar degeneration can also be classified according to conditions that an individual may acquire during their lifetime, including infectious, metabolic, autoimmune, paraneoplastic, nutritional or toxic triggers.
+
+== Signs and symptoms ==
+
+Patients with cerebellar degeneration experience a progressive loss of nerve cells (Purkinje cells) throughout the cerebellum. As well as this, it is common to incur an elevated blood protein level and a high volume of lymph cells within the cerebrospinal fluid, resulting in swelling and enlargement of the brain. The most characteristic signs and symptoms experienced by patients with cerebellar degeneration include:
+
+muscle weakness
+an uncoordinated, staggering walk
+quivering of the torso
+jerky arm and leg movements
+tendency to fall over
+dysarthria (difficulty in articulating speech)
+dysphagia (difficulty in deglutition/swallowing of solids and liquids)
+vertigo (dizziness)
+nystagmus (rapid, involuntary eye movements), causing sleep disturbances
+ophthalmoplegia (paralysis of extraocular muscles)
+diplopia (double vision)
+Scientific studies have revealed that psychiatric symptoms are also common in patients with cerebellar degeneration, where dementia is a typical psychiatric disorder resulting from cerebellar damage. Approximately 50% of all patients experience dementia as a result of paraneoplastic cerebellar degeneration.
+
+== Causes ==
+The root cause of incurring a cerebellar degenerative condition can be due to a range of different inherited or acquired (non-genetic and non-inherited) conditions, including neurological diseases, paraneoplastic disorders, nutritional deficiency, and chronic heavy alcohol use.
+
+=== Neurological diseases ===
+A neurological disease refers to any ailment of the central nervous system, including abnormalities of the brain, spinal cord and other connecting nerve fibres. Where millions of people are affected by neurological diseases on a worldwide scale, it has been identified that the number of different types of neurological diseases exceeds six hundred, any of which an individual can incur. Some of the most prevalent types include Alzheimer's disease, cerebral palsy, epilepsy, Parkinson's disease and stroke. More specifically, the neurological diseases that can cause cerebellar degeneration include:
+
+==== Inherited ====
+Spinocerebellar ataxia (SCA), which refers to a group of conditions caused by mutations in the genes of a human, and are characterised by degenerative changes to many parts of the central nervous system, inclusive of the cerebellum, brain stem, and spinal cord. If a parent is affected by SCA, each of their children will have a 50% risk of inheriting the mutated gene.
+
+==== Non-inherited ====
+Multiple sclerosis (MS), a progressive and incurable condition caused by the combination of an individual's genetic influences and environmental circumstances. It occurs when the myelin sheath of the nerve cells becomes damaged. As the myelin sheath is responsible for protecting the nerves and conducting rapid impulses between them, any damage to this lipid-rich layer will result in delayed and interrupted nerve impulses to and from the brain.
+Transmissible spongiform encephalopathies (TSEs), which refers to a combination of diseases caused by the subsistence of foreign proteins in the blood, called prions. Prions originate in the bloodstream via ingestion of contaminated foods or through contact with contaminated medical instruments, body fluids, or infected tissue. This causes severe inflammation of the brain, impairing one's memory, personality and muscular coordination.
+Acute & haemorrhagic stroke, resulting in the death of neurons in the cerebellum due to a disrupted flow of oxygen to the brain. This disrupted flow may be due to one of two causes; either a narrowing or blocked artery which derives from a build-up of plaque in the inner walls of the coronary arteries, or a ruptured blood vessel, commonly deriving from high blood pressure or head trauma.
+
+=== Paraneoplastic disorders ===
+Paraneoplastic disorders are a combination of non-inherited conditions that are activated by an individual's autoimmune response to a malignant tumour. These disorders prevail when T-cells (also known as white blood cells) begin to harm familiar cells in the central nervous system rather than the cancerous cells, resulting in degeneration of neurons in the cerebellum. Other signs and symptoms that commonly result from the incursion of a paraneoplastic disorder include an impaired ability to talk, walk, sleep, maintain balance and coordinate muscle activity, as well as experiencing seizures and hallucinations. Paraneoplastic disorders are prevalent among middle-aged individuals, typically those with lung, lymphatic, ovarian or breast cancer.
+
+=== Nutritional deficiency ===
+Nutritional deficiency relates to an insufficient amount of macronutrients and micronutrients being provided to the body. Nutrient deficiencies are most prevalent among infants, the elderly, the poverty-stricken, and individuals with eating disorders. Alcohol use disorder is the diagnosis of which an individual frequently consumes excessive amounts of alcohol, and thus becomes dependent on the intoxicating substance. Studies show that men of every age group consume more alcohol than women, where the prevalence is higher in some regions of the world than others, such as across Western Europe and Australia. Nutritional deficiency is a non-inherited condition that lead to impaired absorption or utilisation of the vitamin thiamine (B-1) by the body, thus causing temporary or permanent damage to cerebellar cells. Alcoholic degeneration of cerebellar cells is one of the most common triggers of acquired cerebellar ataxia.
+
+== Diagnosis ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cerebellar_degeneration-1.md b/data/en.wikipedia.org/wiki/Cerebellar_degeneration-1.md
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+++ b/data/en.wikipedia.org/wiki/Cerebellar_degeneration-1.md
@@ -0,0 +1,25 @@
+---
+title: "Cerebellar degeneration"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Cerebellar_degeneration"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:56.519839+00:00"
+instance: "kb-cron"
+---
+
+To select an appropriate and accurate diagnostic test for cerebellar degeneration, it is crucial that a range of factors specific to each patient are taken into consideration. These include; the patient's age, acuity of their signs and symptoms, associated neurological conditions, and family history of hereditary forms of cerebellar degeneration. A diagnosis for cerebellar degeneration is regarded after any of the aforementioned signs and symptoms surface. For genetically classified forms of cerebellar degeneration, genetic testing can be carried out in order to confirm or deny the diagnosis, where this form of testing is only possible if the gene responsible for the cause of the condition is recognised. In saying this, for most conditions the genetic cause of cerebellar degeneration is unidentified, hence these patients cannot proceed with genetic testing. In cases where cerebellar degeneration is acquired, a diagnosis can be established using imaging methods such as computerised tomography (CT scans) and magnetic resonance imaging (MRI), necessary to detect brain abnormalities in patients with cerebellar degeneration.
+
+== Treatment ==
+Like any other disease, treatment for cerebellar degeneration is contingent on the underlying cause, unique to each patient. As of present time, hereditary forms of cerebellar degeneration are incurable, though they can be managed. Management is centred around coping with symptoms and improving a patient's quality of life. In these cases, immediate management of inherited cerebellum damage should involve consultation with a neurologist, followed by specific management approaches based on the signs and symptoms experienced by each unique patient. These management approaches aim to provide supportive care to the patient, consisting of physical therapy to strengthen muscles, occupational therapy, and speech pathology. Long-term management of inherited cerebellar degeneration involves an ongoing commitment to supportive care therapies, as well as a longitudinal relationship with a neurologist. In some instances adjustments need to be made in the patients home, to improve accessibility and mobility in and around their living environment, to optimise safety. The cerebellum is highly reactive to transcranial direct current stimulation, a technique which may improve ataxia.
+For non-hereditary types of cerebellar degeneration, some physical and mental indicators can be reversed by treating the fundamental cause. For instance, the signs and symptoms of paraneoplastic cerebellar degeneration can be managed by initially terminating the underlying cancer with treatments such as surgery, radiation therapy and chemotherapy. In cases of nutritional or alcoholic cerebellar degeneration, symptoms of these conditions can be relieved by initially consuming a balanced diet and discontinuing the consumption of alcohol respectively, followed by dietary supplementation with thiamine.
+
+== Prognosis ==
+The long-term prospect for patients with cerebellar degeneration differs according to the underlying cause of the disease. Each inherited or acquired disease that results in cerebellar degeneration has its own specific prognosis; however, most are generally poor, progressive and often fatal.
+
+== Epidemiology ==
+Cerebellar degeneration continues to carry a considerable burden on the health of the world population, as well as on health agencies and governing bodies across the globe. Cerebellum-related disorders generally transpire in individuals between the ages of 45 and 65 years; however, the age of symptomatic onset differs in accordance with the underlying cause of the degenerative disorder. For paraneoplastic cerebellar degeneration, the average age of onset is 50 years, generally affecting a greater population of males than females. Nutritional and alcoholic cerebellar degeneration, being more prevalent than paraneoplastic cerebellar degeneration, affects individuals with a thiamine deficiency and dipsomaniacs, respectively. Recent epidemiological studies on cerebellar degeneration estimated a global prevalence rate of 26 per 100,000 cases of cerebellar degeneration in children.
+
+== References ==
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cerebral_perfusion_pressure-0.md b/data/en.wikipedia.org/wiki/Cerebral_perfusion_pressure-0.md
new file mode 100644
index 000000000..7c6d1f144
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cerebral_perfusion_pressure-0.md
@@ -0,0 +1,220 @@
+---
+title: "Cerebral perfusion pressure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cerebral_perfusion_pressure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:57.755648+00:00"
+instance: "kb-cron"
+---
+
+Cerebral perfusion pressure (CPP) is the net pressure gradient causing cerebral blood flow to the brain (brain perfusion).  It must be maintained within narrow limits because too little pressure could cause brain tissue to become ischemic (having inadequate blood flow), and too much could raise intracranial pressure (ICP).
+
+
+== Definitions ==
+The cranium encloses a fixed-volume space that holds three components: blood, cerebrospinal fluid (CSF), and very soft tissue (the brain).  While both the blood and CSF have poor compression capacity, the brain is easily compressible.
+Every increase of ICP can cause a change in tissue perfusion and an increase in stroke events.
+
+
+=== From resistance ===
+CPP can be defined as the pressure gradient causing cerebral blood flow (CBF) such that
+
+  
+    
+      
+        C
+        B
+        F
+        =
+        C
+        P
+        P
+        
+          /
+        
+        C
+        V
+        R
+      
+    
+    {\displaystyle CBF=CPP/CVR}
+  
+
+where:
+
+CVR is cerebrovascular resistance
+
+
+=== By intracranial pressure ===
+An alternative definition of CPP is:
+
+  
+    
+      
+        C
+        P
+        P
+        =
+        M
+        A
+        P
+        −
+        I
+        C
+        P
+      
+    
+    {\displaystyle CPP=MAP-ICP}
+  
+
+where: 
+
+MAP is mean arterial pressure
+ICP is intracranial pressure
+JVP is jugular venous pressure
+This definition may be more appropriate if considering the circulatory system in the brain as a Starling resistor, where an external pressure (in this case, the intracranial pressure) causes decreased blood flow through the vessels. In this sense, more specifically, the cerebral perfusion pressure can be defined as either:
+
+  
+    
+      
+        C
+        P
+        P
+        =
+        M
+        A
+        P
+        −
+        I
+        C
+        P
+      
+    
+    {\displaystyle CPP=MAP-ICP}
+  
+ (if ICP is higher than JVP)
+or
+
+  
+    
+      
+        C
+        P
+        P
+        =
+        M
+        A
+        P
+        −
+        J
+        V
+        P
+      
+    
+    {\displaystyle CPP=MAP-JVP}
+  
+ (if JVP is higher than ICP).
+Physiologically, increased intracranial pressure (ICP) causes decreased blood perfusion of brain cells by mainly two mechanisms:
+
+Increased ICP constitutes an increased interstitial hydrostatic pressure that, in turn, causes a decreased driving force for capillary filtration from intracerebral blood vessels.
+Increased ICP compresses cerebral arteries, causing increased cerebrovascular resistance (CVR).
+FLOW
+Ranging from 
+  
+    
+      
+        
+          
+          
+            20
+            
+            
+              
+                mL
+              
+            
+          
+        
+        
+          
+            /
+          
+          
+            100
+            
+            
+              
+                g
+              
+            
+            
+              ⋅
+            
+            
+              
+                min
+              
+            
+          
+        
+      
+    
+    {\displaystyle ^{20\,{\textrm {mL}}}/_{100\,{\textrm {g}}{\cdot }{\textrm {min}}}}
+  
+ in white matter to 
+  
+    
+      
+        
+          
+          
+            70
+            
+            
+              
+                mL
+              
+            
+          
+        
+        
+          
+            /
+          
+          
+            100
+            
+            
+              
+                g
+              
+            
+            
+              ⋅
+            
+            
+              
+                min
+              
+            
+          
+        
+      
+    
+    {\displaystyle ^{70\,{\textrm {mL}}}/_{100\,{\textrm {g}}{\cdot }{\textrm {min}}}}
+  
+ in grey matter.
+
+
+== Autoregulation ==
+Under normal circumstances a MAP between 60 and 160 mmHg and ICP about 10 mmHg (CPP of 50-150 mmHg) sufficient blood flow can be maintained with autoregulation. Although the classic 'autoregulation curve' suggests that CBF is fully stable between these blood pressure values (known also as the limits of autoregulation), in practice spontaneous fluctuations can occur.
+Outside of the limits of autoregulation, raising MAP raises CBF and raising ICP lowers it (this is one reason that increasing ICP in traumatic brain injury is potentially deadly). In trauma some recommend CPP not go below 70 mmHg. Recommendations in children is at least 60 mmHg.
+Within the autoregulatory range, as CPP falls there is, within seconds, vasodilation of the cerebral resistance vessels, a fall in cerebrovascular resistance and a rise in cerebral-blood volume (CBV), and therefore CBF will return to baseline value within seconds (see as ref. Aaslid, Lindegaard, Sorteberg, and Nornes 1989: http://stroke.ahajournals.org/cgi/reprint/20/1/45.pdf). These adaptations to rapid changes in blood pressure (in contrast with changes that occur over periods of hours or days) are known as dynamic cerebral autoregulation.
+
+
+== Footnotes ==
+
+
+== References ==
+Sanders, MJ; McKenna, K (2001). "Ch. 22: Head and Facial Trauma". Mosby's Paramedic Textbook (2nd revised ed.). Mosby.
+Walters, FJM (1998). "Intracranial Pressure and Cerebral Blood Flow". Physiology (8, Article 4). Archived from the original on 2011-05-14. Retrieved 2011-02-10.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cervical_conization-0.md b/data/en.wikipedia.org/wiki/Cervical_conization-0.md
new file mode 100644
index 000000000..de4efdce3
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cervical_conization-0.md
@@ -0,0 +1,30 @@
+---
+title: "Cervical conization"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Cervical_conization"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:59.084677+00:00"
+instance: "kb-cron"
+---
+
+Cervical conization refers to an excision of a cone-shaped portion of tissue from the mucous membrane of the cervix. Conization is used for diagnostic purposes as part of a biopsy and for therapeutic purposes to remove pre-cancerous cells (cervical intraepithelial neoplasia) or early stage cervical cancer. Ablative treatments are also available to treat abnormal cervical cells. The decision to perform a cervical conization procedure is made with consideration of a patient's pap smear, colposcopy, and HPV test results. The American College of Obstetricians and Gynecologists (ACOG) recommends that decisions regarding excision should be based on the risk of CIN3+. A conization can be performed in the office or the operating room, depending on the type of conization performed. This procedure carries few risks, with the most common one being bleeding after the procedure.
+
+== History ==
+Before the introduction of the speculum, cervical cancer was only found once it was advanced. With the invention and use of a speculum, changes in the cervix could be appreciated. First, they were evaluated macroscopically and eventually were also assessed using a microscope. In 1927, H. Hinselmann discovered the transformation zone, where metaplastic squamous epithelium is found between the columnar epithelium of the endocervix and the squamous epithelium of the ectocervix. The transformation zone is clinically significant, as it is where almost all cervical cancers and precancerous lesions arise.
+All current cervical conization methods can be traced back to amputation of the ectocervix, which was developed by Marion Sims in 1861. Before this, any excisions of cervical carcinomas were mainly a palliative care treatment option. A. Sturmdorf was the first to describe an excision of a cone shape from the ectocervix; however, he utilized this as a treatment for cervicitis. J. E. Ayre was the first to introduce cold knife conization in 1948 and stressed the importance of evaluating the excised tissue in serial sections to assess the extent of invasion. This method of cold knife conization has been utilized, and eventually, options for excisions using electrocautery were developed as well. Initially, excised tissue utilizing electrocautery was not satisfactory for evaluation, but as the loops used have become finer, the quality of the surgical specimens has improved to rival those of cold knife conization. Presently, electrocautery methods are often preferred to cold knife conization due to the greater ease of procedure.
+
+== Anatomy ==
+
+The cervix connects the uterine cavity to the vagina. The cervix can be viewed by placing a speculum in the vagina. The part of the cervix that can be directly viewed upon placing a speculum in the vagina is the ectocervix. The beginning of the endocervix is called the cervical os. The endocervix leads from the vagina into the uterine cavity. The area where the columnar epithelium of the endocervix and the squamous epithelium of the ectocervix meet is called the transformation zone or the squamocolumnar junction (SCJ). This is the area of the cervix that is most susceptible to human papillomavirus (HPV) infection and is where the vast majority of cervical precancers and cancers arise. This is the tissue that is sampled during a pap smear as a screening test to find abnormal cells or the presence of an HPV infection.
+
+== Types ==
+Types of conization include:
+
+Cold knife conization (CKC)
+Loop electrical excision procedure (LEEP)
+
+== Indications ==
+Abnormal cervical cells found on pap smear and colposcopy are the basis for the recommendation of a conization procedure. The amount of irregularity will be graded by the pathologist after the colposcopy as CIN1, CIN2, or CIN3. CIN3 represents the most irregularly appearing cells of the possible grading options. Conization may be recommended once the risk of CIN3 is greater than 25%. Conization before a radical hysterectomy is associated with better outcomes for early -stage cervical cancers as well, so it may be recommended even when hysterectomy will be the definitive surgical option. The American Society for Colposcopy and Cervical Pathology has developed a tool to aid in decision -making with abnormal cervical cancer screening and abnormal colposcopy results.
+
+== Procedure ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cervical_conization-1.md b/data/en.wikipedia.org/wiki/Cervical_conization-1.md
new file mode 100644
index 000000000..77c1b1f85
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cervical_conization-1.md
@@ -0,0 +1,23 @@
+---
+title: "Cervical conization"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Cervical_conization"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:59.084677+00:00"
+instance: "kb-cron"
+---
+
+The vagina is prepped using antimicrobial scrub or iodine. Draping is placed to maintain a sterile surgical field. Some physicians may choose to drain the bladder using a catheter. The speculum will be placed, and the cervix visualized. The tissue is then excised from the cervix. The tissue will include the transformation zone and will be shaped like a cone, as the procedure name suggests. The physician will ensure hemostasis has been achieved before removing the speculum and ending the procedure. Typically, the physician will place a suture at the 12 o'clock position of the excised tissue to serve as a reference point during histological examination.
+The main difference between cold knife conization and LEEP is the instrument used to excise the tissue. In a LEEP, a thin wire loop electrode is used to remove the cone-shaped surgical specimen. During a cold knife cone, a scalpel is used to excise the tissue. Both LEEP and cold knife cone have shown equal effectiveness, so the decision for which procedure is often based on the physician's comfort with each procedure or other clinical considerations. Cold knife cone is performed with a scalpel, and one advantage of this procedure is that the margins of the excised tissue will be free from thermal damage that would be present in the excised tissue from a LEEP. This can allow for more accurate analysis of the margin of the specimen.
+Contraindications to completing the procedure are cervicitis, pelvic inflammatory disease, or anticoagulation. Pregnancy is a relative contraindication, meaning that decisions of whether to perform the procedure in pregnant patients would be made on an individual basis.
+After treatment, screenings will continue. HPV screening is recommended 6 months after conization. Regular cervical cancer screening will resume as well, with the schedule of screening being determined by the type of abnormal cells that were present in the cervix. HPV vaccination may also be recommended as a part of the treatment plan to reduce the chances of abnormal cervical cells developing again.
+
+== Complications ==
+The most common complication of cervical conization is bleeding during the procedure or within a few weeks after the procedure. Infection after the procedure is possible but very rare. There is the possibility of cervical stenosis or cervical insufficiency. The data regarding the risk of preterm birth and low birth weight in future pregnancies is mixed; however, it is generally accepted that for patients desiring to carry future pregnancies, limiting the amount of cervical tissue that is excised is the best option to limit this risk. However, taking less tissue does produce an increased risk that the margins of the excised specimen will be positive, so the decision on how aggressively the excision is performed must be discussed between the patient and physician. 
+Cervical conization effectively reduces the risk of cancer developing or spreading. The chances of cancer recurrence and premature birth depend on the type of conization. Cold knife conization is associated with 7% chance of the cancer recurring and a 16% chance of premature birth, laser conization comes with 6% cancer recurrence and 13% premature birth, and loop excision comes with a 10% recurrence and 11% premature birth.
+
+== See also ==
+Cervicectomy
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cervical_dislocation-0.md b/data/en.wikipedia.org/wiki/Cervical_dislocation-0.md
new file mode 100644
index 000000000..805a21f65
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cervical_dislocation-0.md
@@ -0,0 +1,28 @@
+---
+title: "Cervical dislocation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cervical_dislocation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:00.313128+00:00"
+instance: "kb-cron"
+---
+
+Cervical dislocation is a common method of animal euthanasia. It refers to a technique used in physical euthanasia of small animals by applying pressure to the neck and dislocating the spinal column from the skull or brain. The aim is to quickly separate the spinal cord from the brain so as to provide the animal with a fast, painless, and easy death. 
+
+
+== Technique ==
+Firm pressure is applied at the base of the skull, along with a sharp pinching and twisting of the thumb and forefinger. At the same time, the tail is pulled backward. This severs the spinal cord at the base of the brain or within the cervical spine area (the upper third of the neck). According to the Canadian Council on Animal Care (CCAC), cervical dislocation is normally only conducted on small animals.
+
+
+== Ethics ==
+The University of Iowa and some veterinary associations consider the technique to be an ethically acceptable method for killing small rodents such as rats, mice, squirrels, etc.
+
+
+== See also ==
+Cervical fracture
+Blunt trauma
+Slaughter (livestock)
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Chain_of_survival-0.md b/data/en.wikipedia.org/wiki/Chain_of_survival-0.md
new file mode 100644
index 000000000..cfeadfd10
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Chain_of_survival-0.md
@@ -0,0 +1,28 @@
+---
+title: "Chain of survival"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Chain_of_survival"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:01.490920+00:00"
+instance: "kb-cron"
+---
+
+The chain of survival refers to a series of actions that, properly executed, reduce the mortality associated with sudden cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The six interdependent links in the chain of survival are early recognition of sudden cardiac arrest and access to emergency medical care, early CPR, early defibrillation, early advanced cardiac life support, and physical and emotional recovery. The first three links in the chain can be performed by lay bystanders, while the second three links are designated to medical professionals. Currently, between 70 and 90% of cardiac arrest patients die before they reach the hospital. However, a cardiac arrest does not have to be lethal if bystanders can take the right steps immediately.
+
+== Background ==
+According to the American Heart Association, out-of-hospital cardiac arrest can affect more than 300,000 people in the United States each year. Three minutes after the onset of cardiac arrest, a lack of blood flow starts to damage the brain, and 10 minutes after, the chances of survival are low. Therefore, bystanders have only a few minutes to act to optimize a person's chances of survival and recovery.
+To improve survival outcomes for people who have experienced out-of-hospital cardiac arrest, the American Heart Association–International Liaison Committee on Resuscitation recommended the chain of survival concept in the early 2000s. Originally, the chain consisted of four steps: early access to emergency medical care was the first link, the second link was early CPR, early defibrillation was the third link, and the final link was early advanced cardiac life support. Over the years, the American Heart Association has added two new links to the chain: post-resuscitation care in 2010, and physical and emotional recovery in 2020. Also in 2020, the American Heart Association issued a new pediatric chain of survival for infants, children, and adolescents.  
+Mary M. Newman, co-founder and president/CEO of the Sudden Cardiac Arrest (SCA) Foundation and previous executive director of the National Center for Early Defibrillation at the University of Pittsburgh, developed the chain of survival metaphor and first described it  in an article she wrote for the Journal of Emergency Medical Services in 1989, and further promoted in an editorial she wrote for the first issue of Currents in Emergency Cardiac Care in 1990. The American Heart Association later adopted the concept and elaborated on it in its 1992 guidelines for cardiopulmonary resuscitation and emergency cardiac care, The International Liaison Committee on Resuscitation (ILCOR) echoed the concept in 1997. The links of the Chain of survival are described below.
+
+== Early access to emergency medical care ==
+Ideally, someone must recognize an impending cardiac arrest or otherwise witness the cardiac arrest and activate the EMS system as early as possible with an immediate call to the emergency services. Unfortunately, many persons experiencing symptoms (for example, angina) that may lead to a cardiac arrest ignore these warning symptoms or, recognizing these warning symptoms correctly, fail to activate the EMS system, preferring to contact relatives instead (e.g., the elderly often contact their adult offspring rather than contact emergency services).
+
+== Early CPR ==
+To be most effective, bystanders should provide CPR immediately after a patient collapses. In their 2015 guidelines, the American Heart Association re-emphasized the importance of more bystanders performing hands-only CPR until EMS personnel arrive because, at present, fewer than 40% of people who have an out-of-hospital cardiac arrest receive CPR from a bystander. The guidelines recommend lay rescuers start CPR on a person with presumed cardiac arrest because the overall risk of harm to patients from CPR is low, even if their heart hasn't stopped beating. Properly performed CPR can keep the heart in a shockable rhythm for 10–12 minutes longer.
+
+== Early defibrillation ==
+Most adults who can be saved from cardiac arrest are in ventricular fibrillation or pulseless ventricular tachycardia, which means their heart has fallen out of rhythm. Early defibrillation is the link in the chain most likely to improve survival since defibrillation can help shock the heart back into a regular beat. Early, rapid defibrillation is considered the most important link in the chain of survival. Rapid defibrillation outside of the hospital improves the chances of survival by as much as 30%, and involves using an automated external defibrillator (AED) to shock the patient's heart.
+While CPR keeps blood flowing artificially, rapid defibrillation is the only way to restart the heart and reset it to a healthy rhythm. And while only 40% of adults experiencing cardiac arrest receive CPR, fewer than 12% receive shocks from an AED before EMS arrival. What is more, the chances of the patient's survival decrease by as much as 10% with every minute that they do not receive rapid defibrillation.
+AEDs are becoming more common in businesses, schools, and even the home as the public becomes more aware of the importance of rapid defibrillation. AEDs come with pre-recorded instructions and are easy to use. If an AED is not available, bystanders will need to continue CPR until emergency responders arrive with a defibrillator, which is why it is important to recognize cardiac arrest and call for help quickly.
+Public access defibrillation may be the key to improving survival rates in out-of-hospital cardiac arrest, but is of the greatest value when the other links in the chain do not fail.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Chain_of_survival-1.md b/data/en.wikipedia.org/wiki/Chain_of_survival-1.md
new file mode 100644
index 000000000..022db2eef
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Chain_of_survival-1.md
@@ -0,0 +1,33 @@
+---
+title: "Chain of survival"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Chain_of_survival"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:01.490920+00:00"
+instance: "kb-cron"
+---
+
+== Early advanced care ==
+Early advanced cardiac life support by paramedics is another critical link in the chain of survival. In communities with survival rates > 20%, a minimum of two of the rescuers are trained to the advanced level.
+Some ACLS ambulance providers will administer medications to manage pain, arrhythmias, shock, and pulmonary congestion; monitor the heart rhythm to identify any potentially lethal cardiac arrhythmias; or initiate transcutaneous pacing. ACLS ambulance providers use the mnemonic "MONA" (morphine, oxygen, nitroglycerin, and aspirin) to reflect the out-of-hospital therapies they will use for cardiac arrest.
+Often, ACLS ambulance providers will attach an electrocardiogram to the patient and transmit its findings to the receiving hospital or care facility, which leads to earlier diagnosis of a heart attack, and significantly reduces time to treatment at the hospital. This prearrival ECG and notification has been shown to improve patient outcomes. In the event of a complication at the scene of the event or on the way to the hospital, ACLS ambulance providers can administer life saving therapies, including CPR, rapid defibrillation, airway management, and intravenous medications.
+
+== Recovery ==
+In October 2020, the American Heart Association added the recovery phase as the sixth link in the chain of survival. Recovery consists of cardiac arrest survivors receiving treatment, surveillance, and rehabilitation at a hospital. It also includes an assessment for anxiety, depression, and post-traumatic stress, which can all lead to future repeated events. Before being discharged from the hospital, the American Heart Association recommends that cardiac arrest survivors receive rehabilitation assessment and treatment for physical, neurologic, cardiopulmonary, and cognitive impairments. They also recommend that cardiac arrest survivors and their caregivers receive comprehensive, multidisciplinary discharge planning to include medical and rehabilitative treatment recommendations and return to activity and work expectations.
+A patient's recovery from cardiac arrest continues long after their initial hospitalization following the event, so the American Heart Association recommended in their 2020 guidelines that patients have formal assessment and support for their physical, cognitive, and psychosocial needs.
+
+== See also ==
+Basic life support
+Cardiac arrest
+Cardiac Arrest Registry to Enhance Survival (CARES)
+Cardiopulmonary resuscitation
+Defibrillation
+Call-Push-Shock
+Rearrest
+
+== References ==
+
+== External links ==
+"The Links in the Chain of Survival," American Heart Association
+"Chain of Survival: Converting a Nation," Citizen CPR Foundation
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cheesewiring-0.md b/data/en.wikipedia.org/wiki/Cheesewiring-0.md
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+---
+title: "Cheesewiring"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cheesewiring"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:02.729782+00:00"
+instance: "kb-cron"
+---
+
+In medicine, the term cheesewiring or cheesewire effect (used interchangeably) describes any process in which cells or intercellular matrix are dissected or extruded either by the material being pressed through a taut element, or by the tension of a taut element pulling through tissue. The procedure is typically conducted in a surgical setting.
+Cheesewiring or the cheesewire effect can also describe the process of suture material cutting or tearing through viscera at the time of suture anastomosis and tension.
+
+
+== As a complication ==
+Cheesewiring can be a complication or part of a negative outcome of a procedure.  Examples include tumor growth penetrating the openings in a bowel stent that was placed to open an obstructed bowel, sutures used to hold a transplanted cornea in place, and treatment of tendon rupture, when sutures pull through the tendon.
+Evidence that the cheesewire effect has occurred is most clearly seen after surgery has been completed. Postoperatively as wound margins begin to swell, a suture can drag through the thin portion of tissue present near the surface. This suture drag is most often the result of tension being reduced in tying or placing the suture. It is apparent that cheesewiring has occurred if the suture has moved a little closer to the insertion site. A tell tale Y-shaped scar is evidence that cheesewiring has taken place. Cheesewiring that causes drag can lead to damage to tissue and make a surgeon tug on the material, leading to suture pullout. This causes an increased procedure time for the surgeon as well as a prolonged recovery period for the patient.
+Cheesewire complications are most often seen in cornea surgeries due to the soft tissue present in the eye. One of the most common occurrences is cheese wiring of the puncta occurring during intubation. This can occur for many different reasons. One cause is excessive tension on the tubing. Cheesewiring can also occur late as scar tissue forms around the tubing. The scar tissue fixes the tube in place and prevents the movement in the canalicular system with each blink creating problems. The tubing must be removed if cheesewiring is greater than 3 mm. 
+
+
+=== Technique for removal of the cheesewire suture ===
+Whether intentional or non-intentionally occurring, a cheesewire suture can be removed in surgery. A cheesewire suture is removed by a small incision made in the conjunctiva overlying the two ends of the suture.  Fine removal suture forceps are used to grasp both ends of the suture. Tangential traction is then used to cheesewire through the scar tissue 
+There are many complications that can arise from the removal of the cheesewire suture. In the eye specifically, suture breaking can result in significant tissue scarring. This results in a large amount of traction force required to remove the suture.  Occular Hypotony and hyphema following the removal of cheesewire sutures are also common occurrences. 
+
+
+=== Reducing suture drag ===
+Surgeons can take several precautions to help decrease the probability of cheesewiring occurring. One technique determined to decrease suture drag is placement of the needle perpendicularly through the entire corneal thickness encompassed by the suture bite on each side of the incision. Certain sutures are also more prone to cheesewiring. 3-0 Vicryl is one of the least likely sutures to experience cheesewiring. Sutures may also be coated in materials to reduce tissue drag. Monofilament sutures create less drag while passing through tissue, but may decrease tensile strength and cause crimping. Therefore, multifilament sutures are more commonly used to prevent the occurrence of cheesewiring despite a decrease in mechanical properties 
+Factors such as the type and size of the needle, suture type and thickness, and suture placement should all be considered as all factors have a significant effect on the surgical result. For instance, having a suture that is too short can lead to inflammation in tissue, while a suture that is too tight can cause necrosis, especially in association with significant edema.
+
+
+== As an intentional procedure ==
+The term cheesewiring can also be used to name the process of using a guidewire or suture intentionally to cut through tissue during a surgical procedure or allowing a suture to slowly cut through tissue over time. Examples of cheesewiring used intentionally include treating fistulas, use in trabeculectomies, and to aid in endovascular aortic repair.
+
+
+=== Cheesewiring as used in treatment of a fistula ===
+Treatment of fistulas often involves placing a suture and allowing it to cut off the fistula over time.
+
+
+=== Cheesewiring as used in a trabeculectomy ===
+Cheesewiring is used as an intentional procedure in a trabeculectomy. In a trabecuiectomy, a loop of 8-0 nylon sutures is placed under the scleral flap. The cheesewiring suture allows rescuing failing or failed bleb, by mechanically breaking down the subscleral flap.
+In this procedure, a triangular partial thickness scleral flap is created using a diamond knife. The scleral flap is then extended to the limbus that is hinged anteriorly. A sclerotomy is then made with a punch followed by a peripheral iridectomy. An 8-0 nylon suture is then passed through the conjunctiva from the external aspect into the subconjunctival space. This process creates the cheesewiring effect. The needle is entered 3 mm (0.12 in) from the lateral edge of the future bleb site and 3–4 mm (0.12–0.16 in) away from the limbus. The 8-0 nylon suture is taken under the scleral flap. Once this happens, the suture is reversed and the needle is passed through the conjunctiva from the inside towards the outside position. A singular 10-0 vicryl suture can secure the scleral flap and then the cheesewire suture can then be cut flush to the conjunctiva. The conjunctiva flap can be then secured with 26 10-0 vicryl sutures at either end of the limbus. A single 10-0 vicryl mattress suture can be placed in the middle. This entire process allows for blebs to be rescued.
+
+
+=== Cheesewiring as to aid in endovascular aortic valve repair ===
+Cheesewiring is commonly used in the endovascular repair. The cheesewire technique can be used to fenestrate an intimal flap, alleviating malperfusion in aortic dissection. Pulling both ends of a guide wire in a caudally sawing motion down through the infrarenal neck and into the aneurysm sac completes the technique. This process shears the flap with minimal damage.
+
+
+== See also ==
+Surgical suture
+List of medical topics
+Cheese knife
+Ligature (medicine)
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Chemoprophylaxis-0.md b/data/en.wikipedia.org/wiki/Chemoprophylaxis-0.md
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+---
+title: "Chemoprophylaxis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Chemoprophylaxis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:03.934272+00:00"
+instance: "kb-cron"
+---
+
+Chemoprevention or chemoprophylaxis refers to the administration of a medication for the purpose of preventing disease or infection. Antibiotics, for example, may be administered to patients with disorders of immune system function to prevent bacterial infections (particularly opportunistic infection). Antibiotics may also be administered to healthy individuals to limit the spread of an epidemic, or to patients who have repeated infections (such as urinary tract infections) to prevent recurrence. It may also refer to the administration of heparin to prevent deep venous thrombosis in hospitalized patients.
+In some cases, chemoprophylaxis is initiated to prevent the spread of an existing infection in an individual to a new organ system, as when intrathecal chemotherapy is administered in patients with malignancy to prevent further infection.
+The use of chemoprophylaxis is limited primarily by two factors: risk and financial costs.
+
+All medications have the potential to cause side effects. In general, chemoprophylaxis should be initiated only when the benefits of treatment outweigh the risks.
+The cost associated with chemoprophylaxis may be prohibitive, particularly when the cost of treatment is high or the incidence of the target disease is low. Many forms of chemoprophylaxis are therefore not cost-effective.
+
+
+== Specific diseases ==
+Using chemoprophylaxis as a treatment against early signs of tuberculosis has proven to be effective. In familial adenomatous polyposis physicians observed polyps regression with NSAIDs for anti-inflammatory therapy. Chemoprophylaxis is also used to treat several different varieties of meningococcal infections for close contact exposure to Neisseria meningitidis.
+The World Health Organization recommends chemoprevention to prevent Malaria in the Sahel region of Sub-Saharan Africa through the use of the drugs sulfadoxine/pyrimethamine and amodiaquine. This technique is called Seasonal Malaria Chemoprevention (SMC). The charity evaluator GiveWell lists the Malaria Consortium's SMC program as one of its priority programs due to its high level of cost-effectiveness and ability to absorbe additional funding.
+
+
+== Cancer ==
+Chemoprevention in cancer, was first proposed by Michael Sporn, seeks to identify ‘agents to reverse, suppress or prevent the carcinogenic process,’ from premalignancy to invasive and or metastatic cancer, by ‘using physiological mechanisms that do not kill healthy cells. Anand Reddi proposed a role for the antidiabetes drug metformin as a chemoprevention agent for skin cancer.
+
+
+== See also ==
+Prophylaxis, a more general term.
+Primary prevention, in which measures are undertaken to prevent the onset of disease in individuals who are susceptible (as when patients receive aspirin or statins to delay the development of coronary artery disease).
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Chief_complaint-0.md b/data/en.wikipedia.org/wiki/Chief_complaint-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Chief_complaint-0.md
@@ -0,0 +1,29 @@
+---
+title: "Chief complaint"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Chief_complaint"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:05.058536+00:00"
+instance: "kb-cron"
+---
+
+The chief complaint, formally known as CC in the medical field, or termed presenting complaint (PC) in Europe and Canada, forms the second step of medical history taking. It is sometimes also referred to as reason for encounter (RFE), presenting problem, problem on admission or reason for presenting. The chief complaint is a concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other reason for a medical
+encounter. In some instances, the nature of a patient's chief complaint may determine if services are covered by health insurance.
+When obtaining the chief complaint, medical students are advised to use open-ended questions. Once the presenting problem is elucidated, a history of present illness can be done using acronyms such as SOCRATES or OPQRST to further analyze the severity, onset and nature of the presenting problem. The patient's initial comments to a physician, nurse, or other health care professionals are important for formulating differential diagnoses.
+
+
+== Prevalence ==
+The collection of chief complaint data may be useful in addressing public health issues. Certain complaints are more common in certain settings and among certain populations. Fatigue has been reported as one of the ten most common reasons for seeing a physician. In acute care settings, such as emergency rooms, reports of chest pain are among the most common chief complaints. The most common complaint in ERs has been reported to be abdominal pain. Among nursing home residents seeking treatment at ERs, respiratory symptoms, altered mental status, gastrointestinal symptoms, and falls are the most commonly reported.
+
+
+== See also ==
+Identified patient
+Medical history
+
+
+== References ==
+
+
+== External links ==
+MedEd at Loyola ipm/comphx1/sld003.htm
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-0.md b/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-0.md
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+---
+title: "Children with Special Healthcare Needs in the United States"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:06.242840+00:00"
+instance: "kb-cron"
+---
+
+Children with Special Healthcare Needs (CSHCN) are defined by the Maternal and Child Health Bureau as: 
+
+"Those who have one or more chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally"
+
+== Types of special healthcare needs ==
+There are a wide variety of physical, mental, and psychological health conditions considered to be special healthcare needs in the United States. They range from relatively mild to chronic and severe. The functional impairments of CSHCN include problems with one or more of the following criteria: breathing, swallowing/digestion/metabolism, blood circulation, chronic pain, hearing even with corrective devices, seeing even with corrective devices, taking care of self, coordination/moving around, learning/understanding/paying attention, speaking/communicating, making/keeping friends, and behavior. The list below states health conditions considered to be special healthcare needs. 
+
+Attention deficit disorder (ADD)
+Attention deficit hyperactivity disorder (ADHD)
+Depression
+Anxiety problems
+Behavioral problems
+Autism spectrum disorders (ASD)
+Diabetes
+Developmental disability
+Intellectual disability (ID)
+Epilepsy
+Migraines
+Traumatic brain injury (TBI)
+Heart problems
+Blood problems
+Cystic fibrosis
+Cerebral palsy
+Muscular dystrophy
+Down syndrome
+Arthritis
+Joint problems
+Allergies
+
+== Population ==
+As of 2009, 15.1% of all children in the US are considered to have special healthcare needs,
+
+=== Epidemiology ===
+The prevalence of children with special healthcare needs in the population depends on several factors, including gender, age, socioeconomic level and family household education. In the National Survey of Children's Health Data in 2007, gender is the strongest predictor of special health care needs—about 60% of children with special health care needs are boys and 30% are girls. A study by Newacheck et al. found that age is also a strong predictor, as school-age children are found to be twice as likely as toddlers to require special needs care, and this prevalence continues to increase as children grow older. Families with income below the federal poverty level are 1/3 more likely to have children with special health care needs, and families with 12 or fewer years of education have increased prevalence of a child with SHCN as well. Family structure also correlates with this prevalence—for single-mother families are 40% more likely to have a CSHCN than two-parent households.
+
+=== Challenges ===
+In a comprehensive study by the U.S. Health Resources and Services Administration (HRSA), using the 2007 National Survey of Children's Health data, it was found that children with SHCN when compared to those children without SHCN, face more inadequacies in healthcare, education, health of family, and maintaining a healthy lifestyle. CSHCN face more difficulties with accessing mental health care  as well as having a medical home. A medical home is one of the standards of administering healthcare recommended by the Maternal and Child Health Bureau. In school, these children have an increased risk of missing class, being disengaged in the classroom, and repeating a grade. They also have more cases of inadequate sleep every night in comparison to their peers. CSHCN are more likely to not exercise the recommended four times a week, and they have higher chance of being overweight/obese. They also face increased challenges in making friends. The parents of CSHCN have challenges as well. The study by HRSA, found that the parents of special needs children experience more stress, decreased health, and more questioning of their parenting skills.
+Despite these challenges, children with SHCN fare better than non-affected children in preventative health care and preventative dental care. They have a higher rate of having health insurance than normal children. They more frequently complete the recommended annual primary care visit, and bi-annual dentist visit. They also have a tendency to use more Developmental Screening, especially those with public healthcare. Developmental screening is used by doctors to check and evaluate for proper child development over time on a physical and cognitive level. The American Academy of Pediatrics recommends visits for developmental screening at ages 9,18 and at 24–30 months.
+
+=== Challenges for CSHCN with emotional and behavioral disorders ===
+Emotional and behavioral disorders (EBD) are disorders that include ADD/ADHD, anxiety, ASD, depression, OCD/conduct disorder, developmental delay and Tourette's Syndrome, and they increase the challenges CSHCN face. 40% of CSHCN have an EBD and 80% of these children also experience another health problem along with their EBD, according to the 2007 National Survey of Children's Health. The Health Resources and Services Administration found that these disorders are associated with an even greater decrease in quality of family-life, education and healthcare. Parent's health worsens and stress increases when they have children with an EBD. These EBD children miss more classes and are more disengaged in class than non-EBD CSHCN. EBD-CSHCN experience reduced family center-care and effective care-coordination. They also face greater difficulty in their ability to make friends than non-EBD CSHCN.
+
+=== Effective Support for Families ===
+A systematic review of randomized controlled trials found evidence that
+
+Including parents in psychological therapies to help children manage painful conditions was effective;
+Cognitive behavioral therapy that includes parents reduces primary symptoms;
+Problem solving therapy for parents improves their skills and mental health.
+
+== United states government involvement ==
+The United States governments employs several different programs in order to provide insurance and care for CSHCN. These include Title V grants, Medicaid and Children's Health Insurance Program (CHIP). These three programs vary in their definition and eligibility of care for CSHCN.
+
+=== Medicaid ===
+Medicaid is the program implemented under Title XIX of the Social Security Act. It is a public insurance program that provides mandatory services for patients such as: 
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-1.md b/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-1.md
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@@ -0,0 +1,41 @@
+---
+title: "Children with Special Healthcare Needs in the United States"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:06.242840+00:00"
+instance: "kb-cron"
+---
+
+Inpatient/outpatient hospital resources
+Transportation for non-emergency medical care
+Home health services
+Laboratory procedures
+Physician services
+Family planning
+Nursing facilities
+Early Periodic Screening, Diagnosis, and Treatment (EPDST) program
+Tobacco cessation programs for pregnant women
+Medicaid requires no co-payment or deductibles. To be eligible for the program one must be in one of four categories. The first is income level, the second is disability criteria, the third is eligibility for institutional level of care, and the fourth is out of home placement. Many CSHCN qualify for Medicaid based on low income level, but some children qualify independently of income level due to their disabilities. Medicaid has a more restrictive definition of disabilities and special healthcare needs than the Maternal and Children's Health Bureau (MCHB), and defines special needs as needs that must impede daily functioning. Medicaid accepts children who need to receive Supplemental Security Income program money, and children who are defined as medically needy. Medically needy children are those whose families have above the maximum income to receive Medicaid, but due to health expenditures their income is lowered to the level required. 40 states currently offer this program. Medicaid programs in each state are administered differently, and federal dollars go to each state based on per capita income levels. As of 2010, the Medicaid program had 405 billion dollars for the entire program. With the new Patient Protection and Affordable Care Act, by 2014 state Medicaid levels will rise to 138% of the Federal Poverty Line, increasing the number of CSHCN receiving Medicaid.
+
+=== Children's health insurance program ===
+This program, the Children's Health Insurance Program (CHIP), was created with Title XXI of the Social Security Act, and is meant to cover the gap between children who qualify for Medicaid and those who can afford private insurance. It covers children up to nineteen years of age and many states also choose to help insure pregnant women. 46 of the states and the District of Columbia insure up to 200% of the Federal Poverty Line. CHIP receives its funding from the federal government but it is capped, unlike Medicaid. CSHCN who use CHIP receive all of the same federally mandated programs that Medicaid must offer. The program also requires that mental health services be offered as equally as physical health services.
+
+=== Title V ===
+This Social Security Act, Title V, states that $850,000,000 in grant money is to be allotted starting in 2001 and every year after to the states in order to accomplish health goals of the Public Health Service Act as well as the goals of Title V. The Title V grant money is set out to specifically affect CSHCN in several ways. First, it requires states to provide rehabilitation services for blind or disabled individuals under the age of 16. It also allocates money to projects of both national and state importance that help maternal and child health as well as children with special healthcare needs. The act requires that there are community-based programs such as daycare that help provide for CSHCN. Another requirement is the creation of family-to-family health information centers that assist families with CSHCN to make informed decisions regarding healthcare and resources.
+This program works with the Maternal and Child Health Bureau, and employs their definition of CSHCN as stated earlier. Title V does not provide as much money as CHIP or Medicaid, but is used to fill the gaps where these programs do not cover. The Title V money is used to help with the Early Periodic Screening Diagnosis and Treatment Program (EPSDT) that is employed by Medicaid to test children. Title V shares the data collection responsibility of these three programs as well as develops educational materials. The Title V programs also have the goal to promote community-based services for all children as well as to promote coordinated care for families.
+
+== Childhood Care ==
+Children with special healthcare needs require more healthcare for their various health conditions as well as more types of therapies and treatments. Therapies include occupational therapy, physical therapy, and speech-language pathology among others.
+
+=== Medical home ===
+The American Academy of Pediatrics (AAP) medical home model is the suggested form of healthcare administration for children with special health care needs due to their increased healthcare needs. In a study by Judith Palfrey et al. it was found to indicate improved health and increase patient satisfaction. This model as defined by the AAP is a total coordination of care for infants, children and adolescents. It consists of a primary physician, preferably a pediatrician, that a child and their family know well and who is a medical advocate for the care of the child. All medical care in the medical home is accessible, continuous, comprehensive, family-centered, compassionate and coordinated. This model requires several elements:  
+
+Provision of preventative care
+Assurance of ambulatory/inpatient care at any time
+Provision of care over a long period of time
+Ability to identify need for sub-specialists and to make these referrals
+Interaction with the school and community programs of a child to work with a child's special needs
+Central record keeping data base
+The pediatrician assumes the ultimate responsibility for all care that is provided for the child even though other medical professionals are involved. Currently, 48.9% of CSHCN have access to a medical home while 59.6% of non-affected children have access to a medical home.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-2.md b/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-2.md
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+++ b/data/en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States-2.md
@@ -0,0 +1,27 @@
+---
+title: "Children with Special Healthcare Needs in the United States"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Children_with_Special_Healthcare_Needs_in_the_United_States"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:06.242840+00:00"
+instance: "kb-cron"
+---
+
+=== Therapy for CSHCN ===
+Therapies for children with special healthcare needs can be accessed via public schools or private therapists. The Individuals with Disabilities Education Act  (IDEA) includes occupational and physical therapy as well as other therapies, as part of the special education that should be offered in all public schools to CSHCN. This act states that all children with disabilities should have access to education that suits their SHCN, including needed therapies. Out of school therapies can also be used be employed by children with SHCN but only 3.2% of CSHCN qualify for uses of special therapy under their insurance programs.
+One type of therapy for children with SHCN is occupational therapy. Occupational therapists work with CSHCN by supporting them and their families to learn how to participate in everyday routines and daily activities. They encourage children with physical, cognitive, communication and behavior challenges to develop ways to live, play, learn and make friends despite their special needs. Occupational therapists can work with these children and their schools to create more accommodating learning environments. Another skill these professionals teach to  children with SHCN is how to use adaptive equipment such as wheelchairs, eating aids and braces in daily life. Some occupational therapists try to work with very young children at risk for SHCN in order to try and prevent future disability through occupational therapy.
+
+=== Insurance for CSHCN ===
+The types of insurance vary for children with special healthcare needs, 9.3% of CSHCN have no insurance at all, 52.4% have private insurance, 35.9% have public insurance and 8.2% have some combination of both public and private. Insurance gaps and other health costs affect 21.6% of families with CSHCN, who state that they face financial problems due to their CSHCN. In total, 34.3% of these families believe that their current insurance is not adequate in providing for all of their additional healthcare costs.
+
+== Adult care ==
+The Maternal and Child Health Bureau requires services to be available that are necessary for CSHCN to transition to all aspects of adult life. 90% of Adolescents with SHCN (ASHCN) are expected to live into adulthood, and access to healthcare decreases as ASHCN grow older according to the Maternal and Child Health Bureau. Youth lose health coverage they received in the past from programs like CHIP as well as Supplemental Security Income once they reach the ages of 18–21. Adult healthcare providers are not as familiar with childhood onset conditions as pediatricians. A study by Jane Park et al. found that mental health conditions increase in prevalence as children get older and age into adulthood, and ASHCN who have mental health conditions (with or without physical conditions) fare worse on their transition to adult healthcare. The MCHB recommends that children should have their transition to adult healthcare be mediated and provided for by their doctors. The Bureau requires that doctors need to have discussed with the adolescents with SHCN and their families three points: how to transition to adult primary care doctors as opposed to pediatricians, how health needs will change as the youth become adults, and how to maintain health insurance as an adult. The doctor is also supposed to encourage youth to take responsibility for their own health needs. Currently 60% of doctors of adolescents with SHCN do not meet these criteria.
+
+=== Healthcare transition plan ===
+Another recommendation for healthcare providers by the Maternal and Child Health Bureau is the creation of a written Healthcare Transition (HCT) plan. According to a study by Peter Scal and Marjorie Ireland, 30.08%  of ASHCN had discussed such a plan. It was also found that adolescents who were older and who had more complicated needs were more likely to have an HCT.
+
+=== Patient protection and affordable care act ===
+The Patient Protection and Affordable Care Act passed by the Obama administration in 2010 sets forth new requirements for ability of adolescents with SHCN to transition healthcare services from pediatric services. The Act also expands their ability to pay for and access these services. It states three criteria that must be met for adolescents. First, adolescents need to have access to a comprehensive healthcare system that they can find a way to pay for, as well as be able to navigate the system. Second, preventable health problems need to be successfully prevented. Third, chronic conditions need to be managed and the transition to adult healthcare needs to be assured. Skills that ASHCN are recommended to possess to accomplish these goals include the ability to describe their own illness, know their own medication and dosages, know how to contact a clinician, and the ability to schedule appointments and call in for refills.
+
+== References ==
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+---
+title: "Chronic care"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Chronic_care"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:08.631564+00:00"
+instance: "kb-cron"
+---
+
+Chronic care refers to medical care which addresses pre-existing or long-term illness, as opposed to acute care which is concerned with short term or severe illness of brief duration. Chronic medical conditions include asthma, diabetes, emphysema, chronic bronchitis, congestive heart disease, cirrhosis of the liver, hypertension and depression. Without effective treatment chronic conditions may lead to disability.
+The incidence of chronic disease has increased as mortality rates have decreased. It is estimated that by 2030 half of the population of the USA will have one or more chronic conditions.
+According to the CDC, 6 out of 10 adults in the U.S. are managing at least one chronic disease and 42% of adults have two or more chronic conditions.
+Conditions, injuries and diseases which were previously fatal can now be treated with chronic care. Chronic care aims to maintain wellness by keeping symptoms in remission while balancing treatment regimes and quality of life. Many of the core functions of primary health care are central to chronic care. Chronic care is complex in nature because it may extend over a pro-longed period of time, requires input from a diverse set of health professionals, various medications and possibly monitoring equipment.
+
+
+== Policy making ==
+According to 2008 figures from the Centers for Disease Control and Prevention chronic medical care accounts for more than 75% of health care spending in the US. In response to the increased government expenditure in dealing with chronic care policy makers are searching for effective interventions and strategies. These strategies can broadly be described within four categories. These are disease prevention and early detection, new providers, settings and qualifications, disease management programs and integrated care models.
+
+
+== Challenges ==
+One of the major problems from a health care system which is poorly coordinated for people with chronic conditions is the incidence of patients receiving conflicting advice from different providers. Patients will often be given prescriptions for medication that adversely interact with
+one another. One recent study estimated that more than 20% of older patients in the USA took at least one medication which could negatively impact another condition. This is referred to as therapeutic competition.
+Effective chronic care requires an information platform to track patients' status and ensure appropriate treatments are given.
+There is a recognised gap between treatment guidelines and current practice for chronic care. Individualised treatment plans are critical in treating chronic conditions because patients will place varying important on health outcomes. For example, some patients will fore-go complex, inconvenient medication regimes at the expense of quality of life.
+
+
+=== Multiple conditions ===
+One of the greatest challenges in this field of health care is dealing with the co-existence of multiple long-term conditions, also known as multimorbidity. There are few incentives within current health care systems to coordinate care across multiple providers and varying services. A 2001 survey by Mathematica Policy Research found that physicians feel they have inadequate training to deal with multiple chronic conditions. An increase in the number of chronic conditions correlates with an increase in the number of inappropriate hospitalizations. Self-management can be challenging because recommended activities for one condition may be made difficult because of another condition.
+
+
+== Approach ==
+
+Chronic care is a patient-based approach to provide chronically ill patients with the knowledge and resources to help them better understand their conditions and to help them to adhere with treatment for better outcomes. Chronic care patients may require the services of a variety of care providers, including dietitians, nutritionists, occupational therapists, nurses, behavioral care, pain management, surgery, and pastoral care. Working in collaboration with the patient, the chronic care provider coordinates care these and other specialist providers. Additionally, the patient may require palliative or hospice care, especially at end of life.
+
+
+== See also ==
+
+Chronic pain
+
+
+== References ==
+
+
+== External links ==
+As good as it gets? Chronic care management in nine leading US physician organisations - American Hospital Association Chronic Care Management
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+---
+title: "Chronic condition"
+chunk: 1/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+A chronic condition, also known as chronic disease or chronic illness, is a health condition or disease that is persistent or otherwise long-lasting in its effects. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes, functional gastrointestinal disorder, eczema, arthritis, asthma, chronic obstructive pulmonary disease, autoimmune diseases, genetic disorders and some viral diseases such as acquired immunodeficiency syndrome. Chronic illnesses are sometimes contrasted with terminal illnesses, which will end the affected person’s life. It is possible for an illness to change in definition from terminal to chronic as medicine progresses. For example, type 1 diabetes and HIV were once terminal, but are now considered chronic illnesses due to the availability of daily medications which allow these individuals to live while managing symptoms.
+In medicine, chronic conditions are distinguished from those that are acute. An acute condition typically affects a person for a few days to several weeks. On the other hand, a chronic condition persists for an extended period of time or is lifelong, even with treatment. Chronic conditions may have periods of remission, where a person has few or no symptoms, and relapse, where symptoms reappear. Periods of remission and relapse are commonly discussed when referring to substance abuse disorders, which some consider to fall under the category of chronic condition.
+Chronic conditions are often non-communicable diseases, which are not caused by an infection and cannot spread between people. However, some chronic conditions are caused by transmissible infections such as HIV/AIDS. 63% of all deaths worldwide are from chronic conditions. Chronic diseases constitute a major cause of mortality, and the World Health Organization (WHO) attributes 38 million deaths a year to non-communicable diseases. In the United States approximately 40% of adults have at least two chronic conditions. Having more than one chronic condition is referred to as multimorbidity.
+
+== Types ==
+
+Chronic conditions have often been used to describe the various health related states of the human body such as syndromes, physical impairments, disabilities as well as diseases. Epidemiologists have found interest in chronic conditions due to the fact they contribute to disease, disability, and diminished physical and/or mental capacity. For example, high blood pressure or hypertension is considered to be not only a chronic condition itself but also correlated with diseases such as heart attack or stroke. Researchers, particularly those studying the United States, utilize the Chronic Condition Indicator (CCI) which maps ICD codes as "chronic" or "non-chronic". The list below includes these chronic conditions and diseases. In 2015, the World Health Organization produced a report on non-communicable diseases, citing the four major types as:
+
+Cancers
+Cardiovascular diseases, including cerebrovascular disease, heart failure, and ischemic cardiopathy
+Chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD)
+Diabetes mellitus (type 1, type 2, pre-diabetes)
+Other examples of chronic diseases and health conditions include:
+
+Atrial fibrillation
+Atopic dermatitis
+Autoimmune diseases, such as lupus erythematosus, Crohn's disease, coeliac disease, psoriasis, and Hashimoto's thyroiditis
+Blindness
+Cerebral palsy
+Chronic hepatitis
+Chronic kidney disease
+Chronic osteoarticular diseases, such as osteoarthritis and rheumatoid arthritis
+Chronic pain syndromes such as complex regional pain syndrome
+Down syndrome
+Dwarfism
+Deafness
+Ehlers–Danlos syndrome
+Endometriosis
+Epilepsy
+Fetal alcohol spectrum disorder
+Fibromyalgia
+HIV/AIDS
+Hypertension
+Migraines
+Mental disorders such as anxiety disorder, depressive disorders, or substance use disorders
+Multiple sclerosis
+Myalgic encephalomyelitis (a.k.a. chronic fatigue syndrome)
+Narcolepsy
+Neurodevelopmental disorders such as ADHD and autism spectrum disorder
+Obesity
+Osteoporosis
+Parkinson's disease
+Polycystic Ovarian Syndrome
+Postural orthostatic tachycardia syndrome
+Prader-Willi Syndrome
+Sickle cell anemia and other hemoglobin disorders
+Sleep apnea
+Thyroid disease
+Tuberculosis
+Williams Syndrome
+
+== Risk factors ==
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+---
+title: "Chronic condition"
+chunk: 2/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+While risk factors vary, many common chronic diseases are caused by dietary, lifestyle, and metabolic risk factors. Therefore, these conditions might be prevented by behavioral changes, such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases. Social factors, e.g., socioeconomic status, education level, and race/ethnicity, are a major cause for the disparities observed in the care of chronic disease. Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations. Those barriers to medical care complicate patients monitoring and continuity in treatment. In the US, minorities and low-income populations are less likely to seek, access and receive preventive services necessary to detect conditions at an early stage.
+The majority of US health care and economic costs associated with medical conditions are incurred by chronic diseases and conditions and associated health risk behaviors. Eighty-four percent of all health care spending in 2006 was for the 50% of the population who have one or more common chronic medical conditions (CDC, 2014). There are several psychosocial risk and resistance factors among children with chronic illness and their family members. Adults with chronic illness were significantly more likely to report life dissatisfaction than those without chronic illness. Compared to their healthy peers, children with chronic illness have about a twofold increase in psychiatric disorders. Higher parental depression and other family stressors predicted more problems among patients. In addition, sibling problems along with the burden of illness on the family as a whole led to more psychological strain on the patients and their families.
+Africa
+African countries are currently grappling with a double health burden—while infectious diseases continue to be a major cause of death, chronic illnesses are increasingly becoming more deadly, particularly in sub-Saharan Africa. This region reports some of the highest chronic disease mortality rates globally, impacting both men and women alike. 
+The surge in chronic conditions such as diabetes, hypertension, and cardiovascular disease is being driven by poor lifestyle choices like unhealthy diets, physical inactivity, smoking, and obesity. These modifiable behaviors are becoming widespread across both rural and urban areas. In addition to lifestyle factors, genetics also plays a role in the region's chronic disease profile, particularly for conditions like high blood pressure and diabetes. Compounding the problem is the state of healthcare systems, which often lack the infrastructure, funding, and public awareness needed to respond effectively to this growing crisis.
+Asia
+Asia's chronic disease burden is rising sharply, driven by a mix of aging populations, genetic predispositions, and fast-paced urbanization. The transition to more sedentary lifestyles and Westernized diets brought on by industrialization and economic growth—has contributed significantly to the growing number of non-communicable diseases (NCDs). South Asians, in particular, are at greater risk, developing these conditions earlier in life and often at lower body weights compared to global norms, resulting in higher healthcare costs and lower productivity. Tobacco use remains a critical risk factor across South Asia, with a strong link to chronic illnesses. For instance, the Maldives has reported some of the highest rates of NCD-related deaths among women. Poor diets and smoking rank among the top contributors to early death and disability, made worse by limited access to healthcare and low levels of health awareness in many communities.
+Latin America and the Caribbean
+In Latin America and the Caribbean, changing lifestyles and environmental conditions are key contributors to the rise in chronic diseases. Many young people, including students, are engaging in habits such as poor nutrition, high consumption of processed foods and sugary drinks, and low levels of physical activity all of which increase their vulnerability to conditions like diabetes and heart disease. The region's rapid urban growth and influence from global food and media trends have also shifted daily routines toward more sedentary and unhealthy patterns. Combined with existing social and economic challenges, these changes are putting additional pressure on public health systems, underscoring the urgent need for prevention strategies and stronger public policies.
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+---
+title: "Chronic condition"
+chunk: 3/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+== Prevention ==
+A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. Clinical preventive services include screening for the existence of the disease or predisposition to its development, counseling and immunizations against infectious agents. Despite their effectiveness, the utilization of preventive services is typically lower than for regular medical services.  In contrast to their apparent cost in time and money, the benefits of preventive services are not directly perceived by patient because their effects are on the long term or might be greater for society as a whole than at the individual level.
+Public health programs are important in educating the public, and promoting healthy lifestyles and awareness about chronic diseases. While those programs can benefit from funding at different levels (state, federal, private) their implementation is mostly in charge of local agencies and community-based organizations. Studies have shown that public health programs are effective in reducing mortality rates associated to cardiovascular disease, diabetes and cancer, but the results are somewhat heterogeneous depending on the type of condition and the type of programs involved. For example, results from different approaches in cancer prevention and screening depended highly on the type of cancer.
+The rising number of patient with chronic diseases has renewed the interest in prevention and its potential role in helping control costs.  In 2008, the Trust for America's Health produced a report that estimated investing $10 per person annually in community-based programs of proven effectiveness and promoting healthy lifestyle (increase in physical activity, healthier diet and preventing tobacco use) could save more than $16 billion annually within a period of just five years.
+A 2017 review (updated in 2022) found that it is uncertain whether school-based policies on targeting risk factors on chronic diseases such as healthy eating policies, physical activity policies, and tobacco policies can improve student health behaviours or knowledge of staffs and students. The updated review in 2022 did determine a slight improvement in measures of obesity and physical activity as the use of improved strategies lead to increased implementation interventions but continued to call for additional research to address questions related to alcohol use and risk.  Encouraging those with chronic conditions to continue with their outpatient (ambulatory) medical care and attend scheduled medical appointments may help improve outcomes and reduce medical costs due to missed appointments. Finding patient-centered alternatives to doctors or consultants scheduling medical appointments has been suggested as a means of improving the number of people with chronic conditions that miss medical appointments, however there is no strong evidence that these approaches make a difference.
+
+== Nursing ==
+Nursing can play an important role in assisting patients with chronic diseases achieve longevity and experience wellness. Scholars point out that the current neoliberal era emphasizes self-care, in both affluent and low-income communities. This self-care focus extends to the nursing of patients with chronic diseases, replacing a more holistic role for nursing with an emphasis on patients managing their own health conditions. Critics note that this is challenging if not impossible for patients with chronic disease in low-income communities where health care systems, and economic and social structures do not fully support this practice.
+A study in Ethiopia showcases a nursing-heavy approach to the management of chronic disease. Foregrounding the problem of distance from healthcare facility, the study recommends patients increase their request for care. It uses nurses and health officers to fill, in a cost-efficient way, the large unmet need for chronic disease treatment. They led their health centers staffed by nurses and health officers; so, there are specific training required for involvement in the programmed must be carried out regularly, to ensure that new staff is educated in administering chronic disease care. The program shows that community-based care and education, primarily driven by nurses and health officers, works. It highlights the importance of nurses following up with individuals in the community, and allowing nurses flexibility in meeting their patients' needs and educating them for self-care in their homes.
+
+== Epidemiology ==
+The epidemiology of chronic disease is diverse and the epidemiology of some chronic diseases can change in response to new treatments.  In the treatment of HIV, the success of anti-retroviral therapies means that many patients will experience this infection as a chronic disease that for many will span several decades of their chronic life. Some epidemiology of chronic disease can apply to multiple diagnosis.  Obesity and body fat distribution for example contribute and are risk factors for many chronic diseases such as diabetes, heart, and kidney disease. 
+Other epidemiological factors, such as social, socioeconomic, and environment do not have a straightforward cause and effect relationship with chronic disease diagnosis. While typically higher socioeconomic status is correlated with lower occurrence of chronic disease, it is not known is there is a direct cause and effect relationship between these two variables. The epidemiology of communicable chronic diseases such as AIDS is also different from that of noncommunicable chronic disease.  While Social factors do play a role in AIDS prevalence, only exposure is truly needed to contract this chronic disease. Communicable chronic diseases are also typically only treatable with medication intervention, rather than lifestyle change as some non-communicable chronic diseases can be treated.
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+---
+title: "Chronic condition"
+chunk: 4/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+=== United States ===
+As of 2003, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection.  The hope of these programs is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease. In the United States, as of 2004 nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64. The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. The most common chronic conditions are high blood pressure, arthritis, respiratory diseases like emphysema, and high cholesterol.
+Based on data from 2014 Medical Expenditure Panel Survey (MEPS), about 60% of adult Americans were estimated to have one chronic illness, with about 40% having more than one; this rate appears to be mostly unchanged from 2008. MEPS data from 1998 showed 45% of adult Americans had at least one chronic illness, and 21% had more than one. According to research by the CDC, chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population. It is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions. The two most common chronic conditions in the elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population.
+In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer's disease. Though the rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups. Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer's disease, mental illness and kidney diseases) were six of the top ten causes of mortality in the general US population.
+
+=== Canada ===
+The government of Canada put a high emphasis on chronic conditions in the country. At least 45.1% of Canadians will experience one chronic condition in their lifetime. On 11 December 2024, Sun Life, a prominent health insurance provider in Canada, reported an increase in chronic diseases across all age groups. They emphasize that chronic conditions affect both young individuals and the elderly. Sun Life highlights that a growing number of young people are facing chronic issues such as diabetes, asthma, high blood pressure, and elevated cholesterol levels. The report examined drug claims for chronic conditions from over three million Sun Life plan members.
+Diabetes is one of the fastest-growing chronic conditions in Canada, having increased by approximately 30% from 2019 to 2023. Claims for diabetes medications have surged more rapidly among Canadians under the age of 30. Chronic diseases are prevalent among older Canadians. A report indicates that 73% of individuals aged 65 and older have at least one of ten common chronic conditions. The ten most frequent chronic diseases in Canada include hypertension, affecting 65.7% of the elderly, periodontal disease at 52.0%, osteoarthritis at 38.0%, ischemic heart disease at 27.0%, diabetes at 26.8%, osteoporosis at 25.1%, cancer at 21.5%,  COPD at 20.2%, asthma at 10.7%, and mood and anxiety disorders at 10.5%. Additionally, COVID-19 has impacted chronic conditions in seniors, and its effects are currently being studied.
+
+== Economic impact ==
+
+=== United States ===
+Chronic diseases are a major factor in the continuous growth of medical care spending. In 2002, the U.S. Department of Health and Human Services stated that the health care for chronic diseases cost the most among all health problems in the U.S. Healthy People 2010 reported that more than 75% of the $2 trillion spent annually in U.S. medical care are due to chronic conditions; spending are even higher in proportion for Medicare beneficiaries (aged 65 years and older). Furthermore, in 2017 it was estimated that 90% of the $3.3 billion spent on healthcare in the United States was due to the treatment of chronic diseases and conditions. Spending growth is driven in part by the greater prevalence of chronic illnesses and the longer life expectancy of the population. Also, improvement in treatments has significantly extended the lifespans of patients with chronic diseases but results in additional costs over long period of time. A striking success is the development of combined antiviral therapies that led to remarkable improvement in survival rates and quality of life of HIV-infected patients.
+In addition to direct costs in health care, chronic diseases are a significant burden to the economy, through limitations in daily activities, loss in productivity and loss of days of work. A particular concern is the rising rates of overweight and obesity in all segments of the U.S. population. Obesity itself is a medical condition and not a disease, but it constitutes a major risk factor for developing chronic illnesses, such as diabetes, stroke, cardiovascular disease and cancers. Obesity results in significant health care spending and indirect costs, as illustrated by a recent study from the Texas comptroller reporting that obesity alone cost Texas businesses an extra $9.5 billion in 2009, including more than $4 billion for health care, $5 billion for lost productivity and absenteeism, and $321 million for disability.
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+---
+title: "Chronic condition"
+chunk: 5/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+=== Canada ===
+The Public Health Agency of Canada states that chronic disease has a negative impact on the labor force participant of individuals. In particular, people with chronic diseases "are likely to have recurrent sick leave, long-term absences from work, and often face an early retirement from the labour force." In 2000, the Public Health Agency of Canada stated that the total economic burden of arthritis totaled 6.4 billion Canadian dollars per year, representing 28.9% of all musculoskeletal disease expenditures. 65% of the total economic cost was incurred by those aged 35-64 years old. It is anticipated that people aged 55 and older will most significantly contribute to the prevalence of arthritis. This is projected to result in reduced labor force participant and a substantial increase in morbidity costs. The Public Health Agency of Canada recommends focusing on prevention strategies, minimizing costs by improving health and reducing disability, and providing support to people with arthritis to remain active in the workforce.
+
+=== Japan ===
+As of 2004, the estimated economic burden of Chronic obstructive pulmonary disease (COPD) is 805.5 billion yen per year. Direct costs, which include inpatient care, outpatient care, and home oxygen therapy, account for 645.1 billion yen per year. Meanwhile, indirect costs are estimated to cost 160.4 billion yen per year in lost productivity due to absenteeism from work. The high smoking rate and increasing size of the elderly population are likely to exacerbate the economic impact of COPD in Japan. Major indirect costs of COPD are a decrease in labor force participation, increased cost of healthcare due to assisted living expenses, increased prevalence of premature death, and care giver support cost. In 1999, a survey demonstrated that patients with chronic bronchitis, COPD, or emphysema missed an average of 42.2 days of work per year due to their condition.
+
+== Social and personal impact ==
+There have been recent links between social factors and prevalence as well as outcome of chronic conditions.
+
+=== Mental health ===
+The connection between loneliness, overall health, and chronic conditions has recently been highlighted.  Some studies have shown that loneliness has detrimental health effects similar to that of smoking and obesity.  One study found that feelings of isolation are associated with higher self reporting of health as poor, and feelings of loneliness increased the likelihood of mental health disorders in individuals. The connection between chronic illness and loneliness is established, yet oftentimes ignored in treatment.  One study for example found that a greater number of chronic illnesses per individual were associated with feelings of loneliness.  Some of the possible reasons for this listed are an inability to maintain independence as well as the chronic illness being a source of stress for the individual.  A study of loneliness in adults over age 65 found that low levels of loneliness as well as high levels of familial support were associated with better outcomes of multiple chronic conditions such as hypertension and diabetes.
+There are some recent movements in the medical sphere to address these connections when treating patients with chronic illness.  The biopsychosocial approach for example, developed in 2006 focuses on patients "patient's personality, family, culture, and health dynamics."  Physicians are leaning more towards a psychosocial approach to chronic illness to aid the increasing number of individuals diagnosed with these conditions.  Despite this movement, there is still criticism that chronic conditions are not being treated appropriately, and there is not enough emphasis on the behavioral aspects of chronic conditions or psychological types of support for patients.
+The mental health intersectionality on those with chronic conditions is a large aspect often overlooked by doctors. And chronic illness therapists are available for support to help with the mental toll of chronic illness as it is often underestimated in society. Adults with chronic illness that restrict their daily life present with more depression and lower self-esteem than healthy adults and adults with non-restricting chronic illness. The emotional influence of chronic illness also has an effect on the intellectual and educational development of the individual. For example, people living with type 1 diabetes endure a lifetime of monotonous and rigorous health care management usually involving daily blood glucose monitoring, insulin injections, and constant self-care. This type of constant attention that is required by type 1 diabetes and other chronic illness can result in psychological maladjustment. There have been several theories, namely one called diabetes resilience theory, that posit that protective processes buffer the impact of risk factors on the individual's development and functioning.
+
+=== Financial cost ===
+People with chronic conditions pay more out-of-pocket; a study found that Americans spent $2,243 more on average. The financial burden can increase medication non-adherence. In some countries, laws protect patients with chronic conditions from excessive financial responsibility; for example, as of 2008 France limited copayments for those with chronic conditions, and Germany limits cost sharing to 1% of income versus 2% for the general public. Within the medical-industrial complex, chronic illnesses can impact the relationship between pharmaceutical companies and people with chronic conditions. Life-saving drugs, or life-extending drugs, can be inflated for a profit. There is little regulation on the cost of chronic illness drugs, which suggests that abusing the lack of a drug cap can create a large market for drug revenue. Likewise, certain chronic conditions can last throughout one's lifetime and create pathways for pharmaceutical companies to take advantage of this.
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+---
+title: "Chronic condition"
+chunk: 6/6
+source: "https://en.wikipedia.org/wiki/Chronic_condition"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:07.415511+00:00"
+instance: "kb-cron"
+---
+
+=== Gender ===
+Gender influences how chronic disease is viewed and treated in society.  Women's chronic health issues are often considered to be most worthy of treatment or most severe when the chronic condition interferes with a woman's fertility.  Historically, there is less of a focus on a woman's chronic conditions when it interferes with other aspects of her life or well-being.  Many women report feeling less than or even "half of a woman" due to the pressures that society puts on the importance of fertility and health when it comes to typically feminine ideals.  These kinds of social barriers interfere with women's ability to perform various other activities in life and fully work toward their aspirations.
+
+=== Socioeconomic class and race ===
+Race is also implicated in chronic illness, although there may be many other factors involved.  Racial minorities are 1.5-2 times more likely to have most chronic diseases than white individuals.  Non-Hispanic blacks are 40% more likely to have high blood pressure that non-Hispanic whites, diagnosed diabetes is 77% higher among non-Hispanic blacks, and American Indians and Alaska Natives are 60% more likely to be obese than non-Hispanic whites.  Some of this prevalence has been suggested to be in part from environmental racism.  Flint, Michigan, for example, had high levels of lead poisoning in their drinkable water after waste was dumped into low-value housing areas.  There are also higher rates of asthma in children who live in lower income areas due to an abundance of pollutants being released on a much larger scale in these areas.
+
+== Advocacy and research organizations ==
+In Europe, the European Chronic Disease Alliance was formed in 2011, which represents over 100,000 healthcare workers. In the United States, there are a number of nonprofits focused on chronic conditions, including entities focused on specific diseases such as the American Diabetes Association, Alzheimer's Association, or Crohn's and Colitis Foundation. There are also broader groups focused on advocacy or research into chronic illness in general, such as the National Association of Chronic Disease Directors, Partnership to Fight Chronic Disease, the Chronic Disease Coalition which arose in Oregon in 2015, and the Chronic Policy Care Alliance.
+
+== See also ==
+Chronic care management
+Chronic disease in China
+Chronic disease in Northern Ontario
+Chronic Illness (journal)
+Chronic pain
+Long COVID
+Course (medicine)
+Disability studies
+Disease management (health)
+Dynamic treatment regimes
+Medical tattoo
+Multimorbidity
+Natural history of disease
+Virtual Wards (a UK term)
+
+== References ==
+
+== Further reading ==
+
+== External links ==
+
+"List of Chronic Human Diseases Linked to Infectious Pathogens". Archived from the original on 18 January 2021.
+Center for Managing Chronic Disease, University of Michigan
+CHRODIS: EU Joint Action on Chronic Diseases and Promoting Healthy Ageing Across the Life-Cycle
+MEDICC Review theme issue on Confronting Chronic Diseases With longer life expectancies in most countries and the globalization of "Western" diets and sedentarism, the main burden of disease and death from these conditions is falling on already-disadvantaged developing countries and poor communities everywhere.
+Public Health Agency of Canada: Chronic Disease
+World Health Organization: Chronic Disease and Health Promotion
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diff --git a/data/en.wikipedia.org/wiki/Clinical_formulation-0.md b/data/en.wikipedia.org/wiki/Clinical_formulation-0.md
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+---
+title: "Clinical formulation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Clinical_formulation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:09.793793+00:00"
+instance: "kb-cron"
+---
+
+A clinical formulation, also known as case formulation, case conceptualisation, and problem formulation, is a theoretically based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide a framework for developing the most suitable treatment approach. It is most commonly used by mental health professionals and is deemed to be a core component of that profession. Clinical psychologists, mental health nurses, social workers, and some psychiatrists use this formulation based on specific psychological frameworks.
+
+
+== Types of formulation ==
+Different psychological schools or models utilize clinical formulations, including cognitive behavioral therapy (CBT) and related therapies: systemic therapy, psychodynamic therapy, and applied behavior analysis. The structure and content of a clinical formulation is determined by the psychological model. Most systems of formulation contain the following broad categories of information: symptoms and problems; precipitating stressors or events; predisposing life events or stressors; and an explanatory mechanism that links the preceding categories together and offers a description of the precipitants and maintaining influences of the person's problems.
+Behavioral case formulations used in applied behavior analysis and behavior therapy are built on a rank list of problem behaviors, from which a functional analysis is conducted, sometimes based on relational frame theory. Such functional analysis is also used in third-generation behavior therapy or clinical behavior analysis such as acceptance and commitment therapy and functional analytic psychotherapy. Functional analysis looks at setting events (ecological variables, history effects, and motivating operations), antecedents, behavior chains, the problem behavior, and the consequences, short- and long-term, for the behavior.
+A model of formulation that is more specific to CBT is described by Jacqueline Persons. This has seven components: problem list, core beliefs, precipitants and activating situations, origins, working hypothesis, treatment plan, and predicted obstacles to treatment.
+A psychodynamic formulation would consist of a summarizing statement, a description of nondynamic factors, description of core psychodynamics using a specific model (such as ego psychology, object relations or self psychology), and a prognostic assessment which identifies the potential areas of resistance in therapy.
+One school of psychotherapy which relies heavily on the formulation is cognitive analytic therapy (CAT). CAT is a fixed-term therapy, typically of around 16 sessions. At around session four, a formal written reformulation letter is offered to the patient which forms the basis for the rest of the treatment. This is usually followed by a diagrammatic reformulation to amplify and reinforce the letter.
+Many psychologists use an integrative psychotherapy approach to formulation. This is to take advantage of the benefits of resources from each model the psychologist is trained in, according to the patient's needs.
+
+
+== Critical evaluation of formulations ==
+The quality of specific clinical formulations, and the quality of the general theoretical models used in those formulations, can be evaluated with criteria such as:
+
+Clarity and parsimony: Is the model understandable and internally consistent, and are key concepts discrete, specific, and non-redundant?
+Precision and testability: Does the model produce testable hypotheses, with operationally defined and measurable concepts?
+Empirical adequacy: Are the posited mechanisms within the model empirically validated?
+Comprehensiveness and generalizability: Is the model holistic enough to apply across a range of clinical phenomena?
+Utility and applied value: Does it facilitate shared meaning-making between clinician and client, and are interventions based on the model shown to be effective?
+Formulations can vary in temporal scope from case-based to episode-based or moment-based, and formulations may evolve during the course of treatment. Therefore, ongoing monitoring, testing, and assessment during treatment are necessary: monitoring can take the form of session-by-session progress reviews using quantitative measures, and formulations can be modified if an intervention is not as effective as hoped.
+
+
+== History ==
+Psychologist George Kelly, who developed personal construct theory in the 1950s, noted his complaint against traditional diagnosis in his book The Psychology of Personal Constructs (1955): "Much of the reform proposed by the psychology of personal constructs is directed towards the tendency for psychologists to impose preemptive constructions upon human behaviour. Diagnosis is all too frequently an attempt to cram a whole live struggling client into a nosological category." In place of nosological categories, Kelly used the word "formulation" and mentioned two types of formulation: a first stage of structuralization, in which the clinician tentatively organizes clinical case information "in terms of dimensions rather than in terms of disease entities" while focusing on "the more important ways in which the client can change, and not merely ways in which the psychologist can distinguish him from other persons", and a second stage of construction, in which the clinician seeks a kind of negotiated integration of the clinician's organization of the case information with the client's personal meanings.
+Psychologists Hans Eysenck, Monte B. Shapiro, Vic Meyer, and Ira Turkat were also among the early developers of systematic individualized alternatives to diagnosis. Meyer has been credited with providing perhaps the first training course of behaviour therapy based on a case formulation model, at the Middlesex Hospital Medical School in London in 1970. Meyer's original choice of words for clinical formulation were "behavioural formulation" or "problem formulation".
+
+
+== Data-Informed Clinical Formulation ==
+Modern approaches to clinical formulation increasingly emphasize the use of routine outcome measurement (ROM) to validate and refine case conceptualizations. By integrating Feedback-Informed Treatment (FIT) into the formulation process, supervisors can help trainees use self-report inventories (such as the Outcome Rating Scale) to test their clinical hypotheses and measure clinical progress. This iterative process allows for a more responsive treatment plan that can be adjusted if the client's progress deviates from the formulated trajectory. Some clinical supervisor training programs integrate data-informed clinical formulation protocols, leading to more accurate and effective clinical formulations.
+
+
+== See also ==
+
+
+== References ==
+
+
+== Further reading ==
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diff --git a/data/en.wikipedia.org/wiki/Clinical_pathway-0.md b/data/en.wikipedia.org/wiki/Clinical_pathway-0.md
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+---
+title: "Clinical pathway"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Clinical_pathway"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:10.961778+00:00"
+instance: "kb-cron"
+---
+
+A clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is one of the main tools used to manage the quality in healthcare concerning the standardisation of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways aim to promote organised and efficient patient care based on evidence-based medicine, and aim to optimise outcomes in settings such as acute care and home care. A single clinical pathway may refer to multiple clinical guidelines on several topics in a well specified context.
+
+
+== Definition ==
+A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare). Outcomes are tied to specific interventions.
+The concept of clinical pathways may have different meanings to different stakeholders. Managed care organizations often view clinical pathways in a similar way as they view care plans, in which the care provided to a patient is definitive and deliberate. Clinical pathways can range in scope from simple medication utilization to a comprehensive treatment plan. Clinical pathways aim for greater standardization of treatment regimens and sequencing as well as improved outcomes, from both a quality of life and a clinical outcomes perspective.
+
+
+== History ==
+The clinical pathway concept appeared for the first time at the New England Medical Center (Boston, United States) in 1985, inspired by Karen Zander and Kathleen Bower. Clinical pathways appeared as a result of the adaptation of the documents used in industrial quality management, the standard operating procedures (SOPs), whose goals are:
+
+Improve efficiency in the use of resources.
+Finish work in a set time.
+
+
+== Characteristics ==
+Clinical pathways (integrated care pathways) can be seen as an application of process management thinking to the improvement of patient healthcare. An aim is to re-center the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently. Instead, all are emphasised to be working together, in the same way as a cross-functional team.
+More than just a guideline or a protocol, a care pathway is typically recorded in a single all-encompassing bedside document that will stand as an indicator of the care a patient is likely to be provided in the course of the pathway going forward; and ultimately as a single unified legal record of the care the patient has received, and the progress of their condition, as the pathway has been undertaken.
+The pathway design tries to capture the foreseeable actions which will most commonly represent best practice for most patients most of the time, and include prompts for them at the appropriate time in the pathway document to ascertain whether they have been carried out, and whether results have been as expected. In this way results are recorded, and important questions and actions are not overlooked. However, pathways are typically not prescriptive; the patient's journey is an individual one, and an important part of the purpose of the pathway documents is to capture information on "variances", where due to circumstances or clinical judgment different actions have been taken, or different results unfolded. The combined variances for a sufficiently large population of patients are then analysed to identify important or systematic features, which can be used to improve the next iteration of the pathway.
+
+
+== Selection criteria ==
+The following signals may indicate that it may be useful to commit resources to establish and implement a clinical pathway for a particular condition:
+
+Prevalent pathology within the care setting
+Pathology with a significant risk for patients
+Pathology with a high cost for the hospital
+Predictable clinical course
+Pathology well defined and that permits homogeneous care
+Existence of recommendations of good practices or experts opinions
+Unexplained variability of care
+Possibility of obtaining professional agreement
+Multidisciplinary implementation
+Motivation by professionals to work on a specific condition
+
+
+== Examples ==
+Liverpool Care Pathway for the Dying Patient
+
+
+== See also ==
+Clinical formulation
+European Pathway Association
+Health economics
+Medical case management
+Nursing care plan
+
+
+== References ==
+
+
+== Further reading ==
+
+
+== External links ==
+"Clinical Pathways Congress". clinicalpathwayscongress.com. Retrieved 12 October 2017.
+"European Pathway Association". e-p-a.org. Retrieved 12 October 2017.
+"HealthPathways Community, New Zealand". healthpathwayscommunity.org. Retrieved 12 October 2017.
+"Journal of Clinical Pathways". journalofclinicalpathways.com. Retrieved 12 October 2017.
+"International Journal of Care Coordination (formerly published as the International Journal of Care Pathways)". icp.sagepub.com. Retrieved 12 October 2017. ISSN 2053-4345, 2053-4353
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diff --git a/data/en.wikipedia.org/wiki/Clinical_research_center-0.md b/data/en.wikipedia.org/wiki/Clinical_research_center-0.md
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+---
+title: "Clinical research center"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Clinical_research_center"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:12.161397+00:00"
+instance: "kb-cron"
+---
+
+The term "Clinical research center" (CRC) or "General clinical research center" (GCRC) refers to any designated medical facility used to conduct clinical research, such as at a hospital or medical clinic. They have been used to perform clinical trials of various medical procedures. The medical profession has had specific uses for CRC facilities, including awarding grants to support various types of research.
+For example, the U.S. National Institutes of Health had, for years, issued GCRC grants, but later changed to awarding a Clinical and Translational Science Award (CTSA). Many hospitals or clinics have included a wing, ward, or other area titled as "Clinical Research Center" (with capitalized words).
+
+
+== Example facilities ==
+Some examples of CRC facilities are:
+
+Harvard-Thorndike General Clinical Research Center in Massachusetts.
+Mallinckrodt General Clinical Research Center in Massachusetts.
+Mark O. Hatfield Clinical Research Center in Maryland.
+UCLA General Clinical Research Center in California.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Clinical_supervision-0.md b/data/en.wikipedia.org/wiki/Clinical_supervision-0.md
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+---
+title: "Clinical supervision"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Clinical_supervision"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:13.366942+00:00"
+instance: "kb-cron"
+---
+
+Supervision is used in counselling, psychotherapy, and other mental health disciplines as well as many other professions engaged in working with people. Supervision may be applied as well to practitioners in somatic disciplines for their preparatory work for patients as well as collateral with patients. Supervision is a replacement instead of formal retrospective inspection, delivering evidence about the skills of the supervised practitioners.
+It consists of the practitioner meeting regularly with another professional, not necessarily more senior, but normally with training in the skills of supervision, to discuss casework and other professional issues in a structured way. This is often known as clinical or counselling supervision (consultation differs in being optional advice from someone without a supervisor's formal authority). The purpose is to assist the practitioner to learn from his or her experience and progress in expertise, as well as to ensure good service to the client or patient. Learning shall be applied to planning work as well as to diagnostic work and therapeutic work.
+Derek Milne defined clinical supervision as: "The formal provision, by approved supervisors, of a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s". The main methods that supervisors use are corrective feedback on the supervisee's performance, teaching, and collaborative goal-setting. It therefore differs from related activities, such as mentoring and coaching, by incorporating an evaluative component. Supervision's objectives are "normative" (e.g. quality control), "restorative" (e.g. encourage emotional processing) and "formative" (e.g. maintaining and facilitating supervisees' competence, capability and general effectiveness).
+Some practitioners (e.g. art, music and drama therapists, chaplains, psychologists, and mental health occupational therapists) have used this practice for many years. In other disciplines the practice may be a new concept. For NHS nurses, the use of clinical supervision is expected as part of good practice. In a randomly controlled trial in Australia, White and Winstanley looked at the relationships between supervision, quality of nursing care and patient outcomes, and found that supervision had sustainable beneficial effects for supervisors and supervisees. Waskett believes that maintaining the practice of clinical supervision always requires managerial and systemic backing, and has examined the practicalities of introducing and embedding clinical supervision into large organisations such as NHS Trusts (2009, 2010). Clinical supervision has some overlap with managerial activities, mentorship, and preceptorship, though all of these end or become less direct as staff develop into senior and autonomous roles.
+Key issues around clinical supervision in healthcare raised have included time and financial investment. It has however been suggested that quality improvement gained, reduced sick leave and burnout, and improved recruitment and retention make the process worthwhile.
+
+== United Kingdom ==
+Clinical supervision is used in many disciplines in the British National Health Service. Registered allied health professionals such as occupational therapists, physiotherapists, dieticians, speech and language therapists and art, music and drama therapists are now expected to have regular clinical supervision. C. Waskett (2006) has written on the application of solution focused supervision skills to either counselling or clinical supervision work. Practising members of the British Association for Counselling and Psychotherapy are bound to have supervision for at least 1.5 hours a month. Students and trainees must have it at a rate of one hour for every eight hours of client contact.
+The concept is also well used in psychology, social work, the probation service and at other workplaces.
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diff --git a/data/en.wikipedia.org/wiki/Clinical_supervision-1.md b/data/en.wikipedia.org/wiki/Clinical_supervision-1.md
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+---
+title: "Clinical supervision"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Clinical_supervision"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:13.366942+00:00"
+instance: "kb-cron"
+---
+
+== Models or approaches ==
+There are many different ways of developing supervision skills which can be helpful to the clinician or practitioner in their work. Specific models or approaches to both counselling supervision and clinical supervision come from different historical strands of thinking and beliefs about relationships between people. A few examples are given below.
+Peter Hawkins (1985) developed an integrative process model which is used internationally in a variety of helping professions. His "Seven Eyed model of Supervision" was further developed by Peter Hawkins along with Robin Shohet, Judy Ryde and Joan Wilmot in "Supervision in the Helping Professions" (1989, 2000 and 2006 and 2012) and with Nick Smith in "Coaching, Mentoring and organisational Consultancy: Supervision and Development" (2006 and 2013) and is taught on the courses of the Centre for Supervision and Team Development as well as many other supervision training courses.
+S. Page and V. Wosket describe a cyclical structure.
+F. Inskipp and B. Proctor (1993, 1995) developed an approach based on the normative, formative and restorative elements of the relationship between supervisor and supervisee. The Brief Therapy practice teaches a solution focused approach based on the work of Steve de Shazer and Insoo Kim Berg which uses the concepts of respectful curiosity, the preferred future, recognition of strengths and resources, and the use of scaling to assist the practitioner to progress (described in ). Waskett has described teaching solution-focused supervision skills to a variety of professionals
+Evidence-based CBT supervision is a distinctive and recent model that is based on cognitive-behaviour therapy (CBT), enhanced by relevant theories (e.g. experiential learning theory), expert consensus statements, and on applied research findings (Milne & Reiser, 2017). It is therefore an example of evidence-based practice, applied to supervision. CBT supervision meets the general definition of clinical supervision, adding some distinctive features that reflect CBT as a therapy. This includes a high degree of session structure and direction (e.g. detailed agenda-setting), but within a fundamentally collaborative relationship. Also, there is a primary emphasis on cognitive case conceptualization, mainly through the use of case discussion, intended to develop diagrammatic CBT formulations. But discussion should properly be combined with other CBT techniques, including Socratic questioning, guided discovery, educational role-play, behavioural rehearsal, and corrective feedback. Another distinctive aspect is a focus on evidence-based principles and methods, including the use of reliable instruments for feedback and evaluation, in relation to both therapy and supervision. Perhaps the single most defining characteristic of evidence-based CBT supervision is the active and routine commitment to research methods and findings: where other approaches refer to theory and clinical/supervisory experience for guidance, evidence-based CBT supervision appeals ultimately to 'the data'. Examples of the use of relevant theories, expert consensus statements and research, together with six formally-developed supervision guidelines (illustrated through video clips), can be found in Milne & Reiser (2017).
+Deliberate practice supervision is a focused and structured approach where therapists continuously work on refining specific skills through targeted exercises and feedback. Supervisors help identify areas for improvement, set clear objectives, and provide real-time, constructive feedback. Based on the work of K. Anders Ericsson, deliberate practice supervision emphasizes repetitive practice and reflection to enhance clinical effectiveness and adaptability, ultimately aiming to bridge the gap between current capabilities and desired performance levels in therapeutic settings. Over 20 peer-reviewed empirical studies have examined the process and outcome of deliberate practice supervision. A review published in 2024 described two major models of deliberate practice supervision. The Better Results model, created by Scott Miller, Mark Hubble, and Daryl Chow, uses data from Feedback Informed Treatment to guide deliberate practice supervision.  The Sentio Supervision Model, created by the Sentio Marriage and Family Therapy MA program in California, systematically integrates psychotherapy skill building with the use of clinical videos and outcome data to increase trainees' clinical competence and confidence.
+Developmental models of supervision view supervisees as progressing through distinct stages of professional growth, requiring different types of supervision at each stage. Stoltenberg & Delworth’s Integrated Developmental Model (IDM) proposes three levels of supervisee development (beginner, intermediate, advanced), each with increasing autonomy and complexity in clinical skills. Loganbill, Hardy, & Delworth's developmental model describes cycles of stagnation, confusion, and integration as supervisees develop. 
+In the Discrimination Model of supervision by Janine Bernard, supervisors take on three roles: Teacher (instructing and guiding), Counselor (helping with emotional reactions), and Consultant (collaborative problem-solving), and focus on three skill areas: Process (e.g., interpersonal dynamics), Conceptualization (understanding client issues), and Personalization (how the therapist uses themselves in therapy).
+
+== Research on the effectiveness of supervision ==
+Some studies have suggested that supervision may improve clinical effectiveness. Other studies have raised questions about the effectiveness of supervision. Three literature reviews of research in this topic raised concerns about the reliability of these findings and voiced caution in assuming that supervision may improve clinical effectiveness.   
+
+== Training in supervision ==
+Counselling or clinical supervisors will be experienced in their discipline and normally then have further training in any of the above-mentioned approaches, or others. The guidelines of the American Psychological Association, American Counseling Association, and American Association for Marriage and Family Therapists provide standards for supervisor competence and training. There are many different ways of developing supervision skills which can be helpful to the clinician or practitioner in their work. Training programs in psychology, counseling, social work, and other allied fields often provide graduate-level coursework in supervision. Post-graduate supervisor training is also offered, often by non-profit organizations. For example, the non-profit Sentio Counseling Center offers a one-year Deliberate Practice supervisor training program  that provides over 50 hours of video-based training in Deliberate Practice supervision methods, aiming to enhance supervisory skills through close mentorship with experienced trainers.  
+
+== See also ==
+The works of Lawrence Shulman
+Behavioral psychotherapy
+
+== References ==
+
+=== Citations ===
+
+=== Sources ===
+
+== External links ==
+Clinical Supervision for Nurses and Allied Health Professionals: the 4S Model
+Models of Clinical Supervision
+Implementing clinical supervision in healthcare https://web.archive.org/web/20170916091813/http://www.supervisionandcoaching.com/
+Clinical Supervision: 8 Answers to Common Questions and 1 Nobody Knows (But Should) https://therapyinsd.com/mft-lcsw-supervision-8-answers-to-common-questions-and-1-nobody-asks-but-should/
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diff --git a/data/en.wikipedia.org/wiki/Clinophilia-0.md b/data/en.wikipedia.org/wiki/Clinophilia-0.md
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+---
+title: "Clinophilia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Clinophilia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:14.564316+00:00"
+instance: "kb-cron"
+---
+
+In medicine, clinophilia is a sleep disorder described as the tendency of a patient to remain in bed in a reclined position without sleeping for prolonged periods of time.
+
+
+== Etymology and consequences ==
+The word clinophilia means "liking to lie down" (from the Greek clino- 'lying down' and -philia 'love').
+It is one of the first symptoms of depression or schizophrenia, but is not in itself a disease. Clinophiliacs generally experience feelings of isolation and repressed sadness.
+
+
+== Description ==
+This is a psychologically based disorder sometimes found in depression or certain forms of schizophrenia. Clinophiles generally feel lonely. Care must be taken not to confuse this disorder with true hypersomnia, since in the latter patients sleep genuinely and very deeply, whereas in clinophilia, the long sleep times patients may describe are not objectively present. In clinophilia, if patients complain of oversleeping, this is due to psychic problems and not to a physiological defect in the wake/sleep system, as in idiopathic hypersomnia or narcolepsy. Similarly, it should not be confused with dysania, which describes a difficulty in getting out of bed, whereas clinophilia does not describe an "impediment" to getting up, but rather a "willingness" to lie down.
+Clinophilia can also accompany a post-fall syndrome as part of an overall psychomotor regression in the elderly. Although it can affect anyone, clinophilia seems to be more prevalent in women aged between 20 and 40 (particularly after major hormonal changes) and in the elderly.
+
+
+== See also ==
+Bed rotting
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cluttering-0.md b/data/en.wikipedia.org/wiki/Cluttering-0.md
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+---
+title: "Cluttering"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cluttering"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:15.816505+00:00"
+instance: "kb-cron"
+---
+
+Cluttering is a speech and communication disorder characterized by a rapid rate of speech, erratic rhythm, and poor syntax or grammar, making speech difficult to understand.
+
+
+== Classification ==
+Cluttering is a speech and communication disorder that has also been described as a fluency disorder.
+It is defined as:
+
+Cluttering is a fluency disorder characterized by a rate that is perceived to be abnormally rapid, irregular, or both for the speaker (although measured syllable rates may not exceed normal limits). These rate abnormalities further are manifest in one or more of the following symptoms: (a) an excessive number of disfluencies, the majority of which are not typical of people with stuttering; (b) the frequent placement of pauses and use of prosodic patterns that do not conform to syntactic and semantic constraints; and (c) inappropriate (usually excessive) degrees of coarticulation among sounds, especially in multisyllabic words.
+
+
+== Signs and symptoms ==
+Cluttering is sometimes confused with stuttering. Both communication disorders break the normal flow of speech, but they are distinct. A stutterer has a coherent pattern of thoughts, but may have a difficult time vocally expressing those thoughts; in contrast, a clutterer has no problem putting thoughts into words, but those thoughts become disorganized during speaking. Cluttering affects not only speech, but also thought patterns, writing, typing, and conversation.
+Stutterers are usually dysfluent on initial sounds, when beginning to speak, and become more fluent towards the ends of utterances. In contrast, clutterers are most clear at the start of utterances, but their speaking rate increases and intelligibility decreases towards the end of utterances.
+Stuttering is characterized by struggle behavior, such as overtense speech production muscles. Cluttering, in contrast, is effortless.  Cluttering is also characterized by slurred speech, especially dropped or distorted /r/ and /l/ sounds; and monotone speech that starts loud and trails off into a murmur.
+A clutterer described the feeling associated with a clutter as:
+
+It feels like 1) about twenty thoughts explode on my mind all at once, and I need to express them all, 2) that when I'm trying to make a point, that I just remembered something that I was supposed to say, so the person can understand, and I need to interrupt myself to say something that I should have said before, and 3) that I need to constantly revise the sentences that I'm working on, to get it out right.
+
+
+== Differential diagnosis ==
+Cluttering can often be confused with various language disorders, learning disabilities, and attention deficit hyperactivity disorder (ADHD).  Clutterers often have reading and writing disabilities, especially sprawling, disorderly handwriting, which poorly integrate ideas and space. It can occur with Parkinson's disease.
+
+
+== Treatment ==
+The common goals of treatment for cluttering include slowing the rate of speech, heightening monitoring, using clear articulation, using acceptable and organized language, interacting with listeners, speaking naturally, and reducing excessive disfluencies.
+Slowing the rate of speech can help many of the symptoms of cluttering, and can be achieved in a couple of different ways. It is important that speech language pathologists do not nag their clients to "slow down" incessantly, as this does not help and can actually hinder progress. Additionally, it is important to remember that speech rate often increases when emotional arousal or stress increases. Instead of constant verbal reminders, clinicians may use a combination of delayed auditory feedback (DAF), giving out "speeding tickets" (written reminders to slow down speech), or recording speech and having clients transcribe it, writing in where there is need for spaces and pauses.
+Many people who clutter are either unable or unwilling to think about their speech, particularly in casual speech. The strategies to slow speech down all require careful monitoring of speech, which can be very difficult for those who clutter. Imagination and careful observation are used to increase monitoring. For instance, an adult who clutters may be asked to visualize themselves speaking slowly and clearly before they actually speak. Additionally, video and audio recordings may be used to show those who clutter where communication starts to break down in their speech.
+In general, slowing the rate of speech and/or monitoring speech more effectively should lead to clearer articulation. However, if they do not, additional treatment is needed. These articulation treatment strategies include practicing short sentences with "over-articulated", unnatural but technically correct, speech. Reading multisyllabic words and focusing on including each of the sounds is another strategy to enhance articulation.
+Some individuals who clutter will need help learning to tell stories logically and sequentially. This can be aided by learning how to begin narratives with simple, short sentences, and slowly building to longer, more complex ones. Additionally, clinicians may transcribe cluttered speech to clients to show them run-ons and ramblings, and then ask them to just state the necessary, most important information in the utterance.
+Additional strategies that may help people who clutter include checking in, ensuring that they have understood any non-verbal or turn-taking cues in the conversation, imitating clinician models of speech to improve natural speech, and treating any stuttering that may be co-occurring with cluttering. The two are separate disorders, but many people who clutter also stutter.
+
+
+== History ==
+Battaros was a legendary Libyan king who spoke quickly and in a disorderly fashion.  Others who spoke as he did were said to have battarismus. This is the earliest record of the speech disorder of cluttering.
+In the 1960s, cluttering was called tachyphemia, a word derived from the Greek for 'fast speech'. This word is no longer used to describe cluttering because fast speech is not a required element of cluttering.
+Deso Weiss described cluttering as the outward manifestation of a "central language imbalance".
+The First World Conference on Cluttering was held in May 2007 in Razlog, Bulgaria. It had over 60 participants from North America, Europe, the Middle East and Asia.
+
+
+== Society and culture ==
+Weiss claimed that Battaros, Demosthenes, Pericles, Justinian, Otto von Bismarck, and Winston Churchill were clutterers.  He says about these people, "Each of these contributors to world history viewed his world holistically, and was not deflected by exaggerated attention to small details.  Perhaps then, they excelled because of, rather than in spite of, their [cluttering]."
+
+
+== See also ==
+Voice disorders
+Developmental verbal dyspraxia
+
+
+== References ==
+
+
+== Sources ==
+Studies in Tachyphemia, An Investigation of Cluttering and General Language Disability. Speech Rehabilitation Institute.  New York, 1963.
+Myers, F. and K. St. Louis, (1992) Cluttering: A Clinical Perspective, Leicester, England: Far Communications
+
+
+== External links ==
+
+Too fast for words: Easy explanations and tips for treatment and coping
+Cluttering: Some Guidelines
+Overview of Cluttering
+International Cluttering Association page
+ASHA Cluttering Updated Article
+ISAD presentation on cluttering experience
+Computer Aided Assessment of Cluttering Severity
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Combination_therapy-0.md b/data/en.wikipedia.org/wiki/Combination_therapy-0.md
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+---
+title: "Combination therapy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Combination_therapy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:17.093860+00:00"
+instance: "kb-cron"
+---
+
+Combination therapy or polytherapy is therapy that uses more than one medication or modality. Typically, the term refers to using multiple therapies to treat a single disease, and often all the therapies are pharmaceutical (although it can also involve non-medical therapy, such as the combination of medications and talk therapy to treat depression). 'Pharmaceutical' combination therapy may be achieved by prescribing/administering separate drugs, or, where available, dosage forms that contain more than one active ingredient (such as fixed-dose combinations).
+Polypharmacy is a related term, referring to the use of multiple medications (without regard to whether they are for the same or separate conditions/diseases). Sometimes "polymedicine" is used to refer to pharmaceutical combination therapy. Most of these kinds of terms lack a universally consistent definition, so caution and clarification are often advisable.
+
+
+== Uses ==
+Conditions treated with combination therapy include tuberculosis, leprosy, cancer, malaria, and HIV/AIDS. One major benefit of combination therapies is that they reduce development of drug resistance since a pathogen or tumor is less likely to have resistance to multiple drugs simultaneously.  Artemisinin-based monotherapies for malaria are explicitly discouraged to avoid the problem of developing resistance to the newer treatment.
+Combination therapy may seem costlier than monotherapy in the short term, but when it is used appropriately, it causes significant savings: lower treatment failure rate, lower case-fatality ratios, fewer side-effects than monotherapy, slower development of resistance, and thus less money needed for the development of new drugs.
+
+
+=== In oncology ===
+Combination therapy has gained momentum in oncology in recent years, with various studies demonstrating higher response rates with combinations of drugs compared to monotherapies, and the FDA recently approving therapeutic combination regimens that demonstrated superior safety and efficacy to monotherapies. In a recent study about solid cancers, Martin Nowak, Bert Vogelstein, and colleagues showed that in most clinical cases, combination therapies are needed to avoid the evolution of resistance to targeted drugs. Furthermore, they find that the simultaneous administration of multiple targeted drugs minimizes the chance of relapse when no single mutation confers cross-resistance to both drugs.
+Various systems biology methods must be used to discover combination therapies to overcome drug resistance in select cancer types. Recent precision medicine approaches have focused on targeting multiple biomarkers found in individual tumors by using combinations of drugs. However, with 300 FDA-approved cancer drugs on the market, there almost 45,000 possible two-drug combinations and almost 4.5 million three-drug combinations for to choose from. That level of complexity is one of the primary impediments to the growth of combination therapy in oncology.
+The National Cancer Institute has recently highlighted combination therapy as a top research priority in oncology.
+
+
+=== Bacterial infections ===
+Combination therapy with two or more antibiotics are often used in an effort to treat multi-drug resistant Gram-negative bacteria. In bacterial infections, combination therapy can provide several advantages, including a broadened antimicrobial spectrum, a reduced risk of resistance development or a synergistic effect. However, it may also increase treatment costs and the risk of drug toxicity or other adverse effects.
+
+
+== Contrast to monotherapy ==
+Monotherapy, or the use of a single therapy, can be applied to any therapeutic approach, but it is most commonly used to describe the use of a single medication.  Normally, monotherapy is selected because a single medication is adequate to treat the medical condition.  However, monotherapies may also be used because of unwanted side effects or dangerous drug interactions.
+
+
+== See also ==
+Polypill, a medication which contains a combination of multiple active ingredients
+Combination drug
+
+
+== References ==
+
+
+== External links ==
+Drug combination database. covers information on more than 1300 drug combinations in either clinical use or different testing stages.
+Perturbation biology method for the discovery of anti-resistance drug combinations with network pharmacology.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Communicans-0.md b/data/en.wikipedia.org/wiki/Communicans-0.md
new file mode 100644
index 000000000..2f8a0106c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Communicans-0.md
@@ -0,0 +1,16 @@
+---
+title: "Communicans"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Communicans"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:18.216211+00:00"
+instance: "kb-cron"
+---
+
+Communicans is a Latin word meaning "communicating". It is most commonly used in medical or biological terminology.
+
+The rami communicans are connective spinal nerves that attach to the ganglion of the sympathetic trunk. The two branches of the nerves are termed the White ramus communicans.
+The arteria comminicans are the three arteries in the brain that form the circle of Willis. Communicating artery is a synonym for this term.
+The macula communicans (or zonula communicans) is a synonym for a gap junction. These are locations on the cellular membrane that lie 2–4 nm from an adjacent cell and are penetrated by a connexon.
+A ductus communicans is a constriction of a swim bladder between the anterior and posterior chambers.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Complication_(medicine)-0.md b/data/en.wikipedia.org/wiki/Complication_(medicine)-0.md
new file mode 100644
index 000000000..fe5f0e859
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Complication_(medicine)-0.md
@@ -0,0 +1,40 @@
+---
+title: "Complication (medicine)"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Complication_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:19.410220+00:00"
+instance: "kb-cron"
+---
+
+A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in the severity of the disease or the development of new signs, symptoms, or pathological changes that may become widespread throughout the body and affect other organ systems. Thus, complications may lead to the development of new diseases resulting from previously existing diseases. Complications may also arise as a result of various treatments.
+The development of complications depends on a number of factors, including the degree of vulnerability, susceptibility, age, health status, and immune system condition. Knowledge of the most common and severe complications of a disease, procedure, or treatment allows for prevention and preparation for treatment if they should occur.
+Complications are not to be confused with sequelae, which are residual effects that occur after the acute (initial, most severe) phase of an illness or injury. Sequelae can appear early in the development of disease or weeks to months later and are a result of the initial injury or illness. For example, a scar resulting from a burn or dysphagia resulting from a stroke would be considered sequelae. In addition, complications should not be confused with comorbidities, which are diseases that occur concurrently but have no causative association. Complications are similar to adverse effects, but the latter term is typically used in pharmacological contexts or when the negative consequence is expected or common.
+
+== Common illnesses and complications ==
+
+=== Iatrogenic complications ===
+Medical errors can fall into various categories listed below:
+
+Medication: Medication medical errors include wrong prescription, impaired delivery, or improper adherence. The process of prescribing medication is a complex process that relies on the accurate transfer of information through various parties. Prevention methods include increased use of electronic prescription, pre-packaging unit dosing, and ensuring medical literacy among patients.
+Surgical: Surgery-related medical errors can be anesthesia-related, but most often include wrong-site and wrong-patient procedural errors. Preventive measures include following and double-checking standardized surgical protocol before, during, and after procedures. Universal surgical protocols include verification of patient identity and proper site-marking.
+Diagnostic: Diagnostic errors include misdiagnosis, wrong diagnosis, and over diagnosis. Diagnostic errors are often the result of patient characteristics and physician bias.
+Machine interface: Errors in this category refer to mistakes in human interaction with tools or machines. Machine-related errors can be reduced by standardization and clear differentiation in design of products.
+Transition and handoff: Errors in this category can occur person-to-person or site-to-site during transfer, and can be managed by adhering to proper hand-off protocols.
+Human factors, teamwork, and communication: Errors in this category highlight the impact of culture and relationships on communication. These concepts can play a role in other categories of medical errors. Preventive measures include cultivating a "culture of safety" which includes creating an environment where people feel comfortable discussing concerns, feedback, and errors without fear of punishment.
+Healthcare-associated infections (HAIs): HAIs are complications of general treatments involving microorganisms or viral infections and are most commonly caused by indwelling devices (urinary catheters, central lines) or previous surgical procedures. Common microbes involved in HAIs are Escherichia coli, Proteus mirabilis, and Clostridioides difficile. The most effective preventive measure is hand-hygiene.
+
+=== Cardiovascular complications ===
+
+==== Atrial fibrillation ====
+Atrial fibrillation is a type of arrhythmia characterized by rapid and irregular heart rhythms due to irregular atrial activation by the atrioventricular (AV) node. In the pathogenesis of atrial fibrillation, there is no effective pumping of blood into either the pulmonary or systemic circulation from the left ventricle of the heart. The left and right ventricles (lower chambers of the heart) do not fill properly due to the irregular contraction of the left and right atria (upper chambers of the heart).
+A patient with atrial fibrillation may experience symptoms of fatigue, dizziness or lightheadedness, heart palpitations, chest pain, and shortness of breath. The heart does not effectively pump blood into the pulmonary or systemic vasculature, and causes the blood to remain within the chambers of the heart. The collection of blood within the heart due to atrial fibrillation can cause and increase the risk of development of a thrombus (blood clot). The thrombus can also develop into an embolus (mobile blood clot) and travel into the systemic circulation. Atrial fibrillation is associated with an increase in risk of having a stroke especially if the embolus travels to the brain.
+Other examples
+
+Thrombosis in the heart or brain, causing stroke or acute myocardial infarction can be complications of blood coagulation disorders, phlebitis (inflammation of the veins), endocarditis and artificial heart valves.
+
+=== Metabolic complications ===
+
+==== Diabetes mellitus ====
+Diabetes mellitus, also known simply as diabetes, is a disorder of the regulation of blood glucose (a common type of sugar) levels. There are two types of chronic diabetes mellitus: type I and type II. Both lead to abnormally high levels of blood glucose as the body is not able to properly absorb the sugar into tissues. Diabetes requires a life-long consistent monitoring of food intake, blood sugar levels, and physical activity. Diabetes mellitus may present a series of complications in an advanced or more severe stage, such as:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Complication_(medicine)-1.md b/data/en.wikipedia.org/wiki/Complication_(medicine)-1.md
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+++ b/data/en.wikipedia.org/wiki/Complication_(medicine)-1.md
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+---
+title: "Complication (medicine)"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Complication_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:19.410220+00:00"
+instance: "kb-cron"
+---
+
+Cardiovascular disease. Adults with diabetes are significantly more likely to die from heart disease than are those without diabetes. Diabetes is associated with risk factors for various cardiovascular diseases including obesity, insulin resistance, high blood cholesterol and triglyceride content, and high blood pressure. These conditions increase risk of thrombosis, atherosclerosis (blockage of coronary arteries leading to inadequate supply of oxygen to parts of the heart), and hypertension which can lead to myocardial infarction, coronary artery disease (CAD), and others.
+Diabetic neuropathy. Hyperglycemia can eventually cause damage to nerves in the distal extremities (peripheral neuropathy), thighs and hips (radiculoplexus neuropathy), face (mononeuropathy), and internal organs (autonomic neuropathy). Initial symptoms may present as numbness, tingling, pain, muscular weakness, loss of reflexes or proper bodily functions, and many others.
+Diabetic nephropathy. Excessive amounts of certain solutes passing through the kidneys for prolonged periods of time can lead to kidney damage. Diabetic nephropathy is specifically characterized by abnormally high levels of urinary albumin excretion. This affects approximately 40% of patients with type I or type II diabetes.
+Diabetic retinopathy. Chronic or prolonged type I and type II diabetes can lead to damage in the blood vessels of the retina due to hyperglycemia (excessive blood glucose). Damage and blockage of the vessels causes microaneurysms, tears, and leakage of fluid into the back of the eye. This can eventually lead to abnormal blood vessel growth, nerve damage, or excessive pressure buildup in the eye. Symptoms initially present as blurred vision but can lead to more serious complications such as blindness, glaucoma, retinal detachment, and vitreous hemorrhage.
+Foot damage. Diabetes mellitus can lead to poor vascular blood flow to the extremities. Injury of the foot with inadequate blood flow can progress to ulcers and become infected. Individuals with diabetic neuropathy may not notice the damage and may develop gangrene (tissue necrosis due to inadequate blood supply).
+Skin conditions. Insulin insensitivity in the case of type II diabetes can cause prolonged increases in blood insulin. Insulin normally binds to insulin receptors but in excess amounts may bind to insulin-like growth factor (IGF) receptors in epithelial tissue. This can cause excessive proliferation of keratinocytes and fibroblasts. This presents as acanthosis nigricans, a thickening and darkening of areas of the skin such as the armpits, necks, hands, and face. Other skin conditions include diabetic dermopathy, digital sclerosis, eruptive xanthomatosis, and others.
+
+=== Neurologic / psychiatric complications ===
+Hepatic encephalopathy is a possible complication of liver cirrhosis.
+Significant intellectual, physical, and developmental disability are common complications of untreated hydrocephalus.
+Suicide is a common complication of many disorders and conditions that consistently affect a person's life negatively, such as major depressive disorder, posttraumatic stress disorder, schizophrenia, anxiety disorders, or substance abuse.
+Complications of outpatient drugs are very common and many patients experience worry or discomfort due to them.
+Paradoxical reaction to a drug; that is, a reaction that is the opposite to the intended purpose of the drug. An example is benzodiazepines, a class of psychoactive drugs considered minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, and muscle relaxant effects; paradoxically they may also create hyperactivity, anxiety, convulsions etc. in susceptible individuals.
+
+=== Reproductive complications ===
+
+==== Pregnancy ====
+Pregnancy is the development of an embryo or fetus inside the womb of a female for the rough duration of 9 months or 40 weeks from the last menstrual period until birth. It is divided into three trimesters, each lasting for about 3 months. The first trimester is when the developing embryo becomes a fetus, organs start to develop, limbs grow, and facial features appear. The 2nd and 3rd trimesters are marked by a significant amount of growth and functional development of the body. During this time, the woman's body undergoes a series of changes and many complications may arise involving either the fetus, the mother, or both.
+
+Hypertension. The developing fetus enlarges in the mother's womb, placing pressure on the arteries and vasculature of the mother. This causes a reduction in blood flow and a systemic increase in blood pressure. If the mother had high blood pressure prior to and after pregnancy it is considered chronic hypertension; if it occurs after 20 weeks of gestation or pregnancy, it is gestational hypertension. A previously hypertensive mother who shows signs of gestational hypertension can lead to preeclampsia, a more severe case which can be detrimental to the mother and developing fetus.
+Gestational diabetes. Appropriate levels of blood sugar is typically maintained by insulin secretion from the pancreas. During pregnancy the placenta surrounding the developing fetus produces hormones that can inhibit the action of insulin, preventing the mother's blood sugar from decreasing. Occurs primarily in the second half of pregnancy and can cause excessive birth weight, preterm delivery, and place the child at greater risk for type II diabetes.
+Preterm labor. Delivery of the baby prior to 37 weeks of pregnancy is considered preterm. This can cause a variety of issues with the child including underdeveloped viscera (organs), behavioral or learning disabilities, low birth weight, and respiratory issues.
+Miscarriage. The loss of the developing fetus prior to 20 weeks of pregnancy. Common causes may be related to chromosomal abnormalities (abnormal genetic makeup) of the fetus but can also include ectopic pregnancy, maternal age, and other factors.
+Stillbirth. The loss of the developing fetus after 20 weeks of pregnancy. Can be due to a variety of reasons including chromosomal abnormalities, developmental issues, or health-related problems of the mother.
+Hyperemesis gravidarum. Persistent, acute nausea throughout pregnancy that does not go away after the first trimester. Different from morning sickness which is more common and less severe.
+
+=== Respiratory complications ===
+
+==== Streptococcal pharyngitis ====
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Complication_(medicine)-2.md b/data/en.wikipedia.org/wiki/Complication_(medicine)-2.md
new file mode 100644
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+++ b/data/en.wikipedia.org/wiki/Complication_(medicine)-2.md
@@ -0,0 +1,45 @@
+---
+title: "Complication (medicine)"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Complication_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:19.410220+00:00"
+instance: "kb-cron"
+---
+
+Streptococcal pharyngitis, also known as strep throat, is an infection of the respiratory tract caused by group A Strep, Streptococcus pyogenes, a gram-positive, cocci, beta-hemolytic (lyses blood cells) bacteria. It is primarily spread by direct contact and the transfer of fluids via oral or other secretions and manifests largely in children. Common symptoms associated with streptococcal pharyngitis include sore throat, fever, white excretions at the back of the mouth, and cervical adenopathy (swollen lymph nodes underneath the chin and around the neck area). Streptococcal pharyngitis can lead to various complications and recurrent infection can increase the likelihood. In many of these, lack of treatment and the body's immune response is responsible for the additional adverse reactions. These include:
+
+Scarlet fever. In addition to the symptoms of strep throat, individuals may experience increased a red rash, increased red tone, and strawberry tongue. The prominent rash generally fades after a few days and may peel for a few weeks. Treatment is the same as for strep throat.
+Rheumatic fever. Rheumatic fever generally develops a few weeks after symptoms of strep throat have passed and is less likely to develop if prompt treatment (antibiotics) is given. Typical symptoms can include polyarthritis (temporary joint pain in multiple areas), carditis or chest pain, rash, subcutaneous nodules, and involuntary jerks. Rheumatic fever is believed to be the result of an autoimmune reaction to various tissues in the body that are similar to toxins produced by Streptococcus pyogenes. Rheumatic fever may lead to more serious complications of the heart such as rheumatic heart disease.
+Glomerulonephritis. Onset of kidney damage that may present a few weeks after strep infection. Rather than being a direct result of infection in the kidneys, It is believed to be caused by an overreactive immune response. Symptoms can include blood or protein in the urine, hypertension, and reduced urine output. Can lead to further kidney damage later in life
+Otitis media. Infection of the middle ear.
+Meningitis. Infection of the meninges of the central nervous system (brain and spinal cord) that leads to swelling. Symptoms vary and differ between adults and children but can include headaches, fever, stiff neck, and other neurological-related issues. Early treatment is important to prevent more serious complications.
+Toxic shock syndrome. A severe reaction of the body to toxins produced by various bacteria such as Streptococcus pyogenes. Results from an overactive response by the immune system and can cause hypotension, fever, and in more severe cases, organ failure.
+
+=== Surgical / procedural complications ===
+Puerperal fever was a common complication of childbirth, contributing to the high mortality of mothers before the advent of antisepsis and antibiotics.
+Erectile dysfunction and urinary incontinence which may follow prostatectomy.
+Malignant hyperthermia can be a reaction to general anesthetics, as a complication in a surgery.
+Fractured ribs and sternum may be a complication of cardiopulmonary resuscitation attempts.
+
+=== Other examples of complications ===
+Sepsis (infection of the blood) may occur as a complication of a bacterial, viral, or fungal infection.
+Miscarriage is the most common complication of early pregnancy.
+Eczema vaccinatum is a rare and severe complication of smallpox vaccination in people with eczema.
+
+== See also ==
+Adverse effect
+Classification of Pharmaco-Therapeutic Referrals
+Diagnosis
+Iatrogenesis
+Late effect
+Nocebo
+Placebo
+Prognosis
+Sequela
+Transplant rejection
+
+== References ==
+
+== Further reading ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-0.md b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-0.md
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+++ b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-0.md
@@ -0,0 +1,72 @@
+---
+title: "Computerized physician order entry"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Computerized_physician_order_entry"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:20.608307+00:00"
+instance: "kb-cron"
+---
+
+Computerized physician order entry (CPOE), sometimes referred to as computerized provider order entry or computerized provider order management (CPOM), is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
+The entered orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order. CPOE reduces the time it takes to distribute and complete orders, while increasing efficiency by reducing transcription errors including preventing duplicate order entry, while simplifying inventory management and billing.
+CPOE is a form of patient management software.
+
+== Required data ==
+
+In a graphical representation of an order sequence, specific data should be presented to CPOE system staff in cleartext, including:
+
+identity of the patient
+role of required member of staff
+resources, materials and medication applied
+procedures to be performed
+operational sequence to be obeyed
+feedback to be noted
+case specific documentation to build
+Some textual data can be reduced to simple graphics.
+
+== CPOE related terminology ==
+
+CPOE systems use terminology familiar to medical and nursing staff, but there are different terms used to classify and concatenate orders. The following items are examples of additional terminology that a CPOE system programmer might need to know:
+
+=== Filler ===
+The application responding to, i.e., performing, a request for services (orders) or producing an observation.  The filler can also originate requests for services (new orders), add additional services to existing orders, replace existing orders, put an order on hold, discontinue an order, release a held order, or cancel existing orders.
+
+=== Order ===
+A request for a service from one application to a second application. In some cases an application is allowed to place orders with itself.
+
+=== Order detail segment ===
+One of several segments that can carry order information. Future ancillary specific segments may be defined in subsequent releases of the Standard if they become necessary.
+
+=== Placer ===
+The application or individual originating a request for services (order).
+
+=== Placer order group ===
+A list of associated orders coming from a single location regarding a single patient.
+
+=== Order Set ===
+A grouping of orders used to standardize and expedite the ordering process for a common clinical scenario. (Typically, these orders are started, modified, and stopped by a licensed physician.)
+
+=== Protocol ===
+A grouping of orders used to standardize and automate a clinical process on behalf of a physician. (Typically, these orders are started, modified, and stopped by a nurse, pharmacist, or other licensed health professional.)
+
+== Features of CPOE systems ==
+
+Features of the ideal computerized physician order entry system (CPOE) include:
+
+Ordering
+Physician orders are standardized across the organization, yet may be individualized for each doctor or specialty by using order sets. Orders are communicated to all departments and involved caregivers, improving response time and avoiding scheduling problems and conflict with existing orders.
+Patient-centered decision support
+The ordering process includes a display of the patient's medical history and current results and evidence-based clinical guidelines to support treatment decisions.  Often uses medical logic module and/or Arden syntax to facilitate fully integrated Clinical Decision Support Systems (CDSS).
+Patient safety features
+The CPOE system allows real-time patient identification, drug dose recommendations, adverse drug reaction reviews, and checks on allergies and test or treatment conflicts. Physicians and nurses can review orders immediately for confirmation.
+Intuitive Human interface
+The order entry workflow corresponds to familiar "paper-based" ordering to allow efficient use by new or infrequent users.
+Regulatory compliance and security
+Access is secure, and a permanent record is created, with electronic signature.
+Portability
+The system accepts and manages orders for all departments at the point-of-care, from any location in the health system (physician's office, hospital or home) through a variety of devices, including wireless PCs and tablet computers.
+Management
+The system delivers statistical reports online so that managers can analyze patient census and make changes in staffing, replace inventory and audit utilization and productivity throughout the organization. Data is collected for training, planning, and root cause analysis for patient safety events.
+Billing
+Documentation is improved by linking diagnoses (ICD-9-CM or ICD-10-CM codes) to orders at the time of order entry to support appropriate charges.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-1.md b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-1.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-1.md
@@ -0,0 +1,21 @@
+---
+title: "Computerized physician order entry"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Computerized_physician_order_entry"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:20.608307+00:00"
+instance: "kb-cron"
+---
+
+== Patient safety benefits ==
+In the past, physicians have traditionally hand-written or verbally communicated orders for patient care, which are then transcribed by various individuals (such as unit clerks, nurses, and ancillary staff) before being carried out.  Handwritten reports or notes, manual order entry, non-standard abbreviations and poor legibility lead to errors and injuries to patients, . A follow-up IOM report in 2001 advised use of electronic medication ordering, with computer- and internet-based information systems to support clinical decisions. Prescribing errors are the largest identified source of preventable hospital medical error. A 2006 report by the Institute of Medicine estimated that a hospitalized patient is exposed to a medication error each day of his or her stay. While further studies have estimated that CPOE implementation at all nonrural hospitals in the United States could prevent over 500,000 serious medication errors each year. Studies of computerized physician order entry (CPOE) has yielded evidence that suggests the medication error rate can be reduced by 80%, and errors that have potential for serious harm or death for patients can be reduced by 55%, and other studies have also suggested benefits. Further, in 2005, CMS and CDC released a report that showed only 41 percent of prophylactic antibacterials were correctly stopped within 24 hours of completed surgery. The researchers conducted an analysis over an eight-month period, implementing a CPOE system designed to stop the administration of prophylactic antibacterials. Results showed CPOE significantly improved timely discontinuation of antibacterials from 38.8 percent of surgeries to 55.7 percent in the intervention hospital. CPOE/e-Prescribing systems can provide automatic dosing alerts (for example, letting the user know that the dose is too high and thus dangerous) and interaction checking (for example, telling the user that 2 medicines ordered taken together can cause health problems). In this way, specialists in pharmacy informatics work with the medical and nursing staffs at hospitals to improve the safety and effectiveness of medication use by utilizing CPOE systems.
+
+== Advantages ==
+Generally, CPOE is advantageous, as it leaves the trails of just better formatting retrospective information, similarly to traditional hospital information systems designs. The key advantage of providing information from the physician in charge of treatment for a single patient to the different roles involved in processing he treatise itself is widely innovative. This makes CPOE the primary tool for information transfer to the performing staff and lesser the tool for collecting action items for the accounting staff. However, the needs of proper accounting get served automatically upon feedback on completion of orders.
+CPOE is generally not suitable without reasonable training and tutoring respectively. As with other technical means, the system based communicating of information may be inaccessible or inoperable due to failures. That is not different from making use of an ordinary telephone or with conventional hospital information systems. Beyond, the information conveyed may be faulty or erratic. A concatenated validating of orders must be well organized. Errors lead to liability cases as with all professional treatment of patients.
+Prescriber and staff inexperience may cause slower entry of orders at first, use more staff time, and is slower than person-to-person communication in an emergency situation. Physician to nurse communication can worsen if each group works alone at their workstations.
+But, in general, the options to reuse order sets anew with new patients lays the basic for substantial enhancement of the processing of services to the patients in the complex distribution of work amongst the roles involved. The basic concepts are defined with the clinical pathway approach. However, success does not occur by itself. The preparatory work has to be budgeted from the very beginning and has to be maintained all the  time. Patterns of proper management from other service industry and from production industry may apply. However, the medical methodologies and nursing procedures do not get affected by the management approaches.
+
+== Risks ==
+CPOE presents several possible dangers by introducing new types of errors. Automation causes a false sense of security, a misconception that when technology suggests a course of action, errors are avoided. These factors contributed to an increased mortality rate in the Children's Hospital of Pittsburgh's Pediatric ICU when a CPOE system was introduced. In other settings, shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses. Frequent alerts and warnings can interrupt work flow, causing these messages  to be ignored or overridden due to alert fatigue. CPOE and automated drug dispensing was identified as a cause of error by 84% of over 500 health care facilities participating in a surveillance system by the United States Pharmacopoeia. Introducing CPOE to a complex medical environment requires ongoing changes in design to cope with unique patients and care settings, close supervision of overrides caused by automatic systems, and training, testing and re-training all users.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-2.md b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-2.md
new file mode 100644
index 000000000..6bbd73ba3
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Computerized_physician_order_entry-2.md
@@ -0,0 +1,32 @@
+---
+title: "Computerized physician order entry"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Computerized_physician_order_entry"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:20.608307+00:00"
+instance: "kb-cron"
+---
+
+== Implementation ==
+CPOE systems can take years to install and configure. Despite ample evidence of the potential to reduce medication errors, adoption of this technology by doctors and hospitals in the United States has been slowed by resistance to changes in physician's practice patterns, costs and training time involved, and concern with interoperability and compliance with future national standards. According to a study by RAND Health, the US healthcare system could save more than 81 billion dollars annually, reduce adverse medical events and improve the quality of care if it were to widely adopt CPOE and other health information technology. As more hospitals become aware of the financial benefits of CPOE, and more physicians with a familiarity with computers enter practice, increased use of CPOE is predicted. Several high-profile failures of CPOE implementation have occurred, so a major effort must be focused on change management, including restructuring workflows, dealing with physicians' resistance to change, and creating a collaborative environment.
+An early success with CPOE by the United States Department of Veterans Affairs (VA) is the Veterans Health Information Systems and Technology Architecture or VistA. A graphical user interface known as the Computerized Patient Record System (CPRS) allows health care providers to review and update a patient's record at any computer in the VA's over 1,000 healthcare facilities. CPRS includes the ability to place orders by CPOE, including medications, special procedures, x-rays, patient care nursing orders, diets and laboratory tests.
+The world's first successful implementation of a CPOE system was at El Camino Hospital in Mountain View, California in the early 1970s. The Medical Information System (MIS) was originally developed by a software and hardware team at Lockheed in Sunnyvale, California, which became the TMIS group at Technicon Instruments Corporation. The MIS system used a light pen to allow physicians and nurses to quickly point and click items to be ordered.
+As of 2005, one of the largest projects for a national EHR is by the National Health Service (NHS) in the United Kingdom.  The goal of the NHS is to have 60,000,000 patients with a centralized electronic health record by 2010. The plan involves a gradual roll-out commencing May 2006, providing  general practices in England access to the National Programme for IT (NPfIT). The NHS component, known as the "Connecting for Health Programme", includes office-based CPOE for medication prescribing and test ordering and retrieval, although some concerns have been raised about patient safety features.
+In 2008, the Massachusetts Technology Collaborative and the New England Healthcare Institute (NEHI) published research showing that 1 in 10 patients admitted to a Massachusetts community hospital suffered a preventable medication error. The study argued that Massachusetts hospitals could prevent 55,000 adverse drug events per year and save $170 million annually if they fully implemented CPOE. The findings prompted the Commonwealth of Massachusetts to enact legislation requiring all hospitals to implement CPOE by 2012 as a condition of licensure.
+In addition, the study also concludes that it would cost approximately $2.1 million to implement a CPOE system, and a cost of $435,000 to maintain it in the state of Massachusetts while it saves annually about $2.7 million per hospital.  The hospitals will still see payback within 26 months through reducing hospitalizations generated by error.  Despite the advantages and cost savings, the CPOE is still not well adapted by many hospitals in the US.
+The Leapfrog's 2008 survey showed that most hospitals are still not complying with having a fully implemented, effective CPOE system.  The CPOE requirement became more challenging to meet in 2008 because the Leapfrog introduced a new requirement: Hospitals must test their CPOE systems with Leapfrog's CPOE Evaluation Tool.  So the number of hospitals in the survey considered to be fully meeting the standard dropped to 7% in 2008 from 11% the previous year.  Though the adoption rate seems very low in 2008, it is still an improvement from 2002 when only 2% of hospitals met this Leapfrog standard.
+
+== See also ==
+Continuity of Care Record
+Electronic health record
+Electronic medical record
+Electronic prescribing
+Health informatics
+Pharmacy informatics
+VistA – Veterans Health Information Systems and Technology Architecture
+
+== References ==
+
+== External links ==
+AHRQ National Resource Center for Health IT
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Conservative_treatment-0.md b/data/en.wikipedia.org/wiki/Conservative_treatment-0.md
new file mode 100644
index 000000000..f0cf77173
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Conservative_treatment-0.md
@@ -0,0 +1,31 @@
+---
+title: "Conservative treatment"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Conservative_treatment"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:21.793562+00:00"
+instance: "kb-cron"
+---
+
+Conservative treatment is a type of medical treatment defined by the avoidance of invasive procedures, such as surgery, usually with the intent to preserve function or body parts, maintain quality of life, or avoid the risk of complications from surgery. The effectiveness of a conservative treatment plan depends on patient/provider goals as well as the stage and type of disease or injury.
+
+
+== Effectiveness of conservative treatment ==
+
+
+=== Kidney failure ===
+In patients with advanced kidney failure, Conservative Kidney Management (CKM), or Comprehensive Conservative Care (CCC), is an alternative to dialysis or transplant. CKM includes management of pain and other symptoms, nutrition, and preservation of kidney function through noninvasive methods with an emphasis on quality of life. Studies of treatment strategies among elderly patients show that while more aggressive treatments such as dialysis may increase life expectancy, this effect diminishes among patients over 80, while patients who choose conservative treatment report a higher quality of life. One barrier to establishing strong provider-patient communication about CKM is disagreement among providers over the specific terms used, including "conservative treatment," "conservative care," "supportive care," "palliative care," "Conservative Kidney Management," and "Comprehensive Conservative Care."
+
+
+=== Appendicitis ===
+Conservative treatment of acute appendicitis has been attempted with mixed results. Across all ages, patients who received antibiotic therapy had one-year recurrence rates of 13%-38%. Most patients who attempted a second round of antibiotic therapy eventually required surgical treatment.
+The overwhelming of hospitals during the COVID-19 pandemic led some providers to shift from immediate surgical treatment of acute appendicitis to antibiotic therapy in pediatric patients. In studies of uncomplicated cases of pediatric appendicitis, nonoperative management was inferior to operative management (surgery), resulting in significantly higher rates of failure initially, after one year, and overall. These patients were also more likely to experience adverse advents and rehospitalization. Though some carefully selected patients may benefit from this therapy, surgery remains the standard treatment strategy.
+
+
+=== Cancer ===
+Standard treatment for endometrial cancer is total hysterectomy. Conservative therapy for patients with endometrial atypical hyperplasia or low grade early stage endometrial cancer involves hysteroscopic resection followed by hormone therapy. This treatment has been shown to be safe and effective in specific types of low-risk patients who wish to preserve their fertility.
+Standard treatment for ductal carcinoma in situ of the breast is surgical resection. In low-risk cases detected through screening, patients who received active surveillance experienced similar 5 and 10-year outcomes as patients who received surgical treatment.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Contraindication-0.md b/data/en.wikipedia.org/wiki/Contraindication-0.md
new file mode 100644
index 000000000..ec306e684
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Contraindication-0.md
@@ -0,0 +1,29 @@
+---
+title: "Contraindication"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Contraindication"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:23.038235+00:00"
+instance: "kb-cron"
+---
+
+In medicine, a contraindication is a condition (a situation or factor) that serves as a reason not to take a certain medical treatment due to the harm that it would cause the patient.  Contraindication is the opposite of indication, which is a reason to use a certain treatment.
+Absolute contraindications are contraindications for which there are no reasonable circumstances for undertaking a course of action (that is, overriding the prohibition).  For example:
+
+Children and teenagers with viral infections should not be given aspirin because of the risk of Reye syndrome.
+A person with an anaphylactic food allergy should never eat the food to which they are allergic.
+A person with hemochromatosis should not be administered iron preparations.
+Some medications are so teratogenic that they are absolutely contraindicated in pregnancy; examples include thalidomide and isotretinoin.
+Relative contraindications are contraindications for circumstances in which the patient is at higher risk of complications from treatment, but these risks may be outweighed by other considerations or mitigated by other measures. For example, pregnant individuals should normally avoid getting X-rays, but the risk from radiography may be outweighed by the benefit of diagnosing (and then treating) a serious condition such as tuberculosis.
+Another principal pair of terms for relative contraindications versus absolute contraindications is cautions versus contraindications, or (similarly) precautions versus contraindications: these pairs of terms are respectively synonymous. Which pair is used depends on nomenclature enforced by each organization's style. For example, the British National Formulary uses the cautions versus contraindications pair, and various U.S. CDC webpages use precautions versus contraindications. The logic of the latter two styles is the idea that readers must never be confused: the word contraindication in that usage always is meant in its absolute sense, providing unmistakable word-sense disambiguation.
+
+
+== See also ==
+Classification of Pharmaco-Therapeutic Referrals
+Drug reaction testing
+Indication (medicine)
+Never events
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Convulsion-0.md b/data/en.wikipedia.org/wiki/Convulsion-0.md
new file mode 100644
index 000000000..770f18d29
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Convulsion-0.md
@@ -0,0 +1,67 @@
+---
+title: "Convulsion"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Convulsion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:24.230938+00:00"
+instance: "kb-cron"
+---
+
+A convulsion is a medical condition where the body muscles contract and relax rapidly and repeatedly, resulting in uncontrolled shaking. Because epileptic seizures typically include convulsions, the term convulsion is often used as a synonym for seizure. However, not all epileptic seizures result in convulsions, and not all convulsions are caused by epileptic seizures. Non-epileptic convulsions have no relation with epilepsy, and are caused by non-epileptic seizures.
+Convulsions can be caused by epilepsy, infections (including a severe form of listeriosis which is caused by eating food contaminated by Listeria monocytogenes), brain trauma, or other medical conditions. They can also occur from an electric shock or improperly enriched air for scuba diving.
+The word fit is sometimes used to mean a convulsion or epileptic seizure.
+
+
+== Signs and symptoms ==
+A person having a convulsion may experience several different symptoms, such as a brief blackout, confusion, drooling, loss of bowel or bladder control, sudden shaking of the entire body, uncontrollable muscle spasms, or temporary cessation of breathing. Symptoms usually last from a few seconds to several minutes, although they can last longer.
+Convulsions in children are not necessarily benign, and may lead to brain damage if prolonged. In these patients, the frequency of occurrence should not downplay their significance, as a worsening seizure state may reflect the damage caused by successive attacks. Symptoms may include:
+
+Lack of awareness
+Loss of consciousness
+Eyes rolling back
+Changes to breathing
+Stiffening of the arms, legs, or whole body
+Jerky movements of the arms, legs, body, or head
+Lack of control over movements
+Inability to respond
+
+
+== Causes ==
+Most convulsions are the result of abnormal electrical activity in the brain. Often, a specific cause is not clear. Numerous conditions can cause a convulsion.
+Convulsions can be caused by specific chemicals in the blood, as well as infections like meningitis or encephalitis. Other possibilities include celiac disease, head trauma, stroke, or lack of oxygen to the brain. Sometimes the convulsion can be caused by genetic defects or brain tumors. Convulsions can also occur when the blood sugar is too low or there is a deficiency of vitamin B6 (pyridoxine). The pathophysiology of convulsion remains ambiguous.
+Convulsions are often caused by epileptic seizures, febrile seizures, non-epileptic seizures, or paroxysmal kinesigenic dyskinesia. In rare cases, it may be triggered by reactions to certain medications, such as antidepressants, stimulants, and antihistamines.
+
+
+=== Epileptic seizures ===
+Epilepsy is a neuronal disorder with multifactorial manifestations. It is a noncontagious illness and is usually associated with sudden attacks of seizures, which are an immediate and initial anomaly in the electrical activity of the brain that disrupts part or all of the body. Various areas of the brain can be disturbed by epileptic events. Epileptic seizures can have contrary clinical features. Epileptic seizures can have long-lasting effects on cerebral blood flow.
+Various kinds of epileptic seizures affect 60 million people worldwide.
+
+
+=== Generalized seizures ===
+
+The most common type of seizure is called a generalized seizure, also known as a generalized convulsion. This is characterized by a loss of consciousness which may lead to the person collapsing. The body stiffens for about a minute and then jerks uncontrollably for the next minute. During this, the patient may fall and injure themselves or bite their tongue, may lose control of their bladder, and their eyes may roll back. A familial history of seizures puts a person at a greater risk of developing them. Generalized seizures have been broadly classified into two categories: motor and non-motor.
+
+A generalized tonic-clonic seizure (GTCS), also known as a grand mal seizure, is a whole-body seizure that has a tonic phase followed by clonic muscle retrenchments. GTCSs can happen in people of all ages. GTCSs are very hazardous, and they increase the risk of injuries and sudden unexpected death in epilepsy (SUDEP). SUDEP is a sudden, unexpected, nontraumatic death in patients with epilepsy. Strong convulsions that are related to GTCSs can also cause falls and severe injuries.
+Not all generalized seizures produce convulsions. For example, in an absence seizure, also known as a petit mal seizure, the brain experiences electrical disturbances but the body remains motionless and unresponsive.
+
+
+=== Febrile convulsion ===
+
+A common cause of convulsions in children is febrile seizures, a type of seizure associated with a high body temperature. This high temperature is a usual immune response to infection, and in febrile convulsions, the reason for the fever is extra-cranial (such as a body-wide viral infection). In Nigeria, malaria—which can cause sudden, high fevers—is a significant cause of convulsions among children under 5 years of age.
+Febrile seizures fall into two categories: simple and complex. A simple febrile seizure is generalized, occurs singularly, and lasts less than 15 minutes. A complex febrile seizure can be focused in an area of the body, occur more than once, and lasts for more than 15 minutes. Febrile seizures affect 2–4% of children in the United States and Western Europe. It is the most common childhood seizure. The exact reason for febrile convulsion is unidentified, though it might be the outcome of the interchange between environmental and genetic factors.
+
+
+=== Psychogenic non-epileptic seizures ===
+
+Psychogenic non-epileptic seizures (PNES) are described as neurobehavioral conditions or "psychogenic illnesses" which occur not due to the electrical disturbances in a person's brain but due to mental and emotional stress. PNES are an important differential diagnosis and a common occurrence in epilepsy centers. According to the 5th Edison of Diagnostic and Statistical Manual of Mental Disorders (DSM 5), PNES is classified as a "conversion disorder" or Functional Neurologic Symptom Disorder characterized by alterations in behavior, motor activity, consciousness, and sensation. A few neuroimaging (functional and structural) studies suggest that PNES may replicate sensorimotor alterations, emotional regulation, cognitive control, and integration of neural circuits.
+
+
+=== Paroxysmal kinesigenic dyskinesia ===
+There is a linkage between infantile convulsion and paroxysmal dyskinesia. Paroxysmal kinesigenic dyskinesia (PKD) is characterized by sudden involuntary movement caused by sudden stress or excitement. The relationship between convulsion and PKD is mainly due to the common mechanism of pathophysiology.
+
+
+== Notes ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Corpulence_index-0.md b/data/en.wikipedia.org/wiki/Corpulence_index-0.md
new file mode 100644
index 000000000..4134d3d4e
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Corpulence_index-0.md
@@ -0,0 +1,171 @@
+---
+title: "Corpulence index"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Corpulence_index"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:25.492049+00:00"
+instance: "kb-cron"
+---
+
+The Corpulence Index (CI) (also Ponderal Index (PI), Rohrer's Index, Tri-ponderal Mass Index, or Triponderal Mass Index (TMI)) is a measure of corpulence, or of leanness in other variants, of a person calculated as a relationship between mass and height.
+It was first proposed in 1921 as the "Corpulence measure" by Swiss physician Fritz Rohrer and hence is also known as Rohrer's Index. It is similar to the body mass index, but the mass is normalized with the third power of body height rather than the second power.
+
+  
+    
+      
+        
+          C
+          I
+        
+        =
+        
+          
+            
+              m
+              a
+              s
+              s
+            
+            
+              
+                h
+                e
+                i
+                g
+                h
+                t
+              
+              
+                3
+              
+            
+          
+        
+      
+    
+    {\displaystyle \mathrm {CI} ={\frac {\mathrm {mass} }{\mathrm {height} ^{3}}}}
+  
+
+with 
+  
+    
+      
+        
+          m
+          a
+          s
+          s
+        
+      
+    
+    {\displaystyle \mathrm {mass} }
+  
+ in kilograms and 
+  
+    
+      
+        
+          h
+          e
+          i
+          g
+          h
+          t
+        
+      
+    
+    {\displaystyle \mathrm {height} }
+  
+ in metres, giving a measure with the same dimensions as density. The corpulence index yields valid results even for very short and very tall persons, which is a problem with BMI —  for example, an ideal body weight for a person 152.4 cm tall (48 kg) will render BMI of 20.7 and CI of 13.6, while for a person 200 cm tall (99 kg), the BMI will be 24.8, very close to the "overweight" threshold of 25, while CI will be 12.4.
+Because of this property, it is most commonly used in pediatrics. (For a baby, one can take crown-heel length for the height.) The normal values for infants are about twice as high as for adults, which is the result of their relatively short legs. It does not need to be adjusted for age after adolescence.  It has also been shown to have a lower false positive rate in athletes.
+The corpulence index is variously defined (the first definition should be preferred due to the use of SI-units kg and m) as follows:
+
+In 2015, Sultan Babar showed that CI does not need to be adjusted for age after adolescence. Babar also tested the corpulence  index against the BMI as a method  of predicting body fat content in the NHANES III study, which calculated body fat percentage based on bioelectrical impedance analysis. The  corpulence  index performed somewhat better than the BMI in terms of sensitivity,  specificity, and predictive  value. It also out-performed  the  Lorentz index and Broca's estimate of ideal body mass.
+
+
+== Significance ==
+It plays a role in assessing whether the intrauterine growth restriction of a child is symmetrical or asymmetrical.
+CI has been shown to have higher sensitivity, specificity, and positive and negative predictive values than body mass index for determining adiposity.
+It is used to calculate ectomorphy in the Heath–Carter formula.
+
+
+== Categories ==
+
+For infants, units of grams and centimeters are used instead, then the value is multiplied by 100.
+
+  
+    
+      
+        
+          
+            PI
+          
+          
+            child
+          
+        
+        =
+        0.1
+        ×
+        
+          
+            PI
+          
+          
+            adult
+          
+        
+        =
+        100
+        ×
+        
+          
+            
+              
+                
+                  mass
+                
+                
+                  g
+                
+              
+              
+                
+                  height
+                
+                
+                  cm
+                
+                
+                  3
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\text{PI}}_{\text{child}}=0.1\times {\text{PI}}_{\text{adult}}=100\times {\dfrac {{\text{mass}}_{\text{g}}}{{\text{height}}_{\text{cm}}^{3}}}}
+  
+
+
+== See also ==
+Body adiposity index
+Body mass index
+Body roundness index
+Waist-to-height ratio
+
+
+== Notes ==
+
+
+== References ==
+
+
+== External links ==
+Online Ponderal Index Calculator, which uses the first definition.
+Ponderal Index Calculator, which uses metric values. (English site)
+Ponderal Index Calculator, which uses metric values. (German site)
+Android App for Corpulence Index
+Apple app for Corpulence Index
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cosmesis-0.md b/data/en.wikipedia.org/wiki/Cosmesis-0.md
new file mode 100644
index 000000000..0f76d549a
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cosmesis-0.md
@@ -0,0 +1,19 @@
+---
+title: "Cosmesis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cosmesis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:26.654274+00:00"
+instance: "kb-cron"
+---
+
+Cosmesis is the preservation, restoration, or bestowing of bodily beauty. In the medical context, it usually refers to the surgical correction of a disfiguring defect, or the cosmetic improvements made by a surgeon following incisions. Its use is generally limited to the additional, usually minor, steps that the surgeon (who is generally operating for noncosmetic indications) takes to improve the aesthetic appearance of the scars associated with the operation. Typical actions include removal of damaged tissue, mitigation of tension on the wound, and/or using fine (thin) sutures to close the outer layer of skin.
+Cosmetic surgery is the portion of plastic surgery that concerns itself with the elective improvement of cosmesis.
+
+
+== Prosthetic limbs ==
+The practice of cosmesis, the creation of lifelike limbs made from silicone or PVC, has grown in popularity. Such prosthetics, such as artificial hands, can now be made to mimic the appearance of real limbs, complete with freckles, veins, hair, fingerprints, and even tattoos. Custom-made silicone cosmeses are generally more expensive, costing thousands of US dollars depending on the level of detail. Standard cosmeses come ready-made in various sizes, though they are often not as realistic as their custom-made counterparts. Another option is the custom-made silicone cover, which can be made to match a person's skin tone, but not details such as freckles or wrinkles. Cosmeses are attached to the body using an adhesive, suction, form-fitting, stretchable skin, or a skin sleeve. Cosmeses act as a barrier from dirt, water and other particles, thus protecting the technology inside the glove. 
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Counterstimulation-0.md b/data/en.wikipedia.org/wiki/Counterstimulation-0.md
new file mode 100644
index 000000000..1eb0f5f89
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Counterstimulation-0.md
@@ -0,0 +1,24 @@
+---
+title: "Counterstimulation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Counterstimulation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:27.843943+00:00"
+instance: "kb-cron"
+---
+
+Counterstimulation is a treatment for pain based on distraction.
+A basic example is the practice of rubbing a fresh bruise, so that attention is paid to the sense of touch and pressure, rather than to the pain of the injury. Liniment and "medicated" products containing menthol work in the same way, producing sensations such as heat or cold or strong odors.
+Counterstimulation can also be applied to a remote part of the body.
+Pain control can also be achieved by the use of electronic media, such as television or virtual reality.
+
+
+== See also ==
+Counterirritant
+
+
+== References ==
+
+A definition of counterstimulation
+Virtual reality for pain management
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Course_(medicine)-0.md b/data/en.wikipedia.org/wiki/Course_(medicine)-0.md
new file mode 100644
index 000000000..ae20d5a45
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Course_(medicine)-0.md
@@ -0,0 +1,25 @@
+---
+title: "Course (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Course_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:29.002187+00:00"
+instance: "kb-cron"
+---
+
+In medicine the term course generally takes one of two meanings, both reflecting the sense of "path that something or someone moves along...process or sequence or steps":
+
+A course of medication is a period of continual treatment with drugs, sometimes with variable dosage and in particular combinations. For instance treatment with some drugs should not end abruptly. Instead, their course should end with a tapering dosage.
+Antibiotics: Taking the full course of antibiotics is important to prevent reinfection and/or development of drug-resistant bacteria.
+Steroids:  For both short-term and long-term steroid treatment, when stopping treatment, the dosage is tapered rather than abruptly ended.  This permits the adrenal glands to resume the body's natural production of cortisol.  Abrupt discontinuation can result in adrenal insufficiency; and/or steroid withdrawal syndrome (a rebound effect in which exaggerated symptoms return).
+The course of a disease, also called its natural history, is the development of the disease in a patient, including the sequence and speed of the stages and forms they take. Typical courses of diseases include:
+chronic
+recurrent or relapsing
+subacute: somewhere between an acute and a chronic course
+acute: beginning abruptly, intensifying rapidly, not lasting long
+fulminant or peracute: particularly acute, especially if unusually violent
+A patient may be said to be at the beginning, the middle or the end, or at a particular stage of the course of a disease or a treatment. A precursor is a sign or event that precedes the course or a particular stage in the course of a disease, for example chills often are precursors to fevers.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Craniocervical_instability-0.md b/data/en.wikipedia.org/wiki/Craniocervical_instability-0.md
new file mode 100644
index 000000000..250dbb7ea
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Craniocervical_instability-0.md
@@ -0,0 +1,66 @@
+---
+title: "Craniocervical instability"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Craniocervical_instability"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:30.316146+00:00"
+instance: "kb-cron"
+---
+
+Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2. The condition can cause neural injury and compression of nearby structures, including the brain stem,  spinal cord, vagus nerve, and vertebral artery, resulting in a constellation of symptoms.
+Craniocervical instability is more common in people with a connective tissue disease, including Ehlers–Danlos syndromes, osteogenesis imperfecta, and rheumatoid arthritis. It is frequently co-morbid with atlanto-axial joint instability, Chiari malformation, or tethered spinal cord syndrome.
+The condition can be brought on by physical trauma, including whiplash, laxity of the ligaments surrounding the joint, or other damage to the surrounding connective tissue.
+
+
+== Symptoms and signs ==
+The experience of craniocervical instability can range from minor symptoms to severe disability, in which patients are bedbound. The constellation of symptoms caused by craniocervical instability is known as cervico-medullary syndrome, which may include:
+
+Anxiety disorders
+Bobble-head doll syndrome – a sensation that the skull may fall off the cervical spine
+Clumsiness and motor delay
+Cognitive and memory decline
+Double or blurred vision
+Dysphagia – a sensation of choking
+Dyspnea
+Fatigue
+Lhermitte's sign
+Migraine
+Nausea
+Neck, shoulder, and jaw pain
+Occipital headaches
+Orthostatic intolerance
+Photophobia
+Syncope
+Tenderness at base of skull
+Tinnitus
+Tremors
+Palpitations
+Vertigo or dizziness
+Weakness of limbs
+Symptoms are frequently worsened by a Valsalva maneuver or by being upright for long periods of time. Being upright is problematic because gravity allows increased interaction between the brain stem and the top of the spinal column, increasing symptoms.
+Lying in the supine position can bring short-term relief. Lying supine eliminates the downward gravitational pull, reducing symptoms to some degree. Lying with the feet somewhat higher and head lower can be helpful in symptom reduction.
+
+
+== Diagnosis ==
+Craniocervical instability is usually diagnosed through neuro-anatomical measurement using radiography. Digital Motion X-ray is considered the most accurate method. Upright magnetic resonance imaging, supine magnetic resonance imaging, CT scan, and flexion and extension x-rays may also be used but are far less accurate and have a much higher potential for false negatives.
+The measurements to diagnose craniocervical instability are:
+
+Clivo-Axial Angle equal or less than 135 degrees
+Grabb-Oakes measurement equal or greater than 9 mm
+Harris measurement greater than 12 mm
+Spinal subluxation
+Alternatively, craniocervical instability can be diagnosed if a trial of cervical traction, typically using a halo fixation device, results in a significant alleviation of symptoms.
+
+
+== Treatment ==
+Conservative treatment of craniocervical instability includes physical therapy and the use of a cervical collar to keep the neck stable.
+Cervical spinal fusion is performed on patients with more severe symptoms.
+
+
+== See also ==
+
+Hypermobility spectrum disorder
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Culture_conversion-0.md b/data/en.wikipedia.org/wiki/Culture_conversion-0.md
new file mode 100644
index 000000000..334ab71e9
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Culture_conversion-0.md
@@ -0,0 +1,14 @@
+---
+title: "Culture conversion"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Culture_conversion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:31.571045+00:00"
+instance: "kb-cron"
+---
+
+Culture conversion is a diagnostic criteria indicating the point at which samples taken from a person infected with a tuberculosis can no longer produce tuberculosis cell cultures. Culture conversion is a positive prognostic marker indicating that a person is cured of, or is recovering from, tuberculosis.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Cure-0.md b/data/en.wikipedia.org/wiki/Cure-0.md
new file mode 100644
index 000000000..e81bf99bf
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Cure-0.md
@@ -0,0 +1,146 @@
+---
+title: "Cure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Cure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:32.738778+00:00"
+instance: "kb-cron"
+---
+
+A cure is a substance or procedure that resolves a medical condition. This may include a medication, a surgical operation, a lifestyle change, or even a philosophical shift that alleviates a person's suffering or achieves a state of healing. The medical condition can be a disease, mental illness or genetic disorder.
+An incurable disease is not necessarily a terminal illness, and conversely, a curable illness can still be fatal.
+The cure fraction or cure rate—the proportion of people with a disease who are cured by a given treatment—is determined by comparing disease-free survival in treated individuals against a matched control group without the disease.
+Another method for determining the cure fraction and/or "cure time" involves measuring when the hazard rate in a diseased group returns to the hazard rate observed in the general population.
+The concept of a cure inherently implies the permanent resolution of a specific instance of a disease. For example, a person who recovers from the common cold is considered cured, even though they may contract another cold in the future. Conversely, a person who effectively manages a disease like diabetes mellitus to prevent undesirable symptoms without permanently eliminating it is not considered cured.
+Related concepts with potentially differing meanings include response, remission, and recovery.
+
+
+== Statistical model ==
+In complex diseases like cancer, researchers use statistical comparisons of disease-free survival (DFS) between patients and matched, healthy control groups. This approach equates indefinite remission with a cure. The Kaplan-Meier estimator is commonly used for this comparison.
+The simplest cure rate model was published by Joseph Berkson and Robert P. Gage in 1952. In this model, survival at any given time equals the sum of those who are cured and those who are not cured but have not yet died or, in diseases with asymptomatic remissions, have not yet experienced a recurrence of signs and symptoms. Once all non-cured individuals have died or experienced disease recurrence, only the permanently cured population members remain, and the DFS curve becomes flat. The earliest point at which the curve flattens indicates when all remaining disease-free survivors are considered permanently cured. If the curve never flattens, the disease is formally considered incurable (with existing treatments).
+The Berkson and Gage equation is
+
+  
+    
+      
+        S
+        (
+        t
+        )
+        =
+        p
+        +
+        [
+        (
+        1
+        −
+        p
+        )
+        ⋅
+        
+          S
+          
+            ∗
+          
+        
+        (
+        t
+        )
+        ]
+      
+    
+    {\displaystyle S(t)=p+[(1-p)\cdot S^{*}(t)]}
+  
+
+where 
+  
+    
+      
+        S
+        (
+        t
+        )
+      
+    
+    {\displaystyle S(t)}
+  
+ is the proportion of people surviving at any given time, 
+  
+    
+      
+        p
+      
+    
+    {\displaystyle p}
+  
+ is the proportion permanently cured, and 
+  
+    
+      
+        
+          S
+          
+            ∗
+          
+        
+        (
+        t
+        )
+      
+    
+    {\displaystyle S^{*}(t)}
+  
+ is an exponential curve representing the survival of non-cured individuals.
+Cure rate curves can be determined through data analysis. This analysis allows statisticians to determine the proportion of people permanently cured by a treatment and the time needed post-treatment to declare an asymptomatic individual cured.
+Several cure rate models exist, including the expectation-maximization algorithm and Markov chain Monte Carlo model. Cure rate models can be used to compare the efficacy of different treatments. Generally, survival curves are adjusted for the effects of normal aging on mortality, especially in studies of diseases affecting older populations.
+From the patient's perspective, especially after receiving a new treatment, the statistical model can be frustrating. It may take years to gather enough data to determine when the DFS curve flattens (indicating no further relapses are expected). Some diseases may be technically incurable but require infrequent treatment, making them practically equivalent to a cure. Other diseases may have multiple plateaus, leading to unexpected late relapses after what was initially considered a "cure." Consequently, patients, parents, and psychologists have developed the concept of psychological cure, the point at which the patient decides the treatment is sufficiently likely to be a cure to be considered one. For example, a patient may declare themselves "cured" and choose to live as if the cure is confirmed immediately after treatment.
+
+
+== Related terms ==
+Response
+Response is a partial reduction in symptoms following treatment.
+Recovery
+Recovery is the restoration of health or function. A person who is cured may not be fully recovered, and a person who has recovered may not be cured, as in the case of a person in temporary remission (medicine) or who is an asymptomatic carrier of an infectious disease.
+Preventive medicine
+Prevention is a way to avoid injury, illness, disability, or disease, and it generally does not help someone already ill (although there are exceptions). For example, many babies and young children are vaccinated against polio and other infectious diseases, preventing them from contracting polio. However, vaccination does not work on individuals who already have polio. Treatment or cure is applied after a medical problem has already begun.
+Therapy
+Therapy treats a problem and may or may not lead to a cure. In incurable conditions, treatment improves the medical condition, often only while the treatment continues or for a short time after it ends. For example, there is no cure for AIDS, but treatments can slow the harm caused by HIV and extend the affected person's life. Treatments are not always effective. For example, chemotherapy is a cancer treatment, but it may not work for every patient. In easily curable cancers, such as childhood leukemias, testicular cancer, and Hodgkin lymphoma, cure rates can approach 90%. In other forms, treatment may be essentially impossible. A treatment does not need to be successful in 100% of patients to be considered curative; a given treatment may permanently cure only a small number of patients;, but as long as those patients are cured, the treatment is considered curative.
+
+
+== Examples ==
+Cures can include natural antibiotics (for bacterial infections), synthetic antibiotics like sulphonamides or fluoroquinolones, antivirals (for a few viral infections), antifungals, antitoxins, vitamins, gene therapy, surgery, chemotherapy, radiotherapy, and so on. Despite the development of numerous cures, many diseases remain incurable.
+
+
+=== 1700s ===
+Scurvy became curable (and preventable) with vitamin C (e.g., in limes) after James Lind published A Treatise on the Scurvy (1753).
+
+
+=== 1890s ===
+Emil Adolf von Behring and colleagues produced antitoxins for diphtheria and tetanus toxins from 1890. The use of diphtheria antitoxin to treat diphtheria was considered by The Lancet to be the "most important advance of the [19th] Century in the medical treatment of acute infectious disease."
+
+
+=== 1930s ===
+Sulphonamides became the first widely available cure for bacterial infections.
+Antimalarials were first synthesized, making malaria curable.
+
+
+=== 1940s ===
+Bacterial infections became curable with the development of antibiotics.
+
+
+=== 2010s ===
+Hepatitis C, a viral infection, became curable through treatment with antiviral medications.
+
+
+== See also ==
+
+Eradication of infectious diseases
+Preventive medicine
+Remission (medicine)
+Relapse, the reappearance of a disease
+Spontaneous remission
+Antidote
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dead_on_arrival-0.md b/data/en.wikipedia.org/wiki/Dead_on_arrival-0.md
new file mode 100644
index 000000000..406ed601f
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dead_on_arrival-0.md
@@ -0,0 +1,45 @@
+---
+title: "Dead on arrival"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dead_on_arrival"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:34.005679+00:00"
+instance: "kb-cron"
+---
+
+Dead on arrival (DOA) indicates that a patient is unsalvageable, i.e. cannot be resuscitated, upon arrival at a medical facility or the arrival of paramedics at the scene. Dead in the field, brought in dead (BID), and dead right there (DRT) are terms which similarly indicate that a patient was found to be already clinically dead upon the arrival of professional medical assistance, often in the form of first responders such as emergency medical technicians, paramedics, firefighters, or police.
+In some jurisdictions, first responders must consult verbally with a physician before officially pronouncing a patient deceased, but once cardiopulmonary resuscitation (CPR) is initiated, it must be continued until a physician can pronounce the patient dead.
+
+
+== Medical DOA ==
+When presented with a patient, medical professionals are required to perform cardiopulmonary resuscitation (CPR) unless specific conditions are met that allow them to pronounce the patient as deceased. In most places, these are examples of such criteria:
+
+Injuries that are incompatible with life. These include but are not necessarily limited to decapitation, catastrophic brain trauma, incineration, gross dismemberment, or injuries that do not permit effective administration of CPR. If a patient has sustained such injuries, it should be intuitively obvious that the patient is non-viable.
+Rigor mortis, indicating that the patient has been dead for at least a few hours. Rigor mortis can sometimes be difficult to determine, so it is often reported along with other determining factors.
+Obvious decomposition
+Livor mortis (lividity), indicating that the body has been pulseless and in the same position long enough for blood to sink and collect within the body, creating purplish discolorations at the lowest points of the body (with respect to gravity)
+Stillbirth. If it can be determined without a doubt that an infant died prior to birth, as indicated by skin blisters, an unusually soft head, and an extremely offensive odor, resuscitation should not be attempted. If there is even the slightest hope that the infant is viable, CPR should be initiated; some jurisdictions maintain that life-saving efforts should be attempted on all infants to assure parents that all possible actions were performed to save their child, futile as the medical professionals may have known them to be.
+Identification of valid do not resuscitate orders
+This list may not be a comprehensive picture of medical practice in all jurisdictions or conditions. For example, it may not represent the standard of care for patients with terminal diseases such as advanced cancer. In addition, jurisdictions such as Texas permit withdrawal of medical care from patients who are deemed unlikely to recover. 
+Regardless of the patient, a pronouncement of death must always be made with absolute certainty and only after it has been determined that the patient is not a candidate for resuscitation. This type of decision is rather sensitive and can be difficult to make.
+Legal definitions of death vary from place to place; for example, irreversible brain-stem death, prolonged clinical death, etc.
+
+
+== Colloquial use ==
+When, as with computers, product complexity is high and diagnostics are involved, the medical metaphor is perhaps appropriate, as complex diagnostics might be required to determine if the product "is really dead".
+This term is also commonly applied to consumer electronics or other products that are defective straight out of the box, meaning they don't function properly from the moment they're unpacked or turned on for the first time.
+In another context, "dead on arrival" may be used to describe an idea, concept, or product that is considered to be fundamentally flawed, and therefore viewed as an utter failure from the start.
+In politics, the term is often used to describe incumbent politicians who are believed to have little or no chance of re-election.
+
+
+== See also ==
+Emergency department
+Morgue
+
+
+== References ==
+
+
+== External links ==
+ The dictionary definition of dead on arrival at Wiktionary
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dead_space_(physiology)-0.md b/data/en.wikipedia.org/wiki/Dead_space_(physiology)-0.md
new file mode 100644
index 000000000..84540a544
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dead_space_(physiology)-0.md
@@ -0,0 +1,302 @@
+---
+title: "Dead space (physiology)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Dead_space_(physiology)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:35.255677+00:00"
+instance: "kb-cron"
+---
+
+Dead space is the volume of air that is inhaled that does not take part in the gas exchange, because it either remains in the conducting airways or reaches alveoli that are not perfused or poorly perfused. It means that not all the air in each breath is available for the exchange of oxygen and carbon dioxide. Mammals breathe in and out of their lungs, wasting that part of the inhalation which remains in the conducting airways where no gas exchange can occur.
+
+== Components ==
+Total dead space (also known as physiological dead space) is the sum of the anatomical dead space and the alveolar dead space.
+Benefits do accrue to a seemingly wasteful design for ventilation that includes dead space.
+
+Carbon dioxide is retained, making a bicarbonate-buffered blood and interstitium possible.
+Inspired air is brought to body temperature, increasing the affinity of hemoglobin for oxygen, improving O2 uptake.
+Particulate matter is trapped on the mucus that lines the conducting airways, allowing its removal by mucociliary transport.
+Inspired air is humidified, improving the quality of airway mucus.
+In humans, about a third of every resting breath has no change in O2 and CO2 levels. In adults, it is usually in the range of 150 mL.
+Dead space can be increased (and better envisioned) by breathing through a long tube, such as a snorkel. Although one end of the snorkel is open to the air, when the wearer breathes in, they inhale a significant quantity of air that remained in the snorkel from the previous exhalation. Therefore, a snorkel increases the person's dead space by adding even more airway that does not participate in gas exchange.
+
+=== Anatomical dead space ===
+Anatomical dead space is the volume of the conducting airways (from the nose, mouth and trachea to the terminal bronchioles). These conduct gas to the alveoli but no gas exchange occurs here. In healthy lungs where the alveolar dead space is small, Fowler's method accurately measures the anatomic dead space using a single breath nitrogen washout technique.
+The normal value for dead space volume (in mL) is approximately the lean mass of the body (in pounds), and averages about a third of the resting tidal volume (450-500 mL). In Fowler's original study, the anatomic dead space was 156 ± 28 mL (n=45 males) or 26% of their tidal volume. Despite the flexibility of the trachea and smaller conducting airways, their overall volume (i.e. the anatomic dead space) changes little with bronchoconstriction or when breathing hard during exercise.
+As birds have a longer and wider trachea than mammals the same size, they have a disproportionately large anatomic dead space, reducing the airway resistance. This adaptation does not impact gas exchange because birds flow air through their lungs - they do not breathe in and out like mammals.
+
+=== Alveolar dead space ===
+Alveolar dead space is defined as the difference between the physiologic dead space and the anatomic dead space. It is contributed to by all the terminal respiratory units that are over-ventilated relative to their perfusion. Therefore it includes, firstly those units that are ventilated but not perfused, and secondly those units which have a ventilation-perfusion ratio greater than one. 
+Alveolar dead space is negligible in healthy individuals, but it can increase dramatically in some lung diseases due to ventilation-perfusion mismatch.
+
+== Calculating ==
+Just as dead space wastes a fraction of the inhaled breath, dead space dilutes alveolar air during exhalation. By quantifying this dilution, it is possible to measure physiological dead space, employing the concept of mass balance, as expressed by the Bohr equation.
+
+  
+    
+      
+        
+          
+            
+              V
+              
+                d
+              
+            
+            
+              V
+              
+                t
+              
+            
+          
+        
+        =
+        
+          
+            
+              
+                P
+                
+                  a
+                  
+                  
+                    
+                      CO
+                      
+                        2
+                      
+                      
+                        
+                      
+                    
+                  
+                
+              
+              −
+              
+                P
+                
+                  e
+                  
+                  
+                    
+                      CO
+                      
+                        2
+                      
+                      
+                        
+                      
+                    
+                  
+                
+              
+            
+            
+              P
+              
+                a
+                
+                
+                  
+                    CO
+                    
+                      2
+                    
+                    
+                      
+                    
+                  
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\frac {V_{d}}{V_{t}}}={\frac {P_{a\,{\ce {CO2}}}-P_{e\,{\ce {CO2}}}}{P_{a\,{\ce {CO2}}}}}}
+  
+
+where 
+  
+    
+      
+        
+          V
+          
+            d
+          
+        
+      
+    
+    {\displaystyle V_{d}}
+  
+ is the dead space volume and 
+  
+    
+      
+        
+          V
+          
+            t
+          
+        
+      
+    
+    {\displaystyle V_{t}}
+  
+ is the tidal volume;
+
+  
+    
+      
+        
+          P
+          
+            a
+            
+            
+              
+                CO
+                
+                  2
+                
+                
+                  
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle P_{a\,{\ce {CO2}}}}
+  
+ is the partial pressure of carbon dioxide in the arterial blood, and
+
+  
+    
+      
+        
+          P
+          
+            e
+            
+            
+              
+                CO
+                
+                  2
+                
+                
+                  
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle P_{e\,{\ce {CO2}}}}
+  
+ is the partial pressure of carbon dioxide in the mixed expired (exhaled) air.
+
+=== Physiological dead space ===
+The Bohr equation is used to measure physiological dead space. Unfortunately, the concentration of carbon dioxide (CO2) in alveoli is required to use the equation but this is not a single value as the ventilation-perfusion ratio is different in different lung units both in health and in disease. In practice, the arterial partial pressure of CO2 is used as an estimate of the average alveolar partial pressure of CO2, a modification introduced by Henrik Enghoff in 1938 (Enghoff H. Volumen inefficax. Bemerkungen zur Frage des schadlichen Raumes. Upsala Läkarefören Forhandl., 44:191-218, 1938). In effect, the single arterial pCO2 value averages out the different pCO2 values in the different alveoli, and so makes the Bohr equation useable. 
+The quantity of CO2 exhaled from the healthy alveoli is diluted by the air in the conducting airways (anatomic dead space) and by gas from alveoli that are over-ventilated in relation to their perfusion. This dilution factor can be calculated once the mixed expired pCO2 in the exhaled breath is determined (either by electronically monitoring the exhaled breath or by collecting the exhaled breath in a gas impermeant bag (a Douglas bag) and then measuring the pCO2 of the mixed expired gas in the collection bag). Algebraically, this dilution factor will give us the physiological dead space as calculated by the Bohr equation:
+
+  
+    
+      
+        
+          
+            
+              V
+              
+                physiological
+                
+                dead
+                
+                space
+              
+            
+            
+              V
+              
+                t
+              
+            
+          
+        
+        =
+        
+          
+            
+              
+                P
+                
+                  a
+                  
+                  
+                    
+                      CO
+                      
+                        2
+                      
+                      
+                        
+                      
+                    
+                  
+                
+              
+              −
+              
+                P
+                
+                  mixed
+                  
+                  expired
+                  
+                  
+                    CO
+                    
+                      2
+                    
+                    
+                      
+                    
+                  
+                
+              
+            
+            
+              P
+              
+                a
+                
+                
+                  
+                    CO
+                    
+                      2
+                    
+                    
+                      
+                    
+                  
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\frac {V_{\ce {physiological\,dead\,space}}}{V_{t}}}={\frac {P_{a\,{\ce {CO2}}}-P_{\ce {mixed\,expired\,CO2}}}{P_{a\,{\ce {CO2}}}}}}
+  
+
+=== Alveolar dead space ===
+The alveolar dead space is determined as the difference between the physiological dead space (measured using the Enghoff modification of the Bohr equation) and the anatomic dead space (measured using Fowler's single breath technique). 
+A clinical index of the size of the alveolar dead space is the difference between the arterial partial pressure of CO2 and the end-tidal partial pressure of CO2.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dead_space_(physiology)-1.md b/data/en.wikipedia.org/wiki/Dead_space_(physiology)-1.md
new file mode 100644
index 000000000..4d21b6997
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dead_space_(physiology)-1.md
@@ -0,0 +1,49 @@
+---
+title: "Dead space (physiology)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Dead_space_(physiology)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:35.255677+00:00"
+instance: "kb-cron"
+---
+
+=== Anatomic dead space ===
+A different maneuver is employed in measuring anatomic dead space: the test subject breathes all the way out, inhales deeply from a 0% nitrogen gas mixture (usually 100% oxygen) and then breathes out into equipment that measures nitrogen and gas volume. This final exhalation occurs in three phases. The first phase (phase 1) has no nitrogen as that is gas that is 100% oxygen in the anatomic dead space. The nitrogen concentration then rapidly increases during the brief second phase (phase 2) and finally reaches a plateau in the third phase (phase 3). The anatomic dead space is equal to the volume exhaled during the first phase plus the volume up to the mid-point of the transition from phase 1 to phase 3.
+
+== Ventilated patient ==
+The depth and frequency of our breathing is determined by chemoreceptors and the brainstem, as modified by a number of subjective sensations. When mechanically ventilated using a mandatory mode, the patient breathes at a rate and tidal volume that is dictated by the machine.
+Because of dead space, taking deep breaths more slowly (e.g. ten 500 ml breaths per minute) is more effective than taking shallow breaths quickly (e.g. twenty 250 ml breaths per minute). Although the amount of gas per minute is the same (5 L/min), a large proportion of the shallow breaths is dead space, which does not help oxygen to get into the blood.
+
+== Mechanical dead space ==
+Mechanical dead space or external dead space is volume in the  passages of a breathing apparatus in which the breathing gas flows in both directions as the user breathes in and out, causing the last exhaled gas to be immediately inhaled on the next breath, increasing the necessary tidal volume and respiratory effort to get the same amount of usable air or breathing gas, and increasing the accumulation of carbon dioxide from shallow breaths. It is in effect an external extension of the physiological dead space.
+It can be reduced by:
+
+Using separate intake and exhaust passages with one-way valves placed in each passage, usually between each passage and the mouthpiece. This limits the dead space to between the non return valves and the user's mouth or nose. Not all of the volume  between the non-return valves is necessarily dead space, as exhaled gas in narrow ducting will not necessarily mix well with fresh gas from inhalation ducting, but exhaled gas beyond the exhaust non-return valves can reasonably be assumed to not mix with fresh gas if the valves function correctly. The total effective dead space can be minimized by keeping the volume of this external dead space as small as possible, but this should not unduly increase the work of breathing, which can become critical in breathing apparatus used  at high ambient pressure.
+With a full face mask or demand diving helmet:
+Keeping the inside volume small
+Having a small internal orinasal mask inside the main mask or helmet, which separates the external respiratory passage from the rest of the mask interior.
+In a few models of full face mask a mouthpiece like those used on diving regulators is fitted, which has the same function as an orinasal mask, but can further reduce the volume of the external dead space, at the cost of forcing mouth-breathing (and acting like a gag, preventing clear talking).
+
+=== Effects ===
+Dead space reduces the amount of fresh breathing gas which reaches the alveoli during each breath. This reduces the oxygen available for gas exchange, and the amount of carbon dioxide that can be removed. The buildup of carbon dioxide is usually the more noticeable effect unless the breathing gas is hypoxic as occurs at high altitude. The body can compensate to some extent by increasing the volume of inspired gas, but this also increases work of breathing, and is only effective when the ratio of dead space to tidal volume is reduced sufficiently to compensate for the additional carbon dioxide load due to the increased work of breathing.
+Continued buildup of carbon dioxide will lead to hypercapnia and respiratory distress.
+
+== Changes with exercise ==
+In healthy people, Vd is about one-third of Vt at rest and decreases with exercise to about one-fifth mainly due to an increase in Vt, as anatomic dead space does not change much and alveolar dead space should be negligible or very small.
+External dead space for a given breathing apparatus is usually fixed, and this volume must be added to tidal volume to provide equivalent effective ventilation at any given level of exertion.
+
+== See also ==
+Bohr equation – Equation describing the amount of physiological dead space in a person's lungs
+Christian Bohr – Danish physician and professor of physiology
+Multiple inert gas elimination technique – Medical technique
+Respiratory system – Biological system in animals and plants for gas exchange
+
+== References ==
+
+== Further reading ==
+Arend Bouhuys. 1964. "Respiratory dead space." in Handbook of Physiology. Section 3: Respiration. Vol 1. Wallace O. Fenn and Hermann Rahn (eds). Washington: American Physiological Society.
+John B. West. 2011. Respiratory Physiology: The Essentials. Lippincott Williams & Wilkins; Ninth edition. ISBN 978-1609136406.
+
+== External links ==
+The Dead space page on Johns Hopkins School of Medicine Interactive Respiratory Physiology website.
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diff --git a/data/en.wikipedia.org/wiki/Death_by_misadventure-0.md b/data/en.wikipedia.org/wiki/Death_by_misadventure-0.md
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+++ b/data/en.wikipedia.org/wiki/Death_by_misadventure-0.md
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+---
+title: "Death by misadventure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Death_by_misadventure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:36.467338+00:00"
+instance: "kb-cron"
+---
+
+In the United Kingdom, death by misadventure is the recorded manner of death for an accidental death caused by a risk taken voluntarily.
+Misadventure in English law, as recorded by coroners and on death certificates and associated documents, is a death that is primarily attributed to an accident that occurred due to a risk that was taken voluntarily. In contrast, when the manner of death is given as an accident, the coroner has determined that the decedent had taken no unreasonable willful risk.
+
+"Misadventure may be the right conclusion when a death arises from some deliberate human act which unexpectedly and unintentionally goes wrong."
+Legally defined manner of death: a way by which an actual cause of death (trauma, exposure, etc.) was allowed to occur. For example, a death caused by an illicit drug overdose may be ruled a death by misadventure, as the user took the risk of drug usage voluntarily. Misadventure is a form of unnatural death, a category that also includes accidental death, suicide, and homicide.
+In the case of R v Wolverhampton Coroner, it was held that the coroner must establish death by misadventure on the balance of probabilities, commonly known as "more likely than not". This is opposed to beyond reasonable doubt, which is used elsewhere.
+
+
+== Selected list of deaths by misadventure ==
+
+
+== See also ==
+Inquests in England and Wales
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Decompensation-0.md b/data/en.wikipedia.org/wiki/Decompensation-0.md
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+---
+title: "Decompensation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Decompensation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:37.741951+00:00"
+instance: "kb-cron"
+---
+
+In medicine, decompensation is the functional deterioration of a structure or system that had been previously working with the help of compensation. Decompensation may occur due to fatigue, stress, illness, or old age. When a system is "compensated", it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.
+
+
+== Medical term ==
+For example, cardiac decompensation may refer to the failure of the heart to maintain adequate blood circulation, after long-standing (previously compensated) vascular disease (see heart failure). Short-term treatment of cardiac decompensation can be achieved through administration of dobutamine, resulting in an increase in heart contractility via an inotropic effect.
+Kidney failure can also occur following a slow degradation of kidney function due to an underlying untreated illness; the symptoms of the latter can then become much more severe due to the lack of efficient compensation by the kidney.
+Some of the signs of chronic liver disease detectable on clinical examination are associated with decompensation.
+
+
+== Psychology ==
+In psychology, the term refers to an individual's loss of healthy defense mechanisms in response to stress, resulting in personality disturbance or psychological imbalance.
+
+
+== References ==
+
+
+== External links ==
+
+Heffner, C.L. (2001). Psychology 101. Archived 3 March 2011 at the Wayback Machine
+Tucker-Ladd, C.E. (1996–2000). Psychological Self-Help.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Deficiency_(medicine)-0.md b/data/en.wikipedia.org/wiki/Deficiency_(medicine)-0.md
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+++ b/data/en.wikipedia.org/wiki/Deficiency_(medicine)-0.md
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+---
+title: "Deficiency (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Deficiency_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:39.068236+00:00"
+instance: "kb-cron"
+---
+
+In medicine, a deficiency is a lack or shortage of a functional entity, by less than normal or necessary supply or function. A person can have chromosomal deficiencies,  mental deficiencies, nutritional deficiencies, complement deficiencies, or enzyme deficiencies.
+
+
+== Nutritional deficiency ==
+
+Protein-energy malnutrition (PEM) is a condition where people consume very little in the way of energy, proteins, or both in their diets; as a result, it is common in developing nations. The two main illnesses associated with this condition are kwashiorkor, which is characterized by severe protein deficiency, and marasmus, which is total food deprivation with abnormally low amounts of protein and energy.
+
+
+=== Carbohydrates deficiency ===
+Certain human body cells, such as neurons, require high glucose concentrations. When there are insufficient carbohydrates in the diet, the breakdown of body proteins, dietary proteins, and glycerol from fats is what drives gluconeogenesis. Most gluconeogenesis occurs in the liver. A condition known as ketosis (increased ketones production), which is characterized by a strangely sweet-smelling patient, may result from a prolonged shortage of carbohydrates.
+
+
+=== Essential fatty acids deficiency ===
+The essential fatty acids (EFA) omega-3 and omega-6 are polyunsaturated. Clinical signs of an EFA deficiency include stunted growth in kids and babies, a scaly, dry rash, slowed wound healing and heightened susceptibility to infections.
+
+
+== Enzyme deficiency ==
+
+Enzymes are unique protein subtypes that are needed during metabolism, the process by which the body obtains energy for regular growth and development, to break down food molecules into fuel. A variety of conditions that can change or even endanger life are caused by inherited defects known as enzyme deficiencies, or the lack of these enzymes. Enzyme deficiencies include Niemann-Pick disease, Lysosomal storage diseases, and Mucopolysaccharidoses.
+
+
+== See also ==
+Complement deficiency
+Micronutrient deficiency
+Mineral deficiency
+Vitamin deficiency
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Degeneration_(medicine)-0.md b/data/en.wikipedia.org/wiki/Degeneration_(medicine)-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Degeneration_(medicine)-0.md
@@ -0,0 +1,26 @@
+---
+title: "Degeneration (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Degeneration_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:40.395082+00:00"
+instance: "kb-cron"
+---
+
+Degeneration is deterioration in the medical sense.  Generally, it is the change from a higher to a lower form.  More specifically, it is the change of tissue to a lower or less functionally active form. 
+
+True degeneration: when there is actual chemical change of the tissue itself.
+Infiltration: when the change consists of the deposit of abnormal matter in the tissues
+Degenerative disease
+
+
+== See also ==
+Dysgenics
+Macular degeneration
+Neurodegenerative disease
+Social degeneration
+
+
+== References ==
+Dorland's Illustrated Medical Dictionary (Twenty-sixth Edition)  (ISBN 0-7216-1645-3)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dense_breast_tissue-0.md b/data/en.wikipedia.org/wiki/Dense_breast_tissue-0.md
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+++ b/data/en.wikipedia.org/wiki/Dense_breast_tissue-0.md
@@ -0,0 +1,28 @@
+---
+title: "Dense breast tissue"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Dense_breast_tissue"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:41.578373+00:00"
+instance: "kb-cron"
+---
+
+Dense breast tissue, also known as dense breasts, is a condition of the breasts where a higher proportion of the breasts are made up of glandular tissue and fibrous tissue than fatty tissue. Around 40–50% of women have dense breast tissue and one of the main medical components of the condition is that mammograms are unable to differentiate tumorous tissue from the surrounding dense tissue. This increases the risk of late diagnosis of breast cancer in women with dense breast tissue. Additionally, women with such tissue have a higher likelihood of developing breast cancer in general, though the reasons for this are poorly understood.
+
+== Definition and prevalence ==
+Dense breast tissue is defined based on the amount of glandular and fibrous tissue as compared to the percentage of fatty tissue. The current mammography classifications split up the density of breasts into four categories. Approximately 10% of women have almost entirely fatty breasts, 40% with small pockets of dense tissue, 40% with even distribution of dense tissue throughout, and 10% with extremely dense tissue. The latter two groups are those included under the definition of dense breasts. These categories were officially determined as a part of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS).
+Dense breast tissue, which is affected by hormone levels including estrogen, is more common among younger, pre-menopausal women and decreases with age. Other factors include genetics and body mass index (BMI), with those with higher BMIs tending to have less dense tissue.
+When undergoing a mammogram, tissue density is differentiated with bright and dark spots, with the radiolucent dark areas representing fatty tissue and the radioopaque bright spots representing combined fibroglandular tissue. Assessing the new growth of a tumor as a bright spot is the primary method radiologists use to identify early-stage cancer. However, women with dense breasts have an overall white coloration referred to as the "masking effect" that prevents the identification of new bright spots in the tissue.
+
+== History ==
+The problem of dense breasts and mammography screenings was first identified by John Wolfe in 1976 where Wolfe laid out a new classification system based on the density of female breasts and the prominence of fibral duct tissue. He also noted that the higher the density of a woman's breasts and how the pattern of the parenchymal tissue of the breasts formed, the higher the correlative risk there was for developing breast cancer, with the densest examples seeing a 37-fold increased risk. His findings, however, were not replicable by other researchers and so his claims about the connection between dense breasts and a higher risk of cancer were dismissed by the radiology community.
+While it was agreed that the "masking effect" impact of dense breasts on conducting mammograms made it difficult to identify developing breast cancer, it was not until a 2007 publication by Norman Boyd that a replication of Wolfe's work was shown. Boyd compared a wide variety of case controls and the risk of the women developing cancer over time based on the density of their breasts. He found on the extreme ends that women with a high breast density developed cancer at a rate five times higher than those with almost entirely fatty breast tissue. It has also been suggested by some researchers, such as in Byrne et al. (1995), that breast density is the greatest risk factor to the development of breast cancer.
+Boyd suggested a new classification system that went beyond Wolfe's and titled his the Six Class Categories (SCC) that split up breasts based on the percentage density of fibroglandular versus fatty tissue. A third classification system was suggested by Tabar et al. (2005) that took into account the percentage of all three types of tissue and the linear density and defined six groups based on all four percentages at once.
+
+== Legislation and guidelines ==
+The creation of legislation related to dense breasts has focused on requiring the notification of women by their medical provider that they have dense breasts after this is diagnosed during mammograms, along with improving general awareness of the condition among the public.
+Arguments against such legislation by some medical providers and physicians have been concerns that notification of such risks would result in women avoiding mammograms in fear of receiving a breast cancer diagnosis. Yeh et al. (2015) found that notifying women resulted in an overall increase in intention of the informed individuals to have future ultrasounds and other testing to account for the higher potential risk of developing breast cancer. However, the authors noted that women with a high level of ambiguity aversion were less likely to desire future mammograms; this was especially true for women where ultrasounds were not covered by their health insurance. A 2023 review of guidelines found that in general, patients wanted to receive their density information.
+A 2024 review of guidelines on dense breasts found that most sets of guidelines recommend annual or biannual screening mammograms for those over the age of 40 who have dense breasts, or potentially tomosynthesis imaging or breast MRI. Though some guidelines do not recommend additional screening, most updated or published in 2023–2024 recommend supplemental screening, such as ultrasound. Most place an emphasis on shared decision-making between patient and doctor; several also include providing information on modifiable cancer risk factors such as alcohol consumption and smoking, obesity, and hormonal factors.
+
+=== North America ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dense_breast_tissue-1.md b/data/en.wikipedia.org/wiki/Dense_breast_tissue-1.md
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@@ -0,0 +1,25 @@
+---
+title: "Dense breast tissue"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Dense_breast_tissue"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:41.578373+00:00"
+instance: "kb-cron"
+---
+
+==== United States ====
+The issues of diagnosing breast cancer for such affected women are required to be a part of the information given and the suggestion of additional testing using alternative methods. Most legislation also has any mammograms taken be given to the patient's physician and made a part of their medical record. The first state legislation on dense breast notifications was passed in 2009 in Connecticut after advocacy by breast cancer survivor Nancy Cappello, who had been diagnosed with stage 3 cancer owing to the failure of mammograms to detect the growing tumor. Other states have passed their own legislation, with Texas, for example, passing Henda's Law in 2011. By 2015, 19 states had legal notification statutes for dense breast tissue.
+A federal law titled the Mammography Quality Standards Act (MQSA) already covers and regulates how mammography reports are handled and requires sending dense breast identification to physicians. But the law did not include notifying the patient; state-level laws have sought to account for this gap in regulation since 2009. A federal bill to expand the MQSA was presented to Congress in October of 2011, but was not passed. Subsequent federal bills were signed into law in February of 2019 and resulted in the FDA updating the MQSA to require reporting of mammograms to patients by all mammography facilities. The MQSA was amended again in 2023, requiring all patients to be notified of their breast density ("dense" or "not dense") in their mammogram reports as of September 10, 2024.
+Research in 2021 by Kressin et al. on the impact of the state and federal laws regarding dense breasts found that notification laws increased the likelihood of women being informed about dense breasts by 1.5 times, but women who were people of color (POC) and particularly those with lower incomes were less likely to be informed by their physicians than non-POC who were in wealthier income brackets. This included being informed of the higher risk of developing breast cancer. Another 2021 review found that breast density notifications led to higher supplemental screening.
+
+==== Canada ====
+As of 2023, most provinces require notification of breast density level; some regions such as Quebec, the Northwest Territories, and Yukon record the data but do not automatically inform patients.
+
+=== Europe ===
+In 2022, the European Society of Breast Imaging, part of the European Society of Radiology, published a recommendation that women be informed at screenings of their breast density, as well as recommending MRI screening every two to four years for those between the ages of 50 and 70 with extremely dense breast tissue. A 2025 review published in the European Journal of Radiology found that MRI screening on extremely dense breasts may be limited due to inaccessibility and high cost.
+
+=== Australia ===
+The 2020 position statement from BreastScreen Australia states that the "Standing Committee on Screening recommends that, until more evidence is available on how breast density is best assessed and managed (including evidence to support clinical pathways), BreastScreen Australia should not routinely record breast density or provide supplemental testing for women with dense breasts." As of 2023, women in South Australia will be informed of their breast density after a study showed they strongly preferred to be informed of this information.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dental_abrasion-0.md b/data/en.wikipedia.org/wiki/Dental_abrasion-0.md
new file mode 100644
index 000000000..87f60ded2
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+++ b/data/en.wikipedia.org/wiki/Dental_abrasion-0.md
@@ -0,0 +1,32 @@
+---
+title: "Dental abrasion"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Dental_abrasion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:42.908553+00:00"
+instance: "kb-cron"
+---
+
+Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.
+Abrasion frequently presents at the cemento-enamel junction and can be caused by many contributing factors, all with the ability to affect the tooth surface in varying degrees.
+The appearance may vary depending on the cause of abrasion, however most commonly presents in a V-shaped caused by excessive lateral pressure whilst tooth-brushing. The surface is shiny rather than carious, and sometimes the ridge is deep enough to see the pulp chamber within the tooth itself.
+Non-carious cervical loss due to abrasion may lead to consequences and symptoms such as increased tooth sensitivity to hot and cold, increased plaque trapping which will result in caries and periodontal disease, and difficulty of dental appliances such as retainers or dentures engaging the tooth. It may also be aesthetically unpleasant to some people.
+For successful treatment of abrasion, the cause first needs to be identified and ceased (e.g. overzealous brushing). Once this has occurred, subsequent treatment may involve the changes in oral hygiene, application of fluoride to reduce sensitivity, or the placement of a restoration to help prevent further loss of tooth structure and aid plaque control.
+
+== Cause ==
+
+Cause of abrasion may arise from interaction of teeth with other objects such as toothbrushes, toothpicks, floss, and ill-fitting dental appliance like retainers and dentures. Apart from that, people with habits such as nail biting, chewing tobacco, lip or tongue piercing, and having occupation such as joiner, are subjected to higher risks of abrasion.
+The aetiology of dental abrasion can be due to a single stimulus or, as in most cases, multi-factorial. The most common cause of dental abrasion is the combination of mechanical and chemical wear.
+Tooth brushing is the most common cause of dental abrasion, which is found to develop along the gingival margin, due to vigorous brushing in this area. The type of toothbrush, the technique used and the force applied when brushing can influence the occurrence and severity of resulting abrasion. Further, brushing for extended periods of time (exceeding 2-3 min) in some cases, when combined with medium/hard bristled toothbrushes can cause abrasive lesions. Abrasion may also be exacerbated by overzealous use of certain types of dentifrice; some have more abrasive qualities to remove stains such as whitening toothpastes.
+The bristles combined with forceful brushing techniques applied can roughen the tooth surface and cause abrasion as well as aggravating the gums. Repetitive irritation to the gingival margin can eventually cause recession of the gums. When the gums recede, the root surface is exposed which is more susceptible to abrasion.
+Comparatively, electric toothbrushes have less abrasive tendencies.
+When combined with incorrect brushing technique, toothpastes can also damage enamel and dentine due to the abrasive properties. Specific ingredients are used in toothpaste to target removal of the bio-film and extrinsic staining however in some cases can contribute to the pastes being abrasive. 
+In-home and clinical whitening have been proven to increase the likelihood of an individual experiencing dental abrasion. It is believed that dental abrasion due to the whitening process is caused by a combination of both mechanical and chemical irritants, for example, using whitening toothpaste and at home bleaching kits together. However, if an individual is regimented in their after-whitening care then they can avoid loss of tooth structure and in turn abrasion can be avoided.
+Another factor that can contribute to abrasive loss of tooth structure is the alteration of pH levels at the tooth surface. This can associated with the consumption of acidic foods and liquids or regurgitation of stomach acid, a process known as dental erosion. An increase in acidity at the tooth surface can induce demineralization and softening, therefore leaving the tooth structure susceptible to abrasive factors such as tooth brushing. When the surface of the tooth structure is softened by acid, mechanical forces such as brushing can cause irreparable damage on tooth surface. Remineralization of the softened surface can help prevent this damage from occurring.
+
+== Relative dentin abrasivity ==
+Relative dentin abrasivity (RDA) is a standardised measurement of the abrasive effect that the components of a toothpaste have.
+The RDA scale was developed by the American Dental Association (ADA), government bodies and other stakeholders to quantify the abrasivity of a toothpaste. It was not designed to rank safety of toothpastes, and all toothpastes with an RDA of 250 or less are considered to be equally safe for regular use in terms of abrasivity. The RDA scale compares toothpaste abrasivity to standard abrasive materials and measures the depth of cut at an average of 1 millimetre per 100,000 brush strokes onto dentine. This comparison generates abrasive values for the dentifrices that would be safe for daily use.
+Since 1998, the RDA value is set by the standards DIN EN ISO 11609. Currently, the claim on products such as toothpaste are not regulated by law, however a dentifrice is required to have a level lower than 250 to be considered safe and before being given the ADA seal of approval. The vast majority of toothpastes commercially available have RDA values of 250 or less and are unlikely to have a significant impact on abrasion of tooth structure over a lifetime of use. On average, data suggests less than 400 μm of tooth wear occurs over a lifetime using toothpastes of RDA 250 or less.
+The RDA score of a toothpaste is not the primary factor to consider when managing and preventing dental abrasion. Other factors such as the amount of pressure used whilst brushing, the type, thickness and dispersion of bristle in the toothbrush and the time spent brushing are significant factors that contribute to the risk of dental abrasion.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dental_abrasion-1.md b/data/en.wikipedia.org/wiki/Dental_abrasion-1.md
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+++ b/data/en.wikipedia.org/wiki/Dental_abrasion-1.md
@@ -0,0 +1,61 @@
+---
+title: "Dental abrasion"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Dental_abrasion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:42.908553+00:00"
+instance: "kb-cron"
+---
+
+== Treatment ==
+There are several reasons to treat abrasion lesion(s) (also known as 'Class V cavity') such as:
+
+Sensitivity.
+Presence of carious lesion.
+Aesthetically unpleasant.
+Arresting the progression of the lesion.
+Reducing potential onset of caries or periodontal disease as these lesions can present as a plaque retention factor.
+Where there is a risk of pulpal exposure if lesion depth is severe enough.
+When retention of a removable appliance is interfered, i.e. denture
+To improve denture clasp(s) retention.
+Overall integrity of tooth structure is compromised.
+In order for successful treatment of abrasion to occur, the aetiology first needs to be identified. The most accurate way of doing so is completing a thorough medical, dental, social and diet history. All aspects need to be investigated as in many cases the cause of abrasion can be multi-factorial. Once a definitive diagnosis is completed the appropriate treatment can commence. 
+Treatment for abrasion can present in varying difficulties depending on the current degree or progress caused by the abrasion. Abrasion often presents in conjunction with other dental conditions such as attrition, decay and erosion. Evidence suggest there is a decrease in the effect of dental abrasion with dental erosion when fluoride varnish is applied onto teeth. Successful treatment focuses on the prevention and progression on the condition and modifies the current habit/s instigating the condition.
+
+=== Removal of causes ===
+If the cause of abrasion is due to habitual behaviours, the discontinuation and change of habit is critical in the prevention of further tooth loss. The correct brushing technique is pivotal and involves a gentle scrub technique with small horizontal movements with an extra-soft/soft bristle brush. Excessive lateral force can be corrected by holding the toothbrush in a pen grasp or by using the non-dominant hand to brush. If abrasion is the result of an ill-fitting dental appliance, this should be corrected or replaced by a dental practitioner and should not be attempted in a home setting.
+
+=== Chemical ===
+The current selection of dentifrice should also be critically analysed and changed to include a less abrasive and gentler paste such as sensitive toothpaste as evidence suggests that a  very abrasive toothpaste would lead to loss of tooth structure. A toothpaste containing increased fluoride will also help combat the increased sensitivity and risk to dental decay.  Toothpastes containing stannous fluoride have been shown to inhibit acid erosion of tooth structure, thereby reducing its susceptibility to abrasive wear. Fluoride varnish can also be used as a preventive measure for patients at high risk of dental erosion, as the fluoride varnish increases resistance to erosion and subsequent tooth wear.
+Treatment in the dental chair may include a fluoride application or the placement of a restoration in more severe cases. If the lesion is small and confined to enamel or cementum, a restoration is not warranted, instead the eradication of rough edges should occur to reduce plaque retentive properties. However, in the case of dental decay, aesthetic concerns or defects close to the pulp a restoration may be completed. Further restorative work may be required when the lesion compromises the overall strength of the tooth or when the defect contributes to a periodontal problem the lesion may be restored.
+Once abrasive lesions have been diagnosed and treated they should be closely monitored to identify further progression or potential relief of symptoms.
+
+=== Restoration ===
+Ideal properties of restoration materials particularly for these lesions include:
+
+Satisfactory wear resistance most commonly caused by overzealous/excessive force used during toothbrushing.
+Low modulus of elasticity, given that teeth (anterior dentition) have been considered to flex around the cervical area (area closest to gum levels).
+Good aesthetics.
+There are other properties of restoration materials which could be considered appropriate, although not specific to Class V restorations, which includes:
+
+Small filler particles for polishability to achieve better aesthetics.
+Sufficiently stiff consistency to hold shape but still allows easy handling for placement into a cavity.
+Self-curing/setting or curable to any depth.
+Dimensionally stable or low shrinkage/stress.
+Fluoride release.
+Self-adhesive to enamel and dentine.
+Dental materials such as amalgam, glass ionomer (GI), resin-modified glass ionomer (a variant of GI) and resin composite are the types of restoration materials available when active treatment by means of restoration is appropriate.
+Taking into consideration these factors and their respective dental materials' properties, evidence and studies has shown that resin-modified glass ionomer (RMGI) restoration material is the recommended restoration material in clinical situations as it performs optimally - provided aesthetics is not the top priority when restoring these lesions. The surface of such lesions should be roughened prior to its restoration - whether material is GI-based or resin-based - with no need for bevelling of the coronal aspect of the cavity.
+
+== See also ==
+Tooth wear
+Attrition
+Erosion
+Abfraction
+Bruxism
+Air abrasion
+
+== References ==
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/Dentomandibular_sensorimotor_dysfunction-0.md b/data/en.wikipedia.org/wiki/Dentomandibular_sensorimotor_dysfunction-0.md
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+---
+title: "Dentomandibular sensorimotor dysfunction"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Dentomandibular_sensorimotor_dysfunction"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:44.166953+00:00"
+instance: "kb-cron"
+---
+
+Dentomandibular sensorimotor dysfunction (DMSD) is a medical condition involving the mandible (lower jaw), upper three cervical (neck) vertebrae, and the surrounding muscle and nerve areas.
+There is a concentrated nerve center in this area called the trigeminal nucleus. This major pathway of nerves controls pain signals from the teeth, face, head, and neck, and carries them to the brain. DMSD is a condition in which an individual experiences chronic pain or stiffness from these nerve inputs as a result of dental force imbalances.
+
+== Signs and symptoms ==
+There are many symptoms associated with DMSD conditions. The most commonly reported are:
+
+Headache/Migraine
+Chronic daily headache
+Tension-type headache
+Myofascial pain
+Tinnitus
+Temporomandibular joint disorder (TMJD)
+Pulpitis
+Poor airway control
+Sleep/arousal disorder
+Changes in brain chemistry and neurotransmitter balance
+Bruxism
+Abfraction
+Tooth fracture/damage
+Unstable dental arch form
+Restricted range of motion and postural adaptations
+Clenching with or without torus formation
+Abnormal tooth wear patterns
+Malocclusion
+Parafunction
+Degenerative joint disease
+This condition affects all ages and both genders. However, females are more likely to suffer from DMSD. Individuals who have experienced chronic headaches and/or migraines without finding lasting relief through traditional medicine can be assessed for DMSD through a combination of objective tests, evaluations, and a comprehensive discussion of their symptoms, medical history, headache history, pharmacological background, and head health. Research used in sports medicine and rehabilitation allows dentists to address the population with DMSD symptoms.
+
+== Dental foundation ==
+The dental foundation consists of teeth, muscles, and joints in the dentofacial (head and neck) area. The dental foundation is considered to be out of balance when one or more of the following conditions apply:
+
+Advanced aging or disability of the muscles which open the jaw.
+Movement or noises in the jaw joints which indicate the disks in the neck are moving, deformed, or swollen.
+Tooth wear or breakage.
+Limited range of motion in the jaw and cervical (neck) spine.
+Painful or sore head and/or neck muscles with very sensitive spots referred to as trigger points.
+Pain that stems from the trigeminal cervical nucleus.
+Any lifestyle limitation related to the teeth, muscles, or joints of the head and neck.
+
+== Diagnosis ==
+The protocol for assessment of the condition is typically done in several stages:
+
+A physical examination with head health, headache, pharmacological and complete medical histories. Additionally, dental, periodontal, occlusal, orthodontic, and airway examinations are encouraged as part of the initial screening process.
+Next, a panoramic radiograph (also called a curved surface tomograph) is used to identify or confirm dental conditions which may contribute to painful DMSD symptoms. Computed tomography (CT scans) can also be utilized at this point for further aid in assessment and treatment planning.
+Muscle palpation is used to evaluate where the individual is experiencing trigger points. These are areas of high sensitivity in the facial, head, and neck muscles. When these areas are pressed, it causes pain either in that muscle (localized pain), or in another area (referred pain). A muscle palpation examination is performed to aid in the discovery of “latent trigger points”, or trigger points which cause no pain unless direct pressure is applied.
+
+=== Digital portion ===
+
+==== Tekscan's T-Scan ====
+This tool is used for digital force analysis to measure the presence and amount of imbalance at closing of the mouth, during closure, and during mastication (chewing). The computer displays the results of how the forces in the mouth spread along the arch, the center of force, the center of force trajectory, and the left/right force balance. This means the dentist can show patients which teeth are generating the most force, and facilitates the dentist's knowledge of what adjustments need to be made to teeth and soft tissue to create a stable dental foundation.
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+---
+title: "Dentomandibular sensorimotor dysfunction"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Dentomandibular_sensorimotor_dysfunction"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:44.166953+00:00"
+instance: "kb-cron"
+---
+
+==== Range-of-motion (ROM) assessment ====
+This test digitally measures an individual's cervical range of motion from a standing position and displays the results in terms of flexion and extension, left and right lateral flexion, and left and right rotation. Limited cervical range of motion is a disability, and being able to understand what is normal—and where their own mouth, head and neck are during the examination—helps people see how this disability is affecting their condition.
+This is also when the amount a person can open their mouth is measured. Along with normal opening movement, the jaw should slide symmetrically from left to right at least 25% of the total mouth opening distance.
+Finally, during the range of motion assessment, a record of jaw joint vibrations and sounds are made. Normal jaw joints glide without noise or vibrations.
+Depending on the assessment findings, patients are classified as needing 1 of 4 levels of care (see Table 1: Levels of Dental Headache Care) to treat and manage their pain and balance their dental foundation. Every level has a regimented therapy protocol designed to provide the most effective, long-lasting care for each individual.
+Once the type of headache pain and extent of dental foundation imbalance is determined, treatment options are discussed. 
+Historically, the treatments for headache pain included one or a combination of herbal remedies, stress-reduction exercises, massage, acupuncture, non-steroidal anti-inflammatory drugs (NSAID), narcotic pain relievers, anti-seizure medications, chiropractic adjustments, anti-depressants or sedatives.
+The combination of advanced dentistry techniques and sports rehabilitation-derived therapies used in treating dental force imbalances in dental headache care has resulted in a dentist reported 93% success rate in providing patients with real, lasting relief from their DMSD symptoms. The methods used control muscle force and force balance, restore proper function and range of motion, and change the way the brain perceives stimuli, so pain levels, dysfunction, and improper muscle activity 
+return to normal. By balancing the muscles, joints, and teeth, and controlling the way the body feels pain in the head and neck 
+areas, long lasting pain relief can be achieved.
+Once the individual has had the proper dental adjustments to restore normalcy to the dental foundation, and has been prescribed and fitted for their at-home orthotic (worn in the mouth for the short term, typically only during the 4- to 12-week rehabilitation period) for muscle re-training, the sports rehabilitation-derived components of therapy begin.
+
+== Treatment ==
+
+=== Therapeutic ultrasound ===
+The goal of therapeutic ultrasound treatment is to restore circulation to sore, strained muscles through increased blood flow and heat. Another objective is to break up scar tissue and deep adhesions (areas where connective tissue fibers have formed over muscle) through sound waves. Therapeutic exposure to ultrasound reduces trigger point sensitivity and is considered a useful clinical tool for managing myofascial pain. Moreover, the ultrasound has also been shown to lessen the stiffness and discomfort of trigger points.
+
+=== Transcutaneous electrical stimulation ===
+Sub-threshold micro-current stimulation reduces muscle spasms and referral pain through a low electrical signal that decreases lactic acid buildup and encourages healthy nerve stimulation. Micro-current electrotherapy is known to significantly aid in increasing mouth opening.
+
+=== Low-level laser (light) therapy ===
+Low-level laser therapy, sometimes called light therapy for short, decreases pain and inflammation, accelerates the healing of muscle and joint tissues by 25%-35%, and reconnects the brain stem’s neurological pathways, effectively inhibiting pain. Low-level laser therapy combined with electrical stimulation improves mouth opening in patients diagnosed with TMJ/D. The musculoskeletal system's natural healing ability decreases pain and promotes TMJ stability.
+
+=== Manual muscle or trigger-point therapy ===
+Manual trigger-point therapy, also known as manual muscle therapy, decreases and eliminates pain and tension in the trigger points by breaking up muscle knots and increasing blood flow. This decreases inflammation and pain in the muscles.
+As part of their in-office treatment, a dentist-monitored homecare system/deprogrammer and intraoral orthotic device are given to patients for their own personal use on their own time.
+
+=== Table 1: Levels of dental force imbalance and dental headache care ===
+Patients will typically need:
+
+A rehabilitation orthotic and some occlusal adjustments
+A rehabilitation orthotic, and some occlusal adjustments
+In-office treatments, rehabilitation orthotic, a basic at-home care kit, and occlusal adjustments
+A greater number of in-office treatments, a rehabilitation orthotic, a basic at-home care kit, a micro-current stimulation kit, and occlusal adjustments.
+
+== See also ==
+Temporomandibular joint disorder
+
+== References ==
+
+== External links ==
+Ritsco, Ronald G. (October 2012). "Treating Dentomandibular Sensorimotor Dysfunction Using the TruDenta System: System offers objective diagnosis plus systematic and predictable symptom treatment". Inside Dentistry. 8 (10). Aegis Dental Network. Online edition.
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diff --git a/data/en.wikipedia.org/wiki/Depression_(physiology)-0.md b/data/en.wikipedia.org/wiki/Depression_(physiology)-0.md
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+---
+title: "Depression (physiology)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Depression_(physiology)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:45.334730+00:00"
+instance: "kb-cron"
+---
+
+In physiology and medicine, depression  refers to a lowering, in particular a reduction in a specific biological variable or the functions of an organ. It is the opposite of elevation. For example, it is possible to refer to "depressed thyroid function" or to a depression of blood flow in a particular area.  
+Further examples:
+
+Depression of the central nervous system of an animal may be expressed as drowsiness or sleep, lack of coordination and unconsciousness.
+Respiratory depression or hypoventilation.
+
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-0.md b/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-0.md
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+---
+title: "Developmental origins of health and disease"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:46.543071+00:00"
+instance: "kb-cron"
+---
+
+Developmental origins of health and disease (DOHaD) is an approach to medical research factors that can lead to the development of human diseases during early life development.  These factors include  the role of prenatal and perinatal exposure to environmental factors, such as undernutrition, stress, environmental chemical, etc. This approach includes an emphasis on epigenetic causes of adult chronic non-communicable diseases. As well as physical human disease, the psychopathology of the foetus can also be predicted by epigenetic factors.
+
+== Origin ==
+DOHaD has evolved into its modern understanding from several precursor concepts. In the 19th century the idea of "maternal impressions" was popular. Maternal impression is the idea that anything the mother did before giving birth could affect her offspring. Our modern understanding of DOHaD was developed by several studies by David Barker and his colleagues, which showed a strong relationship between infant mortality rates from 1921 to 1925 and ischemic heart disease rates from 1968 to 1978. This led to the fetal origins hypothesis of the origins of adult diseases, which proposed that this relationship was caused by differences in early life nutrition, with a supporting theory that birthweight is connected to the development of chronic disease.
+During the Dutch Hunger Winter Famine (1944-1945) mothers were not able to receive the proper nutrition needed to healthily carry a baby. The babies who were born during this time developed diseases (such as heart disease, schizophrenia, and type 2 diabetes) at increased levels. Researchers were able to determine, decades after the famine, that the babies born during Dutch famine had an increase in methylation in some genes and a decrease in methylation in other genes compared to their siblings who were not born during the famine. The methylation levels explain why these individuals were predisposed to certain diseases. Data collected from the Dutch famine and similar events, such as the one at Leningrad, provided a reliable source of information to scientists studying DOHaD.
+These studies in turn led to greater interest in the roles of developmental plasticity and early life environmental exposures in adult disease. The World Congress on Fetal Origins of Adult Disease held two meetings – one in 2001 and the other in 2003 – summarizing the new research in these areas. This congress later evolved into the International Society for Developmental Origins of Health and Disease.
+
+== Dutch hunger winter study ==
+Between 1944 and 1945, in the western regions of the Netherlands and in Amsterdam, a famine broke out due to a railway strike and German control limiting supplies. The people of these countries were receiving extremely limited calories (around 400-800 a day) which had an extreme effect on pregnant women and their children.  Researchers began studying a cohort of middle-aged individuals whose mothers had been pregnant with them during the famine.  The Dutch Hunger Winter study provided significant data to support the DOHaD. Further studies indicated that older people had a resilience to the effects of malnutrition on physical health in late life, but a higher vulnerability to socioeconomic stunting. Results concluded that the women with low caloric and nutritional intake during pregnancy had children that had greater rates of obesity as opposed to those who were not exposed to famine. This is conclusive with the DOHaD theory. The study goes on to investigate at what points in development  DOHaD stood true. It is thought that exposure to famine in early gestational periods has a greater effect on the foetus, however, these theories are still under investigation.
+
+== Developmental plasticity ==
+
+=== Thrifty phenotype hypothesis ===
+The thrifty phenotype hypothesis was proposed by C. Nicholas Hales and David Barker in a study published in 1992. This hypothesis suggested that poor growth during the fetal and infant stages can cause a development of type 2 diabetes later in life. Hales and Barker suggested that this poor growth was due to maternal malnutrition which leads to low birth weight. As previously stated, low infant birth weight usually leads to an increased risk of obesity which, if not acted on, can lead to type 2 diabetes.
+The paper suggests that due to maternal malnutrition, infants can have lower birth weights. Since this is occurring during the plastic stage of development, this can cause the foetus to be "programmed" to conserve energy and store fat, thus leading to a lower metabolism. If there is a surplus of food during adulthood their body simply stores this abundance as more fat. This can then lead to not only diabetes but other metabolic diseases, too.
+
+=== Responses of plasticity ===
+There are two different types of plasticity responses when dealing with human development. The first is an immediate adaptive response. This response will alter the development that is needed to survive if there have been changes in the environment. An example of this type of response is when oxygen deprivation causes a change in blood flow that would normally help with the expense of less critical tissues. Predictive adaptive response (PAR) is the second type of plasticity response. PARs are cues that happen in early life development that cause phenotype development to change that are normally adapted to environmental cues in later life. This can be a benefit only  when the predicted and actual postnatal environment match.
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diff --git a/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-1.md b/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-1.md
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+---
+title: "Developmental origins of health and disease"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:46.543071+00:00"
+instance: "kb-cron"
+---
+
+=== Environmental mismatch hypothesis ===
+This is also referred to as the mismatch theory. Foetal malnutrition followed by excess nutrition in adults is a key example of environmental mismatches. This is very common among people born in impoverished societies. For pregnant women who are living in this type of circumstance the foetuses which are in utero are more likely to sense a low-protein condition and alter their development to survive. Therefore, the foetus will predict that getting food will be very difficult which then will set its metabolism for a "thrifty phenotype". By doing this it will use every calorie to its most efficient use for survival. This can be the same cause for a society with plenty of food available. The embryo will develop insulin resistance and enzyme levels will convert the food that is not being used into fat, which in later life can lead to obesity and diabetes.  Overall the environmental mismatch hypothesis is an advantage for human development but not without some disadvantage in later life.
+
+== Mechanisms ==
+Epigenetic alterations of gene expression are closely related with developmental origins of the health and disease hypothesis. DNA methylation, histone modifications and non-coding RNAs are altered by the environment in the womb and potentially go on to produce higher rates of adult disease later in life.
+
+=== DNA methylation ===
+The process of DNA methylation is the most studied epigenetic response as it relates to the developmental origins of health and disease. The methylation of chief regulatory cytosines changes the DNA's hydrophobicity and begins to inhibit interactions with transcription factors responsible for the expression of the gene. Certain metabolic disorders, cancer and neurodegenerative disorders can be attributed to DNA methylation events.
+
+=== Histone modification ===
+Modifications of histones are important processes in developmental programming, with studies showing that maternal and paternal stress can induce histone modifications. These histone modifications alter phenotypes of organisms and can be the mechanism behind the  predisposition of some metabolic disorders. Unbalanced diets increase the thioredoxin-interacting protein expressions causing blastocysts to form incorrectly because of altered histone methylation. High-fat diets are shown to alter histone methylation and acetylation and potentially lead to changes in gene expression within fetal adipose, liver, and skeletal muscle tissues.
+
+=== Non-coding RNAs ===
+Recent studies have shown the importance in non-coding RNA's ability to regulate cell differentiation and organismal development. There are many types of non-coding RNA that are present and play a role in differentiating stem cells. There are many non-coding RNAs responsible for differentiating cells for human brain and muscle development. These RNA molecules have also been implicated in having a role in cardiovascular development. Long non-coding RNA called lncRNA Fendrr has shown to be an important regulator of heart development and it modifies chromatin and controls developmental signaling of genetically modified mice hearts. There is still a vast amount of research needed to fully understand this mechanism and its relation to DOHaD.
+
+== Examples ==
+
+=== Cardiovascular disease ===
+In a study done by Barker, he found a strong connection between poor prenatal environments and increased possibilities of cardiovascular diseases in adults. He found a direct correlation between infant mortality in 1921-1925 and mortality rates in 1968-1978 because of heart diseases in England. In areas where pregnant mothers had to face poor nutritional states, their newborn children were at a high risk of death. If they survived the early stages of life, they developed a higher risk of cardiovascular diseases.
+Studies on rats found that maternal nutrient restriction resulted in damage to the cardiac renin-angiotensin system (which regulates blood pressure and volume). Additionally, these studies have shown a decrease in the number of nephrons produced by the offspring of these mothers. These differences have been found to affect males and females differently, at least in the early stages. The exact mechanism of action is unknown but it is believed that it is epigenetic.
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diff --git a/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-2.md b/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-2.md
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+---
+title: "Developmental origins of health and disease"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:46.543071+00:00"
+instance: "kb-cron"
+---
+
+=== Metabolic diseases ===
+A study done at UC Irvine looked at the impact that maternal stress has on foetal development and overall foetal health. The researchers determined that a mother's stress and adverse pregnancy outcomes (APOs) related to the length of gestation and growth of the foetus along with impacts on the endocrine and immune systems of the foetus.
+Early life influences, both prenatal and postnatal, have important effects on children later in life. It was determined that breastfed infants have significantly lower risks of obesity later in life than infants that were formula-fed.
+Nutrition and growth during the early years of life can be related to the growth of diseases in humans later in their lives. For example, a study done in Jamaica showed that the blood pressure of children was associated with the mother's hemoglobin levels and body fat during pregnancy. Another example of this is shown in an article from the New England Journal of Medicine which took place during the Dutch famine. This study concluded that those who were in utero at the time of the famine were at a greater risk of obesity, hypertension, and heart disease than those who were born before or after the famine.
+A maternal high-fat diet was used to help investigate how saturated fats cause unrestrained gestational weight gain and maternal obesity of offspring. When there is high-fat feeding during pregnancy, there are effects on the maternal metabolism and body composition. Some of the effects are insulin resistance, increased circulating lipids, increased adiposity, and hyperinsulinemia (high insulin in blood). When the fat intake was increased it started to adjust consumption of other macronutrients in the diet, which reduced the carbohydrate and protein consumption to match the increase of fatty acid. On another note, people who have obesity and a diet that is high in fat can develop a condition called dyslipidemia. It can lead to fibrosis of the liver, which is the cause for about 45% of deaths in the world.
+During the Dutch famine doctors found that under-nutrition during the gestation period related to reduced glucose tolerance and raised insulin concentrations between the ages 50 and 58. There were 120 minute glucose and insulin concentrations that were known to be higher in people that were exposed to the famine at any stage during foetal development than those who were not exposed. The effect could be explained due to the lower birth rates of babies that were born during the famine and the low weight gain of their mothers. People that were born before the famine had a larger increase in glucose and insulin concentration. That was due to them experiencing starvation during the early stage of their life which might have impacted their postnatal growth pattern.
+
+=== Autism spectrum disorder ===
+Autism spectrum disorder (ASD) is a condition that typically manifests during the first three years of a person's life. It is a developmental disorder that impairs the brain's ability to develop the typical social and communication skills that are necessary for everyday life. People with ASD may experience difficulties with social interactions, verbal and nonverbal communication, and repetitive or restricted behaviors. The degree to which ASD affects an individual can vary widely, with some people experiencing mild symptoms while others may face more significant challenges.
+The precise cause of ASD is still unknown, but it is believed that a combination of factors may contribute to its development. Research suggests that genetics may play a role, as ASD can run in families. In addition, certain medications taken during pregnancy may increase the risk of a child developing ASD. While some theories have been proposed, they have yet to be proven. For instance, some scientists believe that damage to a specific region of the brain, the amygdala, may be linked to ASD, while others are examining the possibility that a viral infection may trigger the disorder.
+There has been some controversy regarding whether vaccines can cause ASD, but numerous studies have shown that there is no evidence of a link between vaccines and ASD. Major medical and government organizations have also confirmed this finding. The increase in ASD diagnoses in recent years may be attributed to better awareness and more comprehensive definitions of the disorder. Treatment for ASD involves a highly structured schedule of constructive activities that build on the child's interests and various techniques. It is important to avoid unproven treatments and seek advice from ASD specialists.
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diff --git a/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-3.md b/data/en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease-3.md
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+---
+title: "Developmental origins of health and disease"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Developmental_origins_of_health_and_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:46.543071+00:00"
+instance: "kb-cron"
+---
+
+=== Schizophrenia ===
+Large-scale famines offer insights into the effects prenatal malnutrition has on developing foetuses. A team led by Mingqing Xu investigated this possible connection between prenatal malnutrition and schizophrenia by analyzing medical records of people born between 1960 and 1961 during the Great Chinese Famine. This study found that there was a two-fold risk for someone who was born in a rural area during this period of famine to later develop schizophrenia than someone who was born either before or after. However, being born in an urban area during this time was not associated with an increased risk of schizophrenia. This is probably due to factors that exacerbated the impact of the famine in rural areas such as grain procurement and lack of large-scale grain storage.
+Similar results have been found in studying the effects of the Dutch famine from 1944 to 1945. A study by Hoek compared the levels of schizophrenia for those born between August 15 and December 31, 1945, to those born after the famine had ended. This study found that those born during the time period were between two and two and a half times more likely to have schizophrenia than those born after the famine had ended.
+The exact mechanism which connects undernutrition to an increased chance of schizophrenia later in life is not fully understood. Famines may lead to an enhanced risk of schizophrenia because they deprive the developing foetus of key micronutrients. Some of the leading candidates are folate, essential fatty acids, retinoids, vitamin D, and iron. Of these micronutrients, folate, iron and vitamin D seem to be the most promising.  Folate jumps out as a key candidate as the occurrence of neural tube defects raised alongside schizophrenia during the Dutch famine.  A lack of folate could cause DNA methylation which may affect the expression of genes crucial to neurodevelopment, and it could impede the conversion of homocysteine to methionine, causing homocysteine to accumulate and cause problems in the developing brain. Iron has been put forward as a leading candidate as low levels of hemoglobin, a molecule created by iron, during development was highly associated with developing schizophrenia later on in life. This connection may be due to iron having a key role in the creation and function of dopamine transmission.
+Another, less accepted, theory that explains the connection between famine and schizophrenia is protein-calorie malnutrition. Protein-calorie malnutrition has been associated with increased dopamine and serotonin release and malfunctions in the hippocampus such as reduced dendritic branching and a lower cell count, which are also found in people with schizophrenia.
+
+=== Maternal stress ===
+The effect stress has on expecting women may not only affect them, but their child as well. Studies have shown a link between child mental health and behavioral problems to maternal stress during pregnancy. Stress in the body leads to an increase in the cortisol levels. Maternal stress, therefore, exposes the fetus to high cortisol levels. Additionally stress falls along the line of exposure to depression or anxiety within the mother. These factors have been found to been associated with emotional and cognitive issues within the child's later life. These levels have been linked to neurological and behavioral regulation issues in the child later in life. For example, cognitive performance at 5 years of age was impaired in kids who mother had experienced stress from a catastrophic ice storm. Investigators found that schizophrenia was frequent in offspring that mothers endured the ice storm during pregnancy. Prenatal stress has been shown to increase reactivity in infants. Infants that are from pregnancy with a lot of stress are harder to soothe rather than those that mothers didn't experience any stress during pregnancy. Human and animal studies did show that infants from stressed pregnancies have a poor immune function and are more likely to contract childhood illnesses as well as mental disorders.
+There was a study published in the Journal of Pediatrics of August 19, 2020, which looked at how  maternal recognition and stress can affect infant health after or during pregnancy. The study consisted of women from low income areas, and those that were overweight which were at the age of 28 years old.  The women had to rate how they felt during challenges they had to endure. The infants born during this study had to get their medical records looked at from the first year of their lives. There was a 38 percent increase for having infectious illnesses. There was a 73 percent increase from not having non-infectious illnesses with an increase of 53 percent in other illnesses amid the infants. It seems that the effects were more likely later in the pregnancy, but after the study was completed they realized that stress and depression in mothers is not associated with increase in illnesses amongst the infants.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diadochokinesia-0.md b/data/en.wikipedia.org/wiki/Diadochokinesia-0.md
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+---
+title: "Diadochokinesia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diadochokinesia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:47.860542+00:00"
+instance: "kb-cron"
+---
+
+Diadochokinesia or diadochokinesis is the ability to make antagonistic movements in quick succession, alternately bringing a limb into opposite positions, as of flexion and extension or of pronation and supination. Speech-language pathology defines it as the speed necessary to stop a determined motor impulse and substitute it with its opposite. The relative timing of this kind of movements is also called alternate motion rates (AMR) or sequential motor rates (SMR).
+Loss of this ability, called dysdiadochokinesia, is a characteristic sign of cerebellar diseases. Many clinical tests may be employed to test for such disturbances.
+
+Alternating movements: Patient is told e.g. to pronate and supinate their hands in rapid succession, holding forearms vertically. In cerebellar diseases, the movements are irregular and inaccurate; in case of the pyramidal tract lesion the motion may be slowed or incomplete.
+Stewart-Holmes rebound sign: Patient tries to flex the elbow against applied resistance. When physician's grip is suddenly released, the patient should be able to deter it from rebounding. With cerebellar disease, the forearm may sway in several cycles. The patient may even strike themself if not guarded.
+Various instrumental techniques can be used to investigate speech motor skills, such as imaging movement transduction and point tracking.
+
+
+== See also ==
+Adiadochokinesia
+Dysdiadochokinesia
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diagnosis-0.md b/data/en.wikipedia.org/wiki/Diagnosis-0.md
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+++ b/data/en.wikipedia.org/wiki/Diagnosis-0.md
@@ -0,0 +1,71 @@
+---
+title: "Diagnosis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:48.997079+00:00"
+instance: "kb-cron"
+---
+
+Diagnosis (pl.: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different disciplines, with variations in the use of logic, analytics, and experience, to determine "cause and effect". In systems engineering and computer science, it is typically used to determine the causes of symptoms, mitigations, and solutions.
+
+
+== Computer science and networking ==
+Bayesian network
+Complex event processing
+Diagnosis (artificial intelligence)
+Event correlation
+Fault management
+Fault tree analysis
+Grey problem
+RPR problem diagnosis
+Remote diagnostics
+Root cause analysis
+Troubleshooting
+Unified Diagnostic Services
+
+
+== Mathematics and logic ==
+Bayesian probability
+Block Hackam's dictum
+Occam's razor
+Regression diagnostics
+Sutton's law
+
+
+== Medicine ==
+
+Medical diagnosis
+Molecular diagnostics
+
+
+=== Methods ===
+CDR computerized assessment system
+Computer-aided diagnosis
+Differential diagnosis
+Retrospective diagnosis
+
+
+=== Tools ===
+DELTA (taxonomy)
+DXplain
+List of diagnostic classification and rating scales used in psychiatry
+
+
+== Organizational development ==
+Organizational diagnostics
+
+
+== Systems engineering ==
+Five whys
+Eight disciplines problem solving
+Fault detection and isolation
+Problem solving
+
+
+== References ==
+
+
+== External links ==
+ The dictionary definition of diagnosis at Wiktionary
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diff --git a/data/en.wikipedia.org/wiki/Diagnosis-related_group-0.md b/data/en.wikipedia.org/wiki/Diagnosis-related_group-0.md
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+---
+title: "Diagnosis-related group"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Diagnosis-related_group"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:51.426194+00:00"
+instance: "kb-cron"
+---
+
+Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group (currently coded as 999) being "Ungroupable". This system of classification was developed in the 1970s as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides.  Examples include appendectomy, normal newborn (vaginal delivery), heart failure or psychoses. 
+The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point.  DRGs are assigned by a "grouper" program based on ICD (International Classification of Diseases) diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs).  DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.
+
+== Purpose ==
+The original objective of diagnosis-related groups (DRG) was to develop a classification system that identified the "products" that the patient received.  Since the introduction of DRGs in the early 1980s, the healthcare industry has evolved and developed an increased demand for a patient classification system that can serve its original objective at a higher level of sophistication and precision.  To meet those evolving needs, the objective of the DRG system had to expand in scope.
+Several different DRG systems have been developed in the United States.  They include:
+
+Medicare DRG (CMS-DRG & MS-DRG)
+Refined DRGs (R-DRG)
+All Patient DRGs (AP-DRG)
+Severity DRGs (S-DRG)
+All Patient, Severity-Adjusted DRGs (APS-DRG)
+All Patient Refined DRGs (APR-DRG)
+International-Refined DRGs (IR-DRG)
+Other DRG systems have been developed for markets such as Latin America and ASIA, for example:
+
+AVEDIAN DRG Grouper (LAT-GRC)
+
+== Statistics ==
+As of 2003, the top 10 DRGs accounted for almost 30% of acute hospital admissions.
+In 1991, the top 10 DRGs overall were: normal newborn (vaginal delivery), heart failure, psychoses, Caesarean section, neonate with significant problems, angina pectoris, specific cerebrovascular disorders, pneumonia, and hip/knee replacement. These DRGs comprised nearly 30 percent of all hospital discharges.
+In terms of geographic variation, as of 2011 hospital payments varied across 441 labor markets.
+
+== History ==
+The system was created in the early 1970s by Robert Barclay Fetter and John D. Thompson at Yale University with the material support of the former Health Care Financing Administration (HCFA), now called the Centers for Medicare & Medicaid Services (CMS).
+DRGs were first implemented in New Jersey, beginning in 1980 at the initiative of NJ Health Commissioner Joanne Finley with a small number of hospitals partitioned into three groups according to their budget positions — surplus, breakeven, and deficit — prior to the imposition of DRG payment. The New Jersey experiment continued for three years, with additional cadres of hospitals being added to the number of institutions each year until all hospitals in New Jersey were dealing with this prospective payment system.
+DRGs were designed to be homogeneous units of hospital activity to which binding prices could be attached. A central theme in the advocacy of DRGs was that this reimbursement system would, by constraining the hospitals, oblige their administrators to alter the behaviour of the physicians and surgeons comprising their medical staffs. Hospitals were forced to leave the "nearly risk-free world of cost reimbursement" and face the uncertain financial consequences associated with the provision of health care. DRGs were designed to provide practice pattern information that administrators could use to influence individual physician behaviour.
+DRGs were intended to describe all types of patients in an acute hospital setting. DRGs encompassed elderly patients as well as new born, pediatric and adult populations.
+The prospective payment system implemented as DRGs had been designed to limit the share of hospital revenues derived from the Medicare program budget. In 1982 the US Congress passed Tax Equity and Fiscal Responsibility Act with provisions to reform Medicare payment, and in 1983, an amendment was passed to use DRGs for Medicare, with HCFA (now CMS) maintaining the definitions.
+In 1988, New York state passed legislation instituting DRG-based payments for all non-Medicare patients. This legislation required that the New York State Department of Health (NYS DOH) evaluate the applicability of Medicare DRGs to a non-Medicare population.  This evaluation concluded that the Medicare DRGs were not adequate for a non-Medicare population.  Based on this evaluation, the NYS DOH entered into an agreement with 3M to research and develop all necessary DRG modifications. The modifications resulted in the initial APDRG, which differed from the Medicare DRG in that it provided support for transplants, high-risk obstetric care, nutritional disorders, and pediatrics along with support for other populations.  One challenge in working with the APDRG groupers is that there is no set of common data/formulas that is shared across all states as there is with CMS.  Each state maintains its own information.
+The history, design, and classification rules of the DRG system, as well as its application to patient discharge data and updating procedures, are presented in the CMS DRG Definitions Manual (Also known as the Medicare DRG Definitions Manual and the Grouper Manual). A new version generally appears every October. The 20.0 version appeared in 2002.
+In 2007, Rick Mayes described DRGs as:
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diff --git a/data/en.wikipedia.org/wiki/Diagnosis-related_group-1.md b/data/en.wikipedia.org/wiki/Diagnosis-related_group-1.md
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@@ -0,0 +1,56 @@
+---
+title: "Diagnosis-related group"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Diagnosis-related_group"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:51.426194+00:00"
+instance: "kb-cron"
+---
+
+...the single most influential postwar innovation in medical financing: Medicare's prospective payment system (PPS). Inexorably rising medical inflation and deep economic deterioration forced policymakers in the late 1970s to pursue radical reform of Medicare to keep the program from insolvency. Congress and the Reagan administration eventually turned to the one alternative reimbursement system that analysts and academics had studied more than any other and had even tested with apparent success in New Jersey: prospective payment with diagnosis-related groups (DRGs). Rather than simply reimbursing hospitals whatever costs they charged to treat Medicare patients, the new model paid hospitals a predetermined, set rate based on the patient's diagnosis. The most significant change in health policy since Medicare and Medicaid's passage in 1965 went virtually unnoticed by the general public. Nevertheless, the change was nothing short of revolutionary. For the first time, the federal government gained the upper hand in its financial relationship with the hospital industry. Medicare's new prospective payment system with DRGs triggered a shift in the balance of political and economic power between the providers of medical care (hospitals and physicians) and those who paid for it - power that providers had successfully accumulated for more than half a century.
+
+== United States state-based usage ==
+DRGs were originally developed in New Jersey before the federal adoption for Medicare in 1983. After the federal adoption, the system was adopted by states, including in Medicaid payment systems, with twenty states using some DRG-based system in 1991; however, these systems may have their own unique adjustments.
+In 1992, New Jersey repealed the DRG payment system after political controversy.
+
+== Example calculation ==
+
+== DRG changes ==
+
+== International ==
+DRGs and similar systems have expanded internationally; for example, in Europe some countries imported the scheme from US or Australia, and in other cases they were developed independently. In England, a similar set of codes exist called Health Resource Groups. As of 2018, Asian countries such as South Korea, Japan, and Thailand have limited adoption of DRGs.
+Latin American countries use a DRG system adapted to regionally extended medical classifications and nomenclatures. This DRG system is called AVEDIAN DRG GROUPER (LAT-GRC).
+
+=== Indonesia ===
+Indonesia implements a DRG-based prospective payment system called INA-CBG (Indonesia Case Based Groups) for its national health insurance program, Jaminan Kesehatan Nasional (JKN), managed by BPJS Kesehatan.
+The system was first introduced in 2008 as INA-DRG, developed in collaboration with the University of Indonesia and United Nations University. In 2014, it was replaced by INA-CBG using grouper software developed by the Center for Casemix at Universiti Kebangsaan Malaysia (UKM). INA-CBG classifies inpatient episodes using ICD-10 diagnosis codes and ICD-9-CM procedure codes, assigning patients to one of approximately 1,077 case groups across three severity levels.
+As of 2025, JKN covers over 270 million beneficiaries — the world's largest single-payer system — with more than 2,600 participating hospitals. Tariffs vary by hospital class (A through D), geographic region (five tariff regions), and severity level (I through III).
+Indonesia announced a planned transition from INA-CBG to a domestically developed system called INA-DRG (Indonesia Diagnosis Related Groups) beginning in 2025, with full implementation targeted by 2027. The new system aims to use Indonesian hospital costing data and integrate with the national health information exchange platform, SATUSEHAT.
+
+== See also ==
+Case mix index
+Diagnosis code
+Healthcare Resource Group, UK's implementation
+International Classification of Diseases (ICD)
+Medical classification
+Ambulatory Patient Group, similar to DRG but for outpatient care
+Risk of mortality (ROM)
+Severity of illness (SOI)
+Pay for Performance
+
+== References ==
+
+== External links ==
+Official CMS website
+CMS Acute Inpatient Prospective Payment System
+DRG codes for FY2005, also referred to as version 23
+DRG codes for FY2010, also referred to as version 27
+MS-DRG Grouper version 35 (FY2018) Software, PC and Mainframe, supports versions 16-35
+Healthcare Cost and Utilization Project (Search engine can be used to find Definitions Manual)
+Agency for Healthcare Research and Quality (AHRQ).
+DRG definition.
+Most Frequent Diagnoses and Procedures for DRGs Archived 2012-06-19 at the Wayback Machine.
+Medical Billing and Coding Information Guide
+Diagnosis Related Groups (DRGs) and the Medicare Program - Implications for Medical Technology (PDF format). A 1983 document found in the "CyberCemetery: OTA Legacy" section of University of North Texas Libraries Government Documents department.
+Mayes, Rick, "The Origins, Development, and Passage of Medicare's Revolutionary Prospective Payment System" Journal of the History of Medicine and Allied Sciences Volume 62, Number 1, January 2007, pp. 21–55
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diagnosis_of_exclusion-0.md b/data/en.wikipedia.org/wiki/Diagnosis_of_exclusion-0.md
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@@ -0,0 +1,42 @@
+---
+title: "Diagnosis of exclusion"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diagnosis_of_exclusion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:50.188477+00:00"
+instance: "kb-cron"
+---
+
+A diagnosis of exclusion or by exclusion (per exclusionem) is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination or testing. Such elimination of other reasonable possibilities is a major component in performing a differential diagnosis.
+Diagnosis by exclusion tends to occur where scientific knowledge is scarce, specifically where the means to verify a diagnosis by an objective method is absent. It can also commonly occur where objective diagnostic tests do exist, but extensive diagnostic testing or sufficient exploration of differential diagnosis by a multidisciplinary team is not undertaken due to financial constraints or assessment bias (health inequity).
+The largest category of diagnosis by exclusion is seen among psychiatric disorders where the presence of physical or organic disease must be excluded as a prerequisite for making a functional diagnosis.
+
+
+== Examples ==
+An example of such a diagnosis is "fever of unknown origin": to explain the cause of elevated temperature the most common causes of unexplained fever (infection, neoplasm, or collagen vascular disease) must be ruled out.
+Other examples include:
+
+Fibromyalgia
+Adult-onset Still's disease
+Behçet's disease
+Bell's palsy
+Burning mouth syndrome
+Chronic recurrent multifocal osteomyelitis
+Long COVID
+Inappropriate sinus tachycardia
+Psychogenic polydipsia
+Schizophrenia
+Somatic symptom disorder
+Sudden infant death syndrome
+Thoracic outlet syndrome
+Tolosa–Hunt syndrome
+Systemic-onset juvenile idiopathic arthritis
+
+
+== See also ==
+Idiopathic
+Wastebasket diagnosis
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diagnostic_greed-0.md b/data/en.wikipedia.org/wiki/Diagnostic_greed-0.md
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@@ -0,0 +1,25 @@
+---
+title: "Diagnostic greed"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diagnostic_greed"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:52.629258+00:00"
+instance: "kb-cron"
+---
+
+Diagnostic greed is a medical term coined by physician Maurice Pappworth to describe the rigidity of physicians in insisting on every classic symptom and physical sign be present before making a diagnosis. Pappworth explained that “overwhelming evidence is not essential for correct diagnosis, and the absence of some expected symptom or sign often does not invalidate an otherwise reasonable diagnosis.”
+Where a diagnosis may have considerable impact, additional tests providing supporting evidence might be required, making diagnostic greed advantageous.
+
+
+== Origin and definition ==
+The term "diagnostic greed" was coined by physician Maurice Pappworth to describe the rigidity of physicians in insisting on every classic symptom and physical sign be present before making a diagnosis. Pappworth explained that “overwhelming evidence is not essential for correct diagnosis, and the absence of some expected symptom or sign often does not invalidate an otherwise reasonable diagnosis.” He recorded that the correct question was "wherefore is this disease different from all other disease?" Coming to a correct diagnosis "is not like a jury's verdict. It does not have to be proved beyond a reasonable doubt."
+
+
+== Examples ==
+Where a person presents with a classic history associated with clearly recognisable symptoms and signs of a condition, a diagnosis can be confidently made with ease. However, clinical scenarios of the same disease frequently vary and insisting on an exact match before making the diagnosis may miss the diagnosis and therefore be considered a "sin of greed". One example is of kidney cancer, which classically presents with flank pain, blood in urine and a mass felt in the abdomen; a triad of features which present in less than 10% of cases. In practice, all "essential" features are rarely present and a person may reveal just a few classic features, which is where the request for testing plays a role in confirming or ruling out the suspected diagnosis.
+In dermatology, every textbook feature of a lesion need not be present to make the diagnosis. Likewise, in cardiology, the expectation to explain every change on an ECG to conclude a diagnosis may represent diagnostic greed. Another example has been of lead poisoning, where toxicology results have failed to support the diagnosis despite other features of heavy metal poisoning being present.
+Arguments for the need, on occasion, to have diagnostic greed, have also been made. Where a diagnosis may have considerable impact, additional tests providing supporting evidence might be required, making diagnostic greed advantageous.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diastasis_(physiology)-0.md b/data/en.wikipedia.org/wiki/Diastasis_(physiology)-0.md
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@@ -0,0 +1,19 @@
+---
+title: "Diastasis (physiology)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diastasis_(physiology)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:53.849340+00:00"
+instance: "kb-cron"
+---
+
+In physiology, diastasis is the middle stage of diastole during the cycle of a heartbeat, where the initial passive filling of the heart's ventricles has slowed, but before the atria contract to complete the active filling.
+Diastasis is the longest phase of cardiac cycle.
+
+
+== See also ==
+Compare diastasis (pathology)
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Diathesis_(medicine)-0.md b/data/en.wikipedia.org/wiki/Diathesis_(medicine)-0.md
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index 000000000..497664be7
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Diathesis_(medicine)-0.md
@@ -0,0 +1,30 @@
+---
+title: "Diathesis (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diathesis_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:55.158526+00:00"
+instance: "kb-cron"
+---
+
+In  medicine and allied fields, diathesis (from Greek διάθεσις) is a hereditary or constitutional predisposition to a group of diseases, an allergy, or other disorder. There are many types of diathesis. Some including strumous diathesis, sthenic diathesis, and many more.
+Atopic diathesis is a predisposition to develop one or more of hay fever, allergic rhinitis, bronchial asthma, or atopic dermatitis.
+
+
+== Types ==
+Lupus diathesis
+Strumous diathesis
+Sthenic diathesis
+
+
+== See also ==
+Bleeding diathesis
+Diathesis–stress model
+
+
+== References ==
+
+
+== External links ==
+ Media related to Diathesis (medicine) at Wikimedia Commons
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-0.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-0.md
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@@ -0,0 +1,109 @@
+---
+title: "Differential diagnosis"
+chunk: 1/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+In healthcare, a nomothetic (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to diagnose the specific disease in a patient, or, at least, to consider any imminently life-threatening conditions. Often, each possible disease is called a differential diagnosis (e.g., acute bronchitis could be a differential diagnosis in the evaluation of a cough, even if the final diagnosis is common cold).
+More generally, a differential diagnostic procedure is a systematic diagnostic method used to identify the presence of a disease entity where multiple alternatives are possible. This method may employ algorithms, akin to the process of elimination, or at least a process of obtaining information that decreases the "probabilities" of candidate conditions to negligible levels, by using evidence such as symptoms, patient history, and medical knowledge to adjust epistemic confidences in the mind of the diagnostician (or, for computerized or computer-assisted diagnosis, the software of the system).
+Differential diagnosis can be regarded as implementing aspects of the hypothetico-deductive method, in the sense that the potential presence of candidate diseases or conditions can be viewed as hypotheses that clinicians further determine as being true or false.
+A differential diagnosis is also commonly used within the field of psychiatry, where two different diagnoses can be attached to a patient who is exhibiting symptoms that could fit into either diagnosis. For example, a patient who has been diagnosed with bipolar disorder may also be given a differential diagnosis of attention deficit hyperactivity disorder, major depressive disorder, post-traumatic stress disorder, anxiety disorders, and borderline personality disorder, given the overlap and similarity of signs and symptoms across the conditions.
+Strategies used in preparing a differential diagnosis list vary with the experience of the healthcare provider. While novice providers may work systemically to assess all possible explanations for a patient's concerns, those with more experience often draw on clinical experience and pattern recognition to protect the patient from delays, risks, and cost of inefficient strategies or tests. Effective providers utilize an evidence-based approach, complementing their clinical experience with knowledge from clinical research.
+
+== General components ==
+
+A nomothetic has four general steps. The clinician will:
+
+Gather relevant information about the person's medical history and present signs and/or symptoms list.
+List possible causes (candidate conditions) for the symptoms. The list need not be in writing.
+Prioritize the list by balancing the risks of a diagnosis with the probability.  These are subjective, not objective parameters.
+Perform tests to determine the actual diagnosis.  This is known by the colloquial phrase "to Rule Out".  Even after the process, the diagnosis is not clear.  The clinician again considers the risks and may treat them empirically, often called "Educated Best Guess."
+A mnemonic to help in considering multiple possible pathological processes is VINDICATEM:
+
+Vascular
+Inflammatory / Infectious
+Neoplastic
+Degenerative / Deficiency / Drugs
+Idiopathic / Intoxication / Iatrogenic
+Congenital
+Autoimmune / Allergic / Anatomic
+Traumatic
+Endocrine / Environmental
+Metabolic
+
+== Specific methods ==
+There are several methods for differential diagnostic procedures and several variants among those. Furthermore, a differential diagnostic procedure can be used concomitantly or alternately with protocols, guidelines, or other diagnostic procedures (such as pattern recognition or using medical algorithms).
+For example, in case of medical emergency, there may not be enough time to do any detailed calculations or estimations of different probabilities, in which case the ABC protocol (airway, breathing and circulation) may be more appropriate. Later, when the situation is less acute, a more comprehensive differential diagnostic procedure may be adopted.
+The differential diagnostic procedure may be simplified if a "pathognomonic" sign or symptom is found (in which case it is almost certain that the target condition is present) or in the absence of a sine qua non sign or symptom (in which case it is almost certain that the target condition is absent).
+A diagnostician can be selective, considering first those disorders that are more likely (a probabilistic approach), more serious if left undiagnosed and untreated (a prognostic approach), or more responsive to treatment if offered (a pragmatic approach). Since the subjective probability of the presence of a condition is never exactly 100% or 0%, the differential diagnostic procedure may aim at specifying these various probabilities to form indications for further action.
+The following are two methods of differential diagnosis, being based on epidemiology and likelihood ratios, respectively.
+
+=== Epidemiology-based method ===
+One method of performing a differential diagnosis by epidemiology aims to estimate the probability of each candidate condition by comparing their probabilities to have occurred in the first place in the individual. It is based on probabilities related both to the presentation (such as pain) and probabilities of the various candidate conditions (such as diseases).
+
+==== Theory ====
+The statistical basis for differential diagnosis is Bayes' theorem. As an analogy, when a die has landed the outcome is certain by 100%, but the probability that it Would Have Occurred in the First Place (hereafter abbreviated WHOIFP) is still 1/6. In the same way, the probability that a presentation or condition would have occurred in the first place in an individual (WHOIFPI) is not same as the probability that the presentation or condition has occurred in the individual, because the presentation has occurred by 100% certainty in the individual. Yet, the contributive probability fractions of each condition are assumed the same, relatively:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        Presentation is caused by condition in individual
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        Presentation has occurred in individual
+                      
+                      )
+                    
+                  
+                
+                =
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        Presentation WHOIFPI by condition
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        Presentation WHOIFPI
+                      
+                      )
+                    
+                  
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&{\frac {\Pr({\text{Presentation is caused by condition in individual}})}{\Pr({\text{Presentation has occurred in individual}})}}={\frac {\Pr({\text{Presentation WHOIFPI by condition}})}{\Pr({\text{Presentation WHOIFPI}})}}\end{aligned}}}
+  
+
+where:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-1.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-1.md
new file mode 100644
index 000000000..b8b1c0757
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Differential_diagnosis-1.md
@@ -0,0 +1,216 @@
+---
+title: "Differential diagnosis"
+chunk: 2/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+Pr(Presentation is caused by condition in individual) is the probability that the presentation is caused by condition in the individual; condition without further specification refers to any candidate condition
+Pr(Presentation has occurred in individual) is the probability that the presentation has occurred in the individual, which can be perceived and thereby set at 100%
+Pr(Presentation WHOIFPI by condition) is the probability that the presentation Would Have Occurred in the First Place in the Individual by condition
+Pr(Presentation WHOIFPI) is the probability that the presentation Would Have Occurred in the First Place in the Individual
+When an individual presents with a symptom or sign, Pr(Presentation has occurred in individual) is 100% and can therefore be replaced by 1, and can be ignored since division by 1 does not make any difference:
+
+  
+    
+      
+        Pr
+        (
+        
+          Presentation is caused by condition in individual
+        
+        )
+        =
+        
+          
+            
+              Pr
+              (
+              
+                Presentation WHOIFPI by condition
+              
+              )
+            
+            
+              Pr
+              (
+              
+                Presentation WHOIFPI
+              
+              )
+            
+          
+        
+      
+    
+    {\displaystyle \Pr({\text{Presentation is caused by condition in individual}})={\frac {\Pr({\text{Presentation WHOIFPI by condition}})}{\Pr({\text{Presentation WHOIFPI}})}}}
+  
+
+The total probability of the presentation to have occurred in the individual can be approximated as the sum of the individual candidate conditions:
+
+  
+    
+      
+        
+          
+            
+              
+                Pr
+                (
+                
+                  Presentation WHOIFPI
+                
+                )
+              
+              
+                
+                =
+                Pr
+                (
+                
+                  Presentation WHOIFPI by condition 1
+                
+                )
+              
+            
+            
+              
+              
+                
+                
+
+                
+                +
+                Pr
+                (
+                
+                  Presentation WHOIFPI by condition 2
+                
+                )
+              
+            
+            
+              
+              
+                
+                
+
+                
+                +
+                Pr
+                (
+                
+                  Presentation WHOIFPI by condition 3
+                
+                )
+                +
+                
+                  etc.
+                
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}\Pr({\text{Presentation WHOIFPI}})&=\Pr({\text{Presentation WHOIFPI by condition 1}})\\&{}+\Pr({\text{Presentation WHOIFPI by condition 2}})\\&{}+\Pr({\text{Presentation WHOIFPI by condition 3}})+{\text{etc.}}\end{aligned}}}
+  
+
+Also, the probability of the presentation to have been caused by any candidate condition is proportional to the probability of the condition, depending on what rate it causes the presentation:
+
+  
+    
+      
+        Pr
+        (
+        
+          Presentation WHOIFPI by condition
+        
+        )
+        =
+        Pr
+        (
+        
+          Condition WHOIFPI
+        
+        )
+        ⋅
+        
+          r
+          
+            
+              condition
+            
+            →
+            
+              presentation
+            
+          
+        
+        ,
+      
+    
+    {\displaystyle \Pr({\text{Presentation WHOIFPI by condition}})=\Pr({\text{Condition WHOIFPI}})\cdot r_{{\text{condition}}\rightarrow {\text{presentation}}},}
+  
+
+where:
+
+Pr(Presentation WHOIFPI by condition) is the probability that the presentation Would Have Occurred in the First Place in the Individual by condition
+Pr(Condition WHOIFPI) is the probability that the condition Would Have Occurred in the First Place in the Individual
+rCondition → presentation is the rate at which a condition causes the presentation, that is, the fraction of people with conditions that manifests with the presentation.
+The probability that a condition would have occurred in the first place in an individual is approximately equal to that of a population that is as similar to the individual as possible except for the current presentation, compensated where possible by relative risks given by known risk factor that distinguish the individual from the population:
+
+  
+    
+      
+        Pr
+        (
+        
+          Condition WHOIFPI
+        
+        )
+        ≈
+        R
+        
+          R
+          
+            condition
+          
+        
+        ⋅
+        Pr
+        (
+        
+          Condition in population
+        
+        )
+        ,
+      
+    
+    {\displaystyle \Pr({\text{Condition WHOIFPI}})\approx RR_{\text{condition}}\cdot \Pr({\text{Condition in population}}),}
+  
+
+where:
+
+Pr(Condition WHOIFPI) is the probability that the condition Would Have Occurred in the First Place in the Individual
+RRcondition is the relative risk for condition conferred by known risk factors in the individual that are not present in the population
+Pr(Condition in population) is the probability that the condition occurs in a population that is as similar to the individual as possible except for the presentation
+The following table demonstrates how these relations can be made for a series of candidate conditions:
+
+One additional "candidate condition" is the instance of there being no abnormality, and the presentation is only a (usually relatively unlikely) appearance of a basically normal state. Its probability in the population (P(No abnormality in population)) is complementary to the sum of probabilities of "abnormal" candidate conditions.
+
+==== Example ====
+This example case demonstrates how this method is applied but does not represent a guideline for handling similar real-world cases. Also, the example uses relatively specified numbers with sometimes several decimals, while in reality, there are often simply rough estimations, such as of likelihoods being very high, high, low or very low, but still using the general principles of the method.
+For an individual (who becomes the "patient" in this example), a blood test of, for example, serum calcium shows a result above the standard reference range, which, by most definitions, classifies as hypercalcemia, which becomes the "presentation" in this case. A clinician (who becomes the "diagnostician" in this example), who does not currently see the patient, gets to know about his finding.
+By practical reasons, the clinician considers that there is enough test indication to have a look at the patient's medical records. For simplicity, let's say that the only information given in the medical records is a family history of primary hyperparathyroidism (here abbreviated as PH), which may explain the finding of hypercalcemia. For this patient, let's say that the resultant hereditary risk factor is estimated to confer a relative risk of 10 (RRPH = 10).
+The clinician considers that there is enough motivation to perform a differential diagnostic procedure for the finding of hypercalcemia. The main causes of hypercalcemia are primary hyperparathyroidism (PH) and cancer, so for simplicity, the list of candidate conditions that the clinician could think of can be given as:
+
+Primary hyperparathyroidism (PH)
+Cancer
+Other diseases that the clinician could think of (which is simply termed "other conditions" for the rest of this example)
+No disease (or no abnormality), and the finding is caused entirely by statistical variability
+The probability that 'primary hyperparathyroidism' (PH) would have occurred in the first place in the individual (P(PH WHOIFPI)) can be calculated as follows:
+Let's say that the last blood test taken by the patient was half a year ago and was normal and that the incidence of primary hyperparathyroidism in a general population appropriately matches the individual (except for the presentation and mentioned heredity) is 1 in 4000 per year. Ignoring more detailed retrospective analyses (such as including speed of disease progress and lag time of medical diagnosis), the time-at-risk for having developed primary hyperparathyroidism can roughly be regarded as being the last half-year because a previously developed hypercalcemia would probably have been caught up by the previous blood test. This corresponds to a probability of primary hyperparathyroidism (PH) in the population of:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-2.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-2.md
new file mode 100644
index 000000000..8d416d97a
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Differential_diagnosis-2.md
@@ -0,0 +1,783 @@
+---
+title: "Differential diagnosis"
+chunk: 3/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+  
+    
+      
+        Pr
+        (
+        
+          PH in population
+        
+        )
+        =
+        0.5
+        
+           years
+        
+        ⋅
+        
+          
+            1
+            4000 per year
+          
+        
+        =
+        
+          
+            1
+            8000
+          
+        
+      
+    
+    {\displaystyle \Pr({\text{PH in population}})=0.5{\text{ years}}\cdot {\frac {1}{\text{4000 per year}}}={\frac {1}{8000}}}
+  
+
+With the relative risk conferred from the family history, the probability that primary hyperparathyroidism (PH) would have occurred in the first place in the individual given from the currently available information becomes:
+
+  
+    
+      
+        Pr
+        (
+        
+          PH WHOIFPI
+        
+        )
+        ≈
+        R
+        
+          R
+          
+            P
+            H
+          
+        
+        ⋅
+        Pr
+        (
+        
+          PH in population
+        
+        )
+        =
+        10
+        ⋅
+        
+          
+            1
+            8000
+          
+        
+        =
+        
+          
+            1
+            800
+          
+        
+        =
+        0.00125
+      
+    
+    {\displaystyle \Pr({\text{PH WHOIFPI}})\approx RR_{PH}\cdot \Pr({\text{PH in population}})=10\cdot {\frac {1}{8000}}={\frac {1}{800}}=0.00125}
+  
+
+Primary hyperparathyroidism can be assumed to cause hypercalcemia essentially 100% of the time (rPH → hypercalcemia = 1), so this independently calculated probability of primary hyperparathyroidism (PH) can be assumed to be the same as the probability of being a cause of the presentation:
+
+  
+    
+      
+        
+          
+            
+              
+                Pr
+                (
+                
+                  Hypercalcemia WHOIFPI by PH
+                
+                )
+              
+              
+                
+                =
+                Pr
+                (
+                
+                  PH WHOIFPI
+                
+                )
+                ⋅
+                
+                  r
+                  
+                    
+                      PH
+                    
+                    →
+                    
+                      hypercalcemia
+                    
+                  
+                
+              
+            
+            
+              
+              
+                
+                =
+                0.00125
+                ⋅
+                1
+                =
+                0.00125
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}\Pr({\text{Hypercalcemia WHOIFPI by PH}})&=\Pr({\text{PH WHOIFPI}})\cdot r_{{\text{PH}}\rightarrow {\text{hypercalcemia}}}\\&=0.00125\cdot 1=0.00125\end{aligned}}}
+  
+
+For cancer, the same time-at-risk is assumed for simplicity, and let's say that the incidence of cancer in the area is estimated at 1 in 250 per year, giving a population probability of cancer of:
+
+  
+    
+      
+        Pr
+        (
+        
+          cancer in population
+        
+        )
+        =
+        0.5
+        
+           years
+        
+        ⋅
+        
+          
+            1
+            250 per year
+          
+        
+        =
+        
+          
+            1
+            500
+          
+        
+      
+    
+    {\displaystyle \Pr({\text{cancer in population}})=0.5{\text{ years}}\cdot {\frac {1}{\text{250 per year}}}={\frac {1}{500}}}
+  
+
+For simplicity, let's say that any association between a family history of primary hyperparathyroidism and risk of cancer is ignored, so the relative risk for the individual to have contracted cancer in the first place is similar to that of the population (RRcancer = 1):
+
+  
+    
+      
+        Pr
+        (
+        
+          cancer WHOIFPI
+        
+        )
+        ≈
+        R
+        
+          R
+          
+            cancer
+          
+        
+        ⋅
+        Pr
+        (
+        
+          cancer in population
+        
+        )
+        =
+        1
+        ⋅
+        
+          
+            1
+            500
+          
+        
+        =
+        
+          
+            1
+            500
+          
+        
+        =
+        0.002.
+      
+    
+    {\displaystyle \Pr({\text{cancer WHOIFPI}})\approx RR_{\text{cancer}}\cdot \Pr({\text{cancer in population}})=1\cdot {\frac {1}{500}}={\frac {1}{500}}=0.002.}
+  
+
+However, hypercalcemia only occurs in, very approximately, 10% of cancers, (rcancer → hypercalcemia = 0.1), so:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  Hypercalcemia WHOIFPI by cancer
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                Pr
+                (
+                
+                  cancer WHOIFPI
+                
+                )
+                ⋅
+                
+                  r
+                  
+                    
+                      cancer
+                    
+                    →
+                    
+                      hypercalcemia
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                0.002
+                ⋅
+                0.1
+                =
+                0.0002.
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{Hypercalcemia WHOIFPI by cancer}})\\=&\Pr({\text{cancer WHOIFPI}})\cdot r_{{\text{cancer}}\rightarrow {\text{hypercalcemia}}}\\=&0.002\cdot 0.1=0.0002.\end{aligned}}}
+  
+
+The probabilities that hypercalcemia would have occurred in the first place by other candidate conditions can be calculated in a similar manner. However, for simplicity, let's say that the probability that any of these would have occurred in the first place is calculated at 0.0005 in this example.
+For the instance of there being no disease, the corresponding probability in the population is complementary to the sum of probabilities for other conditions:
+
+  
+    
+      
+        
+          
+            
+              
+                Pr
+                (
+                
+                  no disease in population
+                
+                )
+              
+              
+                
+                =
+                1
+                −
+                Pr
+                (
+                
+                  PH in population
+                
+                )
+                −
+                Pr
+                (
+                
+                  cancer in population
+                
+                )
+              
+            
+            
+              
+              
+                
+                
+
+                
+                
+                −
+                Pr
+                (
+                
+                  other conditions in population
+                
+                )
+              
+            
+            
+              
+              
+                
+                
+
+                
+                =
+                0.997.
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}\Pr({\text{no disease in population}})&=1-\Pr({\text{PH in population}})-\Pr({\text{cancer in population}})\\&{}\quad -\Pr({\text{other conditions in population}})\\&{}=0.997.\end{aligned}}}
+  
+
+The probability that the individual would be healthy in the first place can be assumed to be the same:
+
+  
+    
+      
+        Pr
+        (
+        
+          no disease WHOIFPI
+        
+        )
+        =
+        0.997.
+        
+      
+    
+    {\displaystyle \Pr({\text{no disease WHOIFPI}})=0.997.\,}
+  
+
+The rate at which the case of no abnormal condition still ends up in measurement of serum calcium of being above the standard reference range (thereby classifying as hypercalcemia) is, by the definition of standard reference range, less than 2.5%. However, this probability can be further specified by considering how much the measurement deviates from the mean in the standard reference range. Let's say that the serum calcium measurement was 1.30 mmol/L, which, with a standard reference range established at 1.05 to 1.25 mmol/L, corresponds to a standard score of 3 and a corresponding probability of 0.14% that such degree of hypercalcemia would have occurred in the first place in the case of no abnormality:
+
+  
+    
+      
+        
+          r
+          
+            
+              no disease
+            
+            →
+            
+              hypercalcemia
+            
+          
+        
+        =
+        0.0014
+      
+    
+    {\displaystyle r_{{\text{no disease}}\rightarrow {\text{hypercalcemia}}}=0.0014}
+  
+
+Subsequently, the probability that hypercalcemia would have resulted from no disease can be calculated as:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  Hypercalcemia WHOIFPI by no disease
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                Pr
+                (
+                
+                  no disease WHOIFPI
+                
+                )
+                ⋅
+                
+                  r
+                  
+                    
+                      no disease
+                    
+                    →
+                    
+                      hypercalcemia
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                0.997
+                ⋅
+                0.0014
+                ≈
+                0.0014
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{Hypercalcemia WHOIFPI by no disease}})\\=&\Pr({\text{no disease WHOIFPI}})\cdot r_{{\text{no disease}}\rightarrow {\text{hypercalcemia}}}\\=&0.997\cdot 0.0014\approx 0.0014\end{aligned}}}
+  
+
+The probability that hypercalcemia would have occurred in the first place in the individual can thus be calculated as:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia WHOIFPI
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia WHOIFPI by PH
+                
+                )
+                +
+                Pr
+                (
+                
+                  hypercalcemia WHOIFPI by cancer
+                
+                )
+              
+            
+            
+              
+              
+                
+                
+
+                
+                +
+                Pr
+                (
+                
+                  hypercalcemia WHOIFPI by other conditions
+                
+                )
+                +
+                Pr
+                (
+                
+                  hypercalcemia WHOIFPI by no disease
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                0.00125
+                +
+                0.0002
+                +
+                0.0005
+                +
+                0.0014
+                =
+                0.00335
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia WHOIFPI}})\\=&\Pr({\text{hypercalcemia WHOIFPI by PH}})+\Pr({\text{hypercalcemia WHOIFPI by cancer}})\\&{}+\Pr({\text{hypercalcemia WHOIFPI by other conditions}})+\Pr({\text{hypercalcemia WHOIFPI by no disease}})\\=&0.00125+0.0002+0.0005+0.0014=0.00335\end{aligned}}}
+  
+
+Subsequently, the probability that hypercalcemia is caused by primary hyperparathyroidism (PH) in the individual can be calculated as:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia is caused by PH in individual
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI by PH
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI
+                      
+                      )
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    0.00125
+                    0.00335
+                  
+                
+                =
+                0.373
+                =
+                37.3
+                %
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by PH in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by PH}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.00125}{0.00335}}=0.373=37.3\%\end{aligned}}}
+  
+
+Similarly, the probability that hypercalcemia is caused by cancer in the individual can be calculated as:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia is caused by cancer in individual
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI by cancer
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI
+                      
+                      )
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    0.0002
+                    0.00335
+                  
+                
+                =
+                0.060
+                =
+                6.0
+                %
+                ,
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by cancer in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by cancer}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0002}{0.00335}}=0.060=6.0\%,\end{aligned}}}
+  
+
+and for other candidate conditions:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia is caused by other conditions in individual
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI by other conditions
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI
+                      
+                      )
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    0.0005
+                    0.00335
+                  
+                
+                =
+                0.149
+                =
+                14.9
+                %
+                ,
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is caused by other conditions in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by other conditions}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0005}{0.00335}}=0.149=14.9\%,\end{aligned}}}
+  
+
+and the probability that there actually is no disease:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-3.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-3.md
new file mode 100644
index 000000000..9dfc31d4b
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Differential_diagnosis-3.md
@@ -0,0 +1,156 @@
+---
+title: "Differential diagnosis"
+chunk: 4/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+  
+    
+      
+        
+          
+            
+              
+              
+                
+                Pr
+                (
+                
+                  hypercalcemia is present despite no disease in individual
+                
+                )
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI by no disease
+                      
+                      )
+                    
+                    
+                      Pr
+                      (
+                      
+                        hypercalcemia WHOIFPI
+                      
+                      )
+                    
+                  
+                
+              
+            
+            
+              
+                =
+              
+              
+                
+                  
+                    0.0014
+                    0.00335
+                  
+                
+                =
+                0.418
+                =
+                41.8
+                %
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{aligned}&\Pr({\text{hypercalcemia is present despite no disease in individual}})\\=&{\frac {\Pr({\text{hypercalcemia WHOIFPI by no disease}})}{\Pr({\text{hypercalcemia WHOIFPI}})}}\\=&{\frac {0.0014}{0.00335}}=0.418=41.8\%\end{aligned}}}
+  
+
+For clarification, these calculations are given as the table in the method description:
+
+Thus, this method estimates that the probability that the hypercalcemia is caused by primary hyperparathyroidism, cancer, other conditions or no disease at all are 37.3%, 6.0%, 14.9%, and 41.8%, respectively, which may be used in estimating further test indications.
+This case is continued in the example of the method described in the next section.
+
+=== Likelihood ratio-based method ===
+The procedure of differential diagnosis can become extremely complex when fully taking additional tests and treatments into consideration. One method that is somewhat a tradeoff between being clinically perfect and being relatively simple to calculate is one that uses likelihood ratios to derive subsequent post-test likelihoods.
+
+==== Theory ====
+The initial likelihoods for each candidate condition can be estimated by various methods, such as:
+
+By epidemiology as described in the previous section.
+By clinic-specific pattern recognition, such as statistically knowing that patients coming into a particular clinic with a particular complaint statistically has a particular likelihood of each candidate condition.
+One method of estimating likelihoods even after further tests uses likelihood ratios (which is derived from sensitivities and specificities) as a multiplication factor after each test or procedure. In an ideal world, sensitivities and specificities would be established for all tests for all possible pathological conditions. In reality, however, these parameters may only be established for one of the candidate conditions. Multiplying with likelihood ratios necessitates conversion of likelihoods from probabilities to odds in favor (hereafter simply termed "odds") by:
+
+  
+    
+      
+        
+          odds
+        
+        =
+        
+          
+            probability
+            
+              1
+              −
+              
+                probability
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\text{odds}}={\frac {\text{probability}}{1-{\text{probability}}}}}
+  
+
+However, only the candidate conditions with known likelihood ratio need this conversion. After multiplication, conversion back to probability is calculated by:
+
+  
+    
+      
+        
+          probability
+        
+        =
+        
+          
+            odds
+            
+              
+                odds
+              
+              +
+              1
+            
+          
+        
+      
+    
+    {\displaystyle {\text{probability}}={\frac {\text{odds}}{{\text{odds}}+1}}}
+  
+
+The rest of the candidate conditions (for which there is no established likelihood ratio for the test at hand) can, for simplicity, be adjusted by subsequently multiplying all candidate conditions with a common factor to again yield a sum of 100%.
+The resulting probabilities are used for estimating the indications for further medical tests, treatments or other actions. If there is an indication for an additional test, and it returns with a result, then the procedure is repeated using the likelihood ratio of the additional test. With updated probabilities for each of the candidate conditions, the indications for further tests, treatments, or other actions change as well, and so the procedure can be repeated until an endpoint where there no longer is any indication for currently performing further actions. Such an endpoint mainly occurs when one candidate condition becomes so certain that no test can be found that is powerful enough to change the relative probability profile enough to motivate any change in further actions. Tactics for reaching such an endpoint with as few tests as possible includes making tests with high specificity for conditions of already outstandingly high-profile-relative probability, because the high likelihood ratio positive for such tests is very high, bringing all less likely conditions to relatively lower probabilities. Alternatively, tests with high sensitivity for competing candidate conditions have a high likelihood ratio negative, potentially bringing the probabilities for competing candidate conditions to negligible levels. If such negligible probabilities are achieved, the clinician can rule out these conditions, and continue the differential diagnostic procedure with only the remaining candidate conditions.
+
+==== Example ====
+This example continues for the same patient as in the example for the epidemiology-based method. As with the previous example of epidemiology-based method, this example case is made to demonstrate how this method is applied but does not represent a guideline for handling similar real-world cases. Also, the example uses relatively specified numbers, while in reality, there are often just rough estimations. In this example, the probabilities for each candidate condition were established by an epidemiology-based method to be as follows:
+
+These percentages could also have been established by experience at the particular clinic by knowing that these are the percentages for final diagnosis for people presenting to the clinic with hypercalcemia and having a family history of primary hyperparathyroidism.
+The condition of highest profile-relative probability (except "no disease") is primary hyperparathyroidism (PH), but cancer is still of major concern, because if it is the actual causative condition for the hypercalcemia, then the choice of whether to treat or not likely means life or death for the patient, in effect potentially putting the indication at a similar level for further tests for both of these conditions.
+Here, let's say that the clinician considers the profile-relative probabilities of being of enough concern to indicate sending the patient a call for a clinician visit, with an additional visit to the medical laboratory for an additional blood test complemented with further analyses, including parathyroid hormone for the suspicion of primary hyperparathyroidism.
+For simplicity, let's say that the clinician first receives the blood test (in formulas abbreviated as "BT") result for the parathyroid hormone analysis and that it showed a parathyroid hormone level that is elevated relative to what would be expected by the calcium level.
+Such a constellation can be estimated to have a sensitivity of approximately 70% and a specificity of approximately 90% for primary hyperparathyroidism. This confers a likelihood ratio positive of 7 for primary hyperparathyroidism.
+The probability of primary hyperparathyroidism is now termed Pre-BTPH because it corresponds to before the blood test (Latin preposition prae means before). It was estimated at 37.3%, corresponding to an odds of 0.595. With the likelihood ratio positive of 7 for the blood test, the post-test odds is calculated as:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-4.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-4.md
new file mode 100644
index 000000000..9739180c3
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Differential_diagnosis-4.md
@@ -0,0 +1,317 @@
+---
+title: "Differential diagnosis"
+chunk: 5/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+  
+    
+      
+        Odds
+        ⁡
+        (
+        
+          
+            PostBT
+          
+          
+            P
+            H
+          
+        
+        )
+        =
+        Odds
+        ⁡
+        (
+        
+          
+            PreBT
+          
+          
+            P
+            H
+          
+        
+        )
+        ⋅
+        L
+        H
+        (
+        B
+        T
+        )
+        =
+        0.595
+        ⋅
+        7
+        =
+        4.16
+        ,
+      
+    
+    {\displaystyle \operatorname {Odds} ({\text{PostBT}}_{PH})=\operatorname {Odds} ({\text{PreBT}}_{PH})\cdot LH(BT)=0.595\cdot 7=4.16,}
+  
+
+where:
+
+Odds(PostBTPH) is the odds for primary hyperparathyroidism after the blood test for parathyroid hormone
+Odds(PreBTPH is the odds in favor of primary hyperparathyroidism before the blood test for parathyroid hormone
+LH(BT) is the likelihood ratio positive for the blood test for parathyroid hormone
+An Odds(PostBTPH) of 4.16 is again converted to the corresponding probability by:
+
+  
+    
+      
+        Pr
+        (
+        
+          
+            PostBT
+          
+          
+            P
+            H
+          
+        
+        )
+        =
+        
+          
+            
+              Odds
+              ⁡
+              (
+              
+                
+                  PostBT
+                
+                
+                  P
+                  H
+                
+              
+              )
+            
+            
+              Odds
+              ⁡
+              (
+              
+                
+                  PostBT
+                
+                
+                  P
+                  H
+                
+              
+              )
+              +
+              1
+            
+          
+        
+        =
+        
+          
+            4.16
+            
+              4.16
+              +
+              1
+            
+          
+        
+        =
+        0.806
+        =
+        80.6
+        %
+      
+    
+    {\displaystyle \Pr({\text{PostBT}}_{PH})={\frac {\operatorname {Odds} ({\text{PostBT}}_{PH})}{\operatorname {Odds} ({\text{PostBT}}_{PH})+1}}={\frac {4.16}{4.16+1}}=0.806=80.6\%}
+  
+
+The sum of the probabilities for the rest of the candidate conditions should therefore be:
+
+  
+    
+      
+        Pr
+        (
+        
+          
+            PostBT
+          
+          
+            r
+            e
+            s
+            t
+          
+        
+        )
+        =
+        100
+        %
+        −
+        80.6
+        %
+        =
+        19.4
+        %
+      
+    
+    {\displaystyle \Pr({\text{PostBT}}_{rest})=100\%-80.6\%=19.4\%}
+  
+
+Before the blood test for parathyroid hormone, the sum of their probabilities were:
+
+  
+    
+      
+        Pr
+        (
+        
+          
+            PreBT
+          
+          
+            rest
+          
+        
+        )
+        =
+        6.0
+        %
+        +
+        14.9
+        %
+        +
+        41.8
+        %
+        =
+        62.7
+        %
+      
+    
+    {\displaystyle \Pr({\text{PreBT}}_{\text{rest}})=6.0\%+14.9\%+41.8\%=62.7\%}
+  
+
+Therefore, to conform to a sum of 100% for all candidate conditions, each of the other candidates must be multiplied by a correcting factor:
+
+  
+    
+      
+        
+          Correcting factor
+        
+        =
+        
+          
+            
+              Pr
+              (
+              
+                
+                  PostBT
+                
+                
+                  rest
+                
+              
+              )
+            
+            
+              Pr
+              (
+              
+                
+                  PreBT
+                
+                
+                  rest
+                
+              
+              )
+            
+          
+        
+        =
+        
+          
+            19.4
+            62.7
+          
+        
+        =
+        0.309
+      
+    
+    {\displaystyle {\text{Correcting factor}}={\frac {\Pr({\text{PostBT}}_{\text{rest}})}{\Pr({\text{PreBT}}_{\text{rest}})}}={\frac {19.4}{62.7}}=0.309}
+  
+
+For example, the probability of cancer after the test is calculated as:
+
+  
+    
+      
+        Pr
+        (
+        
+          
+            PostBT
+          
+          
+            cancer
+          
+        
+        )
+        =
+        Pr
+        (
+        
+          
+            PreBT
+          
+          
+            cancer
+          
+        
+        )
+        ⋅
+        
+          Correcting factor
+        
+        =
+        6.0
+        %
+        ⋅
+        0.309
+        =
+        1.9
+        %
+      
+    
+    {\displaystyle \Pr({\text{PostBT}}_{\text{cancer}})=\Pr({\text{PreBT}}_{\text{cancer}})\cdot {\text{Correcting factor}}=6.0\%\cdot 0.309=1.9\%}
+  
+
+The probabilities for each candidate conditions before and after the blood test are given in following table:
+
+These "new" percentages, including a profile-relative probability of 80% for primary hyperparathyroidism, underlie any indications for further tests, treatments, or other actions. In this case, let's say that the clinician continues the plan for the patient to attend a clinician visit for a further checkup, especially focused on primary hyperparathyroidism.
+A clinician visit can, theoretically, be regarded as a series of tests, including both questions in a medical history, as well as components of a physical examination, where the post-test probability of a previous test, can be used as the pre-test probability of the next. The indications for choosing the next test are dynamically influenced by the results of previous tests.
+Let's say that the patient in this example is revealed to have at least some of the symptoms and signs of depression, bone pain, joint pain or constipation of more severity than what would be expected by the hypercalcemia itself, supporting the suspicion of primary hyperparathyroidism, and let's say that the likelihood ratios for the tests, when multiplied together, roughly results in a product of 6 for primary hyperparathyroidism.
+The presence of unspecific pathologic symptoms and signs in the history and examination are often concurrently indicative of cancer as well, and let's say that the tests gave an overall likelihood ratio estimated at 1.5 for cancer. For other conditions, as well as the instance of not having any disease at all, let's say that it is unknown how they are affected by the tests at hand, as often happens in reality. This gives the following results for the history and physical examination (abbreviated as P&E):
+
+These probabilities after the history and examination may make the physician confident enough to plan the patient for surgery for a parathyroidectomy to resect the affected tissue.
+At this point, the probability of "other conditions" is so low that the physician cannot think of any test for them that could make a difference that would be substantial enough to form an indication for such a test, and the physician thereby practically regards "other conditions" as ruled out, in this case not primarily by any specific test for such other conditions that were negative, but rather by the absence of positive tests so far.
+For "cancer", the cutoff at which to confidently regard it as ruled out maybe more stringent because of severe consequences of missing it, so the physician may consider that at least a histopathologic examination of the resected tissue is indicated.
+This case is continued in the example of Combinations in the corresponding section below.
+
+== Coverage of candidate conditions ==
+The validity of both the initial estimation of probabilities by epidemiology and further workup by likelihood ratios are dependent on the inclusion of candidate conditions that are responsible for a large part as possible of the probability of having developed the condition, and it is clinically important to include those where relatively fast initiation of therapy is most likely to result in the greatest benefit. If an important candidate condition is missed, no method of differential diagnosis will supply the correct conclusion. The need to find more candidate conditions for inclusion increases with the increasing severity of the presentation itself. For example, if the only presentation is a deviating laboratory parameter and all common harmful underlying conditions have been ruled out, then it may be acceptable to stop finding more candidate conditions, but this would much more likely be unacceptable if the presentation would have been severe pain.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Differential_diagnosis-5.md b/data/en.wikipedia.org/wiki/Differential_diagnosis-5.md
new file mode 100644
index 000000000..ad838c05c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Differential_diagnosis-5.md
@@ -0,0 +1,42 @@
+---
+title: "Differential diagnosis"
+chunk: 6/6
+source: "https://en.wikipedia.org/wiki/Differential_diagnosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:56.437702+00:00"
+instance: "kb-cron"
+---
+
+== Combinations ==
+If two conditions get high post-test probabilities, especially if the sum of the probabilities for conditions with known likelihood ratios becomes higher than 100%, then the actual condition is a combination of the two. In such cases, that combined condition can be added to the list of candidate conditions, and the calculations should start over from the beginning.
+To continue the example used above, let's say that the history and physical examination were indicative of cancer as well, with a likelihood ratio of 3, giving an Odds(PostH&E) of 0.057, corresponding to a P(PostH&E) of 5.4%. This would correspond to a "Sum of known P(PostH&E)" of 101.5%. This is an indication for considering a combination of primary hyperparathyroidism and cancer, such as, in this case, a parathyroid hormone-producing parathyroid carcinoma. A recalculation may therefore be needed, with the first two conditions being separated into "primary hyperparathyroidism without cancer", "cancer without primary hyperparathyroidism" as well as "combined primary hyperparathyroidism and cancer", and likelihood ratios being applied to each condition separately. In this case, however, tissue has already been resected, wherein a histopathologic examination can be performed that includes the possibility of parathyroid carcinoma in the examination (which may entail appropriate sample staining).
+Let's say that the histopathologic examination confirms primary hyperparathyroidism, but also showed a malignant pattern. By an initial method by epidemiology, the incidence of parathyroid carcinoma is estimated at 1 in 6 million people per year, giving a very low probability before taking any tests into consideration. In comparison, the probability that non-malignant primary hyperparathyroidism would have occurred at the same time as an unrelated non-carcinoma cancer that presents with malignant cells in the parathyroid gland is calculated by multiplying the probabilities of the two. The resultant probability is, however, much smaller than the 1 in 6 million. Therefore, the probability of parathyroid carcinoma may still be close to 100% after histopathologic examination despite the low probability of occurring in the first place.
+
+== Machine differential diagnosis ==
+
+Machine differential diagnosis is the use of computer software to partly or fully make a differential diagnosis. It may be regarded as an application of artificial intelligence.  Alternatively, it may be seen as "augmented intelligence" if it meets the FDA criteria, namely that (1) it reveals the underlying data, (2) reveals the underlying logic, and (3) leaves the clinician in charge to shape and make the decision. Machine learning AI is generally seen as a device by the FDA, whereas augmented intelligence applications are not.
+Many studies demonstrate improvement of quality of care and reduction of medical errors by using such decision support systems. Some of these systems are designed for a specific medical problem such as schizophrenia, Lyme disease or ventilator-associated pneumonia. Others are designed to cover all major clinical and diagnostic findings to assist physicians with faster and more accurate diagnosis.
+However, these tools all still require advanced medical skills to rate symptoms and choose additional tests to deduce the probabilities of different diagnoses. Machine differential diagnosis is also currently unable to diagnose multiple concurrent disorders. Their usage by non-experts is therefore not a substitute for professional diagnosis.
+
+== History ==
+The method of differential diagnosis was first suggested for use in the diagnosis of mental disorders by Emil Kraepelin. It is more systematic than the old-fashioned method of diagnosis by gestalt (impression).
+
+== Alternative medical meanings ==
+"Differential diagnosis" is also used more loosely to refer simply to a list of the most common causes of a given symptom, to a list of disorders similar to a given disorder, or to such lists when they are annotated with advice on how to narrow the list down (French's Index of Differential Diagnosis is an example). Thus, a differential diagnosis in this sense is medical information specially organized to aid in diagnosis.
+
+== Usage apart from in medicine ==
+Methods similar to those of differential diagnostic processes in medicine are also used by biological taxonomists to identify and classify organisms, living and extinct. For example, after finding an unknown species, there can first be a listing of all potential species, followed by ruling out of one by one until, optimally, only one potential choice remains.
+Similar procedures may be used by plant and maintenance engineers and automotive mechanics and used to be used in diagnosing faulty electronic circuitry.
+
+== In popular culture ==
+In the American television medical drama House, the main protagonist Dr. Gregory House leads a team of diagnosticians who regularly use differential diagnostics procedures.
+
+== See also ==
+Comorbidity
+Diagnosis of exclusion
+Dual diagnosis
+Gender-bias in medical diagnosis
+List of medical symptoms
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Disease-0.md b/data/en.wikipedia.org/wiki/Disease-0.md
new file mode 100644
index 000000000..97b0601fb
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Disease-0.md
@@ -0,0 +1,19 @@
+---
+title: "Disease"
+chunk: 1/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are associated with specific signs and symptoms. A disease may be caused by external factors such as pathogens or by internal dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of different diseases, including various forms of immunodeficiency, hypersensitivity, allergies, and autoimmune disorders.
+In humans, disease is often used more broadly to refer to any condition that causes pain, dysfunction, distress, social problems, or death to the person affected, or similar problems for those in contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders, syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and function, while in other contexts and for other purposes these may be considered distinguishable categories. Diseases can affect people not only physically but also mentally, as contracting and living with a disease can alter the affected person's perspective on life.
+Death due to disease is called death by natural causes. There are four main types of disease: infectious diseases, deficiency diseases, hereditary diseases, and physiological diseases. Diseases can also be classified in other ways, such as communicable versus non-communicable diseases. The deadliest diseases in humans are ischemic heart disease (blood flow obstruction), followed by stroke and COPD (a lung disease). In developed countries, the diseases that cause the most sickness overall are neuropsychiatric conditions, such as depression and anxiety.
+Pathology, the study of disease, includes etiology, or the study of cause, e.g., one may look at the syndrome of acquired immunodeficiency (AIDS) or the causal agents: human immunodeficiency viruses (HIVs).
+
+== Terminology ==
+
+=== Concepts ===
+In many cases, terms such as disease, disorder, morbidity, sickness and illness are used interchangeably; however, there are situations when specific terms are considered preferable.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Disease-1.md b/data/en.wikipedia.org/wiki/Disease-1.md
new file mode 100644
index 000000000..67c8703e9
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Disease-1.md
@@ -0,0 +1,29 @@
+---
+title: "Disease"
+chunk: 2/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+Disease
+The term disease broadly refers to any condition that impairs the normal functioning of the body. For this reason, diseases are associated with the dysfunction of the body's normal homeostatic processes. Commonly, the term is used to refer specifically to infectious diseases, which are clinically evident diseases that result from the presence of pathogenic microbial agents, including viruses, bacteria, fungi, protozoa, multicellular organisms, and aberrant proteins known as prions. An infection or colonization that does not and will not produce clinically evident impairment of normal functioning, such as the presence of the normal bacteria and yeasts in the gut, or of a passenger virus, is not considered a disease. By contrast, an infection that is asymptomatic during its incubation period, but expected to produce symptoms later, is usually considered a disease. Non-infectious diseases are all other diseases, including most forms of cancer, heart disease, and genetic disease. Acquired disease
+An acquired disease is one that began at some point during one's lifetime, as opposed to disease that was already present at birth, which is congenital disease. Acquired sounds like it could mean "caught via contagion", but it simply means acquired sometime after birth. It also sounds like it could imply secondary disease, but acquired disease can be primary disease. Acute disease
+An acute disease is one of a short-term nature (acute); the term sometimes also connotes a fulminant nature
+Chronic condition or chronic disease
+A chronic disease is one that persists over time, often for at least six months, but may also include illnesses that are expected to last for the entirety of one's natural life. Congenital disorder or congenital disease
+A congenital disorder is one that is present at birth. It is often a genetic disease or disorder and can be inherited. It can also be the result of a vertically transmitted infection from the mother, such as HIV/AIDS. Genetic disease
+A genetic disorder or disease is caused by one or more genetic mutations. It is often inherited, but some mutations are random and de novo. Hereditary or inherited disease
+A hereditary disease is a type of genetic disease caused by genetic mutations that are hereditary (and can run in families)
+Iatrogenic disease
+An iatrogenic disease or condition is one that is caused by medical intervention, whether as a side effect of a treatment or as an inadvertent outcome. Idiopathic disease
+An idiopathic disease has an unknown cause or source. As medical science has advanced, many diseases with entirely unknown causes have had some aspects of their sources explained and therefore shed their idiopathic status. For example, when germs were discovered, it became known that they were a cause of infection, but particular germs and diseases had not been linked. In another example, it is known that autoimmunity is the cause of some forms of diabetes mellitus type 1, even though the particular molecular pathways by which it works are not yet understood. It is also common to know certain factors are associated with certain diseases; however, association does not necessarily imply causality. For example, a third factor might be causing both the disease, and the associated phenomenon. Incurable disease
+A disease that cannot be cured. Incurable diseases are not necessarily terminal diseases, and sometimes a disease's symptoms can be treated sufficiently for the disease to have little or no impact on quality of life. Primary disease
+A primary disease is a disease that is due to a root cause of illness, as opposed to secondary disease, which is a sequela, or complication that is caused by the primary disease. For example, a common cold is a primary disease, where rhinitis is a possible secondary disease, or sequela. A doctor must determine what primary disease, a cold or bacterial infection, is causing a patient's secondary rhinitis when deciding whether or not to prescribe antibiotics. Secondary disease
+A secondary disease is a disease that is a sequela or complication of a prior, causal disease, which is referred to as the primary disease or simply the underlying cause (root cause). For example, a bacterial infection can be primary, wherein a healthy person is exposed to bacteria and becomes infected, or it can be secondary to a primary cause, that predisposes the body to infection. For example, a primary viral infection that weakens the immune system could lead to a secondary bacterial infection. Similarly, a primary burn that creates an open wound could provide an entry point for bacteria, and lead to a secondary bacterial infection. Terminal disease
+A terminal disease is one that is expected to have the inevitable result of death. Previously, AIDS was a terminal disease; it is now incurable, but can be managed indefinitely using medications. Illness
+The terms illness and sickness are both generally used as synonyms for disease; however, the term illness is occasionally used to refer specifically to the patient's personal, subjective experience of their disease. In this model, it is possible for a person to have a disease without being ill (to have an objectively definable, but asymptomatic, medical condition, such as a subclinical infection, or to have a clinically apparent physical impairment but not feel sick or distressed by it), and to be ill without being diseased (such as when an objectively healthy person perceives a normal experience as a medical condition, or medicalizes a non-disease situation in their life – for example, a person who feels unwell as a result of embarrassment, and who interprets those feelings as sickness rather than normal emotions). Symptoms of illness are often not directly the result of infection, but a collection of evolved responses – sickness behavior by the body – that helps clear infection and promote recovery. Such aspects of illness can include lethargy, depression, loss of appetite, sleepiness, hyperalgesia, and inability to concentrate. Disorder
+A disorder is a functional abnormality or disturbance that may or may not show specific signs and symptoms. Medical disorders can be categorized into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and functional disorders. The term disorder is often considered more value-neutral and less stigmatizing than the terms disease or illness, and therefore is preferred terminology in some circumstances. In mental health, the term mental disorder is used as a way of acknowledging the complex interaction of biological, social, and psychological factors in psychiatric conditions; however, the term disorder is also used in many other areas of medicine, primarily to identify physical disorders that are not caused by infectious organisms, such as metabolic disorders. Medical condition or health condition
+A medical condition or health condition is a broad concept that includes all diseases, lesions, disorders, or nonpathologic condition that normally receives medical treatment, such as pregnancy or childbirth. While the term medical condition generally includes mental illnesses, in some contexts the term is used specifically to denote any illness, injury, or disease except for mental illnesses. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the widely used psychiatric manual that defines all mental disorders, uses the term general medical condition to refer to all diseases, illnesses, and injuries except for mental disorders. This usage is also commonly seen in the psychiatric literature.
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+---
+title: "Disease"
+chunk: 3/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+Some health insurance policies also define a medical condition as any illness, injury, or disease except for psychiatric illnesses. As it is more value-neutral than terms like disease, the term medical condition is sometimes preferred by people with health issues that they do not consider deleterious. However, by emphasizing the medical nature of the condition, this term is sometimes rejected, such as by proponents of the autism rights movement. The term medical condition is also a synonym for medical state, in which case it describes an individual patient's current state from a medical standpoint. This usage appears in statements that describe a patient as being in critical condition, for example. Morbidity
+Morbidity (from Latin  morbidus 'sick, unhealthy') is a diseased state, disability, or poor health due to any cause. The term may refer to the existence of any form of disease, or to the degree that the health condition affects the patient. Among severely ill patients, the level of morbidity is often measured by ICU scoring systems. Comorbidity, or co-existing disease, is the simultaneous presence of two or more medical conditions, such as schizophrenia and substance abuse. In epidemiology and actuarial science, the term morbidity (also morbidity rate or morbidity frequency) can refer to either the incidence rate, the prevalence of a disease or medical condition, or the percentage of people who experience a given condition within a given timeframe (e.g., 20% of people will get influenza in a year). This measure of sickness is contrasted with the mortality rate of a condition, which is the proportion of people dying during a given time interval. Morbidity rates are used in actuarial professions, such as health insurance, life insurance, and long-term care insurance, to determine the premiums charged to customers. Morbidity rates help insurers predict the likelihood that an insured will contract or develop any number of specified diseases. Pathosis or pathology
+Pathosis (plural pathoses) is synonymous with disease. The word pathology also has this sense, in which it is commonly used by physicians in the medical literature, although some editors prefer to reserve pathology to its other senses. Sometimes a slight connotative shade causes preference for pathology or pathosis implying "some [as yet poorly analyzed] pathophysiologic process" rather than disease implying "a specific disease entity as defined by diagnostic criteria being already met". This is hard to quantify denotatively, but it explains why cognitive synonymy is not invariable. Syndrome
+A syndrome is the association of several signs and symptoms, or other characteristics that often occur together, regardless of whether the cause is known. Some syndromes such as Down syndrome are known to have only one cause (an extra chromosome at birth). Others such as Parkinsonian syndrome are known to have multiple possible causes. Acute coronary syndrome, for example, is not a single disease itself but is rather the manifestation of any of several diseases including myocardial infarction secondary to coronary artery disease. In yet other syndromes, however, the cause is unknown. A familiar syndrome name often remains in use even after an underlying cause has been found or when there are a number of different possible primary causes. Examples of the first-mentioned type are that Turner syndrome and DiGeorge syndrome are still often called by the "syndrome" name despite that they can also be viewed as disease entities and not solely as sets of signs and symptoms. Predisease
+Predisease is a subclinical or prodromal vanguard of a disease. Prediabetes and prehypertension are common examples. The nosology or epistemology of predisease is contentious, though, because there is seldom a bright line differentiating a legitimate concern for subclinical or premonitory status and the conflict of interest–driven over-medicalization (e.g., by pharmaceutical manufacturers) or de-medicalization (e.g., by medical and disability insurers). Identifying legitimate predisease can result in useful preventive measures, such as motivating the person to get a healthy amount of physical exercise, but labeling a healthy person with an unfounded notion of predisease can result in overtreatment, such as taking drugs that only help people with severe disease or paying for treatments with a poor benefit–cost ratio. One review proposed three criteria for predisease:
+a high risk for progression to disease making one "far more likely to develop" it than others are- for example, a pre-cancer will almost certainly turn into cancer over time
+actionability for risk reduction – for example, removal of the precancerous tissue prevents it from turning into a potentially deadly cancer
+benefit that outweighs the harm of any interventions taken – removing the precancerous tissue prevents cancer, and thus prevents a potential death from cancer.
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+---
+title: "Disease"
+chunk: 4/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+=== Types by body system ===
+Mental
+Mental illness is a broad, generic label for a category of illnesses that may include affective or emotional instability, behavioral dysregulation, cognitive dysfunction or impairment. Specific illnesses known as mental illnesses include major depression, generalized anxiety disorders, and schizophrenia, to name a few. Mental illness can be of biological (e.g., anatomical, chemical, or genetic) or psychological (e.g., trauma or conflict) origin. It can impair the affected person's ability to work or study and can harm interpersonal relationship.
+Organic
+An organic disease is one caused by a physical or physiological change to some tissue or organ of the body. The term sometimes excludes infections. It is commonly used in contrast with mental disorders. It includes emotional and behavioral disorders if they are due to changes to the physical structures or functioning of the body (such as after a stroke or a traumatic brain injury — organic brain disease is a dated term for such cases) but not if they are due to psychosocial issues.
+
+=== Stages ===
+In an infectious disease, the incubation period is the time between infection and the appearance of symptoms. The latency period is the time between infection and the ability of the disease to spread to another person, which may precede, follow, or be simultaneous with the appearance of symptoms. Some viruses also exhibit a dormant phase, called viral latency, in which the virus hides in the body in an inactive state. For example, varicella zoster virus causes chickenpox in the acute phase; after recovery from chickenpox, the virus may remain dormant in nerve cells for many years, and later cause herpes zoster (shingles).
+
+Acute disease
+An acute disease is a short-lived disease, like the common cold.
+Chronic disease
+A chronic disease is one that lasts for a long time, usually at least six months. During that time, it may be constantly present, or it may go into remission and periodically relapse. A chronic disease may be stable (does not get any worse) or it may be progressive (gets worse over time). Some chronic diseases can be permanently cured. Most chronic diseases can be beneficially treated, even if they cannot be permanently cured.
+Clinical disease
+One that has clinical consequences; in other words, the stage of the disease that produces the characteristic signs and symptoms of that disease. AIDS is the clinical disease stage of HIV infection.
+Cure
+A cure is the end of a medical condition or a treatment that is very likely to end it, while remission refers to the disappearance, possibly temporarily, of symptoms. Complete remission is the best possible outcome for incurable diseases.
+Flare-up
+
+A flare-up can refer to either the recurrence of symptoms or an onset of more severe symptoms.
+Progressive disease
+Progressive disease is a disease whose typical natural course is the worsening of the disease until death, serious debility, or organ failure occurs. Slowly progressive diseases are also chronic diseases; many are also degenerative diseases. The opposite of progressive disease is stable disease or static disease: a medical condition that exists, but does not get better or worse.
+Refractory disease
+A refractory disease is a disease that resists treatment, especially an individual case that resists treatment more than is normal for the specific disease in question.
+Subclinical disease
+Also called silent disease, silent stage, or asymptomatic disease. This is a stage in some diseases before the symptoms are first noted.
+Terminal phase
+If a person will die soon from a disease, regardless of whether that disease typically causes death, then the stage between the earlier disease process and active dying is the terminal phase.
+Recovery
+Recovery can refer to the repairing of physical processes (tissues, organs etc.) and the resumption of healthy functioning after damage causing processes have been cured.
+
+=== Extent ===
+
+Localized disease
+A localized disease is one that affects only one part of the body, such as athlete's foot or an eye infection.
+Disseminated disease
+A disseminated disease has spread to other parts; with cancer, this is usually called metastatic disease.
+Systemic disease
+A systemic disease is a disease that affects the entire body, such as influenza or high blood pressure.
+
+== Classification ==
+
+Diseases may be classified by cause, pathogenesis (mechanism by which the disease is caused), or by symptoms. Alternatively, diseases may be classified according to the organ system involved, though this is often complicated since many diseases affect more than one organ.
+A chief difficulty in nosology is that diseases often cannot be defined and classified clearly, especially when cause or pathogenesis are unknown. Thus diagnostic terms often only reflect a symptom or set of symptoms (syndrome).
+Classical classification of human disease derives from the observational correlation between pathological analysis and clinical syndromes. Today it is preferred to classify them by their cause if it is known.
+The most known and used classification of diseases is the World Health Organization's ICD. This is periodically updated. Currently, the last publication is the ICD-11.
+
+== Causes ==
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+---
+title: "Disease"
+chunk: 5/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+Diseases can be caused by any number of factors and may be acquired or congenital. Microorganisms, genetics, the environment or a combination of these can contribute to a diseased state.
+Only some diseases such as influenza are contagious and commonly believed infectious. The microorganisms that cause these diseases are known as pathogens and include varieties of bacteria, viruses, protozoa, and fungi. Infectious diseases can be transmitted, e.g. by hand-to-mouth contact with infectious material on surfaces, by bites of insects or other carriers of the disease, and from contaminated water or food (often via fecal contamination), etc. Also, there are sexually transmitted diseases. In some cases, microorganisms that are not readily spread from person to person play a role, while other diseases can be prevented or ameliorated with appropriate nutrition or other lifestyle changes.
+Some diseases, such as most (but not all) forms of cancer, heart disease, and mental disorders, are non-infectious diseases. Many non-infectious diseases have a partly or completely genetic basis (see genetic disorder) and may thus be transmitted from one generation to another.
+Social determinants of health are the social conditions in which people live that determine their health. Illnesses are generally related to social, economic, political, and environmental circumstances. Social determinants of health have been recognized by several health organizations such as the Public Health Agency of Canada and the World Health Organization to greatly influence collective and personal well-being. The World Health Organization's Social Determinants Council also recognizes Social determinants of health in poverty. Climate change can exacerbate the transmission and burden of some infectious diseases.
+When the cause of a disease is poorly understood, societies tend to mythologize the disease or use it as a metaphor or symbol of whatever that culture considers evil. For example, until the bacterial cause of tuberculosis was discovered in 1882, experts variously ascribed the disease to heredity, a sedentary lifestyle, depressed mood, and overindulgence in sex, rich food, or alcohol, all of which were social ills at the time.
+When a disease is caused by a pathogenic organism (e.g., when malaria is caused by Plasmodium), one should not confuse the pathogen (the cause of the disease) with disease itself. For example, West Nile virus (the pathogen) causes West Nile fever (the disease). The misuse of basic definitions in epidemiology is frequent in scientific publications.
+
+=== Types of causes ===
+
+Airborne
+An airborne disease is any disease that is caused by pathogens and transmitted through the air.
+Foodborne
+Foodborne illness or food poisoning is any illness resulting from the consumption of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.
+Infectious
+Infectious diseases, also known as transmissible diseases or communicable diseases, comprise clinically evident illness (i.e., characteristic medical signs or symptoms of disease) resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism. Included in this category are contagious diseases – an infection, such as influenza or the common cold, that commonly spreads from one person to another – and communicable diseases – a disease that can spread from one person to another, but does not necessarily spread through everyday contact.
+Lifestyle
+A lifestyle disease is any disease that appears to increase in frequency as countries become more industrialized and people live longer, especially if the risk factors include behavioral choices like a sedentary lifestyle or a diet high in unhealthful foods such as refined carbohydrates, trans fats, or alcoholic beverages.
+Non-communicable
+A non-communicable disease is a medical condition or disease that is non-transmissible. Non-communicable diseases cannot be spread directly from one person to another. Heart disease and cancer are examples of non-communicable diseases in humans.
+
+== Prevention ==
+
+Many diseases and disorders can be prevented through a variety of means. These include sanitation, proper nutrition, adequate exercise, vaccinations and other self-care and public health measures, such as obligatory face mask mandates.
+
+== Treatments ==
+
+Medical therapies or treatments are efforts to cure or improve a disease or other health problems. In the medical field, therapy is synonymous with the word treatment. Among psychologists, the term may refer specifically to psychotherapy or "talk therapy". Common treatments include medications, surgery, medical devices, and self-care. Treatments may be provided by an organized health care system, or informally, by the patient or family members.
+Preventive healthcare is a way to avoid an injury, sickness, or disease in the first place. A treatment or cure is applied after a medical problem has already started. A treatment attempts to improve or remove a problem, but treatments may not produce permanent cures, especially in chronic diseases. Cures are a subset of treatments that reverse diseases completely or end medical problems permanently. Many diseases that cannot be completely cured are still treatable. Pain management (also called pain medicine) is that branch of medicine employing an interdisciplinary approach to the relief of pain and improvement in the quality of life of those living with pain.
+Treatment for medical emergencies must be provided promptly, often through an emergency department or, in less critical situations, through an urgent care facility.
+
+== Epidemiology ==
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+---
+title: "Disease"
+chunk: 6/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+Epidemiology is the study of the factors that cause or encourage diseases. Some diseases are more common in certain geographic areas, among people with certain genetic or socioeconomic characteristics, or at different times of the year.
+Epidemiology is considered a cornerstone methodology of public health research and is highly regarded in evidence-based medicine for identifying risk factors for diseases. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection, and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic. Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (the current raw information available), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors). Epidemiology can help identify causes as well as guide prevention efforts.
+In studying diseases, epidemiology faces the challenge of defining them. Especially for poorly understood diseases, different groups might use significantly different definitions. Without an agreed-on definition, different researchers may report different numbers of cases and characteristics of the disease.
+Some morbidity databases are compiled with data supplied by states and territories health authorities, at national levels or larger scale (such as European Hospital Morbidity Database (HMDB)) which may contain hospital discharge data by detailed diagnosis, age and sex. The European HMDB data was submitted by European countries to the World Health Organization Regional Office for Europe.
+
+=== Burdens of disease ===
+Disease burden is the impact of a health problem in an area measured by financial cost, mortality, morbidity, or other indicators.
+There are several measures used to quantify the burden imposed by diseases on people. The years of potential life lost (YPLL) is a simple estimate of the number of years that a person's life was shortened due to a disease. For example, if a person dies at the age of 65 from a disease, and would probably have lived until age 80 without that disease, then that disease has caused a loss of 15 years of potential life. YPLL measurements do not account for how disabled a person is before dying, so the measurement treats a person who dies suddenly and a person who died at the same age after decades of illness as equivalent. In 2004, the World Health Organization calculated that 932 million years of potential life were lost to premature death.
+The quality-adjusted life year (QALY) and disability-adjusted life year (DALY) metrics are similar but take into account whether the person was healthy after diagnosis. In addition to the number of years lost due to premature death, these measurements add part of the years lost to being sick. Unlike YPLL, these measurements show the burden imposed on people who are very sick, but who live a normal lifespan. A disease that has high morbidity, but low mortality, has a high DALY and a low YPLL. In 2004, the World Health Organization calculated that 1.5 billion disability-adjusted life years were lost to disease and injury. In the developed world, heart disease and stroke cause the most loss of life, but neuropsychiatric conditions like major depressive disorder cause the most years lost to being sick.
+
+== Society and culture ==
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+---
+title: "Disease"
+chunk: 7/7
+source: "https://en.wikipedia.org/wiki/Disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:57.596378+00:00"
+instance: "kb-cron"
+---
+
+How a society responds to diseases is the subject of medical sociology.
+A condition may be considered a disease in some cultures or eras but not in others. For example, obesity was associated with prosperity and abundance, and this perception persists in many African regions, especially since the beginning of the HIV/AIDS. Epilepsy is considered a sign of spiritual gifts among the Hmong people.
+Sickness confers the social legitimization of certain benefits, such as illness benefits, work avoidance, and being looked after by others. The person who is sick takes on a social role called the sick role. A person who responds to a dreaded disease, such as cancer, in a culturally acceptable fashion may be publicly and privately honored with higher social status. In return for these benefits, the sick person is obligated to seek treatment and work to become well once more. As a comparison, consider pregnancy, which is not interpreted as a disease or sickness, even if the mother and baby may both benefit from medical care.
+Most religions grant exceptions from religious duties to people who are sick. For example, one whose life would be endangered by fasting on Yom Kippur or during the month of Ramadan is exempted from the requirement, or even forbidden from participating. People who are sick are also exempted from social duties. For example, ill health is the only socially acceptable reason for an American to refuse an invitation to the White House.
+The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognition of diseases such as repetitive stress injury (RSI) and post-traumatic stress disorder (PTSD) has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations, and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread.
+Lepers were people who were historically shunned because they had an infectious disease, and the term "leper" still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma.
+Social standing and economic status affect health. Diseases of poverty are diseases that are associated with poverty and low social status; diseases of affluence are diseases that are associated with high social and economic status. Which diseases are associated with which states vary according to time, place, and technology. Some diseases, such as diabetes mellitus, may be associated with both poverty (poor food choices) and affluence (long lifespans and sedentary lifestyles), through different mechanisms. The term lifestyle diseases describes diseases associated with longevity and that are more common among older people. For example, cancer is far more common in societies in which most members live until they reach the age of 80 than in societies in which most members die before they reach the age of 50.
+
+=== Language of disease ===
+An illness narrative is a way of organizing a medical experience into a coherent story that illustrates the sick individual's personal experience.
+People use metaphors to make sense of their experiences with disease. The metaphors move disease from an objective thing that exists to an affective experience. The most popular metaphors draw on military concepts: Disease is an enemy that must be feared, fought, battled, and routed. The patient or the healthcare provider is a warrior, rather than a passive victim or bystander. The agents of communicable diseases are invaders; non-communicable diseases constitute internal insurrection or civil war. Because the threat is urgent, perhaps a matter of life and death, unthinkably radical, even oppressive, measures are society's and the patient's moral duty as they courageously mobilize to struggle against destruction. The "war on cancer" is an example of this metaphorical use of language. This language is empowering to some patients, but leaves others feeling like they are failures.
+Another class of metaphors describes the experience of illness as a journey: The person travels to or from a place of disease, and changes himself, discovers new information, or increases his experience along the way. He may travel "on the road to recovery" or make changes to "get on the right track" or choose "pathways". Some are explicitly immigration-themed: the patient has been exiled from the home territory of health to the land of the ill, changing identity and relationships in the process. This language is more common among British healthcare professionals than the language of physical aggression.
+Some metaphors are disease-specific. Slavery is a common metaphor for addictions: The alcoholic is enslaved by drink, and the smoker is captive to nicotine. Some cancer patients treat the loss of their hair from chemotherapy as a metonymy or metaphor for all the losses caused by the disease.
+Some diseases are used as metaphors for social ills: "Cancer" is a common description for anything that is endemic and destructive in society, such as poverty, injustice, or racism. AIDS was seen as a divine judgment for moral decadence, and only by purging itself from the "pollution" of the "invader" could society become healthy again. More recently, when AIDS seemed less threatening, this type of emotive language was applied to avian flu and type 2 diabetes mellitus. Authors in the 19th century commonly used tuberculosis as a symbol and a metaphor for transcendence. People with the disease were portrayed in literature as having risen above daily life to become ephemeral objects of spiritual or artistic achievement. In the 20th century, after its cause was better understood, the same disease became the emblem of poverty, squalor, and other social problems.
+
+== See also ==
+
+== References ==
+
+== External links ==
+
+"Man and Disease", BBC Radio 4 discussion with Anne Hardy, David Bradley & Chris Dye (In Our Time, 15 December 2002)
+CTD The Comparative Toxicogenomics Database is a scientific resource connecting chemicals, genes, and human diseases.
+Free online health-risk assessment by Your Disease Risk at Washington University in St. Louis
+Health Topics A–Z, fact sheets about many common diseases at the Centers for Disease Control
+Health Topics, MedlinePlus descriptions of most diseases, with access to current research articles.
+NLM Comprehensive database from the US National Library of Medicine
+OMIM Comprehensive information on genes that cause disease at Online Mendelian Inheritance in Man
+The Merck Manual containing detailed description of most diseases
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+---
+title: "Disease-modifying treatment"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Disease-modifying_treatment"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:01.433151+00:00"
+instance: "kb-cron"
+---
+
+A disease-modifying drug, or disease-modifying therapy, is a treatment that delays, slows or reverses the progression of a disease by targeting its underlying cause. They are distinguished from symptomatic treatments that treat the symptoms of a disease but do not address its underlying cause.
+
+
+== Examples ==
+Disease-modifying osteoarthritis drug
+Disease-modifying antirheumatic drug
+
+
+== References ==
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+---
+title: "Disease registry"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Disease_registry"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:58.923750+00:00"
+instance: "kb-cron"
+---
+
+Disease or patient registries are collections of secondary data related to patients with a specific diagnosis, condition, or procedure.  
+In its simplest form, a disease registry could consist of a collection of paper cards kept inside "a shoe box" by an individual physician. Most frequently registries vary in sophistication from  simple spreadsheets that only can be accessed by a small group of physicians to very complex databases that are accessed online across multiple institutions. Registries are different from indexes in that they contain more extensive data.
+They can help to hypothesize risk factors and allow scientific research. They provide health care providers (or patients) with reminders to check certain tests in order to reach certain quality goals. They play a role in epidemiological research,  drug safety and  post marketing surveillance of pharmaceuticals and devices.
+
+== Definition ==
+A disease registry is a data collection related to persons with a specific diagnosis, condition, or procedure.
+Registries can be sponsored by a government agency, nonprofit organization, health care facility, or private company. Data ownerhip and data access as well as goals vary accordingly. 
+Registries have traditionally been less complex and simpler to set up than electronic medical records, which according to a 2008 survey were only used by 9% of small US practices, where almost half of the US doctors work.
+
+== Types ==
+
+Many measures registries track are based on evidence-based medicine and are defined and standardized by national organizations like the NCQA.
+
+=== Medical conditions tracked ===
+As of November 2025, the NIH listed 80 disease registries on its website.
+The lastest one to be launched in the US was the autism registry.
+Registries target certain conditions because medical expenses are unevenly distributed: most health care expenses are spent treating patients with a few chronic diseases. As of 2011 more than 130 million Americans lived with chronic diseases and chronic diseases accounted for 70% of all deaths in the US. "The medical care costs of people with chronic diseases account for more than 75% of the nation's $2 trillion medical care costs."
+Diabetes is one of the conditions tracked by registries. Diabetes is also amenable to this because there is a defined target population and there is evidence that certain tests like retina exams, LDL levels, HgbA1c levels correlate with quality of care in diabetes.
+New York City created a HbA1C Registry (NYCAR) to help health providers keep track of patients with diabetes. 
+Another example of disease registry is the New York State CABG Registry that tracks all cardiac bypass surgery performed in the state of New York.
+The Australian cerebral palsy register represents an example of a recognized disease register. The aim of the Australian CP register is to conduct surveillance or constant observation of cerebral palsy prevalence, clinical patterns and complications. It is also tasked with providing recommendations to public health policy makers and improving health service delivery to individuals with cerebral palsy. More recently, several developing countries such as Bangladesh and Sri lanka have established cerebral palsy registers geared toward achieving the same above-noted aims.
+Tests like Pap smears are also useful to keep track in registries because there is evidence that when done annually in women of certain ages groups can detect and prevent cervical cancer.
+
+=== International ===
+Below is a small list of international patient registries.
+
+Newborn Screening (NBS) Connect Patient Registry for patients with inborn errors of metabolism
+DuchenneConnect Patient Registry for patients with Duchenne and Becker Muscular Dystrophy.
+PatientCrossroads – pan disease patient registries
+International Collaborative Gaucher Group (ICGG) Gaucher Registry is largest ongoing longitudinal international database that tracks demographic and clinical outcome data from patients with Gaucher disease
+Vascular health ASsessment Of The hypertENSive patients (VASOTENS) Registry, the international registry for ambulatory blood pressure and arterial stiffness telemonitoring.
+TREAT-NMD patient registries in neuromuscular disorders
+
+=== Medical devices ===
+Countries like Australia, Britain, Norway, Sweden, and America have a national joint replacement registry to track patients with artificial joints.
+"The use of joint registries has proven beneficial abroad. In Australia, regulators use such data to force manufacturers to justify why poorly performing hips or knees should remain available, and products have been withdrawn as a result. In Sweden several years ago, surgeons alerted by their national registry stopped using a badly flawed hip long before their American counterparts did. A few medical organizations in the USA, like Kaiser Permanente, operate their own registries to good effect and the Hospital for Special Surgery in New York has recently set up a registry.
+Experts say that the United States wastes billions of dollars annually on medical treatments which may not work. But the financial and human consequences are also large when evidence exists but is not collected."
+
+== Goals ==
+Registries can be used for epidemiological research, evaluating for risk factors or outcomes. 
+Patient registries are particularly useful for evaluating drug safety, particularly orphan drugs in specific populations. As of 2023, it was getting more and more common to use data of different healthcare and disease registries  for different purposes such as for generating evidence for healthcare efficiency and market access planning.
+
+=== Quality improvement ===
+They can provide health providers (or patients) with reminders to check certain tests in order to reach certain quality goals. They play a role in post marketing surveillance of pharmaceuticals.
+
+=== Improve cost-effectiveness ===
+The cost-effectiveness of a disease registry is related with the cost-effectiveness of prevention of specific medical conditions. Increasing compliance through a registry with preventive measures like children vaccination or colonoscopy screening can actually be a cost-saving measure. "A mammogram every 2 years for women aged 50–69 costs only about $9,000 per year of life saved. This cost compares favorably with other widely used clinical preventive services."
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+---
+title: "Disease registry"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Disease_registry"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:27:58.923750+00:00"
+instance: "kb-cron"
+---
+
+=== Pay-for-performance (P4P) ===
+Registries can be associated with pay-for-performance (P4P) quality based contracts for individualhealth care providers, groups of  or even all doctors in a country. For example, the United Kingdom, rewards physicians according to 146 quality measures related with 10 chronic diseases that are tracked electronically.
+In 2017 in the United States, Medicare started a 1.5% P4P contract based on health  measures that can be tracked by disease registries.
+
+== Technical aspects of data tracking ==
+The quality of a disease registry is contingent on the quality of its data and all the processes involved in updating it and keeping its integrity. In every registry there is always a risk of "garbage in, garbage out". Issues that can affect a registry and its acceptance by a physician group:
+
+Is the registry only updated centrally or can a physician update or correct it? For example, a physician does not want to get reminders from a registry regarding diabetes patients that died, moved to another state or left her/his practice.
+Most frequently, a list of patients with a certain condition (e.g. diabetes) is generated based on certain criteria. In the U.S., Healthcare Effectiveness Data and Information Set (HEDIS) criteria are set annually by the National Committee for Quality Assurance (NCQA). These criteria, in order to avoid paper charts reviews are in most cases based on insurance claims. For example, for diabetes, HEDIS selects an eligible population based on age (18–75 years), continuous enrollment with a certain health insurer and certain "Events/diagnosis" from pharmacy data (electronic), insurance claims data (electronic) or from medical records. Pharmacy data is based on a list of medications prescribed for diabetes. Claims data is based on having two outpatient visits with a doctor or one inpatient hospital admission or one emergency room visit with the diagnosis of diabetes. Patients are excluded if they have polycystic ovaries or just gestational diabetes. Despite the strict criteria it is possible for physicians to have patients on their registries that are not truly diabetic.
+
+== See also ==
+Clinical trials registry
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Disease_theory_of_alcoholism-0.md b/data/en.wikipedia.org/wiki/Disease_theory_of_alcoholism-0.md
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+---
+title: "Disease theory of alcoholism"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:00.228979+00:00"
+instance: "kb-cron"
+---
+
+The modern disease theory of alcoholism states that problem drinking is sometimes caused by a disease of the brain, characterized by altered brain structure and function. Today, alcohol use disorder (AUD) is used as a more scientific and suitable approach to alcohol dependence and alcohol-related problems. 
+The largest association of physicians – the American Medical Association (AMA) – declared that alcoholism was an illness in 1956. In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.
+
+== Theory ==
+Under the model of alcoholism, alcohol use disorder is viewed as chronic problem for which abstinence is required. A brain disease model of addiction, based on the extent of neuroadaptation and impaired control, is main position advanced for proposing a disease model of alcohol use disorder. However, if managed properly, damage to the brain can be stopped and to some extent reversed.   In addition to problem drinking, the disease is characterized by symptoms including an impaired control over alcohol, compulsive thoughts about alcohol, and distorted thinking.  Alcoholism can also lead indirectly, through excess consumption, to physical dependence on alcohol, and diseases such as cirrhosis of the liver.
+The risk of developing alcoholism depends on many factors, such as environment.  Those with a family history of alcoholism are more likely to develop it themselves (Enoch & Goldman, 2001); however, many individuals have developed alcoholism without a family history of the disease.  Since the consumption of alcohol is necessary to develop alcoholism, the availability of and attitudes towards alcohol in an individual's environment affect their likelihood of developing the disease. Current evidence indicates that in both men and women, alcoholism is 50–60% genetically determined, leaving 40–50% for environmental influences.
+In a review in 2001, McLellan et al. compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. They found that genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders, providing evidence that drug (including alcohol) dependence is a chronic medical illness.
+
+== Genetics and environment ==
+According to the theory, genes play a strong role in the development of alcoholism.
+Twin studies, adoption studies, and artificial selection studies have shown that a person's genes can predispose them to developing alcoholism. Evidence from twin studies show that concordance rates for alcoholism are higher for monozygotic twins than dizygotic twins—76% for monozygotic twins and 61% for dizygotic twins. However, female twin studies demonstrate that females have much lower concordance rates than males. Reasons for gender differences may include environmental factors, such as negative public attitudes towards female drinkers.
+Adoption studies also suggest a strong genetic tendency towards alcoholism. Studies on children separated from their biological parents demonstrates that sons of alcoholic biological fathers were more likely to become alcoholic, even though they have been separated and raised by non alcoholic parents.
+In artificial selection studies, specific strains of rats were bred to prefer alcohol. These rats preferred drinking alcohol over other liquids, resulting in a tolerance for alcohol and exhibited a physical dependency on alcohol. Rats that were not bred for this preference did not have these traits. Upon analyzing the brains of these two strains of rats, it was discovered that there were differences in chemical composition of certain areas of the brain. This study suggests that certain brain mechanisms are more genetically prone to alcoholism.
+The convergent evidence from these studies present a strong case for the genetic basis of alcoholism.
+
+== History ==
+Historians debate who has primacy in arguing that habitual drinking carried the characteristics of a disease.  Some note that Scottish physician Thomas Trotter was the first to characterize excessive drinking as a mental disease or medical defect.
+Others point to American physician Benjamin Rush (1745–1813), a signatory to the United States Declaration of Independence, who understood drunkenness to be what we would now call a "loss of control", as possibly the first to use the term addiction in this sort of meaning.
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+---
+title: "Disease theory of alcoholism"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:00.228979+00:00"
+instance: "kb-cron"
+---
+
+My observations authorize me to say, that persons who have been addicted to them, should abstain from them suddenly and entirely. 'Taste not, handle not, touch not' should be inscribed upon every vessel that contains spirits in the house of a man, who wishes to be cured of habits of intemperance.
+Rush argued that "habitual drunkenness should be regarded not as a bad habit but as a disease", describing it as "a palsy of the will". Rush expounded his views in a book published in 1808. His views are described by Valverde, Levine Spode, and Perkins-McVey. Already in 1802 the prominent German physician Christoph Wilhelm Hufeland had published a book on the "brandy plague" stating that the "infection" with spirits makes it "inevitably necessary to drink ever more." Later he wrote an enthusiastic preface to the book On the addiction to drink and a rational cure of it by German-Russian physician C. von Brühl-Cramer. As Spode points out, this study marked the birth of a consistent "paradigm" of addiction as a mental illness, although it took many decades until this view was accepted. Perkins-McVey argues that Rush, Trotter, and Brühl-Cramer each independently developed their own disease theories of alcoholism as a result of their shared interest in the Brunonian system of medicine, which classified alcohol as a stimulant of the vital force. As Perkins-McVey argues, this "understanding of the disease of habitual drunkenness as a phenomena  [sic] of stimulus dependence is arguably the primary vehicle driving the disease model in the works of Rush, Trotter, and Brühl-Cramer." This shifts the discussion away from the question of historical priority, instead identifying a common conceptual influence on early disease theorists.
+In 1849, Swedish physician Magnus Huss coined the term alcoholism in his book Alcoholismus chronicus. Some argue he was the first to systematically describe the physical characteristics of habitual drinking and claim that it was a mental disease. However, Huss regarded heavy drinking still as a vice (that causes a destruction of the nervous system).  Moreover, this came decades after Trotter, Rush, Hufeland and Brühl-Cramer wrote their works, and some historians argue that the idea that habitual drinking was a mental disease emerged even earlier.
+Given this controversy, the best one can say is that the idea that habitual alcohol drinking was a disease had become more acceptable by the second half of the nineteenth century, although many writers still argued it was a vice, a sin, and not the purview of medicine but of religion.
+
+Between 1980 and 1991, medical organizations, including the AMA, worked together to establish policies regarding their positions on the disease theory. These policies were developed in 1987 in part because third-party reimbursement for treatment was difficult or impossible unless alcoholism were categorized as a disease. The policies of the AMA, formed through consensus of the federation of state and specialty medical societies within their House of Delegates, state, in part: "The AMA endorses the proposition that drug dependencies, including alcoholism, are diseases and that their treatment is a legitimate part of medical practice."
+In 1991, the AMA further endorsed the dual classification of alcoholism by the International Classification of Diseases under both psychiatric and medical sections.
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+---
+title: "Disease theory of alcoholism"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:00.228979+00:00"
+instance: "kb-cron"
+---
+
+== Controlled drinking ==
+The disease theory is often interpreted as implying that problem drinkers are incapable of returning to 'normal' problem free drinking, and therefore that treatment should focus on total abstinence. Some critics have used evidence of controlled drinking in formerly dependent drinkers to dispute the disease theory of alcoholism.
+The first major empirical challenge to this interpretation of the disease theory followed a 1962 study by Dr. D. L. Davies.  Davies' follow-up of ninety-three problem drinkers found that seven of them were able to return to "controlled drinking" (less than seven drinks per day for at least seven years).  Davies concluded that "the accepted view that no alcohol addict can ever again drink normally should be modified, although all patients should be advised to aim at total abstinence"; After the Davies study, several other researchers reported cases of problem drinkers returning to controlled drinking.
+In 1976, a major study commonly referred to as the RAND report, published evidence of problem drinkers learning to consume alcohol in moderation. The publication of the study renewed controversy over how people with a disease which reputedly leads to uncontrollable drinking could manage to drink controllably. Subsequent studies also reported evidence of return to controlled drinking.  Similarly, according to a 2002 National Institute on Alcohol Abuse and Alcoholism (NIAAA) study, about one of every six (18%) of alcohol dependent adults in the U.S. whose dependence began over one year previously had become "low-risk drinkers" (less than fourteen drinks per week and five drinks per day for men, or less than seven per week and four per day for women). This modern longitudinal study surveyed more than 43,000 individuals representative of the U.S. adult population, rather than focusing solely on those seeking or receiving treatment for alcohol dependence. "Twenty years after onset of alcohol dependence, about three-fourths of individuals are in full recovery; more than half of those who have fully recovered drink at low-risk levels without symptoms of alcohol dependence."
+However, many researchers have debated the results of the smaller studies.  A 1994 followup of the original seven cases studied by Davies suggested that he "had been substantially misled, and the paradox exists that a widely influential paper which did much to stimulate new thinking was based on faulty data."  The most recent study, a long-term (60 year) follow-up of two groups of alcoholic men by George Vaillant at Harvard Medical School concluded that "return to controlled drinking rarely persisted for much more than a decade without relapse or evolution into abstinence." Vaillant also noted that "return-to-controlled drinking, as reported in short-term studies, is often a mirage."
+The second RAND study, in 1980, found that alcohol dependence represents a factor of central importance in the process of relapse.  Among people with low dependence levels at admission, the risk of relapse appears relatively low for those who later drank without problems.  But the greater the initial level of dependence, the higher the likelihood of relapse for nonproblem drinkers.  The second RAND study findings have been strengthened by subsequent research by Dawson et al. in 2005 which found that severity was associated positively with the likelihood of abstinent recovery and associated negatively with the likelihood of non-abstinent recovery or controlled drinking.  Other factors such as a significant period of abstinence or changes in life circumstances were also identified as strong influences for success in a book on Controlled Drinking published in 1981.
+
+=== Managed drinking ===
+As part of a harm reduction strategy, provision of small amounts of alcoholic beverages to homeless alcoholics at homeless shelters in Toronto and Ottawa reduced government costs and improved health outcomes.
+
+== Legal considerations ==
+In 1988, the US Supreme Court upheld a regulation whereby the Veterans' Administration was able to avoid paying benefits by presuming that primary alcoholism is always the result of the veteran's "own willful misconduct." The majority opinion written by Justice Byron R. White echoed the District of Columbia Circuit's finding that there exists "a substantial body of medical literature that even contests the proposition that alcoholism is a disease, much less that it is a disease for which the victim bears no responsibility". He also wrote: "Indeed, even among many who consider alcoholism a 'disease' to which its victims are genetically predisposed, the consumption of alcohol is not regarded as wholly involuntary." However, the majority opinion stated in conclusion that "this litigation does not require the Court to decide whether alcoholism is a disease whose course its victims cannot control. It is not our role to resolve this medical issue on which the authorities remain sharply divided." The dissenting opinion noted that "despite much comment in the popular press, these cases are not concerned with whether alcoholism, simplistically, is or is not a 'disease.'"
+The American Bar Association "affirms the principle that dependence on alcohol or other drugs is a disease."
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+---
+title: "Disease theory of alcoholism"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Disease_theory_of_alcoholism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:00.228979+00:00"
+instance: "kb-cron"
+---
+
+== Current acceptance ==
+Alcoholism is a disease with a known pathology and an established biomolecular signal transduction pathway which culminates in ΔFosB overexpression within the D1-type medium spiny neurons of the nucleus accumbens; when this overexpression occurs, ΔFosB induces the addictive state.
+In 2004, the World Health Organization published a detailed report on alcohol and other psychoactive substances entitled "Neuroscience of psychoactive substance use and dependence". It stated that this was the "first attempt by WHO to provide a comprehensive overview of the biological factors related to substance use and dependence by summarizing the vast amount of knowledge gained in the last 20-30 years. The report highlights the current state of knowledge of the mechanisms of action of different types of psychoactive substances, and explains how the use of these substances can lead to the development of dependence syndrome." The report states that "dependence has not previously been recognized as a disorder of the brain, in the same way that psychiatric and mental illnesses were not previously viewed as being a result of a disorder of the brain. However, with recent advances in neuroscience, it is clear that dependence is as much a disorder of the brain as any other neurological or psychiatric illness."
+The American Society of Addiction Medicine and the American Medical Association both maintain extensive policy regarding alcoholism.  The American Psychiatric Association recognizes the existence of alcoholism as the equivalent of alcohol dependence. The American Hospital Association, the American Public Health Association, the National Association of Social Workers, and the American College of Physicians classify alcoholism as a disease.
+In the US, the National Institutes of Health has a specific institute, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), concerned with the support and conduct of biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. It funds approximately 90 percent of all such research in the United States. The official NIAAA position is that "alcoholism is a disease. The craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. Like many other diseases, alcoholism is chronic, meaning that it lasts a person's lifetime; it usually follows a predictable course; and it has symptoms. The risk for developing alcoholism is influenced both by a person's genes and by his or her lifestyle."
+Certain medications including opioid antagonists such as naltrexone have been shown to be effective in the treatment of alcoholism.
+
+=== Criticism ===
+Some physicians, scientists and others have rejected the disease theory of alcoholism on logical, empirical and other grounds. Indeed, some addiction experts such as Stanton Peele are outspoken in their rejection of the disease model, and other prominent alcohol researchers such as Nick Heather have authored books intending to disprove the disease model.
+These critics hold that by removing some of the stigma and personal responsibility, the disease concept actually increases alcoholism and drug abuse and thus the need for treatment.  This is somewhat supported by a study which found that a greater belief in the disease theory of alcoholism and higher commitment to total abstinence to be factors correlated with increased likelihood that an alcoholic would have a full-blown relapse (substantial continued use) following an initial lapse (single use). However, the authors noted that "the direction of causality cannot be determined from these data. It is possible that belief in alcoholism as a loss-of-control disease predisposes clients to relapse, or that repeated relapses reinforce clients' beliefs in the disease model."
+One study published in 1996 found that only 25 percent of physicians believed that alcoholism is a disease. The majority believed alcoholism to be a social or psychological problem instead of a disease.
+Thomas R. Hobbs says that "Based on my experiences working in the addiction field for the past 10 years, I believe many, if not most, health care professionals still view alcohol addiction as a willpower or conduct problem and are resistant to look at it as a disease."
+The sociologist Lynn M. Appleton noted that "Despite all public pronouncements about alcoholism as a disease, medical practice rejects treating it as such. Not only does alcoholism not follow the model of a 'disease,' it is not amenable to standard medical treatment." She says that "Medical doctors' rejection of the disease theory of alcoholism has a strong basis in the biomedical model underpinning most of their training" and that "medical research on alcoholism does not support the disease model."
+"Many doctors have been loath to prescribe drugs to treat alcoholism, sometimes because of the belief that alcoholism is a moral disorder rather than a disease," according to Dr. Bankole Johnson, Chairman of the Department of Psychiatry at the University of Virginia. Dr Johnson's own pioneering work has made important contributions to the understanding of alcoholism as a disease.
+Frequency and quantity of alcohol use are not related to the presence of the condition; that is, people can drink a great deal without necessarily being alcoholic, and alcoholics may drink minimally or infrequently.
+
+== See also ==
+Disease model of addiction
+
+== References ==
+
+== External links ==
+Is Alcoholism a Disease & Can It Be Cured?
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diff --git a/data/en.wikipedia.org/wiki/Disseminated_disease-0.md b/data/en.wikipedia.org/wiki/Disseminated_disease-0.md
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+---
+title: "Disseminated disease"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Disseminated_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:02.635093+00:00"
+instance: "kb-cron"
+---
+
+Disseminated disease can refer to disseminated cancer which is the movement of cancerous cells from the original tumor to other areas of the body, or disseminated infection which is the pathogen's entry into the host, growth, and dissemination, which results in illness.
+After exiting the main tumor, cancer cells circulate throughout the body. They are known as circulating tumor cells once they are in the blood. Few circulating tumor cells can disseminate to distant locations and remain tumor cells. The amount of disseminated tumor cells that can develop into metastases is even lower.
+
+
+== See also ==
+Metastasis
+Localized disease
+
+
+== References ==
+
+
+== Further reading ==
+Albert, WH; Hauch, S; Zieglschmid, V (2005). "Detection of Disseminated Cancer Cells in Blood". EJIFCC. 16 (2). International Federation of Clinical Chemistry and Laboratory Medicine: 81–85. PMC 6008966. PMID 29942243.
+Ramamoorthi, Ganesan; Kodumudi, Krithika; Gallen, Corey; Zachariah, Nadia Nocera; Basu, Amrita; Albert, Gabriella; Beyer, Amber; Snyder, Colin; Wiener, Doris; Costa, Ricardo L.B.; Czerniecki, Brian J. (2022). "Disseminated cancer cells in breast cancer: Mechanism of dissemination and dormancy and emerging insights on therapeutic opportunities". Seminars in Cancer Biology. 78. Elsevier BV: 78–89. doi:10.1016/j.semcancer.2021.02.004. ISSN 1044-579X. PMID 33626407.
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Distress_(medicine)-0.md b/data/en.wikipedia.org/wiki/Distress_(medicine)-0.md
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+---
+title: "Distress (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Distress_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:03.912155+00:00"
+instance: "kb-cron"
+---
+
+In medicine, distress is an aversive state in which a person is unable to completely adapt to difficult situations and their resulting effects and shows maladaptive behaviors. It can be evident in the presence of various phenomena, such as inappropriate social interaction (e.g., aggression, passivity, or withdrawal).
+Distress is the opposite of eustress, a positive emotion that motivates people.
+
+
+== Risk factors ==
+Stress can be created by influences such as work, school, peers or co-workers, family and death. Other influences vary by age.
+People under constant distress are more likely to become sick, mentally or physically. There is a clear response association between psychological distress and major causes of mortality across the full range of distress.
+Higher education has been linked to a reduction in psychological distress in both men and women, and these effects persist throughout the aging process, not just immediately after receiving education. However, this link does lessen with age. The major mechanism by which higher education plays a role on reducing stress in men is more so related to labor-market resources rather than social resources as in women.
+In the clinic, distress is a patient reported outcome that has a huge impact on patient's quality of life. To assess patient distress, a Hospital Anxiety and Depression Scale (HADS) questionnaire is most commonly used. The score from the HADS questionnaire guides a clinician to recommend lifestyle modifications or further assessment for mental disorders like depression.
+
+
+== Management ==
+
+People often find ways of dealing with distress, in both negative and positive ways. Examples of positive ways are listening to music, calming exercises, coloring, sports and similar healthy distractions. Negative ways can include but are not limited to use of drugs including alcohol, and expression of anger, which are likely to lead to complicated social interactions, thus causing increased distress.
+
+
+== See also ==
+Intentional infliction of emotional distress
+
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Divaricate-0.md b/data/en.wikipedia.org/wiki/Divaricate-0.md
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+---
+title: "Divaricate"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Divaricate"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:05.077629+00:00"
+instance: "kb-cron"
+---
+
+Divaricate means branching, or having separation or a degree of separation. The angle between branches is wide.
+
+
+== In botany ==
+
+In botany, the term is often used to describe the branching pattern of plants.  Plants are said to be divaricating when their growth form is such that each internode diverges widely from the previous internode, producing an often tightly interlaced shrub or small tree. Of the 72 small leaved shrubs found on the Banks Peninsula, for example, some 38 are divaricating.
+
+
+== See also ==
+Diastasis (pathology), a medical term for separation of parts
+Laciniate
+
+
+== References ==
\ No newline at end of file
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+---
+title: "Diverticulum"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Diverticulum"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:06.331221+00:00"
+instance: "kb-cron"
+---
+
+In medicine or biology, a diverticulum is  an outpouching of a hollow (or a fluid-filled) structure in the body. Depending upon which layers of the structure are involved, diverticula are described as being either true or false.
+In medicine, the term usually implies the structure is not normally present, but in embryology, the term is used for some normal structures arising from others, as for instance the thyroid diverticulum, which arises from the tongue.
+The word comes from Latin dīverticulum, "bypath" or "byway".
+
+
+== Classification ==
+Diverticula are described as being true or false depending upon the layers involved:
+
+False diverticula (also known as "pseudodiverticula") do not involve muscular layers or adventitia. False diverticula, in the gastrointestinal tract for instance, involve only the submucosa and mucosa, such as Zenker's diverticulum. False diverticula are typically synonymous with pulsion diverticula, which describes the mechanism of formation as increased intraluminal pressure.
+True diverticula involve all layers of the structure, including muscularis propria and adventitia, such as Meckel's diverticulum. True diverticula are typically synonymous with traction diverticula, which describes the mechanism of formation as pulling forces external to the structure.
+
+
+== Embryology ==
+The kidneys are originally diverticula in the development of the urinary and reproductive organs.
+The lungs are originally diverticula (lung buds) forming off of the ventral foregut.
+The thymus appears in the form of two flask-shape diverticula, which arise from the third branchial pouch (pharyngeal pouch) of the endoderm.
+The thyroid gland develops as a diverticulum arising from a point on the tongue, demarcated as the foramen cecum.
+
+
+== Human pathology ==
+
+
+=== Gastrointestinal tract diverticula ===
+Esophageal diverticula may occur in one of three areas of the esophagus:
+Pharyngeal (Zenker's) diverticula usually occur in the elderly, through Killian's triangle between the thyropharyngeus and cricopharyngeus muscle of the inferior pharyngeal constrictors.
+Midesophageal diverticula
+Epiphrenic diverticula are due to dysfunction of the lower esophageal sphincter, as in achalasia.
+A duodenal diverticulum can be found incidentally in 23% of normal people undergoing imaging. It can be either congenital or acquired, but the acquired form is more common and is due to the weakness of the duodenal wall, which causes protrusions. It is usually found at the second or third part of duodenum, around the ampulla of Vater. Food debris may enter the diverticular outpouchings, causing inflammation or diverticulitis. On CT or MRI imaging, it appears as a sac-like outpouching. If the diverticulum is filled with contrast agents, the wall would be thin and may contain air, fluid, contrast material, or food debris. If the food debris is broken down by bacteria, the outpouching may show "faeces sign". Inflammation of the duodenal wall shows thickening of the wall. Rarely, on barium studies in congenital duodenal diverticula, the contrast material fills up the true lumen, causing "windsock" deformity.
+A jejunal diverticulum is a congenital lesion and may be a source of bacterial overgrowth. It may also perforate or result in abscesses.
+A Killian-Jamieson diverticulum is very similar to a pharyngeal esophageal diverticulum, differing in the fact that the pouching is between the oblique and transverse fibers of the cricopharyngeus muscle.
+A Laimer diverticulum is an outpouching that occurs in the Laimer triangle between the cricopharyngeus and superior esophageal circular muscle.
+Colonic diverticula, although found incidentally during colonoscopy,  may become infected (see diverticulitis) and can perforate, requiring surgery.
+Gastric diverticula are very infrequent.
+Meckel's diverticulum, a persistent portion of the omphalomesenteric duct, is present in 2% of the population, making it the most common congenital gastrointestinal malformation.
+
+Rokitansky-Aschoff sinuses are diverticula in the gallbladder due to chronic cholecystitis
+Most of these pathological types of diverticula are capable of harboring an enterolith. If the enterolith stays in place, it may cause no problems, but a large enterolith expelled from a diverticulum into the lumen can cause obstruction.
+
+
+=== Genito-urinary tract diverticula ===
+Bladder diverticula are balloon-like growths on the bladder commonly associated with chronic outflow obstruction, such as benign prostatic hyperplasia in older males. Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer.
+Calyceal diverticula are usually asymptomatic, but if a stone becomes lodged in the outpouching, they may present with pain.
+Urethral diverticula are usually found in women aged 30 to 70 years old, in between 1 and 6% of adult women. Since most cases are without any symptoms, the true incidence is unknown. Symptoms may vary from frequent urinary tract infections, painful sexual intercourse (dyspareunia), or symptoms due to cancer. A urethral diverticulum is located on the anterior vaginal wall, 1 to 3 cm inside the vaginal introitus. MRI is preferred as the imaging method of choice due to its excellent soft-tissue resolution. On T2-weighted imaging, it shows a  high signal in the diverticulum due to the presence of fluid inside it. Vaginal ultrasonography is highly sensitive in diagnosing the diverticulum, but it is strongly dependent on the skills of the operator.
+
+
+=== Other diverticula ===
+A diverticulum of Kommerell is an outpouching (aneurysm) of the aorta where an aberrant right subclavian artery is located. It is unusual nomenclature, in that focal dilatations of a blood vessel are properly referred to as aneurysms.
+Cardiac diverticulum is a very rare congenital malformation of the heart that is usually benign.
+
+
+== Gallery ==
+
+
+== See also ==
+Christine Menias
+Skeletal pneumaticity
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dose_area_product-0.md b/data/en.wikipedia.org/wiki/Dose_area_product-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dose_area_product-0.md
@@ -0,0 +1,60 @@
+---
+title: "Dose area product"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dose_area_product"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:07.646252+00:00"
+instance: "kb-cron"
+---
+
+Dose area product (DAP) is a quantity used in assessing the radiation risk from diagnostic X-ray radiography examinations and interventional procedures, like angiography. It is defined as the absorbed dose multiplied by the area irradiated, expressed in gray-centimetres squared (Gy·cm2 – sometimes the prefixed units dGy·cm2, mGy·cm2 or cGy·cm2 are also used). Gray (Gy) is the SI unit of absorbed dose of ionizing radiation, while the milligray (mGy) is its subunit, numerically equivalent to the millisievert (mSv) as used to quantify equivalent and effective doses for gamma (γ) and X-rays. 
+
+Manufacturers of DAP meters usually calibrate them in terms of absorbed dose to air. DAP reflects not only the dose within the radiation field but also the area of tissue irradiated. Therefore, it may be a better indicator of the overall risk of inducing cancer than the dose within the field. It also has the advantage of being easily measured, with the permanent installation of a DAP meter on the X-ray set.
+Due to the divergence of a beam emitted from a "point source", the area irradiated (A) increases with the square of distance from the source (A ∝ d2), while radiation intensity (I) decreases according to the inverse square of distance (I ∝ 1/d2). Consequently, the product of intensity and area, and therefore DAP, is independent of distance from the source.
+DICOM "X-Ray Acquisition Dose Module" metadata within each medical imaging study often includes various DAP and dose length product (DLP) parameters.
+
+
+== How DAP is measured ==
+An ionization chamber is placed beyond the X-ray collimators and must intercept the entire X-ray field for an accurate reading. Different parameters of the X-ray set, such as peak voltage (kVp), X-ray tube current (mA), exposure time, or the area of the field, can also be changed. 
+
+For example, a 5 cm × 5 cm X-ray field with an entrance dose of 1 mGy will yield a 25 mGy·cm2 DAP value. When the field is increased to 10 cm × 10 cm with the same entrance dose, the DAP increases to 100 mGy·cm2, which is four times the previous value.
+
+
+== Kerma Area Product ==
+Kerma area product (KAP) is a related quantity, which for all practical radiation protection purposes is equal to dose area product. However, strictly speaking 
+  
+    
+      
+        
+          D
+          A
+          P
+        
+        =
+        
+          K
+          A
+          P
+        
+        ×
+        (
+        1
+        −
+        g
+        )
+      
+    
+    {\displaystyle \mathrm {DAP} =\mathrm {KAP} \times (1-g)}
+  
+, where g is the fraction of energy of liberated charged particles that is lost in radiative processes in the material and the dose is expressed in absorbed dose to air. The value of g for diagnostic X-rays is only a fraction of a percent.
+Adult coronary angiography and PCI procedures expose patients to an average DAP in the range of 20 to 106 Gy·cm2 and 44 to 143 Gy·cm2 respectively.
+
+
+== See also ==
+Effective dose
+Equivalent dose
+Computed tomography dose index
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Drop_attack-0.md b/data/en.wikipedia.org/wiki/Drop_attack-0.md
new file mode 100644
index 000000000..8925f51ab
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Drop_attack-0.md
@@ -0,0 +1,20 @@
+---
+title: "Drop attack"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Drop_attack"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:08.814933+00:00"
+instance: "kb-cron"
+---
+
+A drop attack is a sudden fall without loss of consciousness. A drop attack has been defined as "a collapse or fall with little warning, following which the patient lies motionless or nearly motionless for a variable time, but often with rapid recovery to their normal state". However, the understanding of what constitutes a drop attack varies widely between authors.
+Drop attacks stem from diverse mechanisms, including orthopedic causes (for example, leg weakness and knee instability), hemodynamic causes (for example, transient vertebrobasilar insufficiency, a type of interruption of blood flow to the brain), and neurologic causes (such as epileptic seizures or unstable vestibular function).
+The term "drop attack", also known as "cryptogenic drop attack" or "La maladie des genoux bleus"; is used to categorize otherwise unexplained falls from a wide variety of causes and is considered ambiguous medical terminology; drop attacks are currently reported much less often than in the past, possibly as a result of better diagnostic precision. 
+The common cardiovascular causes of drop attacks include syncope (a sudden transient loss of awareness due to reduced blood flow to the brain), orthostatic hypotension (which is often precipitated by medications), and arrhythmias (abnormalities of the heart beat). A drop of systolic blood pressure more than 20 mm Hg or a drop in diastolic blood pressure more than 10 mm Hg can indicate orthostatic hypotension. Syncope following exertion may indicate structural heart defects like hypertrophic cardiomyopathy or cardiac tumours. While the majority of syncopal events are benign in nature, a drop attack could be a harbinger of a potentially lethal cardiac disorder like Brugada syndrome or long QT syndrome. By definition, drop attacks exclude syncopal falls (fainting), which involve short loss of consciousness. Hence, a detailed cardiac evaluation, including echocardiography and Holter study (a continuous ECG monitoring) is recommended in drop attacks due to syncope.
+In neurology, the term "drop attack" is used to describe certain types of seizure which occur in epilepsy.  Epileptic drop attacks are atonic seizures that can cause sudden, often injurious falls. These are commonly seen in severe childhood epilepsies like Lennox–Gastaut syndrome and Doose Syndrome as well as symptomatic focal epilepsies. These are often difficult to treat and may need a combination of antiseizure medications and/or non-pharmacological measures like vagal nerve stimulation (VNS) or corpus callosotomy (transsection of the midline brain fibres). 
+Drop attacks that have a vestibular origin within the inner ear may be experienced by some people in the later stages of Ménière's disease (these may be referred to as Tumarkin drop attacks, or as Tumarkin's otolithic crisis). These have been attributed to dysfunction of the utricle and saccule. 
+Drop attacks often occur in elderly people; with a majority of documented cases occurring in women. Cardiac disorders are the most common cause of drop attacks in the elderly followed by disorders of gait and balance.  Falls in older adults happen for many reasons, and the goals of health care include preventing any preventable falls and correctly diagnosing any falls that do happen.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dyscopia-0.md b/data/en.wikipedia.org/wiki/Dyscopia-0.md
new file mode 100644
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+++ b/data/en.wikipedia.org/wiki/Dyscopia-0.md
@@ -0,0 +1,37 @@
+---
+title: "Dyscopia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dyscopia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:10.105316+00:00"
+instance: "kb-cron"
+---
+
+Dyscopia consists of the Latin root copia, which means abundance or plenty (see cornucopia), and the Greek prefix dys-, which means "bad", "abnormal", "difficult" or "impaired".
+This word has assumed two meanings, both of which are essentially a play on words based on the phonic similarity of the words "copy" and "cope" with copia.
+In the field of neurology, dyscopia is used to describe a type of developmental coordination disorder related to dyslexia and dysgraphia (inability to read or write). Specifically, it is taken to mean difficulty with coping. Sometimes a similar word, "acopia", is mistaken to mean the same, although this is not a medical term and has no basis in Latin. 
+The term "dyscopia" has also made its way into general medical parlance as a tongue-in-cheek shorthand notation for patients who, after being examined and found to have no specific medical condition, are deemed to be not coping with certain aspects of their lives, and are presumed to be seeking treatment as a form of comfort from the medical profession. More recently, and controversially, the term has been used in this context as a diagnosis for admission to hospital.
+The words have also been used in medical notes as a cryptic indication that certain members of a seriously ill patient's family are not coping with the situation and should be afforded some extra consideration for their feelings when the case is being discussed.
+
+
+== As dystranscribia ==
+In neurology, the word "dyscopia" is used to describe a condition which is common as one of the sequelae of cerebral commisurotomy, a neurosurgical procedure in which the left and right hemispheres of the brain are separated by severing the corpus callosum. This procedure has been shown to reduce the frequency and severity of seizures in extreme cases of epilepsy.
+An affected individual will exhibit difficulty with copying simple line drawings. This is often accompanied to lesser or greater degree by difficulty with writing and other fine motor skills.
+
+
+== As 'not coping' in medical usage ==
+Terms such as "social admission", "atypical presentation", and even the derogatory terms "bed blocker" or "crumblie" have been used in medical notes synonymously with dyscopia or acopia as a reason for hospital admission.
+The use of the term has become sufficiently commonplace in medical notes that a recent publication of a psychiatric dictionary even cites it as an actual diagnosis.
+Patients who are likely to be labelled with one of these terms are sometimes frail and elderly or people with long-term disabilities. Their failure to cope is often a result of inadequate social support coupled with a deterioration of functional capability which is not clearly linked to an obvious or specific medical or psychiatric pathology.
+Sometimes, however, despite the fact that terms such as acopia and social admission can be considered tongue-in-cheek by those adhering to the strictest of medical and psychiatric terminology, they can frequently describe a range of "symptoms", such as extreme lability and emotionality when demands are not met and the unwillingness of a minority of patients that might be encountered in psychiatry, to function and make ends meet, despite the fact that such patients might be lucid and able-bodied. 
+A possible controversy associated with using dyscopia and acopia as diagnoses could arise when wrongfully applied to those who have genuine problems with mobility; genuine medical conditions may be overlooked. Investigation of  symptoms is a legitimate reason for admission, and if medical staff are too swift to dismiss concerns by use of such informal labels, genuine symptoms may not be taken seriously and investigated. This may lead to treatable conditions being overlooked, and in turn, result in compromised quality of life and unnecessary suffering.
+Dyscopia (and likewise acopia), in this context, is not generally used by the medical community for fear of insulting the patient and bringing the caregiver's professional standing into question.
+
+
+== Colloquial usage ==
+Acopia has been adopted as the name of a company based in Crawley, UK, presumably referring the correct Latin root of the word copia meaning abundance.
+The words also appear to be gaining traction in common usage as colloquialisms meaning emotional lability over trivial events or circumstances. This may well assist in demystifying the term and discouraging its usage in medical circles.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dyscrasia-0.md b/data/en.wikipedia.org/wiki/Dyscrasia-0.md
new file mode 100644
index 000000000..441499d50
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dyscrasia-0.md
@@ -0,0 +1,32 @@
+---
+title: "Dyscrasia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dyscrasia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:11.461150+00:00"
+instance: "kb-cron"
+---
+
+In medicine, both ancient and modern, a dyscrasia is any of various disorders. The word has ancient Greek roots meaning "bad mixture". The concept of dyscrasia was developed by the Greek physician Galen (129–216 AD), who elaborated a model of health and disease as a structure of elements, qualities, humors, organs, and temperaments (based on earlier humorism). Health was understood in this perspective to be a condition of harmony or balance among these basic components, called eucrasia.  Disease was interpreted as the disproportion of bodily fluids or four humours: phlegm, blood, yellow bile, and black bile.  The imbalance was called dyscrasia. In modern medicine, the term is still occasionally used in medical context for an unspecified disorder of the blood, such as a plasma cell dyscrasia.
+
+
+== Ancient use ==
+To the Greeks, it meant an imbalance of the four humors: blood, black bile, yellow bile, and water (phlegm). These humors were believed to exist in the body, and any change in the balance among the four of them was the direct cause of all disease.
+This is similar to the concepts of bodily humors in the Tibetan medical tradition and the Indian Ayurvedic system, which both relate health and disease to the equality (Skt. samatā) or inequality (Skt. viṣamatā) of the quantities of three (or four) bodily humors, generally translated as wind, bile, and phlegm (and blood). 
+
+
+== Modern use ==
+The term is still occasionally used in medical contexts for an unspecified disorder of the blood. Specifically, it is defined in current medicine as a morbid general state resulting from the presence of abnormal material in the blood, usually applied to diseases affecting blood cells or platelets. Evidence of dyscrasia can be present with a WBC (white blood cell) count of over 1,000,000.
+"Plasma cell dyscrasia" is sometimes considered synonymous with paraproteinemia or monoclonal gammopathy.
+
+
+== See also ==
+Dysthymia and Euthymia (medicine), similar concepts applied to mood
+
+
+== References ==
+
+
+== External links ==
+"Blood Dyscrasia" at eCureMe
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dysdiadochokinesia-0.md b/data/en.wikipedia.org/wiki/Dysdiadochokinesia-0.md
new file mode 100644
index 000000000..6641a6e03
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dysdiadochokinesia-0.md
@@ -0,0 +1,83 @@
+---
+title: "Dysdiadochokinesia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dysdiadochokinesia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:12.737219+00:00"
+instance: "kb-cron"
+---
+
+Dysdiadochokinesia (DDK) is the medical term for an impaired ability to perform rapid, alternating movements (i.e., diadochokinesia). Complete inability is called adiadochokinesia. The term is from Greek δυς dys "bad", διάδοχος diadochos "working in turn", κίνησις kinesis "movement". The term was first described by neurologist Joseph Francois Félix Babinski in 1902.  Impaired pronation/supination of the upper extremities, hand/finger tapping, and heel-to-shin test are some clinical ways to test for dysdiadochokinesia. Causes can either be from cerebellar or extrapyramidal origin. Management includes treating the underlying cause and neurorehabilitation therapies. 
+
+
+== History of name and origin ==
+The term dysdiadochokinesia came into fruition in 1902 after the neurologist Joseph Francois Félix Babinski observed patients with cerebellar lesions. He noticed that these patients could not perform rapid, alternating movements of agonist and antagonist muscles. During this time period, neurophysiologists discovered that voluntary movements came from the cerebellum.  The term has the Greek roots, "dys", "diadochos", "kinesis", meaning impaired, succeeding, and movement, respectively. 
+
+
+== Signs and symptoms ==
+Abnormalities in dysdiadochokinesia can be seen in the upper extremity, lower extremity, and in speech. These deficits can greatly impact activities of daily living through motor movements. The deficits become visible in the rate of alternation, the completeness of the sequence, and in the variation in amplitude involving both motor coordination and sequencing. Average rate can be used as a measure of performance when testing for dysdiadochokinesia.
+
+
+=== Clinical manifestations ===
+Reduced movement frequency: slowed movements
+Irregular rhythm: abnormal cycling of hands with variability
+Dysmetria: inaccurate targeting
+
+
+=== Clinical testing ===
+
+
+==== Limb testing ====
+Impaired pronation/supination of the upper extremities: reduced angular velocity with variability, patients are asked to tap the palm of one hand with the fingers of the other, then rapidly turn over the fingers and tap the palm with the back of them repeatedly
+Abnormal hand/finger tapping: finger-to-thumb tapping rapidly, can be done bilaterally
+Heel-to-shin test: rubbing the heel of one foot to the opposite shin in an up-and-down motion, the feet normally perform less well than the hands.
+
+
+==== Oral testing ====
+Speech: the patient is asked to repeat syllables such as /pə/, /tə/, and /kə/; variation, excess loudness, and irregular articular breakdown are signs of dysdiadochokinesia
+
+
+=== Quantifying tests ===
+Most commonly, frequency of the tapping or motion is used to quantify deficits. It has been shown to be both sensitive and precise, while also being clinically simple to perform and grade. Further quantifying can be done with ultrasound, where it creates a three-dimensional picture. This resource can be used to quantify factors of dysdiadochokinesia like amplitude, velocity, and smoothness.
+
+
+== Causes ==
+Dysdiadochokinesia is a feature of cerebellar ataxia and may be the result of lesions to either the cerebellar hemispheres or the frontal lobe (of the cerebrum), it can also be a combination of both. It is thought to be caused by the inability to switch on and switch off antagonising muscle groups in a coordinated fashion due to hypotonia, secondary to the central lesion.
+
+
+=== Cerebellar causes ===
+Multiple system atrophy, cerebellar type
+Multiple sclerosis
+Cerebellar stroke
+Alcoholic cerebellar degeneration
+Hereditary ataxias such as Friedreich's ataxia
+
+
+=== Extrapyramidal causes ===
+Parkinson's disease
+Huntington's disease
+Drug-induced parkinsonism
+Dysdiadochokinesia has been linked to a mutation in SLC18A2, which encodes vesicular monoamine transporter 2(VMAT2).
+
+
+== Management ==
+Treatment is focused on the underlying source or condition. There is not an established pharmacological treatment specifically for cerebellar symptoms. The main focus is on neurorehabilitation, where the patient is enrolled in occupational, speech, and physical therapies.
+
+
+=== Occupational therapy ===
+Focus is put on limb grasping and gripping, which in turn help with tasks like turning a doorknob or buttoning up a shirt. Patients also learn how to transfer themselves safely, learning safe techniques to help them to get from a chair to the bed, for example.
+
+
+=== Speech therapy ===
+To help with irregular flow and impaired articulation with motor speech difficulties, patients practice speech rate and rhythm. Although speech therapy is strongly recommended, further research is needed to quantify its effectiveness.
+
+
+=== Physical therapy ===
+Patients focus on task-specific goals, like climbing a flight of stairs or walking across the living room. Emphasis is put on high-intensity coordination, where movements are repeated for practice. Structured physical therapy programs help patients focus on balance and coordination by improving gait and limb swinging.
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Dystrophy-0.md b/data/en.wikipedia.org/wiki/Dystrophy-0.md
new file mode 100644
index 000000000..c068961e9
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Dystrophy-0.md
@@ -0,0 +1,31 @@
+---
+title: "Dystrophy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Dystrophy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:13.930063+00:00"
+instance: "kb-cron"
+---
+
+Dystrophy is the degeneration of tissue, due to disease or malnutrition, most likely due to heredity.
+
+
+== Types ==
+Muscular dystrophy
+Duchenne muscular dystrophy
+Becker's muscular dystrophy
+Myotonic dystrophy
+Reflex neurovascular dystrophy
+Retinal dystrophy
+Cone dystrophy
+Corneal dystrophy
+Lipodystrophy
+Nail dystrophy
+
+
+== See also ==
+Muscle weakness
+Muscle atrophy
+Myotonia
+List of biological development disorders
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/E-patient-0.md b/data/en.wikipedia.org/wiki/E-patient-0.md
new file mode 100644
index 000000000..67a1000a0
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/E-patient-0.md
@@ -0,0 +1,61 @@
+---
+title: "E-patient"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/E-patient"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:15.181300+00:00"
+instance: "kb-cron"
+---
+
+An e-patient is a health consumer who participates fully in their own medical care, primarily by gathering information about medical conditions that impact them and their families, using the Internet and other digital tools. The term encompasses those who seek guidance for their own ailments, and the friends and family members who research on their behalf. E-patients report two effects of their health research: "better health information and services, and different, but not always better, relationships with their doctors."
+E-patients are active in their care and demonstrate the power of the participatory medicine or Health 2.0 / Medicine 2.0. model of care.  The "e" can stand for "electronic" but has also been used to refer to other terms, such as "equipped", "enabled", "empowered" and "expert".
+The current state of knowledge on the impact of e-patients on the healthcare system and the quality of care received indicates:
+
+A growing number of people say the internet played a crucial or important role as they helped another person cope with a major illness.
+Many clinicians underestimated the benefits and overestimated the risks of online health resources for patients.
+Medical online support groups are an important healthcare resource.
+"The net friendliness of clinicians and provider organizations—as rated by the e-patients they serve—is becoming an important new aspect of health care quality."
+According to one study, the advent of patients as partners is one of the most important cultural medical revolutions of the past century.
+In order to understand the impact of the e-patient, clinicians will likely need to move beyond "pre-internet medical constructs".
+Medical education must adapt to take the e-patient into account, and to prepare students for medical practice that includes the e-patient.
+A 2011 study of European e-patients found that they tended to be "inquisitive and autonomous" and that they noted that the number of e-patients in Europe appeared to be rising. A 2012 study found that e-patients uploading videos about their health experienced a loss of privacy, but also positive benefits from social support. A later 2017 study utilizing social network analysis found that when e-patients are included in health care conferences, they increase information flow, expand propagation, and deepen engagement in the conversation of tweets when compared to both physicians and researchers while only making up 1.4% of the stakeholder mix.
+
+
+== Non-English translations and adaptations of "e-patient" ==
+
+
+=== Japan ===
+According to Maho Isono, PhD, at the International University of Health and Welfare in Ōtawara, Japan, the term closest to e-patient in Japanese is tojisha-kenkyu, where "kenkyu means study, investigation and research" and "tojisha refers to interested persons, disabled persons themselves or patients themselves."
+
+
+=== Sweden ===
+Inspired by the seminal work on e-patients by Tom Ferguson and the e-Patients Scholars Working Group, Swedish patient and engineer Sara Riggare coined a new Swedish word,  "spetspatient", meaning "lead user patient" or "lead patient", in February 2016.
+
+
+== See also ==
+Doctor–patient relationship
+eHealth
+mHealth
+Patient opinion leader
+Treatment decision support
+Virtual patient
+
+
+== References ==
+
+
+== External links ==
+van Woerkum CM (1 April 2003). "The Internet and primary care physicians: coping with different expectations". The American Journal of Clinical Nutrition. 77 (4 Suppl): 1016S–1018S. doi:10.1093/ajcn/77.4.1016S. PMID 12663310.
+Susannah Fox; Pew Internet; American Life Project (2004-09-27). "Today's E-Patients: Hunters and Gatherers of Health Information Online". Archived from the original on 2007-05-13. Retrieved 2007-04-23.
+Ferguson, Tom (2007). e-Patients: How They Can Help Us Heal Health Care (PDF). Archived from the original (PDF) on 2008-07-23. Retrieved 2013-10-07.
+Rimer BK, Lyons EJ, Ribisl KM, et al. (July 2005). "How New Subscribers Use Cancer-Related Online Mailing Lists". Journal of Medical Internet Research. 7 (3) e32. doi:10.2196/jmir.7.3.e32. PMC 1550655. PMID 15998623.
+Meier A, Lyons EJ, Frydman G, Forlenza M, Rimer BK (2007). "How Cancer Survivors Provide Support on Cancer-Related Internet Mailing Lists". Journal of Medical Internet Research. 9 (2) e12. doi:10.2196/jmir.9.2.e12. PMC 1874721. PMID 17513283.
+The rise of the e-patient Archived 2009-11-30 at the Wayback Machine, Lee Rainie from the Pew Internet and American Life Project presentation at the Medical Library Association, October 7, 2009
+E-patients With a Disability or Chronic Disease, from the Pew Internet and American Life Project
+Association of Cancer Online Resources (ACOR) Archived 2008-05-01 at the Wayback Machine, an aggregate of e-patient online communities for knowledge-sharing about cancer.
+Haig, Scott (November 8, 2007). "When the patient is a Googler". Time.
+Who Cares Booklet by the Federal Trade Commission, a guide to health information
+Dave deBronkart: Meet e-Patient Dave, video at TED
+Greenwald, Ted. "A Social Network for Crohn's Disease | MIT Technology Review". Technologyreview.com. Retrieved 2013-09-13.
+Bhargava, Rohit; Johnmar, Fard (2013). ePatient 2015: 15 Surprising Trends Changing Healthcare.
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diff --git a/data/en.wikipedia.org/wiki/ESKAPE-0.md b/data/en.wikipedia.org/wiki/ESKAPE-0.md
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+---
+title: "ESKAPE"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/ESKAPE"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:42.622581+00:00"
+instance: "kb-cron"
+---
+
+ESKAPE is an acronym comprising the scientific names of six highly virulent and antibiotic resistant bacterial pathogens including: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. The acronym is sometimes extended to ESKAPEE to include Escherichia coli. This group of Gram-positive and Gram-negative bacteria can evade or 'escape' commonly used antibiotics due to their increasing multi-drug resistance (MDR). As a result, throughout the world, they are the major cause of life-threatening nosocomial or hospital-acquired infections in immunocompromised and critically ill patients who are most at risk.== Training and awareness manuals ==
+In addition to primary research literature, structured training materials have been developed to support understanding of ESKAPE pathogens in public health and biosecurity contexts. One such manual is Demystifying ESKAPE Pathogens (2017), published by the Institute of Nuclear Medicine and Allied Sciences (INMAS), a laboratory of the Defence Research and Development Organisation (DRDO), India.
+The manual provides an overview of multidrug-resistant pathogens, including their epidemiology, mechanisms of resistance, transmission, clinical features, and control strategies, and is used in training and awareness programmes in India. 
+P. aeruginosa and S. aureus are some of the most ubiquitous pathogens in biofilms found in healthcare. P. aeruginosa is a Gram-negative, rod-shaped bacterium, commonly found in the gut flora, soil, and water that can be spread directly or indirectly to patients in healthcare settings. The pathogen can also be spread in other locations through contamination, including surfaces, equipment, and hands. The opportunistic pathogen can cause hospitalized patients to have infections in the lungs (as pneumonia), blood, urinary tract, and in other body regions after surgery. S. aureus is a Gram-positive, cocci-shaped bacterium, residing in the environment and on the skin and nose of many healthy individuals. The bacterium can cause skin and bone infections, pneumonia, and other types of potentially serious infections if it enters the body. S. aureus has also gained resistance to many antibiotic treatments, making healing difficult. Because of natural and unnatural selective pressures and factors, antibiotic resistance in bacteria usually emerges through genetic mutation or acquires antibiotic-resistant genes (ARGs) through horizontal gene transfer - a genetic exchange process by which antibiotic resistance can spread.
+One of the main reasons for the rise in the selection for antibiotic resistance (ABR) and MDR which led to the emergence of the ESKAPE bacteria is from the rash overuse of antibiotics not only in healthcare, but also in the animal, and agricultural sector. Other key factors include misuse and inadequate adherence to treatment guidelines. Due to these factors, fewer and fewer antibiotic treatments are effective in eradicating ABR and MDR bacterial infections, while at the same time there are now no new antibiotics being created due to lack of funding. These ESKAPE pathogens, along with other antibiotic-resistant bacteria, are an interweaved global health threat and are being addressed from a more holistic and One Health perspective.
+
+== Prevalence ==
+From a global perspective, the emergence of multidrug-resistant (MDR) bacteria is responsible for about 15.5% of hospital acquired infection cases and there are currently about 0.7 million deaths from drug-resistant disease. Specifically, the opportunistic nosocomial ESKAPE pathogens correspond with the highest risk of mortality which has the majority of its isolates being MDR. Two pathogens within the ESKAPE group, Carbapenem-resistant Acinetobacter and Carbapenem-resistant Enterobacteriaceae are currently in the top five of the antibiotic resistant bacteria on the CDC's 2019 urgent threat list, and the other 4 pathogens making up the group are on the serious threat list. In addition, the World Health Organization (WHO) created a global priority pathogen list (PPL) of ABR bacteria with the goal to prioritize research and create new effective antibiotic treatments. The global PPL classifies pathogens into 3 categories, critical, high, and medium, and has 4 of the pathogens from the ESKAPE group in the critical priority list and the other 2 pathogens that make up the group in the high priority list.
+
+== Characteristics ==
+ESKAPE pathogens are differentiated from other pathogens due to their increased resistance to commonly used antibiotics such as penicillin, vancomycin, carbapenems, and more. This increased resistance, combined with the clinical significance of these bacteria in the medical field, results in a necessity to understand their mechanisms of resistance and combat them with novel antibiotics. Common mechanisms for resistance include the production of enzymes that attack the structure of antibiotics (for example, β-lactamases inactivating β-lactam antibiotics), modification of the target site that the antibiotic targets so that it can no longer bind properly, efflux pumps, and biofilm production. Efflux pumps are a feature of the membrane of Gram-negative bacteria that allows them to constantly pump out foreign material, including antibiotics, so that the inside of the cell never contains a high enough concentration of the drug to have an effect. Biofilms are a mixture of diverse microbial communities and polymers that protect the bacteria from antibiotic treatment by acting as a physical barrier.
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+---
+title: "ESKAPE"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/ESKAPE"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:42.622581+00:00"
+instance: "kb-cron"
+---
+
+== Clinical threats ==
+Due to their heightened resistance to frequently used antibiotics, these pathogens pose an additional threat to the safety of the general population, particularly those who frequently interact with hospital environments, as they most commonly contribute to hospital-acquired infections (HAI). The increased antimicrobial resistance profile of these pathogens varies, however they arise from similar causes. One common cause of antibiotic resistance is due to incorrect dosing. When a sub-therapeutic dose is prescribed, or a patient chooses to use less of their prescribed antibiotic, bacteria are given the opportunity to adapt to the treatment. At lower doses, or when a course of antibiotics is not completed, certain strains of the bacteria develop drug-resistant strains through the process of natural selection. This is due to the random genetic mutations that are constantly occurring in many forms of living organisms, bacteria and humans included. Natural selection supports the persistence of strains of bacteria that have developed a certain mutation that allows them to survive. Some strains are also able to participate in inter-strain horizontal gene transfer, allowing them to pass resistance genes from one pathogen to another. This can be particularly problematic in nosocomial infections, where bacteria are constantly exposed to antibiotics and those benefiting from resistance as a result of random genetic mutations can share this resistance with bacteria in the area that have not yet developed this resistance on their own.
+
+== Bacterial profiles ==
+
+=== Enterococcus faecium ===
+
+Enterococcus faecium is a Gram-positive spherically shaped (coccus) bacteria that tends to occur in pairs or chains, most commonly involved in HAI in immunocompromised patients. It often exhibits a resistance to β-lactam antibiotics including penicillin and other last resort antibiotics. There has also been a rise in vancomycin resistant enterococci (VRE) strains, including an increase in E. faecium resistance to vancomycin, particularly vancomycin-A. These vancomycin-resistant strains display a profound ability to develop and share their resistance through horizontal gene transfer, as well as code for virulence factors that control phenotypes. These virulence phenotypes range from thicker biofilms to allowing them to grow in a variety of environments including medical devices such as urinary catheters and prosthetic heart valves within the body. The thicker biofilms act as a "mechanical and biochemical shield" that protects the bacteria from the antibiotics and are the most effective protective mechanism that bacteria have against treatment.
+
+=== Staphylococcus aureus ===
+
+Staphylococcus aureus is a Gram-positive round-shaped (coccus) bacteria that is commonly found as a part of the human skin microbiota and is typically not harmful in humans with non-compromised immune systems in these environments. However, S. aureus has the ability to cause infections when it enters parts of the body that it does not typically inhabit, such as wounds. Similar to E. faecium, S. aureus can also cause infections on implanted medical devices and form biofilms that make treatment with antibiotics more difficult. Additionally, approximately 25% of S. aureus strains secrete the TSST-1 exotoxin responsible for causing toxic shock syndrome. Methicillin-resistant S. aureus, or MRSA, includes strains distinct from other strains of S. aureus in the fact that they have developed resistance to β-lactam antibiotics. Some also express an exotoxin that has been known to cause "necrotic hemorrhagic pneumonia" in those with an infection. Vancomycin and similar antibiotics are typically the first choices for treatment of MRSA infections, however from this vancomycin-resistant S. aureus, or VRSA (VISA for those with intermediate resistance) strains have emerged.
+
+=== Klebsiella pneumoniae ===
+
+Klebsiella pneumoniae is a Gram-negative rod-shaped (bacillus) bacteria that is particularly adept to accepting resistance genes in horizontal gene transfer. It is commonly also resistant to phagocyte treatment due to its thick biofilm with strong adhesion to neighboring cells. Certain strains have also developed β-lactamases that allow them to be resistant many of the commonly used antibiotics, including carbapenems, which has led to the creation of carbapenem-resistant K. pneumoniae (CRKP), for which there are very few antibiotics in development that can treat infection.
+
+=== Acinetobacter baumannii ===
+
+Acinetobacter baumannii is most common in hospitals, which has allowed for the development of resistance to all known antimicrobials. The Gram-negative short-rod-shaped (coccobacillus) A. baumannii thrives in a number of unaccommodating environments due to its tolerance to a variety of temperatures, pHs, nutrient levels, as well as dry environments. The Gram-negative aspects of the membrane surface of A. baumannii, including the efflux pump and outer membrane, affords it a wider range of antibiotic resistance. Additionally, some problematic A. baumannii strains are able to acquire families of efflux pumps from other species, and are commonly first to develop new β-lactamases to improve β-lactam resistance.
+
+=== Pseudomonas aeruginosa ===
+
+The Gram-negative, rod-shaped (bacillus) bacterium Pseudomonas aeurginosa is ubiquitous hydrocarbon degrader that is able to survive in extreme environments as well as in soil and many more common environments. Because of this versatility, it survives quite well in the lungs of patients with late-stage cystic fibrosis (CF). It also benefits from the same previously mentioned Gram-negative resistance factors as A. baumannii. Mutants of P. aeruginosa with upregulated efflux pumps also exist that make finding an effective antibiotic or detergent incredibly difficult. There are also some multi-drug resistant (MDR) strains of P. aeruginosa that express β-lactamases as well as upregulated efflux pumps which can make treatment particularly difficult.
+
+=== Enterobacter ===
+
+Enterobacter encompasses a family of Gram-negative, rod-shaped (bacillus) species of bacteria. Some strains cause urinary tract (UTI) and blood infections and are resistant to multiple drug therapies, which therefore puts the human population in critical need for the development of novel and effective antibiotic treatments. Colistin and tigecycline are two of the only antibiotics currently used for treatment, and there are seemingly no other viable antibiotics in development. In some Enterobacter species, a 5–300-fold increase in minimum inhibitory concentration was observed when exposed to several gradually increasing concentrations of benzalkonium chloride (BAC). Other Gram-negative bacteria (including Enterobacter, but also Acinetobacter, Pseudomonas, Klebsiella species, and more) also displayed a similar ability to adapt to the disinfectant BAC.
+
+== One Health problem ==
+The ESKAPE pathogens and ABR bacteria in general are an interconnected global health threat and a clear 'One Health' problem, meaning they can spread between and impact the environment, animal, and human sectors. As one of the largest global health challenges, combatting the highly resistant and opportunistic ESKAPE pathogens necessitates a One Health approach. One Health is a transdisciplinary approach that involves addressing health outcomes from a multifaceted and interdisciplinary perspective for humans, animals, and the environmental on a local, national, and global level. Using this framework and mindset is crucial to combat and prevent the spread and development of the ESKAPE pathogens (including the ABR in general) while addressing its importantly related socioeconomic factors, such as inadequate sanitation. New treatment alternatives for infections caused by ESKAPE are under current scientific research.
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Early_pregnancy_loss-0.md b/data/en.wikipedia.org/wiki/Early_pregnancy_loss-0.md
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+---
+title: "Early pregnancy loss"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Early_pregnancy_loss"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:16.369257+00:00"
+instance: "kb-cron"
+---
+
+Early pregnancy loss is a medical term that when referring to humans can variously be used to mean:
+
+Death of an embryo or fetus during the first trimester. This can happen by implantation failure, miscarriage, embryo resorption, early fetal resorption or vanishing twin syndrome.
+Death of an embryo or fetus before 20 weeks gestation, as in all pregnancy loss before it becomes considered stillbirth.
+
+
+== Causes of early pregnancy loss ==
+Pregnancy loss, in many cases, occurs for unknown reasons, often involving random chromosome issues during conception. Miscarriage is not caused by everyday activities like working, exercising, or having sex. Even falls or blows are rarely to blame. Research on the effects of alcohol, tobacco, and caffeine on miscarriage is inconclusive, so it's not something you could have prevented. It's crucial not to blame yourself for a miscarriage, as it's not the result of anything you did or didn't do.
+
+
+== Symptoms of early pregnancy loss ==
+The most prevalent indication of pregnancy loss is vaginal bleeding. In the later stages of pregnancy, a woman experiencing a stillbirth may cease to sense fetal movements. However, it's important to note that each type of pregnancy loss presents distinct symptoms, so it's essential to consult your healthcare provider for a proper diagnosis.
+
+
+== See also ==
+Pregnancy with abortive outcome
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Ebullism-0.md b/data/en.wikipedia.org/wiki/Ebullism-0.md
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+---
+title: "Ebullism"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Ebullism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:17.583213+00:00"
+instance: "kb-cron"
+---
+
+Ebullism is the formation of water vapour bubbles in bodily fluids due to reduced environmental pressure, usually at extreme high altitude.  It occurs because a system of liquid and gas at equilibrium will see a net conversion of liquid to gas as pressure lowers; for example, liquids reach their boiling points at lower temperatures when the pressure on them is lowered. The injuries and disorder caused by ebullism is also known as ebullism syndrome. Ebullism will expand the volume of the tissues, but the vapour pressure of water at temperatures in which a human can survive is not sufficient to rupture skin or most other tissues encased in skin.
+Ebullism produces predictable injuries, which may be survivable if treated soon enough, and is often accompanied by complications caused by rapid decompression, such as decompression sickness and a variety of barotrauma injuries. Persons at risk are astronauts and high altitude aviators, for whom it is an occupational hazard.
+
+== Symptoms ==
+Symptoms of ebullism include bubbles in the membranes of the mouth and eyes, swelling of the soft tissues with possible bruising, and bubbles in the blood. Blood circulation and breathing may be impaired or stopped by cardiac vapour lock. The brain tissue may be starved of oxygen because of blockage of arteries resulting in rapid loss of consciousness, and the lungs may swell and hemorrhage. Death results unless recompression is rapid enough to restore oxygenation and reduce the bubbles before excessive tissue damage occurs. Head exposure may result in freezing of the corneal surface of the eye, impairing vision.
+Other signs and symptoms of rapid decompression injury may also be present.
+
+=== Complications ===
+A decompression event leading to ebullism will cause acute anoxemia and is likely to cause other decompression injuries such as decompression sickness and possibly one or more forms of decompression barotrauma.
+
+== Causes and mechanism ==
+In the atmospheric pressure present at sea level, water boils at 100 °C (212 °F). At an altitude of 63,000 feet (19,000 m), it boils at only 37 °C (99 °F), the normal body temperature of humans.  This altitude is known as Armstrong's Line. Ebullism occurs when  unprotected humans are exposed to altitudes above the Armstrong limit where the vapor pressure of tissues is less than the ambient pressure. In practice bodily fluids do not boil off continuously at this altitude because the skin and outer organs have enough strength to withstand the internal pressure, so the pressure inside the tissues would increase to match vapour pressure. Nitrogen dissolved in the tissues may also accumulate in the vapour bubbles causing altitude decompression sickness.
+Pathophysiology of ebullism has mostly been studied in animals, including large primates, but no reasons have been found to suggest that the results should not be reasonably extrapolated to predict effects on humans. The experiments show that ebullism occurs non-uniformly at sites where conditions are most conducive to vapourisation of water and outgassing of nitrogen. Factors include temperature, hydrostatic pressure, tissue elasticity, solute concentration, and the presence of gas bubble nuclei, and which can cause vapour bubbles to form at pressures slightly above the theoretical ambient pressure of 47 millimetres of mercury (63 mbar) in some places such as the pleural cavity, where the pressure can drop below ambient, and large central veins where hydrostatic pressure is minimum and blood temperature is at a maximum.
+
+== Diagnosis ==
+Ebullism occurs as a consequence of exposure to ambient pressures below about 47 millimetres of mercury (63 mbar). At higher pressures similar symptoms are likely to be caused by decompression sickness and some forms of barotrauma.
+
+== Prevention ==
+To prevent ebullism, the tissues must be kept under sufficient pressure that vaporisation of the aqueous constituents is not possible in the range of temperature those tissues may experience.
+An effective strategy for preventing ebullism would include multiple redundant levels of protection against decompression, and systems allowing non-catastrophic failure with sufficient time of useful consciousness to take effective countermeasures. Several mitigating strategies have associated hazards of their own. A high concentration of oxygen in the breathing gas reduces the severity of decompression sickness complications and may increase the duration of useful consciousness, but at the same time increases fire hazard. A low initial pressure reduces decompression rate and severity in a catastrophic decompression, which reduces the risk of barotrauma but gives a lower margin of safety in a slow decompression, and can increase the risk of decompression sickness. Outside of a pressurised cabin environment, a pressure suit is the usual protective measure, and is the definitive protection in decompression to vacuum, but they are expensive, heavy, bulky, restrict mobility, cause thermal regulatory problems, and reduce comfort.
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+---
+title: "Ebullism"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Ebullism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:17.583213+00:00"
+instance: "kb-cron"
+---
+
+== Treatment and outcomes ==
+Ebullism produces secondary tissue damage which, when extensive, has generally been considered fatal due to limited availability of treatment options on site. Immediate recompression to a pressure at minimum  pressure for effective oxygenation is necessary for survival in whole-body exposure, along with re-oxygenation. Continued or additional pressurisation where necessary to prevent or treat decompression sickness is also indicated. 
+High-frequency percussive ventilation is recommended by Murray et al (2013) for respiratory support as atelectasis is likely. 
+Initial field evaluation would be
+similar to trauma assessment. It may be necessary to remove a pressure suit to give access for primary and secondary surveys. Airway, breathing, and circulation are immediate priorities, followed by assessment of level of consciousness. Intubation is indicated if unconscious and deteriorating.
+If a pulse cannot be distinguished, and the person is unresponsive, cardiopulmonary resuscitation should be started immediately, with advanced cardiac life support and cardiovascular monitoring as soon as possible.
+Little information is available on the effectiveness of conventional treatment, such as hyperbaric oxygen, or adjunctive therapies, for injuries due to ebullism. Spontaneous recovery has occurred in cases where recompression was applied with minimal delay, or the damage was restricted to parts of the limbs. Other examples were fatal.
+The time needed for recovery will depend on the severity of injury, which is largely dependent on severity and duration of exposure. The main predictor of survival is the establishment of sufficient circulation and breathing.
+
+== Epidemiology ==
+Ebullism risk is associated with spaceflight, particularly EVA accidents, rapid decompression of aircraft at very high altitudes, and pressure suit failure during flight and training exercises.
+
+=== History ===
+In 1960, Joseph Kittinger experienced localised ebullism during a 31 kilometres (19 mi) ascent in a helium-supported gondola. His right-hand glove failed to pressurise and his hand expanded to roughly twice its normal volume accompanied by disabling pain. His hand took about three hours to recover after his return to the ground.
+Tissue samples from the remains of the crew of Space Shuttle STS-107 Columbia revealed evidence of ebullism. Given the level of tissue damage, the crew could not have regained consciousness even with re-pressurization.
+
+== Etymology ==
+The term "space ebullism" was introduced by Captain Julian E. Ward in his paper "The True Nature of the Boiling of Body Fluids in Space", published in Aviation Medicine in October 1956.  It was suggested "because the word ebullism does not connote the addition of heat to produce vapor." It comes from the Latin ebullire, meaning "to bubble out, or to boil up."
+
+== See also ==
+Decompression sickness – Disorder caused by dissolved gases forming bubbles in tissues
+Effect of spaceflight on the human body – Medical issues associated with spaceflight
+High altitude breathing apparatus – Equipment which allows the user to breathe at hypoxic altitudesPages displaying short descriptions of redirect targets
+Pressure suit – Protective suit worn in low-pressure environments
+Space suit – Garment worn to protect a human in space
+Uncontrolled decompression – Unplanned drop in the pressure of a sealed system
+Armstrong limit – Altitude above which water boils at body temperature
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Economic_credentialing-0.md b/data/en.wikipedia.org/wiki/Economic_credentialing-0.md
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+---
+title: "Economic credentialing"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Economic_credentialing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:18.753617+00:00"
+instance: "kb-cron"
+---
+
+Economic credentialing is a term of disapproval used by the American Medical Association (AMA). The association defines the term as "the use of economic criteria unrelated to quality of care or professional competence in determining a physician's qualifications for initial or continuing hospital medical staff membership or privileges."
+Traditionally, physicians applied for hospital staff membership based on education, medical licensure and a record of quality care.  Privileges are requests to perform certain procedures or use certain skills based on training and experience.  For example, an obstetrician and a family practitioner might request privileges for both routine deliveries and caesarean sections. Typically an obstetrician could demonstrate enough experience and be granted those privileges.  The FP might obtain both procedures or be restricted to routine deliveries only, or none at all, based on hospital policy.
+As medical costs have increased and reimbursement has declined or been stagnant, both hospitals and physicians have come under increasing financial pressure.  One response by physicians has been the formation of specialty hospitals or diagnostic centers with physician ownership.  Some hospitals have seen this as a threat to their economic interests and have denied or revoked membership and privileges of the physician owners.
+
+
+== External links ==
+AMA statement on economic credentialing
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diff --git a/data/en.wikipedia.org/wiki/Efficacy-0.md b/data/en.wikipedia.org/wiki/Efficacy-0.md
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+---
+title: "Efficacy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Efficacy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:19.923293+00:00"
+instance: "kb-cron"
+---
+
+Efficacy is the ability to perform a task to a satisfactory or expected degree. The word comes from the same roots as effectiveness, and it has often been used synonymously, although in pharmacology a distinction is now often made between efficacy and effectiveness.
+The word efficacy is used in pharmacology and medicine to refer both to the maximum response achievable from a pharmaceutical drug in research settings, and to the capacity for sufficient therapeutic effect or beneficial change in clinical settings.
+
+
+== Pharmacology ==
+
+In pharmacology, efficacy (Emax) is the maximum response achievable from an applied or dosed agent, for instance, a small molecule drug. Intrinsic activity is a relative term for a drug's efficacy relative to a drug with the highest observed efficacy. It is a purely descriptive term that has little or no mechanistic interpretation.
+In order for a drug to have an effect, it needs to bind to its target, and then to affect the function of this target. The target of a drug is commonly referred to as a receptor, but can in general be any chemically sensitive site on any molecule found in the body. The nature of such binding can be quantified by characterising how tightly these molecules, the drug and its receptor, interact: this is known as the affinity. Efficacy, on the other hand, is a measure of the action of a drug once binding has occurred. The maximum response, Emax, will be reduced if efficacy is sufficiently low.
+The definition of efficacy has been object for discussion. The only way in which absolute measures of efficacy have been obtained is by single ion channel analysis of ligand gated ion channels. It is still not possible to do this for G protein-linked receptors.
+In the case of the glycine receptor and the nicotinic acetylcholine receptor (muscle type), it has been proposed by Sivilotti et al. that opening of the ion channel involves two steps after agonist is bound. Firstly a conformation change to a higher affinity (but still shut) form, followed by the conformation change from shut to open. It was found that partial agonism results from deficiency in the first step, and that the opening and shutting steps are essentially the same for both full and partial agonists. This has been confirmed and extended by Sine and colleagues (2009). The implication of this work is that efficacy has to be defined by at least two equilibrium constants (or, more generally, by four rate constants).
+The combined influences of affinity and efficacy determine how effectively a drug will produce a biological effect, a property known as potency.
+
+
+== Medicine ==
+In medicine, efficacy is the capacity for beneficial change (or therapeutic effect) of a given intervention (for example a drug, medical device, surgical procedure, or a public health intervention). Establishment of the efficacy of an intervention is often done relative to other available interventions, with which it will be compared. Specifically, efficacy refers to "whether a drug demonstrates a health benefit over a placebo or other intervention when tested in an ideal situation, such as a tightly controlled clinical trial." These studies focus on a primary parameter to be shown statistically different between placebo and intervention groups. Comparisons of this type are called 'explanatory' randomized controlled trials, whereas 'pragmatic' trials are used to establish the effectiveness of an intervention regarding also non-specific parameters.
+Effectiveness refers to "how the drug works in a real-world situation", and is "often lower than efficacy because of interactions with other medications or health conditions of the patient, sufficient dose or duration of use not prescribed by the physician or followed by the patient, or use for an off-label condition that had not been tested."
+
+
+== Agriculture ==
+In agriculture and forestry, efficacy is used to describe whether a pesticide is effective in controlling a pest or disease.
+
+
+== Theology ==
+
+
+=== Scripture ===
+In Protestant Theology (esp. in Lutheran but also in Calvinist doctrine) efficacy is an attribute of Scripture. The efficacy of Scripture means that it is united with the power of the Holy Spirit and with it, not only demands, but also creates the acceptance of its teaching and that this teaching produces faith and obedience. Efficacy further means that Holy Scripture is not a dead letter, but rather, the power of the Holy Spirit is inherent in it and that Scripture does not compel a mere intellectual assent to its doctrine, resting on logical argumentation, but rather it creates the living agreement of faith. The Smalcald Articles affirm, "in those things which concern the spoken, outward Word, we must firmly hold that God grants His Spirit or grace to no one, except through or with the preceding outward Word." The Formula of Concord teaches that when humans reject the calling of the Holy Spirit, it is not a result of the Word being less efficacious. Instead, contempt for the means of grace is the result of "the perverse will of man, which rejects or perverts the means and instrument of the Holy Ghost, which God offers him through the call, and resists the Holy Ghost, who wishes to be efficacious, and works through the Word..."
+
+
+=== Prayer ===
+
+
+== See also ==
+Average treatment effect
+Efficiency (disambiguation)
+Placebo (origins of technical term)
+Potency (pharmacology)
+Pragmatic clinical trial
+Self-efficacy
+Vaccine efficacy
+
+
+== References ==
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+---
+title: "Elective surgery"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Elective_surgery"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:21.091015+00:00"
+instance: "kb-cron"
+---
+
+Elective surgery or elective procedure is surgery that is scheduled in advance because it does not involve a medical emergency.  Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately. Most surgeries are elective, scheduled at a time to suit the surgeon, hospital, and patient.
+By contrast, an urgent surgery is one that can wait until the patient is medically stable, but should generally be done within 2 days, and an emergency surgery is one that must be performed without delay; the patient has no choice other than immediate surgery if permanent disability or death is to be avoided. Many surgeries can be performed as either elective or emergency surgeries, depending on the patient's needs.
+
+
+== Description ==
+An elective surgery or elective procedure (from the Latin: eligere, meaning to choose) is a surgery that does not involve a medical emergency and is scheduled in advance. Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately.
+
+
+== Types ==
+
+
+=== Elective ===
+Most surgical medical treatments are elective, that is, scheduled at a time to suit the surgeon, hospital, and patient. These include inguinal hernia surgery, cataract surgery, mastectomy for breast cancer, and the donation of a kidney by a living donor.
+Elective surgeries include all optional surgeries performed for non-medical reasons. This includes cosmetic surgery, such as facelifts, breast implants, liposuction, and breast reduction, which aim to subjectively improve a patient's physical appearance. Another optional surgery is LASIK—currently the top elective surgery in the United States—where a patient weighs the risks against increased quality of life expectations.
+
+
+=== Semi-elective ===
+
+Urgent surgery refers to procedures that must be performed within hours due to potentially life- or organ-threatening conditions.   Semi-elective procedures are typically scheduled within a time frame deemed appropriate for the patient's condition and disease.  Removal of a malignancy, for example, is usually scheduled as semi-elective surgery, to be performed within a set number of days or weeks. 
+
+
+== Urgency ==
+
+In a patient with multiple medical conditions, problems classified as needing semi-elective surgeries may be postponed until emergent conditions have been addressed and the patient is medically stable.  For example, whenever possible, pregnant women typically postpone all elective and semi-elective procedures until after giving birth.
+In some situations, an urgently needed surgery will be postponed briefly to permit even more urgent conditions to be addressed. In other situations, emergency surgery may be performed at the same time as life-saving resuscitation efforts.
+Many surgeries can be performed as either elective or emergency surgeries, depending on the patient's needs. A sudden worsening of gallbladder disease may require immediate removal of the gallbladder by emergency surgery, but this surgery is more commonly scheduled in advance. An appendectomy is considered emergency surgery, but depending upon how early the diagnosis was made, the patient may have more time before the appendix risks rupturing or the infection spreads. Also, in certain emergency conditions, even ones like a heart attack or stroke, surgery may or may not need to be utilized.
+
+
+=== Economic Impact of Waiting Times ===
+Economic modelling studies have shown that reducing waiting times for elective surgeries improves patient health outcomes and can be cost-effective or even cost-saving. A systematic review of economic evaluations from high-income countries, including Canada, France, Australia, Spain, and the United States, found that shorter wait times for joint replacement, cataract surgery, bariatric surgery, and transcatheter aortic valve implantation (TAVI) often resulted in lower long-term healthcare costs and better quality-adjusted life years (QALYs). For instance, immediate total knee arthroplasty was associated with savings of over $1,800 and a gain of 0.57 QALYs compared to a two-year delay, while earlier bariatric surgery significantly reduced diabetes and hypertension management costs over a ten-year horizon.
+A related review focusing on low- and middle-income countries, specifically Egypt, found that prolonged waiting times are associated with delayed return to work, increased caregiver burden, and greater societal costs, particularly in public healthcare systems with constrained capacity. Investment in early surgical intervention was shown to relieve pressure on health systems, improve population health, and increase economic productivity in resource-limited settings.
+
+
+== Best practices ==
+Preoperative carbohydrates may decrease amount of time spent in hospital recovering.
+
+
+== Non-elective surgery ==
+Non-elective surgeries may be classified as urgent or emergency. An urgent surgery is one that can wait until the patient is medically stable, but should generally be done within 2 days. An emergency surgery is one that must be performed without delay; the patient has no choice other than immediate surgery if permanent disability or death is to be avoided. Urgent surgery is typically performed with 48 hours of diagnosis and emergency surgery is performed as soon as a surgeon is available.  A trauma center is a hospital which supports emergency surgery on critically ill patients at the brink of death by ensuring that on a 24/7 basis, a surgeon is always on the premises (or "in-house") to evaluate patients and can take them immediately to the operating room.
+
+
+== References ==
+
+
+== Bibliography ==
+C. Parchment-Smith (2006). Essential Revision Notes for Intercollegiate MRCS: Bk. 1. Knutsford, Cheshire, UK: PasTest, LLC. p. 439. ISBN 1-904627-36-6.
+
+
+== External links ==
+Surgical risk calculator from American College of Surgeons
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+---
+title: "Electronic prescribing"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Electronic_prescribing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:22.279053+00:00"
+instance: "kb-cron"
+---
+
+Electronic prescription (e-prescribing or e-Rx) is the computer-based electronic generation, transmission, and filling of a medical prescription, taking the place of paper and faxed prescriptions. E-prescribing allows a physician, physician assistant, pharmacist, or nurse practitioner to use digital prescription software to electronically transmit a new prescription or renewal authorization to a community or mail-order pharmacy. It outlines the ability to send error-free, accurate, and understandable prescriptions electronically from the healthcare provider to the pharmacy. E-prescribing is meant to reduce the risks associated with traditional prescription script writing. It is also one of the major reasons for the push for electronic medical records. By sharing medical prescription information, e-prescribing seeks to connect the patient's team of healthcare providers to facilitate knowledgeable decision making.
+
+== Functions ==
+An e-prescribing system used in the United States must be capable of performing all of the following functions:
+
+Patient's identification
+Generating a complete active medication list, possibly incorporating electronic data received from an insurance provider
+Access to patient historical data
+Prescribe or add new medication and select the pharmacy where the prescription will be filled.
+Work with an existing medication within the practice, this can involve viewing details of a medication, remove a medication from the active medication list, change dose, etc., for a medication or renew one or more medications
+Printing prescriptions
+Electronically transmitting prescriptions to a transaction hub
+Conducting all safety checks using an integrated decision support system, known as a Drug Utilization Review.  Safety checks include: automated prompts that offer information on the drug being prescribed, potential inappropriate dose or route of administration, drug-drug interactions, allergy concerns, or warnings of caution
+Flagging availability of lower cost, therapeutically appropriate alternatives (if any)
+Providing information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's insurance provider
+System integration capabilities (e.g., connection with various databases, connection with pharmacy and pharmacy benefit manager systems)
+Educational capabilities (e.g., patient education, provider feedback)
+
+== Model ==
+
+The basic components of an electronic prescribing system are the:
+
+Prescriber - typically a physician
+Transaction hub
+Pharmacy with implemented electronic prescribing software
+Pharmacy Benefit Manager (PBM)
+The PBM and transaction hub work closely together. The PBM works as an intermediate actor to ensure the accuracy of information, although other models may not include this to streamline the communication process.
+In addition to pharmacies, medical tests can also be prescribed.
+
+=== Prescriber ===
+The prescriber, generally a clinician or healthcare staff, is defined as the electronic prescribing system user and sign into the system through a verification process to authenticate their identity.
+The prescriber searches through the database of patient records by using patient-specific information such as first and last name, date of birth, current address etc. Once the correct patient file has been accessed, the prescriber reviews the current medical information and uploads or updates new prescription information to the medical file.
+
+=== Transaction hub ===
+The transaction hub provides the common link between all actors (prescriber, pharmacy benefit manager, and pharmacy). It stores and maintains a master patient index for quick access to their medical information as well as a list of pharmacies.
+When the prescriber uploads new prescription information to the patient file, this is sent to the transaction hub. The transaction hub will verify against the patient index. This will automatically send information about this transaction to the PBM, who will respond to the hub with information on patient eligibility, formulary, and medication history back to the transaction hub. The transaction hub then sends this information to the prescriber to improve patient management and care by completing and authorizing the prescription. Upon which, the prescription information is sent to the pharmacy that the patient primarily goes to.
+
+=== Pharmacy ===
+When a pharmacy receives the prescription information from the transaction hub, it will send a confirmation message. The pharmacy also has the ability to communicate to the prescriber that the prescription order has been filled through the system. Further system development will soon allow different messages such as a patient not picking up their medication or is late to pick up medication to improve patient management.
+
+=== Imaging ===
+When an imaging center receives the prescription, the imaging center will then contact the patient and schedule the patient for his/her scan.  The advantage of e-prescribing radiology is that often when a patient is handed a paper script, the patient will lose the prescription or wait to call and schedule.  This can be disastrous for patients with severe underlying conditions.  The imaging center will call and schedule the patient as soon as the referral arrives.  There are mobile ePrescribing portals as well as web portals that handle this well, and there are advantages.
+
+== Benefits ==
+Compared to paper-based prescribing, e-prescribing can improve health and reduce costs because it can:
+
+Reduce prescribing and dispensing errors
+Decrease the work needed to execute a prescription
+Speed receipt of prescribed drugs
+Avoid more adverse drug interactions and reactions
+More reliably offer to substitute less expensive drug alternatives by checking the formulary of the insurance provider in the doctor's office
+Improve medication compliance (taking the prescribed medications on time) by reducing lost and unfilled prescriptions and minimizing patient costs
+Reduce the incidence of drug diversion (drug abuse) by alerting providers and pharmacists of duplicative prescriptions for controlled substances.
+Safety improvements are highly desirable; in 2000, the Institute of Medicine identified medication errors as the most common type of medical error in health care, estimating that this leads to several thousand deaths each year.
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+---
+title: "Electronic prescribing"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Electronic_prescribing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:22.279053+00:00"
+instance: "kb-cron"
+---
+
+=== Improving patient safety and quality of care ===
+Illegibility from handwritten prescriptions is eliminated, decreasing the risk of medication errors while simultaneously decreasing risks related to liability.  Oral miscommunications regarding prescriptions can be reduced, as e-prescribing should decrease the need for phone calls between prescribers and dispensers.  Causes of medication errors include mistakes by the pharmacist incorrectly interpreting illegible handwriting or ambiguous nomenclature, and lapses in the prescriber's knowledge of desired dosage of a drug or undesired interactions between multiple drugs. Electronic prescribing has the potential to eliminate most of these types of errors. Warning and alert systems are provided at the point of care. E-prescribing systems can enhance an overall medication management process through clinical decision support systems that can perform checks against the patient's current medications for drug-drug interactions, drug-allergy interactions, diagnoses, body weight, age, drug appropriateness, and correct dosing.  Based on these algorithms, the system can alert prescribers to contradictions, adverse reactions, and duplicate therapies.  The computer can also ensure that clear and unambiguous instructions are encoded in a structured message to the pharmacist, and decision support systems can flag lethal dosages and lethal combinations of drugs.  E-prescribing allows for increased access to the patient's medical records and their medication history. Having access to this information from all health care providers at the time of prescribing can support alerts related to drug inappropriateness, in combination with other medications or with specific medical issues at hand.  Electronic prescribing has been shown to reduce prescribing errors by up to 30%.
+
+=== Saving clinicians time ===
+According to estimates, almost 30 percent of prescriptions require pharmacy callbacks. This translates into less time available to the pharmacist for other important functions, such as educating consumers about their medications.  In response, E-prescribing can significantly reduce the volume of pharmacy call-backs related to illegibility, mistaken prescription choices, formulary and pharmacy benefits, decreasing the amount of time wasted on the phone.  This ultimately impacts office workflow efficiency and overall productivity in a positive manner.
+Both prescribers and pharmacists can save time and resources spent on faxing prescriptions through a reduction in labor costs, handling costs, and paper expenses waste due to unreliability.
+With e-prescribing, renewal authorization can be an automated process that provides efficiencies for both the prescriber and pharmacist.  Pharmacy staff can generate a renewal request (authorization request) that is delivered through the electronic network to the prescriber's system.  The prescriber can then review the request and act accordingly by approving or denying the request through updating the system.  With limited resource utilization and just a few clicks on behalf of the prescriber, they can complete a medication renewal task while enhancing continuous patient documentation.
+
+=== Increasing patient convenience and medication compliance ===
+It is estimated that 20% of paper-based prescription orders go unfilled by the patient, partly due to the hassle of dropping off a paper prescription and waiting for it to be filled.  By elimination or reducing this waiting period, e-prescribing may help reduce the number of unfilled prescriptions and hence, increasing medication adherence.  Allowing the renewal of medications through this electronic system also helps improve the efficiency of this process, reducing obstacles that may result in less patient compliance.  Availability of information on when patient's prescriptions are filled can also help clinicians assess patient adherence.
+
+=== Allowing greater prescriber mobility ===
+Improved prescriber convenience can be achieved when using mobile devices, that work on a wireless network, to write and renew prescriptions.  Such mobile devices may include laptops, PDAs, tablet computers, or mobile phones.  This freedom of mobility allows prescribers to write/renew prescriptions anywhere, even when not in the office.
+
+=== Improving drug surveillance/recall ability ===
+E-prescribing systems enable embedded, automated analytic tools to produce queries and reports, which would be close to impossible with a paper-based system.  Common examples of such reporting would be: finding all patients with a particular prescription during a drug recall, or the frequency and types of medication provided by certain health care providers.
+
+== Limitations ==
+Although e-prescribing has the ability to streamline workflow process and increase the system's efficiency, challenges and limitations that may hinder the widespread adoption of e-prescribing practices include:
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+---
+title: "Electronic prescribing"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Electronic_prescribing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:22.279053+00:00"
+instance: "kb-cron"
+---
+
+Financial Cost and Return on Investment (ROI) - The costs associated with purchasing, implementing, supporting and maintaining such a system may be beyond the means of most small clinical practices, and noted to be one of the greatest implementation barriers.  Health care workers who are responsible for medical prescription, especially those in small practices, inner-city areas, or remote rural settings, may bear more than their fair share of the cost associated with e-prescribing.  This is in response to the various other stakeholders that may reap the benefits from such a system, without having to financially support it, disseminating their risk substantially.  Clinical practices therefore need to invest significantly in both hardware and software, with varying costs based on system specifications (stand alone system or entire EHR system).  Even clinics that receive free e-prescribing systems may face financial costs pertaining to management of the interface, customization due to flexibility, training, maintenance, and upgrades. On top of this, the clinic must also take into consideration the lost time and efficiency during the transition period of implementation. As a result, large urban areas may see the greatest ROI when compared to those in rural areas.
+Change management - Many underestimate the challenges pertaining to change management when transitioning from paper-based prescriptions to e-prescribing.  This is especially true in busy practices where healthcare providers and associated staff are accustomed to their current management system, in which case change management becomes extremely important.  Potentially difficult and time-consuming analysis may be needed to understand how to change workflow around the management of prescriptions with the introduction of an electronic system. The change also requires pharmacists to increase their awareness of new types of errors associated with e-prescribing, in order to best target their activities to reduce clinical risk. As a result, steps must be taken to ensure effective planning, training, support, and continuous quality improvement for successful transition.
+Hardware and software selection - Choosing the right hardware platform and software applications can be a rather daunting task for practices, especially in regards to small and busy settings.  Many have limited access to expert information technology personnel/staff, leading them to struggle with how to get started, appropriate vendor selection, cost and function negotiations, and most importantly, long-term support to ensure continuous functionality and meaningful use.
+Erroneous alerts - The inability to effectively use clinical decision support systems due to the erroneous triggering of pop-up alerts with ill-defined software is also a great limitation.  Under such circumstances, many opt to turn the notifications off, disabling one of the system's most beneficial aspects.
+Integrity of data input - Accidental data entry errors such as selecting the wrong patient or clicking on the wrong choice in a menu of dosages may occur. Software vendors can reduce errors by continually reviewing user feedback and follow best practices in user interface design.
+Security and privacy - As with many eHealth solutions, privacy of patient information stored in electronic format may lead to the possibility of novel errors, such as inadvertently divulging protected health information on the Internet through inadequate security practices. Instances of negligence may also arise, where employees may forward prescriptions to organizations outside its intended use.  Another security issue that needs to be addressed up front is the verification of electronic signatures, in ensuring the medical integrity of the prescriptions received by pharmacists.  Hospitals, clinics, and pharmacies are counselled to be protected with firewalls, use strict computer permission settings, and remain vigilant toward signs of an intrusion.
+System downtime - Periods of system downtime may arise, either due to network-related issues, hardware failure, or loss of electricity.  The inability to use electronic prescribing when the system is not accessible is of great concern, and must be addressed with the discussion of fall-back procedures and mechanisms when such situations arise.
+Patient Access Lost - In the event of a development beyond the control of the patient, such as a software malfunction in the health care provider's office, the patient can no longer ask the care provider for a paper prescription to take to a pharmacy (in New York, where e-prescribing is mandatory with exceptions; other states to follow suit) in order to obtain needed medicines. States such as New York, Connecticut, Maine and Pennsylvania do however, allow a prescriber to issue paper prescriptions in cases of temporary technological or electronic failure. This leaves the patient at the mercy of technicians or other undiscoverable workers.
+
+== By country ==
+
+=== Australia ===
+The vast majority of community medical prescriptions in Australia continue to be delivered on paper, either in printed or hand-written format. Electronic prescription in Australia is currently provided by two service providers, MediSecure and eRx. Both services can be integrated into many of the existing clinical and pharmacy prescribing software systems. Since December 1991, they have become interoperable allowing bilateral transfer of information.
+
+=== Bangladesh ===
+Private companies started working with electronic prescriptions. On 2017 July easypres.com launched Bangladesh's first cloud-based electronic prescription and patient management software for Doctors in Bangladesh. Within a year, more than a thousand doctors registered for the software out of 83 thousand registered MBBS doctors in Bangladesh for this Digital prescription writing software. High court of Bangladesh issued a rule that doctors need to write the prescription in readable format meaning they need to use software of ALL caps later while writing prescription. This software also stores the medical history of patients and doctors can access these data easily from anywhere using the Internet.
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+---
+title: "Electronic prescribing"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Electronic_prescribing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:22.279053+00:00"
+instance: "kb-cron"
+---
+
+=== Canada ===
+On March 22, 2016, the Government of Canada allocated funds to Canada Health Infoway to develop an e-prescribing service. Infoway is working with Health Canada, the provinces and territories and industry stakeholders to create PrescribeIT, a multi-jurisdiction e-prescribing service. Infoway will create, operate and maintain the service, along with its partners. The service will be financially self-sustaining and is designed to be scaled across the country and will enable prescribers to electronically transmit a prescription to a patient's pharmacy of choice. Physicians, physician assistants, nurse practitioners and other prescribers will be able to use the system either through their existing electronic medical record or through a standalone application. Health Canada included supporting better prescribing practices, including e-prescribing, as part of its Action on Opioid Misuse plan.
+Until recently in Canada, it was the position of Health Canada that, to allow for e-prescribing, amendments to Part C of the Food and Drugs Regulations made under the Food and Drugs Act, regulations made under the Controlled Drugs and Substances Act and possibly regulations made under Personal Information Protection and Electronic Documents Act would be required. After further review, Health Canada has concluded that there are currently no regulatory impediments to moving ahead with electronically generated and transmitted prescriptions and that these are permissible to the extent that they achieve the same objectives as written prescriptions. Provinces and territories wishing to proceed with e-prescribing are obligated to ensure that electronic prescriptions meet existing regulatory requirements and achieve the same objectives as written prescriptions. For example, there must be evidence of a genuine practitioner/patient relationship, and in the case of controlled substances, pharmacists filling prescriptions must verify prescriptions are signed by the practitioner before selling or providing drugs containing controlled substances to a patient. Health Canada has collaborated with Canada Health Infoway on the development of a technical document entitled Ensuring the Authenticity of Electronic Prescriptions, in order to provide advice about how to ensure the authenticity of electronic signatures.
+
+=== Czech Republic ===
+The Czech healthcare system is moving towards a mandatory electronic prescribing system to take effect in 2020.  Patients and clinicians will have access to the prescribing records. Codes and names of medications are allocated by the State Institute for Drug Control.
+
+=== Estonia ===
+Electronic prescriptions were introduced in Estonia in January 2010. By mid-2013, 95% of all prescriptions, and by 2014, 99% of the presciptions in the country were being issued electronically.
+e-Prescription, is a centralized paperless system for issuing and handling medical prescriptions. When a doctor prescribes medicine using the system, he or she does so electronically, with the aid of an online form. At the pharmacy, all a patient needs to do is present an ID-card. The pharmacist then retrieves the patient's information from the system and issues the medicine. Because the e-Prescription system draws on data from the national health insurance fund, any state medical subsidies that the patient is entitled to, also appear, and the medicine is discounted accordingly. Another major advantage of the system is that doctor visits are no longer needed for repeat prescriptions. A patient can contact the doctor by e-mail, Skype or phone, and the doctors can issue repeats with just a few clicks, and the patient can collect the medicine from their closest pharmacy. 99% of all prescriptions in the country are issued electronically. This frees up time for patients and doctors, and reduces administrative strain on hospitals.
+
+=== Europe ===
+
+The use of electronic prescription has been designated as an important strategic policy to improve health care in Europe. The aim of the European Union is to have a cross-border electronic healthcare system in Europe which will enable EU citizens to obtain e-Prescriptions anywhere in Europe. The Scandinavian countries are leading Europe in deploying e-Prescription. Other countries which use the prescription process routinely are Norway, Denmark, Finland, Sweden, Belgium, the Netherlands, Italy, Iceland, Greece, England, Scotland, Wales and Northern Ireland.
+The European Union is pushing for more cross border health data exchange. Multiple perceived barriers impede its incorporation in clinical practice. There are varying interpretations and implementations of data protection and confidentiality laws in the 27 member states. Infrastructures are not in place to support the system and stakeholders in some jurisdictions are reluctant to embrace e-health due to the high cost and the lack of security of the systems. Interoperability of different systems is only a partial solution. Security and enforcement of privacy must also be equally enforced.
+
+=== India ===
+In India some private hospitals started using electronic prescription. But a major step was taken by government of West Bengal in August 2014 when they started the process of issuing e-prescriptions instead of hand-written instructions in top government hospitals.
+The biggest advantage of the system is that a patient has all his medical data stored in the server of state health department which can be referred to in future.
+In the private sector, a number of companies have started initiatives to build software to support e-prescriptions.
+
+=== Russia ===
+With the development and implementation of electronic technologies in Russian healthcare system, electronic prescription became part of the project called EMIAS. EMIAS is the digital system designed to increase the quality and access of the medical aid in the public health facility. The project was designed and being implemented as part of «Digital city» program in execution of the Moscow Government's order from April 7, 2014 (as Moscow government amended on 21.05.2013 No. 22-PP). 
+The system offers special portal Emias.Info, that provides appointment service to the patients and client area with different services including e-Prescription. Government social program allows getting pharmaceutical products for free or with the discount, depending on the category of the citizen.
+
+=== United Kingdom ===
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+++ b/data/en.wikipedia.org/wiki/Electronic_prescribing-4.md
@@ -0,0 +1,43 @@
+---
+title: "Electronic prescribing"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Electronic_prescribing"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:22.279053+00:00"
+instance: "kb-cron"
+---
+
+About 420 million repeat prescriptions are generated in the UK each year - about 200 for each general practitioner each week. They account for about 80% of the cost of medication in primary care. Paper based Repeat Dispensing Services were introduced by the NHS in 1991, and in 1992 it became possible to use the NHS Electronic Prescription Service for this purpose. In 2017 awareness of the scheme among patients was low.
+In October 2017 Keith McNeil, NHS England's chief clinical information officer demanded that NHS hospitals should be moved rapidly onto electronic prescribing in the light of research showing it would cut serious prescribing errors by more than half.  There was no information about the extent to which it is happening in hospitals.
+After successful pilots in London and the East Midlands it was agreed in April 2018 that electronic prescribing should be introduced in all urgent care settings in England, including NHS 111 and other Out-of-hours services so that dispensed medication can be ready for collection at a pharmacy when patients arrive. £78 million was allocated in December 2018 to encourage progress with implementing electronic prescribing in NHS organisations which were struggling.
+Electronic prescribing is to start in English hospitals in the summer of 2022, using the IC24 system which was piloted at Midlands Partnership NHS Foundation Trust from 2020.
+
+=== United States ===
+In the United States, the HITECH Act promotes adoption of this technology by defining e-prescribing as one meaningful use of an electronic medical record. Standards for transmitting, recording, and describing prescriptions have been developed by the National Council for Prescription Drug Programs, in particular the SCRIPT standard, which describes data formats.  Elsewhere in the world, health care systems have been slower to adopt e-prescribing standards.
+Adoption of e-prescribing technology has accelerated in the United States, in large part, due to the arrival of Stage 2 of meaningful use. One of the Stage 2 core measures is: "Generate and transmit permissible prescriptions electronically (e-Rx.)" In order to meet this measure, practices must prescribe and transmit at least 50 percent of permissible prescriptions electronically.
+
+==== Surescripts ====
+According to data released in May 1991 by Surescripts, a company which operates the nation's largest health information (e-prescribing) network, roughly 317,000 office-based physicians now e-prescribe in the United States.
+A more recent report released by the Office of the National Coordinator for Health IT in June 2012 finds that 48 percent of U.S. physicians use e-prescribing systems. National growth in e-prescribing over the period September 2008 through June 2012 increased over 40 percent, with individual states increasing adoption anywhere from 28 percent to 70 percent.  In 2019, the Federal Trade Commission sued Surescripts, alleging that the company employed unlawful restraints in order to maintain its monopolies over electronic prescribing.
+
+=== Ukraine ===
+Starting from April 2019, ePrescription is one of the key components of the reimbursement system in Ukraine. The e-prescription module integrates all primary care physicians (over 23,000 doctors) and almost 50% of pharmacies across the country.
+While the launch of e-prescription was done quickly, the quality was not compromised. The development of the tool was completed according to international standards as well as HL7 FHIR medical data requirements. Ukrainian eHealth system is a two layer system with central core component developed as storage of dictionaries and rules and private IT-companies who offers e-prescription's functionality through interfaces of the doctors and pharmacists. The e-prescription code is open and available.
+As a next step of expansion of eRx functions in Ukraine, Ministry of Health of Ukraine develop the technical requirement for substitution of old-fashioned paper-based prescriptions with digital eRx for all applicable medicines.
+
+== Research ==
+
+=== Prescription errors ===
+A study in the UK tested the Salford Medication Safety Dashboard (SMASH), a web application to help GPs and pharmacists find people in their electronic health records who might face safety hazards due to prescription errors. The dashboard was successfully used in identifying and helping patients with already registered unsafe prescriptions and later it helped monitoring new cases as they appeared.
+
+== See also ==
+Electronic Prescriptions for Controlled Substances
+XML
+Data theft
+Medical privacy
+
+== References ==
+
+== Further reading ==
+Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano; Tarquini, Paola; Donzelli, Paolo; Pinciroli, Francesco (2013). "A Comprehensive e-Prescribing Model to Allow Representing, Comparing, and Analyzing Available Systems". Methods of Information in Medicine. 52 (3): 199–219. doi:10.3414/ME12-01-0069. PMID 23591784. S2CID 21778456.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Electronic_visit_verification-0.md b/data/en.wikipedia.org/wiki/Electronic_visit_verification-0.md
new file mode 100644
index 000000000..1db067875
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Electronic_visit_verification-0.md
@@ -0,0 +1,38 @@
+---
+title: "Electronic visit verification"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Electronic_visit_verification"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:23.527598+00:00"
+instance: "kb-cron"
+---
+
+Electronic visit verification (EVV) is a method used in the United States to verify home healthcare visits to ensure patients are not neglected and to cut down on fraudulently documented home visits. Beginning January 1, 2020, home care agencies that provide personal care services must have an EVV solution in place or risk having their Medicaid claims denied, under a mandate included in the 21st Century Cures Act.
+While the federal mandate sets key data points that must be collected and electronically verified, states create their own systems. State governments decide how to gather and report data that EVV vendors use, and whether to include additional EVV compliance rules. 
+
+
+== History ==
+
+Electronic visit verification was created to help cut down on fraud and ensure that people receive the documented care they need. EVV was designed to help verify that services billed for home healthcare are for actual visits made. The passing of the Affordable Care Act signed into law in 2010 made provisions for the cut down of fraud and over-payments, requiring states to stop Medicaid payments to providers when there is credible evidence of fraud. At least 10 states implemented an office of inspector general to oversee Medicaid fraud investigations, with many moving towards a system of verifying home healthcare visits in order to help reduce fraud.
+
+Several states have introduced electronic visit verification with some mandating it for home healthcare. In January 2014, Illinois became the first state to mandate the use of EVV when the Department of Human Services required it for its home services program. As of June 1, 2015, the Texas Health and Human Services Commission mandates that electronic visit verification be used for all home healthcare visits billed to the state.  The state of Ohio began the process of implementing an electronic verification system that would be used starting in 2016. It estimated the use of EVV will save the state approximately $9.5 million in its first two years of use. Other states that use but do not mandate EVV include Louisiana, Alaska, and Tennessee.
+Electronic visit verification is widely used throughout the healthcare industry, not solely by government entities. Companies use it for compliance and quality assurance. Employers of home healthcare providers use it to verify employee's locations as well as document patient care. It can also be used to verify hours of work and document time sheets for healthcare workers.
+
+
+== Health care fraud ==
+
+Health care fraud includes health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging in fraud are always seeking new ways to circumvent the law. Damages from fraud can be recovered by use of the False Claims Act, most commonly under the qui tam provisions which rewards an individual for being a "whistleblower", or relator (law).
+
+
+== Tracking software ==
+Electronic visit verification is mainly done through the use of GPS tracking and computer software. It can also include the use of telephone based systems where healthcare workers can call-in from each location. GPS can be used to track the location of nurses, or a "check-in" system can be used requiring healthcare providers to clock in when they are at a home visit.
+EVV is also used by employers to track employees and determine their compensation. Electronic visit verification software integrates with payroll systems that allow companies to verify payroll of its nurses. Many EVV software providers employ a cloud-based system that integrates with a mobile app to coordinate schedules, billing, payroll, communication, and patient documentation. Nurses can update patient files with the system while also submitting working hours to their employers. In contrast, companies such as First Data provide a telephone and computer-based system for verification, similar to the system implemented in the state of Texas in 2015.
+
+
+== References ==
+
+
+== External links ==
+Illinois Department of Human Services EVV program page
+Texas Department of Aging and Disability Services EVV program page Archived 2015-04-14 at the Wayback Machine
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Electuary-0.md b/data/en.wikipedia.org/wiki/Electuary-0.md
new file mode 100644
index 000000000..7f415cad1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Electuary-0.md
@@ -0,0 +1,31 @@
+---
+title: "Electuary"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Electuary"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:24.853354+00:00"
+instance: "kb-cron"
+---
+
+An electuary is a medicine consisting of a powder or other ingredient mixed with something sweet such as honey to make it more palatable.
+In German and Swiss cultures, electuary (German: Latwerge or Latwerg) is also more generally a thickened juice and honey preparation with a thick, viscous consistency that is used in for culinary purposes, such as a (bread) spread or as a sauce ingredient.
+In the Indian Ayurveda tradition, electuaries are called Lēhya (लेह्य) (literally, "lickable").
+
+
+== Types ==
+There are several different types of electuary: laxative electuary, joyful electuary, etc.
+The fermentation of mixed herbs in honey and their effects on each other are said to increase the medical properties already present and to create new ones.
+
+
+== Famous electuaries in medicine ==
+Chyawanprash
+Diasenna
+Mithridate
+Faroug
+Figra
+Sootira
+
+
+== References ==
+Avicenna (1999). The Canon of Medicine (al-Qānūn fī'l-ṭibb), vol. 5. translate by Abdurrahman Sharafkandi.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Empyema-0.md b/data/en.wikipedia.org/wiki/Empyema-0.md
new file mode 100644
index 000000000..123051675
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Empyema-0.md
@@ -0,0 +1,40 @@
+---
+title: "Empyema"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Empyema"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:32.131529+00:00"
+instance: "kb-cron"
+---
+
+An empyema (; from Ancient Greek  ἐμπύημα (empúēma) 'abscess') is a collection or gathering of pus within a naturally existing anatomical cavity. The term is most commonly used to refer to pleural empyema, which is empyema of the pleural cavity. It is similar to or the same as abscess in meaning, but the context of use may sometimes be different. For instance, an appendicular empyema is in medicine now generally called an abscess.
+Empyema most commonly occurs as a complication of pneumonia but can also result from other infections or conditions that lead to the collection of infected fluid in a body cavity.
+
+
+== Classification ==
+Empyema occurs in:
+
+the pleural cavity (pleural empyema also known as pyothorax)
+the thoracic cavity
+the uterus (pyometra)
+the appendix (appendicitis)
+the meninges (subdural empyema)
+the joints (septic arthritis)
+the gallbladder
+
+
+== Diagnosis ==
+Chest X-rays or computed tomography (CT) scans can reveal the presence of fluid within the pleural space and help assess its characteristics. Once a fluid-filled cavity has been identified, it is often partially or fully drained with a needle, so that the fluid may be analyzed. This helps determine whether the fluid is infected and allows for the identification of the causative microorganisms. Blood tests may also be performed, which can identify both an elevated neutrophil count, which is indicative of an infection, or bacteremia.
+In addition to CT, suspected cases of empyema in and around the brain are often subjected to more rigorous neuroimaging techniques, including MRI. In these cases, fluid samples are obtained via stereotactic needles rather than lumbar puncture, because unlike most cases of meningitis, a lumbar puncture will most often not reveal anything about the causative microorganisms.
+
+
+== References ==
+
+
+== Further reading ==
+Shen, K. Robert; Bribriesco, Alejandro; Crabtree, Traves; Denlinger, Chad; Eby, Joshua; Eiken, Patrick; Jones, David R.; Keshavjee, Shaf; Maldonado, Fabien; Paul, Subroto; Kozower, Benjamin (February 2017). "The American Association for Thoracic Surgery Consensus Guidelines for the Management of Empyema". The Journal of Thoracic and Cardiovascular Surgery. 153 (6): e129–e146. doi:10.1016/j.jtcvs.2017.01.030. PMID 28274565.
+
+
+== External links ==
+ Media related to Empyemas at Wikimedia Commons
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/End_organ_damage-0.md b/data/en.wikipedia.org/wiki/End_organ_damage-0.md
new file mode 100644
index 000000000..06daf2271
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/End_organ_damage-0.md
@@ -0,0 +1,108 @@
+---
+title: "End organ damage"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/End_organ_damage"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:33.470549+00:00"
+instance: "kb-cron"
+---
+
+End organ damage is severe impairment of major body organs due to systemic disease. Commonly this is referred to in diabetes, high blood pressure, or states of low blood pressure or low blood volume. This can present as a heart attack or heart failure, pulmonary edema, neurologic deficits including a stroke, or acute kidney failure.
+
+== Pathophysiology ==
+End organ damage typically occurs where systemic disease causes cell death in most or all organs. 
+
+=== Hypertensive ===
+When blood pressures are critically high (>180/120 mm Hg) or the rate of rise in blood pressure is rapid, a large volume of blood circulating in a small space creates turbulence and can damage the inner lining of blood vessels. The body’s repair systems are activated by damage and circulating blood components, like platelets, work on repair. The deposition of platelets can clutter the vessel space and impair the body’s natural ability to produce nitrous oxide, which would dilate blood vessels and help lower blood pressure. When high pressure is pushing on the walls of narrowed blood vessels, fluid leaves the inside of blood vessels and moves to the space just outside. This impairs necessary blood flow and cuts off circulating oxygen, which can lead to tissue death and permanent damage to the brain, heart, arteries, and kidneys. This may occur as a result of chronic or poorly controlled hypertension, illicit drug use, or as a complication of pregnancy. Recent studies have shown that activation of the immune system may also be closely involved with the development of end organ damage in hypertensive states.
+
+=== Shock ===
+Shock is when the body does not have adequate circulation to provide oxygen to body tissues. Hypovolemic shock occurs due to low circulating volume of fluids in the blood vessels. Distributive shock, which can occur due to anaphylaxis or sepsis, results in widespread dilation of blood vessels in the body resulting in lower blood pressure. In cases of extremely low circulating volume or inability to maintain an adequate blood pressure, body tissues do not receive enough oxygen and nutrients. When tissues lack oxygen and adequate circulation, organs can fail.
+
+=== Diabetes ===
+In diabetes, the dysregulation of insulin and blood glucose levels damages end organ cells and as the body compensates through regulating fluid volume to adjust glucose concentration, it also incurs collateral damage to organs. Microvascular and macrovascular complications include nephropathy, retinopathy, neuropathy, and ASCVD events. In diabetic neuropathy, glucose promotes oxidative stress leading to nerve damage.  Chronically high insulin levels are also associated with early development of atherosclerotic plaques inside blood vessel walls.
+
+== Clinical presentation ==
+
+=== Hypertensive ===
+
+==== Important definitions ====
+Hypertensive Crisis - blood pressure >180/120 mm Hg with or without signs of end organ damage
+Hypertensive Urgency - blood pressure >180/120 mm Hg without signs of end organ damage
+Hypertensive Emergency - blood pressure >180/120 mm Hg with signs of end organ damage
+
+==== Presentation ====
+Source:
+
+Altered mental status
+Shortness of breath
+Chest pain
+Lower extremity swelling
+New heart murmur
+Unequal blood pressures - may be sign of aortic dissection
+Headache or dizziness
+Neurologic deficits - may be due to a stroke or transient ischemic attack
+Vision changes
+
+=== Shock ===
+
+==== Important definitions ====
+Systemic Inflammatory Response Syndrome (SIRS) meets any two criteria:
+Body temperature >38 or <36 degrees Celsius
+Heart rate >90 beats per minute
+Respiratory rate >20 breaths per minute or partial pressure CO2 <32 mm Hg
+White blood cell count >12000 or <4000 per microliter or >10% immature forms or bands
+qSOFA score helps predict organ dysfunction outside of the intensive care unit by assessing 3 components:
+Systolic blood pressure <100 mm Hg
+Maximum respiratory rate >21 breaths per minute
+Decreased Glasgow coma score <15
+
+==== Presentation ====
+Source:
+
+Altered mental status - person may not be oriented to person, place, or time
+Delayed capillary refill - skin may be pale or mottled, limbs may be cool
+Little or no urine output - poor urine output
+Absent bowel sounds
+
+=== Diabetes ===
+End organ damage can occur at any diagnostic stage of diabetes, including pre-diabetes. 
+
+==== Presentation ====
+Source:
+
+Urinating often
+Feeling very thirsty
+Feeling very hungry—even though you are eating
+Extreme fatigue
+Blurry vision
+Cuts/bruises that are slow to heal
+Weight loss—even though you are eating more (Type 1 diabetes)
+Tingling, pain, or numbness in the hands/feet (Type 2 diabetes)
+
+== Evaluation and work-up ==
+
+=== Physical examination ===
+Heart - evaluate for new-onset heart failure (leg swelling, new murmur)
+Lungs - fluid overload or infection can cause shortness of breath
+Neurologic - a detailed neurologic exam should be performed to evaluate for stroke and peripheral vascular disease
+Fundoscopy - exam of the eye that can show signs of hypertension including papilledema and retinal hemorrhages
+
+=== Labs ===
+Complete Blood Count - check for low red blood cell count, elevated white blood cell count
+Basic Metabolic Panel - evaluate kidney function with creatinine and blood urea nitrogen
+Urinalysis - may show excess protein (hypertensive) or bacteria or white blood cells in urine (infection)
+Urine Drug Screen - illicit drugs like cocaine and PCP can increase blood pressure rapidly
+Cardiac Enzymes - elevated troponin and brain natriuretic peptide may indicate stress on the heart
+Pregnancy Test - pre-eclampsia in pregnancy can cause dangerously high blood pressure
+Lactate - rising lactate in the blood indicates that areas of the body are not getting enough oxygen
+Cultures - blood cultures and source-specific cultures (urine, sputum, etc.) should be collected when septic shock is suspected in order to identify and source and target treatment
+Fasting blood glucose, A1C, Oral Glucose Tolerance Test - for diabetes diagnosis
+
+=== Imaging ===
+Chest X-Ray - may show signs of infection or fluid build-up or enlarged heart
+Electrocardiogram - check for heart dysfunction
+Echocardiogram - may show signs of left ventricular muscle thickening due to heart failure
+CT Head - may show signs of stroke
+CT-Angiogram - evaluate for signs of aortic dissection
+OCT - evaluate signs of diabetic retinopathy
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/End_organ_damage-1.md b/data/en.wikipedia.org/wiki/End_organ_damage-1.md
new file mode 100644
index 000000000..03048e34c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/End_organ_damage-1.md
@@ -0,0 +1,26 @@
+---
+title: "End organ damage"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/End_organ_damage"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:33.470549+00:00"
+instance: "kb-cron"
+---
+
+== Management ==
+
+=== Hypertensive ===
+When there is concern for the presence or development of end organ damage, blood pressure should be lowered emergently with intravenous antihypertensive medications. Patients should be admitted to the hospital to be closely monitored for complications of end organ damage, notably strokes. Blood pressure should be lowered a maximum of 10% over the first hour and 25% over the first two hours as rapid lowering of blood pressure can lead to decreased blood flow in the brain and cause the development of an ischemic stroke. Once blood pressure is stabilized, patients can be changed from intravenous medications to oral.
+For patients with long-standing hypertension, patient education on the importance of consistently taking prescribed medications and keeping blood pressure well-controlled is critical. Additionally, future treatments may focus not only on blood pressure control but also the reduction of local inflammation that can lead to end organ damage.
+In pregnant patients where there is concern for pre-eclampsia, patients should be given magnesium sulfate and admitted. Urine output, breathing, and reflexes should be monitored closely with concern for the development of worsening kidney function and magnesium toxicity. Systolic blood pressure should be treated with antihypertensive medications only if it is higher than 160 mm Hg.
+
+=== Shock ===
+When a patient is in shock, the development of end organ damage is typically due to circulating blood volume or blood pressure that is not high enough to maintain oxygen and nutrient supply to vital organs. Initial treatment is focused on stabilizing the patient. Fluids are given to increase circulating blood volume. Vasopressors, medications that constrict blood vessels, can also be given in order to maintain a higher blood pressure and help vital organs receive enough oxygen and nutrients. High-dose steroids, like hydrocortisone, may also help maintain blood pressures in patients. Close monitoring in the critical care unit is often necessary to measure blood pressures.
+The next step in treating end organ damage due to septic shock is to identify the source of the infection and treat it. Broad-spectrum antibiotics can be started that will treat many potential bacteria before cultures grow the specific bacteria that is causing the infection. Once cultures identify the culprit of the infection, the antibiotic therapy can be changed so that it is only covering what needs to be treated. Treatment of the source of infection should resolve low blood pressures that compromise vital organ function. Complications, including acute respiratory distress syndrome, acute kidney injury, and electrolyte abnormalities, can be treated proactively and managed on an individual basis.
+
+=== Diabetes ===
+
+Lifelong treatment and monitoring is often necessary for glucose control. Glucose levels should be maintained at 90 to 130 mg/dL and HbA1c at less than 7%. Medical treatment includes use of insulin and/or other medications to control glucose levels. Monitoring for end organ damage complications is recommended on guidelines by different regional medical bodies. 
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Endaural_phenomena-0.md b/data/en.wikipedia.org/wiki/Endaural_phenomena-0.md
new file mode 100644
index 000000000..ec14ced8e
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Endaural_phenomena-0.md
@@ -0,0 +1,19 @@
+---
+title: "Endaural phenomena"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Endaural_phenomena"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:34.761333+00:00"
+instance: "kb-cron"
+---
+
+Endaural phenomena are sounds that are heard without any external acoustic stimulation. Endaural means "in the ear". Phenomena include transient ringing in the ears (that sound like sine tones), white noise-like sounds, and subjective tinnitus. Endaural phenomena need to be distinguished from otoacoustic emissions, in which a person's ear emits sounds. The emitter typically cannot hear the sounds made by his or her ear. Endaural phenomena also need to be distinguished from auditory hallucinations, which are sometimes associated with psychosis.
+
+
+== See also ==
+Bruit
+Entoptic phenomenon
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Endogenous_agonist-0.md b/data/en.wikipedia.org/wiki/Endogenous_agonist-0.md
new file mode 100644
index 000000000..b892802cb
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Endogenous_agonist-0.md
@@ -0,0 +1,15 @@
+---
+title: "Endogenous agonist"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Endogenous_agonist"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:36.017714+00:00"
+instance: "kb-cron"
+---
+
+In pharmacology, an endogenous agonist for a particular receptor is a compound naturally produced by the body which binds to and activates that receptor. For example, the primary endogenous agonist for serotonin receptors is serotonin, and the primary endogenous agonist for dopamine receptors is dopamine.
+In general, receptors for small molecule neurotransmitters such as serotonin will have only one endogenous agonist, but often have many different receptor subtypes (e.g. 13 different receptors for serotonin). On the other hand, neuropeptide receptors tend to have fewer subtypes, but may have several different endogenous agonists. This allows for a high degree of complexity in the body's signalling system, with different tissues often showing quite distinct responses to a particular ligand. Some endogenous antagonists and inverse agonists are also known (e.g., kynurenic acid at the NMDA receptor), but these are much less common.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Endotype-0.md b/data/en.wikipedia.org/wiki/Endotype-0.md
new file mode 100644
index 000000000..f2629893a
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Endotype-0.md
@@ -0,0 +1,37 @@
+---
+title: "Endotype"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Endotype"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:37.256928+00:00"
+instance: "kb-cron"
+---
+
+An endotype is a subtype of a health condition, which is defined by a distinct functional or pathobiological mechanism. This is distinct from a phenotype, which is any observable characteristic or trait of a disease, such as development, biochemical or physiological properties without any implication of a mechanism. It is envisaged that patients with a specific endotype present themselves within phenotypic clusters of diseases.
+One example is asthma, which is considered to be a syndrome, consisting of a series of endotypes. This is related to the concept of disease entity.
+
+
+== Disease entity ==
+The main concept in nosology is the disease entity. Normally there are two ways to define a disease entity: Manifestational criteria and causal criteria.
+
+Manifestational criteria. These are a set of criteria based on signs, symptoms and laboratory findings that define a disease. They define a disease by its symptoms and medical findings.
+Causal criteria. These are a causal chain of events that defines the disease describing how it develops. They describe the disease by its etiology.
+Following Fred Gifford, these criteria lead one to view any disease entity in three different forms:
+
+Disease as symptoms: The disease is defined by the symptoms and signs that it produces. In fact, it can be said that the disease is the collection of them. It is the classical way to define a disease or a condition.
+Disease as state: The disease is not defined by a set of symptoms but by the underlying state of the body, including pathological tissues, abnormal cells and any other general medical findings. This kind of definition allows the researchers to speak about silent diseases, which cannot be considered as such by the previous definition. Proponents of this kinds of entity are for example Rudolph Virchow.
+Disease as a process: In the 20th century, a third concept of disease has appeared, based on the works of Caroline Whitbeck in 1977. Whitbeck proposed that a disease may be defined by the clinical course of a set of untreated patients. She also argues that diseases are complex processes of which both clinical and underlying pathophysiological manifestations are proper parts (as contrasted with effects).
+Following again F. Gifford, in fact each of the previous definitions can include the aetiology or can be aetiologically agnostic. Other authors simply continue with the classification of Whitbeck, leaving just three kinds of definition (clinical, pathological and aetiological).
+It is important to note that a real-world definition is normally a hybrid between these above kinds, and an endotype should use all three of the descriptors - including aetiology - to ensure specificity.
+
+
+== See also ==
+Heterogeneous condition
+
+
+== Notes ==
+
+
+== References ==
+Anderson, GP (20 September 2008). "Endotyping asthma: new insights into key pathogenic mechanisms in a complex, heterogeneous disease". Lancet. 372 (9643): 1107–19. doi:10.1016/s0140-6736(08)61452-x. PMID 18805339. S2CID 13161535.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Engel_classification-0.md b/data/en.wikipedia.org/wiki/Engel_classification-0.md
new file mode 100644
index 000000000..4e11d0415
--- /dev/null
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+---
+title: "Engel classification"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Engel_classification"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:38.574402+00:00"
+instance: "kb-cron"
+---
+
+To classify postoperative outcomes for epilepsy surgery, Jerome Engel proposed the following scheme, the Engel Epilepsy Surgery Outcome Scale, which has become the de facto standard when reporting results in the medical literature:
+
+Class I: Free of disabling seizures
+Class II: Rare disabling seizures ("almost seizure-free")
+Class III: Worthwhile improvement
+Class IV: No worthwhile improvement
+
+
+== History ==
+Surgery for epilepsy patients has been used for over a century, but due to technological restrictions and insufficient knowledge of brain surgery, this treatment approach was relatively rare until the 1980s and 90s.  Prior to the 1980s, no classification system existed due to the lack of operations performed up until the time. As surgery as a treatment grew more prevalent, a classification system became a necessity. The appropriate evaluation of patients following epilepsy surgery is extremely important, as medical professionals must know the appropriate course of action to follow in order to achieve seizure freedom for patients.  Accordingly, the Engel classification guidelines were devised by UCLA neurologist Jerome Engel Jr. in 1987 and made public at the 1992 Palm Desert Conference on Epilepsy Surgery. The Engel classification system has since become the standard in reporting postoperative outcomes of epilepsy surgery.
+
+
+== Overview ==
+In Engel's 1993 summary of the 1992 Palm Desert Conference on Epilepsy Surgery, he annotated his classification system with more detail.  The annotation was as follows:
+
+Class I: Seizure free or no more than a few early, nondisabling seizures; or seizures upon drug withdrawal only
+Class II: Disabling seizures occur rarely during a period of at least 2 years; disabling seizures may have been more frequent soon after surgery; nocturnal seizures
+Class III: Worthwhile improvement; seizure reduction for prolonged periods but less than 2 years
+Class IV: No worthwhile improvement; some reduction, no reduction, or worsening are possible
+
+
+== Advantages ==
+The subjectivity of the Engel system leaves much of the postoperative class assignment process to the patients. While many have noted the disadvantages of a classification system where the patients are involved in determining the evaluation, others have praised it.  Proponents of the Engel classification guidelines argue that the patients are best able to perceive the worth of the operation because they are the ones experiencing the seizures before and after the treatment.
+
+
+== Disadvantages ==
+As is the case for all current methods of reviewing epilepsy surgery outcomes, the Engel classification system has subjective components. A "disabling seizure" is subjective and can vary in definition from person to person. While one epileptic experiencing a seizure when driving a car may find the seizure "disabling", the same magnitude of seizure may be interpreted as mild, and thus "nondisabling", by an epileptic resting in bed. Every class other than class I is also subjective because there is no quantitative definition of what determines a rare occurrence or method to measure worthwhileness. One doctor and patient may consider two seizures in a year as a rare occurrence while another doctor may consider ten in a year as rarely occurring. The worthwhileness of the operation is ambiguous because worth can be interpreted differently by various patients and healthcare professionals. Keeping those caveats in mind, most neurologists and neurosurgeons who specialize in epilepsy would most likely agree, as would many persons with epilepsy and even laypeople, that any seizure that leads to a period of status epilepticus (seizure activity, especially of the tonic-clonic, or grand mal, type, for longer than about five to ten minutes, or more – some now say it should be as little as two – without an intervening return to normal, or any repeat seizures without a return to consciousness) is a medical emergency, objectively a major problem, and cannot be considered a satisfactory outcome (unless perhaps if the person had a fatal or very severe form of a neurodegenerative syndrome or other disease where such severe repeat seizures are not unusual, and there are a number of these diseases; even then, such an outcome is usually still not a cure, just an amelioration of a fatal condition or a very disabling condition). Continuing to have to endure a large number of tonic-clonic seizures (grand mal seizures) over a period of days, months, or even over the course of a year or two, would make it impossible to drive and very hard to hold a job away from home entailing much stress, and would pose limits on one's abilities to safely carry out the activities of daily living without at least some monitoring or assistance.
+The Engel classification system has been thought of as a cross-sectional grading system by medical professionals because it does not account for long term changes in patients.  It has been proposed that it would be more beneficial to reevaluate patients on an annual basis, and the International League Against Epilepsy (ILAE) devised a separate rating scale in 2001 that reevaluates patients on every annual anniversary of their surgery. The ILAE also developed their system in hopes of avoiding many of the subjective components found in the Engel system.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Epiphenomenon-0.md b/data/en.wikipedia.org/wiki/Epiphenomenon-0.md
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+++ b/data/en.wikipedia.org/wiki/Epiphenomenon-0.md
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+---
+title: "Epiphenomenon"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Epiphenomenon"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:39.920298+00:00"
+instance: "kb-cron"
+---
+
+An epiphenomenon (plural: epiphenomena) is a secondary phenomenon that occurs alongside or in parallel to a primary phenomenon. The word has two senses: one that connotes known causation and one that connotes absence of causation or reservation of judgment about it.
+
+
+== Examples ==
+
+
+=== Metaphysics ===
+In the philosophy of causality, an epiphenomenon is any effect of a cause apart from the effect under primary consideration. In situations in which an event of interest E is caused by (or, is said to be caused by) an event C, which also causes (or, is said to cause) an event F, then F is an epiphenomenon. The problem of epiphenomena is often a counterexample to theories of causation. For example, take a simplified Lewisian counterfactual analysis of causation that the meaning of propositions about causal relationships between two events A and B can be explained in terms of counterfactual conditionals of the form "if A had not occurred then B would not have occurred". Suppose that C causes E and that C has an epiphenomenon F. We then have that if E had not occurred, then F would not have occurred, either. But then according to the counterfactual analysis of causation, the proposition that there is a causal dependence of F on E is true; that is, on this view, E caused F. Since this is not in line with how we ordinarily speak about causation (we would not say that E caused F), a counterfactual analysis seems to be insufficient.
+
+
+=== Philosophy of mind and psychology ===
+
+An epiphenomenon can be an effect of primary phenomena, but cannot affect a primary phenomenon. In the philosophy of mind, epiphenomenalism is the view that mental phenomena are epiphenomena in that they can be caused by physical phenomena, but cannot cause physical phenomena.  In strong epiphenomenalism, epiphenomena that are mental phenomena can only be caused by physical phenomena, not by other mental phenomena.  In weak epiphenomenalism, epiphenomena that are mental phenomena can be caused by both physical phenomena and other mental phenomena, but mental phenomena cannot be the cause of any physical phenomenon.  
+The physical world operates independently of the mental world in epiphenomenalism; the mental world exists as a derivative parallel world to the physical world, affected by the physical world (and by other epiphenomena in weak epiphenomenalism), but not able to have an effect on the physical world.  Instrumentalist versions of epiphenomenalism allow some mental phenomena to cause physical phenomena, when those mental phenomena can be strictly analyzable as summaries of physical phenomena, preserving causality of the physical world to be strictly analyzable by other physical phenomena.
+
+
+=== Medicine ===
+In the more general use of the word, a causal relationship between the phenomena is implied; the epiphenomenon is a consequence of the primary phenomenon. This is the sense that is related to the noun epiphenomenalism.
+However, in medicine, this relationship is typically not implied, and the word is usually used in its second sense: an epiphenomenon may occur independently, and is called an epiphenomenon because it is not the primary phenomenon under study or because only correlation, not causation, is known or suspected. In this sense, saying that X is associated with Y as an epiphenomenon is preserving an acknowledgment that correlation does not imply causation. Signs, symptoms, syndromes (groups of symptoms), and risk factors can all be epiphenomena in this sense. For example, having an increased risk of breast cancer concurrent with taking an antibiotic is an epiphenomenon. It is not the antibiotic that is causing the increased risk, but the increased inflammation associated with the bacterial infection that prompted the taking of an antibiotic. The metaphor of a tree is one way of helping to explain the difference to someone struggling to understand. If the infection is the root of the tree, and the inflammation is the trunk, then the cancer and the antibiotic are two branches; the antibiotic is not the trunk.
+
+
+=== Electromagnetism ===
+Although electronics is said to be due to the influence of electrons, the standard approach to the study of electrical phenomena due to James Clerk Maxwell views these particles as secondary:
+
+In Maxwell's theory, charge and current are 'epiphenomena' (secondary appearances) of underlying processes in what he termed, following Faraday, the electric and magnetic fields. Indeed, Maxwell's mature theory stays completely away from microstructure of matter and from any consideration of ‘electric substance’. Instead he proposed that certain quantities should be defined at every point in space, such that relations between them (the Maxwell equations) and functions of them (such as energy functions) determine phenomena. These quantities (the fields) may depend on microphysical events, and indeed Maxwell did expend some effort in his early papers on attempting to explain qualitatively how their relations could result in mechanical motions. However, the theory explains only large-scale phenomena, and it is not necessary to have the microscopic model in mind in order to work successfully with it.
+
+
+=== Propositional theory ===
+Zenon Pylyshyn suggested a propositional model of cognition where people do not conceptualize ideas in images but rather in meaningful relationships.  In this theory, epiphenomena refer to images because they are merely products people conceptualize from their actual thought processes. Pylyshyn defends his claim by explaining that we only see images when we envision the form of an object.  While visualizing objects or actions is a frequent process in our mind, it does not occur when we are considering the meaning behind an action or the non-visual properties of an object.  There are many concepts we simply cannot envision.  Additionally, when envisioning an image, it changes based on our preconceived notions, suggesting that semantic relations precede visual images.  Unfortunately, the idea of epiphenomena in propositional theory is largely subjective and not falsifiable.
+
+
+== References ==
+
+
+== External links ==
+ The dictionary definition of epiphenomenon at Wiktionary
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Equianalgesic-0.md b/data/en.wikipedia.org/wiki/Equianalgesic-0.md
new file mode 100644
index 000000000..c33184bb0
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Equianalgesic-0.md
@@ -0,0 +1,58 @@
+---
+title: "Equianalgesic"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Equianalgesic"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:41.388174+00:00"
+instance: "kb-cron"
+---
+
+An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics (drugs used to relieve pain). Equianalgesic charts are used for calculation of an equivalent dose (a dose which would offer an equal amount of analgesia) between different analgesics. Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.
+When using oral morphine as a baseline, the comparison of strengths of opioid analgesics is referred to as oral morphine equivalent.
+
+
+== Format ==
+Equianalgesic tables are available in different formats, such as pocket-sized cards for ease of reference. A frequently-seen format has the drug names in the left column, the route of administration in the center columns and any notes in the right column.
+
+
+== Purpose ==
+There are several reasons for switching a patient to a different pain medication. These include practical considerations such as lower cost or unavailability of a drug at the patient's preferred pharmacy, or medical reasons such as lack of effectiveness of the current drug or to minimize adverse effects. Some patients request to be switched to a different narcotic due to stigma associated with a particular drug (e.g. a patient refusing methadone due to its association with opioid addiction treatment). Equianalgesic charts are also used when calculating an equivalent dosage of the same drug, but with a different route of administration.
+
+
+== Precautions ==
+An equianalgesic chart can be a useful tool, but the user must take care to correct for all relevant variables such as route of administration, cross tolerance, half-life and the bioavailability of a drug. For example, the narcotic levorphanol is 4–8 times stronger than morphine, but also has a much longer half-life. Simply switching the patient from 40 mg of morphine to 10 mg of levorphanol would be dangerous due to dose accumulation, and hence frequency of administration should also be taken into account.
+There are other concerns about equianalgesic charts. Many charts derive their data from studies conducted on opioid-naive patients. Patients with chronic (rather than acute) pain may respond to analgesia differently. Repeated administration of a medication is also different from single dosing, as many drugs have active metabolites that can build up in the body. Patient variables such as sex, age, and organ function may also influence the effect of the drug on the system. These variables are rarely included in equianalgesic charts.
+
+
+== Opioid equivalency table ==
+Opioids are a class of compounds that elicit analgesic (pain killing) effects in humans and animals by binding to the μ-opioid receptor within the central nervous system. The following table lists opioid and non-opioid analgesic drugs and their relative potencies. Values for the potencies represent opioids taken orally unless another route of administration is provided. As such, their bioavailabilities differ, and they may be more potent when taken intravenously.
+
+
+=== Nonlinearities ===
+This chart measures pain relief versus mass of medication. Not all medications have a fixed relationship on this scale. Methadone is different from most opioids because its potency can vary depending on how long it is taken; acute use (1–3 days) yields a potency about 1.5× stronger than that of morphine and chronic use (7 days+) yields a potency about 2.5 to 5× that of morphine. This is called a dose-dependent potency curve and makes methadone somewhat unique among opioids, thought to be caused by the NMDA receptor activity of the drug then altering the behaviour of the opioid receptors that other opioids might target. Similarly, the effect of tramadol increases after consecutive dosing due to the accumulation of its active metabolite and an increase of the oral bioavailability in chronic use.
+
+
+== See also ==
+Oripavine – for more on the comparative strength of oripavine derivatives
+
+
+== References ==
+
+
+=== Explanatory notes ===
+
+
+=== Citations ===
+
+
+=== Bibliography ===
+
+
+==== Books ====
+
+
+==== Articles ====
+
+
+==== Websites ====
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Exacerbation-0.md b/data/en.wikipedia.org/wiki/Exacerbation-0.md
new file mode 100644
index 000000000..971789922
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Exacerbation-0.md
@@ -0,0 +1,18 @@
+---
+title: "Exacerbation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Exacerbation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:43.829883+00:00"
+instance: "kb-cron"
+---
+
+In medicine, an exacerbation is the worsening  of a disease or an increase in its symptoms. Examples includes an acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of congestive heart failure.
+
+
+== See also ==
+Flare-up
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Excavation_(medicine)-0.md b/data/en.wikipedia.org/wiki/Excavation_(medicine)-0.md
new file mode 100644
index 000000000..41be33279
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Excavation_(medicine)-0.md
@@ -0,0 +1,29 @@
+---
+title: "Excavation (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Excavation_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:45.147921+00:00"
+instance: "kb-cron"
+---
+
+In medicine, excavation has two meanings:
+
+the act of hollowing out (e.g., to remove damaged or infected tissue)
+the space hollowed out, or a natural cavity or pouch
+
+
+== In anatomy ==
+Examples of naturally hollow spaces that are considered excavations include:
+
+Rectouterine pouch or excavation, between the uterus and the rectum
+Rectovesical excavation, between the rectum and the male bladder
+Vesicouterine excavation, between the bladder and the uterus in a female
+
+
+== In medical and dental procedures ==
+The tool used to create an excavation (e.g., to remove damaged areas before filling dental caries) is an excavator.  Excavation is also the technique used to remove granulation tissue when necessary.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Exercise_capacity-0.md b/data/en.wikipedia.org/wiki/Exercise_capacity-0.md
new file mode 100644
index 000000000..51c16a6f9
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Exercise_capacity-0.md
@@ -0,0 +1,14 @@
+---
+title: "Exercise capacity"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Exercise_capacity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:46.378462+00:00"
+instance: "kb-cron"
+---
+
+Exercise capacity is defined as "the maximum amount of physical exertion that a patient can sustain".
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Extracorporeal_procedure-0.md b/data/en.wikipedia.org/wiki/Extracorporeal_procedure-0.md
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index 000000000..70f4ca4f1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Extracorporeal_procedure-0.md
@@ -0,0 +1,58 @@
+---
+title: "Extracorporeal procedure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Extracorporeal_procedure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:47.590410+00:00"
+instance: "kb-cron"
+---
+
+An extracorporeal procedure is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surgery.
+
+
+== Circulatory procedures ==
+A procedure in which blood is taken from a patient's circulation to have a process applied to it before it is returned to the circulation. All of the apparatuses carrying the blood outside the body are collectively termed the extracorporeal circuit.
+
+Intra-surgical cell salvage (aspiration, washing and Autotransfusion)
+Apheresis
+Plasmapheresis vs cytapheresis
+centrifugal apheresis vs filtration apheresis vs adsorption
+cascade apheresis
+Hemoadsorption/Hemoperfusion
+Plasma Adsorption
+Aquapheresis
+Hemodialysis
+Hemofiltration
+Hemodiafiltration
+Renal replacement therapy
+Continuous Renal Replacement Therapy (CRRT)
+Extracorporeal carbon dioxide removal
+Extracorporeal cardiopulmonary resuscitation
+Extracorporeal membrane oxygenation (ECMO)
+Cardiopulmonary bypass during open heart surgery
+Liver support system
+Biospleen and other extracorporeal bionic or non bionic spleen-like blood cleansing device
+
+
+== Other procedures ==
+Extracorporeal shockwave lithotripsy (ESWL), which is unrelated to other extracorporeal therapies, in that the device used to break up the kidney stones is held completely outside the body, whilst the lithotripsy itself occurs inside the body.
+Extracorporeal radiotherapy, where a large bone with a tumour is removed and given a dose far exceeding what would otherwise be safe to give to a patient.
+Extracorporeal pulsatile circulatory control (EPCC) is a process by which brain function (animal model) is kept intact, keeping the organ alive and functioning independent from the rest of the body for several hours.
+
+
+== See also ==
+Intracorporeal
+
+
+== References ==
+
+
+== Further reading ==
+Paden, Matthew L.; Conrad, Steven A.; Rycus, Peter T.; Thiagarajan, Ravi R.; ELSO Registry (2013), "Extracorporeal Life Support Organization Registry Report 2012.", ASAIO Journal, 59 (3): 202–210, doi:10.1097/MAT.0b013e3182904a52, PMID 23644605, S2CID 205760474
+Cohn, Lawrence H. (2003), "Fifty Years of Open-Heart Surgery", Circulation, 107 (17), American Heart Association: 2168–2170, doi:10.1161/01.CIR.0000071746.50876.E2, PMID 12732590
+
+
+== External links ==
+
+Extracorporeal Circulation. MedicalGlossary.org
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Extravasation-0.md b/data/en.wikipedia.org/wiki/Extravasation-0.md
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+++ b/data/en.wikipedia.org/wiki/Extravasation-0.md
@@ -0,0 +1,46 @@
+---
+title: "Extravasation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Extravasation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:48.772379+00:00"
+instance: "kb-cron"
+---
+
+Extravasation is the leakage of a fluid out of its contained space into the surrounding area, especially blood or blood cells from vessels. In the case of inflammation, it refers to the movement of white blood cells through the capillary wall, into the surrounding tissues. This is known as leukocyte extravasation, also called diapedesis. In the case of cancer metastasis, it refers to cancer cells exiting the capillaries and entering other tissues, where secondary tumors may form. The term is commonly used in a medical context.
+More specifically, extravasation can refer to:
+
+Extravasation (intravenous)
+Extravasation of infusates
+Extravasation of irrigation fluid
+Extravasation of urine
+Leukocyte extravasation
+Angiopellosis (non-leukocyte cell extravastion)
+
+
+== Irrigation fluid ==
+Extravasation of irrigation fluid is the unintended migration of irrigation fluid (e.g., saline) introduced into a human body. This may occur in several types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.e., arthroscopy, TURP (trans-urethral resection of the prostate), and TCRE (trans-cervical resection of the endometrium).
+In arthroscopy, fluid under pressure is used to inflate and distend a joint and make a working surgical space. An arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. An arthroscopy is done by making surgical portals or puncture wounds into the joint. A surgical instrument called an arthroscope is used to introduce irrigation fluid under pressure to distend the joint. The arthroscope includes a small (typically 4 mm in diameter) optic scope rod to view the joint. Other portals or puncture wounds are made to introduce surgical instruments to perform cutting or repair procedures.
+If the joint is surrounded by soft tissue, as in the shoulder and hip, fluid under pressure may leak out of the joint space through the surgical portals and collect in the patient's soft tissue. A typical arthroscopy can result in 1–3 liters of irrigation fluid being absorbed into the patient's interstitial tissue. This buildup of irrigation fluid in the soft tissue may cause edema. This swelling can interfere with the arthroscopic procedure by collapsing the surgical space, or migrating into the patient's neck and causing airway blockage. In hip arthroscopy, a feared complication is abdominal flooding where the irrigation fluid leaks from the hip joint capsule and drains into the abdominal cavity. Risk factors for fluid extravasation include procedure length (>90–120 min), obesity, and age (>45–50) with accompanying lack of muscle tone.
+Shoulder arthroscopy is typically limited to about 90–120 minutes before the swelling from fluid extravasation interferes with the procedure, and presents a potential risk to the patient. Typically, fluid extravasation is managed by controlling fluid pressure, or hastening the procedure.
+
+
+== Infusates ==
+Extravasation may also refer to the leakage of infused substances from the vasculature tissue into the subcutaneous tissue. The leakage of high-osmolarity solutions or chemotherapy agents can result in significant tissue destruction and significant complications.
+
+
+== See also ==
+Arthroscopy
+Intravasation
+
+
+== References ==
+
+
+== Further reading ==
+
+
+== External links ==
+British National Health Service page on complications from extravasation of infusates.
+Cannuflow Research archive on extravasation in shoulder arthroscopy
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Extravasation_(intravenous)-0.md b/data/en.wikipedia.org/wiki/Extravasation_(intravenous)-0.md
new file mode 100644
index 000000000..077d3a4ee
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Extravasation_(intravenous)-0.md
@@ -0,0 +1,67 @@
+---
+title: "Extravasation (intravenous)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Extravasation_(intravenous)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:50.074837+00:00"
+instance: "kb-cron"
+---
+
+Extravasation is the leakage of intravenously (IV) infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. The leakage can occur through brittle veins in the elderly, through previous venipuncture access, or through direct leakage from wrongly positioned venous access devices. When the leakage is not of harmful consequence it is known as infiltration. Extravasation of medication during intravenous therapy is an adverse event related to therapy that, depending on the medication, amount of exposure, and location, can potentially cause serious injury and permanent harm, such as tissue necrosis.  Milder consequences of extravasation include irritation, characterized by symptoms of pain and inflammation, with the clinical signs of warmth, erythema (redness), or tenderness.
+
+
+== Medications ==
+Complications related to extravasation are possible with any medication. Since vesicants are blistering agents, extravasation may lead to irreversible tissue injury.
+Extravasation is particularly serious during chemotherapy, since chemotherapy medications are highly toxic.
+
+
+== Treatment ==
+The best "treatment" of extravasation is prevention.  Depending on the medication that has extravasated, there are potential management options and treatments that aim to minimize damage, although the effectiveness of many of these treatments has not been well studied.  In cases of tissue necrosis, surgical debridement and reconstruction may be necessary. The following steps are typically involved in managing extravasation:
+
+Stop infusion immediately. Put on sterile gloves.
+Replace infusion lead with a disposable syringe. While doing this, do not exert pressure on the extravasation area.
+Slowly aspirate back blood back from the arm, preferably with as much of the infusion solution as possible.
+Remove the original cannula or other IV access carefully from the arm (removal of the original cannula is not advised by all healthcare institutions, as access to the original cannula by surgeons can be used to help clean extravasated tissue).
+Elevate arm and rest in elevated position. If there are blisters on the arm, aspirate content of blisters with a new thin needle. Warm compresses should be placed initially on the site to help diffuse the contrast medium, and cold compresses are used later to help reduce the swelling.
+If, for the extravasated medication, substance-specific measures apply, carry them out (e.g. topical cooling, DMSO, hyaluronidase or dexrazoxane may be appropriate).
+Recent clinical trials have shown that Totect (USA) or Savene (Europe) (dexrazoxane for extravasation) is effective in preventing the progression of anthracycline extravasation into progressive tissue necrosis. In two open-label, single arm, phase II multicenter clinical trials, necrosis was prevented in 98% of the patients. Dexrazoxane for extravasation is the only registered antidote for extravasation of anthracyclines (daunorubicin, doxorubicin, epirubicin, idarubicin, etc.).
+The only FDA approved treatment for vasopressor extravasation is phentolamine.
+
+
+=== Pain management and other measures ===
+Pain management and local supportive care is important, as it can help to minimize the additional risk of infection and superinfection.
+
+
+== Prevention ==
+Only qualified, chemotherapy-certified nurses who have been trained in venipuncture and administration of medications with vesicant and irritant potential should be allowed to administer vesicants.
+Choose a large, intact vein with good blood flow for the venipuncture and placement of the cannula. Do not choose inadvertently "dislodgeable" veins (e.g. dorsum of hand or vicinity of joints) if an alternative vein is available.
+The digits, hands, and wrists should be avoided as intravenous sites for vesicant administration because of the close network of tendons and nerves that would be destroyed if an extravasation occurred.
+Place the smallest gauge and shortest length catheter to accommodate the infusion.
+Monitor the venipuncture site closely for evidence of infiltration and instructing patients to report any pain, discomfort, or tightness at the site.
+The IV infusion should be freely flowing. The arm with the infusion should not begin to swell (oedema), "get red" (erythema), "get hot" (local temperature increase), and the patient should not notice any irritation or pain on the arm. If this occurs, extravasation management should be initiated.
+The infusion should consist of a suitable carrier solution with an appropriately diluted medicinal/chemotherapy drug inside.
+After the IV infusion has finished, flush the cannula with the appropriate fluid.
+Finally, depending on clinical circumstances, central line access may be most appropriate for patients who require repeated administrations of vesicants and irritants.
+
+
+== Examples of vesicant medicinal drugs ==
+List of vesicant and irritant medications:
+
+
+=== Cytotoxic drugs ===
+
+
+=== Non-cytotoxic drugs ===
+
+
+== References ==
+
+
+== External links ==
+
+Table of chemotherapy vesicants, irritants, and treatments for extravasation
+Management of chemotherapy extravasation: ESMO–EONS Clinical Practice Guidelines
+UK National Extravasation Information Service
+Iv-therapy.net — links to useful websites about extravasation
+Savene website
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/FRAX-0.md b/data/en.wikipedia.org/wiki/FRAX-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/FRAX-0.md
@@ -0,0 +1,53 @@
+---
+title: "FRAX"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/FRAX"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:57.594597+00:00"
+instance: "kb-cron"
+---
+
+FRAX (fracture risk assessment tool) is a diagnostic tool used to evaluate the 10-year probability of bone fracture risk. It was developed by the University of Sheffield.  FRAX integrates clinical risk factors and bone mineral density at the femoral neck to calculate the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). The models used to develop the FRAX diagnostic tool were derived from studying patient populations in North America, Europe, Latin America, Asia and Australia.
+
+
+== Components ==
+The parameters included in a FRAX assessment, many being yes/no questions, are:
+
+Country
+Age
+Sex
+Weight
+Height
+Previous fracture
+Hip fracture of a patient's parent
+Current smoking
+Glucocorticoid treatment
+Rheumatoid arthritis
+Disease strongly associated with osteoporosis, including type I diabetes, osteogenesis imperfecta in adults, untreated long-standing hyperthyroidism, hypogonadism, menopause before age 45, chronic malnutrition or malabsorption, chronic renal failure (dialysis-independent) and chronic liver disease
+Alcohol intake of 30 ml per day or more (three standard drinks)
+Bone mineral density (BMD) of the femoral neck if known
+Trabecular bone score (optional)
+
+
+== Availability and usage ==
+FRAX is available free of charge online, and commercially as a desktop application, in paper-form as a FRAX pad, and as a mobile phone (Apple iOS or Android) application. The tool is compatible with 58 models for 53 countries, and is available in 28 languages.
+FRAX is incorporated into many national guidelines around the world, including those of Belgium, Canada, Japan, Netherlands, Poland, Sweden, Switzerland, UK (NOGG), and US (NOF). FRAX assessments are intended to provide guidance for determining access to treatment in healthcare systems.
+
+
+=== Adjustments ===
+Glucocorticoid use is included FRAX as a dichotomous variable, whereas the increased risk for fractures seen with glucocorticoid use is dependent on glucocorticoid dose and duration of use. Several methods have been proposed how to adjust FRAX accordingly.
+Though known to be a risk factor for fractures, type 2 diabetes is not included as such in FRAX. Some clinicians choose rheumatoid arthritis as an equivalent risk factor instead.
+FRAX was developed and most commonly used to assess fracture risk for previously untreated individuals, though some have suggested it can also be used in those treated in the past or even on current treatment for osteoporosis.
+
+
+== See also ==
+Preventive healthcare
+
+
+== References ==
+
+
+== External links ==
+Official website
+Alternate FRAX calculator that doesn't use Java
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Family_history_(medicine)-0.md b/data/en.wikipedia.org/wiki/Family_history_(medicine)-0.md
new file mode 100644
index 000000000..29677387c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Family_history_(medicine)-0.md
@@ -0,0 +1,42 @@
+---
+title: "Family history (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Family_history_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:51.322749+00:00"
+instance: "kb-cron"
+---
+
+In medicine, a family history (FH or FHx) consists of information about disorders of direct blood relatives of the patient. Genealogy typically includes very little of the medical history of the family, but the medical history could be considered a specific subset of the total history of a family. Accurate knowledge of a patient's family history may identify a predisposition to developing certain illnesses, which can inform clinical decisions and allow effective management or even prevention of conditions.
+
+
+== Eugenic origins and applications ==
+Early mentions of family medical histories in medical literature date from the 1840s. Henry Ancell mentioned inquiring about the family history of a patient in a medical case study in 1842, noting that the patient's presenting concern appears to be present in relatives and remarking on the prolific reproduction of her female relatives. In 1849, W.H. Walshe argued in a lecture at University College London Hospital that in addition to a history of the presenting disease itself, a physician should also collect family history.  Walshe's lecture does not define or justify the family history, which may suggest that taking one was already in common practice. However, later 19th-century physicians did provide a specific apologia for family histories and in some cases explicitly noted that they were not yet being taken routinely.
+
+James Begbie argued that understanding the health of the entire family, including cousins, can help predict otherwise unpredictable illnesses that run in the family.  Begbie's use of the family history for both predictive and normative evaluation of the family anticipated Francis Galton, who championed the routine family history as a eugenic strategy in his 1883 text, Inquiries into Human Faculty and Its Development. Galton writes: "The investigation of human eugenics—that is, of the conditions under which men of a high type are produced—is at present extremely hampered by the want of full family histories, both medical and general, extending over three or four generations. There is no such difficulty in investigating animal eugenics, because the generations of horses, cattle, dogs, etc., are brief, and the breeder of any such stock lives long enough to acquire a large amount of experience from his own personal observation. A man, however, can rarely be familiar with more than two or three generations of his contemporaries before age has begun to check his powers; his working experience must therefore be chiefly based upon records. Believing, as I do, that human eugenics will become recognised before long as a study of the highest practical importance, it seems to me that no time ought to be lost in encouraging and directing a habit of compiling personal and family histories." Galton argued in the early 1900s for the development of eugenic certification based on consulting these histories. Starting in the 1920s, family medical histories were used by government eugenics bodies to evaluate candidates for compulsory sterilization. Eugenics Boards such as the Eugenics Board of North Carolina also considered family medical histories for the issuance of eugenic certificates marking a candidate as fit for marriage and reproduction. The Disability History Museum includes a mock eugenic certificate from circa 1924 which was intended to be sent as a love note.
+
+
+== Uses ==
+Although sometimes neglected, many healthcare professionals glean information on family morbidity of particular diseases (e.g. cardiovascular diseases, autoimmune disorders, mental disorders, diabetes, cancer) to assess whether a person is at risk of developing similar problems.
+Family histories may be imprecise because of various possible reasons:
+
+Adoption, fostering, illegitimacy, and adultery
+Lack of contact between close relatives
+Uncertainty about the relative's exact diagnosis
+In complex situations, a family tree or genogram may be used to organize the resulting information.
+Some medical conditions are carried only by the female line such as X-linked conditions and some Mitochondrial diseases.  Tracing female ancestors can be difficult in societies that change the woman's family name when she marries. Death records often give the maiden name of the deceased, and possibly also the deceased's mother's maiden name. Some of the most useful records for tracing women are wills and probate records.
+Other medical conditions are carried only by the male line, though these Y-linked conditions are rare owing to the small size of the Y Chromosome. Tracing male ancestors may be impossible if the conception is due to rape or sexual activity outside of marriage.
+Attaining the age when family members are diagnosed with a certain disease can also be helpful for screening purposes, like colon and breast cancer.
+
+
+== Consequences ==
+Not all positive family histories imply a genetic cause. If various members of the same family have been exposed to the same toxin, then they may develop similar symptoms without a genetic cause.
+If a patient has a strong family history of a particular disorder (or group of disorders), this will generally lead to a lower threshold for investigating symptoms or initiating treatment. This is seen particularly in cardiac disease, where strong family history is considered a significant cardiovascular risk factor.
+In diseases with a known hereditary component, many otherwise healthy people with a positive family history are tested early, with the aim of an early diagnosis and intervention to prevent the symptoms from developing. This has become accepted in hemochromatosis and various other disorders.
+
+
+== Definitions ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Fascia-0.md b/data/en.wikipedia.org/wiki/Fascia-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Fascia-0.md
@@ -0,0 +1,51 @@
+---
+title: "Fascia"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Fascia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:52.647635+00:00"
+instance: "kb-cron"
+---
+
+A fascia (; pl.: fasciae  or fascias; adjective fascial; from Latin  fascia 'band') is a generic term for macroscopic membranous bodily structures. Fasciae are classified as superficial, visceral or deep, and further designated according to their anatomical location.
+The knowledge of fascial structures is essential in surgery, as they create borders for infectious processes (for example Psoas abscess) and haematoma. An increase in pressure may result in a compartment syndrome, where a prompt fasciotomy may be necessary. For this reason, profound descriptions of fascial structures are available in anatomical literature from the 19th century.
+
+== Function ==
+Fasciae were traditionally thought of as passive structures that transmit mechanical tension generated by muscular activities or external forces throughout the body. An important function of muscle fasciae is to reduce friction of muscular force. In doing so, fasciae provide a supportive and movable wrapping for nerves and blood vessels as they pass through and between muscles. 
+In the tradition of medical dissections it has been common practice to carefully clean muscles and other organs from their surrounding fasciae in order to study their detailed topography and function. However, this practice tends to ignore that many muscle fibers insert into their fascial envelopes and that the function of many organs is significantly altered  when their related fasciae are removed. This insight contributed to several modern biomechanical concepts of the human body, in which fascial tissues take over important stabilizing and connecting functions, by distributing tensional forces across several joints in a network-like manner similar to the architectural concept of tensegrity.
+Starting in 2018 this concept of the fascial tissue serving as a body-wide tensional support system has been successfully expressed as an educational model with the Fascial Net Plastination Project. 
+Fascial tissues – particularly those with tendinous or aponeurotic properties – are also able to store and release elastic potential energy.
+Beyond storing and releasing elastic energy, fascial tissues contribute to proprioception and motor control through dense innervation with mechanoreceptors and nociceptors. Recent biomechanical studies also emphasize the role of fascial networks in distributing strain across multiple joints. This is an idea often framed as a body-wide tensegrity system, so that fascia participates dynamically in coordinated movement and postural stability.
+
+== Anatomical compartments ==
+
+A fascial compartment is a section within the body that contains muscles and nerves and is surrounded by fascia. In the human body, the limbs can each be divided into two segments. The upper limb can be divided into the arm and the forearm; their sectional compartments are the fascial compartments of the arm and the fascial compartments of the forearm, which both contain an anterior and a posterior compartment. The lower limbs can also be divided into two segments: the leg and the thigh; those contain the fascial compartments of the leg and the fascial compartments of the thigh respectively.
+
+== Clinical significance ==
+Fascia itself becomes clinically important when it loses stiffness, becomes too stiff, or has decreased shearing ability. Fascial dysfunction has been implicated in a range of musculoskeletal pain syndromes, including myofascial pain  and some cases of chronic low back pain, where altered fascial gliding or adhesions may contribute to symptoms. Surgical disruption of fascial planes can produce postoperative adhesions and functional limitations. Rehabilitation approaches such as targeted physical therapy and myofascial release aim to restore fascial mobility and reduce pain, though high-quality randomized trials assessing long-term efficacy are limited. When inflammatory fasciitis or trauma causes fibrosis and adhesions, fascial tissue fails to differentiate the adjacent structures effectively. This can happen after surgery, where the fascia has been incised and healing includes a scar that traverses the surrounding structures.
+
+== Research ==
+
+The Fascial Net Plastination Project (FNPP) is an anatomical research initiative spearheaded by fascia researcher Robert Schleip. The project aims to enhance the study of fascia through the technique of plastination. Led by an international team of fascia experts and anatomists, the FNPP resulted in the creation of a full-body fascia plastinate known as FR:EIA (Fascia Revealed: Educating Interconnected Anatomy). This plastinate provides a detailed view of the human fascial network, allowing for a better understanding of its structure and function as an interconnected tissue throughout the body.
+FR:EIA was unveiled at the 2021 Fascia Research Congress and is currently exhibited at the Body Worlds exhibition in Berlin. This project represents a significant contribution to the visualization of fascia and has the potential to influence future research in fields such as medicine, physical therapy, and movement science.
+
+== Terminology ==
+There exists some controversy about what structures are considered "fascia" and how they should be classified.
+The current version of the International Federation of Associations of Anatomists divides into:
+
+Fascia craniocervicalis
+Fascia trunci
+Fascia parietalis
+Fascia extraserosalis
+Fascia visceralis
+Fasciae membrorum
+Fasciae musculorum
+Fascia investiens
+Fascia propria musculi
+
+=== Previous terminology ===
+Two former, rather commonly used systems are:
+
+The one specified in the 1983 edition of Nomina Anatomica (NA 1983)
+The one specified in the 1997 edition of Terminologia Anatomica (TA 1997)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Fascia-1.md b/data/en.wikipedia.org/wiki/Fascia-1.md
new file mode 100644
index 000000000..d337a7a9c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Fascia-1.md
@@ -0,0 +1,42 @@
+---
+title: "Fascia"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Fascia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:52.647635+00:00"
+instance: "kb-cron"
+---
+
+==== Superficial ====
+Superficial fascia is the lowermost layer of the skin in nearly all of the regions of the body, that blends with the reticular dermis layer. It is present on the face, over the upper portion of the sternocleidomastoid, at the nape of the neck and overlying the breastbone. It consists mainly of loose areolar and fatty adipose connective tissue and is the layer that primarily determines the shape of a body. In addition to its subcutaneous presence, superficial fascia surrounds organs, glands and neurovascular bundles, and fills otherwise empty space at many other locations. It serves as a storage medium of fat and water; as a passageway for lymph, nerve and blood vessels; and as a protective padding to cushion and insulate.
+Superficial fascia is present, but does not contain fat, in the eyelid, ear, scrotum, penis and clitoris.
+Due to its viscoelastic properties, superficial fascia can stretch to accommodate the deposition of adipose that accompanies both ordinary and prenatal weight gain. After pregnancy and weight loss, the superficial fascia slowly reverts to its original level of tension.
+
+==== Visceral ====
+Visceral fascia (also called subserous fascia) suspends the organs within their cavities and wraps them in layers of connective tissue membranes.  Each of the organs is covered in a double layer of fascia; these layers are separated by a thin serous membrane.
+
+The outermost wall of the organ is known as the parietal layer
+The skin of the organ is known as the visceral layer. The organs have specialized names for their visceral fasciae. In the brain, they are known as meninges; in the heart they are known as pericardia; in the lungs, they are known as pleurae; and in the abdomen, they are known as peritonea.
+Visceral fascia is less extensible than superficial fascia.  Due to its suspensory role for the organs, it needs to maintain its tone rather consistently. If it is too lax, it contributes to organ prolapse, yet if it is hypertonic, it restricts proper organ motility.
+
+==== Deep ====
+
+Deep fascia is a layer of dense fibrous connective tissue which surrounds individual muscles and divides groups of muscles into fascial compartments. This fascia has a high density of elastin fibre that determines its extensibility or resilience. Deep fascia was originally considered to be essentially avascular but later investigations have confirmed a rich presence of thin blood vessels. Deep fascia is also richly supplied with sensory receptors. Histologically, fascia is composed predominantly of type I collagen fibers with variable amounts of elastin, which together determine tensile strength and extensibility. Fibroblasts are the principal resident cells, and fascial tissue contains vascular elements (particularly in deep fascia), immune cells such as macrophages and mast cells, and a dense array of sensory nerve endings; these features enable fascia to participate in repair, inflammation, and nociception. Examples of deep fascia are fascia lata, fascia cruris, brachial fascia, plantar fascia, thoracolumbar fascia and Buck's fascia.
+
+== See also ==
+Clavipectoral fascia
+Endothoracic fascia
+Extracellular matrix
+Fascia (architecture)
+Interstitial cell
+Pectoral fascia
+Thoracolumbar fascia
+Myofascial trigger point
+
+== References ==
+
+== External links ==
+
+Fascia Research
+lesson1layersofbody at The Anatomy Lesson by Wesley Norman (Georgetown University)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Fibrosis-0.md b/data/en.wikipedia.org/wiki/Fibrosis-0.md
new file mode 100644
index 000000000..3e419df42
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Fibrosis-0.md
@@ -0,0 +1,79 @@
+---
+title: "Fibrosis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Fibrosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:54.008675+00:00"
+instance: "kb-cron"
+---
+
+Fibrosis, also known as fibrotic scarring, is the development of fibrous connective tissue in response to an injury. Fibrosis can be a normal connective tissue deposition or excessive tissue deposition caused by a disease.
+Repeated injuries, chronic inflammation and repair are susceptible to fibrosis, where an accidental excessive accumulation of extracellular matrix components, such as collagen, is produced by fibroblasts, leading to the formation of a permanent fibrotic scar.
+In response to injury, this is called scarring, and if fibrosis arises from a single cell line, this is called a fibroma. Physiologically, fibrosis acts to deposit connective tissue, which can interfere with or totally inhibit the normal architecture and function of the underlying organ or tissue. Fibrosis can be used to describe the pathological state of excess deposition of fibrous tissue, as well as the process of connective tissue deposition in healing. Defined by the pathological accumulation of extracellular matrix (ECM) proteins, fibrosis results in scarring and thickening of the affected tissue — it is in essence a natural wound healing response which interferes with normal organ function.
+
+
+== Physiology ==
+Fibrosis is similar to the process of scarring, in that both involve stimulated fibroblasts laying down connective tissue, including collagen and glycosaminoglycans. The process is initiated when immune cells such as macrophages release soluble factors that stimulate fibroblasts.  The most well characterized pro-fibrotic mediator is TGF beta, which is released by macrophages as well as any damaged tissue between surfaces called interstitium.   Other soluble mediators of fibrosis include CTGF, platelet-derived growth factor (PDGF), and interleukin 10 (IL-10). These initiate signal transduction pathways such as the AKT/mTOR and SMAD  pathways that ultimately lead to the proliferation and activation of fibroblasts, which deposit extracellular matrix into the surrounding connective tissue.  This process of tissue repair is a complex one, with tight regulation of extracellular matrix (ECM) synthesis and degradation ensuring maintenance of normal tissue architecture. However, the entire process, although necessary,  can lead to a progressive irreversible fibrotic response if tissue injury is severe or repetitive, or if the wound healing response itself becomes deregulated.
+
+
+== Anatomical location ==
+Fibrosis can occur in many tissues within the body, typically as a result of inflammation or damage. Common sites of fibrosis include the lungs, liver, kidneys, brain, and heart:
+
+
+=== Lungs ===
+Fibrothorax
+Pulmonary fibrosis
+Cystic fibrosis
+Idiopathic pulmonary fibrosis (idiopathic meaning 'of unknown cause')
+Radiation-induced lung injury (following radiation therapies commonly used to treat cancer)
+
+
+=== Liver ===
+Bridging fibrosis – an advanced stage of liver fibrosis, seen in the progressive form of chronic liver diseases. The term bridging refers to the formation of a "bridge" by a band of mature and thick fibrous tissue from the portal area to the central vein. This form of fibrosis leads to the formation of pseudolobules. Long-term exposure to hepatotoxins, such as thioacetamide, carbon tetrachloride, and diethylnitrosamine, has been shown to cause bridging fibrosis in experimental animal models.
+Senescence of hepatic stellate cells could prevent progression of liver fibrosis, although has not yet been implemented as a therapy due to risks associated with hepatic dysfunction.
+
+Cirrhosis
+
+
+=== Kidney ===
+CYR61 induction of cellular senescence in the kidney has shown potential to limit renal fibrosis.
+
+
+=== Brain ===
+Glial scar
+
+
+=== Heart ===
+Myocardial fibrosis has two forms:
+
+Interstitial fibrosis, described in cases of congestive heart failure and hypertension, and as part of normal cellular aging.
+Replacement fibrosis, indicating tissue damage from previous myocardial infarction.
+
+
+=== Other ===
+Arterial stiffness
+Arthrofibrosis (knee, shoulder, other joints)
+Chronic kidney disease
+Crohn's disease (intestine)
+Dupuytren's contracture (hands, fingers)
+Keloid (skin)
+Lipedema (fat cells, typically in lower limbs)
+Mediastinal fibrosis (soft tissue of the mediastinum)
+Myelofibrosis (bone marrow)
+Myofibrosis (skeletal muscle)
+Peyronie's disease (penis)
+Nephrogenic systemic fibrosis (skin)
+Progressive massive fibrosis (lungs); a complication of pneumoconiosis
+Retroperitoneal fibrosis (soft tissue of the retroperitoneum)
+Scleroderma/systemic sclerosis (skin, lungs)
+Some forms of adhesive capsulitis (shoulder)
+Fibrosis reversal
+Historically, fibrosis was considered an irreversible process. However, several recent studies have demonstrated reversal in liver and lung tissue, and in cases of renal, myocardial, and oral-submucosal fibrosis.
+
+
+== References ==
+
+
+== External links ==
+ Media related to Fibrosis at Wikimedia Commons
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Five-year_survival_rate-0.md b/data/en.wikipedia.org/wiki/Five-year_survival_rate-0.md
new file mode 100644
index 000000000..36f877121
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Five-year_survival_rate-0.md
@@ -0,0 +1,35 @@
+---
+title: "Five-year survival rate"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Five-year_survival_rate"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:55.293134+00:00"
+instance: "kb-cron"
+---
+
+The five-year survival rate is a type of survival rate for estimating the prognosis of a particular disease, normally calculated from the point of diagnosis.  Lead time bias from earlier diagnosis can affect interpretation of the five-year survival rate.
+There are absolute and relative survival rates, but the latter are more useful and commonly used.
+
+
+== Relative and absolute rates ==
+Five-year relative survival rates are more commonly cited in cancer statistics. Five-year absolute survival rates may sometimes also be cited.
+
+Five-year absolute survival rates describe the percentage of patients alive five years after the disease is diagnosed.
+Five-year relative survival rates describe the percentage of patients with a disease alive five years after the disease is diagnosed, divided by the percentage of the general population of corresponding sex and age alive after five years. Typically, cancer five-year relative survival rates are well below 100%, reflecting excess mortality among cancer patients compared to the general population. In contrast to five-year absolute survival rates, five-year relative survival rates may also equal or even exceed 100% if cancer patients have the same or even higher survival rates than the general population. The pattern may occur if cancer patients can generally be cured, or patients diagnosed with cancer have greater socioeconomic wealth or access to medical care than the general population.
+The fact that relative survival rates above 100% were estimated for some groups of patients appears counterintuitive on first view. It is unlikely that occurrence of prostate cancer would increase chances of survival, compared to the general population. A more plausible explanation is that the pattern reflects a selection effect of PSA screening, as screening tests tend to be used less often by socially disadvantaged population groups, who, in general, also have higher mortality.
+
+
+== Uses ==
+Five-year survival rates can be used to compare the effectiveness of treatments. Use of five-year survival statistics is more useful in aggressive diseases that have a shorter life expectancy following diagnosis, such as lung cancer, and less useful in cases with a long life expectancy, such as prostate cancer. Improvements in rates are sometimes attributed to improvements in diagnosis rather than to improvements in prognosis. To compare treatments independently from diagnostics, it may be better to consider survival from reaching a certain stage of the disease or its treatment.
+Analysis performed against the Surveillance, Epidemiology, and End Results database (SEER) facilitates calculation of five-year survival rates.
+
+
+== See also ==
+Prognosis – Medical term for the likely development of a disease
+Relative survival – Calculation in epidemiology
+Survival analysis – Branch of statistics
+Survival rate – Medical analysis of disease
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Fomite-0.md b/data/en.wikipedia.org/wiki/Fomite-0.md
new file mode 100644
index 000000000..5585357de
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Fomite-0.md
@@ -0,0 +1,28 @@
+---
+title: "Fomite"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Fomite"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:56.412800+00:00"
+instance: "kb-cron"
+---
+
+A fomite () or fomes () is any inanimate object that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host.
+
+== Transfer of pathogens by fomites ==
+A fomite is any inanimate object (also called passive vector) that, when contaminated with or exposed to infectious agents (such as pathogenic bacteria, viruses or fungi), can transfer disease to a new host. Contamination can occur when one of these objects comes into contact with bodily secretions, like nasal fluid, vomit or feces from toilet plume. Many common objects can sustain a pathogen until a person comes in contact with the pathogen, increasing the chance of infection. The likely objects are different in a hospital environment than at home or in a workplace. Fomites such as splinters, barbed wire or farmyard surfaces, including soil, feeding troughs or barn beams, have been implicated as sources of virus.
+
+=== Hospital fomites ===
+For humans, common hospital fomites are skin cells, hair, clothing, and bedding.
+Fomites are associated particularly with hospital-acquired infections (HAIs), as they are possible routes to pass pathogens between patients. Stethoscopes and neckties are common fomites associated with health care providers. It worries epidemiologists and hospital practitioners because of the growing selection of microbes resistant to disinfectants or antibiotics (so-called antimicrobial resistance phenomenon).
+Basic hospital equipment, such as IV drip tubes, catheters, and life support equipment, can also be carriers, when the pathogens form biofilms on the surfaces. Careful sterilization of such objects prevents cross-infection. Used syringes, if improperly handled, are particularly dangerous fomites.
+
+=== Daily life ===
+In addition to objects in hospital settings, other common fomites for humans are cups, spoons, pencils, bath faucet handles, toilet flush levers, door knobs, light switches, handrails, elevator buttons, television remote controls, pens, touch screens, common-use phones, keyboards and computer mice, coffeepot handles, countertops, drinking fountains, and any other items that may be frequently touched by different people and infrequently cleaned.
+Cold sores, hand–foot–mouth disease, and diarrhea are some examples of illnesses easily spread by contaminated fomites. The risk of infection by these diseases and others through fomites can be greatly reduced by simply washing one's hands. When two children in one household have influenza, more than 50% of shared items are contaminated with virus. In 40–90% cases, adults infected with rhinovirus have it on their hands.
+
+=== Transmission in fitness environments ===
+Fitness centers and gymnasiums are increasingly recognized as environments that may facilitate fomite-mediated transmission due to shared equipment, high-touch surfaces, and frequent human contact. Items such as free weights, exercise machines, yoga mats, and locker room surfaces can serve as reservoirs for microorganisms if not adequately disinfected.
+Pathogens including methicillin-resistant Staphylococcus aureus (MRSA), dermatophyte fungi, and certain viruses have been associated with transmission in athletic and fitness settings. Transmission may occur when individuals come into contact with contaminated surfaces and subsequently touch their skin, mucous membranes, or open wounds.
+In fitness environments, recommended measures include regular disinfection of shared equipment, proper hand hygiene, use of personal barriers such as towels, and improved ventilation to reduce microbial persistence on surfaces and in the air.
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+---
+title: "Fomite"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Fomite"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:56.412800+00:00"
+instance: "kb-cron"
+---
+
+=== Transmission of specific viruses ===
+Researchers have discovered that smooth (non-porous) surfaces like door knobs transmit bacteria and viruses better than porous materials like paper money because porous, especially fibrous, materials absorb and trap the contagion, making it harder to contract through simple touch. Nonetheless, fomites may include soiled clothes, towels, linens, handkerchiefs, and surgical dressings.
+SARS-CoV-2 was found to be viable on various surfaces from 4 to 72 hours under laboratory conditions. On porous surfaces, studies report inability to detect viable virus within minutes to hours; on non-porous surfaces, viable virus can be detected for days to weeks. However, further research called into question the relevance of such tests, instead finding fomite transmission of SARS-Cov-2 in real world settings is extremely rare when standard cleaning procedure are followed.
+Contact with aerosolized virus (large droplet spread) generated via talking, sneezing, coughing, or vomiting, toilet flushing & produced toilet plume or contact with airborne virus that settles after disturbance of a contaminated fomite (e.g. shaking a contaminated blanket). During the first 24 hours, the risk can be reduced by increasing ventilation and waiting as long as possible before entering the space (at least several hours, based on documented airborne transmission cases), and using personal protective equipment (including any protection needed for the cleaning and disinfection products) to reduce risk.
+The 2007 research showed that the influenza virus was still active on stainless steel 24 hours after contamination. Though on hands it survives only for five minutes, the constant contact with a fomite almost certainly means catching the infection. Transfer efficiency depends not only on surface, but mainly on pathogen type. For example, avian influenza survives on both porous and non-porous materials for 144 hours.
+Smallpox was long supposed to be transmitted either by direct contact or by fomites. However A. R. Rao’s careful researches in the 1960s, before smallpox was declared extinct, found little truth in the traditional belief that smallpox can be spread at a distance through infected clothing or bedding. He concluded that it normally invaded via the lungs. Rao recognized that the virus can be detected on inanimate objects, and therefore might in some cases be transmitted by them, but he concluded that “smallpox is still an inhalation disease ...  the virus has to enter through the nose by inhalation". 
+In 2002 Donald K. Milton published a review of existing research upon the transmission of smallpox and upon recommendations for controlling its spread in the event of its use in biological war. He agreed, citing Rao, Fenner and others, that “careful epidemiologic investigation rarely implicated fomites as a source of infection”; and broadly agreed with  current recommendations for control of secondary smallpox infections, which emphasized transmission via “expelled droplets” upon the breath. He noted that shed scabs (which might be spread via bedsheets or other fomites) often contain “large quantities of virus”, but suggested that the “apparent lack of infectiousness of scab associated virus” might  be due to “encapsulation with inspissated pus”.
+Contaminated needles are the most common fomite that transmits HIV. Fomites from dirty needles also easily spread Hepatitis B.
+
+== Etymology ==
+
+The Italian scholar and physician Girolamo Fracastoro appears to have first used the Latin word fomes, meaning "tinder", in this sense in his essay on contagion, De Contagione et Contagiosis Morbis, published in 1546: "By fomes I mean clothes, wooden objects, and things of that sort, which though not themselves corrupted can, nevertheless, preserve the original germs of the contagion and infect by means of these".
+English usage of fomes, pronounced , is documented since 1658. The English word fomite, which has been in use since 1859, is a back-formation from the plural fomites (originally borrowed from the Latin plural fōmĭtēs [ˈfoːmɪteːs] of fōmĕs [ˈfoːmɛs]). Over time, the English-language pronunciation of the plural fomites changed from ) to , which led to the creation of a new singular fomite, pronounced . 
+In Latin, fomes (genitive: fomitis, plural fomites, stem fomit-) is a third-declension T-stem noun. Such nouns, like miles/militis or comes/comitis, typically lose their T (thereby becoming a syllable shorter) in the nominative singular, but retain it in all other cases. In languages derived from Latin, the French fomite, Italian fomite, Spanish fómite and Portuguese fómite or fômite, retain the full stem.
+
+== See also ==
+Focal infection theory
+Focus of infection
+Disease vector
+
+== References ==
+
+== Bibliography ==
+Cook, Nigel (2013), "10.1 Introduction; the role of fomites in the virus transmission", Viruses in Food and Water: Risks, Surveillance and Control, Cambridge: Woodhead Publishing, pp. 205–215, ISBN 978-0-85709-887-0
+Bennett, John V.; Jarvis, William Robert; Brachman, Philip S. (2007), "Chapter 19: The Inanimate Environment", Bennett & Brachman's Hospital Infections, Philadelphia: Lippincott Williams & Wilkins, p. 277, ISBN 978-0-7817-6383-7
+Fortuine, Robert (2000), The Words of Medicine: Sources, Meanings, and Delights, Springfield: Charles C Thomas Publisher, p. 53, ISBN 0398071322
+Larson, Elaine L.; Liverman, Catharyn T. (2011), "Understanding the Risk to Healthcare Personnel: Fomite Persistence", Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010, Washington: National Academies Press, p. 41, ISBN 978-0-309-16254-8
+Shors, Teri (2017), "Clinical Signs and Symptoms of Human Herpersviruses", Understanding Viruses, Wisconsin: Jones & Bartlett Learning, ISBN 978-1-284-02592-7
+
+== External links ==
+General characteristics and roles of fomites in viral transmission, American Society for Microbiology, 1969 Archived 24 April 2010 at the Wayback Machine
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diff --git a/data/en.wikipedia.org/wiki/Fremitus-0.md b/data/en.wikipedia.org/wiki/Fremitus-0.md
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+---
+title: "Fremitus"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Fremitus"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:58.816310+00:00"
+instance: "kb-cron"
+---
+
+Fremitus is a vibration transmitted through the body. In common medical usage, it usually refers to assessment of the lungs by either the vibration intensity felt on the chest wall (tactile fremitus) and/or heard by a stethoscope on the chest wall with certain spoken words (vocal fremitus), although there are several other types.
+
+
+== Types ==
+
+
+=== Vocal fremitus ===
+When a person speaks, the vocal cords create vibrations (vocal fremitus) in the tracheobronchial tree and through the lungs and chest wall, where they can be felt (tactile fremitus).  This is usually assessed with the healthcare provider placing the flat of their palms on the chest wall and then asking a patient to repeat a phrase containing low-frequency vowels such as "blue balloons" or "toys for tots" (the original diphthong used was the German word neunundneunzig but the translation to the English 'ninety-nine' was a higher-frequency diphthong and thus not as effective in eliciting fremitus).  An increase in tactile fremitus indicates denser or inflamed lung tissue, which can be caused by diseases such as pneumonia.  A decrease suggests air or fluid in the pleural spaces or a decrease in lung tissue density, which can be caused by diseases such as chronic obstructive pulmonary disease or asthma.
+
+
+=== Pleural fremitus ===
+Pleural fremitus is a palpable vibration of the wall of the thorax caused by friction between the parietal and visceral pleura of the lungs. See pleural friction rub for the auditory analog of this sign.
+
+
+=== Dental fremitus ===
+Fremitus appears when teeth move.  This can be assessed by feeling and looking at teeth when the mouth is opened and closed.
+
+
+=== Periodontal fremitus ===
+Periodontal fremitus occurs in either of the alveolar bones when an individual sustains trauma from occlusion. It is a result of teeth exhibiting at least slight mobility rubbing against the adjacent walls of their sockets, the volume of which has been expanded ever so slightly by inflammatory responses, bone resorption or both. As a test to determine the severity of periodontal disease, a patient is told to close their mouth into maximum intercuspation and is asked to grind their teeth ever so slightly. Fingers placed in the labial vestibule against the alveolar bone can detect fremitus.
+
+
+=== Rhonchal fremitus ===
+Rhonchal fremitus, also known as bronchial fremitus, is a palpable vibration produced during breathing caused by partial airway obstruction. The obstruction can be due to mucus or other secretions in the airway, bronchial hyperreactivity, or tumors. See rhonchus (rhonchi) for the auditory analog of this sign.
+
+
+=== Tactile fremitus ===
+Tactile fremitus, known by many other names including pectoral fremitus, tactile vocal fremitus, or just vocal fremitus, is a vibration felt on the patient's chest during low frequency vocalization. Commonly, the patient is asked to repeat a phrase while the examiner feels for vibrations by placing a hand over the patient's chest or back. Phrases commonly used in English include, 'boy oh boy' and 'toy boat' (diphthong phrases), as well as 'blue balloons' and 'Scooby-Doo'. 'Ninety-nine' is classically included, however, this is a misinterpretation of the original German report, in which "neunundneunzig" was the low-frequency diphthong of choice.
+Tactile fremitus is normally more intense in the right second intercostal space, as well as in the interscapular region, as these areas are closest to the bronchial trifurcation (right side) or bifurcation (left side). Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of pleural effusion or pneumothorax (when there is air outside the lung in the chest cavity, preventing lung expansion).
+The reason for increased fremitus in a consolidated lung is the fact that the sound waves are transmitted with less decay in a solid or fluid medium (the consolidation) than in a gaseous medium (aerated lung). Conversely, the reason for decreased fremitus in a pleural effusion or pneumothorax (or any pathology separating the lung tissue itself from the body wall) is that this increased space diminishes or prevents entirely sound transmission.
+It has been suggested that the artifacts caused by eliciting tactile fremitus during breast ultrasonography can be used to differentiate between benign and malignant tumors.
+
+
+=== Tussive fremitus ===
+Tussive fremitus is a vibration felt on the chest when the patient coughs.
+
+
+=== Pericardial fremitus ===
+Pericardial fremitus is a vibration felt on the chest wall due to the friction of the surfaces of the pericardium over each other. See pericardial friction rub for the auditory analog of this sign.
+
+
+=== Hydatid fremitus ===
+Hydatid fremitus is a vibratory sensation felt on palpating a hydatid cyst.
+
+
+== References ==
+
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/Fulminant-0.md b/data/en.wikipedia.org/wiki/Fulminant-0.md
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+---
+title: "Fulminant"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Fulminant"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:00.136142+00:00"
+instance: "kb-cron"
+---
+
+Fulminant () is a medical descriptor for any event or process that occurs suddenly and escalates quickly, and is intense and severe to the point of lethality, i.e., it has an explosive character. The word comes from Latin fulmināre, to strike with lightning. There are several diseases described by this adjective:
+
+Fulminant liver failure
+Fulminant (Marburg variant) multiple sclerosis
+Fulminant colitis
+Fulminant pre-eclampsia
+Fulminant meningitis
+Purpura fulminans
+Fulminant hepatic venous thrombosis (Budd-Chiari syndrome)
+Fulminant jejunoileitis
+Fulminant myocarditis
+Beyond these particular uses, the term is used more generally as a descriptor for sudden-onset medical conditions that are immediately threatening to life or limb. Some viral hemorrhagic fevers, such as Ebola, Lassa fever, and Lábrea fever, may kill in as little as two to five days. Diseases that cause rapidly developing lung edema, such as some kinds of pneumonia, may kill in a few hours. It was said of the "black death" (pneumonic bubonic plague) that some of its victims would die in a matter of hours after the initial symptoms appeared. Other pathologic conditions that may be fulminating in character are acute respiratory distress syndrome, asthma, acute anaphylaxis, septic shock, Sweating sickness, and disseminated intravascular coagulation.
+The term is generally not used to refer to immediate death by trauma, such as gunshot wound, but can refer to trauma-induced secondary conditions, such as commotio cordis, a sudden cardiac arrest caused by a blunt, non-penetrating trauma to the precordium, which causes ventricular fibrillation of the heart. Cardiac arrest and stroke in certain parts of the brain, such as in the brainstem (which controls cardiovascular and respiratory system functions), and massive hemorrhage of the great arteries (such as in perforation of the walls by trauma or by sudden opening of an aneurysm of the aorta) may be very quick, causing "fulminant death". Sudden infant death syndrome (SIDS) is still a mysterious cause of respiratory arrest in infants. Certain infections of the brain, such as rabies, meningococcal meningitis, Acute measles encephalitis, or primary amebic meningoencephalitis can kill within hours to days after symptoms appear.
+Some toxins, such as cyanide, may also provoke fulminant death. Abrupt hyperkalemia provoked by intravenous injection of potassium chloride leads to fulminant death by cardiac arrest.
+
+
+== Related terms ==
+
+To fulminate is to hurl verbal denunciations, severe criticisms, or menacing comments at someone. Rarely, it is used in its original sense, "to kill by lightning".
+Fulminates are a class of explosives used in detonator caps. They are named for the startling suddenness with which they explode.
+
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Functional_disorder-0.md b/data/en.wikipedia.org/wiki/Functional_disorder-0.md
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+---
+title: "Functional disorder"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Functional_disorder"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:01.456201+00:00"
+instance: "kb-cron"
+---
+
+Functional disorders are a group of recognisable medical conditions which are due to changes to the functioning of the systems of the body rather than due to a disease affecting the structure of the body.
+Functional disorders are common and complex phenomena that pose challenges to medical systems. Traditionally in medicine, the body is thought of as consisting of different organ systems, but it is less well understood how the systems interconnect or communicate. Functional disorders can affect the interplay of several organ systems (for example gastrointestinal, respiratory, musculoskeletal or neurological) leading to multiple and variable symptoms. Less commonly there is a single prominent symptom or organ system affected.
+Most symptoms that are caused by structural disease can also be caused by a functional disorder. Because of this, individuals often undergo many medical investigations before the diagnosis is clear. Though research is growing to support explanatory models of functional disorders, structural scans such as MRIs, or laboratory investigation such as blood tests do not usually explain the symptoms or the symptom burden. This difficulty in 'seeing' the processes underlying the symptoms of functional disorders has often resulted in these conditions being misunderstood and sometimes stigmatised within medicine and society.
+Despite being associated with high disability, functional symptoms are not a threat to life, and are considered modifiable with appropriate treatment.
+
+== Definition ==
+
+Functional disorders are a group of conditions characterised by persistent and often distressing symptoms that lead to significant impairment or disability. Unlike structural diseases, where clear abnormalities of organs or tissues can be identified, functional disorders are primarily understood as disturbances in the functioning and communication of body systems. Their pathophysiological basis often reflects dysregulation across neural, autonomic, endocrine, and immune pathways, shaped by interactions between biological, psychological, and social factors.
+
+=== Examples ===
+There are many different functional disorder diagnoses that might be given depending on the symptom or syndrome that is most troublesome. There are many examples of symptoms that individuals may experience; some of these include persistent or recurrent pain, fatigue, weakness, shortness of breath or bowel problems. Single symptoms may be assigned a diagnostic label, such as "functional chest pain", "functional constipation" or "functional seizures". Characteristic collections of symptoms might be described as one of the functional somatic syndromes. A syndrome is a collection of symptoms. Somatic means 'of the body'. Examples of functional somatic syndromes include: irritable bowel syndrome; cyclic vomiting syndrome; some persistent fatigue and chronic pain syndromes, such as fibromyalgia (chronic widespread pain), or chronic pelvic pain; interstitial cystitis; functional neurologic disorder; and multiple chemical sensitivity.
+
+== Overlap ==
+Most medical specialties define their own functional somatic syndrome, and a patient may end up with several of these diagnoses without understanding how they are connected. There is overlap in symptoms between all the functional disorder diagnoses. For example, it is not uncommon to have a diagnosis of irritable bowel syndrome (IBS) and chronic widespread pain/fibromyalgia. All functional disorders share risk factors and factors that contribute to their persistence. Increasingly researchers and clinicians are recognising the relationships between these syndromes.
+
+== Classification ==
+The terminology for functional disorders has been fraught with confusion and controversy, with many different terms used to describe them. Sometimes functional disorders are equated or mistakenly confused with diagnoses like category of "somatoform disorders", "medically unexplained symptoms", "psychogenic symptoms" or "conversion disorders". Many historical terms are now no longer thought of as accurate, and are considered by many to be stigmatising.
+Psychiatric illnesses have historically also been considered as functional disorders in some classification systems, as they often fulfil the criteria above. Whether a given medical condition is termed a functional disorder depends in part on the state of knowledge. Some diseases, such as epilepsy, were historically categorized as functional disorders but are no longer classified that way.
+
+== Prevalence ==
+Functional disorders can affect individuals of all ages, ethnic groups and socioeconomic backgrounds. In clinical populations, functional disorders are common and have been found to present in around one-third of consultations in both specialist practice and primary care.  Chronic courses of disorders are common and are associated with high disability, health-care usage and social costs.
+Rates differ in the clinical population compared with the general population, and will vary depending on the criteria used to make the diagnosis. For example, irritable bowel syndrome is thought to affect 4.1%, and fibromyalgia 0.2–11.4% of the global population.
+A recent large study carried out on population samples in Denmark showed the following: In total, 16.3% of adults reported symptoms fulfilling the criteria for at least one Functional Somatic Syndrome, and 16.1% fulfilled criteria for Bodily Distress Syndrome.
+
+== Diagnosis ==
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+---
+title: "Functional disorder"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Functional_disorder"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:01.456201+00:00"
+instance: "kb-cron"
+---
+
+The diagnosis of functional disorders is usually made in the healthcare setting most often by a doctor — this could be a primary care physician or family doctor, hospital physician or specialist in the area of psychosomatic medicine or a consultant-liaison psychiatrist. The primary care physician or family doctor will generally play an important role in coordinating treatment with a secondary care clinician if necessary.
+The diagnosis is essentially clinical, whereby the clinician undertakes a thorough medical and mental health history and physical examination. Diagnosis should be based on the nature of the presenting symptoms, and is a "rule in" as opposed to "rule out" diagnosis — this means it is based on the presence of positive symptoms and signs that follow a characteristic pattern. There is usually a process of clinical reasoning to reach this point and assessment might require several visits, ideally with the same doctor.
+In the clinical setting, there are no laboratory or imaging tests that can consistently be used to diagnose the conditions; however, as is the case with all diagnoses, often additional diagnostic tests (such as blood tests, or diagnostic imaging) will be undertaken to consider the presence of underlying disease. There are however diagnostic criteria that can be used to help a doctor assess whether an individual is likely to suffer from a particular functional syndrome. These are usually based on the presence or absence of characteristic clinical signs and symptoms. Self-report questionnaires may also be useful.
+There has been a tradition of a separate diagnostic classification systems for "somatic" and "mental" disorder classifications. Currently, the 11th version of the International Classification System of Diseases (ICD-11) has specific diagnostic criteria for certain disorders which would be considered by many clinicians to be functional somatic disorders, such as IBS or chronic widespread pain/fibromyalgia, and dissociative neurological symptom disorder.
+In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) the older term somatoform (DSM-IV) has been replaced by somatic symptom disorder, which is a disorder characterised by persistent somatic (physical) symptoms, and associated psychological problems to the degree that it interferes with daily functioning and causes distress. (APA, 2022). Bodily distress disorder is a related term in the ICD-11.
+Somatic symptom disorder and bodily distress disorder have significant overlap with functional disorders and are often assigned if someone would benefit from psychological therapies addressing psychological or behavioural factors which contribute to the persistence of symptoms. However, people with symptoms partly explained by structural disease (for example, cancer) may also meet the criteria for diagnosis of functional disorders, somatic symptom disorder and bodily distress disorder.
+It is not unusual for a functional disorder to coexist with another diagnosis (for example, functional seizures can coexist with epilepsy, or irritable bowel syndrome with inflammatory bowel disease. This is important to recognise as additional treatment approaches might be indicated in order that the patient achieves adequate relief from their symptoms.
+The diagnostic process is considered an important step in order for treatment to move forward successfully. When healthcare professionals are giving a diagnosis and carrying out treatment, it is important to communicate openly and honestly and not to fall into the trap of dualistic concepts – that is "either mental or physical" thinking; or attempt to "reattribute" symptoms to a predominantly psychosocial cause. It often important to recognise the need to cease unnecessary additional diagnostic testing if a clear diagnosis has been established .
+
+== Causes ==
+Explanatory models that support our understanding of functional disorders take into account the multiple factors involved in symptom development. A personalised, tailored approach is usually needed in order to consider the factors which relate to that individual's biomedical, psychological, social, and material environment.
+More recent functional neuroimaging studies have suggested malfunctioning of neural circuits involved in stress processing, emotional regulation, self-agency, interoception, and sensorimotor integration. A recent article in Scientific American proposed that important brain structures suspected in the pathophysiology of functional neurological disorder include increased activity of the amygdala and decreased activity within the right temporoparietal junction.
+Healthcare professionals might find it useful to consider three main categories of factors: predisposing, precipitating, and perpetuating (maintaining) factors.
+
+=== Predisposing factors ===
+These are factors that make the person more vulnerable to the onset of a functional disorder; and include biological, psychological and social factors. Like all health conditions, some people are probably predisposed to develop functional disorders due to their genetic make-up. However, no single genes have been identified that are associated with functional disorders. Epigenetic mechanisms (mechanisms that affect interaction of genes with their environment) are likely to be important, and have been studied in relation to the hypothalamic–pituitary–adrenal axis. Other predisposing factors include current or prior somatic/physical illness or injury, and endocrine, immunological or microbial factors.
+Functional disorders are diagnosed more frequently in female patients. Medical bias possibly contributes to the sex differences in diagnosis: women are more likely to be diagnosed than men with a functional disorder by doctors.
+People with functional disorders also have higher rates of pre-existing mental and physical health conditions, including depression and anxiety disorders, Post-traumatic stress disorder, multiple sclerosis and epilepsy. Personality style has been suggested as a risk factor in the development of functional disorders but the effect of any individual personality trait is variable and weak. Alexithymia has been widely studied in patients with functional disorders and is sometimes addressed as part of treatment. Migration, cultural and family understanding of illness, are also factors that influence the chance of an individual developing a functional disorder. Being exposed to illness in the family while growing up or having parents who are healthcare professionals are sometimes considered risk factors. Adverse childhood experiences and traumatic experiences of all kinds are known important risk factors. Newer hypotheses have suggested minority stressors may play a role in the development of functional disorders in marginalized communities.
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+---
+title: "Functional disorder"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Functional_disorder"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:01.456201+00:00"
+instance: "kb-cron"
+---
+
+=== Precipitating factors ===
+These are the factors that for some patients appear to trigger the onset of a functional disorder. Typically, these involve either an acute cause of physical or emotional stress, for example an operation, a viral illness, a car accident, a sudden bereavement, or a period of intense and prolonged overload of chronic stressors (for example relationship difficulties, job or financial stress, or caring responsibilities). Not all affected individuals will be able to identify obvious precipitating factors and some functional disorders develop gradually over time.
+
+=== Perpetuating factors ===
+These are the factors that contribute to the development of functional disorder as a persistent condition and maintaining symptoms. These can include the condition of the physiological systems including the immune and neuroimmune systems, the endocrine system, the musculoskeletal system, the sleep-wake cycle, the brain and nervous system, the person's thoughts and experience, their experience of the body, social situation and environment. All these layers interact with each other. Illness mechanisms are important therapeutically as they are seen as potential targets of treatment.
+The exact illness mechanisms that are responsible for maintaining an individual's functional disorder should be considered on an individual basis. However, various models have been suggested to account for how symptoms develop and continue. For some people there seems to be a process of central-sensitisation, chronic low grade inflammation or altered stress reactivity mediated through the hypothalamic-pituitary-adrenal (HPA) axis (Fischer et al., 2022). For some people attentional mechanisms are likely to be important. Commonly, illness-perceptions or behaviours and expectations (Henningsen, Van den Bergh et al. 2018 ) contribute to maintaining an impaired physiological condition.
+Perpetuating illness mechanisms are often conceptualized as "vicious cycles", which highlights the non-linear patterns of causality characteristic of these disorders. Other people adopt a pattern of trying to achieve a lot on "good days" which results in exhaustion for days following and a flare up of symptoms, which has led to various energy management tools being used in the patient community, such as "Spoon Theory."
+Depression, PTSD, sleep disorders, and anxiety disorders can also perpetuate functional disorders and should be identified and treated where they are present. Side effects or withdrawal effects of medication often need to be considered. Iatrogenic factors such as lack of a clear diagnosis, not feeling believed or not taken seriously by a healthcare professional, multiple (invasive) diagnostic procedures, ineffective treatments and not getting an explanation for symptoms can increase worry and unhelpful illness behaviours. Stigmatising medical attitudes and unnecessary medical interventions (tests, surgeries or drugs) can also cause harm and worsen symptoms.
+
+== Treatment ==
+Functional disorders can be treated successfully and are considered reversible conditions. Treatment strategies should integrate biological, psychological and social perspectives. The body of research around evidence-based treatment in functional disorders is growing.
+With regard to self-management, there are many basic things that can be done to optimise recovery. Learning about and understanding the condition is helpful in itself. Many people are able to use bodily complaints as a signal to slow down and reassess their balance between exertion and recovery. Bodily complaints can be used as a signal to begin incorporating stress reduction and balanced lifestyle measures (routine, regular activity and relaxation, diet, social engagement) that can help reduce symptoms and are central to improving quality of life. Mindfulness practice can be helpful for some people. Family members or friends can also be helpful in supporting recovery.
+Most affected people benefit from support and encouragement in this process, ideally through a multi-disciplinary team with expertise in treating functional disorders. Family members or friends may also be helpful in supporting recovery. The aim of treatment overall is to first create the conditions necessary for recovery, and then plan a programme of rehabilitation to re-train mind-body connections making use of the body's ability to change. Particular strategies can be taught to manage bowel symptoms, pain or seizures. Though medication alone should not be considered curative in functional disorders, medication to reduce symptoms might be indicated in some instances, for example where mood or pain is a significant issue, preventing adequate engagement in rehabilitation. It is important to address accompanying factors such as sleep disorders, pain, depression and anxiety, and concentration difficulties.
+Physiotherapy may be relevant for exercise and activation programs, or when weakness or pain is a problem. Psychotherapy might be helpful to explore a pattern of thoughts, actions and behaviours that could be driving a negative cycle – for example tackling illness expectations or preoccupations about symptoms.  Some existing evidence-based treatments include cognitive behavioural therapy (CBT) for functional neurological disorder; physiotherapy for functional motor symptoms, and dietary modification or gut targeting agents for irritable bowel syndrome.
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+---
+title: "Functional disorder"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Functional_disorder"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:01.456201+00:00"
+instance: "kb-cron"
+---
+
+== Controversies and stigma ==
+Despite some progress in the last decade, people with functional disorders continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. Stigma is a common experience for individuals who present with functional symptoms and is often driven by historical narratives and factual inaccuracies. Given that functional disorders do not usually have specific biomarkers or findings on structural imaging that are typically undertaken in routine clinical practice, this leads to potential for symptoms to be misunderstood, invalidated, or dismissed, leading to adverse experiences when individuals are seeking help.
+Part of this stigma is also driven by theories around "mind body dualism", which frequently surfaces as an area of importance for patients, researchers and clinicians in the realm of functional disorders. Artificial separation of the mind/brain/body (for example the use of phrases such as; "physical versus psychological" or "organic versus non-organic") furthers misunderstanding and misconceptions around these disorders, and only serves to hinder progress in scientific domain and for patients seeking treatment. Some patient groups have fought to have their illnesses not classified as functional disorders, because in some insurance based health-care systems these have attracted lower insurance payments. Current research is moving away from dualistic theories, and recognising the importance of the whole person, both mind and body, in diagnosis and treatment of these conditions.
+People with functional disorders frequently describe experiences of doubt, blame, and of being seen as less 'genuine' than those with other disorders. Some clinicians perceive those individuals with functional disorders are imagining their symptoms, are malingering, or doubt the level of voluntary control they have over their symptoms. As a result, individuals with these disorders often wait long periods of time to be seen by specialists and receive appropriate treatment. Currently, there is a lack of specialised treatment services for functional disorders in many countries. However, research is growing in this area, and it is hoped that the implementation of the increased scientific understanding of functional disorders and their treatment will allow effective clinical services supporting individuals with functional disorders to develop. Patient membership organisations/advocate groups have been instrumental in gaining recognition for individuals with these disorders.
+
+== Research ==
+Directions for research involve understanding more about the processes underlying functional disorders, identifying what leads to symptom persistence and improving integrated care/treatment pathways for patients.
+Research into the biological mechanisms which underpin functional disorders is ongoing. Understanding how stress effects the body over a lifetime, for example via the immune endocrine and autonomic nervous systems, is important  Ying-Chih et.al 2020, Tak et. al. 2011, Nater et al. 2011). Subtle dysfunctions of these systems, for example through low grade chronic inflammation, or dysfunctional breathing patterns, are increasingly thought to underlie functional disorders and their treatment. However, more research is needed before these theoretical mechanisms can be used clinically to guide treatment for an individual patient.
+
+== See also ==
+Idiopathic disease
+Functional gastrointestinal disorder
+Functional neurological symptom disorder
+Functional symptom
+Psychosomatic medicine
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Functional_symptom-0.md b/data/en.wikipedia.org/wiki/Functional_symptom-0.md
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+---
+title: "Functional symptom"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Functional_symptom"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:02.778512+00:00"
+instance: "kb-cron"
+---
+
+A functional symptom is a medical symptom with no known physical cause.  In other words, there is no structural or pathologically defined disease to explain the symptom. The use of the term 'functional symptom' does not assume psychogenesis, only that the body is not functioning as expected. Functional symptoms are increasingly viewed within a framework in which 'biological, psychological, interpersonal and healthcare factors' should all be considered to be relevant for determining the aetiology and treatment plans.
+Historically, there has often been fierce debate about whether certain problems are predominantly related to an abnormality of structure (disease) or are psychosomatic in nature (secondary gain), and what are at one stage posited to be functional symptoms are sometimes later reclassified as organic, as investigative techniques improve. It is well established that psychosomatic symptoms are a real phenomenon, so this potential explanation is often plausible, however the commonality of a range of psychological symptoms and functional weakness does not imply that one causes the other. For example, symptoms associated with migraine, epilepsy, schizophrenia, multiple sclerosis, stomach ulcers, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), Lyme disease and many other conditions have all tended historically at first to be explained largely as physical manifestations of the patient's psychological state of mind; until such time as new physiological knowledge is eventually gained. Another specific example is functional constipation, which may have psychological or psychiatric causes. However, one type of apparently functional constipation, anismus, may have a neurological (physical) basis.
+This is also an issue when the patient is involved in litigation such as injuries from motor vehicle accidents or work injuries involving workers compensation benefits and disputes. Studies have shown that unsettled claims affect level of complaints and many medical studies do not include data from cases where outcomes may have been tainted by inclusion of patients involved in worker's compensation cases.
+Whilst misdiagnosis of functional symptoms does occur, in neurology, for example, this appears to occur no more frequently than of other neurological or psychiatric syndromes. However, in order to be quantified, misdiagnosis has to be recognized as such, which can be problematic in such a challenging field as medicine.
+A common trend is to see functional symptoms and syndromes such as fibromyalgia, irritable bowel syndrome and functional neurological symptoms such as functional weakness as symptoms in which both biological and psychological factors are relevant, without one necessarily being dominant.
+
+
+== Weakness ==
+Functional weakness is weakness of an arm or leg without evidence of damage or a disease of the nervous system. Patients with functional weakness experience symptoms of limb weakness which can be disabling and frightening such as problems walking or a 'heaviness' down one side, dropping things or a feeling that a limb just doesn't feel normal or 'part of them'.  Functional weakness may also be described as functional neurological symptom disorder (FNsD), Functional Neurological Disorder (FND) or functional neurological symptoms. If the symptoms are caused by a psychological trigger, it may be diagnosed as 'dissociative motor disorder' or conversion disorder (CD).
+To the patient and the doctor it often looks as if there has been a stroke or have symptoms of multiple sclerosis. However, unlike these conditions, with functional weakness there is no permanent damage to the nervous system which means that it can get better or even go away completely.
+The diagnosis should usually be made by a consultant neurologist so that other neurological causes can be excluded. The diagnosis should be made on the basis of positive features in the history and the examination (such as Hoover's sign). It is dangerous to make the diagnosis simply because tests are normal. Neurologists usually diagnose wrongly about 5% of the time (which is the same for many other conditions.)
+The most effective treatment is physiotherapy, however it is also helpful for patients to understand the diagnosis, and some may find CBT helps them to cope with the emotions associated with being unwell. For those with conversion disorder, psychological therapy is key to their treatment as it is emotional or psychological factors which are causing their symptoms.
+
+
+=== Giveway weakness ===
+Giveway weakness (also "give-away weakness", "collapsing weakness", etc.) refers to a symptom where a patient's arm, leg, can initially provide resistance against an examiner's touch, but then suddenly "gives way" and provides no further muscular resistance. It can also be seen if the examinee is not cooperating with the exam and does not produce a full effort. This may sometimes be associated with secondary gain from being injured.
+
+
+== See also ==
+Functional disorder
+Functional neurological symptom disorder
+Idiopathy
+
+
+== References ==
+
+
+== Further reading ==
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diff --git a/data/en.wikipedia.org/wiki/Gliosis-0.md b/data/en.wikipedia.org/wiki/Gliosis-0.md
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+---
+title: "Gliosis"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Gliosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:06.365369+00:00"
+instance: "kb-cron"
+---
+
+Gliosis is a nonspecific reactive change of glial cells in response to damage to the central nervous system (CNS). In most cases, gliosis involves the proliferation or hypertrophy of several different types of glial cells, including astrocytes, microglia, and oligodendrocytes. In its most extreme form, the proliferation associated with gliosis leads to the formation of a glial scar.
+The process of gliosis involves a series of cellular and molecular events that occur over several days. Typically, the first response to injury is the migration of macrophages and local microglia to the injury site. This process, which constitutes a form of gliosis known as microgliosis, begins within hours of the initial CNS injury. Later, after 3–5 days, oligodendrocyte precursor cells are also recruited to the site and may contribute to remyelination. The final component of gliosis is astrogliosis, the proliferation of surrounding astrocytes, which are the main constituents of the glial scar.
+Gliosis has historically been given a negative connotation due to its appearance in many CNS diseases and the inhibition of axonal regeneration caused by glial scar formation. However, gliosis has been shown to have both beneficial and detrimental effects, and the balance between these is due to a complex array of factors and molecular signaling mechanisms, which affect the reaction of all glial cell types.
+
+== Astrogliosis ==
+
+Reactive astrogliosis is the most common form of gliosis and involves the proliferation of astrocytes, a type of glial cell responsible for maintaining extracellular ion and neurotransmitter concentrations, modulating synapse function, and forming the blood–brain barrier. Like other forms of gliosis, astrogliosis accompanies traumatic brain injury as well as many neuropathologies, ranging from amyotrophic lateral sclerosis to fatal familial insomnia. Although the mechanisms which lead to astrogliosis are not fully understood, neuronal injury is well understood to cause astrocyte proliferation, and astrogliosis has long been used as an index for neuronal damage. Traditionally, astrogliosis has been defined as an increase in intermediate filaments and cellular hypertrophy as well as an increase in the proliferation of astrocytes. Although this hypertrophy and proliferation in their extreme form are most closely associated with the formation of a glial scar, astrogliosis is not an all-or-none process in which a glial scar forms. In fact, it is a spectrum of changes that occur based on the type and severity of central nervous system (CNS) injury or disease triggering the event. Changes in astrocyte function or morphology which occur during astrogliosis may range from minor hypertrophy to major hypertrophy, domain overlap, and ultimately, glial scar formation. The severity of astrogliosis is classically determined by the level of expression of glial fibrillary acidic protein (GFAP) and vimentin, both of which are upregulated with the proliferation of active astrocytes.
+
+=== Modulation of astrogliosis ===
+Changes in astrogliosis are regulated in a context-dependent fashion, and the signaling events which dictate these changes may modify both their nature and severity. It is these changes in astrogliosis which allow the process to be complex and multifaceted, involving both a gain or loss of function as well as both beneficial and detrimental effects. Reactive astrocytes are affected by molecular signals released from a variety of CNS cell types including neurons, microglia, oligodendrocyte precursor cells, leukocytes, endothelia, and even other astrocytes. Some of the many signalling molecules used in these pathways include the cytokines interleukin 6 (IL-6), ciliary neurotrophic factor (CNTF), and leukemia inhibitory factor (LIF). Although many of these specific modulatory relationships are not yet fully understood, it is known that different specific signaling mechanisms result in different morphological and functional changes of astrocytes, allowing astrogliosis to take on a graduated spectrum of severity.
+
+=== Effects of astrogliosis ===
+Although astrogliosis has traditionally been viewed as a negative response inhibitory to axonal regeneration, the process is highly conserved, suggesting it has important benefits beyond its detrimental effects. Generally, the effects of astrogliosis vary with the context of the initial CNS insult and also with time after the injury. A few of the most important effects of astrogliosis are listed below.
+
+==== Beneficial effects ====
+Neuroprotective effects – Reactive astrocytes release neurotrophic factors, such as glial cell-derived neurotrophic factor (GDNF), which protects against programmed cell death
+Maintenance of the extracellular environment – Astrocytes are responsible for the uptake of glutamate, which restricts excitotoxicity to neurons and other cell types, as well as the elimination of free radicals
+Release of anti-inflammatory molecules
+Restoration of blood brain barrier function
+Seclusion of the injury site and containment of infection from healthy tissue
+
+==== Detrimental effects ====
+Restriction of axon regeneration – In cases of glial scar formation, reactive astrocytes enmesh the lesion site and deposit an inhibitory extracellular matrix consisting of chondroitin sulfate proteoglycans. The dense structure of these proteins is a physically and chemically inhibitory barrier to axon regeneration and the reestablishment of axon connections.
+Secretion of neurotoxic substances – These may include pro-inflammatory and cytotoxic cytokines. Examples of these molecules include nitric oxide radicals and TNF-α.
+Release of excitotoxic glutamate
+Hindrance of functional recovery and worsening of clinical signs
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+---
+title: "Gliosis"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Gliosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:06.365369+00:00"
+instance: "kb-cron"
+---
+
+== Microgliosis ==
+Microglia, another type of glial cell, act as macrophage-like cells in the CNS when activated. Unlike other glial cell types, microglia are extremely sensitive to even small changes in the cellular environment, allowing for a rapid response to inflammatory signals and prompt destruction of infectious agents before sensitive neural tissue can be damaged. Due to their fast response time, microgliosis, or the activation of microglia, is commonly the first observed stage of gliosis.
+Microgliosis following a CNS insult most commonly involves the development of an altered cellular morphology, specifically the enlargement of cellular processes. The microglial immunological surface receptor CR3 is also upregulated within 24 hours after the initial injury. Within the first week following the injury, microglia begin to proliferate abnormally and while doing so exhibit several immunophenotypic changes, particularly an increased expression of MHC antigens. The population of activated microglia at the site of a CNS injury includes not only endogenous microglia of the CNS but also exogeneous perivascular cells originating in the bone marrow that migrate to the area and transform into microglia to supplement the microgliosis response.
+While in their activated state, microglia may serve a variety of beneficial functions. For example, active microglia are the primary effectors of innate immunity and fulfill this role by phagocyting the proteins of dead neurons, presenting antigens at their surface, and producing a variety of pro-inflammatory cytokines and toxic molecules that compromise the survival of surrounding neurons which may be similarly damaged or infected. Active microglia also perform critical homeostatic activity, including the clearing of cell debris through phagocytosis, a function essential to neuron survival. In addition, active microglia release anti-inflammatory factors and other molecules, such as IL-6 and TGF-β, which regulate neurogenesis after injury. However, the over-activation of microglia can also be detrimental by producing several neurotoxic substances including pro-inflammatory factors, such as TNF-α, prostaglandin E2, and interferon-γ, and oxidative stress factors, including nitric oxide and hydrogen peroxide. Notably, unlike astrogliosis, microgliosis is a temporary and self-limited event, which generally lasts only one month after injury, even in cases of extreme damage.
+
+=== Neural modulation of microgliosis ===
+Microglial activation has been shown to be a reactive process in which microglia respond to signals given off by injured neurons. Because various characteristics of microgliosis occur in different time frames after the initial triggering insult, microgliosis must depend on mechanisms which fluctuate temporally based on injured neuronal signals. Studies have shown that in cases of reversible neuronal injury, such as axotomy, neuron signals cause microglia to produce trophic factors, which promote neuron survival. In cases of irreversible injury, however, microglia are induced to release neurotoxic factors that promote increased degeneration of the neuron and more rapid phagocytosis by the microglia. Such specificity of the process of microgliosis indicates that it primarily serves a beneficial purpose, selectively conserving some neural tissue while eliminating others, based on the specific initial CNS insult.
+
+=== Microglial regulation of astrogliosis ===
+Although the molecular triggers of gliosis, including both astrogliosis and microgliosis, are not fully understood, in vitro studies have indicated that activated microglia have an important role in initiating and modulating astrogliosis. One critical piece of evidence supporting this relationship is the widely documented temporal correlation between the onsets of the two processes. Unlike the microglial response, which occurs rapidly, the start of astrogliosis is often delayed. A likely cause of this relationship is the pro-inflammatory cytokines and chemokines released at elevated levels by microglia upon activation. These include macrophage inflammatory protein-1 (MIP), macrophage colony stimulating factor (M-CSF), the interleukins IL-1, IL-6, and IL-8, and TNF-α. Receptors for these molecules have been identified on astrocytes, and the molecules, when exogenously introduced, have been shown to induce, enhance, or accompany astrogliosis. Astrocytes themselves also produce cytokines, which may be used for self-regulation or for the regulation of microglia, which contain similar cytokine receptors. This phenomenon creates a feedback loop, allowing both microglia and astrocytes to regulate one another. In addition, evidence suggests microglial regulation of astrogliosis may also include inhibitory effects. Reduced levels of microgliosis have been associated with reduced astrocyte numbers, which also suggests that microglia are important regulators of the degree of astrocyte activation.
+
+== Response of oligodendrocytes ==
+Oligodendrocytes are another type of glial cell which generate and maintain the formation of myelin around the axons of large neurons in the CNS, allowing for rapid transmission of neural signals. Unlike astrocytes and microglia, oligodendrocytes undergo a much more limited reaction to injury. Rather, in cases of CNS trauma, they are more similar to neurons in their susceptibility to sustaining damage. The degeneration of axons as a result of trauma or pathology invariably results in the degeneration of the myelin sheath. Depending on the mechanism of insult, several different patterns of oligodendrocyte injury and reaction may be observed. In all cases, however, some oligodendrocytes are lost, through necrosis or apoptosis, while others survive and may form part of the glial scar along with myelin debris. Oligodendrocyte precursor cells are also affected by CNS insult and are recruited to demyelinated areas within a week following traumatic injury. Some of these cells may produce new myelin when exposed to signals from activated microglia and astrocytes.
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+---
+title: "Gliosis"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Gliosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:06.365369+00:00"
+instance: "kb-cron"
+---
+
+== Triggers of gliosis ==
+In general after any CNS insult, gliosis begins after the blood brain barrier is disrupted, allowing non-CNS molecules, such as blood and serum components, to enter the brain. These components, along with activated macrophages they carry, are known to have a role in beginning the formation of the glial scar by inducing the disconnection of axons, also called secondary axotomy, and the upregulation of fibrous extracellular matrix components which eventually form the scar tissue. The specific molecular triggers responsible for this action, however, remain unknown. One potential trigger is transforming growth factor β (TGF-β). TGF-β2, whose expression is gradually increased as gliosis occurs, has been shown to increase astrocyte production of scar-forming proteoglycans. Experimental reduction of both TGF-β2 and TGF-β1, which is expressed immediately after injury, has resulted in reduced glial scarring. The interleukins are another potential molecular trigger of gliosis. These molecules, notably IL-1, initiate an inflammatory response in various cells including astrocytes that contributes to the gliosis reaction. Finally, interactions between the inflammatory cytokines interferon-γ (IFN-γ) and fibroblast growth factor 2 (FGF2) may also be responsible for the induction of gliosis. In culture, both molecules act as mitogens, prompting the proliferation of astrocytes. Moreover, addition of IFN-γ to brain lesion sites has resulted in an increase in glial scarring.
+
+== In CNS injury and disease ==
+Gliosis is the universal response of the CNS to tissue injury and occurs as a result of many acute conditions such as trauma, ischemia, and stroke. Additionally, gliosis is present in a wide variety of CNS pathologies, including Alzheimer's disease, Korsakoff's syndrome, multiple system atrophy, prion disease, multiple sclerosis, AIDS dementia complex, vasculitis, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease. In every case, gliosis involves some degree of hypertrophy or proliferation of glial cells, but the extent and nature of the gliosis response vary widely based on the triggering insult. Gliosis in any form entails an alteration in cellular activity that has the potential to create widespread effects on neurons as well as other non-neural cells, causing either a loss of normal functions or a gain of detrimental ones. In this light, gliosis may be seen not only as a characteristic of many neuropathologies but as a potential contributor to, or even cause of, many CNS disease mechanisms. A select group of CNS conditions associated with gliosis are described below.
+
+=== CNS trauma ===
+Acute trauma to the brain or spinal cord results in gliosis, most often in its severe form with the development of a glial scar. Different locations around the lesion site may exhibit different severities of gliosis; for example, a glial scar at the location of damaged tissue may be surrounded by areas with less severe astrocyte proliferation or hypertrophy. Diffuse traumatic injury can result in diffuse or more moderate gliosis without scar formation. In such cases, gliosis may also be reversible. In all instances of gliosis resulting from CNS trauma, the long-term clinical outcome is highly dependent on the degree of astrogliosis and scar formation.
+
+=== Multiple sclerosis and autoimmune inflammatory disorders ===
+Gliosis is a prominent feature of many autoimmune inflammatory disorders, notably multiple sclerosis, in which demyelinated plaques are surrounded by reactive astrocytes. These astrocytes often exhibit extreme hypertrophy and multiple distinct nuclei, and their production of pro-inflammatory molecules has been implicated in several inflammatory disorders. Cytokines produced by both active astrocytes and microglia in inflammatory conditions may contribute to myelin damage and may alter blood-brain barrier permeability, allowing the migration of lymphocytes into the CNS and heightening the autoimmune attack.
+
+=== Retinal gliosis ===
+In vertebrates, the retina contains Müller cells, a type of glia not found elsewhere in the CNS. Upon retinal injury, gliosis of these cells occurs, functioning to repair damage, but often having harmful consequences in the process, worsening some of the diseases or problems that initially trigger it. Reactive gliosis in the retina can have detrimental effects on vision; in particular, the production of proteases by astrocytes causes widespread death of retinal ganglion cells. A 2011 study compared the effects of two glial toxins, AAA and Neurostatin, on retinal gliosis in mice. AAA did not inhibit the production of protease by astrocytes, and so did not prevent ganglion cell apoptosis. However, Neurostatin successfully inhibited activation of astrocytes, in turn decreasing retinal ganglion cell death significantly. Neurostatin is also effective in the inhibition of other glial cells, and may be an area of interest in the treatment of degenerative diseases such as glaucoma.
+Massive retinal gliosis (MRG) is a phenomenon in which the retina is completely replaced by proliferation of glial cells, causing deterioration of vision and even blindness in some cases. Sometimes mistaken for an intraocular tumor, MRG can arise from a neurodegenerative disease, congenital defect, or from trauma to the eyeball, sometimes appearing years after such an incident.
+
+=== Alzheimer's disease ===
+Gliosis has long been known as a characteristic of Alzheimer's Disease (AD), although its exact role in the disease remains unknown. Gliosis and glial scarring occur in areas surrounding the amyloid plaques which are hallmarks of the disease, and postmortem tissues have indicated a correlation between the degree of astrogliosis and cognitive decline. Exposure of reactive astrocytes to β-amyloid (Αβ) peptide, the main component of amyloid plaques, may also induce astroglial dysfunction and neurotoxicity. In addition, the ability of reactive astrocytes to degrade extracellular Αβ deposits may suggest that astrogliosis may affect the progression or severity of AD.
+
+=== Amyotrophic lateral sclerosis ===
+Amyotrophic lateral sclerosis (ALS) is a debilitating disease involving the degeneration of motor neurons in the CNS. Reactive astrocytes have been implicated in this condition through either a loss of their neuroprotective ability or through the gain of neurotoxic effects. Late stages of ALS are also characterized by significant astrogliosis and astrocyte proliferation around areas of degeneration.
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+---
+title: "Gliosis"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Gliosis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:06.365369+00:00"
+instance: "kb-cron"
+---
+
+== Potential therapeutic targets in gliosis ==
+The implications of gliosis in various neuropathologies and injury conditions has led to the investigation of various therapeutic routes which would regulate specific aspects of gliosis in order to improve clinical outcomes for both CNS trauma and a wide range of neurological disorders. Because gliosis is a dynamic process which involves a spectrum of changes depending on the type and severity of the initial insult, to date, no single molecular target has been identified which could improve healing in all injury contexts. Rather, therapeutic strategies for minimizing the contribution of astrogliosis to CNS pathologies must be designed to target specific molecular pathways and responses. One promising therapeutic mechanism is the use of β-lactam antibiotics to enhance the glutamate uptake of astrocytes in order to reduce excitotoxicity and provide neuroprotection in models of stroke and ALS. Other proposed targets related to astrogliosis include manipulating AQP4 channels, diminishing the action of NF-kB, or regulating the STAT3 pathway in order to reduce the inflammatory effects of reactive astrocytes. Astrogliosis may also be attenuated by inhibiting the microgliosis response. One notable microglial activation inhibitor is minocycline, which is a known suppressor of astrogliosis. The cell cycle inhibitor olomoucine also has been shown to suppress both microglial and astroglial proliferation as well as glial scar formation. Future directions for identifying novel therapeutic strategies must carefully account for the complex array of factors and signaling mechanisms driving the gliosis response, particularly in different stages after damage and in different lesion conditions.
+
+== See also ==
+Bergmann gliosis
+
+== References ==
+
+== External links ==
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diff --git a/data/en.wikipedia.org/wiki/HEENT_examination-0.md b/data/en.wikipedia.org/wiki/HEENT_examination-0.md
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+---
+title: "HEENT examination"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/HEENT_examination"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:15.188681+00:00"
+instance: "kb-cron"
+---
+
+A HEENT examination is a portion of a physical examination that principally concerns the head, eyes, ears, nose, and throat.
+
+
+== Steps ==
+IPPA
+Inspection of scars or skin changes
+Palpation of temporomandibular joint, thyroid, and lymph nodes
+Percussion may involve the skin above the frontal sinuses and paranasal sinuses to detect any signs of pain
+Auscultation for carotid bruits
+Tests specific to HEENT examination
+Eyes: eye examination and acuity (including ophthalmoscope)
+Ears: hearing examination and evaluation of tympanic membrane (TM) (otoscope used in evaluation of ears, nose, and mouth)
+A neurological examination is usually considered separate from the HEENT evaluation, although there can be some overlap in some cases.
+
+
+== Sample write-up ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/HIV_remission-0.md b/data/en.wikipedia.org/wiki/HIV_remission-0.md
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@@ -0,0 +1,42 @@
+---
+title: "HIV remission"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/HIV_remission"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:20.169498+00:00"
+instance: "kb-cron"
+---
+
+HIV remission is a clinical state in which an individual diagnosed with human immunodeficiency virus (HIV) maintains plasma viral loads below the limit of detection without the ongoing administration of antiretroviral therapy (ART). In the context of HIV/AIDS research, remission is frequently distinguished from a "sterilizing cure," which requires the total elimination of the virus from all anatomical compartments. Instead, remission is often characterized as a "functional cure", wherein the host immune system or external interventions suppress viral replication and prevent disease progression in the absence of medication.
+The primary barrier to achieving durable remission is the latent HIV reservoir. During the early stages of infection, the virus establishes a persistent pool of integrated proviral DNA within long-lived resting CD4+ T cells and other cellular reservoirs. While ART effectively arrests active replication, it has no impact on these dormant cells. Consequently, the cessation of treatment typically results in a viral rebound (the rapid re-emergence of detectable viremia) as the latent virus reactivates.
+
+
+== Mechanisms and clinical pathways ==
+Historically, instances of sustained HIV remission have emerged through three distinct pathways involving genetic resistance, intensive clinical intervention, or exceptional host immune responses.
+
+
+=== 1. Hematopoietic stem cell transplantation ===
+The most robust examples of HIV remission have occurred in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) to treat underlying hematologic malignancies. This pathway relies on two primary biological mechanisms:
+
+CCR5-Δ32 Mutation: Documentation of the "Berlin", "London (Adam Castillejo)", and "Düsseldorf" patients centers on the use of donors homozygous for the CCR5-Δ32 allele. This genetic mutation results in the phenotypic absence of the CCR5 co-receptor on the surface of CD4+ T cells, rendering the host's new immune system largely resistant to infection by R5-tropic HIV strains.
+Graft-versus-host effect: Evidence suggests that the replacement of the recipient's original immune system by donor-derived cells facilitates the depletion of the pre-existing viral reservoir through immunologic clearance.
+
+
+=== 2. Post-treatment control ===
+Post-treatment controllers (PTCs) are individuals who initiate antiretroviral therapy (ART) during the acute phase of infection and subsequently maintain undetectable viral loads following a supervised analytical treatment interruption (ATI). Unlike patients who delay treatment, early-intervention individuals may preserve critical immune functions and limit the initial seeding and diversity of the latent reservoir. This reduction in the viral pool allows for secondary control mechanisms to stabilize viremia levels without ongoing medication.
+
+
+=== 3. Natural viral suppression ===
+A small fraction of the HIV-positive population, estimated at less than 1%, exhibits the ability to control viral replication naturally. These individuals are categorized based on their clinical presentation:
+
+Elite Controllers: This group maintains undetectable viral loads for decades in the absence of ART. The phenotype is strongly associated with specific human leukocyte antigen (HLA) class I alleles, most notably HLA-B27 and HLA-B57. These alleles facilitate a highly efficient cytotoxic T lymphocyte (CTL) response capable of targeting conserved regions of the viral proteome, effectively suppressing replication through superior antigen presentation.
+
+
+== See also ==
+Management of HIV/AIDS
+Undetectable = Untransmittable
+Timeline of HIV/AIDS
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Habit-tic_deformity-0.md b/data/en.wikipedia.org/wiki/Habit-tic_deformity-0.md
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+---
+title: "Habit-tic deformity"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Habit-tic_deformity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:07.695050+00:00"
+instance: "kb-cron"
+---
+
+Habit-tic deformity is a condition of the nail caused by external trauma to the nail matrix. The condition is characterized by ridges which run horizontally across the entire nail, most often occurring on the thumbs, as well as marked damage to or absence of cuticles.
+
+
+== Signs and symptoms ==
+Habit-tic deformity is recognizable for its horizontal ridges that create a fir-tree shape. Discoloration along the affected area of the nail is also common. The condition is not to be confused with median nail dystrophy, a similar but rarer condition which additionally includes a canal-like vertical ridge. The deformity is most commonly seen on the thumbs, but is also less commonly seen on other nails.
+
+
+== Causes ==
+Habit-tic deformity is caused by long-term external trauma to the nail matrix as a result of skin-picking around the affected nail. The underlying cause is habitual skin picking as a body-focused repetitive behavior which often worsens during times of stress, boredom, or inactivity. In the past, habit-tic deformity has been linked to anxiety, tic disorder, and obsessive-compulsive disorder. However, there is no preceding anxiety and subsequent relief felt by an individual after picking, differentiating it from compulsions associated with OCD.
+
+
+== Treatment ==
+Cessation of trauma to the nail is an effective treatment for habit-tic deformity. Several methods have been shown to be effective, including the application of cyanoacrylate adhesive to form an artificial cuticle and promote nail root growth, as well as wearing bandages or tape to prevent picking.
+
+
+== References ==
\ No newline at end of file
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+---
+title: "Head-twitch response"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Head-twitch_response"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:09.145592+00:00"
+instance: "kb-cron"
+---
+
+The head-twitch response (HTR), also sometimes known as wet dog shakes (WDS) in rats, is a rapid side-to-side head movement that occurs in mice and rats in association with serotonin 5-HT2A receptor activation. Serotonergic psychedelics like lysergic acid diethylamide (LSD) and psilocybin consistently induce the HTR in rodents, whereas non-hallucinogenic serotonin 5-HT2A receptor agonists do not. Because of this, the HTR is widely employed in scientific research as an animal behavioral model of hallucinogen effects and in the discovery of new psychedelic drugs.
+The HTR is one of the only behavioral paradigms for assessment of psychedelic-like effects in animals, with the other most notable test being drug discrimination. However, the HTR is far less costly and time-consuming than drug discrimination and hence has become much more popular in recent years. Limitations of the HTR include the fact that various other drugs besides serotonin 5-HT2A receptor agonists, such as NMDA receptor antagonists and muscarinic acetylcholine receptor antagonists, also induce the HTR, and certain indirect non-hallucinogenic serotonin 5-HT2A receptor activators, like 5-hydroxytryptophan (5-HTP) and serotonin releasers, induce the response as well. While a useful test, it should not be regarded as a definitive predictor of human psychedelic potential.
+The HTR was first described as an effect of psychedelics in the mid-1950s. It was subsequently proposed as a behavioral test of psychedelic-like effects in 1967. The HTR became widely used as a test of psychedelic-like effects by the mid-2000s. Automated versions of the HTR test, allowing for high-throughput screening, were developed in the 2010s and 2020s.
+
+== Description ==
+The HTR is a rapid, rhythmic side-to-side or rotational head movement that intermittently occurs in mice and rats in association with central serotonin 5-HT2A receptor activation. In mice, each individual head movement lasts about 10 milliseconds and each HTR consists of 5 to 11 individual head movements. The HTR is spontaneous and irregularly occurring over the drug's duration. Head twitches also occur naturally in rodents but occur at low frequencies and are only rarely observed in non-stimulated animals. Drugs inducing the HTR cause the frequency to increase by many orders of magnitude above the spontaneous rate. Within a 10-minute period, between 4 and 68 head twitches have been observed following administration of DOI, depending on the dose, enantiomer, and rodent species and strain. The head twitches produced by HTR-inducing drugs are identical to spontaneous head twitches and to touch-induced head twitches (also known as the pinna reflex).
+
+In rats, the HTR is also sometimes known instead as wet dog shakes (WDS). This is because the response in rats can involve more of the whole body instead of just the head shaking and can resemble the shaking of dogs coming out of water. On account of the preceding, the test has also been referred to as the head-twitch response/wet dog shake (HTR/WDS) test.
+Serotonin 5-HT2A receptor agonists show an inverted U-shaped dose–response curve for induction of the HTR in terms of its frequency. Tolerance rapidly develops to the induction of the HTR with many but not all serotonergic psychedelics. More specifically, tolerance has been observed with LSD, DOB, DOI, 2C-T-7, 25CN-NBOH, and 5-MeO-AMT, but not with DPT or DiPT. Development of tolerance to the HTR and other serotonin 5-HT2A receptor agonist effects in animals parallels the rapid development of tolerance to the hallucinogenic effects of many psychedelics in humans, including LSD, DOM, psilocybin, and mescaline, among others. Conversely, similarly to the HTR with DPT and DiPT, tolerance does not appear to develop to the psychedelic effects of DMT, ayahuasca (which contains DMT), or 5-MeO-DMT in humans. However, more recent clinical studies employing DMT by continuous intravenous infusion (also known as DMTx) have found rapid and moderate acute tolerance development with DMT. Time-dependent supersensitivity to the HTR in animals has also been reported, for instance with DOI.
+The effective doses (ED50) of numerous serotonergic psychedelics in producing the HTR have been reviewed as well as correlated with human psychedelic doses.
+Different psychedelic and related drugs show differences in efficacy in inducing the HTR, which is quantified by number of or maximal head twitches in a given time period. Although potency in inducing the HTR strongly correlates with hallucinogenic doses in humans, it is unclear whether magnitude of HTR can be considered a proxy of degree of psychedelic effects, for instance ranging from mild to strong hallucinogenic effects, as this subject has not been rigorously assessed. It is notable in this regard that psilocin shows a similar maximal HTR as the non-hallucinogenic Ariadne and related compounds (both ~15–25 head twitches per 15 minutes). Consequently, cautious interpretation of HTR degree is required, for instance when comparing it across different chemical scaffolds or when assessing novel drugs with no human data.
+The HTR is also known to occur in rabbits and certain mole-like shrews such as the least shrew. Conversely, it does not occur in other species like primates or humans. However, HTR-like behaviors are also induced by psychedelics in certain other animal species, for instance cats and stump-tailed macaque monkeys. Other related behaviors to head twitches induced by serotonergic agents in animals include ear scratching in mice, limb jerks or flicks in cats, head bobs in rabbits, and body scratches. However, other behaviors induced by psychedelics may not be as reliable as the HTR. In addition, ear scratches appear to be mediated primarily by activation of the serotonin 5-HT2C receptor rather than by activation of the serotonin 5-HT2A receptor. On the other hand, psychedelic-induced head bobs in rabbits appear to be mediated specifically by central serotonin 5-HT2A receptor activation.
\ No newline at end of file
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+---
+title: "Head-twitch response"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Head-twitch_response"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:09.145592+00:00"
+instance: "kb-cron"
+---
+
+== Procedure ==
+The HTR method is reliable, straightforward, and simple to perform in that it merely involves direct behavioral observation following drug administration. No animal training or expensive equipment are necessarily required. The HTR can be measured in a single animal or a group of animals and can be observed in real-time or via video-recording and later observation. It can also be recorded via a magnet attached to the head or ear.
+DOI is the most commonly used psychedelic to induce the HTR. DOI and other psychedelics show a biphasic or inverted U-shaped dose–response curve in terms of HTR induction. For example, no HTR is observed at 0.1 mg/kg DOI, maximal HTR is observed at 1 to 10 mg/kg, and lesser HTR is observed at 3 to 20 mg/kg in rodents. The doses can vary depending on the rodent species and strain. Hence, based on the preceding, proper drug dosing is important for induction of the HTR.
+A drawback of the HTR assay is that manual observation can be very laborious and time-consuming. More recently however, semi- and fully-automated forms of the assay, notably allowing for the possibility of high-throughput screening, have been developed.
+
+== Mechanisms ==
+
+The HTR produced by serotonergic psychedelics, which act as non-selective serotonin receptor agonists, appears to be mediated specifically by agonism of the serotonin 5-HT2A receptor. Selective and non-selective serotonin 5-HT2A antagonists, like volinanserin (M100907), can block production of the HTR by serotonergic psychedelics. Similarly, the HTR of psychedelics is absent in serotonin 5-HT2A receptor knockout mice. Restoration of the serotonin 5-HT2A receptor to cortical neurons in these knockout mice can restore the HTR. The intracellular signaling cascade activated by the serotonin 5-HT2A receptor to produce the HTR appears to be the Gq pathway. Relatedly, there are robust correlations between serotonin 5-HT2A receptor Gq efficacy and magnitude of the HTR among psychedelic drugs. However, the responsible cascades have not been definitively elucidated, and other pathways, such as the Gs and β-arrestin2 pathways, have also been implicated in other studies.
+The HTR is mediated by central serotonin 5-HT2A receptor activation. Hence, if a given serotonin 5-HT2A receptor agonist produces the HTR, this can be considered evidence that the drug is able to cross the blood–brain barrier and exert central effects. Activation of serotonin 5-HT2A receptors in the medial prefrontal cortex (mPFC), with layer V pyramidal neurons especially implicated and with subsequent release of glutamate in this area, may be the origin of the HTR. However, other brain areas have also been independently implicated. For example, local injection of serotonergic psychedelics into the claustrum produces wet dog shakes (i.e., the HTR) in rats as well. Serotonin 5-HT2A and metabotropic glutamate mGlu2 receptor heterodimeric complexes may or may not be important for induction of the HTR by psychedelics, with research findings in this area being conflicting.
+The HTR is said to resemble a strong pinna reflex involving the whole head. The pinna reflex can be elicited by tactile stimulation, for example stimulation of the ear by a fine hair. In the case of the HTR however, the reflex occurs without tactile stimulation. The HTR induced by the serotonin precursor 5-hydroxytryptophan (5-HTP) has been found to be sensitive to environmental interference by background noise and can be prevented by local anesthesia of the pinna (outer part of the ear). These findings suggest that the HTR might be due specifically to disturbances of auditory sensory processing, although more research is needed to confirm this possibility.
+The reasons for the biphasic or inverted U-shaped dose–response curve with psychedelics are unknown. However, activation of serotonin 5-HT2C and 5-HT1A receptors at higher doses appears to at least partly be involved. In contrast to the HTR, frontal cortex inositol monophosphate (IP1) turnover due to serotonin 5-HT2A receptor activation, which is associated with the hallucinogenic effects of serotonergic psychedelics, has an asymptotic dose–response curve akin to a saturation curve. Based on these findings, it was suggested that psychedelics may continue to increase serotonin 5-HT2A receptor activation at higher doses but that behavioral disruption limits the expression of the HTR.
+Tolerance and tachyphylaxis to the HTR and/or other effects of serotonergic psychedelics may be mediated by serotonin 5-HT2A receptor downregulation. LSD, psilocin, DOM, DOI, and DOB have all been found to reduce the density of brain serotonin 5-HT2A receptors in animals in vivo and/or to desensitize the receptor in transfected cell lines, and this downregulation has been found to recover very slowly. LSD has also been specifically shown to reduce brain serotonin 5-HT2A receptor signaling in animals. Conversely however, DMT, which is not associated with tolerance development in humans, did not desensitize the serotonin 5-HT2A receptor in cell lines. Activation of the serotonin 5-HT2A receptor β-arrestin2 pathway may mediate serotonin 5-HT2A receptor internalization and tolerance. However, findings are conflicting, as β-arrestin2 knockout mice still showed tolerance to the HTR induced by DOI. It is also notable that, in contrast to most G protein-coupled receptors (GPCRs), serotonin 5-HT2A receptor downregulation has been found to occur in response to both agonists and antagonists of the receptor. Besides serotonin 5-HT2A receptor downregulation, tolerance to psychedelics may also develop due to adaptations in downstream glutamate receptors. An alternative possibility to serotonin 5-HT2A receptor biased agonism is that the lack of tolerance with drugs like DMT may simply be due to their very short durations.
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+---
+title: "Head-twitch response"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Head-twitch_response"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:09.145592+00:00"
+instance: "kb-cron"
+---
+
+== Scientific validity ==
+Head twitches do not occur with psychedelics in humans or many other species. In addition, they lack face validity as an animal behavioral proxy of psychedelic effects, in that they bear little resemblance to the human psychedelic experience. In any case, it has been said that head twitches might be a behavioral response to sensory disturbances during hallucinogenic experiences. On the other hand, many drugs that are not hallucinogenic in humans also induce the HTR. Despite the preceding limitations, the assay has strong predictive validity for hallucinogenic effects of serotonin 5-HT2A receptor agonists in humans. There is a strong correlation between the capacity of serotonergic psychedelics to induce head twitches in rodents and their reported potency in inducing hallucinogenic effects in humans. The HTR is easily quantifiable and there is high agreement in counts between independent observers. In addition, there is a low level of within-subject and between-subject variability in induction of the HTR in animals. Nonetheless, while the HTR assay is useful in assessing target engagement, it should not be regarded as a definitive predictor of psychedelic potential.
+
+== Exceptions ==
+
+=== Psychedelics lacking head twitches in animals ===
+There are few or no known examples of serotonergic psychedelics with hallucinogenic effects in humans that do not produce the HTR in animals. It was suggested that one of the only observed exceptions, the LSD prodrug ALD-52 (1-acetyl-LSD), could be explained by species differences in metabolism. However, subsequent research found that ALD-52 actually does produce the HTR. Other possible exceptions, including various 2C psychedelics like 2C-B, 2C-I, and 2C-D, as well as the phenylpiperazine TFMPP, may be explained by these agents having relatively low intrinsic activity at the serotonin 5-HT2A receptor and by species differences in sensitivity to HTR elicitation by serotonin 5-HT2A receptor partial agonists (mice being more sensitive than rats). Dimethyltryptamine (DMT) shows effects on the HTR in mice that are highly strain-dependent, including producing an HTR comparable to other psychedelics, producing an HTR that is much weaker than that of other psychedelics, or producing no HTR at all. These conflicting results may be due to rapid metabolism of DMT and/or other peculiarities of DMT in different species.
+In contrast to serotonergic psychedelics, oneirogens like harmine and ibogaine do not produce the HTR in rodents.
+
+=== Non-psychedelics inducing head twitches ===
+
+The HTR can be non-specific and can have false positives, with head twitches also produced by some drugs that do not act through serotonin 5-HT2 receptors. Examples of these agents include NMDA receptor antagonists like phencyclidine (PCP), certain benzodiazepines and Z-drugs like estazolam, triazolam, and zopiclone, α2-adrenergic receptor antagonists like yohimbine, muscarinic acetylcholine receptor antagonists like atropine and scopolamine, serotonin 5-HT1A receptor antagonists like WAY-100635 and UH-301, and CB1 receptor antagonists like rimonabant. In the cases of benzodiazepines, rimonabant, and serotonin 5-HT1A receptor antagonists however, this effect appeared to be mediated by indirect or direct activation of serotonin 5-HT2A receptors. Acute lithium administration induces the HTR via increased serotonin release in rodents, whereas chronic administration blunts head twitches in response to psychedelics. A number of other drugs, including the acetylcholine receptor agonist carbachol, opioids, and thyrotropin-releasing hormone (TRH) among others, have also been reported to induce the HTR.
+Drugs such as the serotonin precursors tryptophan and 5-hydroxytryptophan (5-HTP), serotonin releasing agents (SRAs) like fenfluramine and para-chloroamphetamine (PCA), and other agents like 1-methylpsilocin and 3,4-dimethoxyphenethylamine (DMPEA) stimulate serotonin receptors and can produce head twitches, but are not known to be hallucinogenic in humans. However, at least in the case of 5-HTP, this could be just be due to the very high doses required. It is notable in this regard that hallucinations are reported in a subset of cases of serotonin syndrome, although it is unclear at the present time whether these hallucinations are psychedelic in nature or are of a different etiology. While the SRA and mixed entactogen and psychedelic MDA likewise induces the HTR, findings are mixed and conflicting for the SRA and less hallucinogenic MDMA. The SRA dexfenfluramine produces wet dog shakes in rats, whereas the serotonin reuptake inhibitor fluoxetine has little or no effect on wet dog shakes. Amphetamine as well as para-hydroxyamphetamine (given intracerebroventricularly) can also elicit the HTR at sufficiently high doses.
+The preceding findings collectively suggest that while the HTR can be a useful indicator as to whether a compound is likely to display hallucinogenic activity in humans, the induction of the HTR does not necessarily mean that a compound will be hallucinogenic. In relation to this, caution should be exercised when interpreting such results.
+
+=== Non-hallucinogenic serotonin 5-HT2A receptor agonists ===
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+---
+title: "Head-twitch response"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Head-twitch_response"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:09.145592+00:00"
+instance: "kb-cron"
+---
+
+Some serotonin 5-HT2A receptor agonists, including lisuride, 2-bromo-LSD (bromolysergide; BOL-148), ergotamine, 6-fluoro-DET, 6-MeO-DMT, Ariadne, zalsupindole (DLX-001; AAZ-A-154), ITI-1549, 25N-N1-Nap, and IHCH-7086 among others, are either non-hallucinogenic or are thought to be non-hallucinogenic in spite of activating the serotonin 5-HT2A receptor. The HTR is among the only animal behavioral tests that can reliably distinguish between hallucinogenic and non-hallucinogenic serotonin 5-HT2A receptor agonists. Although lisuride and other non-hallucinogenic serotonin 5-HT2A receptor agonists do not produce the HTR in rodents, lisuride does produce the HTR in the least shrew, a non-rodent species that is said to be highly sensitive to serotonin 5-HT2A receptor agonists. In any case, it is thought that partial agonism with sufficiently low efficacy for specific intracellular signaling pathways underlies the lack of HTR and psychedelic effects with non-hallucinogenic serotonin 5-HT2A receptor agonists. However, other findings suggest that ergotamine may be non-hallucinogenic due to inability to efficiently cross the blood–brain barrier and peripheral selectivity, while lisuride and 2-bromo-LSD may actually be variably hallucinogenic at sufficiently high doses.
+Serotonin administered by intracerebroventricular injection at high doses produces the HTR in animals. However, serotonin itself has been considered to be non-hallucinogenic in humans. This would be in accordance with the lack of inherent psychedelic effects with serotonin releasing agents, serotonin reuptake inhibitors, and serotonin precursors in humans. The HTR with high doses of serotonin in animals appears to be mediated by formation of more lipophilic N-methylated psychedelic metabolites of serotonin, like bufotenin (N,N-dimethylserotonin).
+
+=== Others ===
+Surprisingly, the HTR induced by the mescaline-related psychedelic drug methallylescaline (MAL) was blocked by the selective serotonin 5-HT2C receptor antagonist SB-242084 but not by the serotonin 5-HT2A receptor antagonist ketanserin. This was in contrast to the case of the 2C and BOx psychedelic BOD (β-methoxy-2C-D) in the same study, for which both ketanserin and SB-242084 blocked the HTR. These findings suggest an involvement of the serotonin 5-HT2C receptor and not the serotonin 5-HT2A receptor in the psychedelic-like effects of methallylescaline in rodents. In addition, they suggest that different psychedelics may differentially activate the serotonin 5-HT2A and 5-HT2C receptors to produce their psychedelic-like effects.
+
+== Modulators of the head-twitch response ==
+While the serotonin 5-HT2A receptor mediates the HTR, other serotonin receptors, including the serotonin 5-HT1A and 5-HT2C receptors, appear to modulate the serotonin 5-HT2A receptor-induced HTR. Serotonin 5-HT1A receptor agonists like 8-OH-DPAT suppress the HTR, while serotonin 5-HT1A receptor antagonists can augment it. In addition, LSM-775, which is a weakly hallucinogenic psychedelic in humans, does not induce the HTR in animals unless the serotonin 5-HT1A receptor is blocked with WAY-100635, suggesting that serotonin 5-HT1A receptor activation masks its psychedelic-like effects. The serotonin 5-HT1A receptor agonist buspirone has been reported to suppress the hallucinogenic effects of serotonergic psychedelics in humans, while the serotonin 5-HT1A receptor antagonist pindolol has been reported to markedly potentiate them. However, paradoxically, whereas the serotonin 5-HT1A receptor full agonist 8-OH-DPAT suppresses the HTR induced by 5-hydroxytryptophan (5-HTP) or DOI, buspirone, a serotonin 5-HT1A receptor partial agonist, has been shown to enhance the HTR induced by 5-HTP plus pargyline. The possible influence of serotonin 5-HT2B receptor signaling on the HTR has been little-studied and is largely unknown. However, a subsequent study found that the highly selective 5-HT2B receptor antagonist RS-127445 diminished the HTR induced by LSD in rats but not in mice.
+Serotonin 5-HT2C receptor agonists, for instance Ro 60-0175, CP-809,101, and meta-chlorophenylpiperazine (mCPP), have been reported to suppress the HTR, while serotonin 5-HT2C receptor antagonists, like SB-242084, have been reported to potentiate the HTR. However, in some studies, serotonin 5-HT2C receptor inactivation, by antagonism with SB-242084 or SB-206553 or by receptor knockout, has been reported to diminish the HTR. The reasons for these contradictory findings are unclear. In any case, animal strain differences have been suggested. In addition, the influence of serotonin 5-HT2C receptor signaling on the HTR may be bimodal, with a more recent study finding that the serotonin 5-HT2C receptor antagonist RS-102221 enhanced the HTR at lower doses but inhibited it at higher doses.
+A number of other drugs have also been found to modulate the HTR. Monoamine oxidase inhibitors (MAOIs) like harmine, iproniazid, pargyline, clorgyline, and tranylcypromine have been found to potentiate the HTR induced by serotonergic psychedelics and other serotonergic agents without inducing the HTR on their own. This is the case even with psychedelics that are not themselves monoamine oxidase (MAO) substrates, indicating that the potentiation is not simply due to inhibition of their metabolism. In contrast to MAOIs, serotonin reuptake inhibitors (SRIs), including citalopram, fluoxetine, fluvoxamine, and imipramine, do not affect the HTR induced by DOI. Conversely, serotonin transporter (SERT) knockout greatly reduces or even eliminates the psychedelic-induced HTR. This may be due to elevated serotonin levels and decreased serotonin 5-HT2A receptor expression. Unlike SRIs, chronic administration of serotonin–norepinephrine reuptake inhibitors (SNRIs) has been found to decrease the DOI-induced HTR. The anticonvulsant phenytoin potentiates the HTR. NMDA receptor antagonists like phencyclidine (PCP), ketamine, and dizocilpine (MK-801) have been found to enhance the DOI-induced HTR as well.
+A variety of other agents, including the β-adrenergic receptor agonist clenbuterol, AMPA receptor antagonists like tezampanel (LY-293558), metabotropic glutamate mGlu2 and mGlu3 receptor agonists like eglumegad and LY-379268, antipsychotics like haloperidol, antihistamines, μ-opioid receptor agonists like morphine, methadone, and pethidine, adenosine A1 receptor agonists like N6-cyclopentyladenosine, and the TAAR1 antagonist EPPTB, have been reported to inhibit the HTR induced by serotonergic psychedelics and/or other serotonergic agents in animals. Conversely, the metabotropic glutamate mGlu2 and mGlu3 receptor antagonist LY-341495 has been found to potentiate the psychedelic-induced HTR. Selective dopamine D3 receptor agonists like WC-44 and WW-III-55 suppress the HTR induced by DOI.
+Serotonin depletion has been found to potentiate the HTR. This appears to be related to increased postsynaptic serotonin 5-HT2 receptors.
+
+== History ==
\ No newline at end of file
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+---
+title: "Head-twitch response"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Head-twitch_response"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:09.145592+00:00"
+instance: "kb-cron"
+---
+
+The HTR was first described as an effect induced by LSD, independently by Winter and Flataker and by Keller and Umbreit, in 1956. Subsequently, it was described as an effect of large doses of 5-HTP, by Corne, Pickering, and Warner, in 1963. At first, the HTR was just a pharmacological curiosity and was not used as a tool in scientific research. In 1967 however, Corne and Pickering demonstrated the influence of a wide range of drugs on the HTR and proposed the HTR as a behavioral predictor of hallucinogenic effects in humans. The reliability of the HTR for identifying psychedelics is said to have been established by the mid-1970s. However, it has been said that the HTR test did not become widely used in studying serotonin 5-HT2A receptor activation until the mid-2000s.
+Studies published in the 1960s and 1970s had shown that serotonin receptor antagonists, such as cinanserin, methysergide, and cyproheptadine, blocked the hallucinogen-like effects of psychedelics in animals. Mediation of the HTR specifically via serotonin 5-HT2 receptor agonism was first proposed by Peroutka, Lebovitz, and Snyder in 1981, followed by supporting studies by Ortmann and colleagues in 1982 and Leysen and colleagues also in 1982. Richard Glennon and colleagues further supported mediation of the hallucinogen-like effects of psychedelics by serotonin 5-HT2 receptor agonism with subsequent studies, for instance employing drug discrimination, in 1983 and thereafter. However, the role of the serotonin 5-HT2A receptor in the mediation of psychedelic-like effects, including the HTR, was not conclusively validated until studies with serotonin 5-HT2A receptor knockout mice were published in 2003. It was found in 1985 that the non-hallucinogenic serotonin receptor agonist lisuride did not produce the HTR in animals and could antagonize the HTR induced by other drugs, leading to the suggestion that it was a low-efficacy partial agonist of the serotonin 5-HT2 receptors.
+Automation of the HTR assay was first described by Adam Halberstadt and colleagues in 2013. They developed a semi-automated assay using magnetometer-based detection. de la Fuente Revenga and colleagues developed a fully automated HTR test based on Halberstadt's work and published their system in 2019. Additional automated HTR systems, including ones employing deep learning techniques, were developed in 2020 and thereafter.
+
+== Other tests ==
+The only other behavioral paradigms for assessment of psychedelic-like effects in animals at present are drug discrimination (DD) and, to a lesser extent, prepulse inhibition (PPI) and time perception. However, the HTR is far less costly and time-consuming than drug discrimination and hence has become much more popular in recent years. Other paradigms for assessing psychedelic-associated effects have also been studied but have not shown satisfactory consistency for general use. In the 2020s, a test of psychedelic-induced visual distortions in animals was published. This study marked the first evidence of psychedelic-induced visual distortions in animals. However, a much earlier test of psychedelic-related visual changes, described by the late 1960s, was a visual object size discrimination task in monkeys.
+
+== See also ==
+Drug discrimination
+
+== References ==
+
+== External links ==
+Psychedelic or Not: Of Mice, 5-HT2A Agonists, and Head Shakes (February 1, 2022) - Nate Seltenrich - Psychedelic Science Review (PSR)
+Do Mice Hallucinate? Do Humans Head-Twitch? (February 24, 2023) - Psychedelic Alpha
+LSD & The Head Twitch Response - Hamilton Morris (with Jason Wallach) - YouTube
+Getting High On HIV Medication (short segment on head-twitch response) - Hamilton Morris - VICE - YouTube
+The Search for Non-Hallucinogenic Psychedelics: Uncovering the Head Twitch Response - Mind & Matter Podcast
+Head-twitch response (psilocybin) - Alex Kwan - YouTube
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Health_Sciences_Descriptors-0.md b/data/en.wikipedia.org/wiki/Health_Sciences_Descriptors-0.md
new file mode 100644
index 000000000..44b03e861
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Health_Sciences_Descriptors-0.md
@@ -0,0 +1,28 @@
+---
+title: "Health Sciences Descriptors"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Health_Sciences_Descriptors"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:11.640069+00:00"
+instance: "kb-cron"
+---
+
+DeCS – Health Sciences Descriptors is a structured and trilingual thesaurus created by BIREME – Latin American and Caribbean Center on Health Sciences Information – in 1986 for indexing scientific journal articles, books, proceedings of congresses, technical reports and other types of materials, as well as for searching and recovering scientific information in LILACS, MEDLINE and other databases. In the VHL, Virtual Health Library, DeCS is the tool that permits the navigation between records and sources of information through controlled concepts and organized in Portuguese, Spanish and English.
+It was developed from MeSH – Medical Subject Headings from the NLM – U.S. National Library of Medicine – in order to permit the use of common terminology for searching in three languages, providing a consistent and unique environment for information retrieval regardless of the language. In addition to the original MeSH terms, four specific areas were developed: Public Health (1986), Homeopathy (1991), Health Surveillance (2005), and Science and Health (2005).
+The concepts that compose the DeCS vocabulary are organized in a hierarchical structure permitting searches in broader or more specific terms or all the terms that belong to a single hierarchy.  
+Its main purpose is to serve as a unique language for indexing and recovery of information among the components of the Latin American and Caribbean Health Sciences Information System, coordinated by BIREME and that encompasses 37 countries in Latin America and the Caribbean, permitting a uniform dialog between nearly 600 libraries.  
+DeCS participates in the unified terminology development project, UMLS – Unified Medical Language System of the NLM, with the responsibility of contributing with the terms in Portuguese and Spanish.
+
+
+== References ==
+
+
+== External links ==
+DeCS – Health Sciences Descriptors
+DeCS on BIREME's Wiki Archived 2016-03-04 at the Wayback Machine
+BIREME – Latin American and Caribbean Center on Health Sciences Information
+VHL Regional Portal – Virtual Health Library
+NLM – U. S. National Library of Medicine
+UMLS – Unified Medical Language System
+LILACS Methodology
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Health_assessment-0.md b/data/en.wikipedia.org/wiki/Health_assessment-0.md
new file mode 100644
index 000000000..b3df9f677
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Health_assessment-0.md
@@ -0,0 +1,34 @@
+---
+title: "Health assessment"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Health_assessment"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:10.384453+00:00"
+instance: "kb-cron"
+---
+
+A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases early in people that may look and feel well.
+Evidence does not support routine health assessments in otherwise healthy people.
+Health assessment is the evaluation of the health status of an individual along the health continuum. The purpose of the assessment is to establish where on the health continuum the individual is because this guides how to approach and treat the individual. The health care approaches range from preventive, to treatment, to palliative care in relation to the individual's status on the health continuum. It is not the treatment or treatment plan. The plan related to findings is a care plan which is preceded by the specialty such as medical, physical therapy, nursing, etc.
+
+
+== Corporate health assessments ==
+Research by Data Bridge Market Research shows that the market for corporate health assessments which was USD 2,91,272.4 million in 2023, is likely to reach USD 8,23,374.65million by 2031 and is expected to undergo a CAGR of 12.5% during the forecast period.
+Healthcare providers such as Bupa and Nuffield now routinely offer health assessments to individuals and corporate clients, building on the growing market for these services.
+Definitions of health assessment are varied, with some using the term health assessment and health checks interchangeably.
+UK healthcare provider Verve Healthcare makes a clear difference:
+
+A staff health check is a routine examination conducted by a health professional to assess an individual's overall health status. The primary aim is to identify health issues early, to monitor ongoing health conditions and to monitor future health risks.
+Health assessments are more detailed than regular health checks. They provide a holistic view of an individual's health and can identify underlying health conditions.
+
+
+== History ==
+Health assessment has been separated by authors from physical assessment to include the focus on health occurring on a continuum as a fundamental teaching. In the healthcare industry it is understood health occurs on a continuum, so the term used is assessment but may be preference by the speciality's focus such as nursing, physical therapy, etc. In healthcare, the assessment's focus is biopsychosocial but the intensity of focus may vary by the type of healthcare practitioner. For example, in the emergency room the focus is chief complaint and how to help that person related to the perceived problem. If the problem is a heart attack then the intensity of focus is on the biological/physical problem initially.
+
+
+== See also ==
+Nursing assessment
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Healthcare_error_proliferation_model-0.md b/data/en.wikipedia.org/wiki/Healthcare_error_proliferation_model-0.md
new file mode 100644
index 000000000..e26cf1da7
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Healthcare_error_proliferation_model-0.md
@@ -0,0 +1,46 @@
+---
+title: "Healthcare error proliferation model"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Healthcare_error_proliferation_model"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:12.835146+00:00"
+instance: "kb-cron"
+---
+
+The healthcare error proliferation model is an adaptation of James Reason’s Swiss Cheese Model designed to illustrate the complexity inherent in the contemporary healthcare delivery system and the attribution of human error within these systems.  The healthcare error proliferation model explains the etiology of error and the sequence of events typically leading to adverse outcomes.  This model emphasizes the role organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction.
+
+
+== Introduction ==
+Healthcare systems are complex in that they are diverse in both structure (e.g. nursing units, pharmacies, emergency departments, operating rooms) and professional mix (e.g. nurses, physicians, pharmacists, administrators, therapists) and made up of multiple interconnected elements with adaptive tendencies in that they have the capacity to change and learn from experience. The term complex adaptive systems (CAS) was coined at the interdisciplinary Santa Fe Institute (SFI), by John H. Holland, and Murray Gell-Mann.  Subsequently, scholars such as Ruth A. Anderson, Rubin McDaniels, and Paul Cilliers have extended CAS theory and research to the social sciences such as education and healthcare.
+
+
+== Model overview ==
+The healthcare error proliferation model (HEPM) adapts the Swiss Cheese Model to the complexity of healthcare delivery systems and integrated organizations.  The Swiss Cheese Model, likens the complex adaptive system to multiple hole infested slices of Swiss cheese positioned side-by-side.  The cheese slices are dubbed defensive layers to describe their role and function as the system location outfitted with features capable of intercepting and deflecting hazards. The layers represent discrete locations or organizational levels potentially populated with errors permitting error progression. The four layers include: 1) organizational leadership, 2) risky supervision, 3) situations for unsafe practices, and 4) unsafe performance.
+The HEPM portrays hospitals as having multiple operational defensive layers outfitted with essential elements necessary to maintain key defensive barricades (Cook & O'Connor, 2005; Reason, 2000). By examining the defensive layers attributes, prospective locales of failure, the etiology of accidents might be revealed (Leape et al., 1995). Experts have discussed the importance of examining these layers within the context of the complex adaptive healthcare system (Kohn et al., 2000; Wiegmann & Shappell, 2003) and considering the psychological safety of clinicians.  Hence, this model expands Reason’s seminal work.
+The model incorporates the complex adaptive healthcare system as a key characteristic.  Complex adaptive systems characteristically demonstrate self-organization as diverse agents interact spontaneously in nonlinear relationships  where professionals act as information processors (Cilliers, 1998; McDaniel & Driebe, 2001) and co-evolve with the environment (Casti, 1997). Healthcare professionals function in the system as diverse actors within the complex environment utilizing different methods to process information (Coleman, 1999) and solve systemic problems within and across organizational layers (McDaniel & Driebe, 2001).
+
+
+=== Definitions ===
+A complex adaptive healthcare system (CAHS) is a care delivery enterprise with diverse clinical and administrative agents acting spontaneously, interacting in nonlinear networks where agents and patients are information processors, and actively co-evolve with their environment with the purposed to produce safe and reliable patient-centered outcomes.
+
+
+== See also ==
+
+
+== Citations ==
+
+
+== References ==
+
+
+=== Articles ===
+
+
+=== Books ===
+
+
+== Other literature ==
+
+
+=== Complexity theory ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Healthcare_proxy-0.md b/data/en.wikipedia.org/wiki/Healthcare_proxy-0.md
new file mode 100644
index 000000000..43009fd4c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Healthcare_proxy-0.md
@@ -0,0 +1,72 @@
+---
+title: "Healthcare proxy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Healthcare_proxy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:13.973480+00:00"
+instance: "kb-cron"
+---
+
+In the field of medicine, a healthcare proxy (commonly referred to as HCP) is a document (legal instrument) with which a patient (primary individual) appoints an agent to legally make healthcare decisions on behalf of the patient, when the patient is incapable of making and executing the healthcare decisions stipulated in the proxy. Once the healthcare proxy is effective, the agent continues making healthcare decisions as long as the primary individual is legally competent to decide. Moreover, in legal-administrative functions, the healthcare proxy is a legal instrument akin to a "springing" healthcare power of attorney. The proxy must declare the healthcare agent who will gain durable power attorney. This document also notifies of the authority given from the principal to the agent and states the limitations of this authority.
+Those over the age of 18 are allowed to have a healthcare proxy, and these documents are useful in situations that render a person unable to communicate their wishes such as being in a persistent vegetative state, having a form of dementia or an illness that takes away one's ability to effectively communicate, or being under anesthesia when a decision needs to be made. Healthcare proxies are one of three ways that surrogate decision makers are enacted, the other two being court orders and laws for the automatic succession of decision makers. In contrast to a living will, healthcare proxies do not set out possible outcomes with predetermined reactions, rather they appoint someone to carry out the wishes of an individual.
+
+
+== History ==
+The methods of healthcare planning and tools of advanced preparation have changed dramatically over the years. The concept of durable power of attorney arose in Virginia in 1954 for the purpose of setting property matters. This allowed for a continued existence of power of attorney following the original person losing capacity to carry out the necessary actions. This concept evolved over the years and in 1983, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research addressed this idea as one of great potential in the healthcare industry. This commission also stated the possibility of abuse as a noted concern going forward. In response to this commission, there was an evolution of this concept throughout the 1980s and the 1990s that eventually led to all states in America having a healthcare power of attorney statute by 1997.
+
+
+== Criteria ==
+Some jurisdictions place limitations on the persons who can act as agents. (Some forbid the appointment of treating physicians as the healthcare proxy.) In any event the agent should be someone close to and trusted by the primary individual. According to the state of Massachusetts, no person who is an employee or administrator of a facility can be an agent unless it is for someone who is of familial relation to them.  In any event, the agent is recommended to be someone close to and trusted by the primary individual. In the absence of a power of attorney, a legal guardian must be appointed.
+
+
+=== Legal guidelines ===
+Healthcare proxies are permitted in forty-nine states as well as the District of Columbia.
+Healthcare forms may differ in structure from state to state and pre-made forms are not compulsory as long as certain guidelines are met. The common guidelines include:
+
+Name and address of the agent.
+Name and address of an alternate agent.
+Duration of the proxy – not indicating a duration means it is valid unless stated otherwise.
+Special instructions – these can broaden or limit the powers of the agent. If the patient doesn't want to be on feeding tubes no matter what, this can be stated here. If there are certain treatments that the patient does not want to receive like dialysis or blood transfusion, then they must be indicated. However, if the patient wants to give the agent more flexibility with some or no restriction, this must be written.
+Name, date and signature of the primary individual.
+Instructions on tissue or organ donation.
+Two adult witnesses must sign the document stating that they have witnessed this agreement and that both parties appear to be sane. The witnesses must be 18 years or older. The agent and primary individual do not qualify as witnesses.
+Presence of a lawyer - such a person may help in drafting a document tailored to the needs of the primary individual.
+Once signed, copies of the form must be given to healthcare providers, the agent, spouse, and close friends. A copy should also be carried by the primary individual (in wallet or purse).
+
+
+=== Powers and limitations ===
+The agent is empowered when a qualified physician determines that the primary individual is unable to make decisions regarding healthcare. The agent may be granted the power to remove or sustain feeding tubes from the primary individual if these tubes are the only things that are keeping the primary individual alive. The agent's decision should draw upon knowledge of the patient's desire in this matter. If the primary individual made his or her wishes clear on the proxy form, then they must be followed despite any possible objections from the agent.
+A person may identify end-of-life decisions in more than one legal document, such as in a living will in addition to a healthcare proxy, in which case it is necessary to examine all of the documents to determine if any limit or revoke the agent's authority as granted in the healthcare proxy. An agent will not be legally or financially liable for decisions made on behalf of the primary individual as long as they follow the terms of the healthcare proxy.
+
+
+== Capacity to appoint ==
+There are limited legal foundations to determine the ability of someone to appoint a healthcare proxy. Although physicians are allowed to deliver life-saving treatment in emergent situations, in non-emergencies, it is determined if the patient has the ability to then appoint a healthcare proxy. It is possible for a patient lacking the ability to make healthcare decisions, to still have the capacity to appoint an agent and have a proxy.
+
+
+=== United Kingdom ===
+In England and Wales, an independent mental health capacity advocate may be appointed under the Mental Capacity Act 2005; the provisions made in the same Act for a lasting power of attorney may also provide a satisfactory basis for providing care via an attorney, who does not require to be professionally qualified. Different arrangements apply elsewhere in the UK.
+
+
+== See also ==
+Advance healthcare directive
+Doe ex. rel. Tarlow v. District of Columbia
+Do Not Resuscitate (DNR)
+Estate planning
+Living will
+Patient refusal of nutrition and hydration
+Power of attorney
+Ulysses pact
+Uniform Rights of the Terminally Ill Act
+Mental health law
+
+
+== References ==
+
+
+== Further reading ==
+
+
+== External links ==
+"Health Care Powers of Attorney" (PDF). American Bar Association. Archived from the original (PDF) on 2014-07-22. Retrieved 2014-08-19.
+"Massachusetts Law about Health Care Proxies and Living Wills". Massachusetts Court System. Archived from the original on 2014-10-01.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Herd_immunity-0.md b/data/en.wikipedia.org/wiki/Herd_immunity-0.md
new file mode 100644
index 000000000..8aff4a4ca
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Herd_immunity-0.md
@@ -0,0 +1,28 @@
+---
+title: "Herd immunity"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Herd_immunity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:16.564067+00:00"
+instance: "kb-cron"
+---
+
+Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become immune to an infection, whether through previous infections or vaccination, that the communicable pathogen cannot maintain itself in the population, its low incidence thereby reducing the likelihood of infection for individuals who lack immunity.
+Once the herd immunity has been reached, disease gradually disappears from a population and may result in eradication or permanent reduction of infections to zero if achieved worldwide. Herd immunity created via vaccination has contributed to the reduction of many diseases.
+
+== Effects ==
+
+=== Protection of those without immunity ===
+
+Some individuals either cannot develop immunity after vaccination or for medical reasons cannot be vaccinated. Newborn infants are too young to receive many vaccines, either for safety reasons or because passive immunity renders the vaccine ineffective. Individuals who are immunodeficient due to HIV/AIDS, lymphoma, leukemia, bone marrow cancer, an impaired spleen, chemotherapy, or radiotherapy may have lost any immunity that they previously had, and vaccines may not be of any use for them because of their immunodeficiency.
+A portion of those vaccinated may not develop long-term immunity. Vaccine contraindications may prevent certain individuals from being vaccinated. In addition to not being immune, individuals in one of these groups may be at a greater risk of developing complications from infection because of their medical status, but they may still be protected if a large enough percentage of the population is immune.
+High levels of immunity in one age group can create herd immunity for other age groups. Vaccinating adults against pertussis reduces pertussis incidence in infants too young to be vaccinated, who are at the greatest risk of complications from the disease. This is especially important for close family members, who account for most of the transmissions to young infants. In the same manner, children receiving vaccines against pneumococci reduces pneumococcal disease incidence among younger, unvaccinated siblings. Vaccinating children against pneumococcus and rotavirus has reduced pneumococcus- and rotavirus-attributable hospitalizations for older children and adults, who do not normally receive these vaccines. Influenza (flu) is more severe in the elderly than in younger age groups, but influenza vaccines lack effectiveness in this demographic due to a waning of the immune system with age. The prioritization of school-aged children for seasonal flu immunization, which is more effective than vaccinating the elderly, however, has been shown to create a certain degree of protection for the elderly.
+For sexually transmitted infections (STIs), high levels of immunity in heterosexuals of one sex induces herd immunity for heterosexuals of both sexes. Vaccines against STIs that are targeted at heterosexuals of one sex result in significant declines in STIs in heterosexuals of both sexes if vaccine uptake in the target sex is high. Herd immunity from female vaccination does not, however, extend to males who have sex with males. High-risk behaviors make eliminating STIs difficult because, though most infections occur among individuals with moderate risk, the majority of transmissions occur because of individuals who engage in high-risk behaviors. For this reason, in certain populations, immunizing high-risk individuals may be necessary regardless of sex.
+
+=== Evolutionary pressure and serotype replacement ===
+Herd immunity itself acts as an evolutionary pressure on pathogens, influencing viral evolution by encouraging the production of novel strains, referred to as escape mutants, that are able to evade herd immunity and infect previously immune individuals. The evolution of new strains is known as serotype replacement, or serotype shifting, as the prevalence of a specific serotype declines due to high levels of immunity, allowing other serotypes to replace it.
+At the molecular level, viruses escape from herd immunity through antigenic drift, which is when mutations accumulate in the portion of the viral genome that encodes for the virus's surface antigen, typically a protein of the virus capsid, producing a change in the viral epitope. Alternatively, the reassortment of separate viral genome segments, or antigenic shift, which is more common when more strains are in circulation, can also produce new serotypes. When either of these occur, memory T cells no longer recognize the virus, so people are not immune to the dominant circulating strain. For both influenza and norovirus, epidemics temporarily induce herd immunity until a new dominant strain emerges, causing successive waves of epidemics. As this evolution poses a challenge to herd immunity, broadly neutralizing antibodies and "universal" vaccines that can provide protection beyond a specific serotype are in development.
+Initial vaccines against Streptococcus pneumoniae significantly reduced nasopharyngeal carriage of vaccine serotypes (VTs), including antibiotic-resistant types, only to be entirely offset by increased carriage of non-vaccine serotypes (NVTs). This did not result in a proportionate increase in disease incidence though, since NVTs were less invasive than VTs. Since then, pneumococcal vaccines that provide protection from the emerging serotypes have been introduced and have successfully countered their emergence. The possibility of future shifting remains, so further strategies to deal with this include expansion of VT coverage, and the development of vaccines that use either killed whole-cells, which have more surface antigens, or proteins present in multiple serotypes.
+
+=== Eradication of diseases ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Herd_immunity-1.md b/data/en.wikipedia.org/wiki/Herd_immunity-1.md
new file mode 100644
index 000000000..60de40fbb
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Herd_immunity-1.md
@@ -0,0 +1,119 @@
+---
+title: "Herd immunity"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Herd_immunity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:16.564067+00:00"
+instance: "kb-cron"
+---
+
+If herd immunity has been established and maintained in a population for a sufficient time, the disease is inevitably eliminated – no more endemic transmissions occur. If elimination is achieved worldwide and the number of cases is permanently reduced to zero, then a disease can be declared eradicated. Eradication can thus be considered the final effect or end-result of public health initiatives to control the spread of contagious disease. In cases in which herd immunity is compromised, on the contrary, disease outbreaks among the unvaccinated population are likely to occur.
+The benefits of eradication include ending all morbidity and mortality caused by the disease, financial savings for individuals, health care providers, and governments, and enabling resources used to control the disease to be used elsewhere. To date, two diseases have been eradicated using herd immunity and vaccination: rinderpest and smallpox. Eradication efforts that rely on herd immunity are currently underway for poliomyelitis, though civil unrest and distrust of modern medicine have made this difficult. Mandatory vaccination may be beneficial to eradication efforts if not enough people choose to get vaccinated.
+
+== Free riding ==
+Herd immunity is vulnerable to the free rider problem. Individuals who lack immunity, including those who choose not to vaccinate, free ride off the herd immunity created by those who are immune. As the number of free riders in a population increases, outbreaks of preventable diseases become more common and more severe due to loss of herd immunity. Individuals may choose to ride free or be hesitant to vaccinate for a variety of reasons, including the belief that vaccines are ineffective, or that the risks associated with vaccines are greater than those associated with infection, mistrust of vaccines or public health officials, bandwagoning or groupthinking, social norms or peer pressure, and religious beliefs. Certain individuals are more likely to choose not to receive vaccines if vaccination rates are high enough to convince a person that he or she may not need to be vaccinated, since a sufficient percentage of others are already immune.
+
+== Mechanism ==
+Individuals who are immune to a disease act as a barrier in the spread of disease, slowing or preventing the transmission of disease to others. An individual's immunity can be acquired via a natural infection or through artificial means, such as vaccination. When a critical proportion of the population becomes immune, called the herd immunity threshold (HIT) or herd immunity level (HIL), the disease may no longer persist in the population, ceasing to be endemic.
+The theoretical basis for herd immunity generally assumes that vaccines induce solid immunity, that populations mix at random, that the pathogen does not evolve to evade the immune response, and that no nonhuman vector exists for the disease.
+
+== Theoretical basis ==
+
+The critical value, or threshold, in a given population, is the point where the disease reaches an endemic steady state, which means that the infection level is neither growing nor declining exponentially. This threshold can be calculated from the effective reproduction number Re, which is obtained by taking the product of the basic reproduction number R0, the average number of new infections caused by each case in an entirely susceptible population that is homogeneous, or well-mixed, meaning each individual is equally likely to come into contact with any other susceptible individual in the population, and S, the proportion of the population who are susceptible to infection, and setting this product to be equal to 1:
+
+  
+    
+      
+        
+          R
+          
+            0
+          
+        
+        ⋅
+        S
+        =
+        1.
+      
+    
+    {\displaystyle R_{0}\cdot S=1.}
+  
+
+S can be rewritten as (1 − p), where p is the proportion of the population that is immune so that p + S equals one. Then, the equation can be rearranged to place p by itself as follows:
+
+  
+    
+      
+        
+          R
+          
+            0
+          
+        
+        ⋅
+        (
+        1
+        −
+        p
+        )
+        =
+        1
+        ,
+      
+    
+    {\displaystyle R_{0}\cdot (1-p)=1,}
+  
+
+  
+    
+      
+        1
+        −
+        p
+        =
+        
+          
+            1
+            
+              R
+              
+                0
+              
+            
+          
+        
+        ,
+      
+    
+    {\displaystyle 1-p={\frac {1}{R_{0}}},}
+  
+
+  
+    
+      
+        
+          p
+          
+            c
+          
+        
+        =
+        1
+        −
+        
+          
+            1
+            
+              R
+              
+                0
+              
+            
+          
+        
+        .
+      
+    
+    {\displaystyle p_{c}=1-{\frac {1}{R_{0}}}.}
+  
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Herd_immunity-2.md b/data/en.wikipedia.org/wiki/Herd_immunity-2.md
new file mode 100644
index 000000000..e0df9a6f2
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Herd_immunity-2.md
@@ -0,0 +1,102 @@
+---
+title: "Herd immunity"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Herd_immunity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:16.564067+00:00"
+instance: "kb-cron"
+---
+
+With p being by itself on the left side of the equation, it can be renamed as pc, representing the critical proportion of the population needed to be immune to stop the transmission of disease, which is the same as the HIT. R0 functions as a measure of contagiousness, so low R0 values are associated with lower HITs, whereas higher R0s result in higher HITs. For example, the HIT for a disease with an R0 of 2 is theoretically only 50%, whereas a disease with an R0 of 10, the theoretical HIT is 90%.
+When the effective reproduction number Re of a contagious disease is reduced to and sustained below 1 new individual per infection, the number of cases occurring in the population gradually decreases until the disease has been eliminated. If a population is immune to a disease in excess of that disease's HIT, the number of cases reduces at a faster rate, outbreaks are even less likely to happen, and outbreaks that occur are smaller than they would be otherwise. If the population immunity falls below the herd immunity threshold, where the effective reproduction number increases to above 1, the population is said to have an "immunity gap", and then the disease is neither in a steady state nor decreasing in incidence, but is actively spreading through the population and infecting a larger number of people than usual. 
+An assumption in these calculations is that populations are homogeneous, or well-mixed, meaning that every individual is equally likely to come into contact with any other individual, when in reality, populations are better described as social networks as individuals tend to cluster together, remaining in relatively close contact with a limited number of other individuals. In these networks, transmission only occurs between those who are geographically or physically close to one another. The shape and size of a network is likely to alter a disease's HIT, making incidence either more or less common. Mathematical models can use contact matrices to estimate the likelihood of encounters and thus transmission.
+In heterogeneous populations, R0 is considered to be a measure of the number of cases generated by a "typical" contagious person, which depends on how individuals within a network interact with each other. Interactions within networks are more common than between networks, in which case the most highly connected networks transmit disease more easily, resulting in a higher R0 and a higher HIT than would be required in a less connected network. In networks that either opt not to become immune or are not immunized sufficiently, diseases may persist despite not existing in better-immunized networks.
+
+=== Overshoot ===
+The cumulative proportion of individuals who get infected during the course of a disease outbreak can exceed the HIT, because the HIT does not represent the point at which the disease stops spreading, but rather the point at which each infected person infects fewer than one additional person on average. When the HIT is reached, the number of additional infections does not immediately drop to zero. The excess of the cumulative proportion of infected individuals over the theoretical HIT is known as the overshoot.
+
+== Boosts ==
+
+=== Vaccination ===
+
+The primary way to boost levels of immunity in a population is through vaccination. Vaccination is originally based on the observation that milkmaids exposed to cowpox were immune to smallpox, so the practice of inoculating people with the cowpox virus began as a way to prevent smallpox. Well-developed vaccines provide protection in a far safer way than natural infections, as vaccines generally do not cause the diseases they protect against, and severe adverse effects are significantly less common than complications from natural infections.
+The immune system does not distinguish between natural infections and vaccines, forming an active response to both, so immunity induced by vaccination is similar to what would have occurred from contracting and recovering from the disease. To achieve herd immunity through vaccination, vaccine manufacturers aim to produce vaccines with low failure rates, and policy makers aim to encourage their use. After the successful introduction and widespread use of a vaccine, sharp declines in the incidence of diseases it protects against can be observed, which decreases the number of hospitalizations and deaths caused by such diseases.
+Assuming a vaccine is 100% effective, then the equation used for calculating the herd immunity threshold can be used for calculating the vaccination level needed to eliminate a disease, written as Vc. Vaccines are usually imperfect, however, so the effectiveness, E, of a vaccine must be accounted for:
+
+  
+    
+      
+        
+          V
+          
+            c
+          
+        
+        =
+        
+          
+            
+              1
+              −
+              
+                
+                  1
+                  
+                    R
+                    
+                      0
+                    
+                  
+                
+              
+            
+            E
+          
+        
+        .
+      
+    
+    {\displaystyle V_{c}={\frac {1-{\frac {1}{R_{0}}}}{E}}.}
+  
+
+From this equation, it can be observed that if E is less than (1 − 1/R0), then eliminating a disease is impossible, even if the entire population is vaccinated. Similarly, waning vaccine-induced immunity, as occurs with acellular pertussis vaccines, requires higher levels of booster vaccination to sustain herd immunity. If a disease has ceased to be endemic to a population, then natural infections no longer contribute to a reduction in the fraction of the population that is susceptible. Only vaccination contributes to this reduction. The relationship between vaccine coverage and effectiveness and disease incidence can be shown by subtracting the product of the effectiveness of a vaccine and the proportion of the population that is vaccinated, pv, from the herd immunity threshold equation as follows:
+
+  
+    
+      
+        
+          (
+          
+            1
+            −
+            
+              
+                1
+                
+                  R
+                  
+                    0
+                  
+                
+              
+            
+          
+          )
+        
+        −
+        (
+        E
+        ×
+        
+          p
+          
+            v
+          
+        
+        )
+        .
+      
+    
+    {\displaystyle \left(1-{\frac {1}{R_{0}}}\right)-(E\times p_{v}).}
+  
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Herd_immunity-3.md b/data/en.wikipedia.org/wiki/Herd_immunity-3.md
new file mode 100644
index 000000000..12ddfade1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Herd_immunity-3.md
@@ -0,0 +1,41 @@
+---
+title: "Herd immunity"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Herd_immunity"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:16.564067+00:00"
+instance: "kb-cron"
+---
+
+As seen from this equation, all other things being equal ("ceteris paribus"), any increase in either vaccine coverage or vaccine effectiveness, including any increase in excess of a disease's HIT, further reduces the number of cases of a disease. The rate of decline in cases depends on a disease's R0, with diseases with lower R0 values experiencing sharper declines.
+Vaccines usually have at least one contraindication for a specific population for medical reasons, but if both effectiveness and coverage are high enough, then herd immunity can protect these individuals. Vaccine effectiveness is not always adversely affected by passive immunity, so additional doses are recommended for some vaccines, while others are not administered until after an individual has lost his or her passive immunity.
+
+=== Passive immunity ===
+
+Individual immunity can also be gained passively, when antibodies to a pathogen are transferred from one individual to another. This can occur naturally, whereby maternal antibodies, primarily immunoglobulin G antibodies, are transferred across the placenta and in colostrum to fetuses and newborns. Passive immunity can also be gained artificially, when a susceptible person is injected with antibodies from the serum or plasma of an immune person.
+Protection generated from passive immunity is immediate, but wanes over the course of weeks to months, so any contribution to herd immunity is temporary. For diseases that are especially severe among fetuses and newborns, such as influenza and tetanus, pregnant women may be immunized to transfer antibodies to the child. In the same way, high-risk groups that are either more likely to experience infection or are more likely to develop complications from infection may receive antibody preparations to prevent these infections or to reduce the severity of symptoms.
+
+== Cost–benefit analysis ==
+Herd immunity is often accounted for when conducting cost–benefit analyses of vaccination programs. It is regarded as a positive externality of high levels of immunity, producing an additional benefit of disease reduction that would not occur had no herd immunity been generated in the population. Therefore, herd immunity's inclusion in cost–benefit analyses results both in more favorable cost-effectiveness or cost–benefit ratios, and an increase in the number of disease cases averted by vaccination. Study designs done to estimate herd immunity's benefit include recording disease incidence in households with a vaccinated member, randomizing a population in a single geographic area to be vaccinated or not, and observing the incidence of disease before and after beginning a vaccination program. From these, disease incidence may be seen to decrease to a level beyond what can be predicted from direct protection alone, indicating that herd immunity contributed to the reduction. Serotype replacement, when accounted for, reduces the predicted benefits of vaccination.
+
+== History ==
+
+Herd immunity was recognized as a naturally occurring phenomenon in the 1930s, when after a significant number of children had become immune to measles, the number of new infections was seen to decrease temporarily. Mass vaccinations to induce herd immunity have since become common and proved successful in preventing the spread of many contagious diseases. Opposition to vaccination has posed a challenge to herd immunity, allowing preventable diseases to persist in or return to populations with inadequate vaccination rates.
+The exact herd immunity threshold (HIT) varies depending on the basic reproduction number of the disease. An example of a disease with a high threshold was the measles, with a HIT exceeding 95%.
+The term "herd immunity" was first used in 1894 by American veterinary scientist and then Chief of the Bureau of Animal Industry (BIA) of the US Department of Agriculture Daniel Elmer Salmon to describe the healthy vitality and resistance to disease of well-fed herds of hogs. In 1916, veterinary scientists inside the BIA used the term to refer to the immunity arising following recovery in cattle infected with brucellosis, also known as "contagious abortion". By 1923, it was being used by British bacteriologists to describe experimental epidemics with mice, tests undertaken as part of efforts to model human epidemic disease. By the end of the 1920s, the concept was used extensively - particularly among British scientists - to describe the buildup of immunity in populations to diseases such as diphtheria, scarlet fever, and influenza. Herd immunity was recognized as a naturally occurring phenomenon in the 1930s, when A. W. Hedrich published research on the epidemiology of measles in Baltimore, and took notice that after many children had become immune to measles, the number of new infections temporarily decreased, including among susceptible children. In spite of this knowledge, efforts to control and eliminate measles were unsuccessful until mass vaccination using the measles vaccine began in the 1960s. Mass vaccination, discussions of disease eradication, and cost–benefit analyses of vaccination subsequently prompted more widespread use of the term "herd immunity". In the 1970s, the theorem used to calculate a disease's herd immunity threshold was developed. During the smallpox eradication campaign in the 1960s and 1970s, the practice of ring vaccination, to which herd immunity is integral, began as a way to immunize every person in a "ring" around an infected individual to prevent outbreaks from spreading.
+Since the adoption of mass and ring vaccination, complexities and challenges to herd immunity have arisen. Modeling of the spread of contagious disease originally made a number of assumptions, namely that entire populations are susceptible and well-mixed, which is not the case in reality, so more precise equations have been developed. In recent decades, the dominant strain of a microorganism in circulation has been recognized to change, possibly  due to herd immunity, either because of herd immunity acting as an evolutionary pressure or because herd immunity against one strain allowed another already-existing strain to spread. Emerging or ongoing fears and controversies about vaccination have reduced or eliminated herd immunity in certain communities, allowing preventable diseases to persist in or return to these communities.
+
+== See also ==
+Premunity
+Social distancing
+
+== Notes ==
+
+== References ==
+
+== External links ==
+
+Topley WW, Wilson GS (May 1923). "The Spread of Bacterial Infection. The Problem of Herd-Immunity". The Journal of Hygiene. 21 (3): 243–9. doi:10.1017/s0022172400031478. PMC 2167341. PMID 20474777.
+A visual simulation of herd immunity written by Shane Killian and modified by Robert Webb
+Herd immunity simulation
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Hickam's_dictum-0.md b/data/en.wikipedia.org/wiki/Hickam's_dictum-0.md
new file mode 100644
index 000000000..e9975fb6b
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Hickam's_dictum-0.md
@@ -0,0 +1,26 @@
+---
+title: "Hickam's dictum"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Hickam's_dictum"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:17.717107+00:00"
+instance: "kb-cron"
+---
+
+Hickam's dictum is a medical principle that a patient's symptoms could be caused by several diseases. It is a counterargument to misapplying Occam's razor in the medical profession. A common version of Hickam's dictum states: "A man can have as many diseases as he damn well pleases." The principle is attributed to an apocryphal physician named Hickam, possibly John Bamber Hickam, MD. When he began saying this is uncertain. 
+Occam's razor is frequently misinterpreted to mean that the simplest explanation is most likely. Applying this in health care, it purports that diagnosticians should assume a single cause for multiple symptoms. Hickam's dictum admits multiple causes can produce the result confronting the diagnostician.
+
+
+== John Hickam, MD ==
+In 1946, John Bamber Hickam was a housestaff member in medicine at Grady Memorial Hospital in Atlanta, Georgia. Later, in the 1950s, he was a faculty member at Duke University in Durham, North Carolina. He subsequently was chairman of medicine at Indiana University in Bloomington, Indiana from 1958 to 1970.
+
+
+== See also ==
+Zebra (medicine)
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/History_of_the_present_illness-0.md b/data/en.wikipedia.org/wiki/History_of_the_present_illness-0.md
new file mode 100644
index 000000000..ccef5c15d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/History_of_the_present_illness-0.md
@@ -0,0 +1,33 @@
+---
+title: "History of the present illness"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/History_of_the_present_illness"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:18.910705+00:00"
+instance: "kb-cron"
+---
+
+Following the chief complaint in medical history taking, a history of the present illness (abbreviated HPI) (termed history of presenting complaint (HPC) in the UK) refers to a detailed interview prompted by the chief complaint or presenting symptom (for example, pain).
+
+
+== Questions to include ==
+Different sources include different questions to be asked while conducting an HPI.
+Several acronyms have been developed to categorize the appropriate questions to include.
+The Centers for Medicare and Medicaid Services has published criteria for what constitutes a reimbursable HPI. A "brief HPI" constitutes one to three of these elements. An "extended HPI" includes four or more of these elements.
+
+Also usable is SOCRATES. For chronic pain, the Stanford Five may be assessed to understand the pain experience from the patient's primary belief system.
+
+
+== See also ==
+Medical record
+Medical history
+Pain scale
+
+
+== References ==
+
+
+== External links ==
+Overview at medicine.ucsd.edu
+Overview at medinfo.ufl.edu
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Homicidal_ideation-0.md b/data/en.wikipedia.org/wiki/Homicidal_ideation-0.md
new file mode 100644
index 000000000..cf4a895f5
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Homicidal_ideation-0.md
@@ -0,0 +1,54 @@
+---
+title: "Homicidal ideation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Homicidal_ideation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:21.488054+00:00"
+instance: "kb-cron"
+---
+
+Homicidal ideation is a common medical term for thoughts about homicide. There is a range of homicidal thoughts which spans from vague and fleeting to detailed and fully formulated plans without the act itself. Most people who have homicidal ideation do not commit homicide. 50–91% of people surveyed on university grounds in various places in the United States admit to having had a homicidal fantasy. Homicidal ideation accounts for 2–5% of patient presentations to psychiatric facilities in the United States.
+Homicidal ideation is not a disease itself, but may result from other illnesses such as delirium and psychosis. Psychosis, which accounts for 89% of admissions with homicidal ideation in one US study, includes substance-induced psychosis (e.g. amphetamine psychosis) and the psychoses related to schizophreniform disorder and schizophrenia. Delirium is often drug induced or secondary to general medical illness(es). Homicidal ideation is also a possible side effect of many psychiatric medications.
+It may arise in association with personality disorders or it may occur in people who do not have any detectable illness. In fact, surveys have shown that the majority of people have had homicidal fantasies at some stage in their life. Many theories have been proposed to explain this.
+
+
+== Diagnosis ==
+
+
+=== Violence risk ===
+There are many associated risk factors which include a history of violence, thoughts of committing harm, poor impulse control and an inability to delay gratification.
+
+
+=== Associated psychopathology ===
+People who have homicidal ideation are at higher risk of other psychopathology than the normal population. This includes suicidal ideation, psychosis, delirium, or intoxication. 
+Homicidal ideation may arise in relation to behavioural conditions such as personality disorder (particularly conduct disorder, narcissistic personality disorder and antisocial personality disorder). A study in Finland showed an increased risk of violence from people who have antisocial personality disorder, which is greater than the risk of violence from people who have schizophrenia. The same study also cites that many other mental disorders are not associated with an increased risk of violence, of note: depression, anxiety disorders and intellectual disability.
+Homicidal ideation may arise in people who are otherwise quite well, as is demonstrated by the fact that the greater majority of people within the general population have had homicidal fantasies. When triggering factors are sought regarding homicidal fantasies the majority seem to be linked in some way to the disruption of a couple relationship. Either jealousy or revenge, greed/lust or even fear and self-defense prompt homicidal thoughts and actions in the majority of cases. In a minority of cases, homicides and acts of violence may be related to mental disorder. These homicides and fantasies do not seem to have the same underlying triggers as those by people without a mental disorder, but when these trigger factors are present the risk for violence is greater than usual.
+People who present with homicidal ideation also have a higher risk of suicide. This shows the need for an assessment of suicide risk in people with thoughts of violence towards others.
+
+
+=== Spurious and fictitious homicidal ideation ===
+Sometimes people claiming to have homicidal ideation do not actually have homicidal thoughts but merely claim to have them. They may do this for a variety of reasons, e.g. to gain attention, to coerce a person or people for or against some action, or to avoid social or legal obligation (sometimes by gaining admission to a hospital) — see malingering or factitious disorder.
+
+
+== Theories ==
+A number of theories have been proposed to explain the phenomenon of homicidal ideation or homicide itself. Many of these theories seem to overlap. They often are not mutually exclusive. At present no single theory explains all the phenomena noted in homicide, although many theories go some way to explaining several areas. Most of these theories follow the reasoning of theories studied in criminology. A brief synopsis of theories specific to homicide follows.
+
+
+=== Homicide adaptation ===
+This is the most recent of evolutionary theories. It claims to explain most of the phenomena associated with homicide. It states that humans have evolved with adaptations that enable us to think of and/or plan homicide. We come up with the idea as a possible answer to our problem position (threat to ourselves, our mates or our resources) and include a range of thought processes regarding killer and victim (degree of relatedness, relative status, gender, reproductive values, size and strength of families, allies and resources) and the potential costs of making use of such a high penalty strategy as homicide. If homicide is determined to be the best solution strategy, then it might be functional.
+
+
+=== By-product hypothesis ("slip up") ===
+According to this hypothesis, homicide is considered to be a mistake or over-reaction. Normal psychological mechanisms for control of property, partner or personal safety may not appear to be sufficient under certain stressful circumstances and abnormal mechanisms develop. Particularly extreme expressions of this may occur leading to homicide where in the normal state the perpetrator would not behave in this manner.
+
+
+== Management ==
+Not much information is available regarding the management of patients with homicidal thoughts. In Western countries, the management of such people lies within the realms of the police force and the health system. It is generally agreed upon that people with homicidal thoughts who are thought to be at high risk of acting them out should be recognized as needing help. They should be brought swiftly to a place where an assessment can be made and any underlying medical or mental disorder should be treated.
+
+
+== References ==
+
+
+== External links ==
+Deadly Dreams - Analysis of homicidal ideation in school shooters. (Scientific American, 1 August 2007)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Hospital_emergency_codes-0.md b/data/en.wikipedia.org/wiki/Hospital_emergency_codes-0.md
new file mode 100644
index 000000000..89cddfe20
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Hospital_emergency_codes-0.md
@@ -0,0 +1,153 @@
+---
+title: "Hospital emergency codes"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Hospital_emergency_codes"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:26.202116+00:00"
+instance: "kb-cron"
+---
+
+Hospital emergency codes are coded messages often announced over a public address system of a hospital to alert staff to various classes of on-site emergencies. The use of codes is intended to convey essential information quickly and with minimal misunderstanding to staff while preventing stress and panic among visitors to the hospital. Such codes are sometimes posted on placards throughout the hospital or are printed on employee identification badges for ready reference.
+Hospital emergency codes have varied widely by location, even between hospitals in the same community. Confusion over these codes has led to the proposal for and sometimes adoption of standardised codes. In many American, Canadian, and Australian hospitals, for example "code blue" indicates a patient has entered cardiac arrest, while "code red" indicates that a fire has broken out somewhere in the hospital.
+In order for a code call to be useful in activating the response of specific hospital personnel to a given situation, it is usually accompanied by a specific location description (e.g., "Code red, second floor, corridor three, room two-twelve"). Other codes, however, only signal hospital staff generally to prepare for the consequences of some external event such as a natural disaster.
+
+== Summary ==
+This table is a simplified summary of the emergency codes documented in this article. Note that there may be additional nuances to meaning and cause in individual regions, and some uncommon codes or callouts are omitted for brevity. More information is given in other sections.
+
+== Standardised colour codes ==
+
+=== Australia ===
+Australian hospitals and other buildings are covered by Australian Standard 4083 (1997)
+
+Code black: security needed, someone is armed, and is a threat to themselves or others
+Code grey: security needed, someone is unarmed, and is a threat to themselves or others
+Code blue: life-threatening medical emergency
+Code brown: external emergency (disaster, mass casualties, etc.)
+Code orange: evacuation
+Code purple: bomb threat
+Code red: fire
+Code yellow: internal emergency
+MET call: a medical emergency that is not cardiac or respiratory arrest; not a code blue situation, but one that may escalate to code blue
+Code pink: a mother is going into labour unexpectedly, or there is a newborn medical emergency,
+Code green: in some hospitals, indicates an urgent Caesarean section
+
+=== Canada ===
+
+==== Alberta ====
+Codes in Alberta are prescribed by Alberta Health Services.
+
+Code black: bomb threat/suspicious package
+Code blue: cardiac arrest/medical emergency
+Code brown: chemical spill/hazardous material
+Code green: evacuation
+Code grey: shelter in place/air exclusion
+Code orange: mass casualty incident
+Code purple: hostage situation
+Code red: fire
+Code white: violence/aggression
+Code yellow: missing patient
+Code 66: rapid medical intervention to prevent the patient deteriorating
+
+==== British Columbia ====
+Codes used in British Columbia, prescribed by the British Columbia Ministry of Health.
+
+Code amber: missing or abducted infant or child
+Code black: bomb threat
+Code blue: cardiac or respiratory arrest
+Code brown: hazardous spill
+Code green: evacuation
+Code grey: system failure
+Code orange: disaster or mass casualties
+Code pink: paediatric emergency or obstetrical emergency
+Code red: fire
+Code white: aggression
+Code yellow: missing patient
+Code silver: active shooter
+Code purple: neonatal resuscitation
+Code 77: stroke
+Code 99: incoming trauma
+
+==== Manitoba ====
+Codes used in Manitoba as defined in WRHA policy,"Codes: Standardised Emergency"; policy No. 50.00.010
+
+Code red: fire
+Code blue: cardiopulmonary arrest
+Code orange: disaster (external influx of patients)
+Code green: evacuation
+Code yellow: missing patient/resident
+Code black: bomb threat/search
+Code white: violent incident
+Code brown: internal chemical spill
+Code grey: external air contamination (exclusion)
+Code pink: abduction (infant, child, dependant adult)
+Code 25: medical emergency
+
+==== Nova Scotia ====
+The following codes are in use in Nova Scotia.
+
+Code black: bomb threat
+Code blue: cardio/respiratory arrest, choking, or other life-threatening emergency
+Code brown: hazardous substance spill/release
+Code census: emergency department overcrowding
+Code green precautionary: evacuation (precautionary)
+Code green stat: evacuation (crisis)
+Code grey: external air exclusion/shelter in place
+Code orange: external disaster/reception of mass casualties
+Code pink: paediatric emergency and/or obstetrical emergency
+Code red: fire
+Code silver: person with a weapon
+Code white: violent person/situation
+Code yellow: missing patient/client
+
+==== Ontario ====
+In Ontario, a standard emergency colour code system is used, with minor variations for some hospitals. Additional clinical codes, such as code transfusion, code trauma, code 99,etc. "KGH Emergency code review" (PDF). kingstonhsc.ca. etc. 
+
+Code amber: missing child/child abduction
+Code black: bomb threat/suspicious object
+Code blue: cardiac arrest/medical emergency
+Code brown: in-facility hazardous spill
+Code green: evacuation (precautionary)
+Code green stat: evacuation (crisis)
+Code grey: infrastructure loss or failure
+Code grey button-down: external air exclusion
+Code orange: external disaster
+Code orange CBRN: CBRN (chemical, biological, radiological, and nuclear) disaster
+Code pink: cardiac arrest/medical emergency – infant/child
+Code purple: hostage taking
+Code red: fire
+Code silver: active attacker
+Code white: violent/behavioural situation
+Code yellow: missing person
+
+==== Quebec ====
+The following codes are in use in Quebec.
+
+Code black: bomb threat/suspicious object
+Code blue: adult cardiac or respiratory arrest, loss of consciousness
+Code brown: in-facility hazardous spill
+Code green: evacuation
+Code orange: external disaster
+Code pink: paediatric cardiac or respiratory arrest, loss of consciousness
+Code purple/lavender: infant/neonatal cardiac or respiratory arrest
+Code red: fire
+Code white: violent patient
+Code yellow: missing or lost patient
+Code silver: active shooter
+
+==== Saskatchewan ====
+Codes used in Saskatchewan, prescribed by the Saskatchewan Health Authority.
+
+Code red: fire and water
+Code orange: incoming casualties/expanded services
+Code green: evacuation/relocation
+Code black: bomb threat/suspicious package
+Code purple: hostage taking
+Code white: aggressive/hostile/combative person
+Code yellow: missing person
+Code blue: cardiac/respiratory arrest
+Code brown: hazardous material/chemical spill
+Code silver: active assailant/person with a weapon
+
+==== Yukon ====
+The following codes are in use in Yukon.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Hospital_emergency_codes-1.md b/data/en.wikipedia.org/wiki/Hospital_emergency_codes-1.md
new file mode 100644
index 000000000..69732e1f6
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Hospital_emergency_codes-1.md
@@ -0,0 +1,48 @@
+---
+title: "Hospital emergency codes"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Hospital_emergency_codes"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:26.202116+00:00"
+instance: "kb-cron"
+---
+
+Code black: bomb threat
+Code blue: cardiac or respiratory arrest
+Code brown: hazardous material
+Code gold: earthquake (Yukon has the highest seismic activity rate in Canada)
+Code green stage 1: partial evacuation to a safe area within the building
+Code green stage 2: complete evacuation of the building
+Code grey: shelter in place/air exclusion
+Code orange: mass casualty
+Code red: fire
+Code white: aggressive behaviour
+Lockdown: violent situation/hostage taking
+Code yellow: missing patient
+
+=== United Kingdom ===
+
+In the UK, hospitals have standardised codes across individual NHS trusts (England and Wales) and health boards (Scotland), but there are not many standardised codes across the entire NHS. This allows for differences in demands on hospitals in different areas, and also for hospitals of different roles to communicate different alerts according to their needs (e.g., a major trauma centre like St. George's Hospital in South London has different priority alert needs to a rural community hospital like West Berkshire Community Hospital).
+Some more standardised codes are as follows:
+
+Code black: hospital at capacity – no available beds for new admissions from A&E. A code black is declared by the hospital's general bed manager, who then relays this to the local ambulance service and posts updates for local healthcare services such as GPs and district nursing teams.
+Code red: This is the United Kingdom's rapid response code. This call gets specialist doctors and trauma teams to the location for assistance in things like major traumas and deteriorating patients in situations like choking or airway compromise. This call also can be used to activate a major hemorrhage protocol in the event of a massive bleed. This call is referred to as code red, staff assist, trauma protocol or rapid response. This is the only emergency protocol which has a code. The only other is what is announced as a mass casualty protocol not any codes. This is to show a major incident has taken place like a terrorist attack and the protocol is activated to alert specialists and begin special emergency procedures like mass casualty triage and decontamination.
+Major haemorrhage protocol: activated via the code red system. A peri-arrest call is put out, but the transfusion lab is also alerted. A specified number of units of O-negative packed red blood cells, and sometimes fresh frozen plasma and platelets, are immediately sent to the location of the call. The transfusion lab will cross-match any saved blood samples for the patient, or await an urgent cross-match sample to be sent. Once this is done, units matching the patient's blood type will be continually sent until the major haemorrhage protocol is stood down.
+Otherwise, non-colour codes are mostly used across the NHS:
+
+2222 (crash call or peri-arrest call): dialling 2222 from any internal phone in nearly all NHS hospitals will connect the caller immediately to the switchboard. The caller can then specify the type of cardiac arrest or peri-arrest call (usually adult, paediatric (or neonatal) or obstetric) and give a location (eg "Adult cardiac arrest, Surgical Admissions Unit, ground floor B block" or "Obstetric peri-arrest, obstetric theatres, 4th floor maternity wing") and the switchboard will bleep the members of the relevant cardiac arrest or peri-arrest team. Some UK hospitals do not have a peri-arrest team, and the cardiac arrest team can be used for urgent medical emergencies where cardiac arrest is imminent.
+3333 (security alert)
+4444 (fire alert)
+"Fast bleep" codes: a 2222 call for a specific member of staff. For example, in status epilepticus, it is not necessary to call the crash team (as is done in cardiac arrest) but a fast bleep can be made to the on-call anaesthetist to come urgently.
+Trauma call:
+adult (trauma centres only): usually called over a PA system across the emergency department, triggering a "trauma call" paging request to all members of the trauma team: including a trauma surgeon and senior members their surgical team, an anaesthetist and ODP, emergency medicine consultant or registrar and members of their team (this will be usually be an FY1 or SHO). Trauma calls are similar to "resus codes" used in the US.
+paediatric (trauma centres only): triggers a "trauma call" paging request to all members of the paediatric trauma team – including a trauma surgeon and senior members of their surgical team, often additionally a paediatric surgeon, a paediatric anaesthetist, ODP, (paediatric) emergency medicine consultant or registrar and members of their team (this will be usually be an FY1 or SHO).
+
+=== United States ===
+In 2000, the Hospital Association of Southern California (HASC) determined that a uniform code system was needed after three people were killed in a shooting incident at a hospital after the wrong emergency code was called. While codes for fire (red) and medical emergency (blue) were similar in 90% of California hospitals queried, 47 different codes were used for infant abduction and 61 for combative person. In light of this, the HASC published a handbook titled Healthcare Facility Emergency Codes: A Guide for Code Standardization listing various codes and has strongly urged hospitals to voluntarily implement the revised codes.
+In 2003, Maryland mandated that all acute hospitals in the state have uniform codes.
+In 2008, the Oregon Association of Hospitals & Health Systems, Oregon Patient Safety Commission, and Washington State Hospital Association formed a taskforce to standardise emergency code calls. After both states had conducted a survey of all hospital members, the task force found many hospitals used the same code for fire (code red); however, there were tremendous variations for codes representing respiratory and cardiac arrest, infant and child abduction, and combative persons.
+Consistent across the thirteen states with uniform codes as of 2020 were code red (fire), code blue (cardiac arrest and/or medical emergency), and code orange (hazardous material spill/release). Some other colour codes used in multiple states are listed in the table below. Of these, only Maryland's code is mandatory as of 2020.
+
+Additional codes (not including plain-language codes) include, but are not limited to:
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+---
+title: "Hospital emergency codes"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Hospital_emergency_codes"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:28:26.202116+00:00"
+instance: "kb-cron"
+---
+
+Code white: paediatric medical emergency, combative person without a weapon, or emergency operating procedures dependent on the state.
+Code gold: bomb threat
+Code brown: missing adult patient
+Code violet: combative person
+Code triage: mass casualty
+Code walker: missing adult patient
+
+==== Plain-language alerts ====
+In 2015, the South Carolina Hospital Association formed a work group to develop plain language standardisation code recommendations. Abolishing all colour codes was suggested. In 2016, the Texas Hospital Association encouraged the use of standardised plain language emergency alerts at all Texas hospitals. The only colour code that was still recommended was "code blue," meaning a cardiac arrest.
+Plain language alerts are announced using the following format: Alert type + description + location (general to specific) + instructions (if applicable). For example, if a patient in ICU Bed 4 went into cardiac arrest, the alert would be "Medical alert + code blue + second floor + intensive care unit + bed 4."
+In January 2025, the Washington State Hospital Association (WSHA) recommended plain-language codes, although it advised keeping the legacy colour codes of "Code Blue" and "Amber Alert." The new system, which is "strongly recommend[ed]" but not required, classifies alerts into "Facility," "Medical," and "Security" alerts.
+
+== Codes ==
+
+Note: Different codes are used in different hospitals.
+
+=== Code blue ===
+
+"Code blue” is used to indicate that a patient requires resuscitation or is in need of immediate medical attention, most often as the result of a respiratory arrest or cardiac arrest. When called overhead, the page takes the form of "Code blue, [floor], [room]" to alert the resuscitation team where to respond. Every hospital, as a part of its disaster plans, sets a policy to determine which units provide personnel for code coverage. In theory any medical professional may respond to a code, but in practice, the team makeup is limited to those with advanced cardiac life support or other equivalent resuscitation training. Frequently these teams are staffed by physicians from anaesthesia, internal medicine or emergency medicine, respiratory therapists, pharmacists, and nurses. A code team leader will be a physician in attendance on any code team; this individual is responsible for directing the resuscitation effort and is said to "run the code".
+This phrase was coined at Bethany Medical Centre in Kansas City, Kansas. The term "code" by itself is commonly used by medical professionals as a slang term for this type of emergency, as in "calling a code" or describing a patient in arrest as "coding" or "coded".
+
+Australian standard
+Californian standard
+In some hospitals or other medical facilities, the resuscitation team may purposely respond slowly to a patient in cardiac arrest, a practice known as "slow code", or may fake the response altogether for the sake of the patient's family, a practice known as "show code". Such practices are ethically controversial, and are banned in some jurisdictions.
+
+==== Variations ====
+"Plan blue" was used at St. Vincent's Hospital in New York City to indicate arrival of a trauma patient so critically injured that even the short delay of a stop in the A&E for evaluation could be fatal; "plan blue" was called out to alert the surgeon on call to go immediately to the A&E entrance and take the patient for immediate surgery.
+
+=== "Doctor" codes ===
+"Doctor" codes are often used in hospital settings for announcements over a general loudspeaker or paging system that might cause panic or endanger a patient's privacy. Most often, "doctor" codes take the form of "Paging Dr. Sinclair", where the doctor's "name" is a code word for a dangerous situation or a patient in crisis, e.g.: "Paging Dr. Firestone, third floor," to indicate a possible fire on the floor specified.
+
+=== "Resus" codes ===
+Specific to emergency medicine, incoming patients in immediate danger of life or limb, whether presenting via ambulance or walk-in triage, are paged locally within the emergency department as "roesus" [ri:səs] codes. These codes indicate the type of emergency (general medical, trauma, cardiopulmonary or neurological) and type of patient (adult or paediatric). An estimated time of arrival may be included, or "now" if the patient is already in the department. The patient is transported to the nearest open trauma bay or evaluation room, and is immediately attended by a designated team of physicians and nurses for purposes of immediate stabilisation and treatment.
+
+== See also ==
+Inspector Sands, code used over PA system in British public transport to indicate a serious situation
+Vessel emergency codes codes used on cruise ships.
+
+== Notes ==
+
+== References ==
+
+== External links ==
+Codes Listing, Texas Tech University Health Sciences Center
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+---
+title: "Host factor"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Host_factor"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:22.754558+00:00"
+instance: "kb-cron"
+---
+
+Host factor (sometimes known as risk factor) is a medical term referring to the traits of an individual person or animal that affect susceptibility to disease, especially in comparison to other individuals. The term arose in the context of infectious disease research, in contrast to "organism factors", such as the virulence and infectivity of a microbe. Host factors that may vary in a population and affect disease susceptibility can be innate or acquired.
+Some examples: 
+
+general health
+psychological characteristics and attitude
+nutritional state
+social ties
+previous exposure to the organism or related antigens
+haplotype or other specific genetic differences of immune function
+substance abuse
+race
+
+The term is now used in oncology and many other medical contexts related to individual differences of disease vulnerability.
+
+
+== See also ==
+Vulnerability index
+Epidemiology
+Immunology
+
+
+== References ==
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+---
+title: "Human body temperature"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Human_body_temperature"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:23.993847+00:00"
+instance: "kb-cron"
+---
+
+Normal human body temperature (normothermia, euthermia) is the typical temperature range found in humans. The normal human body temperature range is typically stated as 36.5–37.5 °C (97.7–99.5 °F).
+Human body temperature varies. It depends on sex, age, time of day, exertion level, health status (such as illness and menstruation), what part of the body the measurement is taken at, state of consciousness (waking, sleeping, sedated), and emotions. Body temperature is kept in the normal range by a homeostatic function known as thermoregulation, in which adjustment of temperature is triggered by the central nervous system.
+
+== Methods of measurement ==
+
+Taking a human's temperature is an initial part of a full clinical examination. There are various types of medical thermometers, as well as sites used for measurement, including:
+
+Under the armpit (axillary temperature)
+In the mouth (oral temperature)
+In the rectum (rectal temperature)
+In the ear (tympanic temperature)
+On the skin of the forehead over the temporal artery
+Using heat flux sensors
+
+=== Variations ===
+
+Temperature control (thermoregulation) is a homeostatic mechanism that keeps the organism at optimum operating temperature, as the temperature affects the rate of chemical reactions. In humans, the average internal temperature is widely accepted to be 37 °C (98.6 °F), a "normal" temperature established in the 1800s.  But newer studies show that average internal temperature for men and women is 36.4 °C (97.5 °F). No person always has exactly the same temperature at every moment of the day. Temperatures cycle regularly up and down through the day, as controlled by the person's circadian rhythm. The lowest temperature occurs about two hours before the person normally wakes up. Additionally, temperatures change according to activities and external factors.
+In addition to varying throughout the day, normal body temperature may also differ as much as 0.5 °C (0.90 °F) from one day to the next, so that the highest or lowest temperatures on one day will not always exactly match the highest or lowest temperatures on the next day.
+Normal human body temperature varies slightly from person to person and by the time of day. Consequently, each type of measurement has a range of normal temperatures.  The range for normal human body temperatures, taken orally, is 36.8 ± 0.5 °C (98.2 ± 0.9 °F). This means that any oral temperature between 36.3 and 37.3 °C (97.3 and 99.1 °F) is likely to be normal.
+The normal human body temperature is often stated as 36.5–37.5 °C (97.7–99.5 °F). In adults a review of the literature has found a wider range of 33.2–38.2 °C (91.8–100.8 °F) for normal temperatures, depending on the gender and location measured.
+Reported values vary depending on how it is measured: oral (under the tongue): 36.8 ± 0.4 °C (98.2 ± 0.7 °F), internal (rectal, vaginal): 37.0 °C (98.6 °F). A rectal or vaginal measurement taken directly inside the body cavity is typically slightly higher than oral measurement, and oral measurement is somewhat higher than skin measurement. Other places, such as under the arm or in the ear, produce different typical temperatures. While some people think of these averages as representing normal or ideal measurements, a wide range of temperatures has been found in healthy people. The body temperature of a healthy person varies during the day by about 0.5 °C (0.9 °F) with lower temperatures in the morning and higher temperatures in the late afternoon and evening, as the body's needs and activities change. Other circumstances also affect the body's temperature. The core body temperature of an individual tends to have the lowest value in the second half of the sleep cycle; the lowest point, called the nadir, is one of the primary markers for circadian rhythms. The body temperature also changes when a person is hungry, sleepy, sick, or cold.
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+---
+title: "Human body temperature"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Human_body_temperature"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:23.993847+00:00"
+instance: "kb-cron"
+---
+
+=== Natural rhythms ===
+Body temperature normally fluctuates over the day following circadian rhythms, with the lowest levels around 4 a.m. and the highest in the late afternoon, between 4:00 and 6:00 p.m. (assuming the person sleeps at night and stays awake during the day). Therefore, an oral temperature of 37.3 °C (99.1 °F) would, strictly speaking, be a normal, healthy temperature in the afternoon but not in the early morning. An individual's body temperature typically changes by about 0.5 °C (0.9 °F) between its highest and lowest points each day.
+Body temperature is sensitive to many hormones, so women have a temperature rhythm that varies with the menstrual cycle, called a circamensal rhythm. A woman's basal body temperature rises sharply after ovulation, as estrogen production decreases and progesterone increases.  Fertility awareness programs use this change to identify when a woman has ovulated to achieve or avoid pregnancy. During the luteal phase of the menstrual cycle, both the lowest and the average temperatures are slightly higher than during other parts of the cycle.  However, the amount that the temperature rises during each day is slightly lower than typical, so the highest temperature of the day is not very much higher than usual.  Hormonal contraceptives both suppress the circamensal rhythm and raise the typical body temperature by about 0.6 °C (1.1 °F).
+Temperature also may vary with the change of seasons during each year.  This pattern is called a circannual rhythm.  Studies of seasonal variations have produced inconsistent results.  People living in different climates may have different seasonal patterns.
+It has been found that physically active individuals have larger changes in body temperature throughout the day. Physically active people have been reported to have lower body temperatures than their less active peers in the early morning and similar or higher body temperatures later in the day.
+With increased age, both average body temperature and the amount of daily variability in the body temperature tend to decrease. Elderly people may have a decreased ability to generate body heat during a fever, so even a somewhat elevated temperature can indicate a serious underlying cause in geriatrics. One study suggested that the average body temperature has also decreased since the 1850s. The study's authors believe the most likely explanation for the change is a reduction in inflammation at the population level due to decreased chronic infections and improved hygiene.
+
+=== Measurement methods ===
+
+Different methods used for measuring temperature produce different results.  The temperature reading depends on which part of the body is being measured.  The typical daytime temperatures among healthy adults are as follows:
+
+Temperature in the rectum (rectal), vagina, or in the ear (tympanic) is about 37.5 °C (99.5 °F)
+Temperature in the mouth (oral) is about 36.8 °C (98.2 °F)
+Temperature under the arm (axillary) is about 36.5 °C (97.7 °F)
+Generally, oral, rectal, gut, and core body temperatures, although slightly different, are well-correlated.
+Oral temperatures are influenced by drinking, chewing, smoking, and breathing with the mouth open. Mouth breathing, cold drinks or food reduce oral temperatures; hot drinks, hot food, chewing, and smoking raise oral temperatures.
+Each measurement method also has different normal ranges depending on sex.
+
+=== Infrared thermometer ===
+
+As of 2016, reviews of infrared thermometers have found them to be of variable accuracy. This includes tympanic infrared thermometers in children.
+
+=== Variations due to outside factors ===
+Sleep disturbances also affect temperatures.  Normally, body temperature drops significantly at a person's normal bedtime and throughout the night.  Short-term sleep deprivation produces a higher temperature at night than normal, but long-term sleep deprivation appears to reduce temperatures.  Insomnia and poor sleep quality are associated with smaller and later drops in body temperature.  Similarly, waking up unusually early, sleeping in, jet lag and changes to shift work schedules may affect body temperature.
+
+== Concept ==
+
+=== Fever ===
+
+A temperature setpoint is the level at which the body attempts to maintain its temperature.  When the setpoint is raised, the result is a fever.  Most fevers are caused by infectious disease and can be lowered, if desired, with antipyretic medications.
+An early morning temperature higher than 37.3 °C (99.1 °F) or a late afternoon temperature higher than 37.7 °C (99.9 °F) is normally considered a fever, assuming that the temperature is elevated due to a change in the hypothalamus's setpoint.  Lower thresholds are sometimes appropriate for elderly people.  The normal daily temperature variation is typically 0.5 °C (0.90 °F), but can be greater among people recovering from a fever.
+An organism at optimum temperature is considered afebrile, meaning "without fever". If temperature is raised, but the setpoint is not raised, then the result is hyperthermia.
+
+=== Hyperthermia ===
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+---
+title: "Human body temperature"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Human_body_temperature"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:23.993847+00:00"
+instance: "kb-cron"
+---
+
+Hyperthermia occurs when the body produces or absorbs more heat than it can dissipate. It is usually caused by prolonged exposure to high temperatures. The heat-regulating mechanisms of the body eventually become overwhelmed and unable to deal effectively with the heat, causing the body temperature to climb uncontrollably.  Hyperthermia at or above about 40 °C (104 °F) is a life-threatening medical emergency that requires immediate treatment.  Common symptoms include headache, confusion, and fatigue.  If sweating has resulted in dehydration, then the affected person may have dry, red skin.
+In a medical setting, mild hyperthermia is commonly called heat exhaustion or heat prostration; severe hyperthermia is called heat stroke.  Heatstroke may come on suddenly, but it usually follows the untreated milder stages.  Treatment involves cooling and rehydrating the body; fever-reducing drugs are useless for this condition.  This may be done by moving out of direct sunlight to a cooler and shaded environment, drinking water, removing clothing that might keep heat close to the body, or sitting in front of a fan. Bathing in tepid or cool water, or even just washing the face and other exposed areas of the skin, can be helpful.
+With fever, the body's core temperature rises to a higher temperature through the action of the part of the brain that controls the body temperature; with hyperthermia, the body temperature is raised without the influence of the heat control centers.
+
+=== Hypothermia ===
+
+In hypothermia, body temperature drops below that required for normal metabolism and bodily functions. In humans, this is usually due to excessive exposure to cold air or water, but it can be deliberately induced as a medical treatment. Symptoms usually appear when the body's core temperature drops by 1–2 °C (1.8–3.6 °F) below normal temperature.
+
+=== Basal body temperature ===
+
+Basal body temperature is the lowest temperature attained by the body during rest (usually during sleep). It is generally measured immediately after awakening and before any physical activity has been undertaken, although the temperature measured at that time is somewhat higher than the true basal body temperature.  In women, temperature differs at various points in the menstrual cycle, and this can be used in the long term to track ovulation both to aid conception or avoid pregnancy.  This process is called fertility awareness.
+
+=== Core temperature ===
+Core temperature, also called core body temperature, is the operating temperature of an organism, specifically in deep structures of the body such as the liver, in comparison to temperatures of peripheral tissues.  Core temperature is normally maintained within a narrow range so that essential enzymatic reactions can occur. Significant core temperature elevation (hyperthermia) or depression (hypothermia) over more than a brief period of time is fatal.
+Temperature examination in the heart, using a catheter, is the traditional gold standard measurement used to estimate core temperature (oral temperature is affected by hot or cold drinks, ambient temperature fluctuations as well as mouth-breathing). Since catheters are highly invasive, the generally accepted alternative for measuring core body temperature is through rectal measurements. Rectal temperature is expected to be approximately 1 °F (0.56 °C) higher than an oral temperature taken on the same person at the same time. Ear thermometers measure temperature from the tympanic membrane using infrared sensors and also aim to measure core body temperature, since the blood supply of this membrane is directly shared with the brain. However, this method of measuring body temperature is not as accurate as rectal measurement and has a low sensitivity for fever, failing to determine three or four out of every ten fever measurements in children. Ear temperature measurement may be acceptable for observing trends in body temperature but is less useful in consistently identifying and diagnosing fever.
+Until recently, direct measurement of core body temperature required either an ingestible device or surgical insertion of a probe. Therefore, a variety of indirect methods have commonly been used as the preferred alternative to these more accurate albeit more invasive methods.  The rectal or vaginal temperature is generally considered to give the most accurate assessment of core body temperature, particularly in hypothermia. In the early 2000s, ingestible thermistors in capsule form were produced, allowing the temperature inside the digestive tract to be transmitted to an external receiver; one study found that these were comparable in accuracy to rectal temperature measurement. More recently, a new method using heat flux sensors have been developed. Several research papers show that its accuracy is similar to the invasive methods.
+
+=== Internal variation ===
+Measurement within the body finds internal variation temperatures as different as 21.5 °C (70.7 °F) for the radial artery and 31.1 °C (88.0 °F) for the brachial artery. It has been observed that "chaos" has been "introduced into physiology by the fictitious assumption of a constant blood temperature".
+
+== Temperature variation ==
+
+=== Hot ===
+44 °C (111.2 °F) or more – Almost certainly death will occur; however, people have been known to survive up to 46.5 °C (115.7 °F).
+43 °C (109.4 °F) – Normally death, or there may be serious brain damage, convulsions, and shock. Cardio-respiratory collapse will likely occur.
+42 °C (107.6 °F) – Subject may turn red. They may become comatose, be in severe delirium, and convulsions can occur.
+41 °C (105.8 °F) – (Medical emergency) – Fainting, severe headache, dizziness, confusion, hallucinations, delirium, and drowsiness can occur. There may also be palpitations and breathlessness.
+40 °C (104 °F) – Fainting, dehydration, weakness, headache, breathlessness, and dizziness may occur as well as profuse sweating.
+39 °C (102.2 °F) – Severe sweating, and red. Fast heart rate and breathlessness. There may be exhaustion accompanying this. Children and people with epilepsy may suffer convulsions at this temperature.
+38 °C (100.4 °F) – (Classed as hyperthermia if not caused by a fever) – Feeling hot, sweating, feeling thirsty, feeling very uncomfortable.
+37.6 °C (99.7 °F) — Classed as a slight fever. May lose appetite, feeling hot, feeling uncomfortable, feeling thirsty.
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+---
+title: "Human body temperature"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Human_body_temperature"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:23.993847+00:00"
+instance: "kb-cron"
+---
+
+=== Normal ===
+36.5–37.5 °C (97.7–99.5 °F) is a typically reported range for normal body temperature.
+
+=== Cold ===
+35.5 °C (95.9 °F) – Feeling cold, mild to moderate shivering. This can be a normal body temperature for sleeping.
+35 °C (95 °F) – Threshold for hypothermia. Intense shivering, numbness and bluish/grayness of the skin. There is the possibility of heart irritability.
+34 °C (93.2 °F) – Severe shivering, loss of movement of fingers, blueness, and confusion. Some behavioral changes may take place.
+33 °C (91.4 °F) – Moderate to severe confusion, sleepiness, depressed reflexes, progressive loss of shivering, slow heartbeat, shallow breathing. Shivering may stop. The subject may be unresponsive to certain stimuli.
+32 °C (89.6 °F) – (Medical emergency) – Hallucinations, delirium, complete confusion, extreme sleepiness that is progressively becoming comatose. Shivering is absent. Reflex may be absent or very slight.
+31 °C (87.8 °F) – Comatose, very rarely conscious. No or slight reflexes.  Very shallow breathing and slow heart rate. Possibility of serious heart rhythm problems.
+28 °C (82.4 °F) – Severe heart rhythm disturbances are likely and breathing may stop at any time. The person may appear to be dead.
+24–26 °C (75.2–78.8 °F) or less – Death usually occurs due to irregular heart beat or respiratory arrest; however, some patients have been known to survive with body temperatures lower than 12.7 °C (54.9 °F). The lowest recorded core temperature from a patient with accidental hypothermia who survived without neurological sequelae is 11.8 °C (53.2 °F).
+There are non-verbal corporal cues that can hint at an individual experiencing a low body temperature, which can be used for those with dysphasia or infants. Examples of non-verbal cues of coldness include stillness and being lethargic, unusual paleness of skin among light-skinned people, and, among males, shrinkage, and contraction of the scrotum.
+
+== Effect of environment ==
+Environmental conditions, primarily temperature and humidity, affect the ability of the mammalian body to thermoregulate. The psychrometric temperature, of which the wet-bulb temperature is the main component, largely limits thermoregulation. It was thought that a wet-bulb temperature of about 35 °C (95 °F) was the highest sustained value consistent with human life.
+A 2022 study on the effect of heat on young people found that the critical wet-bulb temperature at which heat stress can no longer be compensated, Twb,crit, in young, healthy adults performing tasks at modest metabolic rates mimicking basic activities of daily life was much lower than the 35 °C (95 °F) usually assumed, at about 30.55 °C (86.99 °F) in 36–40 °C (97–104 °F) humid environments, but progressively decreased in hotter, dry ambient environments.
+At low temperatures the body thermoregulates by generating heat, but this becomes unsustainable at extremely low temperatures.
+
+== Historical understanding ==
+In the 19th century, most books quoted "blood heat" as 98 °F, until a study published the mean (but not the variance) of a large sample as 36.88 °C (98.38 °F). Subsequently, that mean was widely quoted as "37 °C or 98.4 °F" until editors realized 37 °C is equal to 98.6 °F, not 98.4 °F. The 37 °C value was set by German physician Carl Reinhold August Wunderlich in his 1868 book, which put temperature charts into widespread clinical use. Dictionaries and other sources that quoted these averages did add the word "about" to show that there is some variance, but generally did not state how wide the variance is.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Human_equivalent-0.md b/data/en.wikipedia.org/wiki/Human_equivalent-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Human_equivalent-0.md
@@ -0,0 +1,32 @@
+---
+title: "Human equivalent"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Human_equivalent"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:25.201027+00:00"
+instance: "kb-cron"
+---
+
+The term human equivalent is used in a number of different contexts. This term can refer to human equivalents of various comparisons of animate and inanimate things.
+
+
+== Animal models in chemistry and medicine ==
+Animal models are used to learn more about a disease, its diagnosis and its treatment, with animal models predicting human toxicity in up to 71% of cases. The human equivalent dose (HED) or human equivalent concentration (HEC) is the quantity of a chemical that, when administered to humans, produces an effect equal to that produced in test animals by a smaller dose. Calculating the HED is a step in carrying out a clinical trial of a pharmaceutical drug.
+
+
+== Human energy usage and conversion ==
+The concept of human-equivalent energy (H-e) assists in understanding of energy flows in physical and biological systems by expressing energy units in human terms: it provides a “feel” for the use of a given amount of energy by expressing it in terms of the relative quantity of energy needed for human metabolism, assuming an average human energy expenditure of 12,500 kJ per day and a basal metabolic rate of 80 watts. A light bulb running at 100 watts is running at 1.25 human equivalents (100/80), i.e. 1.25 H-e. On the other hand, a human may generate as much as 1,000 watts for a task lasting a few minutes, or even more for a task of a few seconds' duration, while climbing a flight of stairs may represent work at a rate of about 200 watts.
+
+
+== Animal attributes expressed in terms of human equivalents ==
+
+
+=== Cat and dog years ===
+The ages of domestic cats and dogs are often referred to in terms of "cat years" or "dog years", representing a conversion to human-equivalent years. One formula for cat years is based on a cat reaching maturity in approximately 1 year, which could be seen as 16 in human terms, then adding about 4 years for every year the cat ages. A 5-year-old cat would then be (5 − 1) × 4 + 16 = 32 "cat years" (i.e. human-equivalent years), and a 10-year-old cat (10 − 1) × 4 + 16 = 52 in human terms.
+
+
+== See also ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Hyperkatifeia-0.md b/data/en.wikipedia.org/wiki/Hyperkatifeia-0.md
new file mode 100644
index 000000000..e02d0440b
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Hyperkatifeia-0.md
@@ -0,0 +1,15 @@
+---
+title: "Hyperkatifeia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Hyperkatifeia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:26.364618+00:00"
+instance: "kb-cron"
+---
+
+Hyperkatifeia is defined as hypersensitivity to emotional distress in the context of opioid abuse.
+Hyperkatifeia and opioid-induced hyperalgesia can be seen with long-term use of illicit street opioids e.g. heroin, and prescription opioids e.g. hydrocodone and oxycodone during withdrawal.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Hypoplasia-0.md b/data/en.wikipedia.org/wiki/Hypoplasia-0.md
new file mode 100644
index 000000000..56b4c1310
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Hypoplasia-0.md
@@ -0,0 +1,38 @@
+---
+title: "Hypoplasia"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Hypoplasia"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:27.587927+00:00"
+instance: "kb-cron"
+---
+
+Hypoplasia (from Ancient Greek  ὑπo- (hypo-) 'under' and  πλάσις (plasis) 'formation'; adjective form hypoplastic) is underdevelopment or incomplete development of a tissue or organ.  Although the term is not always used precisely, it properly refers to an inadequate or below-normal number of cells.  Hypoplasia is similar to aplasia, but less severe. It is technically not the opposite of hyperplasia (too many cells). Hypoplasia is a congenital condition, while hyperplasia generally refers to excessive cell growth later in life.  (Atrophy, the wasting away of already existing cells, is technically the direct opposite of both hyperplasia and hypertrophy.)
+Hypoplasia can be present in any tissue or organ. It is descriptive of many medical conditions, including underdevelopment of organs such as:
+
+Breasts during puberty
+Testes in Klinefelter's syndrome
+Ovaries in Fanconi anemia, gonadal dysgenesis, trisomy X
+Thymus in DiGeorge syndrome
+Labia majora in popliteal pterygium syndrome
+Corpus callosum, connecting the two sides of the brain, in agenesis of the corpus callosum
+Cerebellum caused by mutation in the reelin gene
+Tooth caused by oral pathology, such as Turner's hypoplasia
+Chambers of the heart in hypoplastic left heart syndrome and hypoplastic right heart syndrome
+Optic nerve in optic nerve hypoplasia
+Sacrum in sacral agenesis
+Facial muscle in asymmetric crying facies
+Thumb from birth
+Lungs, often as a result of oligohydramnios during gestation or the existence of congenital diaphragmatic hernia
+Small bowel in coeliac disease
+Fingers and ears in harlequin-type ichthyosis
+Mandible in congenital hypothyroidism
+
+
+== See also ==
+Atrophy, when an existing part wastes away
+List of biological development disorders
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Idiopathic_disease-0.md b/data/en.wikipedia.org/wiki/Idiopathic_disease-0.md
new file mode 100644
index 000000000..281e162fa
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Idiopathic_disease-0.md
@@ -0,0 +1,55 @@
+---
+title: "Idiopathic disease"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Idiopathic_disease"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:28.918087+00:00"
+instance: "kb-cron"
+---
+
+An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin.  
+For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of instances, the cause may not be readily apparent or characterized. In these cases, the origin of the condition is said to be idiopathic. With some other medical conditions, the root cause for a large percentage of all cases has not been established—for example, focal segmental glomerulosclerosis or ankylosing spondylitis; the majority of these cases are deemed idiopathic. Certain medical conditions, when idiopathic, notably some forms of epilepsy and stroke, are preferentially described by the synonymous term of cryptogenic.
+
+
+== Derivation ==
+The term 'idiopathic' derives from Greek ἴδιος idios "one's own" and πάθος pathos "suffering", so idiopathy means approximately "a disease of its own kind".
+
+
+== Examples ==
+Diseases where the cause is seen as wholly or partly idiopathic include:
+
+Idiopathic pulmonary fibrosis
+Idiopathic pulmonary haemosiderosis
+Idiopathic intracranial hypertension
+Idiopathic chronic fatigue
+Granulomatous prostatitis
+
+
+== Medical advances and this term ==
+Advances in medical science improve the understanding of causes of diseases and the classification of diseases; thus, regarding any particular condition or disease, as more root causes are discovered and as events that seemed spontaneous have their origins revealed, the percentage of cases designated as idiopathic will decrease.  Environmental and occupational risk factors are increasingly being associated with diseases classified as idiopathic. Emerging evidence indicates a complex relationship between intrinsic (genetic) and extrinsic (environmental and occupational) factors in disease physiopathology.
+
+
+== Usage of synonyms ==
+The word essential is sometimes synonymous with idiopathic (as in essential hypertension, essential thrombocythemia, and essential tremor) and the same is true of primary (as in primary biliary cholangitis, or primary amenorrhea), with the latter term being used in such cases to contrast with secondary in the sense of "secondary to [i.e., caused by] some other condition." Another, less common synonym is agnogenic (agno-, "unknown" + -gen, "cause" + -ic). 
+The word cryptogenic (crypto-, "hidden" + -gen, "cause" + -ic) has a sense that is synonymous with idiopathic and a sense that is contradistinguished from it. Some disease classifications prefer the use of the synonymous term cryptogenic disease as in cryptogenic stroke, and cryptogenic epilepsy. The use of cryptogenic is also sometimes reserved for cases where it is presumed that the cause is simple and will be found in the future.
+Some congenital conditions are idiopathic, and sometimes the word congenital is used synonymously with idiopathic; but careful usage prefers to reserve the word congenital for conditions to which the literal sense of the word applies (that is, those whose pathophysiology has existed since the neonatal period).
+
+
+== Syndrome without a name ==
+The term syndrome without a name (SWAN) is used "when a child or young adult is believed to have a genetic condition and testing has failed to identify its genetic cause". It is believed that "about half (50%) of children with learning disabilities and approximately 60% of children with congenital disabilities (disabilities which are apparent from birth) do not have a definitive diagnosis to explain the cause of their difficulties".
+
+
+== See also ==
+Diagnosis of exclusion
+Embolic stroke of undetermined source
+Functional disorder
+Idiosyncratic drug reaction
+Fever of unknown origin
+
+
+== References ==
+
+
+== External links ==
+ The dictionary definition of idiopathic disease at Wiktionary
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Idiosyncrasy-0.md b/data/en.wikipedia.org/wiki/Idiosyncrasy-0.md
new file mode 100644
index 000000000..c8a06a8f5
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Idiosyncrasy-0.md
@@ -0,0 +1,59 @@
+---
+title: "Idiosyncrasy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Idiosyncrasy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:30.459804+00:00"
+instance: "kb-cron"
+---
+
+An idiosyncrasy is a unique feature of something. The term is often used to express peculiarity.
+
+
+== Etymology ==
+The term "idiosyncrasy" originates from Greek ἰδιοσυγκρασία idiosynkrasía, "a peculiar temperament, habit of body" (from ἴδιος idios, "one's own", σύν syn, "with" and κρᾶσις krasis, "blend of the four humors" (temperament) or literally "particular mingling".
+Idiosyncrasy is sometimes used as a synonym for eccentricity, as these terms "are not always clearly distinguished when they denote an act, a practice, or a characteristic that impresses the observer as strange or singular." Eccentricity, however, "emphasizes the idea of divergence from the usual or customary; idiosyncrasy implies a following of one's particular temperament or bent especially in trait, trick, or habit; the former often suggests mental aberration, the latter, strong individuality and independence of action".
+
+
+== Linguistics ==
+The term can also be applied to symbols or words. Idiosyncratic symbols mean one thing for a particular person, as a blade could mean war, but to someone else, it could symbolize a surgery.
+
+
+=== Idiosyncratic property ===
+In phonology, an idiosyncratic property contrasts with a systematic regularity. While systematic regularities in the sound system of a language are useful for identifying phonological rules during analysis of the forms morphemes can take, idiosyncratic properties are those whose occurrence is not determined by those rules. For example, the fact that the English word cab starts with the sound /k/ is an idiosyncratic property; on the other hand that its vowel is longer than in the English word cap is a systematic regularity, as it arises from the fact that the final consonant is voiced rather than voiceless.
+
+
+== Medicine ==
+
+
+=== Disease ===
+Idiosyncrasy defined the way physicians conceived diseases in the 19th century. They considered each disease as a unique condition, related to each patient. This understanding began to change in the 1870s, when discoveries made by researchers in Europe permitted the advent of a "scientific medicine", a precursor to the evidence-based medicine that is the standard of practice today.
+
+
+=== Pharmacology ===
+The term idiosyncratic drug reaction denotes an aberrant or bizarre reaction or hypersensitivity to a substance, without connection to the pharmacology of the drug. It is what is known as a Type B reaction. Type B reactions have the following characteristics: they are usually unpredictable, might not be picked up by toxicological screening, not necessarily dose-related, incidence and morbidity low but mortality is high. Type B reactions are most commonly immunological (e.g. penicillin allergy).
+
+
+=== Psychiatry and psychology ===
+The word is used for the personal way a given individual reacts, perceives and experiences: a certain dish made of meat may cause nostalgic memories in one person and disgust in another. These reactions are called idiosyncratic.
+
+
+== Economics ==
+In portfolio theory, risks of price changes due to the unique circumstances of a specific security, as opposed to the overall market, are called "idiosyncratic risks". This specific risk, also called unsystematic, can be nulled out of a portfolio through diversification. Pooling multiple securities means the specific risks cancel out. In complete markets, there is no compensation for idiosyncratic risk—that is, a security's idiosyncratic risk does not matter for its price. For instance, in a complete market in which the capital asset pricing model holds, the price of a security is determined by the amount of systematic risk in its returns. Net income received, or losses suffered, by a landlord from renting of one or two properties is subject to idiosyncratic risk due to the numerous things that can happen to real property and variable behavior of tenants.
+According to one macroeconomic model including a financial sector, hedging idiosyncratic risk can be self-defeating as amid the "risk reduction" experts are encouraged to increase their leverage. This works for small shocks but leads to higher vulnerability for larger shocks and makes the system less stable. Thus, while securitisation in principle reduces the costs of idiosyncratic shocks, it ends up amplifying systemic risks in equilibrium.
+In econometrics, "idiosyncratic error" is used to describe error—that is, unobserved factors that impact the dependent variable—from panel data that both changes over time and across units (individuals, firms, cities, towns, etc.)
+
+
+== See also ==
+Humorism
+Allergy
+Portfolio theory
+Idiolect
+
+
+== References ==
+
+
+== External links ==
+ The dictionary definition of idiosyncrasy at Wiktionary
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Idiosyncratic_drug_reaction-0.md b/data/en.wikipedia.org/wiki/Idiosyncratic_drug_reaction-0.md
new file mode 100644
index 000000000..5036eb641
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Idiosyncratic_drug_reaction-0.md
@@ -0,0 +1,29 @@
+---
+title: "Idiosyncratic drug reaction"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Idiosyncratic_drug_reaction"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:31.620982+00:00"
+instance: "kb-cron"
+---
+
+Idiosyncratic drug reactions, also known as type B reactions, are drug reactions that occur rarely and unpredictably amongst the population. This is not to be mistaken with idiopathic, which implies that the cause is not known. They frequently occur with exposure to new drugs, as they have not been fully tested and the full range of possible side-effects have not been discovered; they may also be listed as an adverse drug reaction with a drug, but are extremely rare. Some patients have  multiple-drug intolerance. Patients who have multiple idiopathic effects that are nonspecific are more likely to have anxiety and depression. Idiosyncratic drug reactions appear to not be concentration dependent. A minimal amount of drug will cause an immune response, but it is suspected that at a low enough concentration, a drug will be less likely to initiate an immune response.
+
+
+== Mechanism ==
+In adverse drug reactions involving overdoses, the toxic effect is simply an extension of the pharmacological effect (Type A adverse drug reactions). On the other hand, clinical symptoms of idiosyncratic drug reactions (Type B adverse drug reactions) are different from the pharmacological effect of the drug.
+The proposed mechanism of most idiosyncratic drug reactions is immune-mediated toxicity. To create an immune response, a foreign molecule must be present that antibodies can bind to (i.e. the antigen) and cellular damage must exist. Very often, drugs will not be immunogenic because they are too small to induce immune response. However, a drug can cause an immune response if the drug binds a larger molecule. Some unaltered drugs, such as penicillin, will bind avidly to proteins. Others must be bioactivated into a toxic compound that will in turn bind to proteins. The second criterion of cellular damage can come either from a toxic drug/drug metabolite, or from an injury or infection.
+These will sensitize the immune system to the drug and cause a response.
+Idiosyncratic reactions fall conventionally under toxicology.
+
+
+== See also ==
+Idiosyncrasy
+Allergy
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Imaging_biomarker-0.md b/data/en.wikipedia.org/wiki/Imaging_biomarker-0.md
new file mode 100644
index 000000000..08f652b1d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Imaging_biomarker-0.md
@@ -0,0 +1,25 @@
+---
+title: "Imaging biomarker"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Imaging_biomarker"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:33.011316+00:00"
+instance: "kb-cron"
+---
+
+An imaging biomarker, is a biologic feature, or biomarker detectable in an image. In medicine, an imaging biomarker is a feature of an image relevant to a patient's diagnosis. It is also referred to as radiomics in medical diagnostics. For example, a number of biomarkers are frequently used to determine risk of a lung nodule for lung cancer. First, a simple lesion in the lung detected by X-ray, CT, or MRI can lead to the suspicion of a neoplasm. The lesion itself serves as a biomarker, but the minute details of the lesion serve as biomarkers as well, and can collectively be used to assess the risk of neoplasm. Some of the imaging biomarkers used in lung nodule assessment include size, spiculation, calcification, cavitation, location within the lung, rate of growth, and rate of metabolism. Each piece of information from the image represents a probability. Spiculation increases the probability of the lesion being cancer. A slow rate of growth indicates benignity. These variables can be added to the patient's history, physical exam, laboratory tests, and pathology to reach a proposed diagnosis. Imaging biomarkers can be measured using several techniques, such as CT, PET, SPECT, ultrasound, electroencephalography, magnetoencephalography, and MRI.
+
+== History ==
+Imaging biomarkers are as old as the X-ray itself. A feature of a radiograph that represent some kind of pathology was first coined "Roentgen signs" after Wilhelm Röntgen, the discoverer of the X-ray. As the field of medical imaging developed and expanded to include numerous imaging modalities, imaging biomarkers have grown as well, in both quantity and complexity as finally in chemical imaging.
+
+== Quantitative imaging biomarkers ==
+A quantitative imaging biomarkers (QIB) is an objective characteristic derived from an in vivo image measured on a ratio or interval scale as indicators of normal biological processes, pathogenic processes or a response to a therapeutic intervention. An advantage of QIB's over qualitative imaging biomarkers is that they are better suited to be used for follow-up of patients or in clinical trials. Early examples of a frequently used QIB are the RECIST criteria, measuring the evolution in tumor size to assess treatment response for patients with cancer, the Nuchal scan used for prenatal screening, or the assessment of lesion load and brain atrophy for patients with multiple sclerosis. Subsequent QIB's have focused on physical measurands or dimensionless quantities derived from the same (e.g., z-score). Example QIBs in this vein include the apparent diffusion coefficient, temperature, magnetic susceptibility, standard uptake value (SUV), and shear wave speed. These newer QIBs allow for a metrological traceability, raising the bar for measurement accuracy and precision.
+
+== Use in clinical trials ==
+
+Clinical trials are known to be one of the most valuable sources of data in evidence-based medicine. For a pharmaceutical, device, or procedure to be approved for regular use in the U.S., it must be rigorously tested in clinical trials, and demonstrate sufficient efficacy. Unfortunately clinical trials are also extremely expensive and time consuming. End-points, such as morbidity and mortality, are used as measures to compare groups within a clinical trial. The most basic endpoint used in clinical trials, mortality, requires years and sometimes decades of follow-up to sufficiently assess. Morbidity, although potentially faster to measure than mortality, can also be a very difficult endpoint to measure clinically, as it is often very subjective. These are some of the reasons why biomarkers have been increasingly used in clinical trials to detect subtle changes in physiology and pathology before they can are detected clinically. The biomarkers act as surrogate endpoints. The use of surrogate endpoints has been shown to significantly decrease the time and resources used in clinical trials. Because surrogate end-points allow researchers to assess a marker rather than the patient, it allows participants to act as their own control, and in many cases allows for easier blinding.
+In addition to surrogate endpoints, imaging biomarkers can be used as predictive classifiers, to assist in selecting appropriate candidates for particular treatment. Predictive classifiers are frequently used in molecular imaging in order to ensure enzymatic response to treatment.
+
+== FDA approval of surrogate end-points ==
+The United States Congress and the Food and Drug Administration have acknowledged the value of imaging biomarkers as evidenced by recent actions that encourage their use. The FDA Modernization Act of 1997 was instituted to improve the regulatory process for medical products. Section 112 of the Act gives explicit authority to give expedited approval for drugs that treat serious conditions as long as it has shown to have an effect on a surrogate end-point that reasonably indicates a clinical benefit. Other provisions enables monitoring of the products following market approval to ensure the efficacy of the surrogate end-points and requires the FDA to establish a program that promotes the development and use of surrogate end-points for serious diseases. Although the act does not specifically mention the use of surrogate end-points for medical devices, section 205 requires that the "least burdensome means necessary" be used in their approval. The wording is much more general than the provision for pharmaceuticals, but is generally accepted that surrogate endpoints will often qualify as being the "least burdensome means".
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Imaging_biomarker-1.md b/data/en.wikipedia.org/wiki/Imaging_biomarker-1.md
new file mode 100644
index 000000000..a31ef4f56
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Imaging_biomarker-1.md
@@ -0,0 +1,33 @@
+---
+title: "Imaging biomarker"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Imaging_biomarker"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:33.011316+00:00"
+instance: "kb-cron"
+---
+
+== Qualification and validation ==
+Developing an understanding of clinical significance for specific biomarkers can be a difficult process. There are two steps of certification for a surrogate endpoint to be fully established: Qualification and Validation. For a biomarker to become qualified it must go through a somewhat formal qualification process. A request must be submitted to IPRG to qualify an imaging biomarker for a specific use.  The Biomarker Qualification Review Team, recruited from nonclinical and clinical review divisions, assesses the context and available data regarding the biomarker. They also evaluate the qualification study strategy methods and results and ultimately make a decision to accept or reject. After qualification, a biomarker may have limited use as a surrogate endpoint. They may be used in phase I and II clinical trials, but can only be used in phase III trials for early futility analyses.
+There are two steps to validation, probable validation and known validation. "Probable validation" requires widespread agreement in the medical or scientific community as to its efficacy. "Known validation" requires a scientific framework or body of evidence that appears to elucidate the marker's efficacy. For full validation, a biomarker must demonstrate that the treatment versus control differences are similar to the treatment versus control differences for clinical outcome. It is not sufficient to simply demonstrate that the biomarker responders survive longer than the biomarker non-responders.
+
+== Quality ==
+The following are 3 measures of quality to determine the strength of biomarker for use in clinical trials.
+
+The presence of the imaging biomarker is closely coupled or linked to the presence of the target disease or condition.
+The detection and/or quantitative measurement of the imaging biomarker is accurate, reproducible, and feasible over time.
+The measured changes over time in the imaging biomarker are closely coupled or linked to the success or failure of the therapeutic effect and the true end-point sought for the medical therapy being evaluated.
+
+== Organizations ==
+
+Because the project of compiling a library of validated biomarkers requires an enormous amount of resources, the FDA has encouraged the creation of consortia between public and private organization in order to facilitate the sharing of data for the qualification and validation of biomarkers.
+The Biomarkers Consortium was created by the Foundation for the National Institutes of Health, National Institute of Health, Food and Drug Administration, and Pharmaceutical Research and Manufacturers of America. It is a public-private biomedical research partnership aimed to provide grants for the generation of data for clinical biomarker qualification.
+The Predictive Safety Testing Consortium, was created by the Critical Path Institute and the Food and Drug Administration to develop a framework needed for data sharing between its members in order to make biomarker qualification easier. They are also working with regulatory agencies to replace the currently unstructured qualification process.
+In 2001, the Radiology department at Massachusetts General Hospital, founded the MGH Center for Biomarkers in Imaging, a center dedicated to encourage the development and use of imaging biomarkers. Their initial project was to catalogue the known biomarkers in order to make them readily available to scientists, regulators, and industry representatives (now available on their website). The catalogue includes the pathology specific to the biomarkers, the investigator(s) involved in creating and using the biomarker, and the modalities used in the detection of the biomarker.
+International Cancer Biomarker Consortium was created to assist in discovery of biomarkers by facilitating coordinated research and by leveraging resources. Each international team chooses a cancer site(s) for study, functions independently, and secures its own funding. The president of the organization, Leland Hartwell, won the Nobel Prize for physiology/medicine in 2001.
+Uniform Protocols for Imaging in Clinical Trials (UPICT) was created by the American College of Radiology.
+Imaging Response Assessment Teams was created by the National Cancer Institute and AACI to advance the role of imaging in assessment of response to therapy and to increase the application of quantitative, anatomic, functional, and molecular imaging endpoints in clinical therapeutic trials. Aims to strengthen clinical collaboration between imaging scientists and oncologic investigators.
+Oncology Biomarker Qualification Initiative was created by the Food and Drug Administration and the National Cancer Institute to qualify new cancer biomarkers. Their first project involves PET imaging in non-Hodgkin lymphoma.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Immune_dysregulation-0.md b/data/en.wikipedia.org/wiki/Immune_dysregulation-0.md
new file mode 100644
index 000000000..9bb8a1c38
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Immune_dysregulation-0.md
@@ -0,0 +1,32 @@
+---
+title: "Immune dysregulation"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Immune_dysregulation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:34.278736+00:00"
+instance: "kb-cron"
+---
+
+Immune dysregulation is any proposed or confirmed breakdown or maladaptive change in molecular control of immune system processes. For example, dysregulation is a component in the pathogenesis of autoimmune diseases and some cancers. Immune system dysfunction, as seen in IPEX syndrome leads to immune dysfunction, polyendocrinopathy, enteropathy, X-linked (IPEX). IPEX typically presents during the first few months of life with diabetes mellitus, intractable diarrhea, failure to thrive, eczema, and hemolytic anemia. unrestrained or unregulated immune response.
+
+== IPEX syndrome ==
+IPEX (Immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome) is a syndrome caused by a genetic mutation in the FOXP3 gene, which encodes a major transcription factor of regulatory T cells (Tregs). Such a mutation leads to dysfunctional Tregs and, as a result, autoimmune diseases. The classic clinical manifestations are enteropathy, type I diabetes mellitus and eczema. Various other autoimmune diseases or hypersensitivity are common in other individuals with IPEX syndrome. In addition to autoimmune diseases, individuals experience higher immune reactivity (e.g. chronic dermatitis) and susceptibility to infections. Individuals also develop autoimmune diseases at a young age.
+
+== Other genetic syndromes associated with immune dysregulation ==
+
+=== APECED ===
+Autoimmune polyendocrinopathy-candidiasis-endodermal dystrophy (APECED) is a syndrome caused by a mutation in AIRE (autoimmune regulator). Typical manifestations of APECED are mucocutaneous candidiasis and multiple endocrine autoimmune diseases. APECED causes loss of central immune tolerance.
+
+=== Omenn syndrome ===
+Omenn syndrome  manifests as GVHD (graft versus host disease)-like autoimmune disease. Immune dysregulation is caused by increased IgE production. The syndrome is caused by mutations in the RAG1, RAG2, IL2RG, IL7RA or RMRP genes. The number of immune cells is usually normal in this syndrome, but functionality is reduced
+
+=== Wiskott-Aldrich syndrome ===
+Wiskott-Aldrich syndrome is caused by a mutation in the WAS gene. It manifests itself as a higher susceptibility to infections, eczema, more frequent development of autoimmune hemolytic anemia, neutropenia and arthritis.
+
+== T-cell immunodeficiency ==
+Partial T cell immunodeficiency is characterized by an incomplete reduction in T cell number or activity. In contrast to severe T cell immunodeficiency, some of T-cell ability to respond to infections can be maintained. T-cell immunodeficiencies tend to be associated with autoimmune diseases or hyperreactivity and increased IgE production. Mutations tend to be in genes for cytokines (such as IL-7), TCRs, or proteins important for somatic recombination and antigen presentation.
+Additional T cell-associated immune dysregulation may be due to a mutation in CTLA-4. CTLA-4 is essential for the negative regulation of the immune response and its loss leads to dysregulation and autoimmune diseases. The disease is characterized by hypogammaglobulinemia, frequent infections and the occurrence of autoimmune diseases. In individuals, the disease may manifest itself differently, with in some cases only a partial reduction in the number of Tregs, in others the ability to bind CTLA-4 ligand has been reduced, resulting in disruption homeostasis of effector T and B cells. The inheritance of this syndrome is autosomal dominant with incomplete penetration.
+
+== Immune dysregulation associated with stress ==
+Chronic stress at various stages of life can lead to chronic inflammation and immune dysregulation. Individuals with high stress in childhood (abuse, neglect, etc.) are at higher risk of cardiovascular disease, type II diabetes, osteoporosis, rheumatoid arthritis and other problems associated with immune dysregulation in adulthood. Overall, individuals with higher childhood stress increases the risk of chronic inflammation in adulthood. Higher levels of IL-6 and TNF-α are then noted in stressed individuals. Chronic stress in childhood also promotes the development of proinflammatory types of monocytes and macrophages and they also develop resistance to anti-inflammatory agent (e.g. cortisol). Traumatized individuals also have higher antibody titers to viruses such as Herpes simplex virus, Epstein–Barr virus, or Cytomegalovirus than individuals without chronic stress.
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+---
+title: "Immune dysregulation"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Immune_dysregulation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:34.278736+00:00"
+instance: "kb-cron"
+---
+
+== Aging of the immune system ==
+Dysregulation of the immune system is also associated with immunosenescence, which arises due to aging. Immunosenescence is manifested by a decrease in reactivity to vaccination or infection, an impaired ability of T and B lymphocytes to activate and proliferate, or a lower ability of antigen presentation by dendritic cells. In immunosenescence, memory and effector T cells accumulate at the expense of naïve T cells. The lack of naïve T lymphocytes is the cause of low plasticity of the immune system in the elderly. In aging of the immune system is also a decrease in central tolerance and an increase in the number of autoreactive T cells. B cells also have a decreased repertoire of naïve cells and an increase in memory B cells. They also have reduced the production of antibodies against antigens. In immunosenescence, here is a change in the individual subtypes of immunoglobulins. IgM and IgD levels decrease while IgG1, IgG2, and IgG3 levels increase. IgA is higher in the form of monomers in serum but lower as a dimer on the mucosal surface. The overall accumulation of both effector T and B cells is due to the presence of chronic inflammation due to long-term exposure to antigens. In immunosenescence is also a reduced ability to apoptosis, which promotes the survival of memory cells. In old age, innate immunity cells are also affected, when activated cells have a lower ability to return to a quiescent state, only effector functions decrease. Elderly people show poor NK cell reactivity and impaired ability of antigen presentation by dendritic cells. In macrophages, the ability of phagocytosis is reduced and the M2 phenotype of macrophages (alternatively activated) is promoted. Immunosenescence also results in increased production of some immune mediators, such as proinflammatory IL-6 or IL-1. There may also be higher production of anti-inflammatory IL-10 or IL-4. In old age, the ability to heal wounds also decreases, leading to a susceptibility to further infections at the site of injury. The aging of the immune system is also supported by chronic infections, oxidative stress, or the production and accumulation of reactive oxygen species (ROS). The increase in the proportion of memory cells is also affected by cytomegalovirus infection. A chronic pro-inflammatory condition in an aging organism is also referred to as inflammaging. It is a long-term, low-grade systemic inflammation present without the presence of infection.
+
+== Dysregulation of the immune system in response to toxins ==
+Immune dysregulation can also be caused by toxins. For example, in environmental workers, increased exposure to pesticides (such as DDT, organophosphate, amides, phthalamides, etc.) disrupts immune system responses. The resulting damage depends on the individual's age, dose and time of toxin exposure. At a young age and in adolescents, there are significant negative effects even with a lower dose of toxins. However, the ability to break down toxic substances and the resulting impact on the organism is also related to the metabolism and genetic equipment of the individual. Toxins can act directly on the cellular component of immunity, or by their metabolites, or they can promote reactive oxygen species (ROS) in the body, or by depletion of antioxidants or oxidative stress. The most common clinical manifestations are immunosuppression, hypersensitivity, autoimmune diseases, but also support for the Th2 response and the development of allergies, or support for chronic inflammation. Conventional toxins and irritants in the environment, such as saliva enzymes of blood-feeding parasites, insect poisons, or irritants in plants, can also cause allergic reactions. These substances can disrupt cell membranes, activate cell receptors, aggregate or degrade certain proteins, or disrupt the mucosal surface layer. The immune system often responds to these substances with reactions that lead to the removal of an irritant substance from the body, such as itching, coughing, sneezing, or vomiting. Combining the action of several toxins at the same time can increase the negative effects, but in some cases the effects of the toxins can cancel each other out.
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+---
+title: "Immune dysregulation"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Immune_dysregulation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:34.278736+00:00"
+instance: "kb-cron"
+---
+
+== Allergy ==
+Allergic reactions are misdirected reactions of the immune system to substances commonly found in the environment. Allergens elicit a The immune response, including the involvement of IgE, mast cells, Innate lymphoid cells 2 (ILC2), eosinophils, and basophils. Allergy symptoms are often related to the body's efforts to expel the allergen from the body and to protect it from further exposure to the allergen. Allergic reactions increase the production of mucus by goblet cells on the mucosa. The production of mucus is promoted by IL-13 from ILC2 and Th2 cells. Higher mucus production then creates stronger barrier protection and supports runny nose, coughing, or sneezing. Removal of the allergen from the body by sneezing, coughing, vomiting, or diarrhea is enabled by the activation of peristalsis and contractions of the smooth muscles of the digestive and respiratory systems. Activation of smooth muscles occurs after the action of histamine, which is released by mast cells. Manifestations of allergies generally aim to eliminate the body's allergen. This is also related to hearing the flushing of antigens in the eyes or to attempts to achieve mechanical removal of the surface of the organism.
+Allergies can be caused by genetic and environmental factors. Some theories support the view that allergies enter as protection against environmental substances that can disrupt the body, such as insect venom. Another possibility of activating an allergic reaction is the similarity of some allergens to the molecular patterns of parasites against which the immune system also uses a type 2 immune response. The hygiene hypothesis then relates to changes in lifetime exposure to pathogens in developed countries. In the case of insufficient exposure to pathogens and insufficient stimulation of the Th1 response during an individual's development, the balance between Th1 and Th2 type responses may predominate to proallergic Th2. The theory is supported by the more frequent occurrence of allergies in developed countries compared to developing countries, but also by the higher incidence of allergies in cities compared to villages, where individuals can meet with pathogens of farm animals. Children from small families are also more likely to have allergies than children from families with more children, where there is more frequent contact with pathogens from siblings. Another environmental factor that may promote the predisposition to allergies is a reduction in the diversity of the microbiome – this affects the diet of individuals, but also the diet of the mother during pregnancy, method of delivery, breastfeeding, antibiotics, and the presence of domestic or farm animals in the normal life of individuals.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Implementability_(medicine)-0.md b/data/en.wikipedia.org/wiki/Implementability_(medicine)-0.md
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+---
+title: "Implementability (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Implementability_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:35.410890+00:00"
+instance: "kb-cron"
+---
+
+In medicine, implementability is a property of clinical practice guidelines. It refers to a set of characteristics that predict ease of (and obstacles to) guideline adaptations by clinicians. There is a journal Implementation Science, which "aims to publish research relevant to the scientific study of methods to promote the uptake of research findings into routine healthcare in clinical, organisational or policy contexts".
+
+
+== See also ==
+Implementation
+
+
+== References ==
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diff --git a/data/en.wikipedia.org/wiki/Incidental_medical_findings-0.md b/data/en.wikipedia.org/wiki/Incidental_medical_findings-0.md
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+---
+title: "Incidental medical findings"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Incidental_medical_findings"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:36.664763+00:00"
+instance: "kb-cron"
+---
+
+Incidental medical findings are previously undiagnosed medical or psychiatric conditions that are discovered unintentionally and during evaluation for a medical or psychiatric condition. Such findings may occur in a variety of settings, including routine medical care, during biomedical research, during post-mortem autopsy, or during genetic testing. 
+
+
+== Medical imaging ==
+
+An incidentaloma is a tumor found by coincidence which is often benign and does not cause any clinically significant symptoms; however a small percentage do turn out to be malignant. Incidentalomas are common, with up to 7% of all patients over 60 harboring a benign growth, often of the adrenal gland, which is detected when diagnostic imaging is used for the analysis of unrelated symptoms.
+As 37% of patients receiving whole-body CT scan may have abnormal findings that need further evaluation and with the increase of "whole-body CT scanning" as part of health screening programs, the chance of finding incidentalomas is expected to increase.
+
+
+=== Neuroimaging ===
+Incidental findings in neuroimaging are common, with the prevalence of neoplastic incidental brain findings increasing with age. Even in healthy subjects acting as controls in research incidental findings are not rare. As most neuroimaging studies are performed in adults, less is known about the prevalence of incidental findings in children. A study in 2017 in nearly 4000 children between 8 and 12 reported that approximately 1 in 200 children showed asymptomatic incidental findings that required clinical follow-up.
+Pituitary adenomas are tumors that occur in the pituitary gland, and account for about 15% of intracranial neoplasms. They often remain undiagnosed, and are often an incidental finding during autopsy. Microadenomas (<10mm) have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies).
+
+
+== Genetic testing ==
+Unintentional genetic findings (aka "incidentalomes") are more commonly encountered with the advent of biomedical technologies capable of quickly and reliably performing genomic analysis, such as whole-genome sequencing. As with medical imaging, the capacity to measure biologic information in the form of genetic variation may exceed the scientific understanding of what the findings mean.
+In 2013, the American College of Medical Genetics and Genomic Working Group on Incidental Findings published preliminary guidelines for clinical laboratories that perform clinical exome and genome sequencing. They outlined a list of "medically actionable" pathogenic gene mutations, mostly monogenetic or single-gene disorders, which were significantly associated with important medical diagnoses and which should be reported to the patient "regardless of the proband's phenotype or age".
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Indication_(medicine)-0.md b/data/en.wikipedia.org/wiki/Indication_(medicine)-0.md
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+---
+title: "Indication (medicine)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Indication_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:37.986964+00:00"
+instance: "kb-cron"
+---
+
+In medicine, an indication is a valid reason to use a certain test, medication, procedure, or surgery. There can be multiple indications to use a procedure or medication. An indication can commonly be confused with the term diagnosis. A diagnosis is the assessment that a particular medical condition is present while an indication is a reason for use. The opposite of an indication is a contraindication, a reason to withhold a certain medical treatment because the risks of treatment clearly outweigh the benefits.
+In the US, indications for prescription drugs are approved by the Food and Drug Administration (FDA). Indications are included in the Indications and Usage section of the Prescribing Information. The primary role of this section of labeling is to enable health care practitioners to readily identify appropriate therapies for patients by clearly communicating the drug's approved indication(s). The Indications and Usage section states the disease or condition, or manifestation or symptoms thereof, for which the drug is approved, as well as whether the drug is indicated for the treatment, prevention, mitigation, cure, relief, or diagnosis of that disease or condition. Additionally, the Indications and Usage section should contain the approved age groups as well as other information necessary to describe appropriate use (for example, identifying the indicated patient/disease subgroups, stating if adjunctive therapy is required).
+
+== Drugs ==
+
+Most countries and jurisdictions have a licensing body whose duty is to determine whether to approve a drug for a specific indication, based on the relative safety of the drug and its efficacy for the particular use. In the United States, indications for medications are regulated by the Food and Drug Administration (FDA), and are included in the package insert under the phrase "Indications and Usage". The European Medicines Agency (EMA) holds this responsibility for centrally authorized drugs in the European Union.
+
+=== Label indications vs. off-label indications ===
+In the US, there are label indications and off-label indications.
+
+Label indications
+Medication that have label indications mean that they were approved by the FDA. This means that they are clinically significant for the indication and manufacturers are allowed to market their drug for the indication. A drug can have more than one FDA labeled indication, which means that it can be used for multiple medical conditions. As the evidence and consensus for use of the drug increases and strengthens, its class of indication is improved. Preferred drugs (and other treatments) are also referred to a "first line" or "primary" while others are called "second line", "third line" etc. A drug may be indicated as an "adjunct" or "adjuvant", added to a first line drug.
+Off-label
+Off-label indications are drugs that are used for medical indications that have not been approved by the FDA. Off-label indications often have some clinical significance to back the use, but they have not gone through the extensive testing required by the FDA to have an official labeled indication. Drug companies can not provide any official medication information (such as package inserts) for off-label indications.
+
+=== FDA approval ===
+The purpose for adding FDA-approved indications in the United States is to ensure that healthcare providers can easily identify appropriate use of drug therapy. Gaining FDA approval is based on the body of scientific evidence supporting the effectiveness of a drug treatment. The scientific evidence is gathered in the first 3 steps in the drug development process: discovery and development, pre-clinical research (testing safety), and clinical research (testing efficacy). After there is adequate completion of research and development phases by the drug companies, they send a New Drug Application (NDA) or a Biologics License Application (BLA) for approval to the FDA's Center for Drug Evaluation and Research (CDER) and the proposed scientific evidence for use in an intended population is evaluated by a team of physicians, statisticians, chemists, pharmacologists, and other scientists. Essentially, if it is found that there is substantial evidence that benefits of treatment outweigh the risks, the proposed labeling in the Prescribing Information is appropriate, and the manufacturing process is safe and adequate, then the drug is approved to go to market under that now FDA-approved indication. Even after approval, the FDA CDER continues to do postmarking surveillance of the drug through MedWatch and FDA Adverse Event Reporting System (FAERS).
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+---
+title: "Indication (medicine)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Indication_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:37.986964+00:00"
+instance: "kb-cron"
+---
+
+=== Effect on drug pricing ===
+Indications can impact the pricing of medications through Value-based Pricing, also known as indication specific pricing or indication value-based pricing. Since drugs can be used for different indications, this form of pricing would set different prices for each indication based on the value the drug offers for whatever it is being used to treat. This pricing scheme is often discussed in relation to oncology drugs, which are costly. Oncology drugs can be used for multiple different types of cancers so by applying indication-specific pricing, the drug would be priced based on how effective it is for treating each type of cancer. If the drug is more effective for Cancer A than Cancer B, then the patient taking the drug to treat Cancer A will pay more than the person using it for Cancer B because they receive more value from it.
+Currently, most medications in the United States are priced the same regardless of what they're being used for or how effective they are at improving outcomes. Concerns were therefore raised that patients and insurers may be paying too high prices for indications with a relatively low clinical value. Thereby pharmaceutical companies could realize high returns and firm valuations. Companies like CVS and Express Scripts in the US have begun implementing pricing based on indication and in countries like Italy, similar forms of pricing are already being used. For example, Express Scripts' Oncology Care Value Program uses indication-based pricing for certain oncology medications and was launched in 2016. Italy on the other hand, uses a model similar to indication-based pricing where the amount the hospital pays for certain drugs varies based on what it's used for. Patients can receive reimbursements for treatments based on their response and either be fully or partially refunded. Italy's reimbursement system is run by AIFA, the Italian Medicines Agency, which is the national authority that regulates drugs in Italy. In contrast, Germany and France use weighted-average pricing – a pricing system that calculates a single price based on the average volume and value of all approved indications. Using weighted-average pricing effectively reduces cancer drugs' list prices as new indications are approved. England, Scotland, and Canada use another form of indirect indication-based pricing: differential discounts on single list prices for each indication. Furthermore, European countries were shown to restrict coverage to supplemental low-value indications using clinical coverage restrictions or financial coverage restrictions, such as managed entry agreements.
+
+=== Incorporating indication of use on prescription drug labeling ===
+There has been some thought on incorporating the indication in prescription drug labeling as an approach to improve patient understanding of the medications they are on. This information can help healthcare providers reduce medication errors related to drugs that may look and sound alike. Knowing the indication of the drug can also help providers determine if the dose of the drug is appropriate per indication, and this can greatly improve patient safety and drug effectiveness.
+However, there are still some challenges with incorporating the indication of use on prescription drug labels. Revealing the indication of use on prescription drug labels can breach patient confidentiality since the label will disclose private information publicly. Some medications can also be used for multiple diseases and one disease may have multiple medications for its prevention or treatment, therefore adding an indication on prescription labels in these cases may cause some confusion and may not be able to actually fit onto the label.
+
+== Medical tests ==
+
+Each test has its own indications and contraindications, but in a simplified fashion, how much a test is indicated for an individual depends largely on its net benefit for that individual, which largely depends on the absolute difference between pre- and post-test probability of conditions (such as diseases) that the test is expected to achieve. Additional factors that influence a decision whether a medical test should be performed or not include: cost of the test, time taken for the test or other practical or administrative aspects. The possible benefits of a diagnostic test may also be weighed against the costs of unnecessary tests and resulting unnecessary follow-up and possibly even unnecessary treatment of incidental findings.
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Indirect_agonist-0.md b/data/en.wikipedia.org/wiki/Indirect_agonist-0.md
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@@ -0,0 +1,28 @@
+---
+title: "Indirect agonist"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Indirect_agonist"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:39.159830+00:00"
+instance: "kb-cron"
+---
+
+In pharmacology, an indirect agonist or indirect-acting agonist is a substance that enhances the release or action of an endogenous neurotransmitter but has no specific agonist activity at the neurotransmitter receptor itself. Indirect agonists work through varying mechanisms to achieve their effects, including transporter blockade, induction of transmitter release, and inhibition of transmitter breakdown.
+
+
+== Mechanisms of indirect agonism ==
+
+
+=== Reuptake inhibition ===
+
+Cocaine is a monoamine transporter blocker and, thus, an indirect agonist of dopamine receptors. Cocaine binds the dopamine transporter (DAT), blocking the protein's ability to uptake dopamine from the synaptic cleft and also blocking DAT from terminating dopamine signaling. Blockage of DAT increases the extracellular concentration of dopamine, therefore increasing the amount of dopamine receptor binding and signaling.
+Dipyridamole inhibits reuptake of adenosine, resulting in greater extracellular concentrations of adenosine. Dipyridamole also inhibits the enzyme adenosine deaminase, the enzyme that catalyzes the breakdown of adenosine.
+
+
+=== Evoking transmitter release ===
+
+Fenfluramine is an indirect agonist of serotonin receptors. Fenfluramine binds to the serotonin transporter, blocking serotonin reuptake. However, fenfluramine also acts to induce non-exocytotic serotonin release; in a mechanism similar to that of methamphetamine in dopamine neurons, fenfluramine binds to VMAT2, disrupting the compartmentalization of serotonin into vesicles and increasing the concentration of cytoplasmic serotonin available for drug-induced release.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Individualized_medicine-0.md b/data/en.wikipedia.org/wiki/Individualized_medicine-0.md
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@@ -0,0 +1,35 @@
+---
+title: "Individualized medicine"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Individualized_medicine"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:40.475433+00:00"
+instance: "kb-cron"
+---
+
+Individualized medicine tailors treatment to a single patient. The term refers to an individual, truly personalized medicine that strives to treat each patient on the basis of his own individual biology.
+Individualized medicine represents a further individualization of personalized medicine. While the latter is aimed at a specific group of patients, individualized medicine deals with the individual circumstances of a single person. Thus, individualized medicine goes one step further and can be considered as an increase in personalized medicine.
+Individualized medicine seeks to derive tailored therapies for individuals by taking into account a person's genes as well as the full range of that person's unique nature, including biological, physiological and anatomical information.
+
+
+== Background ==
+Individualized medicine was first mentioned in the literature in 2003 and described the individual drug metabolism in pharmacogenomics. Subsequently, the term was used to improve diagnosis based on genetic differences and physiological information and to better tailor the treatment to the needs of a single patient.
+More recently, a second context has been introduced that relates to therapeutic approaches that use a person's own cell material to develop a treatment that is unique to the patient from whom the material originated. Examples are stem-cell therapies and cancer vaccines, which are based on individually distinct molecular profiles.
+
+
+== Access ==
+Paternalistic, legal and FDA-imposed cost barriers are significant. 
+
+Barriers to individualized medicine for life-threatening diseases can be avoided by treatments allowed by Individualized Treatments Acts. 
+
+
+== Genome research ==
+Genome research has led to new resources that allow more accurate diagnosis and disease management to be tailored to each patient. The challenge of health research is to maximize therapeutic efficacy for each patient while minimizing side effects. An individual medicine approach may be required for those patients who cannot be categorized by mainstream personalized medicine or who suffer diseases without effective drug therapies. The widespread use of advanced imaging techniques and high-throughput technologies that allow for the in-depth study of genes, proteins, and metabolites provides a better understanding of the molecular processes involved in the origin and progression of a disease. Along with other information, these data form the basis for the development of new diagnostic technologies and treatment approaches that are customized for each individual patient.
+
+
+== Individualized medicine in oncology ==
+Individualized medicine is playing an increasingly important role, especially in oncology, given that cancers can be extremely heterogeneous between individual patients and within the tumor itself. For example, individualized cancer immunotherapy with the production of vaccines tailored to match a person's individual constellation of cancer mutations, the mutanome, has become a new field of research. Each patient has an individual mutational signature, and only a very small portion of the mutations are shared between patients. The aim of individualized medicine is to optimize the treatment strategy for a single patient using genetic information as well as molecular and cellular analyzes.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Ineffective_erythropoiesis-0.md b/data/en.wikipedia.org/wiki/Ineffective_erythropoiesis-0.md
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@@ -0,0 +1,29 @@
+---
+title: "Ineffective erythropoiesis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Ineffective_erythropoiesis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:41.755016+00:00"
+instance: "kb-cron"
+---
+
+Ineffective erythropoiesis a condition in which the bone marrow produces red blood cells (erythrocytes) that are unable to mature properly and are pre-maturely destroyed due to various causes. Erythropoiesis is the overall process that the body goes through to produce red blood cells. The red blood cell's main function is to carry and transport oxygen from the lungs to tissues throughout the body. If the red blood cells are unable to mature properly or are destroyed pre-maturely, this can lead to anemia. This mechanism is principally responsible for the anemia seen in acquired conditions such as certain subtypes of myelodysplastic syndrome (MDS) and inherited disorders such as β-thalassemia, inherited sideroblastic anemias, as well as congenital dyserythropoietic anemias. 
+
+
+== See also ==
+Congenital dyserythropoietic anemias
+List of hematologic conditions
+
+
+== References ==
+
+
+== Further reading ==
+Ribeil, Jean-Antoine; Arlet, Jean-Benoit; Dussiot, Michael; Cruz Moura, Ivan; Courtois, Geneviève; Hermine, Olivier (28 March 2013). "Ineffective Erythropoiesis in β-Thalassemia". The Scientific World Journal. 2013 e394295. doi:10.1155/2013/394295. ISSN 2356-6140. PMC 3628659. PMID 23606813.
+Tanno, Toshihiko; Miller, Jeffery L. (11 May 2010). "Iron Loading and Overloading due to Ineffective Erythropoiesis". Advances in Hematology. 2010 e358283. doi:10.1155/2010/358283. ISSN 1687-9104. PMC 2868182. PMID 20467559.
+Rivella, Stefano (2013). "Ineffective erythropoiesis and thalassemias". Current Opinion in Hematology. 16 (3): 187–194. doi:10.1097/MOH.0b013e32832990a4. ISSN 1065-6251. PMC 3703923. PMID 19318943.
+Gupta, Ritama; Musallam, Khaled M.; Taher, Ali T.; Rivella, Stefano (2019). "Ineffective Erythropoiesis, Anemia and Iron Overload". Hematology/Oncology Clinics of North America. 32 (2): 213–221. doi:10.1016/j.hoc.2017.11.009. ISSN 0889-8588. PMC 5824437. PMID 29458727.
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Infiltration_(medical)-0.md b/data/en.wikipedia.org/wiki/Infiltration_(medical)-0.md
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+++ b/data/en.wikipedia.org/wiki/Infiltration_(medical)-0.md
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+---
+title: "Infiltration (medical)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Infiltration_(medical)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:43.013528+00:00"
+instance: "kb-cron"
+---
+
+Infiltration in a medical context is the process of cells or substances moving across a barrier, typically a tissue barrier, into a place they are not normally found, or in which they are typically found in lower concentrations. Infiltration may refer to normal physiological processes, such as the infiltration of certain immune cells into peripheral tissues. Infiltration may also refer to infiltrative disorders, pathological processes such as malignant tumor cells infiltrating new areas of the human body, or small particles infiltrating tissues, where they may cause damage or inflammation.
+
+
+== Types of Infiltration ==
+The term 'infiltration' is frequently used to describe various pathologic and physiologic processes, including but not limited to:
+
+
+=== Immune Infiltration ===
+This occurs when immune cells like lymphocytes and macrophages migrate into tissues in response to infection, injury, or inflammation, aiding in defense and healing but potentially contributing to autoimmune diseases if misdirected. Immune cells (especially lymphocytes) also infiltrate into malignant tumors and other neoplasms.
+
+
+=== Malignant Infiltration ===
+
+Malignant infiltration involves cancerous cells invading surrounding healthy tissues by breaching normal cellular boundaries, which allows tumors to grow locally and facilitates metastasis to distant organs. This is especially relevant for cancers that cross the blood-brain barrier and cause secondary brain tumors.
+
+
+=== Pulmonary Infiltration ===
+
+This term refers to the accumulation of substances such as fluids, immune cells, bacteria, proteins, foreign particulate matter, and other things within the lung tissue, often detected as non-distinct infiltrates on imaging studies. Tissue biopsy and other tests are frequently used to determine the nature of pulmonary infiltrates, as there are many possible causes.
+
+
+=== Immune Complex Infiltration ===
+
+Antibody-antigen immune complexes can sometimes precipitate out of serum and infiltrate tissues surrounding capillaries and other small blood vessels. Pathologically, this is often relevant in lung disease and kidney disease. These typically interact with local complement proteins or induce other immune system responses, resulting in a Type III hypersensitivity reaction.
+
+
+=== Fatty Infiltration ===
+Also known as steatosis, where excessive fat accumulates within cells of organs like the liver or muscle fibers. It is often linked to hyperlipidemia, among other risk factors.
+
+
+=== Anesthetic Infiltration ===
+A medical technique involving the injection of local anesthetics into tissues to provide numbness for minor surgical procedures or pain relief.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Insufflation_(medicine)-0.md b/data/en.wikipedia.org/wiki/Insufflation_(medicine)-0.md
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+++ b/data/en.wikipedia.org/wiki/Insufflation_(medicine)-0.md
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+---
+title: "Insufflation (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Insufflation_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:44.313706+00:00"
+instance: "kb-cron"
+---
+
+Insufflation (Latin: insufflare, lit. 'to blow into') is the act of blowing something (such as a gas, powder, or vapor) into a body cavity. Insufflation has many medical uses, most notably as a route of administration for various drugs.
+
+
+== Medical uses ==
+
+
+=== Surgery ===
+Gases are often insufflated into a body cavity to inflate the cavity for more workroom, e.g. during laparoscopic surgery. The most common gas used in this manner is carbon dioxide, because it is inexpensive, non-flammable, colorless, and dissolves readily in blood.
+
+
+=== Diagnostics ===
+Gases can be insufflated into parts of the body to enhance radiological imaging or to gain access to areas for visual inspection (e.g. during colonoscopy).
+
+
+=== Respiratory assistance ===
+Oxygen can be insufflated into the nose by nasal cannulae to assist in respiration.
+Mechanical insufflation-exsufflation simulates a cough and assists airway mucus clearance. It is used with patients with neuromuscular disease and muscle weakness due to central nervous system injury.
+Glossopharyngeal insufflation is a breathing technique that consists of gulping boluses of air into the lungs. It is also used by breath-hold divers to increase their lung volumes.
+Positive airway pressure is a mode of mechanical or artificial ventilation based on insufflation.
+Pump inhalers for asthmatics deliver aerosolized drugs into the lungs via the mouth. However, the insufflation by the pump is not adequate for delivery to the lungs, necessitating an active inhalation by the patient.
+
+
+=== Anesthesia and critical care ===
+
+Insufflated gases and vapors are used to ventilate and oxygenate patients (oxygen, air, helium), and to induce, assist in or maintain general anaesthesia (nitrous oxide, xenon, volatile anesthetic agents).
+
+
+=== Nasal drug administration ===
+
+Nasal insufflation is the most common method of nasal administration. Other methods are nasal inhalation and nasal instillation. Drugs administered in this way can have a local effect or a systemic effect. The time of onset for systemic drugs delivered via nasal administration is generally only marginally slower than if given intravenously.
+
+
+==== Examples of drugs given ====
+
+Steroids (local effect) and anti-asthma medication
+Hormone replacement
+Decongestants (local effect)
+Nicotine replacement
+Migraine medication
+Vaccines
+Nasal administration can also be used for treatment of children or patients who are otherwise alarmed or frightened by needles, or where intravenous (IV) access is unavailable.
+
+
+== History ==
+In the 18th century, the tobacco smoke enema, an insufflation of tobacco smoke into the rectum, was a common method of reviving drowning victims.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Insult_(medical)-0.md b/data/en.wikipedia.org/wiki/Insult_(medical)-0.md
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+++ b/data/en.wikipedia.org/wiki/Insult_(medical)-0.md
@@ -0,0 +1,15 @@
+---
+title: "Insult (medical)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Insult_(medical)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:45.452002+00:00"
+instance: "kb-cron"
+---
+
+In medical terms, an insult is the cause of some kind of physical or mental injury.  For example, a burn on the skin (the injury) may be the result of a thermal, chemical, radioactive, or electrical event (the insult).  Likewise,  sepsis and trauma are examples of foreign insults, and encephalitis, multiple sclerosis, and brain tumors are examples of insults to the brain. Clinicians may use the term cerebrovascular insult (CVI) as a synonym for a stroke.
+Insults may be categorized as either genetic or environmental.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Integumentary_system-0.md b/data/en.wikipedia.org/wiki/Integumentary_system-0.md
new file mode 100644
index 000000000..4f83c7ce8
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Integumentary_system-0.md
@@ -0,0 +1,36 @@
+---
+title: "Integumentary system"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Integumentary_system"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:47.772667+00:00"
+instance: "kb-cron"
+---
+
+The integumentary system is the set of organs forming the outermost layer of an animal's body, comprising the skin, hair, scales, feathers, hooves, claws, and nails. It acts as a protective physical barrier between the external environment and the internal environment. Additionally, it maintains water balance, protects the deeper tissues, excretes waste, regulates body temperature, and contains the sensory receptors that detect pain, sensation, pressure, and temperature.
+The skin (integument) is a composite organ, made up of at least two major layers of tissue: the outermost epidermis and the inner dermis, which are separated by a basement membrane (comprising basal lamina and reticular lamina). The epidermis comprises five layers: the stratum corneum, stratum granulosum, stratum spinosum and stratum basale. Where the skin is thicker, such as in the palms and soles, there is an extra layer of skin between the stratum corneum and the stratum granulosum known as the stratum lucidum. The dermis comprises two sections, the papillary and reticular layers, and contains connective tissues, blood vessels, glands, follicles, hair roots, sensory nerve endings, and muscular tissue. Between the integument and the deep body musculature there is a transitional subcutaneous zone, the hypodermis.
+
+== Structure ==
+
+=== Skin ===
+
+The skin is one of the largest organs of the body. In humans, it accounts for about 12 to 15 percent of total body weight and covers 1.5 to 2 m2 of surface area.
+
+The skin (integument) is a composite organ, made up of at least two major layers of tissue: the epidermis and the dermis. The epidermis is the outermost layer, providing the initial barrier to the external environment. It is separated from the dermis by the basement membrane (basal lamina and reticular lamina). The epidermis contains melanocytes and gives color to the skin. The deepest layer of the epidermis also contains nerve endings. Beneath this, the dermis comprises two sections, the papillary and reticular layers, and contains connective tissues, blood vessels, glands, follicles, hair roots, sensory nerve endings, and muscular tissue.
+Between the integument and the deep body musculature there is a transitional subcutaneous zone made up of very loose connective and adipose tissue, the hypodermis. Substantial collagen bundles anchor the dermis to the hypodermis in a way that permits most areas of the skin to move freely over the deeper tissue layers.
+
+==== Epidermis ====
+
+The epidermis is the strong, superficial layer that serves as the first line of protection against the outer environment. The human epidermis is composed of stratified squamous epithelial cells, which further break down into four to five layers: the stratum corneum, stratum granulosum, stratum spinosum and stratum basale. Where the skin is thicker, such as in the palms and soles, there is an extra layer of skin between the stratum corneum and the stratum granulosum called the stratum lucidum. The epidermis is regenerated from the stem cells found in the basal layer that develop into the corneum. The epidermis itself is devoid of blood supply and draws its nutrition from its underlying dermis.
+Its main functions are protection, absorption of nutrients, and homeostasis. In structure, it consists of a keratinized stratified squamous epithelium; four types of cells: keratinocytes, melanocytes, Merkel cells, and Langerhans cells.
+The predominant cell keratinocyte, which produces keratin, a fibrous protein that aids in skin protection, is responsible for the formation of the epidermal water barrier by making and secreting lipids.  The majority of the skin on the human body is keratinized, with the exception of the lining of mucous membranes, such as the inside of the mouth. Non-keratinized cells allow water to "stay" atop the structure.
+The protein keratin stiffens epidermal tissue to form fingernails. Nails grow from a thin area called the nail matrix at an average of 1 mm per week. The lunula is the crescent-shape area at the base of the nail, lighter in color as it mixes with matrix cells. Only primates have nails. In other vertebrates, the keratinizing system at the terminus of each digit produces claws or hooves.
+The epidermis of vertebrates is surrounded by two kinds of coverings, which are produced by the epidermis itself. In fish and aquatic amphibians, it is a thin mucus layer that is constantly being replaced. In terrestrial vertebrates, it is the stratum corneum (dead keratinized cells). The epidermis is, to some degree, glandular in all vertebrates, but more so in fish and amphibians. Multicellular epidermal glands penetrate the dermis, where they are surrounded by blood capillaries that provide nutrients and, in the case of endocrine glands, transport their products.
+
+==== Dermis ====
+
+The dermis is the underlying connective tissue layer that supports the epidermis. It is composed of dense irregular connective tissue and areolar connective tissue such as a collagen with elastin arranged in a diffusely bundled and woven pattern.
+The dermis has two layers: the papillary dermis and the reticular layer. The papillary layer is the superficial layer that forms finger-like projections into the epidermis (dermal papillae), and consists of highly vascularized, loose connective tissue. The reticular layer is the deep layer of the dermis and consists of the dense irregular connective tissue. These layers serve to give elasticity to the integument, allowing stretching and conferring flexibility, while also resisting distortions, wrinkling, and sagging. The dermal layer provides a site for the endings of blood vessels and nerves. Many chromatophores are also stored in this layer, as are the bases of integumental structures such as hair, feathers, and glands.
+
+=== Hypodermis ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Integumentary_system-1.md b/data/en.wikipedia.org/wiki/Integumentary_system-1.md
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+++ b/data/en.wikipedia.org/wiki/Integumentary_system-1.md
@@ -0,0 +1,40 @@
+---
+title: "Integumentary system"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Integumentary_system"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:47.772667+00:00"
+instance: "kb-cron"
+---
+
+The hypodermis, otherwise known as the subcutaneous layer, is a layer beneath the skin. It invaginates into the dermis and is attached to the latter, immediately above it, by collagen and elastin fibers. It is essentially composed of a type of cell known as adipocytes, which are specialized in accumulating and storing fats. These cells are grouped together in lobules separated by connective tissue.
+The hypodermis acts as an energy reserve. The fats contained in the adipocytes can be put back into circulation, via the venous route, during intense effort or when there is a lack of energy-providing substances, and are then transformed into energy. The hypodermis participates, passively at least, in thermoregulation since fat is a heat insulator.
+
+== Functions ==
+The integumentary system has multiple roles in maintaining the body's equilibrium. All body systems work in an interconnected manner to maintain the internal conditions essential to the function of the body.  The skin has an important job of protecting the body and acts as the body's first line of defense against infection, temperature change, and other challenges to homeostasis.
+Its main functions include:
+
+Protect the body's internal living tissues and organs
+Protect against invasion by foreign organisms, including infectious organisms
+Protect the body from dehydration
+Protect the body against abrupt changes in temperature, maintain homeostasis
+Help excrete waste materials through perspiration
+Act as a receptor for touch, pressure, pain, heat, and cold (see Somatosensory system)
+Protect the body against sunburns by secreting melanin
+Generate vitamin D through exposure to ultraviolet light
+Store water, fat, glucose, vitamin D
+Maintenance of the body form
+Formation of new cells from stratum germinativum to repair minor injuries
+Protect from UV rays.
+Regulates body temperature
+It distinguishes, separates, and protects the organism from its surroundings.
+Small-bodied invertebrates of aquatic or continually moist habitats respire using the outer layer (integument). This gas exchange system, where gases simply diffuse into and out of the interstitial fluid, is called integumentary exchange.
+
+== Clinical significance ==
+
+Possible diseases and injuries to the human integumentary system include:
+
+== References ==
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/International_Health_Terminology_Standards_Development_Organisation-0.md b/data/en.wikipedia.org/wiki/International_Health_Terminology_Standards_Development_Organisation-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/International_Health_Terminology_Standards_Development_Organisation-0.md
@@ -0,0 +1,51 @@
+---
+title: "International Health Terminology Standards Development Organisation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/International_Health_Terminology_Standards_Development_Organisation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:49.113431+00:00"
+instance: "kb-cron"
+---
+
+The International Health Terminology Standards Development Organisation (IHTSDO), trading as SNOMED International, is  private company limited  by  guarantee  and  established  under  the  laws  of  England  that owns SNOMED CT, a leading clinical terminology used in electronic health records.  IHTSDO was founded in 2007 by 9 charter member countries (Australia, Canada, Denmark, Lithuania, Sweden, the Netherlands, New Zealand, the United Kingdom and the United States) in order to acquire the rights of SNOMED CT from the College of American Pathologists (CAP) and make the development of a global clinical language for healthcare an international, collaborative effort.
+
+
+== Governance ==
+IHTSDO governance is defined in the IHTSDO Articles of Association. The organization is headquartered in the United Kingdom (London).
+Since 2007 the number of member countries has increased from 9 to 29. The members were (as of December 2016): Australia, Belgium, Brunei, Canada, Chile, Czech Republic, Denmark, Estonia, Hong Kong, Iceland, India, Ireland, Israel, Lithuania, Malaysia, Malta, Netherlands, New Zealand, Poland, Portugal, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, the United Kingdom, the United States and Uruguay. The member countries provide the bulk of the institutional financing through payment of yearly member fees, which are based on gross national income. Members of IHTSDO can be either an agency of a national government or another body (such as a corporation or regional government agency) which has been endorsed by an appropriate national government authority within the country it represents. Member countries commit themselves to the dissemination of the IHTSDO terminologies within their jurisdiction, including where appropriate the creation of local translations, extensions, and mappings.
+The general assembly (GA) is the organization's highest authority and is composed of representatives from all member countries with equal representation (although some member countries have not selected GA representatives and therefore are not represented in the GA). The GA is collectively charged with assuring that the purpose, objects and principles of the association are pursued and that the interests of IHTSDO are safeguarded. The GA appoints the management board (MB), which has overall responsibility for the management and direction of IHTSDO and has a duty to act in the best interests of the organization. The member countries are also represented by the member forum, which provides input on member priorities and helps develop the IHTSDO plan of work.
+The organization is structured into four major areas: customer relations, operations, products & services, and strategy.
+Seven advisory groups provide advice to the management team. In addition there are topic-specific project groups (PGs) and special interest groups (SIGs) which supplement and report to the standing committees. These groups are open and are not elected. IHTSDO PGs and SIGs include:
+
+IHTSDO's work is documented on its website. The internal communication is supported by a Collaborative content management system.
+
+
+== Strategic directions ==
+The broad vision for IHTSDO is set out in their Articles of Association. A new five-year plan was formulated in 2015.
+IHTSDO aims to achieve interoperability and harmonization between its terminology products and those standards produced by other international standards development organisations (SDOs). In support of this IHTSDO has negotiated a number of collaboration agreements with other SDOs, such as the World Health Organization, HL7, International Council of Nurses, IEEE, Regenstrief Institute & NPU, openEHR, and WONCA.
+
+
+== Meetings ==
+IHTSDO organizes periodic conferences. Generally within these conferences time is allocated to meetings of advisory groups, project groups and SIGs, to enable them to meet face to face.  In addition there are meetings of the Member Forum and the Affiliate Forum. Advisory Groups, PGs and SIGs also communicate throughout the year via conference calls and manage messages and documents in a content management system (CMS).
+
+
+== Awards ==
+SNOMED International's Award of Excellence is awarded annually.
+
+SNOMED International’s Lifetime Achievement Award is awarded annually.
+
+
+== Documentation ==
+To support the implementation of SNOMED CT, a number of publications are produced by IHTSDO. These range from user guides to technical implementation guides as well as some educational materials and videos. Documents are available through the public website, but some items such as the videos can be found via YouTube. Member countries also contribute to the public domain and documents, which can often be found on individual member country websites; a link to these is provided on the IHTSDO webpages.
+
+
+== Office ==
+The IHTSDO head office is located at 1 Kingdom Street, London, UK W6 6BD.
+
+
+== References ==
+
+
+== External links ==
+Official website
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Intertriginous-0.md b/data/en.wikipedia.org/wiki/Intertriginous-0.md
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+++ b/data/en.wikipedia.org/wiki/Intertriginous-0.md
@@ -0,0 +1,22 @@
+---
+title: "Intertriginous"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Intertriginous"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:50.397041+00:00"
+instance: "kb-cron"
+---
+
+In medicine, an intertriginous area is where two skin areas may touch or rub together. Examples of intertriginous areas are the axilla of the arm, the anogenital region, skin folds of the breasts and between digits. Intertriginous areas are known to harbor large amounts of aerobic cocci and aerobic coryneform bacteria, which are both parts of normal skin flora.
+
+
+== See also ==
+Intertrigo
+
+
+== References ==
+
+
+== Bibliography ==
+Leyden J. Pathophysiology of certain bacterial diseases. In: Soter N, Baden H, eds. Pathophysiology of Dermatologic diseases. New York: McGraw-Hill, 1991:427-51
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Intracorporeal-0.md b/data/en.wikipedia.org/wiki/Intracorporeal-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Intracorporeal-0.md
@@ -0,0 +1,37 @@
+---
+title: "Intracorporeal"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Intracorporeal"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:51.626835+00:00"
+instance: "kb-cron"
+---
+
+Intracorporeal or intracorporal is an adjective that means within (intra-) the body (corpus). Its antonym is extracorporeal.
+It is used frequently in medicine to describe medical procedures that occur within the body, or within a corpus, as opposed to extracorporeal procedures (e.g. extracorporeal membrane oxygenation).
+In a medical or surgical context, it may refer to:
+
+Intracorporeal anastomosis
+Intracorporeal circulation
+Intracorporeal energy harvesting, harvesting energy from the body, and storing it, to sustain a medical device (e.g. a pacemaker).
+Intracorporeal injection
+Intracorporeal microrobotics
+Intracorporeal reconstruction
+Intracorporeal suturing
+Intracorporeal urinary diversion
+Lithotripsy:
+Intracorporeal electrohydraulic lithotripsy
+Intracorporeal laser lithotripsy
+Intracorporeal pneumatic lithotripsy
+Intracorporeal shock wave lithotripsy
+
+
+== See also ==
+ The dictionary definition of intracorporeal at Wiktionary
+ The dictionary definition of intracorpuscular at Wiktionary
+Human body (corpus humanum)
+In vivo
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Involution_(medicine)-0.md b/data/en.wikipedia.org/wiki/Involution_(medicine)-0.md
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index 000000000..b8f65121a
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Involution_(medicine)-0.md
@@ -0,0 +1,33 @@
+---
+title: "Involution (medicine)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Involution_(medicine)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:52.820238+00:00"
+instance: "kb-cron"
+---
+
+Involution is the shrinking or return of an organ to a former size. At a cellular level, involution is characterized by the process of proteolysis of the basement membrane (basal lamina), leading to epithelial regression and apoptosis, with accompanying stromal fibrosis. The consequent reduction in cell number and reorganization of stromal tissue leads to the reduction in the size of the organ.
+
+
+== Examples ==
+
+
+=== Thymus ===
+The thymus continues to grow between birth and sexual maturity and then begins to atrophy, a process directed by the high levels of circulating sex hormones. Proportional to thymic size, thymic activity (T cell output) is most active before maturity. Upon atrophy, the size and activity are dramatically reduced, and the organ is primarily replaced with fat. The atrophy is due to the increased circulating level of sex hormones, and chemical or physical castration of an adult results in the thymus increasing in size and activity.
+
+
+=== Uterus ===
+Involution is the process by which the uterus is transformed from pregnant to non-pregnant state. This period is characterized by the restoration of ovarian function in order to prepare the body for a new pregnancy. It is a physiological process occurring after parturition; the hypertrophy of the uterus has to be undone since it does not need to house the fetus anymore. This process is primarily due to the hormone oxytocin. The completion of this period is defined as when the diameter of the uterus returns to the size it is normally during a woman's menstrual cycle.
+
+
+=== Mammary gland ===
+During pregnancy until after birth, mammary glands grow steadily to a size required for optimal milk production. At the end of nursing, the number of cells in the mammary gland becomes reduced until approximately the same number is reached as before the start of pregnancy.
+
+
+== See also ==
+Subinvolution
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Ketolysis-0.md b/data/en.wikipedia.org/wiki/Ketolysis-0.md
new file mode 100644
index 000000000..f8171a1fe
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Ketolysis-0.md
@@ -0,0 +1,21 @@
+---
+title: "Ketolysis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Ketolysis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:54.044756+00:00"
+instance: "kb-cron"
+---
+
+Ketolysis is the process of catabolizing ketones, the opposite of ketogenesis which is the process of synthesizing ketones. Ketolysis provides more energy for ATP synthesis than fatty acid oxidation (beta oxidation).
+
+Ketogenesis occurs primarily in the liver, whereas ketolysis occurs in non-liver cells, especially in the heart, brain, and skeletal muscle. The SCOT enzyme (aka thiophorase) is required for ketolysis, and is present in the mitochondria of all mammalian cells except for hepatocytes.
+Although type II cells of the pulmonary alveolus possess monocarboxylate transporters to transport of beta hydroxybutyrate precursors into the cytoplasm, the absence of ketolytic enzymes results in the cells being unable to catabolize the beta hydroxybutyrate.
+The cardioprotective effects of SGLT2 inhibitors have been attributed to the elevated ketone levels and increased ketolysis.
+
+
+== The Ketolytic Pathway ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Kissing_contusion-0.md b/data/en.wikipedia.org/wiki/Kissing_contusion-0.md
new file mode 100644
index 000000000..1c68159b2
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Kissing_contusion-0.md
@@ -0,0 +1,14 @@
+---
+title: "Kissing contusion"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Kissing_contusion"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:55.379094+00:00"
+instance: "kb-cron"
+---
+
+Contusions of both surfaces of the knee joint are known as kissing contusions.  These contusions are generally found by magnetic resonance imaging and most cases are associated with ligamentous or meniscal injuries.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Lateral_flow_test-0.md b/data/en.wikipedia.org/wiki/Lateral_flow_test-0.md
new file mode 100644
index 000000000..d1649e0ae
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Lateral_flow_test-0.md
@@ -0,0 +1,42 @@
+---
+title: "Lateral flow test"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Lateral_flow_test"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:56.678548+00:00"
+instance: "kb-cron"
+---
+
+A lateral flow test (LFT), is an assay also known as a lateral flow immunochromatographic test (ICT). It is a simple device intended to detect the presence of a target substance in a liquid sample without the need for specialized and costly equipment.  LFTs are widely used in medical diagnostics in the home, at the point of care, and in the laboratory. For instance, the home pregnancy test is an LFT that detects a specific hormone. These tests are simple and economical and generally show results in around five to thirty minutes. Many lab-based applications increase the sensitivity of simple LFTs by employing additional dedicated equipment. Many LFTs are called rapid diagnostic tests (RDTs), though this term also includes other formats such as the vertical-flow tests.
+LFTs operate on the same principles of affinity chromatography as the enzyme-linked immunosorbent assays (ELISA). In essence, these tests run the liquid sample along the surface of a pad with reactive molecules that show a visual positive or negative result.   The pads are based on a series of capillary beds, such as pieces of porous paper, microstructured polymer, or sintered polymer. Each of these pads has the capacity to transport fluid (e.g., urine, blood, saliva) spontaneously.
+The sample pad acts as a sponge and holds an excess of sample fluid. Once soaked, the fluid flows to the second conjugate pad in which the manufacturer has stored freeze dried bio-active particles called conjugates (see below) in a salt–sugar matrix. The conjugate pad contains all the reagents required for an optimized chemical reaction between the target molecule (e.g., an antigen) and its chemical partner (e.g., antibody) that has been immobilized on the particle's surface. This marks target particles as they pass through the pad and continue across to the test and control lines. The test line shows a signal, often a color as in pregnancy tests. The control line contains affinity ligands which show whether the sample has flowed through and the bio-molecules in the conjugate pad are active. After passing these reaction zones, the fluid enters the final porous material, the wick, that simply acts as a waste container.
+LFTs can operate as either competitive or sandwich assays. Because the target substance is often a biological antigen, many lateral flow tests are rapid antigen tests (RAT or ART).
+
+== History ==
+LFTs derive from paper chromatography, which was developed in 1943 by Martin and Synge, and elaborated in 1944 by Consden, Gordon and Martin. There was an explosion of activity in this field after 1945. The ELISA technology was developed in 1971. A set of LFT patents, including the litigated US 6,485,982 described below, were filed by Armkel LLC starting in 1988.
+The first commercially available lateral flow device was Unipath's Clearblue One Step in 1988. This product combined Paired Monoclonal Antibody technology (patented in 1980 by Unipath's Prof. Philip Porter and colleagues including Paul Davis and Keith May) and the original Clearblue product launched in June 1985.
+
+== Synopsis ==
+
+=== Colored particles ===
+In principle, any colored particle can be used, but latex (blue color) or nanometer-sized particles of gold (red color) are most commonly used. The gold particles are red in color due to localized surface plasmon resonance. Fluorescent or magnetic labelled particles can also be used, but these require the use of an electronic reader to assess the test result.
+
+=== Mechanisms ===
+
+==== Sandwich assays ====
+
+Sandwich assays are generally used for larger analytes (antigens) because they tend to have multiple binding sites. As the sample migrates through the assay it first encounters a conjugate, which is an antibody specific to the target analyte labelled with a visual tag, usually colloidal gold. The antibodies bind to the target analyte within the sample and migrate together until they reach the test line. The test line also contains immobilized antibodies specific to the target analyte, which bind to the migrated analyte bound conjugate molecules. The test line then presents a visual change due to the concentrated visual tag, hence confirming the presence of the target molecules. The majority of sandwich assays also have a control line which will appear whether or not the target analyte is present to ensure proper function of the lateral flow pad.
+The rapid, low-cost sandwich-based assay is commonly used for home pregnancy tests which detect human chorionic gonadotropin, hCG, in the urine of pregnant women.
+
+==== Competitive assays ====
+Competitive assays are generally used for smaller analytes since smaller analytes have fewer binding sites. The sample first encounters antibodies to the target analyte labelled with a visual tag (colored particles). The test line contains the target analyte fixed to the surface. When the target analyte is absent from the sample, unbound antibody will bind to these fixed analyte molecules, meaning that a visual marker will show. Conversely, when the target analyte is present in the sample, it binds to the antibodies to prevent them binding to the fixed analyte in the test line, and thus no visual marker shows. This differs from sandwich assays in that no band means the analyte is present.
+
+==== Alternative binding mechanisms ====
+The LFT principle works with any collection of molecules that bind to each other with high affinity, so long as some of them can be immobilized to the gold nanoparticles and the test line respectively. For example:
+
+A sandwich LFT that looks for antibodies reactive against a certain antigen is made by replacing the antibody on test line and color particles with the target antigen.
+A sandwich LFT that looks for nucleic acids conjugated to biotin and digoxigenin (DIG) uses anti-DIG antibodies on the gold nanoparticle and streptavidin on the test line.
+A sandwich LFT that looks for the SARS-Cov-2 spike protein uses anti-spike llama nanobodies on the gold nanoparticle, ACE2 on the test line, and anti-llama antibodies on the control line.
+
+=== Control line ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Lateral_flow_test-1.md b/data/en.wikipedia.org/wiki/Lateral_flow_test-1.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Lateral_flow_test-1.md
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+---
+title: "Lateral flow test"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Lateral_flow_test"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:56.678548+00:00"
+instance: "kb-cron"
+---
+
+Most tests will incorporate a second line which contains a further antibody (one which is not specific to the analyte) that binds some of the remaining colored particles which did not bind to the test line. This confirms that fluid has passed successfully from the sample-application pad, past the test line. By giving confirmation that the sample has had a chance to interact with the test line, this increases confidence that a visibly-unchanged test line can be interpreted as a negative result (or that a changed test line can be interpreted as a negative result in a competitive assay).
+
+=== Blood plasma extraction ===
+Because the intense red color of hemoglobin interferes with the readout of colorimetric or optical detection-based diagnostic tests, blood plasma separation is a common first step to increase diagnostic test accuracy. Plasma can be extracted from whole blood via integrated filters or via agglutination.
+
+=== Speed and simplicity ===
+Time to obtain the test result is a key driver for these products. Tests results can be available in as little as a few minutes. Generally there is a trade off between time and sensitivity: more sensitive tests may take longer to develop. The other key advantage of this format of test compared to other immunoassays is the simplicity of the test, by typically requiring little or no sample or reagent preparation.
+
+=== Quantitative tests ===
+
+Most LFTs are intended to operate on a purely qualitative basis. However, it is possible to measure the intensity of the test line to determine the quantity of analyte in the sample. Handheld diagnostic devices known as lateral flow readers are used by several companies to provide a fully quantitative assay result. By utilizing unique wavelengths of light for illumination in conjunction with either CMOS or CCD detection technology, a signal-rich image can be produced of the actual test lines. Using image processing algorithms specifically designed for a particular test type and medium, line intensities can then be correlated with analyte concentrations. One such handheld lateral flow device platform is made by Detekt Biomedical L.L.C. 
+Alternative non-optical techniques are also able to report quantitative assays results. One such example is a magnetic immunoassay (MIA) in the LFT form also allows for getting a quantified result. Reducing variations in the capillary pumping of the sample fluid is another approach to move from qualitative to quantitative results. Recent work has, for example, demonstrated capillary pumping with a constant flow rate independent from the liquid viscosity and surface energy.
+
+== Patents ==
+This is a highly competitive area and a number of people claim patents in the field, most notably Alere (formerly Inverness Medical Innovations, now owned by Abbott) who own patents originally filed by Unipath. The US 6,485,982 patent, that has been litigated, expired in 2019. A number of other companies also hold patents in this arena. A group of competitors are challenging the validity of the patents. The original patent is apparently from 1988.
+
+== Applications ==
+Lateral flow assays have a wide array of applications and can test a variety of samples including urine, blood, saliva, sweat, serum, and other fluids. They are currently used by clinical laboratories, hospitals, physicians and veterinary clinics, food analysis labs and environmental testing facilities.
+Immediacy in obtaining results is normally the key factor in choosing this technique, although simplicity and lack of a need for formal equipment are also important factors. These features allow ICTs to be used a at-home test or in pharmacies. Because of their exceptional quality, rapid test are also used routinely in well-equipped laboratories when the demand for test is low.
+The broad applications of rapid test can be realized because of their simplicity accompanied by high quality analytical production. The sensitivity and specificity of these techniques tend to be comparable to those of other more complex methods, and on occasion significantly better.
+Other uses for lateral flow assays are food and environmental safety and veterinary medicine for chemicals such as diseases and toxins. LFTs are also commonly used for disease identification such as ebola, but the most common LFT are the home pregnancy and SARS-CoV-2 tests.
+
+=== Infectious diseases ===
+LFTs that detect infectious diseases may test for the antigen (molecules from the pathogen itself) and/or the antibody (the human body's defensive response to antigens). The choice of which one to test for depends on the specific disease. For example, HIV tests generally look for the antibody as immunoreactive p24 antigen levels diminish as the infection progresses where as the antibody level stays high. The p24 antigen remains valuable for reducing the window period as it shows up in detectable levels in blood before the antibodies do. As a result, combined tests are available for HIV.
+LFTs that detect nucleic acids have been developed but are still too new to see much use.
+
+==== COVID-19 testing ====
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Lateral_flow_test-2.md b/data/en.wikipedia.org/wiki/Lateral_flow_test-2.md
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index 000000000..3fc99f36d
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+++ b/data/en.wikipedia.org/wiki/Lateral_flow_test-2.md
@@ -0,0 +1,30 @@
+---
+title: "Lateral flow test"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Lateral_flow_test"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:56.678548+00:00"
+instance: "kb-cron"
+---
+
+Lateral flow assays have played a critical role in COVID-19 testing as they have the benefit of delivering a result in 15–30 minutes. The systematic evaluation of lateral flow assays during the COVID-19 pandemic was initiated at Oxford University as part of a UK collaboration with Public Health England. A study that started in June 2020 in the United Kingdom, FALCON-C19, confirmed the sensitivity of some lateral flow devices (LFDs) in this setting. Four out of 64 LFDs tested had desirable performance characteristics according to these early tests; the Innova SARS-CoV-2 Antigen Rapid Qualitative Test performed moderately in viral antigen detection/sensitivity with excellent specificity, although kit failure rates and the impact of training were potential issues. The Innova test's specificity is more widely publicised, but sensitivity in phase 4 trials was 50.1%. This describes a device for which one out of every two patients infected with COVID-19 and tested in real-world conditions would receive a false-negative result. After closure of schools in January 2021, biweekly LFTs were introduced in England for teachers, pupils, and households of pupils when schools re-opened on March 8, 2021 for asymptomatic testing. Biweekly LFT were made universally available to everyone in England on April 9, 2021. LFTs have been used for mass testing for COVID-19 globally and complement other public health measures for COVID-19.
+Some scientists outside government expressed serious misgivings in late 2020 about the use of Innova LFDs for screening for Covid. According to Jon Deeks, a professor of biostatistics at the University of Birmingham, England, the Innova test is "entirely unsuitable" for community testing: "as the test may miss up to half of cases, a negative test result indicates a reduced risk of Covid, but does not exclude Covid".
+Sensitivity of antigen LFTs used in 2022 was around 70% when using realtime PCR test as the ground truth. LFTs work better in symptomatic patients than in asymptomatic ones, suggesting that the amount of virus present may be too low to detect for the LFTs in many of the false-negative cases. The specificity was quite high at 99%. It is generally agreed that antigen LFTs have a higher limit of detection (LoD) than PCR.
+
+=== Small molecules ===
+
+Competitve lateral-flow assays are commonly used for quick drug tests using urine or saliva. In workplace tests, a negative result is generally interpreted as negative, where as a "positive" result is interpreted as needing further confirmatory lab testing to rule out false positives.
+
+=== Biomarkers ===
+Lateral-flow assays have also been developed for biomarkers such as levels of a certain protein in blood or urine. The HCG (pregnancy) test is one example.
+If the molecule to test for is present in healthy people at a lower level, the assay needs to have an LoD high enough to not show positive for the healthy, reference level. An example is the blood cardiac troponin I (cTnI) LFT, which comes in both qualitative (cTnI > 0.5 ng/L) and quantitative variants. The cTnI LFTs are not as sensitive as a typical lab test, but are sufficient to "rule in" serious cases much faster than a lab test can. Another example is the LFT for sFlt1/PlGF ratio, a predictive biomarker for pre-eclampsia.
+
+== See also ==
+Luteinizing hormone § Predicting ovulation: LFT test for ovulation
+
+== References ==
+
+== Further reading ==
+Hassan, Muntaha M. Rapid Immunochrotographic Techniques. Ramadi, Al Anbar, Iraq: University of Anbar. Didactic presentation (lab notes for students). Retrieved 12 January 2022.
+Porex Clinical Sciences (manufacturer) "Sample Collection & Transport | Sample Preparation | Sample Analysis".
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Left_without_being_seen-0.md b/data/en.wikipedia.org/wiki/Left_without_being_seen-0.md
new file mode 100644
index 000000000..3e68226f9
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Left_without_being_seen-0.md
@@ -0,0 +1,14 @@
+---
+title: "Left without being seen"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Left_without_being_seen"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:57.931077+00:00"
+instance: "kb-cron"
+---
+
+Left Without Being Seen (LWBS) is a healthcare term often used by emergency departments (ED) to designate a patient encounter that ended with the patient leaving the healthcare setting before the patient could be seen by a certified physician.  Often the inclusion of this phrase in a medical record is the result of ED overcrowding (i.e. the patient could no longer wait in the ED to be seen by a physician, so they left without alerting a healthcare professional).  Typically, those patients who leave an emergency department without being seen are not at an increased risk of death, and often do not require inpatient hospital admission. An increase in LWBS patients may be reflective of systemic public healthcare logistical issues. 
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Length_of_stay-0.md b/data/en.wikipedia.org/wiki/Length_of_stay-0.md
new file mode 100644
index 000000000..13e96dc95
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Length_of_stay-0.md
@@ -0,0 +1,29 @@
+---
+title: "Length of stay"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Length_of_stay"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:29:59.189346+00:00"
+instance: "kb-cron"
+---
+
+Length of stay (LOS) is the duration of a single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge.
+
+
+== Analysis ==
+A common statistic associated with length of stay is the average length of stay (ALOS), a mean calculated by dividing the sum of inpatient days by the number of patients admissions with the same diagnosis-related group classification. A variation in the calculation of ALOS can be to consider only length of stay during the period under analysis.
+Length of stay is typically highly skewed and so statistical approaches taking that into account are recommended. While the mean length of stay is useful from the point of view of costs, it may be a poor statistic in terms of representing a typical length of stay, and the median may be preferred.
+It is useful to be able to predict an individual's expected length of stay or to model length of stay to determine factors that affect it. Various analyses have sought to model length of stay in different condition contexts. This has usually been done with regression models, but Markov chain methods have also been applied. Within regression approaches, linear, log-normal and logistic regression approaches have been applied, but have been criticised by other researchers. Carter & Potts (2014) instead recommend use of negative binomial regression.
+
+
+== Quality metric ==
+Length of stay is commonly used as a quality metric. The prospective payment system in U.S. Medicare for reimbursing hospital care promotes shorter length of stay by paying the same amount for procedures, regardless of days spent in the hospital.
+Additionally, length of stay in hospital can be linked to additional quality metrics such as patient satisfaction with health professionals, reduction in hospital readmissions, and even mortality. Discharge planning processes can be effective in reducing a patient's length of stay in hospital. For example, for older people admitted with a medical condition, discharge planning has been shown to   improve satisfaction, reduce the overall length of stay, and within 3-month period reduce the likelihood of readmission. This phenomenon reflects the principles of Goodhart's Law, which states that "when a measure becomes a target, it ceases to be a good measure." In the context of healthcare, overemphasis on LOS as a target metric can compromise the quality of patient care.
+
+
+== Non-health usages ==
+The term "average length of stay" (ALOS) is also applicable to other industries, e.g. entertainment, event marketing, trade show and leisure. ALOS is used to determine the length of time an attendee is expected to spend on a site or in a venue and is part of the calculation used to determine the gross sales potential for selling space to vendors etc. and affects everything from parking to sanitation, staffing and food and beverage. Almost all operational aspects can be altered by an attendee's ALOS.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Lightwood's_law-0.md b/data/en.wikipedia.org/wiki/Lightwood's_law-0.md
new file mode 100644
index 000000000..ebed03244
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Lightwood's_law-0.md
@@ -0,0 +1,15 @@
+---
+title: "Lightwood's law"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Lightwood's_law"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:30:00.416124+00:00"
+instance: "kb-cron"
+---
+
+Lightwood's law is the principle that, in medicine, bacterial infections will tend to localise while viral infections will tend to spread. This is based on the observation that while bacterial sepsis tends, despite affecting the whole body, to have a clear site of origin or 'focus', the opposite may be true of viral infections.  There may be multiple sites across the body which are affected including dermatological manifestations, respiratory symptoms and gastrointestinal symptoms. It is named for Reginald Cyril Lightwood.
+This principle is by no means infallible and in clinical practice a variety of diagnostic tests are used to distinguish between bacterial and viral infections.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/List_of_biological_development_disorders-0.md b/data/en.wikipedia.org/wiki/List_of_biological_development_disorders-0.md
new file mode 100644
index 000000000..924c21024
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/List_of_biological_development_disorders-0.md
@@ -0,0 +1,18 @@
+---
+title: "List of biological development disorders"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/List_of_biological_development_disorders"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:26:35.537754+00:00"
+instance: "kb-cron"
+---
+
+The following is a list of terms used to describe biological disorders of development, arranged by root word and shared prefix:
+
+
+== References ==
+
+
+== Bibliography ==
+Reece, JB; Urry, LA; Cain, ML; Wasserman, SA; Minorsky, PV; Jackson, RB (2014). Campbell Biology (10th ed.). Addison Wesley Longman. ISBN 978-0321834959.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/List_of_bones_of_the_human_skeleton-0.md b/data/en.wikipedia.org/wiki/List_of_bones_of_the_human_skeleton-0.md
new file mode 100644
index 000000000..765455a60
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/List_of_bones_of_the_human_skeleton-0.md
@@ -0,0 +1,159 @@
+---
+title: "List of bones of the human skeleton"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/List_of_bones_of_the_human_skeleton"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:30:01.691476+00:00"
+instance: "kb-cron"
+---
+
+An adult human skeleton is commonly quoted as consisting of 206 bones. Reports on the typical number of bones have varied historically depending on how different sources choose to count features such as fused bones (for example, the sternum). The actual number of bones in any individual skeleton varies depending on factors such as age and anatomical variation. 
+The list of 206 bones in the adult skeleton can be subdivided into the axial skeleton (80 bones) and the appendicular skeleton (126 bones). 172 of 206 bones are part of a pair and the remaining 34 are unpaired. Many small accessory bones, such as sesamoid bones, are not included in the standard list. 
+
+
+== Introduction ==
+
+Infants are born with an estimated 270 bones. During the course of normal human development, many bones fuse, a process that is active throughout childhood and puberty but typically continues until sometime within the third decade of life. Therefore, the number of bones in an individual may be evaluated differently throughout a lifetime. In addition, the bones of the skull and face are counted as separate bones, despite being fused naturally. Some reliable sesamoid bones such as the pisiform are counted, while others, such as the hallux sesamoids, are not.
+Individuals may have more or fewer bones than the average (even accounting for developmental stage) owing to anatomical variations. The most common variations include sutural (wormian) bones, which are located along the sutural lines on the back of the skull, and sesamoid bones which develop within some tendons, mainly in the hands and feet. Some individuals may also have additional (i.e., supernumerary) cervical ribs or lumbar vertebrae. Amputations or other injuries may result in the loss of bones. Complete bone fractures may split one bone into multiple pieces. Other genetic conditions may result in abnormally higher (e.g. polydactyly or conjoined twins) or lower (e.g. oligodactyly) counts of bones.
+
+
+== Bones ==
+
+The axial skeleton, comprising the spine, chest and head, contains 80 bones. The appendicular skeleton, comprising the upper and lower limbs and including the pelvic and shoulder girdles, contains 126 bones, bringing the total for the entire skeleton to 206 bones. 
+
+
+=== Head ===
+
+There are 22 bones in the skull. Including the bones of the middle ear and the hyoid bone, there are 29 bones in total.
+
+Cranial bones (8)
+Occipital bone (1)
+Parietal bones (2)
+Frontal bone (1)
+Temporal bones (2)
+Sphenoid bone (1) (sometimes counted as facial)
+Ethmoid bone (1) (sometimes counted as facial)
+Facial bones (14)
+Nasal bones (2)
+Maxilla (2)
+Lacrimal bones (2)
+Zygomatic bones (2)
+Palatine bones (2)
+Inferior nasal concha bones (2)
+Vomer (1)
+Mandible (1)
+Middle ear bones (6)
+Malleus (2)
+Incus (2)
+Stapes (2)
+Hyoid bone (1)
+
+
+=== Chest (thorax) ===
+There are 25 bones in the rib cage. The sternum is composed of three parts (which are fused and not counted separately).
+
+Sternum (1)
+Manubrium
+Gladiolus
+Xiphoid process
+Ribs - 12 pairs (24)
+Cervical ribs are extra or supernumerary ribs that can occur pathologically in some people.
+
+
+=== Spine (vertebral column) ===
+An adult spine is composed of 24 vertebrae, the sacrum (formed of five fused vertebrae) and the coccyx ("tailbone", formed of 3-5 fused vertebrae), 26 bones in total.
+
+Cervical vertebrae (7)
+Atlas or C1 (1)
+Axis or C2 (1)
+Thoracic vertebrae (12)
+Lumbar vertebrae (5)
+Sacrum (1)
+Coccyx (1)
+
+
+=== Pelvis ===
+The pelvis consists of, laterally and anteriorly, the pelvic girdle and, posteriorly, the pelvic spine. The pelvic spine, consisting of the sacrum and coccyx, is therefore already accounted for (see above). The pelvic girdle is composed of two appendicular hip bones, each formed of three sections (these are fused and not counted separately). 
+
+Hip bone (2)
+Ilium
+Ischium
+Pubis
+
+
+=== Shoulder ===
+The shoulder joint is the articulation of the upper limb with the shoulder girdle. Each shoulder girdle is formed from two bones, the clavicle anteriorly, and the scapula posteriorly. 
+
+Shoulder girdle (4)
+Clavicle (2)
+Scapula (2)
+
+
+=== Upper limb (arm and forearm), and hand ===
+Each upper limb comprises 30 bones: 3 long bones of the arm and forearm, and 27 bones of the hand. There are 60 bones in total in the upper limbs. 
+
+Humerus (2)
+Ulna (2)
+Radius (2)
+Hand (27 bones in each, 54 in total)
+Carpals (8 per wrist, 16 in total)
+Scaphoid (2)
+Lunate (2)
+Triquetrum (2)
+Pisiform bone (2)
+Trapezium (2)
+Trapezoid bone (2)
+Capitate bone (2)
+Hamate bone (2)
+Metacarpals (5 per hand, 10 in total)
+First metacarpal bone (2)
+Second metacarpal bone (2)
+Third metacarpal bone (2)
+Fourth metacarpal bone (2)
+Fifth metacarpal bone (2)
+Phalanges of the hand (14 per hand, 28 in total)
+Proximal phalanges (5 per hand, 10 in total)
+Intermediate phalanges (4 per hand, 8 in total)
+Distal phalanges (5 per hand, 10 in total)
+
+
+=== Lower limb (thigh and leg) and foot ===
+Each lower limb comprises 30 bones: There are a total of 4 bones in the thigh, knee and leg, and 26 in the foot. There are 60 bones in total in the lower limbs. 
+
+Femur (2)
+Patella or kneecap (2)
+Tibia (2)
+Fibula (2)
+Foot (26 bones per foot, 52 bones in total)
+Tarsus (7 per foot, 14 in total)
+Calcaneus or heel bone (2)
+Talus (2)
+Navicular bone (2)
+Medial cuneiform bone (2)
+Intermediate cuneiform bone (2)
+Lateral cuneiform bone (2)
+Cuboid bone (2)
+Metatarsals (5 per foot, 10 in total)
+First metatarsal bone (2)
+Second metatarsal bone (2)
+Third metatarsal bone (2)
+Fourth metatarsal bone (2)
+Fifth metatarsal bone (2)
+Phalanges of the foot (14 per foot, 28 in total)
+Proximal phalanges (5 per foot, 10 in total)
+Intermediate phalanges (4 per foot, 8 in total)
+Distal phalanges (5 per foot, 10 in total)
+
+
+== See also ==
+Human body
+Blood vessels
+Circulatory system
+Outline of human anatomy
+List of nerves of the human body
+List of glands of the human body
+List of skeletal muscles of the human body
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/List_of_medical_abbreviations-0.md b/data/en.wikipedia.org/wiki/List_of_medical_abbreviations-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/List_of_medical_abbreviations-0.md
@@ -0,0 +1,84 @@
+---
+title: "List of medical abbreviations"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/List_of_medical_abbreviations"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:30:03.077429+00:00"
+instance: "kb-cron"
+---
+
+Abbreviations are used very frequently in medicine. They boost efficiency as long as they are used intelligently. The advantages of brevity should be weighed against the possibilities of obfuscation (making the communication harder for others to understand) and ambiguity (having more than one possible interpretation). Certain medical abbreviations are avoided to prevent mistakes, according to best practices (and in some cases regulatory requirements); these are flagged in the list of abbreviations used in medical prescriptions.
+
+
+== Orthographic styling ==
+
+
+=== Periods (stops) ===
+Periods (stops) are often used in styling abbreviations. Prevalent practice in medicine today is often to forgo them as unnecessary.
+
+Example:
+Less common: The diagnosis was C.O.P.D.      [chronic obstructive pulmonary disease]
+More common: The diagnosis was COPD 
+
+
+=== Plurals ===
+The prevalent way to represent plurals for medical acronyms and initialisms is simply to affix a lowercase s (no apostrophe).
+
+Example: one OCP, two OCPs  [oral contraceptive pills]. 
+
+
+=== Possessives ===
+Possessive forms are not often needed, but can be formed using apostrophe + s. Often the writer can also recast the sentence to avoid it.
+
+Example:
+BP's effect on risk of MI is multifaceted.
+The effect of BP on MI risk is multifaceted.
+
+
+=== Arrows ===
+Arrows may be used to indicate numerous conditions including elevation (↑), diminution (↓), and causation (→, ←).
+
+
+== Pronunciation ==
+Pronunciation follows convention outside the medical field, in which acronyms are generally pronounced as if they were a word (JAMA, SIDS), initialisms are generally pronounced as individual letters (DNA, SSRI), and abbreviations generally use the expansion (soln. = "solution", sup. = "superior"). Abbreviations of weights and measures are pronounced using the expansion of the unit (mg = "milligram") and chemical symbols using the chemical expansion (NaCl = "sodium chloride").
+Some initialisms deriving from Latin may be pronounced either as letters (qid = "cue eye dee") or using the English expansion (qid = "four times a day").
+
+
+== Some common medical abbreviations ==
+ Notation conventions
+
+This series of lists omits periods from acronyms and initialisms.
+It uses periods for certain abbreviations that traditionally often have them (mostly older Latin/Neo-Latin abbreviations). For example, both bid and b.i.d. may be found in the list.
+It generally uses the singular form of an abbreviation (not the plural) as the headword.
+This list uses significant capitalization for headwords (the abbreviations) and their expansions.  
+
+
+== See also ==
+List of abbreviations used in medical prescriptions
+List of medical roots, suffixes and prefixes
+Medical dictionary
+Medical slang
+Abbreviation#Style conventions in English
+Acronym and initialism#Orthographic styling
+
+
+== References ==
+
+Movshovitz-Attias, Dana; Cohen, William W. (2012). Alignment-HMM-based Extraction of Abbreviations from Biomedical Text. Montreal, Canada: NAACL.  [1].
+Davis, Neil M. (2014). Medical Abbreviations: 32,000 Conveniences at the Expense of Communication and Safety (15th ed.). Warminster, PA, USA: Neil M Davis Associates. ISBN 978-0-931431-15-9. Available online (by subscription) at MedAbbrev.com.
+Jablonski, Stanley (2008). Jablonski's Dictionary of Medical Acronyms and Abbreviations with CD-ROM (6th ed.). Philadelphia: Saunders. ISBN 978-1-4160-5899-1.
+Sloane, Sheila B. (1997). Medical Abbreviations & Eponyms (2nd ed.). Philadelphia: Saunders. ISBN 978-0-7216-7088-1.
+
+
+== External links ==
+Biggest Collection of Medical Abbreviations 
+Glossary of Medical Terms - Tufts University
+Medical Abbreviations EN English Medical Abbreviations for Android
+JD.MD, Inc. online Medical & Dental Abbreviations Glossary
+Acronyms for Medical & Dental professional organizations
+Medical Abbreviations for iPhone
+Medical abbreviations on mediLexicon
+Medical acronyms and abbreviations on allacronyms.com
+Over 20,000 medical abbreviations sorted into specialist categories
+Medical abbreviations in various categories such as Physiology, Oncology, Laboratory and more
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/List_of_medical_roots_and_affixes-0.md b/data/en.wikipedia.org/wiki/List_of_medical_roots_and_affixes-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/List_of_medical_roots_and_affixes-0.md
@@ -0,0 +1,120 @@
+---
+title: "List of medical roots and affixes"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/List_of_medical_roots_and_affixes"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:37.200007+00:00"
+instance: "kb-cron"
+---
+
+This is a list of roots, suffixes, and prefixes used in medical terminology, their meanings, and their etymologies. Most of them are combining forms in Neo-Latin and hence international scientific vocabulary.  There are a few general rules about how they combine. First, prefixes and suffixes, most of which are derived from ancient Greek or classical Latin, have a droppable vowel, usually -o-.  As a general rule, this vowel almost always acts as a joint-stem to connect two consonantal roots (e.g. arthr- + -o- + -logy = arthrology), but generally, the -o- is dropped when connecting to a vowel-stem (e.g. arthr- + -itis = arthritis, instead of arthr-o-itis). Second, medical roots generally go together according to language, i.e., Greek prefixes occur with Greek suffixes and Latin prefixes with Latin suffixes. Although international scientific vocabulary is not stringent about segregating combining forms of different languages, it is advisable when coining new words not to mix different lingual roots.
+
+
+== Prefixes and suffixes ==
+The following is an alphabetical list of medical prefixes and suffixes, along with their meanings, origins, and English examples.
+
+
+=== A ===
+
+
+=== B ===
+
+
+=== C ===
+
+
+=== D ===
+
+
+=== E ===
+
+
+=== F ===
+
+
+=== G ===
+
+
+=== H ===
+
+
+=== I ===
+
+
+=== J–K ===
+
+
+=== L ===
+
+
+=== M ===
+
+
+=== N ===
+
+
+=== O ===
+
+
+=== P ===
+
+
+=== Q–R ===
+
+
+=== S ===
+
+
+=== T ===
+
+
+=== U ===
+
+
+=== V ===
+
+
+=== X–Z ===
+
+
+== English meanings ==
+This section contains lists of different root classification (e.g. body components, quantity, description, etc.). Each list is alphabetized by English meanings, with the corresponding Greek and Latin roots given.
+
+
+=== Roots of the body ===
+
+
+==== Roots of bodily concepts ====
+
+
+==== Body parts and substances ====
+
+
+=== Roots of color ===
+
+
+=== Roots of description ===
+
+
+=== Roots of position ===
+
+
+=== Prefixes of quantity or amount ===
+
+
+== See also ==
+Glossary of medicine
+Classical compound
+International scientific vocabulary
+List of medical abbreviations
+Medical dictionary
+Medicine
+List of commonly used taxonomic affixes
+
+
+== References ==
+
+
+== External links ==
+"Root Words & Prefixes: Quick Reference." LearnThatWord. N.p., n.d. Web. 3 March 2013.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body-0.md b/data/en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body-0.md
@@ -0,0 +1,61 @@
+---
+title: "List of skeletal muscles of the human body"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:30:04.336896+00:00"
+instance: "kb-cron"
+---
+
+This is a table of skeletal muscles of the human anatomy, with muscle counts and other information.
+
+
+== Table ==
+
+
+== Table explanation and summary ==
+The muscles are described using anatomical terminology. The columns are as follows:
+
+For Origin, Insertion and Action please name a specific Rib, Thoracic vertebrae or Cervical vertebrae, by using C1-7, T1-12 or R1-12.
+
+
+=== Summary in numbers ===
+There does not appear to be a definitive source counting all skeletal muscles. Different sources group muscles differently, regarding physical features as different parts of a single muscle or as several muscles. There are also vestigial muscles that are present in some people but absent in others, such as the palmaris longus muscle. There are between 600 and 840 muscles within the typical human body, depending on how they are counted. In the present table, using statistical counts of the instances of each muscle, and ignoring gender-specific muscles, there are 753 skeletal muscles. Sometimes male and females have the same muscle but with different purposes
+
+
+==== Numbers based on the list above ====
+
+
+=== Agonistic and antagonistic relationships ===
+Muscles are often paired as agonistic and antagonistic muscles. This can be a bit misleading as, in general, it is groups of muscles working together to either make or cancel a movement. The present table lists some well-known relationships but is not at all complete.
+
+
+== Innervation overview ==
+
+
+== See also ==
+Accessory muscle
+List of bones of the human skeleton
+List of nerves of the human body
+Circulatory system
+Blood vessel
+
+
+== Notes ==
+
+
+== References ==
+
+
+== General references ==
+Gosling, J.A.; Harris, P.F.; Humpherson, J.R.; Whitmore, I.; Willan, P.L.T. (2008). Human Anatomy: Color Atlas and Textbook. phot. by A.L. Bentley (5th ed.). Philadelphia: Mosby. ISBN 978-0-7234-3451-1.
+
+
+== External links ==
+LUMEN's Master Muscle List from www.meddean.luc.edu
+The Hosford Muscle Tables for the Human Body from PT Central
+Lower Extremity Muscle Atlas from rad.Washington.edu
+Tutorial and quizzes on skeletal muscular anatomy
+Muscles of human body (also here)
+Anatomy quiz
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Mathematical_proof-0.md b/data/en.wikipedia.org/wiki/Mathematical_proof-0.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Mathematical_proof-0.md
@@ -0,0 +1,30 @@
+---
+title: "Mathematical proof"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Mathematical_proof"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:53.330614+00:00"
+instance: "kb-cron"
+---
+
+A mathematical proof is a deductive argument for a mathematical statement, showing that the stated assumptions logically guarantee the conclusion. The argument may use other previously established statements, such as theorems; but every proof can, in principle, be constructed using only certain basic or original assumptions known as axioms, along with the accepted rules of inference. Proofs are examples of exhaustive deductive reasoning that establish logical certainty, to be distinguished from empirical arguments or non-exhaustive inductive reasoning that establish "reasonable expectation". Presenting many cases in which the statement holds is not enough for a proof, which must demonstrate that the statement is true in all possible cases. A proposition that has not been proved but is believed to be true is known as a conjecture, or a hypothesis if frequently used as an assumption for further mathematical work.
+Proofs employ logic expressed in mathematical symbols, along with natural language that usually admits some ambiguity. In most mathematical literature, proofs are written in terms of rigorous informal logic. Purely formal proofs, written fully in symbolic language without the involvement of natural language, are considered in proof theory. The distinction between formal and informal proofs has led to much examination of current and historical mathematical practice, quasi-empiricism in mathematics, and so-called folk mathematics, oral traditions in the mainstream mathematical community or in other cultures. The philosophy of mathematics is concerned with the role of language and logic in proofs, and mathematics as a language.
+
+== History and etymology ==
+
+The word proof derives from the Latin probare 'to test'; related words include English probe, probation, and probability, as well as Spanish probar 'to taste' (sometimes 'to touch' or 'to test'), Italian provare 'to try', and German probieren 'to try'. The legal term probity means authority or credibility, the power of testimony to prove facts when given by persons of reputation or status.
+Plausibility arguments using heuristic devices such as pictures and analogies preceded strict mathematical proof. It is likely that the idea of demonstrating a conclusion first arose in connection with geometry, which originated in practical problems of land measurement. The development of mathematical proof is primarily the product of ancient Greek mathematics. Thales (624–546 BCE) and Hippocrates of Chios (c. 470–410 BCE) gave some of the first known proofs of theorems in geometry. Eudoxus (408–355 BCE) and Theaetetus (417–369 BCE) formulated theorems but did not prove them. Aristotle (384–322 BCE) said definitions should describe the concept being defined in terms of other concepts already known.
+Mathematical proof was revolutionized by Euclid (300 BCE), who introduced the axiomatic method still in use today. It starts with undefined terms and axioms, propositions concerning the undefined terms which are assumed to be self-evidently true (from Greek axios 'something worthy'). From this basis, the method proves theorems using deductive logic. Euclid's Elements was read by anyone who was considered educated in the West until the middle of the 20th century. In addition to theorems of geometry, such as the Pythagorean theorem, the Elements also covers number theory, including a proof that the square root of two is irrational and a proof that there are infinitely many prime numbers.
+Further advances also took place in medieval Islamic mathematics. In the 10th century, the Iraqi mathematician Al-Hashimi worked with numbers as such, called "lines" but not necessarily considered as measurements of geometric objects, to prove algebraic propositions concerning multiplication, division, etc., including the existence of irrational numbers. An inductive proof for arithmetic progressions was introduced in the Al-Fakhri (1000) by Al-Karaji, who used it to prove the binomial theorem and properties of Pascal's triangle.
+Modern proof theory treats proofs as inductively defined data structures, not requiring an assumption that axioms are "true" in any sense. This allows parallel mathematical theories as formal models of a given intuitive concept, based on alternate sets of axioms, for example axiomatic set theory and non-Euclidean geometry.
+
+== Nature and purpose ==
+As practiced, a proof is expressed in natural language and is a rigorous argument intended to convince the audience of the truth of a statement. The standard of rigor is not absolute and has varied throughout history. A proof can be presented differently depending on the intended audience. To gain acceptance, a proof has to meet communal standards of rigor; an argument considered vague or incomplete may be rejected.
+The concept of proof is formalized in the field of mathematical logic. A formal proof is written in a formal language instead of natural language. A formal proof is a sequence of formulas in a formal language, starting with an assumption, and with each subsequent formula a logical consequence of the preceding ones. This definition makes the concept of proof amenable to study. Indeed, the field of proof theory studies formal proofs and their properties, the most famous and surprising being that almost all axiomatic systems can generate certain undecidable statements not provable within the system.
+The definition of a formal proof is intended to capture the concept of proofs as written in the practice of mathematics. The soundness of this definition amounts to the belief that a published proof can, in principle, be converted into a formal proof. However, outside the field of automated proof assistants, this is rarely done in practice. A classic question in philosophy asks whether mathematical proofs are analytic or synthetic. Kant, who introduced the analytic–synthetic distinction, believed mathematical proofs are synthetic, whereas Quine argued in his 1951 "Two Dogmas of Empiricism" that such a distinction is untenable.
+Proofs may be admired for their mathematical beauty. The mathematician Paul Erdős was known for describing proofs which he found to be particularly elegant as coming from "The Book", a hypothetical tome containing the most beautiful method(s) of proving each theorem. The book Proofs from THE BOOK, published in 2003, is devoted to presenting 32 proofs its editors find particularly pleasing.
+
+== Methods of proof ==
+
+=== Direct proof ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Mathematical_proof-1.md b/data/en.wikipedia.org/wiki/Mathematical_proof-1.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Mathematical_proof-1.md
@@ -0,0 +1,243 @@
+---
+title: "Mathematical proof"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Mathematical_proof"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:53.330614+00:00"
+instance: "kb-cron"
+---
+
+In direct proof, the conclusion is established by logically combining the axioms, definitions, and earlier theorems. For example, direct proof can be used to prove that the sum of two even integers is always even:
+
+Consider two even integers x and y. Since they are even, they can be written as x = 2a and y = 2b, respectively, for some integers a and b. Then the sum is x + y = 2a + 2b = 2(a+b). Therefore x+y has 2 as a factor and, by definition, is even. Hence, the sum of any two even integers is even.
+This proof uses the definition of even integers, the integer properties of closure under addition and multiplication, and the distributive property.
+
+=== Proof by mathematical induction ===
+
+Despite its name, mathematical induction is a method of deduction, not a form of inductive reasoning. In proof by mathematical induction, a single "base case" is proved, and an "induction rule" is proved that establishes that any arbitrary case implies the next case. Since in principle the induction rule can be applied repeatedly (starting from the proven base case), it follows that all (usually infinitely many) cases are provable. This avoids having to prove each case individually. A variant of mathematical induction is proof by infinite descent, which can be used, for example, to prove the irrationality of the square root of two.
+A common application of proof by mathematical induction is to prove that a property known to hold for one number holds for all natural numbers:
+Let N = {1, 2, 3, 4, ...} be the set of natural numbers, and let P(n) be a mathematical statement involving the natural number n belonging to N such that
+
+(i) P(1) is true, i.e., P(n) is true for n = 1.
+(ii) P(n+1) is true whenever P(n) is true, i.e., P(n) is true implies that P(n+1) is true.
+Then P(n) is true for all natural numbers n.
+For example, we can prove by induction that all positive integers of the form 2n − 1 are odd. Let P(n) represent "2n − 1 is odd":
+
+(i) For n = 1, 2n − 1 = 2(1) − 1 = 1, and 1 is odd, since it leaves a remainder of 1 when divided by 2. Thus P(1) is true.
+(ii) For any n, if 2n − 1 is odd (P(n)), then (2n − 1) + 2 must also be odd, because adding 2 to an odd number results in an odd number. But (2n − 1) + 2 = 2n + 1 = 2(n+1) − 1, so 2(n+1) − 1 is odd (P(n+1)). So P(n) implies P(n+1).
+Thus 2n − 1 is odd, for all positive integers n.
+The shorter phrase "proof by induction" is often used instead of "proof by mathematical induction".
+
+=== Proof by contraposition ===
+
+Proof by contraposition infers the statement "if p then q" by establishing the logically equivalent contrapositive statement: "if not q then not p".
+For example, contraposition can be used to establish that, given an integer 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+, if 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+      
+    
+    {\displaystyle x^{2}}
+  
+ is even, then 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ is even:
+
+Suppose 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ is not even. Then 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ is odd. The product of two odd numbers is odd, hence 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+        =
+        x
+        ⋅
+        x
+      
+    
+    {\displaystyle x^{2}=x\cdot x}
+  
+ is odd. Thus 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+      
+    
+    {\displaystyle x^{2}}
+  
+ is not even. Thus, if 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+      
+    
+    {\displaystyle x^{2}}
+  
+ is even, the supposition must be false, so 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ has to be even.
+
+=== Proof by contradiction ===
+
+In proof by contradiction, also known by the Latin phrase reductio ad absurdum (by reduction to the absurd), it is shown that if some statement is assumed true, a logical contradiction occurs, hence the statement must be false. A famous example involves the proof that 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+ is an irrational number:
+
+Suppose that 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+ were a rational number. Then it could be written in lowest terms as 
+  
+    
+      
+        
+          
+            2
+          
+        
+        =
+        
+          
+            a
+            b
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}={a \over b}}
+  
+ where a and b are non-zero integers with no common factor. Thus, 
+  
+    
+      
+        b
+        
+          
+            2
+          
+        
+        =
+        a
+      
+    
+    {\displaystyle b{\sqrt {2}}=a}
+  
+. Squaring both sides yields 2b2 = a2. Since the expression on the left is an integer multiple of 2, the right expression is by definition divisible by 2. That is, a2 is even, which implies that a must also be even, as seen in the proposition above (in #Proof by contraposition). So we can write a = 2c, where c is also an integer. Substitution into the original equation yields 2b2 = (2c)2 = 4c2. Dividing both sides by 2 yields b2 = 2c2. But then, by the same argument as before, 2 divides b2, so b must be even. However, if a and b are both even, they have 2 as a common factor. This contradicts our previous statement that a and b have no common factor, so we must conclude that 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+ is an irrational number.
+To paraphrase: if one could write 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+ as a fraction, this fraction could never be written in lowest terms, since 2 could always be factored from numerator and denominator.
+
+=== Proof by construction ===
+
+Proof by construction, or proof by example, is the construction of a concrete example with a property to show that something having that property exists. Joseph Liouville, for instance, proved the existence of transcendental numbers by constructing an explicit example. It can also be used to construct a counterexample to disprove a proposition that all elements have a certain property.
+
+=== Proof by exhaustion ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Mathematical_proof-2.md b/data/en.wikipedia.org/wiki/Mathematical_proof-2.md
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+++ b/data/en.wikipedia.org/wiki/Mathematical_proof-2.md
@@ -0,0 +1,358 @@
+---
+title: "Mathematical proof"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Mathematical_proof"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:53.330614+00:00"
+instance: "kb-cron"
+---
+
+In proof by exhaustion, the conclusion is established by dividing it into a finite number of cases and proving each one separately. The number of cases sometimes can become very large. For example, the first proof of the four color theorem was a proof by exhaustion with 1,936 cases. This proof was controversial because the majority of the cases were checked by a computer program, not by hand.
+
+=== Closed chain inference ===
+
+A closed chain inference shows that a collection of statements are pairwise equivalent.
+In order to prove that the statements 
+  
+    
+      
+        
+          φ
+          
+            1
+          
+        
+        ,
+        …
+        ,
+        
+          φ
+          
+            n
+          
+        
+      
+    
+    {\displaystyle \varphi _{1},\ldots ,\varphi _{n}}
+  
+ are each pairwise equivalent, proofs are given for the implications 
+  
+    
+      
+        
+          φ
+          
+            1
+          
+        
+        ⇒
+        
+          φ
+          
+            2
+          
+        
+      
+    
+    {\displaystyle \varphi _{1}\Rightarrow \varphi _{2}}
+  
+, 
+  
+    
+      
+        
+          φ
+          
+            2
+          
+        
+        ⇒
+        
+          φ
+          
+            3
+          
+        
+      
+    
+    {\displaystyle \varphi _{2}\Rightarrow \varphi _{3}}
+  
+, 
+  
+    
+      
+        …
+      
+    
+    {\displaystyle \dots }
+  
+, 
+  
+    
+      
+        
+          φ
+          
+            n
+            −
+            1
+          
+        
+        ⇒
+        
+          φ
+          
+            n
+          
+        
+      
+    
+    {\displaystyle \varphi _{n-1}\Rightarrow \varphi _{n}}
+  
+ and 
+  
+    
+      
+        
+          φ
+          
+            n
+          
+        
+        ⇒
+        
+          φ
+          
+            1
+          
+        
+      
+    
+    {\displaystyle \varphi _{n}\Rightarrow \varphi _{1}}
+  
+.
+The pairwise equivalence of the statements then results from the transitivity of the material conditional.
+
+=== Probabilistic proof ===
+
+A probabilistic proof is one in which an example is shown to exist, with certainty, by using methods of probability theory. Probabilistic proof, like proof by construction, is one of many ways to prove existence theorems.
+In the probabilistic method, one seeks an object having a given property, starting with a large set of candidates. One assigns a certain probability for each candidate to be chosen, and then proves that there is a non-zero probability that a chosen candidate will have the desired property. This does not specify which candidates have the property, but the probability could not be positive without at least one.
+A probabilistic proof is not to be confused with an argument that a theorem is 'probably' true, a 'plausibility argument'. The work toward the Collatz conjecture shows how far plausibility is from genuine proof, as does the disproof of the Mertens conjecture. While most mathematicians do not think that probabilistic evidence for the properties of a given object counts as a genuine mathematical proof, a few mathematicians and philosophers have argued that at least some types of probabilistic evidence (such as Rabin's probabilistic algorithm for testing primality) are as good as genuine mathematical proofs.
+
+=== Combinatorial proof ===
+
+A combinatorial proof establishes the equivalence of different expressions by showing that they count the same object in different ways. Often a bijection between two sets is used to show that the expressions for their two sizes are equal. Alternatively, a double counting argument provides two different expressions for the size of a single set, again showing that the two expressions are equal.
+
+=== Nonconstructive proof ===
+
+A nonconstructive proof establishes that a mathematical object with a certain property exists—without explaining how such an object can be found. Often, this takes the form of a proof by contradiction in which the nonexistence of the object is proved to be impossible. In contrast, a constructive proof establishes that a particular object exists by providing a method of finding it. The following famous example of a nonconstructive proof shows that there exist two irrational numbers a and b such that 
+  
+    
+      
+        
+          a
+          
+            b
+          
+        
+      
+    
+    {\displaystyle a^{b}}
+  
+ is a rational number. This proof uses that 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+ is irrational (an easy proof is known since Euclid), but not that 
+  
+    
+      
+        
+          
+            
+              2
+            
+          
+          
+            
+              2
+            
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}^{\sqrt {2}}}
+  
+ is irrational (this is true, but the proof is not elementary).
+
+Either 
+  
+    
+      
+        
+          
+            
+              2
+            
+          
+          
+            
+              2
+            
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}^{\sqrt {2}}}
+  
+ is a rational number and we are done (take 
+  
+    
+      
+        a
+        =
+        b
+        =
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle a=b={\sqrt {2}}}
+  
+), or 
+  
+    
+      
+        
+          
+            
+              2
+            
+          
+          
+            
+              2
+            
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}^{\sqrt {2}}}
+  
+ is irrational so we can write 
+  
+    
+      
+        a
+        =
+        
+          
+            
+              2
+            
+          
+          
+            
+              2
+            
+          
+        
+      
+    
+    {\displaystyle a={\sqrt {2}}^{\sqrt {2}}}
+  
+ and 
+  
+    
+      
+        b
+        =
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle b={\sqrt {2}}}
+  
+. This then gives 
+  
+    
+      
+        
+          
+            (
+            
+              
+                
+                  2
+                
+              
+              
+                
+                  2
+                
+              
+            
+            )
+          
+          
+            
+              2
+            
+          
+        
+        =
+        
+          
+            
+              2
+            
+          
+          
+            2
+          
+        
+        =
+        2
+      
+    
+    {\displaystyle \left({\sqrt {2}}^{\sqrt {2}}\right)^{\sqrt {2}}={\sqrt {2}}^{2}=2}
+  
+, which is thus a rational number of the form 
+  
+    
+      
+        
+          a
+          
+            b
+          
+        
+        .
+      
+    
+    {\displaystyle a^{b}.}
+  
+
+=== Statistical proofs in pure mathematics ===
+
+The expression "statistical proof" may be used technically or colloquially in areas of pure mathematics, such as involving cryptography, chaotic series, and probabilistic number theory or analytic number theory. It is less commonly used to refer to a mathematical proof in the branch of mathematics known as mathematical statistics. See also the "Statistical proof using data" section below.
+
+=== Computer-assisted proofs ===
+
+Until the twentieth century it was assumed that any proof could, in principle, be checked by a competent mathematician to confirm its validity. However, automated theorem provers and proof assistants are now used to prove theorems and carry out calculations that are too long for any human or team of humans to check; the first proof of the four color theorem is an example of a computer-assisted proof. Some mathematicians are concerned that the possibility of an error in a computer program or a run-time error in its calculations calls the validity of such computer-assisted proofs into question. In practice, the chances of an error invalidating a computer-assisted proof can be reduced by incorporating redundancy and self-checks into calculations, and by developing multiple independent approaches and programs. Errors can never be completely ruled out in case of verification of a proof by humans either, especially if the proof contains natural language and requires deep mathematical insight to uncover the potential hidden assumptions and fallacies involved.
\ No newline at end of file
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+---
+title: "Mathematical proof"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Mathematical_proof"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:53.330614+00:00"
+instance: "kb-cron"
+---
+
+== Undecidable statements ==
+A statement that is neither provable nor disprovable from a set of axioms is called undecidable (from those axioms). One example is the parallel postulate, which is neither provable nor refutable from the remaining axioms of Euclidean geometry.
+Mathematicians have shown there are many statements that are neither provable nor disprovable in Zermelo–Fraenkel set theory with the axiom of choice (ZFC), the standard system of set theory in mathematics (assuming that ZFC is consistent); see List of statements undecidable in ZFC.
+Gödel's (first) incompleteness theorem shows that many axiom systems of mathematical interest will have undecidable statements.
+
+== Heuristic mathematics and experimental mathematics ==
+
+While early mathematicians such as Eudoxus of Cnidus did not use proofs, from Euclid to the foundational mathematics developments of the late 19th and 20th centuries, proofs were an essential part of mathematics. With the increase in computing power in the 1960s, significant work began to be done investigating mathematical objects beyond the proof-theorem framework, in experimental mathematics. Early pioneers of these methods intended the work ultimately to be resolved into a classical proof-theorem framework, e.g. the early development of fractal geometry, which was ultimately so resolved.
+
+== Related concepts ==
+
+=== Visual proof ===
+
+=== Elementary proof ===
+
+=== Two-column proof ===
+
+A particular way of organizing a proof using two parallel columns is often used as a mathematical exercise in elementary geometry classes in the United States. The proof is written as a series of lines in two columns. In each line, the left-hand column contains a proposition, while the right-hand column contains a brief explanation of how the corresponding proposition in the left-hand column is either an axiom, a hypothesis, or can be logically derived from previous propositions. The left-hand column is typically headed "Statements" and the right-hand column is typically headed "Reasons".
+
+=== Statistical proof using data ===
+
+=== Inductive logic proofs and Bayesian analysis ===
+
+=== Proofs as mental objects ===
+
+== Ending a proof ==
+
+Sometimes, the abbreviation "Q.E.D." is written to indicate the end of a proof. This abbreviation stands for "quod erat demonstrandum", which is Latin for "that which was to be demonstrated". A more common alternative is to use a square or a rectangle, such as □ or ∎, known as a "tombstone" or "Halmos" after its eponym Paul Halmos. Often, "which was to be shown" is verbally stated when writing "QED", "□", or "∎" during an oral presentation. Unicode explicitly provides the "end of proof" character, U+220E (∎) (220E(hex) = 8718(dec)).
+
+== See also ==
+
+== References ==
+
+== Further reading ==
+Pólya, G. (1954), Mathematics and Plausible Reasoning, Princeton University Press, hdl:2027/mdp.39015008206248, ISBN 9780691080055 {{citation}}: ISBN / Date incompatibility (help).
+Fallis, Don (2002), "What Do Mathematicians Want? Probabilistic Proofs and the Epistemic Goals of Mathematicians", Logique et Analyse, 45: 373–88.
+Franklin, J.; Daoud, A. (2011), Proof in Mathematics: An Introduction, Kew Books, ISBN 978-0-646-54509-7.
+Gold, Bonnie; Simons, Rogers A. (2008). Proof and Other Dilemmas: Mathematics and Philosophy. MAA.
+Solow, D. (2004), How to Read and Do Proofs: An Introduction to Mathematical Thought Processes, Wiley, ISBN 978-0-471-68058-1.
+Velleman, D. (2006), How to Prove It: A Structured Approach, Cambridge University Press, ISBN 978-0-521-67599-4.
+Hammack, Richard (2018), Book of Proof, Richard Hammack, ISBN 978-0-9894721-3-5.
+
+== External links ==
+
+ Media related to Mathematical proof at Wikimedia Commons
+Proofs in Mathematics: Simple, Charming and Fallacious
+A lesson about proofs, in a course from Wikiversity
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diff --git a/data/en.wikipedia.org/wiki/Medical_terminology-0.md b/data/en.wikipedia.org/wiki/Medical_terminology-0.md
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+---
+title: "Medical terminology"
+chunk: 1/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+Medical terminology is language used to describe the components, processes, conditions, medical procedures and treatments of the human body. 
+In the English language, medical terminology generally has a regular morphology; the same prefixes and suffixes are used to add meanings to different roots. The root of a term often refers to an organ, tissue, or condition, and medical roots and affixes are often derived from Ancient Greek or Latin (particularly Neo-Latin). Many medical terms are examples of neoclassical compounds. Historically, all European universities used Latin as the dominant language of instruction and research, as Neo-Latin was the lingua franca of science, medicine, and education in Europe during the early modern period.
+Medical terminology includes a large part of anatomical terminology, which includes the anatomical terms of location, motion, muscle, bone, and histology. It also includes language from biology, chemistry, physics, and physiology, as well as vocabulary unique to the field of medicine, such as medical abbreviations. Each branch of medicine has its own clinical and scientific terminology. Medical dictionaries are specialised dictionaries for medical terminology and may be organised alphabetically or according to medical classification systems such as the Systematized Nomenclature of Medicine, International Classification of Diseases, or Unified Medical Language System.  
+Examples of modern medical dictionaries include Mosby's Dictionary of Medicine, Nursing & Health Professions, Stedman's, Taber's, and Dorland's.
+
+== Linguistics ==
+
+In the English language, medical terms generally have a regular morphology, often being compound words that comprise three kinds of morphemes: roots, prefixes, and suffixes. The etymology of medical terms often originates from Latin (particularly Neo-Latin) and Ancient Greek, with such medical terms being examples of neoclassical compounds. Each language may supply relevant morphemes for medical terms. For example, there are two primary roots for medical terminology relating to kidneys – one from Greek (νεφρός nephr(os)) and one from Latin (ren(es)).  
+Lexical items of medical terminology, which forms part of international scientific vocabulary (ISV), are translingual (that is, being used across multiple languages). The use of ISV was a driving force in the development of the constructed language known as Interlingua. From the 1950s to late 1970s, a number of medical journals were published, or used, Interlingua. 
+
+=== Morphology ===
+Medical roots and affixes are often derived from Greek or Latin.
+
+==== Roots ====
+The word root is developed to include a vowel sound following the term to add a smoothing action to the sound of the word when applying a suffix. The result is the formation of a new term with a vowel attached (word root + vowel) called a combining form. In English, the most common vowel used in the formation of the combining form is the letter -o-, added to the word root. For example, if there is an inflammation of the stomach and intestines, this would be written as gastro- and enter- plus -itis, gastroenteritis.
+The formation of plurals should usually be done using the rules of the source language. Greek and Latin each have differing rules to be applied when forming the plural form of the word root.
+
+==== Affixes ====
+Prefixes and suffixes, primarily in Greek—but also in Latin, have a droppable -o-. As a general rule, this vowel almost always acts as a joint-stem to connect two consonantal roots (e.g. arthr- + -o- + -logy = arthrology), but generally, the -o- is dropped when connecting to a vowel-stem (e.g. arthr- + -itis = arthritis, instead of arthr-o-itis). Generally, Greek prefixes go with Greek suffixes and Latin prefixes with Latin suffixes. Although it is technically considered acceptable to create hybrid words, it is strongly preferred in coining new terms not to mix different lingual roots. Examples of accepted medical words that do mix lingual roots are neonatology and quadriplegia.
+Prefixes do not normally require further modification to be added to a word root because the prefix normally ends in a vowel or vowel sound, although in some cases they may assimilate slightly and an in- may change to im- or syn- to sym-. Suffixes are attached to the end of a word root to add meaning such as condition, disease process, or procedure. Suffixes are categorized as either (1) needing the combining form, or (2) not needing the combining form since they start with a vowel.
+
+== Gross anatomy ==
+
+Descriptive human anatomy often uses terminology that is fairly correct descriptive Latin. For example, musculus gluteus maximus simply means the "largest rump muscle", where musculus was Latin for "little mouse" and applied to muscles; a frenum, a structure for keeping something in place, is Latin for bridle; and a foramen is Latin for a passage or perforation.
+
+=== Location and motion ===
+
+A standardised set of terminology is used in anatomy to describe relative and absolute location and movement of anatomical parts. The standard anatomical position is the orientation that anatomical terms of location and motion are typically used in reference to. In humans, this refers to the body in a standing position with arms at the side and palms facing forward. Other positions referenced in medicine include prone (lying facing down) and supine (lying facing up).
+
+==== Planes and axes ====
+
+Relative to the standard anatomical position, three anatomical planes are widely used in medicine: 
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+---
+title: "Medical terminology"
+chunk: 2/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+The parasagittal (Greek πᾰρᾰ́ (pará), beside) or paramedian or sagittal planes (Latin sagitta, arrow), which include the median or midsagittal plane and divide the body into left and right (in reference to the subject and not the observer).
+The frontal or coronal plane (Latin corona, crown), which divide the body into front and back.
+The axial or horizontal or transverse plane (Latin trans, across; vetere, to turn), which is perpendicular to the other two planes.
+The transpyloric plane, the subcostal plane, and the transumbilical plane planes are also considered in the division of the torso into the quadrants and regions of the abdomen. 
+The three main axes of a human are the left-right (or horizontal or frontal), the craniocaudal (or rostrocaudal, longitudinal, or cephalocaudal), and the anteroposterior (or dorsoventral or sagittal) axes. Other anatomical lines include the axillary lines, parasternal line, and scapular line.
+
+==== Location ====
+
+Many anatomical terms can be combined to indicate a position in two axes simultaneously or the direction of a movement relative to the body: Anterolateral indicates a position that is both anterior and lateral to the standard anatomical position (such as the bulk of the pectoralis major muscle) or a named organ such as the anterolateral tibial tubercle; anteromedial is used, for example, in the anteromedial central arteries; proximodistal describes the axis of an appendage such as an arm or a leg, taken from its tip at the distal part to where it joins the body at the proximal part. Combined terms were once generally hyphenated, but typically the hyphen is omitted.
+
+In radiology, various X-ray views use terminology based on where the X-ray beam enters and leaves the body, including the front to back view (anteroposterior), the back to front view (posteroanterior), and the side view (lateral).
+
+==== Motion ====
+
+Circumduction is a conical movement of a body part, such as a ball and socket joint or the eye. Circumduction is a combination of flexion, extension, adduction and abduction. Circumduction may be performed at ball and socket joints, such as the hip and shoulder, as well as other parts of the body such as fingers, hands, feet, and head. For example, circumduction occurs when spinning the arm when performing a serve in tennis or bowling a cricket ball.
+
+=== Integumentary ===
+The integumentary system is the set of organs forming the outermost layer of the human body, comprising the skin, hair, and nails. It acts as a protective physical barrier between the external environment and the internal environment, while maintaining water balance, protecting deeper tissue, excreting waste, and regulating body temperature.
+The skin (or, integument) is a composite organ, made up of the outermost epidermis and the inner dermis. The epidermis comprises five layers: the stratum corneum, stratum granulosum, stratum spinosum and stratum basale. Where the skin is thicker, such as in the palms and soles, there is an extra layer of skin between the stratum corneum and the stratum granulosum known as the stratum lucidum. The dermis comprises two sections, the papillary and reticular layers, and contains connective tissues, blood vessels, glands, follicles, hair roots, sensory nerve endings, and muscular tissue. Between the integument and the deep body musculature there is a transitional subcutaneous zone, the hypodermis.
+
+=== Musculoskeletal ===
+
+The musculoskeletal system the organ system that gives humans the ability to move using their muscular and skeletal systems, and is described by the anatomical terms of bone and muscle. It is made up of the bones of the skeleton, muscles, cartilage, tendons, ligaments, joints, and other connective tissue that supports and binds tissues and organs together:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Medical_terminology-10.md b/data/en.wikipedia.org/wiki/Medical_terminology-10.md
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+---
+title: "Medical terminology"
+chunk: 11/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+== History ==
+The earliest known glossaries of medical terms were discovered on Egyptian papyrus authored around 1600 B.C. Other precursors to modern medical dictionaries include lists of terms compiled from the Hippocratic Corpus in the first century AD. The Synonyma Simonis Genuensis (the Synonyms of Simon of Genoa), attributed to the physician to Pope Nicholas IV in the year 1288, was printed by Antonius Zarotus at Milan in 1473. Referring to a copy held in the library of the College of Physicians of Philadelphia, Henry wrote in 1905 that "It is the first edition of the first medical dictionary." However, this claim is disputed as the composition only included lists of herbs and drugs.
+At the beginning of the Renaissance, Italian universities began teaching a broader range of courses, such as law and medicine, whilst universities in northern Europe were still dominated by theology and related topics. All European universities required Latin proficiency for admission. Latin was the dominant language of university education, where rules were enforced against the use of vernacular languages. Lectures and debates took place in Latin, and writing was in Latin, across the curriculum. 
+Latin dominated topics of international academic and scientific interest, especially at the level of abstract thought addressed to other specialists. To begin with, knowledge was already transmitted through Latin and it maintained specialised vocabularies not found in vernacular languages. By the early modern period, Neo-Latin had become the lingua franca of science, medicine, legal discourse, theology, and education in Europe. Over time, the use of Latin continued where international communication with specialist audiences was paramount. Later, where some of the discourse moved to French, English or German, translations into Latin would allow texts to cross language boundaries, while authors in countries with much smaller language populations or less known languages would tend to continue to compose in Latin.
+Latin's dominance over medicine began to change in the late seventeenth century, as philosophers and others began to write in their native language first, afterwards translating into Latin for international audiences. In the early part of the 1700s, Latin was still making a significant contribution to academic publishing, but was no longer dominant.
+Examples of modern medical dictionaries include Mosby's Dictionary of Medicine, Nursing & Health Professions, Stedman's, Taber's, and Dorland's.
+
+== See also ==
+Glossary of medicine
+Glossary of scientific naming
+List of deprecated terms for diseases
+List of Greek and Latin roots in English
+
+== Notes ==
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Medical_terminology-11.md b/data/en.wikipedia.org/wiki/Medical_terminology-11.md
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+---
+title: "Medical terminology"
+chunk: 12/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+== Works cited ==
+Bertok L, Chow D (2005). Bertok L, Chow D (eds.). Natural Immunity. Vol. 5 (1st ed.). Elsevier Science. ISBN 978-0-44451-755-5.
+Breinstrup, Thomas (2006). "Un revolution in le mundo scientific" [A revolution in the scientific world]. Historia de interlingua (in Interlingua). Archived from the original on 2019-04-27. Retrieved 2025-01-14.
+Chung, Kyung Won (2005). Gross Anatomy (Board Review). Lippincott Williams & Wilkins. ISBN 0-7817-5309-0.
+Cook, Chad E. (2012). Orthopedic Manual Therapy: An Evidence Based Approach (2nd ed.). Upper Saddle River, NJ: Pearson Education. ISBN 978-0-13-802173-3.
+Breinstrup, Th.; Stenström, Ingvar; Olsson, Jesper, eds. (2007) [2001]. "Biographias: Ingvar Stenström". Interlingua (in Interlingua). Archived from the original on 2019-04-26. Retrieved 2025-01-15.
+Dinour, Lauren M. (2019). "Speaking Out on 'Breastfeeding' Terminology: Recommendations for Gender-Inclusive Language in Research and Reporting". Breastfeeding Medicine. 14 (8). Mary Ann Liebert: 523–532. doi:10.1089/bfm.2019.0110. PMID 31364867.
+Fielding, Lucie (2021). Trans Sex: Clinical Approaches to Trans Sexualities and Erotic Embodiments. New York: Routledge. ISBN 978-0-429-31829-0.
+Edwards, Heather. "Anatomy Talk". pp. 165–168.
+Gopsill, Frank Peter (1990). International languages: a matter for Interlingua. Sheffield, England: British Interlingua Society. ISBN 0-9511695-6-4. OCLC 27813762.
+Gopsill, Frank Peter (1994). Interlingua today: A course for beginners. Sheffield, England: British Interlingua Society. ISBN 978-1-898017-01-1.
+Gopsill, Frank Peter; Sexton, Brian (2006) [2001]. "Le natura, si – un schema, no". Historia de interlingua (in Interlingua). Archived from the original on 2022-04-12. Retrieved 2025-01-14.
+Hill-Meyer, Tobi; Scarborough, Dean (2014). "Sexuality". In Erickson-Schroth, Laura (ed.). Trans Bodies, Trans Selves: A Resource for the Transgender Community (1st ed.). Oxford UP. ISBN 978-0-19-932535-1. OCLC 944726648.
+Houglum, Peggy A.; Bertoli, Dolores B. (2012). Brunnstrom's Clinical Kinesiology. F. A. Davis Company. ISBN 978-0-8036-2352-1.
+Janeway CA, Travers P, Walport M (2001). "Effector mechanisms in allergic reactions". Immunobiology (5th ed.). Garland Science.
+Janeway CA (2005). Immunobiology (6th ed.). Garland Science. ISBN 0-443-07310-4.
+Kendall, Florence Peterson; et al. (2005). Muscles : testing and function with posture and pain (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4780-5.
+Knight, Sarah; Tilg, Stefan, eds. (2015). The Oxford Handbook of Neo-Latin. New York: Oxford University Press. ISBN 978-0-19-088699-8. OL 28648475M.
+Krishnaswamy G, Ajitawi O, Chi DS (2006). "The human mast cell: an overview". Mast Cells. Methods in Molecular Biology. Vol. 315. pp. 13–34. doi:10.1385/1-59259-967-2:013. ISBN 1-59259-967-2. PMID 16110146.
+McArthur, Tom (ed.): The Oxford Companion to the English Language, (Oxford University Press, 1992). ISBN 0-19-214183-X
+Murphy K, Weaver C (2016). Immunobiology (9 ed.). Garland Science. ISBN 978-0-8153-4505-3.
+Plag, Ingo "Word-Formation in English", Cambridge University Press, 2003, ISBN à0521525632, 9780521525633
+Rider, Nic G.; Caso, Taymy J.; Czech, Spencer; Karasic, Dan H. (2022). "Terminology in Transgender Medicine". In van Trotsenburg, Mick; Luikenaar, Rixt A. C.; Meriggiola, Maria Cristina (eds.). Context, Principles and Practice of TransGynecology: Managing Transgender Patients in ObGyn Practice. Cambridge UP. doi:10.1017/9781108899987. ISBN 978-1-108-89998-7.
+Ragosta, Sachiko; Obedin-Maliver, Juno; Fix, Laura; Stoeffler, Ari; Hastings, Jen; Capriotti, Matthew R.; Flentje, Annesa; Lubensky, Micah E.; Lunn, Mitchell R.; Moseson, Heidi (1 September 2021). "From 'Shark-Week' to 'Mangina': An Analysis of Words Used by People of Marginalized Sexual Orientations and/or Gender Identities to Replace Common Sexual and Reproductive Health Terms". Health Equity. 5 (1). Mary Ann Liebert: 707–717. doi:10.1089/heq.2021.0022. PMC 8665782. PMID 34909540.  This article incorporates text from this free content work. Licensed under CC-BY 4.0.
+Rajalingam R (2012). "Overview of the Killer Cell Immunoglobulin-Like Receptor System". Immunogenetics. Methods in Molecular Biology. Vol. 882. pp. 391–414. doi:10.1007/978-1-61779-842-9_23. ISBN 978-1-61779-841-2. PMID 22665247.
+Saladin, Kenneth S. (2010). Anatomy & Physiology The Unity of Form and Function (5th ed.). McGraw Hill. ISBN 978-0077361358.
+Simpson, John A.; Weiner, Edmung (1989). The Oxford English Dictionary. Oxford: Clarendon Press. ISBN 9780198611868.
+Sompayrac L (2019). How the immune system works. Hoboken, NJ: Wiley-Blackwell. ISBN 978-1-119-54212-4. OCLC 1083261548.
+Stvrtinová V, Jakubovský J, Hulín I (1995). Pathophysiology: Principles of Disease. Computing Centre, Slovak Academy of Sciences: Academic Electronic Press.
+Swartz, Mark H. (2010). Textbook of Physical Diagnosis: History and Examination (6th ed.). Saunders/Elsevier. ISBN 978-1-4160-6203-5.
+Concise Oxford Companion to the English Language 1998 entries on classical compound and combining form
+Taber, Clarence Wilbur; Thomas, Clayton L.; Venes, Donald (2001). Taber's cyclopedic medical dictionary (Ed. 19, illustrated in full color ed.). Philadelphia: F.A.Davis Co. ISBN 0-8036-0655-9. ISSN 1065-1357.
+Waquet, Françoise (2001). Latin, or the Empire of a Sign: From the Sixteenth to the Twentieth Centuries. Translated by John Howe. Verso. ISBN 1859844022.
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+---
+title: "Medical terminology"
+chunk: 3/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+Bones are surrounded by a membrane known as the periosteum (Greek περῐ́ (perí), around; Greek ὀστέον (ostéon), bone), and comprise multiple layers, depending on the type of bone, including yellow and red bone marrow, spongy bone, and the endosteum. There are five general classifications of bones:
+Long bones are characterized by a shaft known as the diaphysis, which is much longer than its width, and an epiphysis (Greek ἐπι- (epi-) upon, outside, over), a rounded head at each end of the shaft, connected to the diaphysis by the epiphyseal plate. They are made up mostly of compact bone, with lesser amounts of marrow, located within the medullary cavity, and areas of spongy, cancellous bone at the ends of the bones.
+Short bones are roughly cube-shaped, and have only a thin layer of compact bone surrounding a spongy interior. Short bones provide stability and support as well as some limited motion.
+Flat bones are thin and generally curved, with two parallel layers of compact bone sandwiching a layer of spongy bone.
+Sesamoid bones are bones embedded in tendons. Since they act to hold the tendon further away from the joint, the angle of the tendon is increased and thus the leverage of the muscle is increased.
+Irregular bones do not fit into the above categories. They consist of thin layers of compact bone surrounding a spongy interior. As implied by the name, their shapes are irregular and complicated. Often this irregular shape is due to their many centers of ossification or because they contain bony sinuses.
+A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to bones. The extra-cellular connective tissue between muscle fibers binds to tendons at the distal and proximal ends, and the tendon binds to the periosteum of individual bones at the muscle's origin and insertion. As muscles contract, tendons transmit the forces to the relatively rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing them to function as springs during movement.
+Cartilage is a resilient and smooth type of connective tissue that covers and protects the ends of long bones, and forms a structural component of many body parts including the rib cage, the neck and the bronchial tubes, and the intervertebral discs. It is classified into three types — elastic cartilage, hyaline cartilage, and fibrocartilage.
+Joints, also known as articulations, are structures that connect individual bones and may allow bones to move against each other to cause movement. Joints can be classified by structure and by function. Structurally, synovial joints are joints that are not directly joined, which are lubricated by a solution called synovial fluid; fibrous, bony, and cartilaginous joints are characterised by the presence of their respective connective tissues. There are three functional divisions of joints:
+Diarthroses, which allow extensive mobility between two or more articular heads.
+Amphiarthroses, which allow some movement.
+False joints or synarthroses, which allow little or no movement and are predominantly fibrous.
+A ligament is a small band of dense, white, fibrous elastic tissue. Ligaments connect the ends of bones together in order to form a joint. Most ligaments limit dislocation, and prevent certain movements, such as hyperextension and hyperflexion, which may lead to breaks.
+An enthesis is the connective tissue that attaches tendons and ligaments to bones.
+Fascia (from Latin  fascia 'band') is a generic term for macroscopic membranous bodily structures.
+The human skeleton may be divided into two distinct divisions: the axial skeleton, which includes the vertebral column, and the appendicular skeleton.
+
+==== Action ====
+The action of muscles often involve antagonistic pairs of agonist muscles and antagonist muscles, which, respectively, cause and inhibit a movement. 
+
+Through the activation of agonist muscle, which produces most of the force and control of an action, movement occurs.
+Antagonist muscles are the muscles that produce an opposing joint torque to the agonist muscles.
+Synergist muscles, also called fixators or neutralisers, act around a joint to help, counter, or neutralise the action of an agonist muscle.
+Generally, as one muscle contracts, the other muscle relaxes in a process known as reciprocal inhibition. Muscle contraction may be concentric (i.e. shortening), eccentric (i.e. lengthening), or isometric (i.e. involving no change in length). Muscle groups (e.g. elbow flexors) are sometimes named based on the joint action they produce during concentric contraction. During muscle contraction, the insertion of a muscle is the structure that is moved and is typically a bone that is distal and lighter than the origin; the origin is the bone, typically proximal, that remains more stable during contraction; the head of a muscle is the end part of the muscle that attaches to its origin.
+
+=== Vascular ===
+
+The circulatory system is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the body. It includes the cardiovascular system, which consists of the heart and blood vessels. Some sources use the terms cardiovascular system, vascular system and circulatory system interchangeably. The lymphatic system (comprising lymphatic vessels, lymph nodes, lymphoid organs, lymphatic tissue and lymph) is complementary to the circulatory system and forms part of the immune system. 
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+---
+title: "Medical terminology"
+chunk: 4/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+==== Circulatory system ====
+The network of blood vessels include the great vessels (comprising large elastic arteries and large veins), other arteries (which carry blood away from the heart) and veins (which carry blood to the heart), smaller arterioles, and capillaries, which join with venules. Blood is a fluid consisting of plasma (comprising serum and clotting factors), red blood cells, white blood cells, and platelets. Components of the blood include nutrients (such as proteins and minerals), hemoglobin, hormones, and gases such as oxygen and carbon dioxide. These substances provide nourishment, help the immune system to fight diseases, and help maintain homeostasis through mechanisms such as thermoregulation, osmoregulation, and acid-base regulation. 
+The circulatory system has two divisions, a systemic circuit (i.e. the left heart pumping oxygenated blood to the rest of the body (via the aorta) and into the right heart (via the venae cava)) and a pulmonary circuit (i.e. the right heart pumping deoxygenated blood to the lungs (via the pulmonary artery) and into the left heart (via the pulmonary vein)). In the human heart: 
+
+There is one atrium (which receives blood) and one ventricle (which expels blood) for each circulation, with a total of four chambers: left atrium, left ventricle, right atrium and right ventricle.
+Chambers of the heart are separated by the atrioventricular valves, which include the tricuspid valve on the right and the mitral valve on the left.
+The ventricles are separated from the large arteries via the semilunar valves.
+The heart is lined by a double-layered sac known as the pericardium. Further circulatory routes include the coronary circulation to the heart itself, the cerebral circulation to the brain, renal circulation to the kidneys, and bronchial circulation to the bronchi in the lungs.
+
+==== Lymphatic system ====
+The circulatory system processes an average of 20 litres of blood per day through capillary filtration, which removes plasma from the blood. Roughly 17 litres of the filtered blood are reabsorbed directly into the blood vessels. The lymphatic system provides an accessory return route to the blood for the remaining three litres of interstitial fluid. 
+
+Lymph is circulated in the body via muscle contraction and drains into the lymphatic ducts, which empty into the subclavian veins, returning fluid into blood circulation.
+A lymph node is an organised collection of lymphoid tissue through which the lymph passes on its way back to the blood. Lymph nodes are particularly numerous in the mediastinum, neck, pelvis, axilla, and inguinal region.
+Gut-associated lymphoid tissue, including Peyer's patch, plays a major role in the immune system.
+The spleen produces immune cells to fight antigens in its white pulp, removes particulate matter and aged blood cells, mainly red blood cells in its red pulp, and produces blood cells during fetal life.
+
+=== Neuroendocrine ===
+The nervous system coordinates the actions and sensory information of a person by transmitting signals to and from different parts of the body, working in tandem with the endocrine system to respond to environmental events. The endocrine system comprises feedback loops of hormones that are released by glands directly into the circulatory system, which target and regulate distant organs. In vertebrates, the hypothalamus is the neural control center for all endocrine systems, being adjacent to the pituatary gland, and linking the two systems together as the neuroendocrine system.
+
+==== Nervous system ====
+The connections between neurons, the primary cell of the nervous system, forms neural pathways, neural circuits, and large-scale brain networks. 
+Subsystems of the human nervous system include: 
+
+The central nervous system (CNS), comprising the brain and spinal cord. Nerves that transmit signals from the CNS are called motor nerves. Nerves that exit from the brain are called cranial nerves while those exiting from the spinal cord are called spinal nerves.
+The peripheral nervous system (PNS), comprising mainly nerves, enclosed bundles of axons. The PNS is divided into:
+The somatic nervous system, which links the brain and spinal cord to sensory receptors and skeletal muscle.
+The autonomic nervous system, which is subdivided into:
+The sympathetic nervous system.
+The parasympathetic nervous system.
+The enteric nervous system, which controls the gastrointestinal system.
+The neurovascular unit comprises the cells and vasculature channels within the nervous system that regulate cerebral blood flow.
+
+==== Endocrine system ====
+The major endocrine glands are the thyroid, parathyroid, pituitary, pineal, and adrenal glands (Latin rēn, rēnes, kidney), and the testis and ovaries. The thyroid secretes thyroxine, the pituitary secretes growth hormone, the pineal secretes melatonin, the testis secretes testosterone, and the ovaries secrete estrogen and progesterone.
+The hypothalamus, pancreas, and thymus also function as endocrine glands. The bones, kidneys, liver, heart, and gonads have secondary endocrine functions. Glands that signal each other in sequence are often referred to as an axis, such as the hypothalamic–pituitary–adrenal axis. Endocrinology also comprises the study of the exocrine glands (such as salivary glands, mammary glands, and submucosal glands within the gastrointestinal tract), which secrete hormones to the outside of the body, and of paracrine signalling between cells over a relatively short distance.
+
+=== Ventral ===
+The ventral body cavity is a cavity in the anterior aspect of the human body, comprising the thoracic cavity and abdominopelvic cavity.  
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+---
+title: "Medical terminology"
+chunk: 5/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+The thoracic cavity is protected by the thoracic wall (comprising the rib cage and associated skin, muscle, and fascia), comprising the mediastinum, heart and great vessels, and the bulk of the respiratory tract.
+The abdominal cavity, lined by the peritoneum, contains the bulk of the gastrointestinal tract, the spleen and the kidneys. Abdominal organs may be classified as solid organs or hollow organs.
+The solid organs are the liver, pancreas, spleen, kidneys, and adrenal glands.
+The hollow organs of the abdomen are the stomach, intestines, gallbladder, bladder, and rectum.
+The pelvic cavity contains the urinary bladder, internal reproductive organs, and rectum.
+Viscera are the internal organs of the ventral cavity. The term "visceral" is contrasted with the term "parietal", meaning "of or relating to the wall of a body part, organ or cavity". The two terms are often used in describing a membrane or piece of connective tissue, referring to the opposing sides.
+
+==== Respiratory system ====
+The respiratory system allows for gas exchange, particularly of carbon dioxide and oxygen, in human beings. In the process of breathing or ventilation, the muscles of respiration pump air into the lungs, bringing it into close contact with the blood via millions of microscopic air sacs known as alveoli. The upper respiratory tract includes the nose, nasal cavities, sinuses, pharynx and the part of the larynx above the vocal folds; the lower tract includes the lower part of the larynx and the following aiways: the trachea, bronchi, bronchioles and alveoli. The lungs are surrounded by flattened closed sacs known as pleura.
+
+Contraction of the diaphragm (an upwardly domed sheet of muscle that separates the thoracic cavity from the abdominal cavity) and of the intercostal muscles (which lift up the ribs) increases the volume of the thoracic cavity. Because of this increased volume, the lungs (which comprise elastic connective tissue) begin to inflate.
+Air, usually, enters from the nose. From the nose, air travels into the trachea (the largest of airways) into the two main bronchi, which branch into progressively narrower secondary and tertiary bronchi, which in turn branch into numerous smaller tubes known as the bronchioles, which in turn open into the alveoli.
+The process of "respiration" is used to describe three distinct but related processes in the human body: cellular respiration, physiological respiration, and ventilation (or, breathing).
+
+==== Gastrointestinal system ====
+The human digestive system, also known as the gastrointestinal system, comprises the gastrointestinal tract and the accessory organs of digestion: the tongue, salivary glands, pancreas, liver, and gallbladder. Digestion involves the breakdown of food into smaller and smaller components, until they can be absorbed and assimilated into the body. The process of digestion has three stages: the cephalic phase, the gastric phase, and the intestinal phase.
+
+Gallbladder: a hollow part of the biliary tract that sits just beneath the liver, with the gallbladder body resting in a small depression. Commonly associated with gallstones, or cholelithiasis.
+
+==== Reproductive system ====
+The reproductive system in humans is typically classified into the male and female reproductive systems.
+
+==== Urinary system ====
+The urinary system is the part of the excretory system that removes waste in the form of urine, comprising the kidneys, ureters, bladder, and the urethra. Other purposes of the urinary system include the regulation of blood volume and blood pressure; the control of electrolyte and metabolite levels; and the regulation of blood pH. Each kidney consists of functional units called nephrons. Following filtration of blood and further processing, the ureters carry urine from the kidneys into the urinary bladder. During urination, the urethra carries urine out of the bladder through the penis or vulva. The female and male urinary system are very similar, differing only in the length of the urethra.
+
+== Histology ==
+
+Histology (also known as microanatomy or histoanatomy) is the branch of medicine that studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures visible without a microscope. Histopathology is the branch of histology that includes the microscopic identification and study of diseased tissue.
+
+=== Tissue ===
+
+There are four basic types of tissue, of which all other tissues are considered to be subtypes.
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+---
+title: "Medical terminology"
+chunk: 6/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+Muscle tissue comprises cardiac, skeletal, and smooth muscle.
+Smooth muscles control the flow of substances within the lumens of hollow organs, and are not consciously controlled. In the small intestine, smooth muscle contraction is characterised by peristalsis.
+Skeletal muscles are attached to bones and arranged in opposing groups around joints. Skeletal muscles and cardiac muscles have striations, unlike smooth muscle. Only skeletal and smooth muscles are part of the musculoskeletal system and can move the body.
+Cardiac muscles are found in the heart and are used only to circulate blood; like the smooth muscles, these muscles are not under conscious control.
+Nervous tissue comprises neuroglia, which provide structural and metabolic support, and neurons, which send signals in the form of electrochemical impulses traveling along axons. Bundles of axons are known as nerve tracts and neural pathways. Impulses can be directly transmitted to neighbouring cells through electrical synapses or cause chemicals called neurotransmitters to be released at chemical synapses.
+The CNS includes astrocytes (-cyte, 'cell'; Greek κύτος (kútos), a hollow, vessel), oligodendrocytes, ependyma, and radial glia; the PNS includes Schwann cells, satellite glia, and enteric glia.
+Astrocytes are star-shaped glial cells that have been observed to turn into neurons by virtue of their pluripotency.
+Microglia are specialized macrophages capable of phagocytosis that protect neurons of the central nervous system.
+Pituicytes from the posterior pituitary are glial cells with characteristics in common to astrocytes.
+Tanycytes in the median eminence of the hypothalamus are a type of ependymal cell that descend from radial glia and line the base of the third ventricle.
+Connective tissue is found in between other tissues and comprises connective tissue proper and special connective tissue. Most types of connective tissue consists of three main components: elastic and collagen fibers, ground substance, and cells. Connective tissue membranes include the synovial membrane, which lines the inner surface of capsules of synovial joints, tendon sheaths, and synovial bursas.
+Connective tissue proper includes loose (or areolar) and dense (regular and irregular) connective tissue. Adipose (Latin adeps, adip-, fat) and reticular connective tissue are regarded by older sources as forms of loose connective tissue alongside areolar tissue, while some newer sources have termed them as forms of special connective tissue.
+Special connective tissue includes supportive connective tissue (bone and cartilage) and fluid connective tissue (blood and lymph).
+Epithelial tissue are protective tissue that form the glands and outermost layer of many organs, including the skin (epidermis), internal organs (mesothelium), blood and lymphatic vessels (endothelium), as well as specialised organs (e.g. olfactory, respiratory, intestinal, transitional, vaginal, germinal (female), and germinal (male) epithelia). Epithelia control the secretion of hormones into the circulatory system, as well as the secretion of sweat, mucus, enzymes, and other products that are delivered by ducts Epithelial membranes include the serous membrane (which lines body cavities), cutaneous membrane (i.e. the skin), and mucous membrane (which lines the interior of hollow organs). Other functions of epithelial cells include diffusion, filtration, secretion, selective absorption, and transcellular transport.
+
+==== Fibres ====
+Fibres found in the extracellular matrix are collagen fibers, elastic fibers, and reticular fibers. Collagen fibres are fixated in intercellular spaces via ground substance, a clear, colorless, and viscous fluid containing glycosaminoglycans and proteoglycans.
+
+==== Secretion ====
+Types of secretion include:
+
+Apocrine
+Merocrine
+Holocrine
+Endocrine
+Exocrine
+Paracrine
+
+=== Cellular ===
+
+==== Nervous ====
+
+The neuron is the primary cell of the nervous system, supported structurally and metabolically by the glia. Neurons comprise the following specialised organelles:
+
+Soma, the body of the neuron. Containing the nucleus, most protein synthesis occurs here.
+Dendrites, cellular extensions with many branches. The branches form fractal patterns that repeat at multiple size scales. The majority of input to the neuron occurs via the dendritic spine.
+Axon, a finer and longer cable-like projection. The axon primarily carries nerve signals away from the soma and carries some types of information back to it. Many neurons have only one axon, but this axon will usually undergo extensive branching, enabling communication with many target cells.
+Axon hillock, the part of the axon that emerges from the soma. The axon hillock also has the greatest density of voltage-dependent sodium channels and the most negative threshold potential, making it the most easily-excited part of the neuron and the spike initiation zone for the axon.
+Axon terminal, found at the end of the axon farthest from the soma. Contains synapses.
+Neurons communicate with other cells via synapses, specialised structures that connect neurons and facilitate the transmission of electrical and chemical signals. 
+
+In electrical synapses, the presynaptic and postsynaptic cell membranes are connected by special channels called gap junctions that are capable of facilitating the direct flow of electrical current without the need for neurotransmitters, causing voltage changes in the presynaptic cell to induce voltage changes in the postsynaptic cell.
+In chemical synapses, the activation of voltage-gated calcium channels in the presynaptic neuron results in the release of neurotransmitters into the synaptic cleft, which thereafter bind to receptors located in the plasma membrane of the postsynaptic cell.
+The neurotransmitter may initiate an electrical response or a secondary messenger pathway that may either excite or inhibit the postsynaptic neuron. Chemical synapses can be classified according to the neurotransmitter released: glutamatergic (often excitatory), GABAergic (often inhibitory), cholinergic (e.g. vertebrate neuromuscular junction), and adrenergic (releasing norepinephrine). Depending on their release location, the receptors they bind to, and the ionic circumstances they encounter, various transmitters can be either excitatory or inhibitory. For instance, acetylcholine can either excite or inhibit depending on the type of receptors it binds to.
+In excitatory synapses, an influx of Na+ driven by excitatory neurotransmitters opens cation channels, enhancing the probability of depolarization in postsynaptic neurons and the initiation of an action potential.
+In inhibitory synapses, the opening of either Cl- or K+ channels diminish the probability of depolarization in postsynaptic neurons and the initiation of an action potential.
+Astrocytes also exchange information with the synaptic neurons, responding to synaptic activity and, in turn, regulating neurotransmission. 
+
+==== Connective tissue proper ====
+Types of connective tissue cells include:
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+---
+title: "Medical terminology"
+chunk: 7/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+Fibrocyte
+Mesenchyme
+Adipocyte
+Fibroblast (Greek βλαστός (blastós), germinate or bud)
+
+==== Epithelial ====
+
+The basal surface of epithelial tissue rests on a basement membrane and the free, apical, or apex surface faces body fluid or the outside. The basement membrane acts as a scaffolding on which epithelium can grow and regenerate after injuries, and comprises the basal lamina and reticular lamina; although, some older sources use basement membrane and basal lamina synonymously. The basement membrane acts as a selectively permeable membrane that determines which substances will be able to enter the epithelium, as epithelial tissue has a nerve supply though no blood supply.
+There are three principal shapes of epithelial cell: squamous (scaly), columnar, and cuboidal. Transitional epithelium has cells that can change from squamous to cuboidal, depending on the amount of tension on the epithelium. Epithelial tissue can be further categorised as having a singular layer of cells as simple epithelium; or as layers of two or more cells deep as stratified epithelium—stratified squamous epithelium, stratified cuboidal epithelium, and stratified columnar epithelium. When taller simple columnar epithelial cells are viewed in cross section showing several nuclei appearing at different heights, they can be confused with stratified epithelia, and are thus termed as pseudostratified columnar epithelium. Epithelial cells are often ciliated.
+Stratified epithelia be further divided into keratinised, parakeratinised, and transitional epithelia or urothelia.
+Cell junctions, protein complexes that provide contact between cells and neighbouring cells or the extracellular matrix, are especially abundant in epithelial tissues. They build up the paracellular barrier of epithelia and control the paracellular transport. There are five main types of cell junctions: tight junctions, adherens junctions, desmosomes, hemidesmosomes, and gap junctions.
+
+=== Molecular ===
+
+==== Genetics ====
+Major processes in genetics include:
+
+Translation (biology)
+Transcription (biology)
+
+==== Signalling ====
+Molecules involved in cell signalling include:
+
+Glycoprotein
+Steroid
+Prostaglandin
+
+== Internal medicine ==
+
+=== Immunology ===
+Immunology is the branch of medicine that deals with the immune system, a network of biological systems that protects humans from diseases. The immune system detects and responds to pathogens, such as viruses, bacteria, and parasites, as well as cancer cells and foreign bodies. Humans have two major immune subsystems: The innate immune system, which provides a preconfigured response (e.g. defensins, complement system) to broad groups of situations and stimuli; and the adaptive immune system, which provides a tailored response to each stimulus by developing an immunological memory of molecules previously encountered. Mechanisms common to both subsystems, include phagocytosis, humoural immunity, cell-mediated immunity. 
+
+==== Innate immunity ====
+Cells in the innate immune system use pattern recognition receptors to recognize molecular structures produced by pathogens, identifying two classes of molecules: pathogen-associated molecular patterns (PAMPs), which are associated with microbial pathogens, and damage-associated molecular patterns (DAMPs), which are associated with components of hosts' cells that are released during cell damage or cell death. 
+
+Leukocytes (commonly known as white blood cells) act like independent, single-celled organisms and are the second arm of the innate immune system. The innate leukocytes include: 
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@@ -0,0 +1,33 @@
+---
+title: "Medical terminology"
+chunk: 8/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+The professional phagocytes, which generally patrol the body searching for pathogens, but can be called to specific locations by cytokines. Once a pathogen has been engulfed by a phagocyte, it becomes trapped in an intracellular vesicle called a phagosome, which subsequently fuses with a lysosome vesicle to form a phagolysosome. The pathogen is then killed by the activity of digestive enzymes or following a respiratory burst that releases free radicals into the phagolysosome.
+Macrophages and neutrophils, which travel around the body in pursuit of invading pathogens.
+Macrophages are cells that reside within tissues and produce an array of chemicals including enzymes, complement proteins, and cytokines. They also rid the body of worn-out cells and other debris and act as antigen-presenting cells that activate the adaptive immune system.
+Neutrophils are normally found in the bloodstream and are the most abundant type of phagocyte, representing 50% to 60% of total circulating leukocytes. During the acute phase of inflammation, neutrophils migrate toward the site of inflammation in a process called chemotaxis and are usually the first cells to arrive at the scene of infection.
+Dendritic cells are phagocytes in tissues that are in contact with the external environment, located mainly in the skin, nose, lungs, stomach, and intestines. Dendritic cells are a link between bodily tissues and the innate and adaptive immune systems, as they present antigens to T cells.
+Granulocytes (i.e. leukocytes with specific granules), which include the neutrophils, innate lymphoid cells, mast cells, eosinophils, and basophils.
+Innate lymphoid cells (ILCs) derived from common lymphoid progenitor and belong to the lymphoid lineage.
+Mast cells reside in connective tissues and mucous membranes and regulate the inflammatory response. They are most often associated with allergy and anaphylaxis.
+Basophils and eosinophils are related to neutrophils. They secrete chemical mediators that are involved in defending against parasites and play a role in allergic reactions, such as asthma.
+Natural killer cells (NK cells) do not directly attack invading microbes but destroy compromised host cells, such as tumor cells or virus-infected cells. NK cells recognise such cells by a condition known as "missing self", which involves low levels of a cell-surface marker called MHC I (major histocompatibility complex)—a situation that can arise in viral infection. Normal body cells are not recognized and attacked by NK cells because they express intact self MHC antigens, which inhibit NK cell activity.
+Monocytes, upon moving to injured tissue, turn into dendritic cells and macrophages while promoting tissue healing.
+The major humoral component of the innate immune response is the complement system, a biochemical cascade that attacks the surfaces of foreign cells. This response is activated by the binding of complement proteins to carbohydrates on the surfaces of microbes, or to antibodies that have attached to these microbes, which creates a cell signal that triggers a rapid killing response, whose speed is significantly amplified after sequential proteolytic activation of complement protease molecules, controlled by positive feedback. The cascade results in the production of peptides that attract immune cells; increase vascular permeability; and opsonize the surface of a pathogen, marking it for destruction. Complement binding can also kill cells directly by disrupting their plasma membrane via a membrane attack complex.
+
+===== Inflammation =====
+Inflammation is one of the first responses of the immune system to infection. It is produced by eicosanoids and cytokines, which are released by injured or infected cells. In response to cytosolic PAMPs and DAMPs, pattern-recognition receptors called inflammasomes form in order to generate active forms of the inflammatory cytokines IL-1β and IL-18.
+
+Eicosanoids include prostaglandins that produce fever and the dilation of blood vessels associated with inflammation and leukotrienes that attract certain white blood cells (leukocytes).
+Common cytokines include interleukins that are responsible for communication between white blood cells; chemokines that promote chemotaxis; and interferons that have antiviral effects, such as shutting down protein synthesis in the host cell.
+Growth factors and cytotoxic factors may also be released. These chemicals recruit immune cells to the site of infection and promote the healing of any damaged tissue following the removal of pathogens.
+
+==== Adaptive immune system ====
+The adaptive immune system allows for a stronger immune response as well as immunological memory, where each pathogen is "remembered" by a signature antigen. The adaptive immune response is antigen-specific, allowing for the generation of tailored immune responses, and requiring the recognition of specific "non-self" antigens during a process called antigen presentation. The ability to mount these tailored responses is maintained in the body by memory T-cells and memory B-cells, which may be employed rapidly should a pathogen infect the body more than once. 
+B cells and T cells are the major types of lymphocytes, which form the cells of the adaptive immune system. B cells are involved in the humoral immune response, while T cells are involved in cell-mediated immune response. When B or T cells encounter their related antigens they multiply, and many "clones" of the cells are produced that target the same antigen. This is called clonal selection. Some of the offspring of these B and T cells become long-lived memory cells, which remember each specific pathogen encountered and can mount a strong response if the pathogen is detected again. T-cells recognize pathogens by antigens that bind directly to T-cell surface receptors. B-cells use the protein, immunoglobulin, to recognise pathogens by their antigens.
\ No newline at end of file
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+---
+title: "Medical terminology"
+chunk: 9/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+Killer T cells kill cells that are infected with pathogens or otherwise damaged or dysfunctional, which contain a complex of a specific antigen coupled to a Class I MHC receptor. When the receptor of a cytotoxic or "killer" T-cell contacts such cells, it releases cytotoxins, such as perforin, which form pores in the target cell's plasma membrane, allowing ions, water and toxins to enter. The entry of another toxin called granulysin induces the target cell to undergo apoptosis.
+Helper T cells and regulatory T cells only recognize antigens coupled to Class II MHC molecules.
+Helper T cells regulate both the innate and adaptive immune responses and help determine which immune responses the body makes to a particular pathogen. These cells have no cytotoxic activity and do not kill infected cells or clear pathogens directly. They instead control the immune response by directing other cells to perform these tasks.
+A third, minor subtype are the γδ T cells, which recognise intact antigens that are not bound to MHC receptors.
+A B cell identifies pathogens when antibodies on its surface bind to a specific foreign antigen. This antigen/antibody complex is taken up by the B cell and processed by proteolysis into peptides. The B cell then displays these antigenic peptides on its surface MHC class II molecules, which attracts a matching helper T cell that releases lymphokines and activates the B cell. As the activated B cell then begins to divide, its offspring (plasma cells) secrete millions of copies of the antibody that recognizes this antigen. These antibodies circulate in blood plasma and lymph, bind to pathogens expressing the antigen and mark them for destruction by complement activation or for uptake and destruction by phagocytes. Antibodies can also neutralize challenges directly, by binding to bacterial toxins or by interfering with the receptors that viruses and bacteria use to infect cells.
+
+==== Lymphatic system ====
+
+Lymph contains cellular debris, bacteria, proteins, and lymphocytes, the latter of which are generated largely in the bone marrow and matured or activated in the lymph nodes, spleen, thymus, and tonsils. Lymph also transports antigen-presenting cells, such as dendritic cells, to the lymph nodes where an immune response is stimulated.
+B cells and T cells are the major types of lymphocytes and are derived from hematopoietic stem cells in the bone marrow. From the bone marrow, B cells immediately join the circulatory system and travel to secondary lymphoid organs in search of pathogens. T cells, on the other hand, travel from the bone marrow to the thymus, where they develop further, mature, and become immunocompetent. In the thymus, T cells are exposed to a wide variety of self-antigens; T cells can only recognize a "non-self" target only after antigens have been processed and presented in combination with the major histocompatibility complex (MHC) self-receptor. In contrast, the B cell antigen-specific receptor is an antibody molecule on the B cell surface, recognising unprocessed antigens (e.g. large molecules found on the surfaces of pathogens; small haptens, such as penicillin, attached to carrier molecules) without any need for antigen processing. Each lineage of B cell expresses a different antibody, so the complete set of B cell antigen receptors represents all the antibodies that the human body can manufacture.
+The secondary (or peripheral) lymphoid organs (e.g. lymph nodes and the spleen) maintain mature naive T cells and naive B cells; initiate the adaptive immune response; and are the sites of lymphocyte activation by antigens, which leads to clonal selection and affinity maturation.
+
+==== Immunotherapy ====
+Dysfunction of the immune system can cause autoimmune diseases, inflammatory diseases and cancer. Immunodeficiency occurs when the immune system is less active than normal, resulting in recurring and life-threatening infections, and can be the result of a genetic disease such as severe combined immunodeficiency, acquired conditions such as HIV/AIDS, or the use of immunosuppressive medication. Autoimmunity describes a hyperactive immune system attacking normal tissues as if they were foreign organisms; diseases include Hashimoto's thyroiditis, rheumatoid arthritis, diabetes mellitus type 1, and systemic lupus erythematosus.
+
+Immunomodulation
+
+=== Endocrinology ===
+Hormones include: 
+
+Calcitonin
+
+=== Oncology ===
+List of cancer types:
+
+Carcinoma: Cancers derived from epithelial cells. This group includes many of the most common cancers that occur in older adults. Nearly all cancers developing in the breast, prostate, lung, pancreas, and colon are carcinomas.
+Sarcoma: Cancers arising from connective tissue (i.e. bone, cartilage, fat, nerve), each of which develop from cells originating in mesenchymal cells outside of the bone marrow.
+Lymphoma and leukemia: These two classes of cancer arise from immature cells that originate in the bone marrow, and are intended to fully differentiate and mature into normal components of the immune system and the blood, respectively. Acute lymphoblastic leukemia is the most common type of cancer in children, accounting for ~30% of cases. However, far more adults than children develop lymphoma and leukemia.
+Germ cell tumor: Cancers derived from pluripotent cells, most often presenting in the testicle or the ovary(seminoma and dysgerminoma, respectively).
+Blastoma: Cancers derived from immature "precursor" cells or embryonic tissue. Blastomas are generally more common in children (e.g. neuroblastoma, retinoblastoma, nephroblastoma, hepatoblastoma, medulloblastoma, etc.) than in older adults.
+
+== By organ system and medical specialty ==
+
+=== Ophthalmology ===
+Ophthalmology is the branch of medicine specialising in the eyes.
+
+=== Neurology and psychiatry ===
+Neurology is the branch of medicine dedicated to the nervous system
+
+==== Neuroanatomy ====
+
+Neuroanatomy is the study of the anatomy of the brain and rest of the nervous system and uses a number of specialised anatomical terms of neuroanatomy: 
+
+A gyrus is an outward folding of the brain, for example the precentral gyrus.
+A sulcus is an inward fold, or valley in the brain's surface, for example the central sulcus and lateral sulcus.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Medical_terminology-9.md b/data/en.wikipedia.org/wiki/Medical_terminology-9.md
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+---
+title: "Medical terminology"
+chunk: 10/12
+source: "https://en.wikipedia.org/wiki/Medical_terminology"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:35.931317+00:00"
+instance: "kb-cron"
+---
+
+The human brain contains multiple regions, as does the spinal cord. There are multiple ways to divide the brain, including by the embryological development of the brain; into three parts: the cerebellum, brainstem, and cerebrum; the evolution of the brain; and cytoarchitecture, as in the case of Brodmann areas. A popular model of the 'triune brain' — comprising the reptilian complex (basal ganglia), the paleomammalian complex (limbic system), and the neomammalian complex (neocortex) — was formerly popular during the 1960s, though is now regarded as a myth. 'Limbic system' and associated terms, however, remain in neuroanatomical use, although some neuroscientists have argued against such use.
+
+Various other neuroanatomical systems have been developed according to functions, connections, and systems of the brain.
+Neuroendocrine axes
+Hypothalamic–pituitary–adrenal axis
+Hypothalamic–neurohypophyseal system
+Hypothalamic–pituitary–gonadal axis
+Hypothalamic–pituitary–thyroid axis
+Limbic system, corresponding to
+Cortical areas:
+Limbic lobe
+Orbitofrontal cortex
+Piriform cortex part of the olfactory system
+Entorhinal cortex
+Hippocampus and associated structures
+Fornix and septal nuclei
+Subcortical areas:
+Septal nuclei
+Amygdala
+Nucleus accumbens
+Diencephalic structures:
+Hypothalamus
+Mammillary bodies
+Anterior nuclei of thalamus
+
+==== Neuropathology ====
+In the peripheral nervous system, the most common problem is the failure of nerve conduction, which can be due to different causes including diabetic neuropathy and demyelinating disorders such as multiple sclerosis and amyotrophic lateral sclerosis.
+
+==== Psychopathology ====
+List of mental disorders
+
+== Pathology ==
+Lists of diseases
+Pathology
+List of abbreviations for diseases and disorders
+
+=== -plasia and -trophy ===
+The suffix -plasia refers to the formation and development of cells, tissue, and organs, coming from Greek πλᾰ́σῐς (plásis), moulding, conformation.
+
+Achondroplasia (dwarfism)
+Anaplasia (structural differentiation loss within a cell or group of cells)
+Aplasia (organ or part of organ missing)
+Desmoplasia (connective tissue growth)
+Dysplasia (change in cell or tissue phenotype)
+Hyperplasia (proliferation of cells)
+Hypoplasia (congenital below-average number of cells, especially when inadequate)
+Metaplasia (conversion in cell type)
+Neoplasia (abnormal proliferation)
+Prosoplasia (development of new cell function)
+The suffix trophy refers to the nourishment and development of cells, tissue, and organs, coming from Greek τροφή (trophḗ), food, nourishment.
+
+Abiotrophy (loss in vitality of organ or tissue)
+Atrophy (reduced functionality of an organ, with decrease in the number or volume of cells)
+Hypertrophy (increase in the volume of cells or tissues)
+Hypotrophy  (decrease in the volume of cells or tissues)
+Dystrophy (any degenerative disorder resulting from improper or faulty nutrition)
+Pseudohypertrophy (false enlargement of muscle)
+
+=== Other pathology suffixes ===
+
+== Pharmacology ==
+Anticholinergic
+Alpha blocker
+Beta blocker
+
+== Clinical ==
+
+=== Abbreviations ===
+
+The publication of medical abbreviations for use in the journals published by the American Medical Association is dictated by the AMA Manual of Style is the style guide of the American Medical Association. 
+Periods are generally not used. Plurals for medical acronyms are represented by affixes a lowercase s with no apostrophe. Arrows may also be used to indicate elevation (↑), diminution (↓), and causation (→, ←).
+
+==== Medical slang ====
+Medical slang such as, "TTFO", meaning "told to fuck off", may be used on a patient's chart in an informal and derogatory manner.
+
+=== Diagnosis ===
+Medical diagnosis
+Differential diagnosis
+
+=== Symptomatology ===
+Signs and symptoms
+
+=== Transgender anatomy ===
+
+Although some medical authorities recommend mirroring the terminology transgender people use to describe their own genitals, such usage may feel uncomfortable and intimate to some transgender people, who prefer to use different terms in medical contexts than they would in personal settings. At the same time, patients may also be uncomfortable with anatomical terms they perceive as gendered. 
+Specialists recommend being open to using sex-neutral terms for organs, such as external genitals or lateral folds for the labia, internal reproductive organs for the uterus and ovaries, and chest for the breasts.
+Style guides such as the Publication Manual of the American Psychological Association and AMA Manual of Style recommend using gender-neutral language and distinguishing between gender and biological sex, but do not give guidance on specific anatomical terminology.
+
+=== Mnemonics ===
+Surveys of medical students show that approximately 20% use medical mnemonics.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Modulo_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Modulo_(mathematics)-0.md
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+---
+title: "Modulo (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Modulo_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:33.217058+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the term modulo ("with respect to a modulus of", the Latin ablative of modulus which itself means "a small measure") is often used to assert that two distinct mathematical objects can be regarded as equivalent—if their difference is accounted for by an additional factor. It was initially introduced into mathematics in the context of modular arithmetic by Carl Friedrich Gauss in 1801. Since then, the term has gained many meanings—some exact and some imprecise (such as equating "modulo" with "except for"). For the most part, the term often occurs in statements of the form:
+
+A is the same as B modulo C
+which is often equivalent to "A is the same as B up to C", and means
+
+A and B are the same—except for differences accounted for or explained by C.
+
+
+== History ==
+Modulo is a mathematical jargon that was introduced into mathematics in the book Disquisitiones Arithmeticae by Carl Friedrich Gauss in 1801.  Given the integers a, b and n, the expression "a ≡ b (mod n)", pronounced "a is congruent to b modulo n", means that a − b is an integer multiple of n, or equivalently, a and b both share the same remainder when divided by n. It is the Latin ablative of modulus, which itself means "a small measure." 
+The term has gained many meanings over the years—some exact and some imprecise. The most general precise definition is simply in terms of an equivalence (or congruence) relation R, where a is equivalent (or congruent) to b modulo R if aRb.
+
+
+== Usage ==
+
+
+=== Original use ===
+
+Gauss originally intended to use "modulo" as follows: given the integers a, b and n, the expression a ≡ b (mod n) (pronounced "a is congruent to b modulo n") means that a − b is an integer multiple of n, or equivalently, a and b both leave the same remainder when divided by n. For example:
+
+13 is congruent to 63 modulo 10
+means that
+
+13 − 63 is a multiple of 10 (equiv., 13 and 63 differ by a multiple of 10).
+
+
+=== Computing ===
+In computing and computer science, the term can be used in several ways:
+
+In computing, it is typically the modulo operation: given two numbers (either integer or real), a and n, a modulo n is the remainder of the numerical division of a by n, under certain constraints.
+In category theory as applied to functional programming, "operating modulo" is special jargon which refers to mapping a functor to a category by highlighting or defining remainders.
+
+
+=== Structures ===
+The term "modulo" can be used differently—when referring to different mathematical structures. For example:
+
+Two members a and b of a group are congruent modulo a normal subgroup, if and only if ab−1 is a member of the normal subgroup (see quotient group and isomorphism theorem for more).
+Two members of a ring or an algebra are congruent modulo an ideal, if the difference between them is in the ideal.
+Used as a verb, the act of factoring out a normal subgroup (or an ideal) from a group (or ring) is often called "modding out the..." or "we now mod out the...".
+Two subsets of an infinite set are equal modulo finite sets precisely if their symmetric difference is finite, that is, you can remove a finite piece from the first subset, then add a finite piece to it, and get the second subset as a result.
+A short exact sequence of maps leads to the definition of a quotient space as being one space modulo another; thus, for example, that a cohomology is the space of closed forms modulo exact forms.
+
+
+=== Modding out ===
+In general, modding out is a somewhat informal term that means declaring things equivalent that otherwise would be considered distinct. For example, suppose the sequence 1 4 2 8 5 7 is to be regarded as the same as the sequence 7 1 4 2 8 5, because each is a cyclicly-shifted version of the other:
+
+  
+    
+      
+        
+          
+            
+              
+              
+                1
+              
+              
+              
+                4
+              
+              
+              
+                2
+              
+              
+              
+                8
+              
+              
+              
+                5
+              
+              
+              
+                7
+              
+            
+            
+              
+                ↘
+              
+              
+              
+                ↘
+              
+              
+              
+                ↘
+              
+              
+              
+                ↘
+              
+              
+              
+                ↘
+              
+              
+              
+                ↘
+              
+              
+              
+                ↘
+              
+            
+            
+              
+              
+                7
+              
+              
+              
+                1
+              
+              
+              
+                4
+              
+              
+              
+                2
+              
+              
+              
+                8
+              
+              
+              
+                5
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{array}{ccccccccccccc}&1&&4&&2&&8&&5&&7\\\searrow &&\searrow &&\searrow &&\searrow &&\searrow &&\searrow &&\searrow \\&7&&1&&4&&2&&8&&5\end{array}}}
+  
+
+In that case, one is "modding out by cyclic shifts".
+
+
+== See also ==
+
+Essentially unique
+List of mathematical jargon
+Up to
+
+
+== References ==
+
+
+== External links ==
+Modulo in the Jargon File
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Necessity_and_sufficiency-0.md b/data/en.wikipedia.org/wiki/Necessity_and_sufficiency-0.md
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+---
+title: "Necessity and sufficiency"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Necessity_and_sufficiency"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:34.458153+00:00"
+instance: "kb-cron"
+---
+
+In logic and mathematics, necessity and sufficiency are terms used to describe a conditional or implicational relationship between two statements. For example, in the conditional statement: "If P then Q", Q is necessary for P, because the truth of Q is "necessarily" guaranteed by the truth of P. (Equivalently, it is impossible to have P without Q, or the falsity of Q ensures the falsity of P.) Similarly, P is sufficient for Q, because P being true always or "sufficiently" implies that Q is true, but P not being true does not always imply that Q is not true.
+In general, a necessary condition is one (possibly one of several conditions) that must be present in order for another condition to occur, while a sufficient condition is one that produces the said condition. The assertion that a statement is a "necessary and sufficient" condition of another means that the former statement is true if and only if the latter is true. That is, the two statements must be either simultaneously true, or simultaneously false.
+In ordinary English (also natural language) "necessary" and "sufficient" often indicate relations between conditions or states of affairs, not statements. For example, being round is a necessary condition for being a circle, but is not sufficient since ovals and ellipses are round but not circles – while being a circle is a sufficient condition for being round. Any conditional statement consists of at least one sufficient condition and at least one necessary condition.
+In data analytics, necessity and sufficiency can refer to different causal logics, where necessary condition analysis and qualitative comparative analysis can be used as analytical techniques for examining necessity and sufficiency of conditions for a particular outcome of interest.
+
+== Definitions ==
+In the conditional statement, "if S, then N", the expression represented by S is called the antecedent, and the expression represented by N is called the consequent. This conditional statement may be written in several equivalent ways, such as "N if S", "S only if N", "S implies N", "N is implied by S", S → N, S ⇒ N and "N whenever S".
+In the above situation of "N whenever S", N is said to be a necessary condition for S. In common language, this is equivalent to saying that if the conditional statement is a true statement, then the consequent N must be true—if S is to be true (see third column of "truth table" immediately below). In other words, the antecedent S cannot be true without N being true. For example, in order for someone to be called Socrates, it is necessary for that someone to be Named. Similarly, in order for human beings to live, it is necessary that they have air.
+One can also say S is a sufficient condition for N (refer again to the third column of the truth table immediately below). If the conditional statement is true, then if S is true, N must be true; whereas if the conditional statement is true and N is true, then S may be true or be false. In common terms, "the truth of S guarantees the truth of N". For example, carrying on from the previous example, one can say that knowing that someone is called Socrates is sufficient to know that someone has a Name.
+A necessary and sufficient condition requires that both of the implications 
+  
+    
+      
+        S
+        ⇒
+        N
+      
+    
+    {\displaystyle S\Rightarrow N}
+  
+ and 
+  
+    
+      
+        N
+        ⇒
+        S
+      
+    
+    {\displaystyle N\Rightarrow S}
+  
+ (the latter of which can also be written as 
+  
+    
+      
+        S
+        ⇐
+        N
+      
+    
+    {\displaystyle S\Leftarrow N}
+  
+) hold. The first implication suggests that S is a sufficient condition for N, while the second implication suggests that S is a necessary condition for N. This is expressed as "S is necessary and sufficient for N ", "S if and only if N", or 
+  
+    
+      
+        S
+        ⇔
+        N
+      
+    
+    {\displaystyle S\Leftrightarrow N}
+  
+.
+
+== Necessity ==
+
+The assertion that Q is necessary for P is colloquially equivalent to "P cannot be true unless Q is true" or "if Q is false, then P is false". By contraposition, this is the same thing as "whenever P is true, so is Q".
+The logical relation between P and Q is expressed as "if P, then Q" and denoted "P ⇒ Q" (P implies Q). It may also be expressed as any of "P only if Q", "Q, if P", "Q whenever P", and "Q when P". One often finds, in mathematical prose for instance, several necessary conditions that, taken together, constitute a sufficient condition (i.e., individually necessary and jointly sufficient), as shown in Example 5.
\ No newline at end of file
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+---
+title: "Necessity and sufficiency"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Necessity_and_sufficiency"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:34.458153+00:00"
+instance: "kb-cron"
+---
+
+Example 1
+For it to be true that "John is a bachelor", it is necessary that it be also true that he is
+unmarried,
+male,
+adult,
+since to state "John is a bachelor" implies John has each of those three additional predicates.
+Example 2
+For the whole numbers greater than two, being odd is necessary to being prime, since two is the only whole number that is both even and prime.
+Example 3
+Consider thunder, the sound caused by lightning. One says that thunder is necessary for lightning, since lightning never occurs without thunder. Whenever there is lightning, there is thunder. The thunder does not cause the lightning (since lightning causes thunder), but because lightning always comes with thunder, we say that thunder is necessary for lightning. (That is, in its formal sense, necessity doesn't imply causality.)
+Example 4
+Being at least 30 years old is necessary for serving in the U.S. Senate. If you are under 30 years old, then it is impossible for you to be a senator. That is, if you are a senator, it follows that you must be at least 30 years old.
+Example 5
+In algebra, for some set S together with an operation 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ to form a group, it is necessary that 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ be associative. It is also necessary that S include a special element e such that for every x in S, it is the case that e 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ x and x 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ e both equal x. It is also necessary that for every x in S there exist a corresponding element x″, such that both x 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ x″ and x″ 
+  
+    
+      
+        ⋆
+      
+    
+    {\displaystyle \star }
+  
+ x equal the special element e. None of these three necessary conditions by itself is sufficient, but the conjunction of the three is.
+
+== Sufficiency ==
+
+If P is sufficient for Q, then knowing P to be true is adequate grounds to conclude that Q is true; however, knowing P to be false does not meet a minimal need to conclude that Q is false.
+The logical relation is, as before, expressed as "if P, then Q" or "P ⇒ Q". This can also be expressed as "P only if Q", "P implies Q" or several other variants. It may be the case that several sufficient conditions, when taken together, constitute a single necessary condition (i.e., individually sufficient and jointly necessary), as illustrated in example 5.
+
+Example 1
+"John is a king" implies that John is male. So knowing that John is a king is sufficient to knowing that he is a male.
+Example 2
+A number's being divisible by 4 is sufficient (but not necessary) for it to be even, but being divisible by 2 is both sufficient and necessary for it to be even.
+Example 3
+An occurrence of thunder is a sufficient condition for the occurrence of lightning in the sense that hearing thunder, and unambiguously recognizing it as such, justifies concluding that there has been a lightning bolt.
+Example 4
+If the U.S. Congress passes a bill, the president's signing of the bill is sufficient to make it law. Note that the case whereby the president did not sign the bill, e.g. through exercising a presidential veto, does not mean that the bill has not become a law (for example, it could still have become a law through a congressional override).
+Example 5
+That the center of a playing card should be marked with a single large spade (♠) is sufficient for the card to be an ace. Three other sufficient conditions are that the center of the card be marked with a single diamond (♦), heart (♥), or club (♣). None of these conditions is necessary to the card's being an ace, but their disjunction is, since no card can be an ace without fulfilling at least (in fact, exactly) one of these conditions.
+
+== Relationship between necessity and sufficiency ==
+
+A condition can be either necessary or sufficient without being the other. For instance, being a mammal (N) is necessary but not sufficient to being human (S), and that a number 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ is rational (S) is sufficient but not necessary to 
+  
+    
+      
+        x
+      
+    
+    {\displaystyle x}
+  
+ being a real number (N) (since there are real numbers that are not rational).
+A condition can be both necessary and sufficient. For example, at present, "today is the Fourth of July" is a necessary and sufficient condition for "today is Independence Day in the United States". Similarly, a necessary and sufficient condition for invertibility of a matrix M is that M has a nonzero determinant.
+Mathematically speaking, necessity and sufficiency are dual to one another. For any statements S and N, the assertion that "N is necessary for S" is equivalent to the assertion that "S is sufficient for N". Another facet of this duality is that, as illustrated above, conjunctions (using "and") of necessary conditions may achieve sufficiency, while disjunctions (using "or") of sufficient conditions may achieve necessity. For a third facet, identify every mathematical predicate N with the set T(N) of objects, events, or statements for which N holds true; then asserting the necessity of N for S is equivalent to claiming that T(N) is a superset of T(S), while asserting the sufficiency of S for N is equivalent to claiming that T(S) is a subset of T(N).
+Psychologically speaking, necessity and sufficiency are both key aspects of the classical view of concepts. Under the classical theory of concepts, how human minds represent a category X, gives rise to a set of individually necessary conditions that define X. Together, these individually necessary conditions are sufficient to be X. This contrasts with the probabilistic theory of concepts which states that no defining feature is necessary or sufficient, rather that categories resemble a family tree structure.
+
+== Simultaneous necessity and sufficiency ==
+
+To say that P is necessary and sufficient for Q is to say two things:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Necessity_and_sufficiency-2.md b/data/en.wikipedia.org/wiki/Necessity_and_sufficiency-2.md
new file mode 100644
index 000000000..416318d70
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Necessity_and_sufficiency-2.md
@@ -0,0 +1,145 @@
+---
+title: "Necessity and sufficiency"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Necessity_and_sufficiency"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:34.458153+00:00"
+instance: "kb-cron"
+---
+
+that P is necessary for Q, 
+  
+    
+      
+        P
+        ⇐
+        Q
+      
+    
+    {\displaystyle P\Leftarrow Q}
+  
+, and that P is sufficient for Q, 
+  
+    
+      
+        P
+        ⇒
+        Q
+      
+    
+    {\displaystyle P\Rightarrow Q}
+  
+.
+equivalently, it may be understood to say that P and Q is necessary for the other, 
+  
+    
+      
+        P
+        ⇒
+        Q
+        ∧
+        Q
+        ⇒
+        P
+      
+    
+    {\displaystyle P\Rightarrow Q\land Q\Rightarrow P}
+  
+, which can also be stated as each is sufficient for or implies the other.
+One may summarize any, and thus all, of these cases by the statement "P if and only if Q", which is denoted by 
+  
+    
+      
+        P
+        ⇔
+        Q
+      
+    
+    {\displaystyle P\Leftrightarrow Q}
+  
+, whereas cases tell us that 
+  
+    
+      
+        P
+        ⇔
+        Q
+      
+    
+    {\displaystyle P\Leftrightarrow Q}
+  
+ is identical to 
+  
+    
+      
+        P
+        ⇒
+        Q
+        ∧
+        Q
+        ⇒
+        P
+      
+    
+    {\displaystyle P\Rightarrow Q\land Q\Rightarrow P}
+  
+.
+For example, in graph theory a graph G is called bipartite if it is possible to assign to each of its vertices the color black or white in such a way that every edge of G has one endpoint of each color. And for any graph to be bipartite, it is a necessary and sufficient condition that it contain no odd-length cycles. Thus, discovering whether a graph has any odd cycles tells one whether it is bipartite and conversely. A philosopher might characterize this state of affairs thus: "Although the concepts of bipartiteness and absence of odd cycles differ in intension, they have identical extension.
+In mathematics, theorems are often stated in the form "P is true if and only if Q is true". 
+Because, as explained in previous section, necessity of one for the other is equivalent to sufficiency of the other for the first one, e.g. 
+  
+    
+      
+        P
+        ⇐
+        Q
+      
+    
+    {\displaystyle P\Leftarrow Q}
+  
+ is equivalent to 
+  
+    
+      
+        Q
+        ⇒
+        P
+      
+    
+    {\displaystyle Q\Rightarrow P}
+  
+, if P is necessary and sufficient for Q, then Q is necessary and sufficient for P. We can write 
+  
+    
+      
+        P
+        ⇔
+        Q
+        ≡
+        Q
+        ⇔
+        P
+      
+    
+    {\displaystyle P\Leftrightarrow Q\equiv Q\Leftrightarrow P}
+  
+ and say that the statements "P is true if and only if Q, is true" and "Q is true if and only if P is true" are equivalent.
+
+== INUS condition ==
+INUS condition stands for an insufficient, but necessary part of an unnecessary but sufficient condition. John Mackie introduced the term in the 1960s. Mackie uses the example of a house burning: There was an electric short circuit that caused the fire. There was flammable material nearby, which started to burn after the short circuit happened. He then tries to explain the statement: "The short circuit caused the fire", according to the INUS condition:
+
+The short circuit is not a sufficient part of the condition "short circuit and flammable material".
+The short circuit is a necessary part.
+The condition "short circuit and flammable material" is not necessary for the result (house burning). It can be replaced by other conditions (for example "lightning and flammable material", or "arson") to get the same result.
+"short circuit and flammable material" is a sufficient condition, as it will always result in the house burning.
+INUS conditions need prior experience: Only after you have seen a house burning after a short-circuit putting flammable material on fire several times can you deduce that it is indeed sufficient.
+
+== See also ==
+
+== References ==
+
+== External links ==
+
+Critical thinking web tutorial: Necessary and Sufficient Conditions
+Simon Fraser University: Concepts with examples
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Null_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Null_(mathematics)-0.md
new file mode 100644
index 000000000..53cb40b03
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Null_(mathematics)-0.md
@@ -0,0 +1,22 @@
+---
+title: "Null (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Null_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:35.707916+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the word null (from German: null meaning "zero", which is from Latin: nullus meaning "none") is often associated with the concept of zero, or with the concept of nothing. It is used in varying contexts from "having zero members in a set" (e.g., null set) to "having a value of zero" (e.g., null vector).
+In a vector space, the null vector is the neutral element of vector addition; depending on the context, a null vector may also be a vector mapped to some null by a function under consideration (such as a quadratic form coming with the vector space, see null vector, a linear mapping given as matrix product or dot product, a seminorm in a Minkowski space, etc.). In set theory, the empty set, that is, the set with zero elements, denoted "{}" or "∅", may also be called null set. In measure theory, a null set is a (possibly nonempty) set with zero measure.
+A null space of a mapping is the part of the domain that is mapped into the null element of the image (the inverse image of the null element). For example, in linear algebra, the null space of a linear mapping, also known as kernel, is the set of vectors which map to the null vector under that mapping.
+In statistics, a null hypothesis is a proposition that no effect or relationship exists between populations and phenomena. It is the hypothesis which is presumed true—unless statistical evidence indicates otherwise.
+
+
+== See also ==
+0
+Null sign
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Of_the_form-0.md b/data/en.wikipedia.org/wiki/Of_the_form-0.md
new file mode 100644
index 000000000..ec019d664
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+++ b/data/en.wikipedia.org/wiki/Of_the_form-0.md
@@ -0,0 +1,28 @@
+---
+title: "Of the form"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Of_the_form"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:37.077999+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the phrase "of the form" indicates that a mathematical object, or (more frequently) a collection of objects, follows a certain pattern of expression. It is frequently used to reduce the formality of mathematical proofs.
+
+
+== Example of use ==
+Here is a proof which should be appreciable with limited mathematical background:
+Statement:
+The product of any two even natural numbers is also even.
+Proof:
+Any even natural number is of the form 2n, where n is a natural number. Therefore, let us assume that we have two even numbers which we will denote by 2k and 2l. Their product is (2k)(2l) = 4(kl) = 2(2kl). Since 2kl is also a natural number, the product is even.
+Note:
+In this case, both exhaustivity and exclusivity were needed. That is, it was not only necessary that every even number is of the form 2n (exhaustivity), but also that every expression of the form 2n is an even number (exclusivity). This will not be the case in every proof, but normally, at least exhaustivity is implied by the phrase of the form.
+
+
+== References ==
+
+
+== External links ==
+Weisstein, Eric W. "Of the Form". MathWorld.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Order_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Order_(mathematics)-0.md
new file mode 100644
index 000000000..bb2d7e03c
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Order_(mathematics)-0.md
@@ -0,0 +1,101 @@
+---
+title: "Order (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Order_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:38.280206+00:00"
+instance: "kb-cron"
+---
+
+Order in mathematics may refer to:
+
+
+== Set theory ==
+Total order and partial order, a binary relation generalizing the usual ordering of numbers and of words in a dictionary
+Ordered set
+Order in Ramsey theory, uniform structures in consequence to critical set cardinality
+
+
+== Algebra ==
+Order (group theory), the cardinality of a group or period of an element
+Order of a polynomial (disambiguation)
+Order of a square matrix, its dimension
+Order (ring theory), an algebraic structure
+Ordered group
+Ordered field
+
+
+== Analysis ==
+Order (differential equation) or order of highest derivative, of a differential equation
+Leading-order terms
+NURBS order, a number one greater than the degree of the polynomial representation of a non-uniform rational B-spline
+Order of convergence, a measurement of convergence
+Order of derivation
+Order of an entire function
+Order of a power series, the lowest degree of its terms
+Ordered list, a sequence or tuple
+Orders of approximation in Big O notation
+Z-order (curve), a space-filling curve
+
+
+== Arithmetic ==
+Multiplicative order in modular arithmetic
+Order of operations
+Orders of magnitude, a class of scale or magnitude of any amount
+
+
+== Combinatorics ==
+Order in the Josephus permutation
+Ordered selections and partitions of the twelvefold way in combinatorics
+Ordered set, a  bijection, cyclic order, or permutation
+Weak order of permutations
+
+
+== Fractals ==
+Complexor, or complex order in fractals
+Order of extension in Lakes of Wada
+Order of fractal dimension (Rényi dimensions)
+Orders of construction in the Pythagoras tree
+
+
+== Geometry ==
+Long-range aperiodic order, in pinwheel tiling, for instance
+
+
+== Graphs ==
+Graph order, the number of nodes in a graph
+First order and second order logic of graphs
+Topological ordering of directed acyclic graphs
+Degeneracy ordering of undirected graphs
+Elimination ordering of chordal graphs
+Order, the complexity of a structure within a graph: see haven (graph theory) and bramble (graph theory)
+
+
+== Logic ==
+In logic, model theory and type theory:
+
+Zeroth-order logic
+First-order logic
+Second-order logic
+Higher-order logic
+
+
+== Order theory ==
+Order (journal), an academic journal on order theory
+Dense order, a total order wherein between any unequal pair of elements there is always an intervening element in the order
+Glossary of order theory
+Lexicographical order, an ordering method on sequences analogous to alphabetical order on words
+List of order topics, list of order theory topics
+Order theory, study of various binary relations known as orders
+Order topology, a topology of total order for totally ordered sets
+Ordinal numbers, numbers assigned to sets based on their set-theoretic order
+Partial order, often called just "order" in order theory texts, a transitive antisymmetric relation
+Total order, a partial order that is also total, in that either the relation or its inverse holds between any unequal elements
+
+
+== Statistics ==
+Order statistics
+First-order statistics, e.g., arithmetic mean, median, quantiles
+Second-order statistics, e.g., correlation, power spectrum, variance
+Higher-order statistics, e.g., bispectrum, kurtosis, skewness
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Orthomorphism-0.md b/data/en.wikipedia.org/wiki/Orthomorphism-0.md
new file mode 100644
index 000000000..0b233f8ad
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Orthomorphism-0.md
@@ -0,0 +1,14 @@
+---
+title: "Orthomorphism"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Orthomorphism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:39.493560+00:00"
+instance: "kb-cron"
+---
+
+In abstract algebra, an orthomorphism is a certain kind of mapping from a group into itself.  Let G be a group, and let θ be a permutation of G.  Then θ is an orthomorphism of G if the mapping f defined by f(x) = x−1 θ(x) is also a permutation of G.  A permutation φ of G is a complete mapping if the mapping g defined by g(x) = xφ(x) is also a permutation of G. Orthomorphisms and complete mappings are closely related.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parameter-0.md b/data/en.wikipedia.org/wiki/Parameter-0.md
new file mode 100644
index 000000000..ca3a421b4
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Parameter-0.md
@@ -0,0 +1,193 @@
+---
+title: "Parameter"
+chunk: 1/4
+source: "https://en.wikipedia.org/wiki/Parameter"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:40.755713+00:00"
+instance: "kb-cron"
+---
+
+A parameter (from Ancient Greek  παρά (pará) 'beside, subsidiary' and  μέτρον (métron) 'measure'), generally, is any characteristic that can help in defining or classifying a particular system (meaning an event, project, object, situation, etc.). That is, a parameter is an element of a system that is useful, or critical, when identifying the system, or when evaluating its performance, status, condition, etc.
+Parameter has more specific meanings within various disciplines, including mathematics, computer programming, engineering, statistics, logic, linguistics, and electronic musical composition.
+In addition to its technical uses, there are also extended uses, especially in non-scientific contexts, where it is used to mean defining characteristics or boundaries, as in the phrases 'test parameters' or 'game play parameters'.
+
+== Modelization ==
+
+When a system is modeled by equations, the values that describe the system are called parameters. For example, in mechanics, the masses, the dimensions and shapes (for solid bodies), the densities and the viscosities (for fluids), appear as parameters in the equations modeling movements. There are often several choices for the parameters, and choosing a convenient set of parameters is called parametrization.
+For example, if one were considering the movement of an object on the surface of a sphere much larger than the object (e.g. the Earth), there are two commonly used parametrizations of its position: angular coordinates (like latitude/longitude), which neatly describe large movements along circles on the sphere, and directional distance from a known point (e.g. "10km NNW of Toronto" or equivalently "8km due North, and then 6km due West, from Toronto" ), which are often simpler for movement confined to a (relatively) small area, like within a particular country or region. Such parametrizations are also relevant to the modelization of geographic areas (i.e. map drawing).
+
+== Mathematical functions ==
+Mathematical functions have one or more arguments that are designated in the definition by variables. A function definition can also contain parameters, but unlike variables, parameters are not listed among the arguments that the function takes. When parameters are present, the definition actually defines a whole family of functions, one for every valid set of values of the parameters. For instance, one could define a general quadratic function by declaring
+
+  
+    
+      
+        f
+        (
+        x
+        )
+        =
+        a
+        
+          x
+          
+            2
+          
+        
+        +
+        b
+        x
+        +
+        c
+      
+    
+    {\displaystyle f(x)=ax^{2}+bx+c}
+  
+;
+Here, the variable x designates the function's argument, but a, b, and c are parameters (in this instance, also called coefficients) that determine which particular quadratic function is being considered. A parameter could be incorporated into the function name to indicate its dependence on the parameter. For instance, one may define the base-b logarithm by the formula
+
+  
+    
+      
+        
+          log
+          
+            b
+          
+        
+        ⁡
+        (
+        x
+        )
+        =
+        
+          
+            
+              log
+              ⁡
+              (
+              x
+              )
+            
+            
+              log
+              ⁡
+              (
+              b
+              )
+            
+          
+        
+      
+    
+    {\displaystyle \log _{b}(x)={\frac {\log(x)}{\log(b)}}}
+  
+
+where b is a parameter that indicates which logarithmic function is being used. It is not an argument of the function, and will, for instance, be a constant when considering the derivative 
+  
+    
+      
+        
+          
+            log
+            
+              b
+            
+            ′
+          
+          ⁡
+          (
+          x
+          )
+          =
+          (
+          x
+          ln
+          ⁡
+          (
+          b
+          )
+          
+            )
+            
+              −
+              1
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle \log _{b}'(x)=(x\ln(b))^{-1}}
+  
+.
+In some informal situations it is a matter of convention (or historical accident) whether some or all of the symbols in a function definition are called parameters. However, changing the status of symbols between parameter and variable changes the function as a mathematical object. For instance, the notation for the falling factorial power
+
+  
+    
+      
+        
+          n
+          
+            
+              k
+              _
+            
+          
+        
+        =
+        n
+        (
+        n
+        −
+        1
+        )
+        (
+        n
+        −
+        2
+        )
+        ⋯
+        (
+        n
+        −
+        k
+        +
+        1
+        )
+      
+    
+    {\displaystyle n^{\underline {k}}=n(n-1)(n-2)\cdots (n-k+1)}
+  
+,
+defines a polynomial function of n (when k is considered a parameter), but is not a polynomial function of k (when n is considered a parameter). Indeed, in the latter case, it is only defined for non-negative integer arguments. More formal presentations of such situations typically start out with a function of several variables (including all those that might sometimes be called "parameters") such as
+
+  
+    
+      
+        (
+        n
+        ,
+        k
+        )
+        ↦
+        
+          n
+          
+            
+              k
+              _
+            
+          
+        
+      
+    
+    {\displaystyle (n,k)\mapsto n^{\underline {k}}}
+  
+
+as the most fundamental object being considered, then defining functions with fewer variables from the main one by means of currying.
+Sometimes it is useful to consider all functions with certain parameters as parametric family, i.e. as an indexed family of functions. Examples from probability theory are given further below.
+
+=== Examples ===
+In a section on frequently misused words in his book The Writer's Art, James J. Kilpatrick quoted a letter from a correspondent, giving examples to illustrate the correct use of the word parameter:
+W.M. Woods ... a mathematician ... writes ... "... a variable is one of the many things a parameter is not." ... The dependent variable, the speed of the car, depends on the independent variable, the position of the gas pedal.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parameter-1.md b/data/en.wikipedia.org/wiki/Parameter-1.md
new file mode 100644
index 000000000..b4a3a7043
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Parameter-1.md
@@ -0,0 +1,165 @@
+---
+title: "Parameter"
+chunk: 2/4
+source: "https://en.wikipedia.org/wiki/Parameter"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:40.755713+00:00"
+instance: "kb-cron"
+---
+
+[Kilpatrick quoting Woods] "Now ... the engineers ... change the lever arms of the linkage ... the speed of the car ... will still depend on the pedal position ... but in a ... different manner.  You have changed a parameter"
+A parametric equaliser is an audio filter that allows the frequency of maximum cut or boost to be set by one control, and the size of the cut or boost by another. These settings, the frequency level of the peak or trough, are two of the parameters of a frequency response curve, and in a two-control equaliser they completely describe the curve. More elaborate parametric equalisers may allow other parameters to be varied, such as skew. These parameters each describe some aspect of the response curve seen as a whole, over all frequencies.  A graphic equaliser provides individual level controls for various frequency bands, each of which acts only on that particular frequency band.
+If asked to imagine the graph of the relationship y = ax2, one typically visualizes a range of values of x, but only one value of a. Of course a different value of a can be used, generating a different relation between x and y. Thus a is a parameter: it is less variable than the variable x or y, but it is not an explicit constant like the exponent 2. More precisely, changing the parameter a gives a different (though related) problem, whereas the variations of the variables x and y (and their interrelation) are part of the problem itself.
+In calculating income based on wage and hours worked (income equals wage multiplied by hours worked), it is typically assumed that the number of hours worked is easily changed, but the wage is more static. This makes wage a parameter, hours worked an independent variable, and income a dependent variable.
+
+=== Mathematical models ===
+In the context of a mathematical model, such as a probability distribution, the distinction between variables and parameters was described by Bard as follows:
+
+We refer to the relations which supposedly describe a certain physical situation, as a model. Typically, a model consists of one or more equations. The quantities appearing in the equations we classify into variables and parameters. The distinction between these is not always clear cut, and it frequently depends on the context in which the variables appear. Usually a model is designed to explain the relationships that exist among quantities which can be measured independently in an experiment; these are the variables of the model. To formulate these relationships, however, one frequently introduces "constants" which stand for inherent properties of nature (or of the materials and equipment used in a given experiment). These are the parameters.
+
+=== Analytic geometry ===
+
+In analytic geometry, a curve can be described as the image of a function whose argument, typically called the parameter, lies in a real interval.
+For example, the unit circle can be specified in the following two ways:
+
+implicit form, the curve is the locus of points (x, y) in the Cartesian plane that satisfy the relation 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+        +
+        
+          y
+          
+            2
+          
+        
+        =
+        1.
+      
+    
+    {\displaystyle x^{2}+y^{2}=1.}
+  
+
+parametric form, the curve is the image of the function 
+  
+    
+      
+        t
+        ↦
+        (
+        cos
+        ⁡
+        t
+        ,
+        sin
+        ⁡
+        t
+        )
+      
+    
+    {\displaystyle t\mapsto (\cos t,\sin t)}
+  
+with parameter 
+  
+    
+      
+        t
+        ∈
+        [
+        0
+        ,
+        2
+        π
+        )
+        .
+      
+    
+    {\displaystyle t\in [0,2\pi ).}
+  
+ As a parametric equation this can be written
+  
+    
+      
+        (
+        x
+        ,
+        y
+        )
+        =
+        (
+        cos
+        ⁡
+        t
+        ,
+        sin
+        ⁡
+        t
+        )
+        .
+      
+    
+    {\displaystyle (x,y)=(\cos t,\sin t).}
+  
+The parameter t in this equation would elsewhere in mathematics be called the independent variable.
+
+=== Mathematical analysis ===
+In mathematical analysis, integrals dependent on a parameter are often considered. These are of the form
+
+  
+    
+      
+        F
+        (
+        t
+        )
+        =
+        
+          ∫
+          
+            
+              x
+              
+                0
+              
+            
+            (
+            t
+            )
+          
+          
+            
+              x
+              
+                1
+              
+            
+            (
+            t
+            )
+          
+        
+        f
+        (
+        x
+        ;
+        t
+        )
+        
+        d
+        x
+        .
+      
+    
+    {\displaystyle F(t)=\int _{x_{0}(t)}^{x_{1}(t)}f(x;t)\,dx.}
+  
+
+In this formula, t is the argument of the function F, and on the right-hand side the parameter on which the integral depends. When evaluating the integral, t is held constant, and so it is considered to be a parameter.  If we are interested in the value of F for different values of t, we then consider t to be a variable. The quantity x is a dummy variable or variable of integration (confusingly, also sometimes called a parameter of integration).
+
+=== Statistics and econometrics ===
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parameter-2.md b/data/en.wikipedia.org/wiki/Parameter-2.md
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+---
+title: "Parameter"
+chunk: 3/4
+source: "https://en.wikipedia.org/wiki/Parameter"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:40.755713+00:00"
+instance: "kb-cron"
+---
+
+In statistics and econometrics, the probability framework above still holds, but attention shifts to estimating the parameters of a distribution based on observed data, or testing hypotheses about them. In frequentist estimation parameters are considered "fixed but unknown", whereas in Bayesian estimation they are treated as random variables, and their uncertainty is described as a distribution.
+In estimation theory of statistics, "statistic" or estimator refers to samples, whereas "parameter" or estimand refers to populations, where the samples are taken from. A statistic is a numerical characteristic of a sample that can be used as an estimate of the corresponding parameter, the numerical characteristic of the population from which the sample was drawn.
+For example, the sample mean (estimator), denoted 
+  
+    
+      
+        
+          
+            X
+            ¯
+          
+        
+      
+    
+    {\displaystyle {\overline {X}}}
+  
+, can be used as an estimate of the mean parameter (estimand), denoted μ, of the population from which the sample was drawn. Similarly, the sample variance (estimator), denoted S2, can be used to estimate the variance parameter (estimand), denoted σ2, of the population from which the sample was drawn. (Note that the sample standard deviation (S) is not an unbiased estimate of the population standard deviation (σ): see Unbiased estimation of standard deviation.)
+It is possible to make statistical inferences without assuming a particular parametric family of probability distributions. In that case, one speaks of non-parametric statistics as opposed to the parametric statistics just described. For example, a test based on Spearman's rank correlation coefficient would be called non-parametric since the statistic is computed from the rank-order of the data disregarding their actual values (and thus regardless of the distribution they were sampled from), whereas those based on the Pearson product-moment correlation coefficient are parametric tests since it is computed directly from the data values and thus estimates the parameter known as the population correlation.
+
+=== Probability theory ===
+In probability theory, one may describe the distribution of a random variable as belonging to a family of probability distributions, distinguished from each other by the values of a finite number of parameters. For example, one talks about "a Poisson distribution with mean value λ".  The function defining the distribution (the probability mass function) is:
+
+  
+    
+      
+        f
+        (
+        k
+        ;
+        λ
+        )
+        =
+        
+          
+            
+              
+                e
+                
+                  −
+                  λ
+                
+              
+              
+                λ
+                
+                  k
+                
+              
+            
+            
+              k
+              !
+            
+          
+        
+        .
+      
+    
+    {\displaystyle f(k;\lambda )={\frac {e^{-\lambda }\lambda ^{k}}{k!}}.}
+  
+
+This example nicely illustrates the distinction between constants, parameters, and variables. e is Euler's number, a fundamental mathematical constant. The parameter λ is the mean number of observations of some phenomenon in question, a property characteristic of the system.  k is a variable, in this case the number of occurrences of the phenomenon actually observed from a particular sample.  If we want to know the probability of observing k1 occurrences, we plug it into the function to get 
+  
+    
+      
+        f
+        (
+        
+          k
+          
+            1
+          
+        
+        ;
+        λ
+        )
+      
+    
+    {\displaystyle f(k_{1};\lambda )}
+  
+.  Without altering the system, we can take multiple samples, which will have a range of values of k, but the system is always characterized by the same λ.
+For instance, suppose we have a radioactive sample that emits, on average, five particles every ten minutes.  We take measurements of how many particles the sample emits over ten-minute periods.  The measurements exhibit different values of k, and if the sample behaves according to Poisson statistics, then each value of k will come up in a proportion given by the probability mass function above.  From measurement to measurement, however, λ remains constant at 5.  If we do not alter the system, then the parameter λ is unchanged from measurement to measurement; if, on the other hand, we modulate the system by replacing the sample with a more radioactive one, then the parameter λ would increase.
+Another common distribution is the normal distribution, which has as parameters the mean μ and the variance σ².
+In these above examples, the distributions of the random variables are completely specified by the type of distribution, i.e. Poisson or normal, and the parameter values, i.e. mean and variance.  In such a case, we have a parameterized distribution.
+It is possible to use the sequence of moments (mean, mean square, ...) or cumulants (mean, variance, ...) as parameters for a probability distribution: see Statistical parameter.
+
+== Computer programming ==
+
+In computer programming, two notions of parameter are commonly used, and are referred to as parameters and arguments—or more formally as a formal parameter and an actual parameter.
+For example, in the definition of a function such as
+
+y = f(x) = x + 2,
+x is the formal parameter (the parameter) of the defined function.
+When the function is evaluated for a given value, as in
+
+f(3): or,  y = f(3) = 3 + 2 = 5,
+3 is the actual parameter (the argument) for evaluation by the defined function; it is a given value (actual value) that is substituted for the formal parameter of the defined function. (In casual usage the terms parameter and argument might inadvertently be interchanged, and thereby used incorrectly.)
+These concepts are discussed in a more precise way in functional programming and its foundational disciplines, lambda calculus and combinatory logic. Terminology varies between languages; some computer languages such as C define parameter and argument as given here, while Eiffel uses an alternative convention.
+
+== Artificial intelligence ==
+In artificial intelligence, a model describes the probability that something will occur. Parameters in a model are the weight of the various probabilities. Tiernan Ray, in an article on GPT-3, described parameters this way: A parameter is a calculation in a neural network that applies a great or lesser weighting to some aspect of the data, to give that aspect greater or lesser prominence in the overall calculation of the data. It is these weights that give shape to the data, and give the neural network a learned perspective on the data.
\ No newline at end of file
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+---
+title: "Parameter"
+chunk: 4/4
+source: "https://en.wikipedia.org/wiki/Parameter"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:40.755713+00:00"
+instance: "kb-cron"
+---
+
+== Engineering ==
+In engineering (especially involving data acquisition) the term parameter sometimes loosely refers to an individual measured item. This usage is not consistent, as sometimes the term channel refers to an individual measured item, with parameter referring to the setup information about that channel.
+"Speaking generally, properties are those physical quantities which directly describe the physical attributes of the system; parameters are those combinations of the properties which suffice to determine the response of the system. Properties can have all sorts of dimensions, depending upon the system being considered; parameters are dimensionless, or have the dimension of time or its reciprocal."
+The term can also be used in engineering contexts, however, as it is typically used in the physical sciences.
+
+== Environmental science ==
+In environmental science and particularly in chemistry and microbiology, a parameter is used to describe a discrete chemical or microbiological entity that can be assigned a value: commonly a concentration, but may also be a logical entity (present or absent), a statistical result such as a 95 percentile value or in some cases a subjective value.
+
+== Linguistics ==
+Within linguistics, the word "parameter" is almost exclusively used to denote a binary switch in a Universal Grammar within a Principles and Parameters framework.
+
+== Logic ==
+In logic, the parameters passed to (or operated on by) an open predicate are called parameters by some authors (e.g., Prawitz's Natural Deduction; Paulson's Designing a theorem prover). Parameters locally defined within the predicate are called variables. This extra distinction pays off when defining substitution (without this distinction special provision must be made to avoid variable capture). Others (maybe most) just call parameters passed to (or operated on by) an open predicate variables, and when defining substitution have to distinguish between free variables and bound variables.
+
+== Music ==
+
+In music theory, a parameter denotes an element which may be manipulated (composed), separately from the other elements. The term is used particularly for pitch, loudness, duration, and timbre, though theorists or composers have sometimes considered other musical aspects as parameters. The term is particularly used in serial music, where each parameter may follow some specified series. Paul Lansky and George Perle criticized the extension of the word "parameter" to this sense, since it is not closely related to its mathematical sense, but it remains common.  The term is also common in music production, as the functions of audio processing units (such as the attack, release, ratio, threshold, and other variables on a compressor) are defined by parameters specific to the type of unit (compressor, equalizer, delay, etc.).
+
+== See also ==
+Coefficient
+Coordinate system
+Function parameter
+Occam's razor (with regards to the trade-off of many or few parameters in data fitting)
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parameter_space-0.md b/data/en.wikipedia.org/wiki/Parameter_space-0.md
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+---
+title: "Parameter space"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Parameter_space"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:41.985731+00:00"
+instance: "kb-cron"
+---
+
+The parameter space is the space of all possible parameter values that define a particular mathematical model. It is also sometimes called weight space, and is often a subset of finite-dimensional Euclidean space. 
+In statistics, parameter spaces are particularly useful for describing parametric families of probability distributions. They also form the background for parameter estimation. In the case of extremum estimators for parametric models, a certain objective function is maximized or minimized over the parameter space. Theorems of existence and consistency of such estimators require some assumptions about the topology of the parameter space. For instance, compactness of the parameter space, together with continuity of the objective function, suffices for the existence of an extremum estimator.
+Sometimes, parameters are analyzed to view how they affect their statistical model. In that context, they can be viewed as inputs of a function, in which case the technical term for the parameter space is domain of a function. The ranges of values of the parameters may form the axes of a plot, and particular outcomes of the model may be plotted against these axes to illustrate how different regions of the parameter space produce different types of behavior in the model.
+
+
+== Examples ==
+A simple model of health deterioration after developing lung cancer could include the two parameters gender and smoker/non-smoker, in which case the parameter space is the following set of four possibilities: {(Male, Smoker), (Male, Non-smoker), (Female, Smoker), (Female, Non-smoker)} .
+The logistic map 
+  
+    
+      
+        
+          x
+          
+            n
+            +
+            1
+          
+        
+        =
+        r
+        
+          x
+          
+            n
+          
+        
+        (
+        1
+        −
+        
+          x
+          
+            n
+          
+        
+        )
+      
+    
+    {\displaystyle x_{n+1}=rx_{n}(1-x_{n})}
+  
+ has one parameter, r, which can take any positive value. The parameter space is therefore positive real numbers.
+For some values of r, this function ends up cycling around a few values or becomes fixed on one value. These long-term values can be plotted against r in a bifurcation diagram to show the different behaviours of the function for different values of r.
+In a sine wave model 
+  
+    
+      
+        y
+        (
+        t
+        )
+        =
+        A
+        ⋅
+        sin
+        ⁡
+        (
+        ω
+        t
+        +
+        ϕ
+        )
+        ,
+      
+    
+    {\displaystyle y(t)=A\cdot \sin(\omega t+\phi ),}
+  
+ the parameters are amplitude A > 0, angular frequency ω > 0, and phase φ ∈ S1. Thus the parameter space is 
+  
+    
+      
+        
+          R
+          
+            +
+          
+        
+        ×
+        
+          R
+          
+            +
+          
+        
+        ×
+        
+          S
+          
+            1
+          
+        
+        .
+      
+    
+    {\displaystyle R^{+}\times R^{+}\times S^{1}.}
+  
+
+In complex dynamics, the parameter space is the complex plane C = { z = x + y i : x, y ∈ R }, where i2 = −1.
+The famous Mandelbrot set is a subset of this parameter space, consisting of the points 
+  
+    
+      
+        c
+      
+    
+    {\displaystyle c}
+  
+ in the complex plane which give a bounded set of numbers when a iterated function 
+  
+    
+      
+        
+          z
+          
+            n
+            +
+            1
+          
+        
+        =
+        
+          f
+          
+            c
+          
+        
+        (
+        
+          z
+          
+            n
+          
+        
+        )
+        =
+        
+          z
+          
+            2
+          
+        
+        +
+        c
+      
+    
+    {\displaystyle z_{n+1}=f_{c}(z_{n})=z^{2}+c}
+  
+ is repeatedly applied from that starting point 
+  
+    
+      
+        
+          z
+          
+            0
+          
+        
+        =
+        0
+      
+    
+    {\displaystyle z_{0}=0}
+  
+. The remaining points, which are not in the set, give an unbounded set of numbers (they tend to infinity) when this function is repeatedly applied from that 
+  
+    
+      
+        
+          z
+          
+            0
+          
+        
+      
+    
+    {\displaystyle z_{0}}
+  
+.
+In machine learning, hyperparameters are used to describe models. In deep learning, the parameters of a deep network are called weights. Due to the layered structure of deep networks, their weight space has a complex structure and geometry. For example, in multilayer perceptrons, the same function is preserved when permuting the nodes of a hidden layer, amounting to permuting weight matrices of the network. This property is known as equivariance to permutation of deep weight spaces. The study seeks hyperparameter optimization.
+
+
+== History ==
+Parameter space contributed to the liberation of geometry from the confines of three-dimensional space. For instance, the parameter space of spheres in three dimensions, has four dimensions—three for the sphere center and another for the radius.  According to Dirk Struik, it was the book Neue Geometrie des Raumes (1849) by Julius Plücker that showed
+
+...geometry need not solely be based on points as basic elements. Lines, planes, circles, spheres can all be used as the elements (Raumelemente) on which a geometry can be based. This fertile conception threw new light on both synthetic and algebraic geometry and created new forms of duality. The number of dimensions of a particular form of geometry could now be any positive number, depending on the number of parameters necessary to define the "element".
+The requirement for higher dimensions is illustrated by Plücker's line geometry. Struik writes
+
+[Plücker's] geometry of lines in three-space could be considered as a four-dimensional geometry, or, as Klein has stressed, as the geometry of a four-dimensional quadric in a five-dimensional space.
+Thus the Klein quadric describes the parameters of lines in space.
+
+
+== See also ==
+Sample space
+Configuration space
+Data analysis
+Dimensionality reduction
+Model selection
+Parametric equation
+Parametric surface
+Phase space
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parametric_family-0.md b/data/en.wikipedia.org/wiki/Parametric_family-0.md
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+---
+title: "Parametric family"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Parametric_family"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:43.335955+00:00"
+instance: "kb-cron"
+---
+
+In mathematics and its applications, a parametric family or a parameterized family is a family of objects (a set of related objects) whose differences depend only on the chosen values for a set of parameters.
+Common examples are parametrized (families of) functions, probability distributions, curves, shapes, etc.
+
+
+== In probability and its applications ==
+
+For example, the probability density function fX of a random variable X may depend on a parameter θ. In that case, the function may be denoted 
+  
+    
+      
+        
+          f
+          
+            X
+          
+        
+        (
+        ⋅
+        
+        ;
+        θ
+        )
+      
+    
+    {\displaystyle f_{X}(\cdot \,;\theta )}
+  
+ to indicate the dependence on the parameter θ. θ is not a formal argument of the function as it is considered to be fixed. However, each different value of the parameter gives a different probability density function. Then the parametric family of densities is the set of functions 
+  
+    
+      
+        {
+        
+          f
+          
+            X
+          
+        
+        (
+        ⋅
+        
+        ;
+        θ
+        )
+        ∣
+        θ
+        ∈
+        Θ
+        }
+      
+    
+    {\displaystyle \{f_{X}(\cdot \,;\theta )\mid \theta \in \Theta \}}
+  
+, where Θ denotes the parameter space, the set of all possible values that the parameter θ can take. As an example, the normal distribution is a family of similarly shaped distributions parametrized by their mean and their variance.
+In decision theory, two-moment decision models can be applied when the decision-maker is faced with random variables drawn from a location-scale family of probability distributions.
+
+
+== In algebra and its applications ==
+
+In economics, the Cobb–Douglas production function is a family of production functions parametrized by the elasticities of output with respect to the various factors of production.
+
+In algebra, the quadratic equation, for example, is actually a family of equations parametrized by the coefficients of the variable and of its square and by the constant term.
+
+
+== See also ==
+Indexed family
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Parts-per_notation-0.md b/data/en.wikipedia.org/wiki/Parts-per_notation-0.md
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+---
+title: "Parts-per notation"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Parts-per_notation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:44.742123+00:00"
+instance: "kb-cron"
+---
+
+In science and engineering, parts-per notation is a set of pseudo-units to describe the small values of miscellaneous dimensionless quantities, e.g. mole fraction or mass fraction. 
+Since these fractions are quantity-per-quantity measures, they are pure numbers with no associated units of measurement. Commonly used are
+
+parts-per-million – ppm, 10−6
+parts-per-billion – ppb, 10−9
+parts-per-trillion – ppt, 10−12
+parts-per-quadrillion – ppq, 10−15
+This notation is not part of the International System of Units (the SI system) and its meaning is ambiguous. In chemistry, ambiguity arises because parts-per notation is able to be used to refer to a mole fraction and a mass fraction, which are unequal depending on the molar mass of the substance.
+
+== Applications ==
+Parts-per notation is often used describing dilute solutions in chemistry, for instance, the relative abundance of dissolved minerals or pollutants in water. The quantity "1 ppm" can be used for a mass fraction if a water-borne pollutant is present at one-millionth of a gram per gram of sample solution. When working with aqueous solutions, it is common to assume that the density of water is 1.00 g/mL. Therefore, it is common to equate 1 kilogram of water with 1 L of water. Consequently, 1 ppm corresponds to 1 mg/L and 1 ppb corresponds to 1 μg/L.
+Similarly, parts-per notation is used also in physics and engineering to express the value of various proportional phenomena. For instance, a special metal alloy might expand 1.2 micrometers per meter of length for every degree Celsius and this would be expressed as "α = 1.2 ppm/°C". Parts-per notation is also employed to denote the change, stability, or uncertainty in measurements. For instance, the accuracy of land-survey distance measurements when using a laser rangefinder might be 1 millimeter per kilometer of distance; this could be expressed as "Accuracy = 1 ppm."
+Parts-per notations are all dimensionless quantities: in mathematical expressions, the units of measurement always cancel. In fractions like "2 nanometers per meter" (2 nm/m = 2 × 10−9 = 2 ppb = 2 × 0.000000001), so the quotients are pure-number coefficients with positive values less than or equal to 1. When parts-per notations, including the percent symbol (%), are used in regular prose (as opposed to mathematical expressions), they are still pure-number dimensionless quantities. However, they generally take the literal "parts per" meaning of a comparative ratio (e.g. "2 ppb" would generally be interpreted as "two parts in a billion parts").
+Parts-per notations may be expressed in terms of any unit of the same measure. For instance, the expansion coefficient of some brass alloy, α = 18.7 ppm/°C, may be expressed as 18.7 (μm/m)/°C, or as 18.7 (μ in/in)/°C; the numeric value representing a relative proportion does not change with the adoption of a different unit of length.
+Similarly, a metering pump that injects a trace chemical into the main process line at the proportional flow rate Qp = 12 ppm, is doing so at a rate that may be expressed in a variety of volumetric units, including 125 μL/L, 125 μgal/gal, 125 cm3/m3, etc.
+In nuclear magnetic resonance spectroscopy (NMR), chemical shift is usually expressed in ppm. It represents the difference of a measured frequency in parts per million from the reference frequency. The reference frequency depends on the instrument's magnetic field and the element being measured. It is usually expressed in MHz. Typical chemical shifts are rarely more than a few hundred Hz from the reference frequency, so chemical shifts are conveniently expressed in ppm (Hz/MHz). Parts-per notation gives a dimensionless quantity that does not depend on the instrument's field strength.
+
+== Parts-per expressions ==
+
+One part per hundred is generally represented by the percent sign (%) and denotes one part per 100 (102) parts, and a value of 10−2. This is equivalent to about fourteen minutes out of one day.
+
+One part per thousand should generally be spelled out in full and not as "ppt" (which is usually understood to represent "parts per trillion"). It may also be denoted by the permille sign (‰). Note however, that specific disciplines such as oceanography, as well as educational exercises, do use the "ppt" abbreviation. "One part per thousand" denotes one part per 1,000 (103) parts, and a value of 10−3. This is equivalent to about ninety seconds out of one day.
+One part per ten thousand is denoted by the permyriad sign (‱). Although rarely used in science (ppm is typically used instead), one permyriad has an unambiguous value of one part per 10,000 (104) parts, and a value of 10−4. This is equivalent to about nine seconds out of one day. In contrast, in finance, the basis point is typically used to denote changes in or differences between percentage interest rates (although it can also be used in other cases where it is desirable to express quantities in hundredths of a percent). For instance, a change in an interest rate from 5.15% per annum to 5.35% per annum could be denoted as a change of 20 basis points (per annum). As with interest rates, the words "per annum" (or "per year") are often omitted. In that case, the basis point is a quantity with a dimension of (time−1).
+One part per hundred thousand, per cent mille (pcm) or milli-percent denotes one part per 100,000 (105) parts, and a value of 10−5. It is commonly used in epidemiology for mortality, crime and disease prevalence rates, and nuclear reactor engineering as a unit of reactivity. In time measurement it is equivalent to about 5 minutes out of a year; in distance measurement, it is equivalent to 1 cm of error per km of distance traversed.
+
+One part per million (ppm) denotes one part per 1,000,000 (106) parts, and a value of 10−6. It is equivalent to about 32 seconds out of a year or 1 mm of error per km of distance traversed. In mining, it is also equivalent to one gram per metric ton, expressed as g/t.
\ No newline at end of file
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+---
+title: "Parts-per notation"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Parts-per_notation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:44.742123+00:00"
+instance: "kb-cron"
+---
+
+One part per billion (ppb) denotes one part per 1,000,000,000 (109) parts, and a value of 10−9. This is equivalent to about three seconds out of a century.
+
+One part per trillion (ppt) denotes one part per 1,000,000,000,000 (1012) parts, and a value of 10−12. This is equivalent to about thirty seconds out of every million years.
+
+One part per quadrillion (ppq) denotes one part per 1,000,000,000,000,000 (1015) parts, and a value of 10−15. This is equivalent to about two and a half minutes out of the age of the Earth (4.5 billion years). Although relatively uncommon in analytical chemistry, measurements at the ppq level are sometimes performed.
+
+== Criticism ==
+Although the International Bureau of Weights and Measures (an international standards organization known also by its French-language initials BIPM) recognizes the use of parts-per notation, it is not formally part of the International System of Units (SI). Note that although "percent" (%) is not formally part of the SI, both the BIPM and the International Organization for Standardization (ISO) take the position that "in mathematical expressions, the internationally recognized symbol % (percent) may be used with the SI to represent the number 0.01" for dimensionless quantities. According to IUPAP, "a continued source of annoyance to unit purists has been the continued use of percent, ppm, ppb, and ppt". Although SI-compliant expressions should be used as an alternative, the parts-per notation remains nevertheless widely used in technical disciplines. The main problems with the parts-per notation are set out below.
+
+=== Long and short scales ===
+
+Because the named numbers starting with a "billion" have different values in different countries, the BIPM suggests avoiding the use of "ppb" and "ppt" to prevent misunderstanding. The U.S. National Institute of Standards and Technology (NIST) takes the stringent position, stating that "the language-dependent terms [...] are not acceptable for use with the SI to express the values of quantities".
+
+=== Thousand vs. trillion ===
+Although "ppt" usually means "parts per trillion", it occasionally means "parts per thousand". Unless the meaning of "ppt" is defined explicitly, it has to be determined from the context.
+
+=== Mass fraction vs. mole fraction vs. volume fraction ===
+Another problem of the parts-per notation is that it may refer to mass fraction, mole fraction or volume fraction. Since it is usually not stated which quantity is used, it is better to write the units out, such as kg/kg, mol/mol or m3/m3, even though they are all dimensionless. The difference is quite significant when dealing with gases, and it is very important to specify which quantity is being used. For example, the conversion factor between a mass fraction of 1 ppb and a mole fraction of 1 ppb is about 4.7 for the greenhouse gas CFC-11 in air (Molar mass of CFC-11 / Mean molar mass of air = 137.368 / 28.97 = 4.74). 
+For volume fraction, the suffix V or v is sometimes appended to the parts-per notation (e.g. ppmV, ppbv, pptv). To distinguish the mass fraction from volume fraction or mole fraction, the letter m (for mass, but is ambiguous with mole fraction) or w (standing for weight) is sometimes added to the abbreviation (e.g. ppmw, ppbw).
+Expressions such as "parts per (million) by volume" and "parts per (million) by mass" are sometimes used.
+
+== SI-compliant expressions ==
+SI-compliant units that can be used as alternatives are shown in the chart below. Expressions that the BIPM explicitly does not recognize as being suitable for denoting dimensionless quantities with the SI are marked with !.
+
+Note that the notations in the "SI units" column above are for the most part dimensionless quantities; that is, the units of measurement factor out in expressions like "1 nm/m" (1 nm/m =1 × 10−9) so the ratios are pure-number coefficients with values less than 1.
+
+== Uno (proposed dimensionless unit) ==
+Because of the cumbersome nature of expressing certain dimensionless quantities per SI guidelines, the International Union of Pure and Applied Physics (IUPAP) in 1999 proposed the adoption of the special name "uno" (symbol: U) to represent the number 1 in dimensionless quantities. In 2004, a report to the International Committee for Weights and Measures (CIPM) stated that the response to the proposal of the uno "had been almost entirely negative", and the principal proponent "recommended dropping the idea". To date, the uno has not been adopted by any standards organization.
+
+== Footnotes ==
+
+== See also ==
+International Electrotechnical Commission (IEC)
+Milligram per cent
+Percentage (%) 1 part in 100
+Per mille (‰) 1 part in 1,000
+Permyriad (‱) 1 part in 10,000
+Per cent mille (pcm) 1 part in 100,000
+Per-unit system
+
+== References ==
+
+== External links ==
+
+ Media related to Parts-per notation at Wikimedia Commons
+National Institute of Standards and Technology (NIST)
+International Bureau of Weights and Measures (BIPM)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Pathological_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Pathological_(mathematics)-0.md
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+---
+title: "Pathological (mathematics)"
+chunk: 1/3
+source: "https://en.wikipedia.org/wiki/Pathological_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:45.941558+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, when a mathematical phenomenon runs counter to some intuition, then the phenomenon is sometimes called pathological. On the other hand, if a phenomenon does not run counter to intuition, it is sometimes called well-behaved or nice. These terms are sometimes useful in mathematical research and teaching, but there is no strict mathematical definition of pathological or well-behaved.
+
+== In analysis ==
+A classic example of a pathology is the Weierstrass function, a function that is continuous everywhere but differentiable nowhere. The sum of a differentiable function and the Weierstrass function is again continuous but nowhere differentiable; so there are at least as many such functions as differentiable functions. In fact, using the Baire category theorem, one can show that continuous functions are generically nowhere differentiable.
+Such examples were deemed pathological when they were first discovered. To quote Henri Poincaré:
+
+Logic sometimes breeds monsters. For half a century there has been springing up a host of weird functions, which seem to strive to have as little resemblance as possible to honest functions that are of some use. No more continuity, or else continuity but no derivatives, etc. More than this, from the point of view of logic, it is these strange functions that are the most general; those that are met without being looked for no longer appear as more than a particular case, and they have only quite a little corner left them.
+Formerly, when a new function was invented, it was in view of some practical end. To-day they are invented on purpose to show our ancestors' reasonings at fault, and we shall never get anything more than that out of them.
+
+If logic were the teacher's only guide, he would have to begin with the most general, that is to say, with the most weird, functions. He would have to set the beginner to wrestle with this collection of monstrosities. If you don't do so, the logicians might say, you will only reach exactness by stages.
+Since Poincaré, nowhere differentiable functions have been shown to appear in basic physical and biological processes such as Brownian motion and in applications such as the Black-Scholes model in finance.
+Counterexamples in Analysis is a whole book of such counterexamples.
+Another example of pathological function is Du-Bois Reymond continuous function, that can't be represented as a Fourier series.
+
+== In topology ==
+One famous counterexample in topology is the Alexander horned sphere, showing that topologically embedding the sphere S2 in R3 may fail to separate the space cleanly. As a counterexample, it motivated mathematicians to define the tameness property, which suppresses the kind of wild behavior exhibited by the horned sphere, wild knot, and other similar examples.
+Like many other pathologies, the horned sphere in a sense plays on infinitely fine, recursively generated structure, which in the limit violates ordinary intuition. In this case, the topology of an ever-descending chain of interlocking loops of continuous pieces of the sphere in the limit fully reflects that of the common sphere, and one would expect the outside of it, after an embedding, to work the same. Yet it does not: it fails to be simply connected.
+For the underlying theory, see Jordan–Schönflies theorem.
+Counterexamples in Topology is a whole book of such counterexamples.
+
+== In algebraic geometry ==
+In a sequence of four papers published in the American Journal of Mathematics between 1961 and 1975, David Mumford explored "pathological" behavior in algebraic geometry. His examples fall into two types: (a) bad behavior in characteristic p and (b) bad behavior in moduli spaces.
+Mumford wrote in the 1962 paper Further Pathologies in Algebraic Geometry:
+
+A non-singular characteristic p variety is analogous to a general non-Kähler complex manifold;  in particular, a projective embedding of such a variety is not as strong as a Kähler metric on a complex manifold, and the Hodge–Lefschetz–Dolbeault theorems on sheaf cohomology break down in every possible way.
+In Pathologies I (Pathologies of Modular Algebraic Surfaces), Mumford (a) finds an everywhere regular differential form on a smooth projective surface that is not closed, and shows that Hodge symmetry fails for classical Enriques surfaces in characteristic two.  This example is developed further in Mumford's third paper on classification of surfaces in characteristic p (written with Enrico Bombieri). It can be explained in terms of the Picard scheme of the surface, and in particular, its failure to be a reduced scheme, a theme developed in Mumford's book Lectures on Curves on an Algebraic Surface.  Pathologies related to p-torsion in crystalline cohomology were later explored by Luc Illusie.
+In Pathologies II (Further Pathologies in Algebraic Geometry), Mumford (a) gives a simple example of a surface in characteristic p where the geometric genus is non-zero, but the second Betti number is equal to the rank of the Néron–Severi group. Further such examples arise in Zariski surface theory.  He also conjectured that the Kodaira vanishing theorem is false for surfaces in characteristic p. Mumford also (b) finds that the Hilbert scheme parametrizing space curves of degree 14 and genus 24 has a multiple component. In 2006 Ravi Vakil in his paper "Murphy's law in algebraic geometry" showed that Hilbert schemes can be arbitrarily "bad", with unlimited numbers of components and with arbitrarily large multiplicities.
+In Pathologies III, he (a) gives an example of a normal surface for which Kodaira vanishing fails.  The first example of a smooth surface for which Kodaira vanishing fails was given by Michel Raynaud in 1978.
+In Pathologies IV, he (b) finds reduced and irreducible complete curves which are not specializations of non-singular curves.
\ No newline at end of file
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@@ -0,0 +1,155 @@
+---
+title: "Pathological (mathematics)"
+chunk: 2/3
+source: "https://en.wikipedia.org/wiki/Pathological_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:45.941558+00:00"
+instance: "kb-cron"
+---
+
+== Well-behaved ==
+Mathematicians (and those in related sciences) very frequently speak of whether a mathematical object—a function, a set, a space of one sort or another—is "well-behaved". While the term has no fixed formal definition, it generally refers to the quality of satisfying a list of prevailing conditions, which might be dependent on context, mathematical interests, fashion, and taste. To ensure that an object is "well-behaved", mathematicians introduce further axioms to narrow down the domain of study. This has the benefit of making analysis easier, but produces a loss of generality of any conclusions reached.
+In both pure and applied mathematics (e.g., optimization, numerical integration, mathematical physics), well-behaved also means not violating any assumptions needed to successfully apply whatever analysis is being discussed.
+The opposite case is usually labeled "pathological". It is not unusual to have situations in which most cases (in terms of cardinality or measure) are pathological, but the pathological cases will not arise in practice—unless constructed deliberately.
+The term "well-behaved" is generally applied in an absolute sense—either something is well-behaved or it is not. For example:
+
+In algorithmic inference, a well-behaved statistic is monotonic, well-defined, and sufficient.
+In Bézout's theorem, two polynomials are well-behaved, and thus the formula given by the theorem for the number of their intersections is valid, if their polynomial greatest common divisor is a constant.
+A meromorphic function is a ratio of two well-behaved functions, in the sense of those two functions being holomorphic.
+The Karush–Kuhn–Tucker conditions are first-order necessary conditions for a solution in a well-behaved nonlinear programming problem to be optimal; a problem is referred to as well-behaved if some regularity conditions are satisfied.
+In probability, events contained in the probability space's corresponding sigma-algebra are well-behaved, as are measurable functions.
+Unusually, the term could also be applied in a comparative sense:
+
+In calculus:
+Analytic functions are better-behaved than general smooth functions.
+Smooth functions are better-behaved than general differentiable functions.
+Continuous differentiable functions are better-behaved than general continuous functions. The larger the number of times the function can be differentiated, the more well-behaved it is.
+Continuous functions are better-behaved than Riemann-integrable functions on compact sets.
+Riemann-integrable functions are better-behaved than Lebesgue-integrable functions.
+Lebesgue-integrable functions are better-behaved than general functions.
+In topology:
+Continuous functions are better-behaved than discontinuous ones.
+Euclidean space is better-behaved than non-Euclidean geometry.
+Attractive fixed points are better-behaved than repulsive fixed points.
+Hausdorff topologies are better-behaved than those in arbitrary general topology.
+Borel sets are better-behaved than arbitrary sets of real numbers.
+Spaces with integer dimension are better-behaved than spaces with fractal dimension.
+In abstract algebra:
+Groups are better-behaved than magmas and semigroups.
+Abelian groups are better-behaved than non-Abelian groups.
+Finitely-generated Abelian groups are better-behaved than non-finitely-generated Abelian groups.
+Finite-dimensional vector spaces are better-behaved than infinite-dimensional ones.
+Fields are better-behaved than skew fields or general rings.
+Separable field extensions are better-behaved than non-separable ones.
+Normed division algebras are better-behaved than general composition algebras.
+
+== Pathological examples ==
+
+Pathological examples often have some undesirable or unusual properties that make it difficult to contain or explain within a theory. Such pathological behaviors often prompt new investigation and research, which leads to new theory and more general results. Some important historical examples of this are:
+
+Ranked-choice voting is commonly described as a pathological social choice function, because of its tendency to eliminate candidates for winning too many votes.
+The discovery of irrational numbers by the school of Pythagoras in ancient Greece; for example, the length of the diagonal of a unit square, that is 
+  
+    
+      
+        
+          
+            2
+          
+        
+      
+    
+    {\displaystyle {\sqrt {2}}}
+  
+.
+The discovery of complex numbers in the 16th century in order to find the roots of cubic and quartic polynomial functions.
+Some number fields have rings of integers that do not form a unique factorization domain, for example the extended field 
+  
+    
+      
+        
+          Q
+        
+        (
+        
+          
+            −
+            5
+          
+        
+        )
+      
+    
+    {\displaystyle \mathbb {Q} ({\sqrt {-5}})}
+  
+.
+The discovery of fractals and other "rough" geometric objects (see Hausdorff dimension).
+Weierstrass function, a real-valued function on the real line, that is continuous everywhere but differentiable nowhere.
+Test functions in real analysis and distribution theory, which are infinitely differentiable functions on the real line that are 0 everywhere outside of a given limited interval. An example of such a function is the test function, 
+  
+    
+      
+        φ
+        (
+        t
+        )
+        =
+        
+          
+            {
+            
+              
+                
+                  
+                    e
+                    
+                      −
+                      1
+                      
+                        /
+                      
+                      (
+                      1
+                      −
+                      
+                        t
+                        
+                          2
+                        
+                      
+                      )
+                    
+                  
+                  ,
+                
+                
+                  −
+                  1
+                  <
+                  t
+                  <
+                  1
+                  ,
+                
+              
+              
+                
+                  0
+                  ,
+                
+                
+                  
+                    otherwise
+                  
+                  .
+                
+              
+            
+            
+          
+        
+      
+    
+    {\displaystyle \varphi (t)={\begin{cases}e^{-1/(1-t^{2})},&-1<t<1,\\0,&{\text{otherwise}}.\end{cases}}}
+  
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Pathological_(mathematics)-2.md b/data/en.wikipedia.org/wiki/Pathological_(mathematics)-2.md
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+++ b/data/en.wikipedia.org/wiki/Pathological_(mathematics)-2.md
@@ -0,0 +1,155 @@
+---
+title: "Pathological (mathematics)"
+chunk: 3/3
+source: "https://en.wikipedia.org/wiki/Pathological_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:45.941558+00:00"
+instance: "kb-cron"
+---
+
+The Cantor set is a subset of the interval 
+  
+    
+      
+        [
+        0
+        ,
+        1
+        ]
+      
+    
+    {\displaystyle [0,1]}
+  
+ that has measure zero but is uncountable.
+The fat Cantor set is nowhere dense but has positive measure.
+The Fabius function is everywhere smooth but nowhere analytic.
+Volterra's function is differentiable with bounded derivative everywhere, but the derivative is not Riemann-integrable.
+The Peano space-filling curve is a continuous surjective function that maps the unit interval 
+  
+    
+      
+        [
+        0
+        ,
+        1
+        ]
+      
+    
+    {\displaystyle [0,1]}
+  
+ onto 
+  
+    
+      
+        [
+        0
+        ,
+        1
+        ]
+        ×
+        [
+        0
+        ,
+        1
+        ]
+      
+    
+    {\displaystyle [0,1]\times [0,1]}
+  
+.
+The Dirichlet function, which is the indicator function for rationals, is a bounded function that is not Riemann integrable.
+The Cantor function is a monotonic continuous surjective function that maps 
+  
+    
+      
+        [
+        0
+        ,
+        1
+        ]
+      
+    
+    {\displaystyle [0,1]}
+  
+ onto 
+  
+    
+      
+        [
+        0
+        ,
+        1
+        ]
+      
+    
+    {\displaystyle [0,1]}
+  
+, but has zero derivative almost everywhere.
+The Minkowski question-mark function is continuous and strictly increasing but has zero derivative almost everywhere.
+Satisfaction classes containing "intuitively false" arithmetical statements can be constructed for countable, recursively saturated models of Peano arithmetic. 
+The Osgood curve is a Jordan curve (unlike most space-filling curves) of positive area.
+An exotic sphere is homeomorphic but not diffeomorphic to the standard Euclidean n-sphere.
+At the time of their discovery, each of these was considered highly pathological; today, each has been assimilated into modern mathematical theory. These examples prompt their observers to correct their beliefs or intuitions, and in some cases necessitate a reassessment of foundational definitions and concepts. Over the course of history, they have led to more correct, more precise, and more powerful mathematics. For example, the Dirichlet function is Lebesgue integrable, and convolution with test functions is used to approximate any locally integrable function by smooth functions.
+Whether a behavior is pathological is by definition subject to personal intuition. Pathologies depend on context, training, and experience, and what is pathological to one researcher may very well be standard behavior to another.
+Pathological examples can show the importance of the assumptions in a theorem. For example, in statistics, the Cauchy distribution does not satisfy the central limit theorem, even though its symmetric bell-shape appears similar to many distributions which do; it fails the requirement to have a mean and standard deviation which exist and that are finite.
+Some of the best-known paradoxes, such as Banach–Tarski paradox and Hausdorff paradox, are based on the existence of non-measurable sets. Mathematicians, unless they take the minority position of denying the axiom of choice, are in general resigned to living with such sets.
+
+== Computer science ==
+In computer science, pathological has a slightly different sense with regard to the study of algorithms. Here, an input (or set of inputs) is said to be pathological if it causes atypical behavior from the algorithm, such as a violation of its average case complexity, or even its correctness. For example, hash tables generally have pathological inputs: sets of keys that collide on hash values. Quicksort normally has 
+  
+    
+      
+        O
+        (
+        n
+        log
+        ⁡
+        
+          n
+        
+        )
+      
+    
+    {\displaystyle O(n\log {n})}
+  
+ time complexity, but deteriorates to 
+  
+    
+      
+        O
+        (
+        
+          n
+          
+            2
+          
+        
+        )
+      
+    
+    {\displaystyle O(n^{2})}
+  
+ when it is given input that triggers suboptimal behavior.
+The term is often used pejoratively, as a way of dismissing such inputs as being specially designed to break a routine that is otherwise sound in practice (compare with Byzantine). On the other hand, awareness of pathological inputs is important, as they can be exploited to mount a denial-of-service attack on a computer system. Also, the term in this sense is a matter of subjective judgment as with its other senses. Given enough run time, a sufficiently large and diverse user community (or other factors), an input which may be dismissed as pathological could in fact occur (as seen in the first test flight of the Ariane 5).
+
+== Exceptions ==
+
+A similar but distinct phenomenon is that of exceptional objects (and exceptional isomorphisms), which occurs when there are a "small" number of exceptions to a general pattern (such as a finite set of exceptions to an otherwise infinite rule). By contrast, in cases of pathology, often most or almost all instances of a phenomenon are pathological (e.g., almost all real numbers are irrational).
+Subjectively, exceptional objects (such as the icosahedron or sporadic simple groups) are generally considered "beautiful", unexpected examples of a theory, while pathological phenomena are often considered "ugly", as the name implies. Accordingly, theories are usually expanded to include exceptional objects. For example, the exceptional Lie algebras are included in the theory of semisimple Lie algebras: the axioms are seen as good, the exceptional objects as unexpected but valid.
+By contrast, pathological examples are instead taken to point out a shortcoming in the axioms, requiring stronger axioms to rule them out. For example, requiring tameness of an embedding of a sphere in the Schönflies problem. In general, one may study the more general theory, including the pathologies, which may provide its own simplifications (the real numbers have properties very different from the rationals, and likewise continuous maps have very different properties from smooth ones), but also the narrower theory, from which the original examples were drawn.
+
+== See also ==
+Fractal curve
+List of mathematical jargon
+Runge's phenomenon
+Gibbs phenomenon
+Paradoxical set
+
+== References ==
+
+== Notes ==
+
+== External links ==
+Pathological Structures & Fractals – Extract of an article by Freeman Dyson, "Characterising Irregularity", Science, May 1978
+This article incorporates material from pathological on PlanetMath, which is licensed under the Creative Commons Attribution/Share-Alike License.
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diff --git a/data/en.wikipedia.org/wiki/Percentage_point-0.md b/data/en.wikipedia.org/wiki/Percentage_point-0.md
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+---
+title: "Percentage point"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Percentage_point"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:47.195404+00:00"
+instance: "kb-cron"
+---
+
+A percentage point or percent point is the description for the arithmetic difference between two percentages. For example, moving up from 40 percent to 44 percent is an increase of 4 percentage points (although it is a 10-percent increase in the quantity being measured, if the total amount remains the same). In written text, the unit (the percentage point) is usually either written out, or abbreviated as pp, p.p., or %pt. to avoid confusion with percentage increase or decrease in the actual quantity. After the first occurrence, some writers abbreviate by using just "point" or "points".
+
+
+== Differences between percentages and percentage points ==
+Consider the following hypothetical example: In 1980, 50 percent of the population smoked, and in 1990 only 40 percent of the population smoked. One can thus say that from 1980 to 1990, the prevalence of smoking decreased by 10 percentage points (or by 10 percent of the population) or by 20 percent when talking about smokers only – percentages indicate proportionate part of a total. 
+Percentage-point differences are one way to express a risk or probability. Consider a drug that cures a given disease in 70 percent of all cases, while without the drug, the disease heals spontaneously in only 50 percent of cases. The drug reduces absolute risk by 20 percentage points. Alternatives may be more meaningful to consumers of statistics, such as the  reciprocal, also known as the number needed to treat (NNT). In this case, the reciprocal transform of the percentage-point difference would be 1/(20pp) = 1/0.20 = 5. Thus if 5 patients are treated with the drug, one could expect to cure one more patient than would have gotten well without receiving the treatment.
+For measurements involving percentages as a unit, such as, growth, yield, or ejection fraction, statistical deviations and related descriptive statistics, including the standard deviation and root-mean-square error, the result should be expressed in units of percentage points instead of percentage.  Mistakenly using percentage as the unit for the standard deviation is confusing, since percentage is also used as a unit for the relative standard deviation, i.e. standard deviation divided by average value (coefficient of variation).
+
+
+== Related units ==
+Percentage (%) 1 part in 100
+Per mille (‰) 1 part in 1,000
+Permyriad (‱) 1 part in 10,000
+Basis point (bp) difference of 1 part in 10,000
+Per cent mille (pcm) 1 part in 100,000
+Parts-per notation parts per million (ppm) etc.
+
+
+== See also ==
+Baker percentage – Mathematical notation in cooking
+Percent point function – Statistical function that defines the quantiles of a probability distribution
+Per-unit system – In power systems, expression of system quantities as fractions
+Relative change, also known as relative difference – Comparisons in quantitative sciences
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Pointwise-0.md b/data/en.wikipedia.org/wiki/Pointwise-0.md
new file mode 100644
index 000000000..8076c685d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Pointwise-0.md
@@ -0,0 +1,398 @@
+---
+title: "Pointwise"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Pointwise"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:48.491777+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the qualifier pointwise is used to indicate that a certain property is defined by considering each value 
+  
+    
+      
+        f
+        (
+        x
+        )
+      
+    
+    {\displaystyle f(x)}
+  
+ of some function 
+  
+    
+      
+        f
+        .
+      
+    
+    {\displaystyle f.}
+  
+ An important class of pointwise concepts are the pointwise operations, that is, operations defined on functions by applying the operations to function values separately for each point in the domain of definition. Important relations can also be defined pointwise.
+
+
+== Pointwise operations ==
+
+
+=== Formal definition ===
+A binary operation o: Y × Y → Y on a set Y can be lifted pointwise to an operation O: (X→Y) × (X→Y) → (X→Y) on the set X → Y of all functions from X to Y as follows: Given two functions f1: X → Y and f2: X → Y, define the function O(f1, f2): X → Y by
+
+Commonly, o and O are denoted by the same symbol. A similar definition is used for unary operations o, and for operations of other arity.
+
+
+=== Examples ===
+The pointwise addition 
+  
+    
+      
+        f
+        +
+        g
+      
+    
+    {\displaystyle f+g}
+  
+ of two functions 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ and 
+  
+    
+      
+        g
+      
+    
+    {\displaystyle g}
+  
+ with the same domain and codomain is defined by:
+
+The pointwise product or pointwise multiplication is:
+
+The pointwise product with a scalar is usually written with the scalar term first. Thus, when 
+  
+    
+      
+        λ
+      
+    
+    {\displaystyle \lambda }
+  
+ is a scalar:
+
+An example of an operation on functions which is not pointwise is convolution.
+
+
+=== Properties ===
+Pointwise operations inherit such properties as associativity, commutativity and distributivity from corresponding operations on the codomain. 
+If 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+  is some algebraic structure, the set of all functions 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to the carrier set of 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+ can be turned into an algebraic structure of the same type in an analogous way.
+
+
+== Componentwise operations ==
+Componentwise operations are usually defined on vectors, where vectors are elements of the set 
+  
+    
+      
+        
+          K
+          
+            n
+          
+        
+      
+    
+    {\displaystyle K^{n}}
+  
+ for some natural number 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+ and some field 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+. If we denote the 
+  
+    
+      
+        i
+      
+    
+    {\displaystyle i}
+  
+-th component of any vector 
+  
+    
+      
+        v
+      
+    
+    {\displaystyle v}
+  
+ as 
+  
+    
+      
+        
+          v
+          
+            i
+          
+        
+      
+    
+    {\displaystyle v_{i}}
+  
+, then componentwise addition is 
+  
+    
+      
+        (
+        u
+        +
+        v
+        
+          )
+          
+            i
+          
+        
+        =
+        
+          u
+          
+            i
+          
+        
+        +
+        
+          v
+          
+            i
+          
+        
+      
+    
+    {\displaystyle (u+v)_{i}=u_{i}+v_{i}}
+  
+.
+Componentwise operations can be defined on matrices. Matrix addition, where 
+  
+    
+      
+        (
+        A
+        +
+        B
+        
+          )
+          
+            i
+            j
+          
+        
+        =
+        
+          A
+          
+            i
+            j
+          
+        
+        +
+        
+          B
+          
+            i
+            j
+          
+        
+      
+    
+    {\displaystyle (A+B)_{ij}=A_{ij}+B_{ij}}
+  
+ is a componentwise operation while matrix multiplication is not.
+A tuple can be regarded as a function, and a vector is a tuple. Therefore, any vector 
+  
+    
+      
+        v
+      
+    
+    {\displaystyle v}
+  
+ corresponds to the function 
+  
+    
+      
+        f
+        :
+        n
+        →
+        K
+      
+    
+    {\displaystyle f:n\to K}
+  
+ such that 
+  
+    
+      
+        f
+        (
+        i
+        )
+        =
+        
+          v
+          
+            i
+          
+        
+      
+    
+    {\displaystyle f(i)=v_{i}}
+  
+, and any componentwise operation on vectors is the pointwise operation on functions corresponding to those vectors.
+
+
+== Pointwise relations ==
+In order theory it is common to define a pointwise partial order on functions. With A, B posets, the set of functions A → B can be ordered by defining f ≤ g if (∀x ∈ A) f(x) ≤ g(x). Pointwise orders also inherit some properties of the underlying posets. For instance if A and B are continuous lattices, then so is the set of functions A → B with pointwise order. Using the pointwise order on functions one can concisely define other important notions, for instance:
+
+A closure operator c on a poset P is a monotone and idempotent self-map on P (i.e. a projection operator) with the additional property that idA ≤ c, where id is the identity function.
+Similarly, a projection operator k is called a kernel operator if and only if k ≤ idA.
+An example of an infinitary pointwise relation is pointwise convergence of functions—a sequence of functions
+
+  
+    
+      
+        (
+        
+          f
+          
+            n
+          
+        
+        
+          )
+          
+            n
+            =
+            1
+          
+          
+            ∞
+          
+        
+      
+    
+    {\displaystyle (f_{n})_{n=1}^{\infty }}
+  
+
+with
+
+  
+    
+      
+        
+          f
+          
+            n
+          
+        
+        :
+        X
+        ⟶
+        Y
+      
+    
+    {\displaystyle f_{n}:X\longrightarrow Y}
+  
+
+converges pointwise to a function f if for each x in X
+
+  
+    
+      
+        
+          lim
+          
+            n
+            →
+            ∞
+          
+        
+        
+          f
+          
+            n
+          
+        
+        (
+        x
+        )
+        =
+        f
+        (
+        x
+        )
+        .
+      
+    
+    {\displaystyle \lim _{n\to \infty }f_{n}(x)=f(x).}
+  
+
+
+== Notes ==
+
+
+== References ==
+For order theory examples:
+
+T. S. Blyth, Lattices and Ordered Algebraic Structures, Springer, 2005, ISBN 1-85233-905-5.
+G. Gierz, K. H. Hofmann, K. Keimel, J. D. Lawson, M. Mislove, D. S. Scott: Continuous Lattices and Domains, Cambridge University Press, 2003.
+This article incorporates material from Pointwise on PlanetMath, which is licensed under the Creative Commons Attribution/Share-Alike License.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Porism-0.md b/data/en.wikipedia.org/wiki/Porism-0.md
new file mode 100644
index 000000000..e8ada3a43
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Porism-0.md
@@ -0,0 +1,34 @@
+---
+title: "Porism"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Porism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:49.702070+00:00"
+instance: "kb-cron"
+---
+
+A porism is a mathematical proposition or corollary. It has been used to refer to a direct consequence of a proof, analogous to how a corollary refers to a direct consequence of a theorem. In modern usage, it is a relationship that holds for an infinite range of values but only if a certain condition is assumed, such as Steiner's porism. The term originates from three books of Euclid that have been lost. A proposition may not have been proven, so a porism may not be a theorem or true.
+
+== Origins ==
+The book that talks about porisms first is Euclid's Porisms. What is known of it is in Pappus of Alexandria's Collection, who mentions it along with other geometrical treatises, and gives several lemmas necessary for understanding it. Pappus states:
+
+The porisms of all classes are neither theorems nor problems, but occupy a position intermediate between the two, so that their enunciations can be stated either as theorems or problems, and consequently some geometers think that they are theorems, and others that they are problems, being guided solely by the form of the enunciation. But it is clear from the definitions that the old geometers understood better the difference between the three classes. The older geometers regarded a theorem as directed to proving what is proposed, a problem as directed to constructing what is proposed, and finally a porism as directed to finding what is proposed (εἰς πορισμὸν αὐτοῦ τοῦ προτεινομένου).
+Pappus said that the last definition was changed by certain later geometers, who defined a porism as an accidental characteristic as τὸ λεῖπον ὑποθέσει τοπικοῦ θεωρήματος (to leîpon hypothései topikoû theōrḗmatos), that which falls short of a locus-theorem by a (or in its) hypothesis. Proclus pointed out that the word porism was used in two senses: one sense is that of "corollary", as a result unsought but seen to follow from a theorem. In the other sense, he added nothing to the definition of "the older geometers", except to say that the finding of the center of a circle and the finding of the greatest common measure are porisms.
+
+== Pappus on Euclid's porism ==
+Pappus rejected Euclid's definition of porism. A porism, expressed in modern language, asserts that given four straight lines, of which three turn about the points in which they meet the fourth if two of the points of intersection of these lines lie each on a fixed straight line, the remaining point of intersection will also lie on another straight line. The general definition applies to any number, n, of straight lines, of which n can turn about as many points fixed on the (n + 1)th.  These n straight lines cut two and two into 1⁄2n(n − 1) points, 1⁄2n(n − 1) being a triangular number whose side is n − 1. If they are made to turn about the n fixed points so that any n − 1 of their 1⁄2n(n − 1) points of intersection, chosen subject to a certain limitation, lie on n − 1 given fixed straight lines, then each of the remaining points of intersection, 1⁄2n(n − 1)(n − 2) in number, describes a straight line.
+The above can be expressed as: If about two fixed points, P and Q, one makes the turn two straight lines meeting on a given straight line, L, and if one of them cuts off a segment, AM, from a fixed straight line, AX, given in position, another fixed straight line BY, and a point B fixed on it can be determined, such that the segment BM' made by the second moving line on this second fixed-line measured from B has a given ratio X to AM. The lemmas which Pappus gives in connection with the porisms are:
+
+the fundamental theorem that the cross or anharmonic ratio of a pencil of four straight lines meeting in a point is constant for all transversals;
+the proof of the harmonic properties of a complete quadrilateral;
+the theorem that, if the six vertices of a hexagon lie three and three on two straight lines, the three points of the concourse of opposite sides lie on a straight line.
+
+== Later analysis ==
+Robert Simson explained the only three propositions which Pappus indicates with any completeness, which was published in the Philosophical Transactions in 1723. Later he investigated the subject of porisms generally in a work entitled De porismatibus traclatus; quo doctrinam porisrnatum satis explicatam, et in posterum ab oblivion tutam fore sperat auctor, and published after his death in a volume, Roberti Simson opera quaedam reliqua (Glasgow, 1776).
+Simson's treatise, De porismatibus, begins with the definitions for theorem, problem, datum, porism, and locus. Simon wrote that Pappus's definition is too general, and that he substituted it as:
+
+Porisma est propositio in qua proponitur demonstrare rem aliquam, vel plures datas esse, cui, vel quibus, ut et cuilibet ex rebus innumeris, non quidem datis, sed quae ad ea quae data sunt eandem habent rationem, convenire ostendendum est affectionem quandam communem in propositione descriptam. Porisma etiam in forma problematis enuntiari potest, si nimirum ex quibus data demonstranda sunt, invenienda proponantur.
+
+Simson said that a locus is a species of porism. Then follows a Latin translation of Pappus's note on the porisms, and the propositions which form the bulk of the treatise.
+John Playfair's memoir (Trans. Roy. Soc. Edin., 1794, vol. iii.), a sort of sequel to Simson's treatise, explored the probable origin of porisms, or the steps that led ancient geometers to discover them. Playfair remarked that the careful investigation of all possible particular cases of a proposition would show that 
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Porism-1.md b/data/en.wikipedia.org/wiki/Porism-1.md
new file mode 100644
index 000000000..843aed498
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Porism-1.md
@@ -0,0 +1,35 @@
+---
+title: "Porism"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Porism"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:49.702070+00:00"
+instance: "kb-cron"
+---
+
+under certain conditions a problem becomes impossible;
+under certain other conditions, indeterminate or capable of an infinite number of solutions.
+These cases could be defined separately, were in a manner intermediate between theorems and problems, and were called "porisms." Playfair defined a porism as "[a] proposition affirming the possibility of finding such conditions as will render a certain problem indeterminate or capable of innumerable solutions."
+Although Playfair's definition of a porism appears to be most favoured in England, Simson's view has been most generally accepted abroad, and had the support of Michel Chasles. However, in Liouville's Journal de mathematiques pures et appliquées (vol. xx., July, 1855), P. Breton published Recherches nouvelles sur les porismes d'Euclide, in which he gave a new translation of the text of Pappus, and sought to base a view of the nature of a porism that conforms more closely to Pappus's definition. This was followed in the same journal and in La Science by a controversy between Breton and A. J. H. Vincent, who disputed the interpretation given by the former of Pappus's text, and declared himself in favour of Frans van Schooten's idea, put forward in his Mathematicae exercitationes (1657). According to Schooten, if the various relations between straight lines in a figure are written down in the form of equations or proportions, then the combination of these equations in all possible ways, and of new equations thus derived from them leads to the discovery of innumerable new properties of the figure.
+The discussions between Breton and Vincent, which C. Housel joined, did not carry forward the work of restoring Euclid's Porisms, which was left for Chasles. His work (Les Trois livres de porismes d'Euclide, Paris, 1860) makes full use of all the material found in Pappus.
+An interesting hypothesis about porisms was put forward by H. G. Zeuthen (Die Lehre von den Kegelschnitten im Altertum, 1886, ch. viii.). Zeuthen observed, for example the intercept-porism is still true if the two fixed points are points on a conic, and the straight lines drawn through them intersect on the conic instead of on a fixed straight line. He conjectured that the porisms were a by-product of a fully developed projective geometry of conics.
+
+== See also ==
+
+Poncelet's porism
+Steiner's porism
+
+== Notes ==
+
+== References ==
+Alexander Jones (1986) Book 7 of the Collection, part 1: introduction, text, translation ISBN 0-387-96257-3, part 2: commentary, index, figures ISBN 3-540-96257-3, Springer-Verlag .
+J. L. Heiberg's Litterargeschichtliche Studien über Euklid (Leipzig, 1882) A valuable chapter on porisms (from a philological standpoint) is included.
+August Richter. Porismen nach Simson bearbeitet (Elbing, 1837)
+M. Cantor, "Über die Porismen des Euklid and deren Divinatoren," in Schlomilch's Zeitsch. f. Math. u. Phy. (1857), and Literaturzeitung (1861), p. 3 seq.
+Th. Leidenfrost, Die Porismen des Euklid (Programm der Realschule zu Weimar, 1863)
+John J. Milne (1911) An Elementary Treatise on Cross-Ratio Geometry with Historical Notes, page 115, Cambridge University Press.
+Fr. Buch-binder, Euclids Porismen und Data (Programm der kgl. Landesschule Pforta, 1866).
+Attribution:
+
+This article incorporates text from a publication now in the public domain: Heath, Thomas Little (1911). "Porism". In Chisholm, Hugh (ed.). Encyclopædia Britannica. Vol. 22 (11th ed.). Cambridge University Press. pp. 102–103.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Power,_root-power,_and_field_quantities-0.md b/data/en.wikipedia.org/wiki/Power,_root-power,_and_field_quantities-0.md
new file mode 100644
index 000000000..18e514d2d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Power,_root-power,_and_field_quantities-0.md
@@ -0,0 +1,30 @@
+---
+title: "Power, root-power, and field quantities"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Power,_root-power,_and_field_quantities"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:50.916584+00:00"
+instance: "kb-cron"
+---
+
+A power quantity is a power or a quantity directly proportional to power, e.g., energy density, acoustic intensity, and luminous intensity.  Energy quantities may also be labelled as power quantities in this context.
+A root-power quantity is a quantity such as voltage, current, sound pressure, electric field strength, speed, or charge density, the square of which, in linear systems, is proportional to power.  The term root-power quantity refers to the square root that relates these quantities to power. The term was introduced in ISO 80000-1 § Annex C; it replaces and deprecates the term field quantity.
+
+
+== Implications ==
+It is essential to know which category a measurement belongs to when using decibels (dB) for comparing the levels of such quantities.  A change of one bel in the level corresponds to a 10× change in power, so when comparing power quantities x and y, the difference is defined to be 10×log10(y/x) decibel.  With root-power quantities, however the difference is defined as 20×log10(y/x) dB.
+In the analysis of signals and systems using sinusoids, field quantities and root-power quantities may be complex-valued, as in the propagation constant.
+
+
+== "Root-power quantity" vs. "field quantity" ==
+In justifying the deprecation of the term "field quantity" and instead using "root-power quantity" in the context of levels, ISO 80000 draws attention to the conflicting use of the former term to mean a quantity that depends on the position, which in physics is called a field.  Such a field is often called a field quantity in the literature, but is called a field here for clarity.  Several types of field (such as the electromagnetic field) meet the definition of a root-power quantity, whereas others (such as the Poynting vector and temperature) do not.  Conversely, not every root-power quantity is a field (such as the voltage on a loudspeaker).
+
+
+== See also ==
+Level (logarithmic quantity)
+Fresnel reflection field and power equations
+Sound level, defined for each of several quantities associated with sound
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Projection_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Projection_(mathematics)-0.md
new file mode 100644
index 000000000..d2cdc0010
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Projection_(mathematics)-0.md
@@ -0,0 +1,43 @@
+---
+title: "Projection (mathematics)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Projection_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:52.122463+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a projection is a mapping from a set to itself—or an endomorphism of a mathematical structure—that is idempotent, that is, equals its composition with itself. The image of a point or a subset ⁠
+  
+    
+      
+        S
+      
+    
+    {\displaystyle S}
+  
+⁠ under a projection is called the projection of ⁠
+  
+    
+      
+        S
+      
+    
+    {\displaystyle S}
+  
+⁠.
+An everyday example of a projection is the casting of shadows onto a plane (sheet of paper): the projection of a point is its shadow on the sheet of paper, and the projection (shadow) of a point on the sheet of paper is that point itself (idempotency). The shadow of a three-dimensional sphere is a disk.  Originally, the notion of projection was introduced in Euclidean geometry to denote the projection of the three-dimensional Euclidean space onto a plane in it, like the shadow example. The two main projections of this kind are:
+
+The projection from a point onto a plane or central projection: If C is a point, called the  centre of projection, then the projection of a point P different from C onto a plane that does not contain C is the intersection of the line CP with the plane. The points P such that the line CP is parallel to the plane does not have any image by the projection, but one often says that they project to a point at infinity of the plane (see Projective geometry for a formalization of this terminology). The projection of the point C itself is not defined.
+The projection parallel to a direction D, onto a plane or parallel projection: The image of a point P is the intersection of the plane with the line parallel to D passing through P. See Affine space § Projection for an accurate definition, generalized to any dimension.
+The concept of projection in mathematics is a very old one, and most likely has its roots in the phenomenon of the shadows cast by real-world objects on the ground. This rudimentary idea was refined and abstracted, first in a geometric context and later in other branches of mathematics. Over time different versions of the concept developed, but today, in a sufficiently abstract setting, we can unify these variations.
+In cartography, a map projection is a map of a part of the surface of the Earth onto a plane, which, in some cases, but not always, is the restriction of a projection in the above meaning. The 3D projections are also at the basis of the theory of perspective.
+The need for unifying the two kinds of projections and of defining the image by a central projection of any point different of the center of projection are at the origin of projective geometry.
+
+== Definition ==
+
+Generally, a mapping where the domain and codomain are the same set (or mathematical structure) is a projection if the mapping is idempotent, which means that a projection is equal to its composition with itself. A projection may also refer to a mapping which has a right inverse. Both notions are strongly related, as follows. Let p be an idempotent mapping from a set A into itself (thus p ∘ p = p) and B = p(A) be the image of p. If we denote by π the map p viewed as a map from A onto B and by i the injection of B into A (so that p = i ∘ π), then we have π ∘ i = IdB (so that π has a right inverse). Conversely, if π has a right inverse i, then π ∘ i = IdB implies that i ∘ π ∘ i ∘ π = i ∘ IdB ∘ π = i ∘ π; that is, p = i ∘ π is idempotent.
+
+== Applications ==
+The original notion of projection has been extended or generalized to various mathematical situations, frequently, but not always, related to geometry, for example:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Projection_(mathematics)-1.md b/data/en.wikipedia.org/wiki/Projection_(mathematics)-1.md
new file mode 100644
index 000000000..90da84f78
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Projection_(mathematics)-1.md
@@ -0,0 +1,124 @@
+---
+title: "Projection (mathematics)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Projection_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:52.122463+00:00"
+instance: "kb-cron"
+---
+
+In set theory:
+An operation typified by the j-th projection map, written projj, that takes an element x = (x1, ..., xj, ..., xn) of the Cartesian product X1 × ⋯ × Xj × ⋯ × Xn to the value projj(x) = xj. This map is always surjective and, when each space Xk has a topology, this map is also continuous  and open.
+A mapping that takes an element to its equivalence class under a given equivalence relation is known as the canonical projection.
+The evaluation map sends a function f to the value f(x) for a fixed x.  The space of functions YX can be identified with the Cartesian product 
+  
+    
+      
+        
+          ∏
+          
+            i
+            ∈
+            X
+          
+        
+        Y
+      
+    
+    {\textstyle \prod _{i\in X}Y}
+  
+, and the evaluation map is a projection map from the Cartesian product.
+For relational databases and query languages, the projection is a  unary operation written as 
+  
+    
+      
+        
+          Π
+          
+            
+              a
+              
+                1
+              
+            
+            ,
+            …
+            ,
+            
+              a
+              
+                n
+              
+            
+          
+        
+        (
+        R
+        )
+      
+    
+    {\displaystyle \Pi _{a_{1},\ldots ,a_{n}}(R)}
+  
+ where 
+  
+    
+      
+        
+          a
+          
+            1
+          
+        
+        ,
+        …
+        ,
+        
+          a
+          
+            n
+          
+        
+      
+    
+    {\displaystyle a_{1},\ldots ,a_{n}}
+  
+ is a set of attribute names. The result of such projection is defined as the set that is obtained when all tuples in R are restricted to the set 
+  
+    
+      
+        {
+        
+          a
+          
+            1
+          
+        
+        ,
+        …
+        ,
+        
+          a
+          
+            n
+          
+        
+        }
+      
+    
+    {\displaystyle \{a_{1},\ldots ,a_{n}\}}
+  
+.  R is a database-relation.
+In spherical geometry, projection of a sphere upon a plane was used by Ptolemy (~150) in his Planisphaerium. The method is called stereographic projection and uses a plane tangent to a sphere and a pole C diametrically opposite the point of tangency.  Any point P on the sphere besides C determines a line CP intersecting the plane at the projected point for P. The correspondence makes the sphere a one-point compactification for the plane when a point at infinity is included to correspond to C, which otherwise has no projection on the plane. A common instance is the complex plane where the compactification corresponds to the Riemann sphere. Alternatively, a hemisphere is frequently projected onto a plane using the gnomonic projection.
+In linear algebra, a linear transformation that remains unchanged if applied twice: p(u) = p(p(u)). In other words, an idempotent operator.  For example, the mapping that takes a point (x, y, z) in three dimensions to the point (x, y, 0) is a projection. This type of projection naturally generalizes to any number of dimensions n for the domain and k ≤ n for the codomain of the mapping.  See Orthogonal projection, Projection (linear algebra).  In the case of orthogonal projections, the space admits a decomposition as a product, and the projection operator is a projection in that sense as well.
+In functional analysis and quantum mechanics, a specific kind of projection is used in the construction of projection-valued measures. In their sense, a projection is a self-adjoint idempotent linear operator.
+In differential topology, any fiber bundle includes a projection map as part of its definition.  Locally at least this map looks like a projection map in the sense of the product topology and is therefore open and surjective.
+In topology, a retraction is a continuous map r: X → X which restricts to the identity map on its image. This satisfies a similar idempotency condition r2 = r and can be considered a generalization of the projection map.  The image of a retraction is called a retract of the original space. A retraction which is homotopic to the identity is known as a deformation retraction.  This term is also used in category theory to refer to any split epimorphism.
+The scalar projection (or resolute) of one vector onto another.
+In category theory, the above notion of Cartesian product of sets can be generalized to arbitrary categories.  The product of some objects has a canonical projection morphism to each factor.  Special cases include the projection from the Cartesian product of sets, the product topology of topological spaces (which is always surjective and open), or from the direct product of groups, etc.  Although these morphisms are often epimorphisms and even surjective, they do not have to be.
+
+== References ==
+
+== Further reading ==
+Craig, Thomas  (1882) A Treatise on Projections from University of Michigan Historical Math Collection.
+Henrici, Olaus Magnus Friedrich (1911). "Projection" . Encyclopædia Britannica. Vol. 22 (11th ed.). pp. 427–434.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Proportion_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Proportion_(mathematics)-0.md
new file mode 100644
index 000000000..c3ad8410d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Proportion_(mathematics)-0.md
@@ -0,0 +1,475 @@
+---
+title: "Proportion (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Proportion_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:55.781739+00:00"
+instance: "kb-cron"
+---
+
+A proportion is a mathematical statement expressing equality of two ratios.
+
+  
+    
+      
+        a
+        :
+        b
+        =
+        c
+        :
+        d
+      
+    
+    {\displaystyle a:b=c:d}
+  
+
+a and d are called extremes, b and c are called means.
+Proportion can be written as 
+  
+    
+      
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle {\frac {a}{b}}={\frac {c}{d}}}
+  
+, where ratios are expressed as fractions.
+Such a proportion is known as geometrical proportion, not to be confused with arithmetical proportion and harmonic proportion.
+
+
+== Properties of proportions ==
+Fundamental rule of proportion. This rule is sometimes called Means‐Extremes Property. If the ratios are expressed as fractions, then the same rule can be phrased in terms of the equality of "cross-products" and is called Cross‐Products Property.
+If 
+  
+    
+      
+         
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{b}}={\frac {c}{d}}}
+  
+, then 
+  
+    
+      
+         
+        a
+        d
+        =
+        b
+        c
+      
+    
+    {\displaystyle \ ad=bc}
+  
+
+If 
+  
+    
+      
+         
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{b}}={\frac {c}{d}}}
+  
+, then 
+  
+    
+      
+         
+        
+          
+            b
+            a
+          
+        
+        =
+        
+          
+            d
+            c
+          
+        
+      
+    
+    {\displaystyle \ {\frac {b}{a}}={\frac {d}{c}}}
+  
+
+If 
+  
+    
+      
+         
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{b}}={\frac {c}{d}}}
+  
+, then
+
+  
+    
+      
+         
+        
+          
+            a
+            c
+          
+        
+        =
+        
+          
+            b
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{c}}={\frac {b}{d}}}
+  
+,
+
+  
+    
+      
+         
+        
+          
+            d
+            b
+          
+        
+        =
+        
+          
+            c
+            a
+          
+        
+      
+    
+    {\displaystyle \ {\frac {d}{b}}={\frac {c}{a}}}
+  
+.
+If 
+  
+    
+      
+         
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{b}}={\frac {c}{d}}}
+  
+, then
+
+  
+    
+      
+         
+        
+          
+            
+              
+                a
+                +
+                b
+              
+              b
+            
+          
+        
+        =
+        
+          
+            
+              
+                c
+                +
+                d
+              
+              d
+            
+          
+        
+      
+    
+    {\displaystyle \ {\dfrac {a+b}{b}}={\dfrac {c+d}{d}}}
+  
+,
+
+  
+    
+      
+         
+        
+          
+            
+              
+                a
+                −
+                b
+              
+              b
+            
+          
+        
+        =
+        
+          
+            
+              
+                c
+                −
+                d
+              
+              d
+            
+          
+        
+      
+    
+    {\displaystyle \ {\dfrac {a-b}{b}}={\dfrac {c-d}{d}}}
+  
+.
+If 
+  
+    
+      
+         
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\frac {a}{b}}={\frac {c}{d}}}
+  
+, then
+
+  
+    
+      
+         
+        
+          
+            
+              
+                a
+                +
+                c
+              
+              
+                b
+                +
+                d
+              
+            
+          
+        
+        =
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\dfrac {a+c}{b+d}}={\frac {a}{b}}={\frac {c}{d}}}
+  
+,
+
+  
+    
+      
+         
+        
+          
+            
+              
+                a
+                −
+                c
+              
+              
+                b
+                −
+                d
+              
+            
+          
+        
+        =
+        
+          
+            a
+            b
+          
+        
+        =
+        
+          
+            c
+            d
+          
+        
+      
+    
+    {\displaystyle \ {\dfrac {a-c}{b-d}}={\frac {a}{b}}={\frac {c}{d}}}
+  
+.
+
+
+== History ==
+A Greek mathematician Eudoxus provided a definition for the meaning of the equality between two ratios. This definition of proportion forms the subject of Euclid's Book V, where we can read:
+
+Magnitudes are said to be in the same ratio, the first to the second and the third to the fourth when, if any equimultiples whatever be taken of the first and third, and any equimultiples whatever of the second and fourth, the former equimultiples alike exceed, are alike equal to, or alike fall short of, the latter equimultiples respectively taken in corresponding order.
+Later, the realization that ratios are numbers allowed to switch from solving proportions to equations, and from transformation of proportions to algebraic transformations.
+
+
+== Related concepts ==
+
+
+=== Arithmetic proportion ===
+An equation of the form 
+  
+    
+      
+        a
+        −
+        b
+        =
+        c
+        −
+        d
+      
+    
+    {\displaystyle a-b=c-d}
+  
+ is called arithmetic proportion or difference proportion.
+
+
+=== Harmonic proportion ===
+
+If the means of the geometric proportion are equal, and the rightmost extreme is equal to the difference between the leftmost extreme and a mean, then such a proportion is called harmonic: 
+  
+    
+      
+        a
+        :
+        b
+        =
+        b
+        :
+        (
+        a
+        −
+        b
+        )
+      
+    
+    {\displaystyle a:b=b:(a-b)}
+  
+. In this case the ratio 
+  
+    
+      
+        a
+        :
+        b
+      
+    
+    {\displaystyle a:b}
+  
+ is called golden ratio.
+
+
+== See also ==
+Ratio
+Proportionality
+Correlation
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Proportionality_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Proportionality_(mathematics)-0.md
new file mode 100644
index 000000000..5d41435ae
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Proportionality_(mathematics)-0.md
@@ -0,0 +1,237 @@
+---
+title: "Proportionality (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Proportionality_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:56.943613+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, two sequences of numbers, often experimental data, are proportional or directly proportional if their corresponding elements have a constant ratio. The ratio is called coefficient of proportionality (or proportionality constant) and its reciprocal is known as constant of normalization (or normalizing constant). Two sequences are inversely proportional if corresponding elements have a constant product.
+Two functions 
+  
+    
+      
+        f
+        (
+        x
+        )
+      
+    
+    {\displaystyle f(x)}
+  
+ and 
+  
+    
+      
+        g
+        (
+        x
+        )
+      
+    
+    {\displaystyle g(x)}
+  
+ are proportional if their ratio 
+  
+    
+      
+        
+          
+            
+              f
+              (
+              x
+              )
+            
+            
+              g
+              (
+              x
+              )
+            
+          
+        
+      
+    
+    {\textstyle {\frac {f(x)}{g(x)}}}
+  
+ is a constant function.
+If several pairs of variables share the same direct proportionality constant, the equation expressing the equality of these ratios is called a proportion, e.g., ⁠a/b⁠ = ⁠x/y⁠ = ⋯ = k (for details see Ratio).
+Proportionality is closely related to linearity.
+
+
+== Direct proportionality ==
+
+Given an independent variable x and a dependent variable y, y is directly proportional to x if there is a positive constant k such that:
+
+  
+    
+      
+        y
+        =
+        k
+        x
+        .
+      
+    
+    {\displaystyle y=kx.}
+  
+
+The relation is often denoted using the symbols ∝ (not to be confused with the Greek letter alpha) or ~, with exception of Japanese texts, where ~ is reserved for intervals:
+
+  
+    
+      
+        y
+        ∝
+        x
+        
+        
+          or
+        
+        
+        y
+        ∼
+        x
+        .
+      
+    
+    {\displaystyle y\propto x\quad {\text{or}}\quad y\sim x.}
+  
+
+For x ≠ 0 the proportionality constant can be expressed as the ratio:
+
+  
+    
+      
+        k
+        =
+        
+          
+            y
+            x
+          
+        
+        .
+      
+    
+    {\displaystyle k={\frac {y}{x}}.}
+  
+
+It is also called the constant of variation or constant of proportionality. 
+Given such a constant k, the proportionality relation ∝ with proportionality constant k between two sets A and B is the equivalence relation defined by
+
+  
+    
+      
+        {
+        (
+        a
+        ,
+        b
+        )
+        ∈
+        A
+        ×
+        B
+        :
+        a
+        =
+        k
+        b
+        }
+        .
+      
+    
+    {\displaystyle \{(a,b)\in A\times B:a=kb\}.}
+  
+
+A direct proportionality can also be viewed as a linear equation in two variables with a y-intercept of 0 and a slope of k > 0, which corresponds to linear growth.
+
+
+=== Examples ===
+If an object travels at a constant speed, then the distance traveled is directly proportional to the time spent traveling, with the speed being the constant of proportionality.
+The circumference of a circle is directly proportional to its diameter, with the constant of proportionality equal to π.
+On a map of a sufficiently small geographical area, drawn to scale distances, the distance between any two points on the map is directly proportional to the beeline distance between the two locations represented by those points; the constant of proportionality is the scale of the map.
+The force, acting on a small object with small mass by a nearby large extended mass due to gravity, is directly proportional to the object's mass; the constant of proportionality between the force and the mass is known as gravitational acceleration.
+The net force acting on an object is proportional to the acceleration of that object with respect to an inertial frame of reference. The constant of proportionality in this, Newton's second law, is the classical mass of the object.
+
+
+== Inverse proportionality ==
+
+Two variables are inversely proportional (also called varying inversely, in inverse variation, in inverse proportion) if each of the variables is directly proportional to the multiplicative inverse (reciprocal) of the other, or equivalently if their product is a constant. It follows that the variable y is inversely proportional to the variable x if there exists a non-zero constant k such that
+
+  
+    
+      
+        y
+        =
+        
+          
+            k
+            x
+          
+        
+        
+        
+        ⟺
+        
+        
+        x
+        y
+        =
+        k
+        .
+      
+    
+    {\displaystyle y={\frac {k}{x}}\quad \iff \quad xy=k.}
+  
+
+Hence the constant k is the product of x and y.
+The graph of two variables varying inversely on the Cartesian coordinate plane is a rectangular hyperbola. The product of the x and y values of each point on the curve equals the constant of proportionality k. Since neither x nor y can equal zero (because k is non-zero), the graph never crosses either axis.
+Direct and inverse proportion contrast as follows: in direct proportion the variables increase or decrease together. With inverse proportion, an increase in one variable is associated with a decrease in the other. For instance, in travel, a constant speed dictates a direct proportion between distance and time travelled; in contrast, for a given distance (the constant), the time of travel is inversely proportional to speed: s × t = d.
+
+
+== Hyperbolic coordinates ==
+
+The concepts of direct and inverse proportion lead to the location of points in the Cartesian plane by hyperbolic coordinates; the two coordinates correspond to the constant of direct proportionality that specifies a point as being on a particular ray and the constant of inverse proportionality that specifies a point as being on a particular hyperbola.
+
+
+== Computer encoding ==
+The Unicode characters for proportionality are the following:
+
+U+221D ∝ PROPORTIONAL TO (&prop;, &Proportional;, &propto;, &varpropto;, &vprop;)
+U+007E ~ TILDE
+U+2237 ∷ PROPORTION
+U+223C ∼ TILDE OPERATOR (&sim;, &thicksim;, &thksim;, &Tilde;)
+U+223A ∺ GEOMETRIC PROPORTION (&mDDot;)
+
+
+== See also ==
+Linear map
+Correlation
+Eudoxus of Cnidus
+Golden ratio
+Inverse-square law
+Proportional font
+Ratio
+Rule of three (mathematics)
+Sample size
+Similarity
+Trairāśika
+Basic proportionality theorem
+Linear growth
+Hyperbolic growth
+
+
+== Notes ==
+
+
+== References ==
+Burrell, Brian: Merriam-Webster's Guide to Everyday Math: A Home and Business Reference. Merriam-Webster, 1998, ISBN 9780877796213, p. 85–101.
+Lanius, Cynthia S.; Williams Susan E.: PROPORTIONALITY: A Unifying Theme for the Middle Grades. Mathematics Teaching in the Middle School 8.8 (2003), p. 392–396.
+Seeley, Cathy; Schielack, Jane F.: A Look at the Development of Ratios, Rates, and Proportionality. Mathematics Teaching in the Middle School, 13.3, 2007, p. 140–142.
+Van Dooren, Wim; De Bock, Dirk; Evers, Marleen; Verschaffel, Lieven: Students' Overuse of Proportionality on Missing-Value Problems: How Numbers May Change Solutions. Journal for Research in Mathematics Education, 40.2, 2009, p. 187–211.
+Zeldovich, Ya. B., Yaglom, I. M.: Higher math for beginners, p. 34–35.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Purulent_pericarditis-0.md b/data/en.wikipedia.org/wiki/Purulent_pericarditis-0.md
new file mode 100644
index 000000000..af9a2493e
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Purulent_pericarditis-0.md
@@ -0,0 +1,56 @@
+---
+title: "Purulent pericarditis"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Purulent_pericarditis"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:47.030592+00:00"
+instance: "kb-cron"
+---
+
+Purulent pericarditis refers to localized inflammation in the setting of infection of the pericardial sac surrounding the heart. In contrast to other causes of pericarditis which may have a viral etiology, purulent pericarditis refers specifically to bacterial or fungal infection of the pericardial sac. Clinical etiologies of purulent pericarditis may include recent surgery, adjacent infection, trauma, or even primary infection. The onset of purulent pericarditis is usually acute, with most individuals presenting to a medical facility approximately 3 days following the onset of symptoms.
+As a subtype of pericarditis, purulent pericarditis often presents with substernal chest pain that is exacerbated by deep breathing and lying in the supine position. Other presenting features that may be more specific for purulent pericarditis include fever, rigors/chills, and cardiorespiratory signs (i.e., tachycardia, friction rub, pulsus paradoxus, pericardial effusion, cardiac tamponade, pleural effusion). The incidence of cardiac tamponade varies from 42-77% and is associated with rapid-onset mortality, especially without prompt intervention.
+Chest radiography may reveal cardiomegaly, pneumonia, pleural effusion, and/or mediastinal widening. Electrocardiogram (ECG) is a component of the diagnostic work-up which may suggest pericarditis as the underlying cause of symptoms. The ECG findings for purulent pericarditis are similar to those for other etiologies of pericarditis. ECG findings may include diffuse S-T segment elevation, diffuse T wave inversion, low QRS voltage, and/or electrical alternans. Echocardiogram may be used to evaluate for fluid collection in the pericardial sac, and may be important in guiding therapy in patients with signs of cardiac compromise (i.e., cardiac tamponade).
+Treatment modalities for purulent pericarditis include antibiotic therapy, with potential adjuncts such as pericardiocentesis or pericardial window when cardiac compromise is evident.
+
+
+== Causes ==
+Purulent pericarditis is usually caused by bacterial or fungal infection of the pericardial sac surrounding the heart. In modern medicine, the incidence of purulent pericarditis is uncommon. One study conducted in Spain identified an incidence < 0.006 in a population of 593,600. When comparing the pre-antibiotic period with the modern era of medicine, there is increased difficulty identifying a primary source of infection in the modern era of medicine. Primary infectious disease in the pre-antibiotic era was found most commonly secondary to pneumonia or endocarditis, whereas pneumonia or meningitis have been found more commonly in the modern era. Other risk factors that contribute to the development of purulent pericarditis include recent thoracic surgery, chronic renal failure, malignancy, immunosuppression, alcohol abuse, thoracic surgery, and chest trauma.
+
+
+== Signs and symptoms ==
+Purulent pericarditis usually presents acutely, marked by high fever, tachycardia, cough, and chest pain. While fever is present in almost all presentations, chest pain is less common when comparing purulent pericarditis to acute pericarditis from other etiologies. Additionally, a pericardial friction rub is present in 35-45% of cases, and the incidence of cardiac tamponade ranges from 42 to 77%. Studies have indicated that the average time elapsed before hospitalization is 3–10 days.
+
+
+== Diagnosis ==
+
+The diagnosis of purulent pericarditis requires a combination of clinical assessment, laboratory tests, and imaging studies. Pericardiocentesis with evaluation of pericardial fluid by culture and microscopy is necessary to make the diagnosis, however several other findings may increase the likelihood of purulent pericarditis.
+
+Leukocytosis (an increase in white blood cell count)
+Chest x-ray showing cardiomegaly, pulmonary infiltrates, pleural effusion(s), pericardial effusion, and/or mediastinal widening
+Electrocardiography (ECG) depicting changes consistent with acute pericarditis
+Echocardiography (transthoracic or transesophageal) showing fluid accumulation in the pericardial sac surrounding the heart with possible evidence of cardiac tamponade
+
+
+== Treatment ==
+
+Treatment for purulent pericarditis consists of two main components.
+
+Antimicrobial therapy. Empiric intravenous antimicrobial therapy is recommended as soon as a diagnosis of purulent pericarditis is suspected.
+Pericardial drainage. There are several therapeutic mechanisms that can be used to drain purulent fluid from the pericardial sac. These include pericardiocentesis, and possible subxiphoid pericardiotomy, pericardiectomy, and video-assisted thoracic surgery in complicated cases.
+
+
+== See also ==
+Acute pericarditis
+Chest pain
+Pericardial window
+Pericardiectomy
+Pericardiocentesis
+Pericarditis
+Pericardium
+
+
+== References ==
+
+
+== External links ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Q.E.D.-0.md b/data/en.wikipedia.org/wiki/Q.E.D.-0.md
new file mode 100644
index 000000000..8b8f7df1f
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Q.E.D.-0.md
@@ -0,0 +1,109 @@
+---
+title: "Q.E.D."
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Q.E.D."
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:58.133655+00:00"
+instance: "kb-cron"
+---
+
+Q.E.D. or QED is an initialism of the Latin phrase quod erat demonstrandum, meaning "that which was to be demonstrated". Literally, it states "what was to be shown". Traditionally, the abbreviation is placed at the end of mathematical proofs and philosophical arguments in print publications, to indicate that the proof or the argument is complete.
+
+
+== Etymology and early use ==
+The phrase quod erat demonstrandum is a translation into Latin from the Greek ὅπερ ἔδει δεῖξαι (hoper edei deixai; abbreviated as ΟΕΔ). The meaning of the Latin phrase is "that [thing] which was to be demonstrated" (with demonstrandum in the gerundive). 
+The Greek phrase was used by many early Greek mathematicians, including Euclid and Archimedes.
+The Latin phrase is attested in a 1501 Euclid translation of Giorgio Valla. Its abbreviation q.e.d. is used once in 1598 by Johannes Praetorius, more in 1643 by Anton Deusing, extensively in 1655 by Isaac Barrow in the form Q.E.D., and subsequently by many post-Renaissance mathematicians and philosophers.
+
+
+== Modern philosophy ==
+
+During the European Renaissance, scholars often wrote in Latin, and phrases such as Q.E.D. were often used to conclude proofs.
+
+Perhaps the most famous use of Q.E.D. in a philosophical argument is found in the Ethics of Baruch Spinoza, published posthumously in 1677. Written in Latin, it is considered by many to be Spinoza's magnum opus. The style and system of the book are, as Spinoza says, "demonstrated in geometrical order", with axioms and definitions followed by propositions. For Spinoza, this is a considerable improvement over René Descartes's writing style in the Meditations, which follows the form of a diary.
+
+
+== Difference from Q.E.F. ==
+There is another Latin phrase with a slightly different meaning, usually shortened similarly, but being less common in use. Quod erat faciendum, originating from the Greek geometers' closing ὅπερ ἔδει ποιῆσαι (hoper edei poiēsai), meaning "which had to be done". Because of the difference in meaning, the two phrases should not be confused.
+Euclid used the Greek original of Quod Erat Faciendum (Q.E.F.) to close propositions that were not proofs of theorems, but constructions of geometric objects. For example, Euclid's first proposition showing how to construct an equilateral triangle, given one side, is concluded this way.
+
+
+== Equivalent forms ==
+There is no common formal English equivalent, although the end of a proof may be announced with a simple statement such as "thus it is proved", "this completes the proof", "as required", "as desired", "as expected", "hence proved", "ergo", "so correct", or other similar phrases.
+
+
+== Typographical forms used symbolically ==
+
+Due to the paramount importance of proofs in mathematics, mathematicians since the time of Euclid have developed conventions to demarcate the beginning and end of proofs. In printed English language texts, the formal statements of theorems, lemmas, and propositions are set in italics by tradition. The beginning of a proof usually follows immediately thereafter, and is indicated by the word "proof" in boldface or italics. On the other hand, several symbolic conventions exist to indicate the end of a proof.
+While some authors still use the classical abbreviation, Q.E.D., it is relatively uncommon in modern mathematical texts. Paul Halmos claims to have pioneered the use of a solid black square (or rectangle) at the end of a proof as a Q.E.D. symbol, a practice which has become standard, although not universal. Halmos noted that he adopted this use of a symbol from magazine typography customs in which simple geometric shapes had been used to indicate the end of an article, so-called end marks. This symbol was later called the tombstone, the Halmos symbol, or even a halmos by mathematicians. Often the Halmos symbol is drawn on chalkboard to signal the end of a proof during a lecture, although this practice is not so common as its use in printed text.
+The tombstone symbol appears in TeX as the character 
+  
+    
+      
+        ◼
+      
+    
+    {\displaystyle \blacksquare }
+  
+ (filled square, \blacksquare) and sometimes, as a 
+  
+    
+      
+        ◻
+      
+    
+    {\displaystyle \square }
+  
+ (hollow square, \square or \Box). In the AMS Theorem Environment for LaTeX, the hollow square is the default end-of-proof symbol. Unicode explicitly provides the "end of proof" character, U+220E (∎). Some authors use other Unicode symbols to note the end of a proof, including, ▮ (U+25AE, a black vertical rectangle), and ‣ (U+2023, a triangular bullet). Other authors have adopted two forward slashes (//, 
+  
+    
+      
+        
+          /
+        
+        
+          /
+        
+      
+    
+    {\displaystyle //}
+  
+) or four forward slashes (////, 
+  
+    
+      
+        
+          /
+        
+        
+          /
+        
+        
+          /
+        
+        
+          /
+        
+      
+    
+    {\displaystyle ////}
+  
+). In other cases, authors have elected to segregate proofs typographically—by displaying them as indented blocks.
+
+
+== See also ==
+List of Latin abbreviations
+A priori and a posteriori
+Bob's your uncle
+Ipso facto
+Q.E.A.
+List of Latin phrases (E) § ergo
+
+
+== References ==
+
+
+== External links ==
+
+Earliest Known Uses of Some of the Words of Mathematics (Q)
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Quadrature_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Quadrature_(mathematics)-0.md
new file mode 100644
index 000000000..229c10dae
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Quadrature_(mathematics)-0.md
@@ -0,0 +1,75 @@
+---
+title: "Quadrature (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Quadrature_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:59.521729+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, quadrature is a historic term for the computation of areas and is thus used for computation of integrals. 
+The word is derived from the Latin quadratus meaning "square". The reason is that, for Ancient Greek mathematicians, the computation of an area consisted of constructing a square of the same area. In this sense, the modern term is squaring. For example, the quadrature of the circle, (or squaring the circle) is a famous old problem that has been shown, in the 19th century, to be impossible with the methods available to the Ancient Greeks.
+Integral calculus, introduced in the 17th century, is a general method for computation of areas. Quadrature came to refer to the computation of any integral; such a computation is presently called more often "integral" or "integration". However, the computation of solutions of differential equations and differential systems is also called integration, and quadrature remains useful for distinguishing integrals from solutions of differential equations, in contexts where both problems are considered. This is the case in numerical analysis; see numerical quadrature. Also, reduction to quadratures and solving by quadratures means expressing solutions of differential equations in terms of integrals.
+The remainder of this article is devoted to the original meaning of quadrature, namely, computation of areas.
+
+
+== History ==
+
+
+=== Antiquity ===
+
+Greek mathematicians understood the determination of an area of a figure as the process of geometrically constructing a square having the same area (squaring), thus the name quadrature for this process. The Greek geometers were not always successful (see squaring the circle), but they did carry out quadratures of some figures whose sides were not simply line segments, such as the lune of Hippocrates and the parabola. By a certain Greek tradition, these constructions had to be performed using only a compass and straightedge, though not all Greek mathematicians adhered to this dictum.
+
+For a quadrature of a rectangle with the sides a and b it is necessary to construct a square with the side 
+  
+    
+      
+        x
+        =
+        
+          
+            a
+            b
+          
+        
+      
+    
+    {\displaystyle x={\sqrt {ab}}}
+  
+ (the geometric mean of a and b). For this purpose it is possible to use the following: if one draws the circle with diameter made from joining line segments of lengths a and b, then the height (BH in the diagram) of the line segment drawn perpendicular to the diameter, from the point of their connection to the point where it crosses the circle, equals the geometric mean of a and b. A similar geometrical construction solves the problems of quadrature of a parallelogram and of a triangle.
+
+Problems of quadrature for curvilinear figures are much more difficult. The quadrature of the circle with compass and straightedge was proved in the 19th century to be impossible. Nevertheless, for some figures a quadrature can be performed. The quadratures of the surface of a sphere and a parabola segment discovered by Archimedes became the highest achievement of analysis in antiquity.
+
+The area of the surface of a sphere is equal to four times the area of the circle formed by a great circle of this sphere.
+The area of a segment of a parabola determined by a straight line cutting it is 4/3 the area of a triangle inscribed in this segment (specifically, of a triangle whose vertices are the parabola's two intersection points with the secant line and its intersection with a tangent line of the same slope).
+For the proofs of these results, Archimedes used the method of exhaustion attributed to Eudoxus.
+
+
+=== Medieval mathematics ===
+In medieval Europe, quadrature meant the calculation of area by any method. Most often the method of indivisibles was used; it was less rigorous than the geometric constructions of the Greeks, but it was simpler and more powerful. With its help, Galileo Galilei and Gilles de Roberval found the area of a cycloid arch, Grégoire de Saint-Vincent investigated the area under a hyperbola (Opus Geometricum, 1647), and Alphonse Antonio de Sarasa, de Saint-Vincent's pupil and commentator, noted the relation of this area to logarithms.
+
+
+=== Integral calculus ===
+John Wallis algebrised this method; he wrote in his Arithmetica Infinitorum (1656) some series which are equivalent to what is now called the definite integral, and he calculated their values. Isaac Barrow and James Gregory made further progress: quadratures for some algebraic curves and spirals. Christiaan Huygens successfully performed a quadrature of the surface area of some solids of revolution.
+The quadrature of the hyperbola by Gregoire de Saint-Vincent and A. A. de Sarasa provided a new function, the natural logarithm, of critical importance. With the invention of integral calculus came a universal method for area calculation. In response, the term quadrature has become traditional, and instead the modern phrase finding the area is more commonly used for what is technically the computation of a univariate definite integral.
+
+
+== See also ==
+Gaussian quadrature
+Hyperbolic angle
+Numerical integration
+Quadratrix
+Tanh-sinh quadrature
+
+
+== Notes ==
+
+
+== References ==
+Boyer, C. B. (1989) A History of Mathematics, 2nd ed. rev. by Uta C. Merzbach. New York: Wiley, ISBN 0-471-09763-2 (1991 pbk ed. ISBN 0-471-54397-7).
+Thomas Heath (1921) A History of Greek Mathematics, Oxford, Clarendon Press, via Internet Archive: Volume I, From Thales to Euclid, Volume II, From Aristarchus to Diophantus
+Eves, Howard (1990) An Introduction to the History of Mathematics, Saunders, ISBN 0-03-029558-0,
+Christiaan Huygens (1651) Theoremata de Quadratura Hyperboles, Ellipsis et Circuli
+Jean-Etienne Montucla (1873) History of the Quadrature of the Circle, J. Babin translator, William Alexander Myers editor, link from HathiTrust.
+Christoph Scriba (1983) "Gregory's Converging Double Sequence: a new look at the controversy between Huygens and Gregory over the 'analytical' quadrature of the circle", Historia Mathematica 10:274–85.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Qualitative_property-0.md b/data/en.wikipedia.org/wiki/Qualitative_property-0.md
new file mode 100644
index 000000000..20961169d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Qualitative_property-0.md
@@ -0,0 +1,44 @@
+---
+title: "Qualitative property"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Qualitative_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:00.803798+00:00"
+instance: "kb-cron"
+---
+
+Qualitative properties are properties that are observed and can generally not be measured with a numerical result, unlike quantitative properties, which have numerical characteristics.
+
+
+== Description ==
+Qualitative properties are properties that are observed and can generally not be measured with a numerical result. They are contrasted to quantitative properties which have numerical characteristics.
+
+
+=== Evaluation ===
+Although measuring something in qualitative terms is difficult, most people can (and will) make a judgement about a behaviour on the basis of how they feel treated. This indicates that qualitative properties are closely related to emotional impressions.
+A test method can result in qualitative data about something. This can be a categorical result or a binary classification (e.g., pass/fail, go/no go, conform/non-conform). It can sometimes be an engineering judgement.
+
+
+=== Categorization ===
+The data that all share a qualitative property form a nominal category. A variable which codes for the presence or absence of such a property is called a binary categorical variable, or equivalently a dummy variable.
+
+
+== Types ==
+Some engineering and scientific properties are qualitative.
+Some important qualitative properties that concern businesses are:
+Human factors, human work capital is important issue that deals with qualitative properties. Some common aspects are work, motivation, general participation, etc. Although all of these aspects are not measurable in terms of quantitative criteria, the general overview of them could be summarized as a quantitative property.
+Environmental issues are in some cases quantitatively measurable, but other properties are qualitative, including environmentally friendly manufacturing, responsibility for the entire life of a product (from the raw-material till scrap), attitudes towards safety, efficiency, and minimum waste production.
+Ethical issues are closely related to environmental and human issues, and may be covered in corporate governance. Child labour and illegal dumping of waste are examples of ethical issues.
+The way a company deals with its stockholders (the 'acting' of a company).
+
+
+== See also ==
+Categorical variable
+Level of measurement
+Qualitative research
+Quantitative research
+Statistical data type
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Reduction_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Reduction_(mathematics)-0.md
new file mode 100644
index 000000000..96cb991e6
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Reduction_(mathematics)-0.md
@@ -0,0 +1,408 @@
+---
+title: "Reduction (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Reduction_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:01.964455+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, reduction refers to the rewriting of an expression into a simpler form. For example, the process of rewriting a fraction into one with the smallest whole-number denominator possible (while keeping the numerator a whole number) is called "reducing a fraction". Rewriting a radical (or "root") expression with the smallest possible whole number under the radical symbol is called "reducing a radical". Minimizing the number of radicals that appear underneath other radicals in an expression is called denesting radicals.
+
+
+== Algebra ==
+In linear algebra, reduction refers to applying simple rules to a series of equations or matrices to change them into a simpler form. In the case of matrices, the process involves manipulating either the rows or the columns of the matrix and so is usually referred to as row-reduction or column-reduction, respectively.  Often the aim of reduction is to transform a matrix into its "row-reduced echelon form" or "row-echelon form"; this is the goal of Gaussian elimination.
+
+
+== Calculus ==
+In calculus, reduction refers to using the technique of integration by parts to evaluate integrals by reducing them to simpler forms.
+
+
+== Static (Guyan) reduction ==
+In dynamic analysis, static reduction refers to reducing the number of degrees of freedom. Static reduction can also be used in finite element analysis to refer to simplification of a linear algebraic problem. Since a static reduction requires several inversion steps it is an expensive matrix operation and is prone to some error in the solution. Consider the following system of linear equations in an FEA problem:
+
+  
+    
+      
+        
+          
+            [
+            
+              
+                
+                  
+                    K
+                    
+                      11
+                    
+                  
+                
+                
+                  
+                    K
+                    
+                      12
+                    
+                  
+                
+              
+              
+                
+                  
+                    K
+                    
+                      21
+                    
+                  
+                
+                
+                  
+                    K
+                    
+                      22
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+        
+          
+            [
+            
+              
+                
+                  
+                    x
+                    
+                      1
+                    
+                  
+                
+              
+              
+                
+                  
+                    x
+                    
+                      2
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+        =
+        
+          
+            [
+            
+              
+                
+                  
+                    F
+                    
+                      1
+                    
+                  
+                
+              
+              
+                
+                  
+                    F
+                    
+                      2
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+      
+    
+    {\displaystyle {\begin{bmatrix}K_{11}&K_{12}\\K_{21}&K_{22}\end{bmatrix}}{\begin{bmatrix}x_{1}\\x_{2}\end{bmatrix}}={\begin{bmatrix}F_{1}\\F_{2}\end{bmatrix}}}
+  
+
+where  K and F are known and K, x and F are divided into submatrices as shown above. If F2 contains only zeros, and only x1 is desired, K can be reduced to yield the following system of equations
+
+  
+    
+      
+        
+          
+            [
+            
+              
+                
+                  
+                    K
+                    
+                      11
+                      ,
+                      
+                        reduced
+                      
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+        
+          
+            [
+            
+              
+                
+                  
+                    x
+                    
+                      1
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+        =
+        
+          
+            [
+            
+              
+                
+                  
+                    F
+                    
+                      1
+                    
+                  
+                
+              
+            
+            ]
+          
+        
+      
+    
+    {\displaystyle {\begin{bmatrix}K_{11,{\text{reduced}}}\end{bmatrix}}{\begin{bmatrix}x_{1}\end{bmatrix}}={\begin{bmatrix}F_{1}\end{bmatrix}}}
+  
+
+  
+    
+      
+        
+          K
+          
+            11
+            ,
+            
+              reduced
+            
+          
+        
+      
+    
+    {\displaystyle K_{11,{\text{reduced}}}}
+  
+ is obtained by writing out the set of equations as follows:
+
+Equation (2) can be solved for 
+  
+    
+      
+        
+          x
+          
+            2
+          
+        
+      
+    
+    {\displaystyle x_{2}}
+  
+ (assuming invertibility of 
+  
+    
+      
+        
+          K
+          
+            22
+          
+        
+      
+    
+    {\displaystyle K_{22}}
+  
+):
+
+  
+    
+      
+        −
+        
+          K
+          
+            22
+          
+          
+            −
+            1
+          
+        
+        
+          K
+          
+            21
+          
+        
+        
+          x
+          
+            1
+          
+        
+        =
+        
+          x
+          
+            2
+          
+        
+        .
+      
+    
+    {\displaystyle -K_{22}^{-1}K_{21}x_{1}=x_{2}.}
+  
+
+And substituting into (1) gives
+
+  
+    
+      
+        
+          K
+          
+            11
+          
+        
+        
+          x
+          
+            1
+          
+        
+        −
+        
+          K
+          
+            12
+          
+        
+        
+          K
+          
+            22
+          
+          
+            −
+            1
+          
+        
+        
+          K
+          
+            21
+          
+        
+        
+          x
+          
+            1
+          
+        
+        =
+        
+          F
+          
+            1
+          
+        
+        .
+      
+    
+    {\displaystyle K_{11}x_{1}-K_{12}K_{22}^{-1}K_{21}x_{1}=F_{1}.}
+  
+
+Thus
+
+  
+    
+      
+        
+          K
+          
+            11
+            ,
+            
+              reduced
+            
+          
+        
+        =
+        
+          K
+          
+            11
+          
+        
+        −
+        
+          K
+          
+            12
+          
+        
+        
+          K
+          
+            22
+          
+          
+            −
+            1
+          
+        
+        
+          K
+          
+            21
+          
+        
+        .
+      
+    
+    {\displaystyle K_{11,{\text{reduced}}}=K_{11}-K_{12}K_{22}^{-1}K_{21}.}
+  
+
+In a similar fashion, any row or column i of F with a zero value may be eliminated if the corresponding value of xi is not desired. A reduced K may be reduced again. As a note, since each reduction requires an inversion, and each inversion is an operation with computational cost O(n3), most large matrices are pre-processed to reduce calculation time.
+
+
+== History ==
+In the 9th century, Persian mathematician Al-Khwarizmi's Al-Jabr introduced the fundamental concepts of "reduction" and "balancing", referring to the transposition of subtracted terms to the other side of an equation and the cancellation of like terms on opposite sides of the equation. This is the operation which Al-Khwarizmi originally described as al-jabr. The name "algebra" comes from the "al-jabr" in the title of his book.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Resilience_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Resilience_(mathematics)-0.md
new file mode 100644
index 000000000..2fb4135b5
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Resilience_(mathematics)-0.md
@@ -0,0 +1,97 @@
+---
+title: "Resilience (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Resilience_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:03.234631+00:00"
+instance: "kb-cron"
+---
+
+In mathematical modeling, resilience refers to the ability of a dynamical system to recover from perturbations and return to its original stable steady state. It is a measure of the stability and robustness of a system in the face of changes or disturbances. If a system is not resilient enough, it is more susceptible to perturbations and can more easily undergo a critical transition. A common analogy used to explain the concept of resilience of an equilibrium is one of a ball in a valley. A resilient steady state corresponds to a ball in a deep valley, so any push or perturbation will very quickly lead the ball to return to the resting point where it started. On the other hand, a less resilient steady state corresponds to a ball in a shallow valley, so the ball will take a much longer time to return to the equilibrium after a perturbation.
+The concept of resilience is particularly useful in systems that exhibit tipping points, whose study has a long history that can be traced back to catastrophe theory. While this theory was initially overhyped and fell out of favor, its mathematical foundation remains strong and is now recognized as relevant to many different systems.
+
+
+== History ==
+In 1973, Canadian ecologist C. S. Holling proposed a definition of resilience in the context of ecological systems. According to Holling, resilience is "a measure of the persistence of systems and of their ability to absorb change and disturbance and still maintain the same relationships between populations or state variables". Holling distinguished two types of resilience: engineering resilience and ecological resilience. Engineering resilience refers to the ability of a system to return to its original state after a disturbance, such as a bridge that can be repaired after an earthquake. Ecological resilience, on the other hand, refers to the ability of a system to maintain its identity and function despite a disturbance, such as a forest that can regenerate after a wildfire while maintaining its biodiversity and ecosystem services. With time, the once well-defined and unambiguous concept of resilience has experienced a gradual erosion of its clarity, becoming more vague and closer to an umbrella term than a specific concrete measure.
+
+
+== Definition ==
+Mathematically, resilience can be approximated by the inverse of the return time to an equilibrium given by
+
+  
+    
+      
+        
+          resilience
+        
+        ≡
+        −
+        
+          Re
+        
+        (
+        
+          λ
+          
+            1
+          
+        
+        (
+        
+          
+            A
+          
+        
+        )
+        )
+      
+    
+    {\displaystyle {\text{resilience}}\equiv -{\text{Re}}(\lambda _{1}({\textbf {A}}))}
+  
+
+where 
+  
+    
+      
+        
+          λ
+          
+            1
+          
+        
+      
+    
+    {\textstyle \lambda _{1}}
+  
+ is the maximum eigenvalue of matrix 
+  
+    
+      
+        
+          
+            A
+          
+        
+      
+    
+    {\textstyle {\textbf {A}}}
+  
+.
+The largest this value is, the faster a system returns to the original stable steady state, or in other words, the faster the perturbations decay.
+
+
+== Applications and examples ==
+In ecology, resilience might refer to the ability of the ecosystem to recover from disturbances such as fires, droughts, or the introduction of invasive species. A resilient ecosystem would be one that is able to adapt to these changes and continue functioning, while a less resilient ecosystem might experience irreversible damage or collapse. The exact definition of resilience has remained vague for practical matters, which has led to a slow and proper application of its insights for management of ecosystems.
+In epidemiology, resilience may refer to the ability of a healthy community to recover from the introduction of infected individuals. That is, a resilient system is more likely to remain at the disease-free equilibrium after the invasion of a new infection. Some stable systems exhibit critical slowing down where, as they approach a basic reproduction number of 1, their resilience decreases, hence taking a longer time to return to the disease-free steady state.
+Resilience is an important concept in the study of complex systems, where there are many interacting components that can affect each other in unpredictable ways. Mathematical models can be used to explore the resilience of such systems and to identify strategies for improving their resilience in the face of environmental or other changes. For example, when modelling networks it is often important to be able to quantify network resilience, or network robustness, to the loss of nodes. Scale-free networks are particularly resilient since most of their nodes have few links. This means that if some nodes are randomly removed, it is more likely that the nodes with fewer connections are taken out, thus preserving the key properties of the network.
+
+
+== See also ==
+Engineering resilience
+Ecological resilience
+Critical transition
+Bifurcation theory
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Rigidity_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Rigidity_(mathematics)-0.md
new file mode 100644
index 000000000..30779c95d
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Rigidity_(mathematics)-0.md
@@ -0,0 +1,425 @@
+---
+title: "Rigidity (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Rigidity_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:04.445143+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a rigid collection C of mathematical objects c (for instance sets or functions) is one in which every c ∈ C is uniquely determined by less information about c than one would expect.
+The above statement does not define a mathematical property; instead, it describes in what sense the adjective "rigid" is typically used in mathematics, by mathematicians.
+
+
+== Examples ==
+Some examples include:
+
+Harmonic functions on the unit disk are rigid in the sense that they are uniquely determined by their boundary values.
+Holomorphic functions are determined by the set of all derivatives at a single point. A smooth function from the real line to the complex plane is not,  in general, determined by all its derivatives at a single point, but it is if we require additionally that it be possible to extend the function to one on a neighbourhood of the real line in the complex plane. The Schwarz lemma is an example of such a rigidity theorem.
+By the fundamental theorem of algebra, polynomials in C are rigid in the sense that any polynomial is completely determined by its values on any infinite set, say N, or the unit disk. By the previous example, a polynomial is also determined within the set of holomorphic functions by the finite set of its non-zero derivatives at any single point.
+Linear maps L(X, Y) between vector spaces X, Y are rigid in the sense that any L ∈ L(X, Y) is completely determined by its values on any set of basis vectors of X.
+Mostow's rigidity theorem, which states that the geometric structure of negatively curved manifolds is determined by their topological structure.
+A well-ordered set is rigid in the sense that the only (order-preserving) automorphism on it is the identity function.  Consequently, an isomorphism between two given well-ordered sets will be unique.
+Cauchy's theorem on geometry of convex polytopes states that a convex polytope is uniquely determined by the geometry of its faces and combinatorial adjacency rules.
+Alexandrov's uniqueness theorem states that a convex polyhedron in three dimensions is uniquely determined by the metric space of geodesics on its surface.
+Rigidity results in K-theory show isomorphisms between various algebraic K-theory groups.
+Rigid groups in the inverse Galois problem.
+
+
+== Combinatorial use ==
+In combinatorics, the term rigid is also used to define the notion of a rigid surjection, which is a surjection 
+  
+    
+      
+        f
+        :
+        n
+        →
+        m
+      
+    
+    {\displaystyle f:n\to m}
+  
+ for which the following equivalent conditions hold:
+
+For every 
+  
+    
+      
+        i
+        ,
+        j
+        ∈
+        m
+      
+    
+    {\displaystyle i,j\in m}
+  
+, 
+  
+    
+      
+        i
+        <
+        j
+        
+        ⟹
+        
+        min
+        
+          f
+          
+            −
+            1
+          
+        
+        (
+        i
+        )
+        <
+        min
+        
+          f
+          
+            −
+            1
+          
+        
+        (
+        j
+        )
+      
+    
+    {\displaystyle i<j\implies \min f^{-1}(i)<\min f^{-1}(j)}
+  
+;
+Considering 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ as an 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+-tuple 
+  
+    
+      
+        
+          
+            (
+          
+        
+        f
+        (
+        0
+        )
+        ,
+        f
+        (
+        1
+        )
+        ,
+        …
+        ,
+        f
+        (
+        n
+        −
+        1
+        )
+        
+          
+            )
+          
+        
+      
+    
+    {\displaystyle {\big (}f(0),f(1),\ldots ,f(n-1){\big )}}
+  
+, the first occurrences of the elements in 
+  
+    
+      
+        m
+      
+    
+    {\displaystyle m}
+  
+ are in increasing order;
+
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ maps initial segments of 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+ to initial segments of 
+  
+    
+      
+        m
+      
+    
+    {\displaystyle m}
+  
+.
+This relates to the above definition of rigid, in that each rigid surjection 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ uniquely defines, and is uniquely defined by, a partition of 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+ into 
+  
+    
+      
+        m
+      
+    
+    {\displaystyle m}
+  
+ pieces. Given a rigid surjection 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+, the partition is defined by 
+  
+    
+      
+        n
+        =
+        
+          f
+          
+            −
+            1
+          
+        
+        (
+        0
+        )
+        ⊔
+        ⋯
+        ⊔
+        
+          f
+          
+            −
+            1
+          
+        
+        (
+        m
+        −
+        1
+        )
+      
+    
+    {\displaystyle n=f^{-1}(0)\sqcup \cdots \sqcup f^{-1}(m-1)}
+  
+. Conversely, given a partition of 
+  
+    
+      
+        n
+        =
+        
+          A
+          
+            0
+          
+        
+        ⊔
+        ⋯
+        ⊔
+        
+          A
+          
+            m
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle n=A_{0}\sqcup \cdots \sqcup A_{m-1}}
+  
+, order the 
+  
+    
+      
+        
+          A
+          
+            i
+          
+        
+      
+    
+    {\displaystyle A_{i}}
+  
+ by letting 
+  
+    
+      
+        
+          A
+          
+            i
+          
+        
+        ≺
+        
+          A
+          
+            j
+          
+        
+        
+        ⟺
+        
+        min
+        
+          A
+          
+            i
+          
+        
+        <
+        min
+        
+          A
+          
+            j
+          
+        
+      
+    
+    {\displaystyle A_{i}\prec A_{j}\iff \min A_{i}<\min A_{j}}
+  
+. If 
+  
+    
+      
+        n
+        =
+        
+          B
+          
+            0
+          
+        
+        ⊔
+        ⋯
+        ⊔
+        
+          B
+          
+            m
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle n=B_{0}\sqcup \cdots \sqcup B_{m-1}}
+  
+ is now the 
+  
+    
+      
+        ≺
+      
+    
+    {\displaystyle \prec }
+  
+-ordered partition, the function 
+  
+    
+      
+        f
+        :
+        n
+        →
+        m
+      
+    
+    {\displaystyle f:n\to m}
+  
+ defined by 
+  
+    
+      
+        f
+        (
+        i
+        )
+        =
+        j
+        
+        ⟺
+        
+        i
+        ∈
+        
+          B
+          
+            j
+          
+        
+      
+    
+    {\displaystyle f(i)=j\iff i\in B_{j}}
+  
+ is a rigid surjection.
+
+
+== See also ==
+Uniqueness theorem
+Structural rigidity, a mathematical theory describing the degrees of freedom of ensembles of rigid physical objects connected together by flexible hinges.
+Level structure (algebraic geometry)
+
+
+== References ==
+
+This article incorporates material from rigid on PlanetMath, which is licensed under the Creative Commons Attribution/Share-Alike License.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Scope_(logic)-0.md b/data/en.wikipedia.org/wiki/Scope_(logic)-0.md
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--- /dev/null
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@@ -0,0 +1,315 @@
+---
+title: "Scope (logic)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Scope_(logic)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:06.412643+00:00"
+instance: "kb-cron"
+---
+
+In logic, the scope of a quantifier or connective is the shortest formula in which it occurs, determining the range in the formula to which the quantifier or connective is applied. The notions of a free variable and bound variable are defined in terms of whether that formula is within the scope of a quantifier, and the notions of a dominant connective and subordinate connective are defined in terms of whether a connective includes another within its scope.
+
+
+== Connectives ==
+
+The scope of a logical connective occurring within a formula is the smallest well-formed formula that contains the connective in question. The connective with the largest scope in a formula is called its dominant connective, main connective, main operator, major connective, or principal connective; a connective within the scope of another connective is said to be subordinate to it.
+For instance, in the formula 
+  
+    
+      
+        (
+        
+          (
+          
+            
+              (
+              
+                P
+                →
+                Q
+              
+              )
+            
+            ∨
+            ¬
+            Q
+          
+          )
+        
+        ↔
+        
+          (
+          
+            ¬
+            ¬
+            P
+            ∧
+            Q
+          
+          )
+        
+        )
+      
+    
+    {\displaystyle (\left(\left(P\rightarrow Q\right)\lor \lnot Q\right)\leftrightarrow \left(\lnot \lnot P\land Q\right))}
+  
+, the dominant connective is ↔, and all other connectives are subordinate to it; the → is subordinate to the ∨, but not to the ∧; the first ¬ is also subordinate to the ∨, but not to the →; the second ¬ is subordinate to the ∧, but not to the ∨ or the →; and the third ¬ is subordinate to the second ¬, as well as to the ∧, but not to the ∨ or the →. If an order of precedence is adopted for the connectives, viz., with ¬ applying first, then ∧ and ∨, then →, and finally ↔, this formula may be written in the less parenthesized form 
+  
+    
+      
+        
+          (
+          
+            P
+            →
+            Q
+          
+          )
+        
+        ∨
+        ¬
+        Q
+        ↔
+        ¬
+        ¬
+        P
+        ∧
+        Q
+      
+    
+    {\displaystyle \left(P\rightarrow Q\right)\lor \lnot Q\leftrightarrow \lnot \lnot P\land Q}
+  
+, which some may find easier to read.
+
+
+== Quantifiers ==
+The scope of a quantifier is the part of a logical expression over which the quantifier exerts control. It is the shortest full sentence written right after the quantifier, often in parentheses; some authors describe this as including the variable written right after the universal or existential quantifier. In the formula ∀xP, for example, P (or xP) is the scope of the quantifier ∀x (or ∀).
+This gives rise to the following definitions:
+
+An occurrence of a quantifier 
+  
+    
+      
+        ∀
+      
+    
+    {\displaystyle \forall }
+  
+ or 
+  
+    
+      
+        ∃
+      
+    
+    {\displaystyle \exists }
+  
+, immediately followed by an occurrence of the variable 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+, as in 
+  
+    
+      
+        ∀
+        ξ
+      
+    
+    {\displaystyle \forall \xi }
+  
+ or 
+  
+    
+      
+        ∃
+        ξ
+      
+    
+    {\displaystyle \exists \xi }
+  
+, is said to be 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+-binding.
+An occurrence of a variable 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+ in a formula 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ is free in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ if, and only if, it is not in the scope of any 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+-binding quantifier in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+; otherwise it is bound in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+.
+A closed formula is one in which no variable occurs free; a formula which is not closed is open.
+An occurrence of a quantifier 
+  
+    
+      
+        ∀
+        ξ
+      
+    
+    {\displaystyle \forall \xi }
+  
+ or 
+  
+    
+      
+        ∃
+        ξ
+      
+    
+    {\displaystyle \exists \xi }
+  
+ is vacuous if, and only if, its scope is 
+  
+    
+      
+        ∀
+        ξ
+        ψ
+      
+    
+    {\displaystyle \forall \xi \psi }
+  
+ or 
+  
+    
+      
+        ∃
+        ξ
+        ψ
+      
+    
+    {\displaystyle \exists \xi \psi }
+  
+, and the variable 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+ does not occur free in 
+  
+    
+      
+        ψ
+      
+    
+    {\displaystyle \psi }
+  
+.
+A variable 
+  
+    
+      
+        ζ
+      
+    
+    {\displaystyle \zeta }
+  
+ is free for a variable 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+ if, and only if, no free occurrences of 
+  
+    
+      
+        ξ
+      
+    
+    {\displaystyle \xi }
+  
+ lie within the scope of a quantification on 
+  
+    
+      
+        ζ
+      
+    
+    {\displaystyle \zeta }
+  
+.
+A quantifier whose scope contains another quantifier is said to have wider scope than the second, which, in turn, is said to have narrower scope than the first.
+
+
+== See also ==
+Modal scope fallacy
+Prenex form
+Glossary of logic
+Free variables and bound variables
+Open formula
+
+
+== Notes ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Sides_of_an_equation-0.md b/data/en.wikipedia.org/wiki/Sides_of_an_equation-0.md
new file mode 100644
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--- /dev/null
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@@ -0,0 +1,56 @@
+---
+title: "Sides of an equation"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Sides_of_an_equation"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:07.638119+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, LHS is informal shorthand for the left-hand side of an equation.  Similarly, RHS is the right-hand side. The two sides have the same value, expressed differently, since equality is symmetric.
+More generally, these terms may apply to an inequation or inequality; the right-hand side is everything on the right side of a test operator in an expression, with LHS defined similarly.
+
+
+== Example ==
+The expression on the right side of the "=" sign is the right side of the equation and the expression on the left of the "=" is the left side of the equation.
+For example, in
+
+  
+    
+      
+        x
+        +
+        5
+        =
+        y
+        +
+        8
+      
+    
+    {\displaystyle x+5=y+8}
+  
+
+x + 5 is the left-hand side (LHS) and y + 8 is the right-hand side (RHS).
+
+
+== Homogeneous and inhomogeneous equations ==
+In solving mathematical equations, particularly linear simultaneous equations, differential equations and integral equations, the terminology homogeneous is often used for equations with some linear operator L on the LHS and 0 on the RHS. In contrast, an equation with a non-zero RHS is called inhomogeneous or non-homogeneous, as exemplified by
+
+Lf = g,
+with g a fixed function, which equation is to be solved for f. Then any solution of the inhomogeneous equation may have a solution of the homogeneous equation added to it, and still remain a solution.
+For example in mathematical physics, the homogeneous equation may correspond to a physical theory formulated in empty space, while the inhomogeneous equation asks for more 'realistic' solutions with some matter, or charged particles.
+
+
+== Syntax ==
+More abstractly, when using infix notation
+
+T * U
+the term T stands as the left-hand side and U as the right-hand side of the operator *. This usage is less common, though.
+
+
+== See also ==
+Equals sign
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Significand-0.md b/data/en.wikipedia.org/wiki/Significand-0.md
new file mode 100644
index 000000000..a81d695c1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Significand-0.md
@@ -0,0 +1,51 @@
+---
+title: "Significand"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Significand"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:08.958728+00:00"
+instance: "kb-cron"
+---
+
+The significand (also coefficient, sometimes argument, or more ambiguously mantissa, fraction, or characteristic) is the first (left) part of a number in scientific notation or related concepts in floating-point representation, consisting of its significant digits. For negative numbers, it does not include the initial minus sign.
+Depending on the interpretation of the exponent, the significand may represent an integer or a fractional number, which may cause the term "mantissa" to be misleading, since the mantissa of a logarithm is always its fractional part. Although the other names mentioned are common, significand is the word used by IEEE 754, an important technical standard for floating-point arithmetic. In mathematics, the term "argument" may also be ambiguous, since "the argument of a number" sometimes refers to the length of a circular arc from 1 to a number on the unit circle in the complex plane.
+
+
+== Example ==
+The number 123.45 can be represented as a decimal floating-point number with the integer 12345 as the significand and a 10−2 power term, also called characteristics, where −2 is the exponent (and 10 is the base). Its value is given by the following arithmetic:
+
+123.45 = 12345 × 10−2.
+This same value can also be represented in scientific notation with the significand 1.2345 as a fractional coefficient, and +2 as the exponent (and 10 as the base):
+
+123.45 = 1.2345 × 10+2.
+Computer scientist Hermann Schmid, however, called this representation with a significand ranging between 1.0 and 10 a modified normalized form.
+For base 2, this 1.xxxx form is also called a normalized significand.
+Finally, the value can be represented in the format given by the Language Independent Arithmetic standard and several programming language standards, including Ada, C, Fortran and Modula-2, as
+
+123.45 = 0.12345 × 10+3.
+Schmid called this representation with a significand ranging between 0.1 and 1.0 the true normalized form.
+
+
+== The hidden bit in floating point ==
+For a normalized number, the most significant digit is always non-zero.  When working in binary, this constraint uniquely determines this digit to always be 1. As such, it is not explicitly stored, being called the hidden bit.
+The significand is characterized by its width in (binary) digits, and depending on the context, the hidden bit may or may not be counted toward the width. For example, the same IEEE 754 double-precision format is commonly described as having either a 53-bit significand, including the hidden bit, or a 52-bit significand, excluding the hidden bit. IEEE 754 defines the precision p to be the number of digits in the significand, including any implicit leading bit (e.g., p = 53 for the double-precision format), thus in a way independent from the encoding, and the term to express what is encoded (that is, the significand without its leading bit) is trailing significand field.
+
+
+== Floating-point mantissa ==
+In 1914, Leonardo Torres Quevedo introduced the idea of floating-point arithmetic in his Essays on Automatics, where he proposed the format n; m, showing the need for a fixed-sized significand as currently used for floating-point data.
+In 1946, Arthur Burks used the terms mantissa and characteristic to describe the two parts of a floating-point number (Burks et al.) by analogy with the then-prevalent common logarithm tables: the characteristic is the integer part of the logarithm (i.e. the exponent), and the mantissa is the fractional part. The usage remains common among computer scientists today.
+The term significand was introduced by George Forsythe and Cleve Moler in 1967 and is the word used in the IEEE standard as the coefficient in front of a scientific notation number discussed above. The fractional part is called the fraction.
+To understand both terms, notice that in binary, 1 + mantissa ≈ significand, and the correspondence is exact when storing a power of two. This fact allows for a fast approximation of the base-2 logarithm, leading to algorithms e.g. for computing the fast square-root and fast inverse-square-root. The implicit leading 1 is nothing but the hidden bit in IEEE 754 floating point, and the bitfield storing the remainder is thus the mantissa.
+However, whether or not the implicit 1 is included is a major point of confusion with both terms—and especially so with mantissa. In keeping with the original usage in the context of log tables, it should not be present.
+For those contexts where 1 is considered included, William Kahan, lead creator of IEEE 754, and Donald E. Knuth, prominent computer programmer and author of The Art of Computer Programming, condemn the use of mantissa. This has led to declining use of the term mantissa in all contexts. In particular, the current IEEE 754 standard does not mention it.
+
+
+== See also ==
+Mantissa (logarithm)
+
+
+== Notes ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Stochastic-0.md b/data/en.wikipedia.org/wiki/Stochastic-0.md
new file mode 100644
index 000000000..21e7ccbd1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Stochastic-0.md
@@ -0,0 +1,41 @@
+---
+title: "Stochastic"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Stochastic"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:10.291744+00:00"
+instance: "kb-cron"
+---
+
+Stochastic (; from Ancient Greek  στόχος (stókhos) 'aim, guess') is the property of being well-described by a random probability distribution. Stochasticity and randomness are technically distinct concepts. Stochasticity refers to a modeling approach, while randomness describes phenomena. These terms are often used interchangeably. In probability theory, the formal concept of a stochastic process is also referred to as a random process.
+Stochasticity is used in many different fields, including actuarial science, image processing, signal processing, computer science, information theory, telecommunications, chemistry, ecology, neuroscience, physics, and cryptography. It is also used in finance, medicine, linguistics,  music, media, colour theory,  botany, manufacturing and geomorphology.
+
+== Etymology ==
+The word stochastic in English was originally used as an adjective with the definition "pertaining to conjecturing", and stemming from a Greek word meaning "to aim at a mark,  guess", and the Oxford English Dictionary gives the year 1662 as its earliest occurrence. In his work on probability Ars Conjectandi, originally published in Latin in 1713, Jakob Bernoulli  used the phrase "Ars Conjectandi sive Stochastice", which has been translated to  "the art of conjecturing or stochastics". This phrase was used, with reference to Bernoulli, by Ladislaus Bortkiewicz, who in 1917 wrote in German the word Stochastik with a sense meaning random.  The term stochastic process first appeared in English in a 1934 paper by  Joseph L. Doob. For the term and a specific mathematical definition, Doob cited another 1934 paper, where the term stochastischer Prozeß  was used in German by Aleksandr Khinchin, though the German term had been used earlier in 1931 by Andrey Kolmogorov.
+
+== Mathematics ==
+In the early 1930s, Aleksandr Khinchin gave the first mathematical definition of a stochastic process as a family of random variables indexed by the real line. Further fundamental work on probability theory and stochastic processes was done by Khinchin as well as other mathematicians such as Andrey Kolmogorov, Joseph Doob, William Feller, Maurice Fréchet, Paul Lévy, Wolfgang Doeblin, and Harald Cramér. Decades later Cramér referred to the 1930s as the "heroic period of mathematical probability theory".
+In mathematics, the theory of stochastic processes is an important contribution to probability theory, and continues to be an active topic of research for both theory and applications.
+The word stochastic is used to describe other terms and objects in mathematics. Examples include a stochastic matrix, which describes a stochastic process known as a Markov process, and stochastic calculus, which involves differential equations and  integrals based on stochastic processes such as the Wiener process, also called the Brownian motion process.
+
+== Natural science ==
+One of the simplest continuous-time stochastic processes is Brownian motion. This was first observed by botanist Robert Brown while looking through a microscope at pollen grains in water.
+
+== Physics ==
+The Monte Carlo method is a stochastic method popularized by physics researchers Stanisław Ulam, Enrico Fermi, John von Neumann, and Nicholas Metropolis. The use of randomness and the repetitive nature of the process are analogous to the activities conducted at a casino.
+Methods of simulation and statistical sampling generally did the opposite: using simulation to test a previously understood deterministic problem. Though examples of an "inverted" approach do exist historically, they were not considered a general method until the popularity of the Monte Carlo method spread.
+Perhaps the most famous early use was by Enrico Fermi in 1930, when he used a random method to calculate the properties of the newly discovered neutron. Monte Carlo methods were central to the simulations required for the Manhattan Project, though they were severely limited by the computational tools of the time. Therefore, it was only after electronic computers were first built (from 1945 on) that Monte Carlo methods began to be studied in depth. In the 1950s they were used at Los Alamos for early work relating to the development of the hydrogen bomb, and became popularized in the fields of physics, physical chemistry, and operations research. The RAND Corporation and the U.S. Air Force were two of the major organizations responsible for funding and disseminating information on Monte Carlo methods during this time, and they began to find a wide application in many different fields.
+Uses of Monte Carlo methods require large amounts of random numbers, and it was their use that spurred the development of pseudorandom number generators, which were far quicker to use than the tables of random numbers which had been previously used for statistical sampling.
+
+== Biology ==
+In biological systems the technique of stochastic resonance - introducing stochastic "noise" - has been found to help improve the signal-strength of the internal feedback-loops for balance and other vestibular communication. The technique has helped diabetic and stroke patients with balance control.
+Many biochemical events lend themselves to stochastic analysis. Gene expression, for example, has a stochastic component through the molecular collisions—e.g., during binding and unbinding of RNA polymerase to a gene promoter which contributes to bursts of transcription and super-Poissonian variability in cell-to-cell RNA distributions —via the solution's Brownian motion.
+
+== Creativity ==
+Simonton (2003, Psych Bulletin) argues that creativity in science (of scientists) is a constrained stochastic behaviour such that new theories in all sciences are, at least in part, the product of a stochastic process.
+
+== Computer science ==
+Stochastic ray tracing is the application of Monte Carlo simulation to the computer graphics ray tracing algorithm. "Distributed ray tracing samples the integrand at many randomly chosen points and averages the results to obtain a better approximation. It is essentially an application of the Monte Carlo method to 3D computer graphics, and for this reason is also called Stochastic ray tracing."
+Stochastic forensics analyzes computer crime by viewing computers as stochastic steps.
+In artificial intelligence, stochastic programs work by using probabilistic methods to solve problems, as in simulated annealing, stochastic neural networks, stochastic optimization, genetic algorithms, and genetic programming. A problem itself may be stochastic as well, as in planning under uncertainty. Large language models have been described as stochastic parrots.
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+---
+title: "Stochastic"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Stochastic"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:10.291744+00:00"
+instance: "kb-cron"
+---
+
+== Finance ==
+The financial markets use stochastic models to represent the seemingly random behaviour of various financial assets, including the random behavior of the price of one currency compared to that of another (such as the price of US Dollar compared to that of the Euro), and also to represent random behaviour of interest rates. These models are then used by financial analysts to value options on stock prices, bond prices, and on interest rates, see Markov models. Moreover, it is at the heart of the insurance industry.
+
+== Geomorphology ==
+
+The formation of river meanders has been analyzed as a stochastic process.
+
+== Language and linguistics ==
+Non-deterministic approaches in language studies are largely inspired by the work of Ferdinand de Saussure, for example, in functionalist linguistic theory, which argues that competence is based on performance. This distinction in functional theories of grammar should be carefully distinguished from the langue and parole distinction. To the extent that linguistic knowledge is constituted by experience with language, grammar is argued to be probabilistic and variable rather than fixed and absolute.  This conception of grammar as probabilistic and variable follows from the idea that one's competence changes in accordance with one's experience with language. Though this conception has been contested, it has also provided the foundation for modern statistical natural language processing and for theories of language learning and change.
+
+== Manufacturing ==
+Manufacturing processes are assumed to be stochastic processes.  This assumption is largely valid for either continuous or batch manufacturing processes.  Testing and monitoring of the process is recorded using a process control chart which plots a given process control parameter over time.  Typically a dozen or many more parameters will be tracked simultaneously.  Statistical models are used to define limit lines which define when corrective actions must be taken to bring the process back to its intended operational window.
+This same approach is used in the service industry where parameters are replaced by processes related to service level agreements.
+
+== Media ==
+The marketing and the changing movement of audience tastes and preferences, as well as the solicitation of and the scientific appeal of certain film and television debuts (i.e., their opening weekends, word-of-mouth, top-of-mind knowledge among surveyed groups, star name recognition and other elements of social media outreach and advertising), are determined in part by stochastic modeling.
+
+== Medicine ==
+
+Stochastic effect, or "chance effect" is one classification of radiation effects that refers to the random, statistical nature of the damage. In contrast to the deterministic effect, severity is independent of dose. Only the probability of an effect increases with dose.
+
+== Music ==
+In music, mathematical processes based on probability can generate stochastic elements.
+Stochastic processes may be used in music to compose a fixed piece or may be produced in performance. Stochastic music was pioneered by Iannis Xenakis, who coined the term stochastic music. Specific examples of mathematics, statistics, and physics applied to music composition are the use of the statistical mechanics of gases in Pithoprakta, statistical distribution of points on a plane in Diamorphoses, minimal constraints in Achorripsis, the normal distribution in ST/10 and Atrées, Markov chains in Analogiques, game theory in Duel and Stratégie, group theory in Nomos Alpha (for Siegfried Palm), set theory in Herma and Eonta, and Brownian motion in N'Shima. Xenakis frequently used computers to produce his scores, such as the ST series including Morsima-Amorsima and Atrées, and founded CEMAMu. Earlier, John Cage and others had composed aleatoric or indeterminate music, which is created by chance processes but does not have the strict mathematical basis (Cage's Music of Changes, for example, uses a system of charts based on the I-Ching). Lejaren Hiller and Leonard Issacson used generative grammars and Markov chains in their 1957 Illiac Suite. Modern electronic music production techniques make these processes relatively simple to implement, and many hardware devices such as synthesizers and drum machines incorporate randomization features. Generative music techniques are therefore readily accessible to composers, performers, and producers.
+
+== Social sciences ==
+Stochastic social science theory is similar to systems theory in that events are interactions of systems, although with a marked emphasis on unconscious processes.  The event creates its own conditions of possibility, rendering it unpredictable if simply for the number of variables involved.  Stochastic social science theory can be seen as an elaboration of a kind of 'third axis' in which to situate human behavior alongside the traditional 'nature vs. nurture' opposition.  See Julia Kristeva on her usage of the 'semiotic', Luce Irigaray on reverse Heideggerian epistemology, and Pierre Bourdieu on polythetic space for examples of stochastic social science theory.
+The term stochastic terrorism has come into frequent use with regard to lone wolf terrorism. The terms "Scripted Violence" and "Stochastic Terrorism" are linked in a "cause <> effect" relationship. "Scripted violence" rhetoric can result in an act of "stochastic terrorism". The phrase "scripted violence" has been used in social science since at least 2002.
+Author David Neiwert, who wrote the book Alt-America, told Salon interviewer Chauncey Devega:
+
+Scripted violence is where a person who has a national platform describes the kind of violence that they want to be carried out. He identifies the targets and leaves it up to the listeners to carry out this violence. It is a form of terrorism. It is an act and a social phenomenon where there is an agreement to inflict massive violence on a whole segment of society. Again, this violence is led by people in high-profile positions in the media and the government. They're the ones who do the scripting, and it is ordinary people who carry it out.Think of it like Charles Manson and his followers. Manson wrote the script; he didn't commit any of those murders. He just had his followers carry them out.
+
+== Subtractive color reproduction ==
+When color reproductions are made, the image is separated into its component colors by taking multiple photographs filtered for each color. One resultant film or plate represents each of the cyan, magenta, yellow, and black data. Color printing is a binary system, where ink is either present or not present, so all color separations to be printed must be translated into dots at some stage of the work-flow. Traditional line screens which are amplitude modulated had problems with moiré but were used until stochastic screening became available. A stochastic (or frequency modulated) dot pattern creates a sharper image.
+
+== See also ==
+Jump process
+Sortition
+Stochastic process
+
+== Notes ==
+
+== References ==
+
+== Further reading ==
+Formalized Music: Thought and Mathematics in Composition by Iannis Xenakis, ISBN 1-57647-079-2
+Frequency and the Emergence of Linguistic Structure by Joan Bybee and Paul Hopper (eds.), ISBN 1-58811-028-1/ISBN 90-272-2948-1 (Eur.)
+The Stochastic Empirical Loading and Dilution Model provides documentation and computer code for modeling stochastic processes in Visual Basic for Applications.
+
+== External links ==
+ The dictionary definition of stochastic at Wiktionary
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diff --git a/data/en.wikipedia.org/wiki/Stratification_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Stratification_(mathematics)-0.md
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+---
+title: "Stratification (mathematics)"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Stratification_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:11.575927+00:00"
+instance: "kb-cron"
+---
+
+Stratification has several usages in mathematics.
+
+
+== In mathematical logic ==
+In mathematical logic, stratification is any consistent assignment of numbers to predicate symbols guaranteeing that a unique formal interpretation of a logical theory exists. Specifically, we say that a set of clauses of the form 
+  
+    
+      
+        
+          Q
+          
+            1
+          
+        
+        ∧
+        ⋯
+        ∧
+        
+          Q
+          
+            n
+          
+        
+        ∧
+        ¬
+        
+          Q
+          
+            n
+            +
+            1
+          
+        
+        ∧
+        ⋯
+        ∧
+        ¬
+        
+          Q
+          
+            n
+            +
+            m
+          
+        
+        →
+        P
+      
+    
+    {\displaystyle Q_{1}\wedge \dots \wedge Q_{n}\wedge \neg Q_{n+1}\wedge \dots \wedge \neg Q_{n+m}\rightarrow P}
+  
+ is stratified if and only if
+there is a stratification assignment S that fulfills the following conditions:
+
+If a predicate P is positively derived from a predicate Q (i.e., P is the head of a rule, and Q occurs positively in the body of the same rule), then the stratification number of P must be greater than or equal to the stratification number of Q, in short 
+  
+    
+      
+        S
+        (
+        P
+        )
+        ≥
+        S
+        (
+        Q
+        )
+      
+    
+    {\displaystyle S(P)\geq S(Q)}
+  
+.
+If a predicate P is derived from a negated predicate Q (i.e., P is the head of a rule, and Q occurs negatively in the body of the same rule), then the stratification number of P must be greater than the stratification number of Q, in short 
+  
+    
+      
+        S
+        (
+        P
+        )
+        >
+        S
+        (
+        Q
+        )
+      
+    
+    {\displaystyle S(P)>S(Q)}
+  
+.
+The notion of stratified negation leads to a very effective operational semantics for stratified programs in terms of the stratified least fixpoint, that is obtained by iteratively applying the fixpoint operator to each stratum of the program, from the lowest one up.
+Stratification is not only useful for guaranteeing unique interpretation of Horn clause
+theories. 
+
+
+== In a specific set theory ==
+In New Foundations (NF) and related set theories, a formula 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ in the language of first-order logic with equality and membership is said to be
+stratified if and only if there is a function
+
+  
+    
+      
+        σ
+      
+    
+    {\displaystyle \sigma }
+  
+ which sends each variable appearing in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ (considered as an item of syntax) to
+a natural number (this works equally well if all integers are used) in such a way that
+any atomic formula 
+  
+    
+      
+        x
+        ∈
+        y
+      
+    
+    {\displaystyle x\in y}
+  
+ appearing in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ satisfies 
+  
+    
+      
+        σ
+        (
+        x
+        )
+        +
+        1
+        =
+        σ
+        (
+        y
+        )
+      
+    
+    {\displaystyle \sigma (x)+1=\sigma (y)}
+  
+ and any atomic formula 
+  
+    
+      
+        x
+        =
+        y
+      
+    
+    {\displaystyle x=y}
+  
+ appearing in 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ satisfies 
+  
+    
+      
+        σ
+        (
+        x
+        )
+        =
+        σ
+        (
+        y
+        )
+      
+    
+    {\displaystyle \sigma (x)=\sigma (y)}
+  
+.
+It turns out that it is sufficient to require that these conditions be satisfied only when
+both variables in an atomic formula are bound in the set abstract 
+  
+    
+      
+        {
+        x
+        ∣
+        ϕ
+        }
+      
+    
+    {\displaystyle \{x\mid \phi \}}
+  
+
+under consideration.  A set abstract satisfying this weaker condition is said to be
+weakly stratified.
+The stratification of New Foundations generalizes readily to languages with more
+predicates and with term constructions.  Each primitive predicate needs to have specified
+required displacements between values of 
+  
+    
+      
+        σ
+      
+    
+    {\displaystyle \sigma }
+  
+ at its (bound) arguments
+in a (weakly) stratified formula.  In a language with term constructions, terms themselves
+need to be assigned values under 
+  
+    
+      
+        σ
+      
+    
+    {\displaystyle \sigma }
+  
+, with fixed displacements from the
+values of each of their (bound) arguments in a (weakly) stratified formula.  Defined term
+constructions are neatly handled by (possibly merely implicitly) using the theory
+of descriptions:  a term 
+  
+    
+      
+        (
+        ι
+        x
+        .
+        ϕ
+        )
+      
+    
+    {\displaystyle (\iota x.\phi )}
+  
+ (the x such that 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+) must
+be assigned the same value under 
+  
+    
+      
+        σ
+      
+    
+    {\displaystyle \sigma }
+  
+ as the variable x.
+A formula is stratified if and only if it is possible to assign types to all variables appearing
+in the formula in such a way that it will make sense in a version TST of the theory of
+types described in the New Foundations article, and this is probably the best way
+to understand the stratification of New Foundations in practice.
+The notion of stratification can be extended to the lambda calculus; this is found
+in papers of Randall Holmes.
+A motivation for the use of stratification is to address Russell's paradox, the antinomy considered to have undermined Frege's central work Grundgesetze der Arithmetik (1902).
+Quine, Willard Van Orman (1963) [1961]. From a Logical Point of View (2nd ed.). New York: Harper & Row. p. 90. LCCN 61-15277.
+
+
+== In topology ==
+
+In singularity theory, there is a different meaning, of a decomposition of a topological space X into disjoint subsets each of which is a topological manifold (so that in particular a  stratification defines a  partition of the topological space). This is not a useful notion when unrestricted; but when the various strata are defined by some recognisable set of conditions (for example being locally closed), and fit together manageably, this idea is often applied in geometry. Hassler Whitney and René Thom first defined formal conditions for stratification.  See Whitney stratification and topologically stratified space.
+
+
+== In statistics ==
+See stratified sampling.
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Strict-0.md b/data/en.wikipedia.org/wiki/Strict-0.md
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+---
+title: "Strict"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Strict"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:12.769533+00:00"
+instance: "kb-cron"
+---
+
+In mathematical writing, the term strict refers to the property of excluding equality and equivalence and often occurs in the context of inequality and monotonic functions. It is often attached to a technical term to indicate that the exclusive meaning of the term is to be understood. The opposite is non-strict, which is often understood to be the case but can be put explicitly for clarity. In some contexts, the word "proper" can also be used as a mathematical synonym for "strict".
+
+
+== Use ==
+This term is commonly used in the context of inequalities — the phrase "strictly less than" means "less than and not equal to" (likewise "strictly greater than" means "greater than and not equal to"). More generally, a strict partial order, strict total order, and strict weak order exclude equality and equivalence.
+When comparing numbers to zero, the phrases "strictly positive" and "strictly negative" mean "positive and not equal to zero" and "negative and not equal to zero", respectively. In the context of functions, the adverb "strictly" is used to modify the terms "monotonic", "increasing", and "decreasing".
+On the other hand, sometimes one wants to specify the inclusive meanings of terms. In the context of comparisons, one can use the phrases "non-negative", "non-positive", "non-increasing", and "non-decreasing" to make it clear that the inclusive sense of the terms is being used.
+The use of such terms and phrases helps avoid possible ambiguity and confusion. For instance, when reading the phrase "x is positive", it is not immediately clear whether x = 0 is possible, since some authors might use the term positive loosely to mean that x is not less than zero. Such an ambiguity can be mitigated by writing "x is strictly positive" for x > 0, and "x is non-negative" for x ≥ 0. (A precise term like non-negative is never used with the word negative in the wider sense that includes zero.)
+The word "proper" is often used in the same way as "strict". For example, a "proper subset" of a set S is a subset that is not equal to S itself, and a "proper class" is a class which is not also a set.
+
+
+== See also ==
+Strictly positive measure
+Monotonic function
+
+
+== References ==
+This article incorporates material from strict on PlanetMath, which is licensed under the Creative Commons Attribution/Share-Alike License.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/T.C._Mits-0.md b/data/en.wikipedia.org/wiki/T.C._Mits-0.md
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+---
+title: "T.C. Mits"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/T.C._Mits"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:14.020975+00:00"
+instance: "kb-cron"
+---
+
+T.C. Mits (acronym for "the celebrated man in the street"), is a term coined by Lillian Rosanoff Lieber to refer to an everyman. In Lieber's works, T.C. Mits was a character who made scientific topics more approachable to the public audience.
+The phrase has enjoyed sparse use by authors in fields such as molecular biology, secondary education, and general semantics.
+
+
+== The Education of T.C. MITS ==
+Dr. Lillian Rosanoff Lieber wrote this treatise on mathematical thinking in twenty chapters. The writing took a form that resembled free-verse poetry, though Lieber included an introduction stating that the form was meant only to facilitate rapid reading, rather than emulate free-verse. Lieber's husband, a fellow professor at Long Island University, Hugh Gray Lieber, provided illustrations for the book. The title of the book was meant to emphasize that mathematics can be understood by anyone, which was further shown when a special "Overseas edition for the Armed Forces" was published in 1942, and approved by the Council on Books in Wartime to be sent to American troops fighting in World War II.
+
+
+== See also ==
+John Doe
+The man on the Clapham omnibus
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/The_Politics_of_Modelling,_Numbers_Between_Science_and_Policy-0.md b/data/en.wikipedia.org/wiki/The_Politics_of_Modelling,_Numbers_Between_Science_and_Policy-0.md
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+---
+title: "The Politics of Modelling, Numbers Between Science and Policy"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/The_Politics_of_Modelling,_Numbers_Between_Science_and_Policy"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:15.216481+00:00"
+instance: "kb-cron"
+---
+
+The Politics of Modelling, Numbers Between Science and Policy is a multi-authors book edited by Andrea Saltelli and Monica Di Fiore and published in August 2023 by Oxford University Press.
+
+
+== Synopsis ==
+The Politics of Modelling elaborates and expands on themes of responsible modelling from a manifesto published in the journal  Nature  in 2020. The text is structured into three main sections: Meeting Models, The Rules, and The Rules in Practice. The combination of theory with policy relevant examples makes the book accessible to modellers, researchers of modelling, and policy makers.
+The volume comes with a foreword of Wendy Nelson Espeland and a preface of Daniel Sarewitz, with chapters from Andy Stirling, Wolfgang Drechsler, Philip B. Stark, Ting Xu, Paolo Vineis, Andrea Saltelli, and other scholars.
+
+
+== Reception ==
+The book argues that models live in a "state of exception" provided by their access to a wealth of methodology of analysis, and by their epistemic authority borrowed from mathematics. This state allows models to better defend an appearance of neutrality that is appreciated by policymakers in search of a justification. A review published in the Science notes that the volume incorporated insights from science and technology studies to explore modeling beyond its technical aspects A second review in the  Minerva notes the book's reference to the works of historians Margaret Morrison and Mary S. Morgan in considering   models as mediators whereby models are simultaneously a tool, an interpretation, and a representation of the system.
+The book contrasts the danger of cynicism with suggestions to make models serve society, based on theory, examples, and a call for participatory modelling linked to Post-normal science, sensitivity auditing and the concept of extended peer community. Reviewers also noted that the book ignores other ongoing efforts in enhancing or formalizing modelling practices such as the framework proposed van Voorn, and the Good Modelling Practice handbook developed for water management purposes in the Netherlands.  Reviewers pointed to the book's failure to cover the 'fit-for purpose' movement in modelling. Other points where the book was found to be lacking by critics were the challenge of participatory modelling, related to gaming and power relations such as  Arnsteinds' ladder of participation.
+A review in Mathematics Magazine notes the book's attention to sensitivity analysis: "[The authors] stress the importance of sensitivity analysis, with a highly-illustrative and illuminating example that analyzes the EOQ (economic order quantity) formula." Another review  in the journal Acta Sociologica notes that the collection brings the reflexive sensibility of social criticism to realworld applications: the pandemic, certainly, but also other arenas in which modeling serves as a technology of governance such as economics and climate change. 
+
+
+== References ==
+
+
+== Links ==
+Saltelli, A. and Di Fiore, M. (eds) (2023) The politics of modelling. Numbers between science and policy. Oxford: Oxford University Press, at OUP website.
+Chapters available in open access.
+Models: a state of exception, Oxford Martin School, November 20 2023, Launch of The Politics of Modelling – video.
+Podcast – interview for ABC NET RADIO, AUS August 26, 2023: Assumptions and consequences: the politics of modelling, Guests: Ehsan Nabavi and Andrea Saltelli, Producer – Chris Bullock.
+
+
+== See also ==
+Sociology of quantification
+Ethics of quantification
+Sensitivity analysis
+Sensitivity auditing
+
+
+== Related readings ==
+Desrosières, Alain. (1998). The Politics of Large Numbers: a history of statistical reasoning, Harvard University Press.
+Scoones, I., & Stirling, A. (2020). The Politics of Uncertainty. (I. Scoones & A. Stirling, Eds.), Abingdon, Oxon; New York, NY: Routledge, 2020. Series: Pathways to sustainability: Routledge. doi:10.4324/9781003023845
+Mennicken, A., & Salais, R. (Eds.). (2022b). The New Politics of Numbers: Utopia, Evidence and Democracy, Palgrave Macmillan.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Theorem-0.md b/data/en.wikipedia.org/wiki/Theorem-0.md
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+---
+title: "Theorem"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:16.454658+00:00"
+instance: "kb-cron"
+---
+
+In mathematics and formal logic, a theorem is a statement that has been proven, or can be proven. The proof of a theorem is a logical argument that uses the inference rules of a deductive system to establish that the theorem is a logical consequence of the axioms and previously proved theorems.
+In mainstream mathematics, the axioms and the inference rules are commonly left implicit, and, in this case, they are almost always those of Zermelo–Fraenkel set theory with the axiom of choice (ZFC), or of a less powerful theory, such as Peano arithmetic. Generally, an assertion that is explicitly called a theorem is a proved result that is not an immediate consequence of other known theorems. Moreover, many authors qualify as theorems only the most important results, and use the terms lemma, proposition and corollary for less important theorems.
+In mathematical logic, the concepts of theorems and proofs have been formalized in order to allow mathematical reasoning about them. In this context, statements become well-formed formulas of some formal language. A theory consists of some basis statements called axioms, and some deducing rules (sometimes included in the axioms). The theorems of the theory are the statements that can be derived from the axioms by using the deducing rules. This formalization led to proof theory, which allows proving general theorems about theorems and proofs. In particular, Gödel's incompleteness theorems show that every consistent theory containing the natural numbers has true statements on natural numbers that are not theorems of the theory (that is they cannot be proved inside the theory).
+As the axioms are often abstractions of properties of the physical world, theorems may be considered as expressing some truth, but in contrast to the notion of a scientific law, which is experimental, the justification of the truth of a theorem is purely deductive.
+A conjecture is a tentative proposition that may evolve to become a theorem if proven true.
+
+== Theoremhood and truth ==
+Until the late 19th century and the foundational crisis of mathematics, all mathematical theorems were built from a few basic properties that were considered self-evident, such as the fact that every natural number has a successor or that there is exactly one  line that passes through two given distinct points, or the logical inference rules used to combine these facts in the proof of a theorem. These basic properties that were considered as absolutely evident were called postulates or axioms, for example Euclid's postulates. All theorems were proved by using these basic properties implicitly or explicitly. And because these basic properties were considered self-evident, a proved theorem was considered as a definitive truth, unless there was an error in the proof. For example, Euclid proved from a few axioms and postulates that the sum of the interior angles of a triangle equals 180°, and this was considered an unquestionable fact.
+One aspect of the foundational crisis of mathematics was the discovery of non-Euclidean geometries created by changing Euclid's fifth postulate. These geometries do not lead to any internal contradictions, although, in such geometries, the sum of the angles of a triangle is different from 180°. In other words, the property "the sum of the angles of a triangle equals 180°" can be either true or false, depending on whether Euclid's fifth postulate is assumed or denied. Similarly, in the 19th century, the use of some "evident" basic properties of sets led to the contradiction of Russell's paradox. This has been resolved by modifying the axioms that are allowed for manipulating sets.
+In general, the crisis of the 19th century was resolved by revisiting the foundations of mathematics to make them more rigorous. In these new foundations, a theorem is a well-formed formula of a mathematical theory that can be proved from the axioms and inference rules of the theory. So, the above theorem on the sum of the angles of a triangle becomes: Under the axioms and inference rules of Euclidean geometry, the sum of the interior angles of a triangle equals 180°. Similarly, Russell's paradox disappears because, in modern axiomatized set theory, the set of all sets cannot be expressed with a well-formed formula. More precisely, if the set of all sets could be expressed with a well-formed formula, this would imply that the theory is inconsistent, and every well-formed assertion, as well as its negation, would be a theorem.
+In this context, the validity of a theorem depends only on the correctness of its proof. It is independent from the truth, or even the meaning of the axioms in the "real world." This does not mean that the meaning of the axioms is uninteresting, but only that the validity of a theorem is independent from the meaning of the axioms. This independence may be useful by allowing the use of results of some area of mathematics in apparently unrelated areas.
+An important consequence of this way of thinking about mathematics is that it allows defining mathematical theories and theorems as mathematical objects, and to prove theorems about them. In particular, there are well-formed assertions that can be proved to not be a theorem of the ambient theory, although they can be proved in a wider theory. An example is Goodstein's theorem, which can be stated in Peano arithmetic, but is proved to be not provable in Peano arithmetic. However, it is provable in some more general theories, such as Zermelo–Fraenkel set theory.
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+---
+title: "Theorem"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:16.454658+00:00"
+instance: "kb-cron"
+---
+
+== Epistemological considerations ==
+Many mathematical theorems are conditional statements, whose proofs deduce conclusions from conditions known as hypotheses or premises. In light of the interpretation of proof as justification of truth, the conclusion is often viewed as a necessary consequence of the hypotheses. Namely, that the conclusion is true in case the hypotheses are true—without any further assumptions. However, the conditional could also be interpreted differently in certain deductive systems, depending on the meanings assigned to the derivation rules and the conditional symbol (e.g., non-classical logic).
+Although theorems can be written in a completely symbolic form (e.g., as propositions in propositional calculus), they are often expressed informally in a natural language such as English for better readability. The same is true of proofs, which are often expressed as logically organized and clearly worded informal arguments, intended to convince readers of the truth of the statement of the theorem beyond any doubt, and from which a formal symbolic proof can in principle be constructed.
+In addition to the better readability, informal arguments are typically easier to check than purely symbolic ones—indeed, many mathematicians would express a preference for a proof that not only demonstrates the validity of a theorem, but also explains in some way why it is obviously true. In some cases, one might even be able to substantiate a theorem by using a picture as its proof.
+Because theorems lie at the core of mathematics, they are also central to its aesthetics. Theorems are often described as being "trivial", or "difficult", or "deep", or even "beautiful". These subjective judgments vary not only from person to person, but also with time and culture: for example, as a proof is obtained, simplified or better understood, a theorem that was once difficult may become trivial. On the other hand, a deep theorem may be stated simply, but its proof may involve surprising and subtle connections between disparate areas of mathematics. Fermat's Last Theorem is a particularly well-known example of such a theorem.
+
+== Informal account of theorems ==
+Logically, many theorems are of the form of an indicative conditional: If A, then B. Such a theorem does not assert B — only that B is a necessary consequence of A. In this case, A is called the hypothesis of the theorem ("hypothesis" here means something very different from a conjecture), and B the conclusion of the theorem. The two together (without the proof) are called the proposition or statement of the theorem (e.g. "If A, then B" is the proposition). Alternatively, A and B can be also termed the antecedent and the consequent, respectively. The theorem "If n is an even natural number, then n/2 is a natural number" is a typical example in which the hypothesis is "n is an even natural number", and the conclusion is "n/2 is also a natural number".
+In order for a theorem to be proved, it must be in principle expressible as a precise, formal statement. However, theorems are usually expressed in natural language rather than in a completely symbolic form—with the presumption that a formal statement can be derived from the informal one.
+It is common in mathematics to choose a number of hypotheses within a given language and declare that the theory consists of all statements provable from these hypotheses. These hypotheses form the foundational basis of the theory and are called axioms or postulates. The field of mathematics known as proof theory studies formal languages, axioms and the structure of proofs.
+
+Some theorems are "trivial", in the sense that they follow from definitions, axioms, and other theorems in obvious ways and do not contain any surprising insights. Some, on the other hand, may be called "deep", because their proofs may be long and difficult, involve areas of mathematics superficially distinct from the statement of the theorem itself, or show surprising connections between disparate areas of mathematics. A theorem might be simple to state and yet be deep. An excellent example is Fermat's Last Theorem, and there are many other examples of simple yet deep theorems in number theory and combinatorics, among other areas.
+Other theorems have a known proof that cannot easily be written down. The most prominent examples are the four color theorem and the Kepler conjecture. Both of these theorems are only known to be true by reducing them to a computational search that is then verified by a computer program. Initially, many mathematicians did not accept this form of proof, but it has become more widely accepted. The mathematician Doron Zeilberger has even gone so far as to claim that these are possibly the only nontrivial results that mathematicians have ever proved. Many mathematical theorems can be reduced to more straightforward computation, including polynomial identities, trigonometric identities and hypergeometric identities.
+
+== Relation with scientific theories ==
+Theorems in mathematics and theories in science are fundamentally different in their epistemology. A scientific theory cannot be proved; its key attribute is that it is falsifiable, that is, it makes predictions about the natural world that are testable by experiments. Any disagreement between prediction and experiment demonstrates the incorrectness of the scientific theory, or at least limits its accuracy or domain of validity. Mathematical theorems, on the other hand, are purely abstract formal statements: the proof of a theorem cannot involve experiments or other empirical evidence in the same way such evidence is used to support scientific theories.
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diff --git a/data/en.wikipedia.org/wiki/Theorem-2.md b/data/en.wikipedia.org/wiki/Theorem-2.md
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+---
+title: "Theorem"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:16.454658+00:00"
+instance: "kb-cron"
+---
+
+Nonetheless, there is some degree of empiricism and data collection involved in the discovery of mathematical theorems. By establishing a pattern, sometimes with the use of a powerful computer, mathematicians may have an idea of what to prove, and in some cases even a plan for how to set about doing the proof. It is also possible to find a single counter-example and so establish the impossibility of a proof for the proposition as-stated, and possibly suggest restricted forms of the original proposition that might have feasible proofs.
+For example, both the Collatz conjecture and the Riemann hypothesis are well-known unsolved problems; they have been extensively studied through empirical checks, but remain unproven. The Collatz conjecture has been verified for start values up to about 2.88 × 1018. The Riemann hypothesis has been verified to hold for the first 10 trillion non-trivial zeroes of the zeta function. Although most mathematicians can tolerate supposing that the conjecture and the hypothesis are true, neither of these propositions is considered proved.
+Such evidence does not constitute proof. For example, the Mertens conjecture is a statement about natural numbers that is now known to be false, but no explicit counterexample (i.e., a natural number n for which the Mertens function M(n) equals or exceeds the square root of n) is known: all numbers less than 1014 have the Mertens property, and the smallest number that does not have this property is only known to be less than the exponential of 1.59 × 1040, which is approximately 10 to the power 4.3 × 1039. Since the number of particles in the universe is generally considered less than 10 to the power 100 (a googol), there is no hope to find an explicit counterexample by exhaustive search.
+The word "theory" also exists in mathematics, to denote a body of mathematical axioms, definitions and theorems, as in, for example, group theory (see mathematical theory). There are also "theorems" in science, particularly physics, and in engineering, but they often have statements and proofs in which physical assumptions and intuition play an important role; the physical axioms on which such "theorems" are based are themselves falsifiable.
+
+== Terminology ==
+A number of different terms for mathematical statements exist; these terms indicate the role statements play in a particular subject. The distinction between different terms is sometimes rather arbitrary, and the usage of some terms has evolved over time.
+
+An axiom or postulate is a fundamental assumption regarding the object of study, that is accepted without proof. A related concept is that of a definition, which gives the meaning of a word or a phrase in terms of known concepts. Classical geometry discerns between axioms, which are general statements; and postulates, which are statements about geometrical objects. Historically, axioms were regarded as "self-evident"; today they are merely assumed to be true.
+A conjecture is an unproved statement that is believed to be true. Conjectures are usually made in public, and named after their maker (for example, Goldbach's conjecture and Collatz conjecture). The term hypothesis is also used in this sense (for example,  Riemann hypothesis), which should not be confused with "hypothesis" as the premise of a proof. Other terms are also used on occasion, for example problem when people are not sure whether the statement should be believed to be true.
+Sometimes the name of a problem in common use does not match what would be technically most correct. Fermat's Last Theorem was historically called a theorem, although, for centuries, it was only a conjecture. Conversely, the Poincaré conjecture is still generally referred to as a conjecture, despite having been proved in 2002.
+A theorem is a statement that has been proven to be true based on axioms and other theorems.
+A proposition is a theorem of lesser importance, or one that is considered so elementary or immediately obvious, that it may be stated without proof. This should not be confused with "proposition" as used in propositional logic. In classical geometry the term "proposition" was used differently: in Euclid's Elements (c. 300 BCE), all theorems and geometric constructions were called "propositions" regardless of their importance.
+A lemma is an "accessory proposition" - a proposition with little applicability outside its use in a particular proof. Over time a lemma may gain in importance and be considered a theorem, though the term "lemma" is usually kept as part of its name (e.g. Gauss's lemma, Zorn's lemma, and the fundamental lemma).
+A corollary is a proposition that follows immediately from another theorem or axiom, with little or no required proof. A corollary may also be a restatement of a theorem in a simpler form, or for a special case: for example, the theorem "all internal angles in a rectangle are right angles" has a corollary that "all internal angles in a square are right angles" - a square being a special case of a rectangle.
+A generalization of a theorem is a theorem with a similar statement but a broader scope, from which the original theorem can be deduced as a special case (a corollary).
+Other terms may also be used for historical or customary reasons, for example:
+
+An identity is a theorem stating an equality between two expressions, that holds for any value within its domain (e.g. Bézout's identity and Vandermonde's identity).
+A rule is a theorem that establishes a useful formula (e.g. Bayes' rule and Cramer's rule).
+A law or principle is a theorem with wide applicability (e.g. the law of large numbers, law of cosines, Kolmogorov's zero–one law, Harnack's principle, the least-upper-bound principle, and the pigeonhole principle).
+A few well-known theorems have even more idiosyncratic names, for example, the division algorithm, Euler's formula, and the Banach–Tarski paradox.
+
+== Layout ==
+A theorem and its proof are typically laid out as follows:
\ No newline at end of file
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+---
+title: "Theorem"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:16.454658+00:00"
+instance: "kb-cron"
+---
+
+Theorem (name of the person who proved it, along with year of discovery or publication of the proof)
+Statement of theorem (sometimes called the proposition)
+Proof
+Description of proof
+End
+The end of the proof may be signaled by the letters Q.E.D. (quod erat demonstrandum) or by one of the tombstone marks, such as "□" or "∎", meaning "end of proof", introduced by Paul Halmos following their use in magazines to mark the end of an article.
+The exact style depends on the author or publication. Many publications provide instructions or macros for typesetting in the house style.
+It is common for a theorem to be preceded by definitions describing the exact meaning of the terms used in the theorem. It is also common for a theorem to be preceded by a number of propositions or lemmas which are then used in the proof. However, lemmas are sometimes embedded in the proof of a theorem, either with nested proofs, or with their proofs presented after the proof of the theorem.
+Corollaries to a theorem are either presented between the theorem and the proof, or directly after the proof. Sometimes, corollaries have proofs of their own that explain why they follow from the theorem.
+
+== Lore ==
+It has been estimated that over a quarter of a million theorems are proved every year.
+The well-known aphorism, "A mathematician is a device for turning coffee into theorems", is probably due to Alfréd Rényi, although it is often attributed to Rényi's colleague Paul Erdős (and Rényi may have been thinking of Erdős), who was famous for the many theorems he produced, the number of his collaborations, and his coffee drinking.
+The classification of finite simple groups is regarded by some to be the longest proof of a theorem. It comprises tens of thousands of pages in 500 journal articles by some 100 authors. These papers are together believed to give a complete proof, and several ongoing projects hope to shorten and simplify this proof. Another theorem of this type is the four color theorem whose computer generated proof is too long for a human to read.
+
+== Theorems in logic ==
+In mathematical logic, a formal theory is a set of sentences within a formal language. A sentence is a well-formed formula with no free variables. A sentence that is a member of a theory is one of its theorems, and the theory is the set of its theorems. Usually a theory is understood to be closed under the relation of logical consequence. Some accounts define a theory to be closed under the semantic consequence relation (
+  
+    
+      
+        ⊨
+      
+    
+    {\displaystyle \models }
+  
+), while others define it to be closed under the syntactic consequence, or derivability relation (
+  
+    
+      
+        ⊢
+      
+    
+    {\displaystyle \vdash }
+  
+).
+
+For a theory to be closed under a derivability relation, it must be associated with a deductive system that specifies how the theorems are derived. The deductive system may be stated explicitly, or it may be clear from the context. The closure of the empty set under the relation of logical consequence yields the set that contains just those sentences that are the theorems of the deductive system.
+In the broad sense in which the term is used within logic, a theorem does not have to be true, since the theory that contains it may be unsound relative to a given semantics, or relative to the standard interpretation of the underlying language. A theory that is inconsistent has all sentences as theorems.
+The definition of theorems as sentences of a formal language is useful within proof theory, which is a branch of mathematics that studies the structure of formal proofs and the structure of provable formulas. It is also important in model theory, which is concerned with the relationship between formal theories and structures that are able to provide a semantics for them through interpretation.
+Although theorems may be uninterpreted sentences, in practice mathematicians are more interested in the meanings of the sentences, i.e. in the propositions they express. What makes formal theorems useful and interesting is that they may be interpreted as true propositions and their derivations may be interpreted as a proof of their truth. A theorem whose interpretation is a true statement about a formal system (as opposed to within a formal system) is called a metatheorem.
+Some important theorems in mathematical logic are:
+
+Compactness of first-order logic
+Completeness of first-order logic
+Gödel's incompleteness theorems of first-order arithmetic
+Consistency of first-order arithmetic
+Tarski's undefinability theorem
+Church-Turing theorem of undecidability
+Löb's theorem
+Löwenheim–Skolem theorem
+Lindström's theorem
+Craig's theorem
+Cut-elimination theorem
+
+=== Syntax and semantics ===
+
+The concept of a formal theorem is fundamentally syntactic, in contrast to the notion of a true proposition, which introduces semantics. Different deductive systems can yield other interpretations, depending on the presumptions of the derivation rules (i.e. belief, justification or other modalities). The soundness of a formal system depends on whether or not all of its theorems are also validities. A validity is a formula that is true under any possible interpretation (for example, in classical propositional logic, validities are tautologies). A formal system is considered semantically complete when all of its theorems are also tautologies.
+
+=== Interpretation of a formal theorem ===
+
+=== Theorems and theories ===
+
+== See also ==
+
+Law (mathematics)
+List of theorems
+List of theorems called fundamental
+Formula
+Inference
+Toy theorem
+
+== Citations ==
+
+=== Notes ===
+
+=== References ===
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+---
+title: "Theorem"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:16.454658+00:00"
+instance: "kb-cron"
+---
+
+=== Works cited ===
+Boolos, George; Burgess, John; Jeffrey, Richard (2007). Computability and Logic (5th ed.). Cambridge University Press.
+Enderton, Herbert (2001). A Mathematical Introduction to Logic (2nd ed.). Harcourt Academic Press.
+Heath, Sir Thomas Little (1897). The works of Archimedes. Dover. Retrieved 2009-11-15.
+Hedman, Shawn (2004). A First Course in Logic. Oxford University Press.
+Hinman, Peter (2005). Fundamentals of Mathematical Logic. Wellesley, MA: A K Peters.
+Hoffman, Paul (1998). The Man Who Loved Only Numbers: The Story of Paul Erdős and the Search for Mathematical Truth. Hyperion, New York. ISBN 1-85702-829-5.
+Hodges, Wilfrid (1993). Model Theory. Cambridge University Press.
+Johnstone, P. T. (1987). Notes on Logic and Set Theory. Cambridge University Press.
+Monk, J. Donald (1976). Mathematical Logic. Springer-Verlag.
+Petkovsek, Marko; Wilf, Herbert; Zeilberger, Doron (1996). A = B (PDF). A.K. Peters, Wellesley, Massachusetts. ISBN 1-56881-063-6.
+Rautenberg, Wolfgang (2010). A Concise Introduction to Mathematical Logic (3rd ed.). Springer.
+van Dalen, Dirk (1994). Logic and Structure (3rd ed.). Springer-Verlag.
+Wentworth, G.; Smith, D.E. (1913). Plane Geometry. Ginn & Co.
+
+== Further reading ==
+Chiswell, Ian; Hodges, Wilfred (2007). Mathematical Logic. Oxford University Press.
+Hunter, Geoffrey (1996) [1971]. Metalogic: An Introduction to the Metatheory of Standard First-Order Logic. University of California Press (published 1973). ISBN 9780520023567. OCLC 36312727. (accessible to patrons with print disabilities)
+Mates, Benson (1972). Elementary Logic. Oxford University Press. ISBN 0-19-501491-X.
+
+== External links ==
+
+ Media related to Theorems at Wikimedia Commons
+Weisstein, Eric W. "Theorem". MathWorld.
+Theorem of the Day
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diff --git a/data/en.wikipedia.org/wiki/Toy_model-0.md b/data/en.wikipedia.org/wiki/Toy_model-0.md
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+---
+title: "Toy model"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Toy_model"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:17.746720+00:00"
+instance: "kb-cron"
+---
+
+In scientific modeling, a toy model is a deliberately simplistic model with many details removed so that it can be used to explain a mechanism concisely. It is also useful in a description of the fuller model.
+
+In toy mathematical models used in mathematical physics, this is usually done by reducing or extending the number of dimensions or reducing the number of fields/variables or restricting them to a particular symmetric form.
+In toy economic models, some may be only loosely based on theory, others more explicitly so. They allow for a quick first pass at some question, and present the essence of the answer from a more complicated model or from a class of models. For the researcher, they may come before writing a more elaborate model, or after, once the elaborate model has been worked out. Blanchard's list of examples includes the IS–LM model, the Mundell–Fleming model, the RBC model, and the New Keynesian model.
+The phrase "tinker-toy model" is also used, in reference to the Tinkertoys product used for children's constructivist learning.
+
+
+== Examples ==
+Examples of toy models in physics include:
+
+the Ising model as a toy model for ferromagnetism, or lattice models more generally. It is the simplest model that allows for Euclidean quantum field theory in statistical physics.
+Newtonian orbital mechanics as described by assuming that Earth is attached to the Sun by an elastic band;
+the Schwarzschild metric, general relativistic model describing a single symmetrical non-rotating non-charged concentration of mass (such as a perfect spherical mass): a simple relativistic "equivalent" of the classical symmetric Newtonian mass (in fact, the first solution of the Einstein field equations to be developed);
+Hawking radiation around a black hole described as conventional radiation from a fictitious membrane at radius r = 2m (the black hole membrane paradigm);
+frame-dragging around a rotating star considered as the effect of space being a conventional viscous fluid;
+the null dust;
+the Gödel metric in general relativity, which allows closed timelike curves;
+the Lambda-CDM model of cosmology, in which general relativistic effects of structure formation are not taken into account.
+the empty universe, a simple expanding universe model;
+the Bohr model of the atom, a "semi-classical" quantum mechanical model of the atom, which can be solved exactly for the hydrogen atom;
+the particle in a box in quantum mechanics;
+the Spekkens model, a hidden-variable theory;
+the primon gas, which illustrates some connections between number theory and physics.
+
+
+== See also ==
+
+Physical model – Informative representation of an entityPages displaying short descriptions of redirect targets
+Spherical cow – Humorous concept in scientific models
+Toy problem – Simplified example problem used for research or exposition
+Toy theorem – Simplified instance of a general theorem
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Toy_theorem-0.md b/data/en.wikipedia.org/wiki/Toy_theorem-0.md
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+---
+title: "Toy theorem"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Toy_theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:18.952329+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a toy theorem is a simplified instance (special case) of a more general theorem, which can be useful in providing a handy representation of the general theorem, or a framework for proving the general theorem. One way of obtaining a toy theorem is by introducing some simplifying assumptions in a theorem.
+In many cases, a toy theorem is used to illustrate the claim of a theorem, while in other cases, studying the proofs of a toy theorem (derived from a non-trivial theorem) can provide insight that would be hard to obtain otherwise. 
+Toy theorems can also have educational value as well. For example, after presenting a theorem (with, say, a highly non-trivial proof), one can sometimes give some assurance that the theorem really holds, by proving a toy version of the theorem.
+
+
+== Examples ==
+A toy theorem of the Brouwer fixed-point theorem is obtained by restricting the dimension to one. In this case, the Brouwer fixed-point theorem follows almost immediately from the intermediate value theorem.
+Another example of toy theorem is Rolle's theorem, which is obtained from the mean value theorem by equating the function values at the endpoints.
+
+
+== See also ==
+Corollary
+Fundamental theorem
+Lemma (mathematics)
+Toy model
+
+
+== References ==
+This article incorporates material from toy theorem on PlanetMath, which is licensed under the Creative Commons Attribution/Share-Alike License.
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diff --git a/data/en.wikipedia.org/wiki/Transport_of_structure-0.md b/data/en.wikipedia.org/wiki/Transport_of_structure-0.md
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+---
+title: "Transport of structure"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Transport_of_structure"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:20.207704+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, particularly in universal algebra and category theory, transport of structure refers to the process whereby a mathematical object acquires a new structure and its canonical definitions, as a result of being isomorphic to (or otherwise identified with) another object with a pre-existing structure. Definitions by transport of structure are regarded as canonical.
+
+
+== Examples ==
+Since mathematical structures are often defined in reference to an underlying space, many examples of transport of structure involve spaces and mappings between them.  For example, if 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ and 
+  
+    
+      
+        W
+      
+    
+    {\displaystyle W}
+  
+ are vector spaces with 
+  
+    
+      
+        (
+        ⋅
+        ,
+        ⋅
+        )
+      
+    
+    {\displaystyle (\cdot ,\cdot )}
+  
+ being an inner product on 
+  
+    
+      
+        W
+      
+    
+    {\displaystyle W}
+  
+, such that there is an isomorphism 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ from 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ to 
+  
+    
+      
+        W
+      
+    
+    {\displaystyle W}
+  
+, then one can define an inner product 
+  
+    
+      
+        [
+        ⋅
+        ,
+        ⋅
+        ]
+      
+    
+    {\displaystyle [\cdot ,\cdot ]}
+  
+ on 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ by the following rule:
+
+  
+    
+      
+        [
+        
+          v
+          
+            1
+          
+        
+        ,
+        
+          v
+          
+            2
+          
+        
+        ]
+        =
+        (
+        ϕ
+        (
+        
+          v
+          
+            1
+          
+        
+        )
+        ,
+        ϕ
+        (
+        
+          v
+          
+            2
+          
+        
+        )
+        )
+      
+    
+    {\displaystyle [v_{1},v_{2}]=(\phi (v_{1}),\phi (v_{2}))}
+  
+
+Although the equation makes sense even when 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ is not an isomorphism, it only defines an inner product on 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ when 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ is, since otherwise it will cause 
+  
+    
+      
+        [
+        ⋅
+        ,
+        ⋅
+        ]
+      
+    
+    {\displaystyle [\cdot ,\cdot ]}
+  
+ to be degenerate.  The idea is that 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ allows one to consider 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ and 
+  
+    
+      
+        W
+      
+    
+    {\displaystyle W}
+  
+ as "the same" vector space, and by following this analogy, then one can transport an inner product from one space to the other.
+A more elaborated example comes from differential topology, in which the notion of smooth manifold is involved: if 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ is such a manifold, and if 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ is any topological space which is homeomorphic to 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+, then one can consider 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ as a smooth manifold as well. That is, given a homeomorphism 
+  
+    
+      
+        ϕ
+        :
+        X
+        →
+        M
+      
+    
+    {\displaystyle \phi \colon X\to M}
+  
+, one can define coordinate charts on 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ by "pulling back" coordinate charts on 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ through 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+.  Recall that a coordinate chart on 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ is an open set 
+  
+    
+      
+        U
+      
+    
+    {\displaystyle U}
+  
+ together with an injective map
+
+  
+    
+      
+        c
+        :
+        U
+        →
+        
+          
+            R
+          
+          
+            n
+          
+        
+      
+    
+    {\displaystyle c\colon U\to \mathbb {R} ^{n}}
+  
+
+for some natural number 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+; to get such a chart on 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+, one uses the following rules:
+
+  
+    
+      
+        
+          U
+          ′
+        
+        =
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        (
+        U
+        )
+      
+    
+    {\displaystyle U'=\phi ^{-1}(U)}
+  
+ and 
+  
+    
+      
+        
+          c
+          ′
+        
+        =
+        c
+        ∘
+        ϕ
+      
+    
+    {\displaystyle c'=c\circ \phi }
+  
+.
+Furthermore, it is required that the charts cover 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ (the fact that the transported charts cover 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ follows immediately from the fact that 
+  
+    
+      
+        ϕ
+      
+    
+    {\displaystyle \phi }
+  
+ is a bijection). Since 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ is a smooth manifold, if U and V, with their maps 
+  
+    
+      
+        c
+        :
+        U
+        →
+        
+          
+            R
+          
+          
+            n
+          
+        
+      
+    
+    {\displaystyle c\colon U\to \mathbb {R} ^{n}}
+  
+ and 
+  
+    
+      
+        d
+        :
+        V
+        →
+        
+          
+            R
+          
+          
+            n
+          
+        
+      
+    
+    {\displaystyle d\colon V\to \mathbb {R} ^{n}}
+  
+, are two charts on 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+, then the composition, the "transition map"
+
+  
+    
+      
+        d
+        ∘
+        
+          c
+          
+            −
+            1
+          
+        
+        :
+        c
+        (
+        U
+        ∩
+        V
+        )
+        →
+        
+          
+            R
+          
+          
+            n
+          
+        
+      
+    
+    {\displaystyle d\circ c^{-1}\colon c(U\cap V)\to \mathbb {R} ^{n}}
+  
+ (a self-map of 
+  
+    
+      
+        
+          
+            R
+          
+          
+            n
+          
+        
+      
+    
+    {\displaystyle \mathbb {R} ^{n}}
+  
+)
+is smooth. To verify this for the transported charts on 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+, notice that
+
+  
+    
+      
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        (
+        U
+        )
+        ∩
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        (
+        V
+        )
+        =
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        (
+        U
+        ∩
+        V
+        )
+      
+    
+    {\displaystyle \phi ^{-1}(U)\cap \phi ^{-1}(V)=\phi ^{-1}(U\cap V)}
+  
+,
+and therefore
+
+  
+    
+      
+        
+          c
+          ′
+        
+        (
+        
+          U
+          ′
+        
+        ∩
+        
+          V
+          ′
+        
+        )
+        =
+        (
+        c
+        ∘
+        ϕ
+        )
+        (
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        (
+        U
+        ∩
+        V
+        )
+        )
+        =
+        c
+        (
+        U
+        ∩
+        V
+        )
+      
+    
+    {\displaystyle c'(U'\cap V')=(c\circ \phi )(\phi ^{-1}(U\cap V))=c(U\cap V)}
+  
+, and
+
+  
+    
+      
+        
+          d
+          ′
+        
+        ∘
+        (
+        
+          c
+          ′
+        
+        
+          )
+          
+            −
+            1
+          
+        
+        =
+        (
+        d
+        ∘
+        ϕ
+        )
+        ∘
+        (
+        c
+        ∘
+        ϕ
+        
+          )
+          
+            −
+            1
+          
+        
+        =
+        d
+        ∘
+        (
+        ϕ
+        ∘
+        
+          ϕ
+          
+            −
+            1
+          
+        
+        )
+        ∘
+        
+          c
+          
+            −
+            1
+          
+        
+        =
+        d
+        ∘
+        
+          c
+          
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle d'\circ (c')^{-1}=(d\circ \phi )\circ (c\circ \phi )^{-1}=d\circ (\phi \circ \phi ^{-1})\circ c^{-1}=d\circ c^{-1}}
+  
+.
+Thus the transition map for 
+  
+    
+      
+        
+          U
+          ′
+        
+      
+    
+    {\displaystyle U'}
+  
+ and 
+  
+    
+      
+        
+          V
+          ′
+        
+      
+    
+    {\displaystyle V'}
+  
+ is the same as that for 
+  
+    
+      
+        U
+      
+    
+    {\displaystyle U}
+  
+ and 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+, hence smooth.  That is, 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ is a smooth manifold via transport of structure. This is a special case of transport of structures in general.
+The second example also illustrates why "transport of structure" is not always desirable. Namely, one can take 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ to be the plane, and 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to be an infinite one-sided cone.  By "flattening" the cone, a homeomorphism of 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ and 
+  
+    
+      
+        M
+      
+    
+    {\displaystyle M}
+  
+ can be obtained, and therefore the structure of a smooth manifold on 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+, but the cone is not "naturally" a smooth manifold. That is, one can consider 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ as a subspace of 3-space, in which context it is not smooth at the cone point.  
+A more surprising example is that of exotic spheres, discovered by John Milnor, which states that there are exactly 28 smooth manifolds which are homeomorphic but not diffeomorphic to 
+  
+    
+      
+        
+          S
+          
+            7
+          
+        
+      
+    
+    {\displaystyle S^{7}}
+  
+, the 7-dimensional sphere in 8-space. Thus, transport of structure is most productive when there exists a canonical isomorphism between the two objects.
+
+
+== See also ==
+List of mathematical jargon
+Equivalent definitions of mathematical structures#Transport of structures; isomorphism
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Triviality_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Triviality_(mathematics)-0.md
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@@ -0,0 +1,210 @@
+---
+title: "Triviality (mathematics)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Triviality_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:21.450294+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the adjective trivial is often used to refer to a claim or a case which can be readily obtained from context, or a particularly simple object possessing a given structure (e.g., group, topological space). The noun triviality usually refers to a simple technical aspect of some proof or definition. The origin of the term in mathematical language comes from the medieval trivium curriculum, which distinguishes from the more difficult quadrivium curriculum. The opposite of trivial is nontrivial, which is commonly used to indicate that an example or a solution is not simple, or that a statement or a theorem is not easy to prove.
+Triviality does not have a rigorous definition in mathematics. It is subjective, and often determined in a given situation by the knowledge and experience of those considering the case.
+
+== Trivial and nontrivial solutions ==
+In mathematics, the term "trivial" is often used to refer to objects (e.g., groups, topological spaces) with a very simple structure. These include, among others:
+
+Empty set: the set containing no or null members
+Trivial group: the mathematical group containing only the identity element
+Trivial ring: a ring defined on a singleton set
+"Trivial" can also be used to describe solutions to an equation that have a very simple structure, but for the sake of completeness cannot be omitted. These solutions are called the trivial solutions. For example, consider the differential equation
+
+  
+    
+      
+        
+          y
+          ′
+        
+        =
+        y
+      
+    
+    {\displaystyle y'=y}
+  
+
+where 
+  
+    
+      
+        y
+        =
+        y
+        (
+        x
+        )
+      
+    
+    {\displaystyle y=y(x)}
+  
+ is a function whose derivative is 
+  
+    
+      
+        
+          y
+          ′
+        
+      
+    
+    {\displaystyle y'}
+  
+. The trivial solution is the zero function
+
+  
+    
+      
+        y
+        (
+        x
+        )
+        =
+        0
+      
+    
+    {\displaystyle y(x)=0}
+  
+
+while a nontrivial solution is the exponential function
+
+  
+    
+      
+        y
+        (
+        x
+        )
+        =
+        
+          e
+          
+            x
+          
+        
+        .
+      
+    
+    {\displaystyle y(x)=e^{x}.}
+  
+
+The differential equation 
+  
+    
+      
+        
+          f
+          ″
+        
+        (
+        x
+        )
+        =
+        −
+        λ
+        f
+        (
+        x
+        )
+      
+    
+    {\displaystyle f''(x)=-\lambda f(x)}
+  
+ with boundary conditions 
+  
+    
+      
+        f
+        (
+        0
+        )
+        =
+        f
+        (
+        L
+        )
+        =
+        0
+      
+    
+    {\displaystyle f(0)=f(L)=0}
+  
+ is important in mathematics and physics, as it could be used to describe a particle in a box in quantum mechanics, or a standing wave on a string. It always includes the solution 
+  
+    
+      
+        f
+        (
+        x
+        )
+        =
+        0
+      
+    
+    {\displaystyle f(x)=0}
+  
+, which is considered obvious and hence is called the "trivial" solution. In some cases, there may be other solutions (sinusoids), which are called "nontrivial" solutions.
+Similarly, mathematicians often describe Fermat's Last Theorem as asserting that there are no nontrivial integer solutions to the equation 
+  
+    
+      
+        
+          a
+          
+            n
+          
+        
+        +
+        
+          b
+          
+            n
+          
+        
+        =
+        
+          c
+          
+            n
+          
+        
+      
+    
+    {\displaystyle a^{n}+b^{n}=c^{n}}
+  
+, where n is greater than 2. Clearly, there are some solutions to the equation. For example, 
+  
+    
+      
+        a
+        =
+        b
+        =
+        c
+        =
+        0
+      
+    
+    {\displaystyle a=b=c=0}
+  
+ is a solution for any n, but such solutions are obvious and obtainable with little effort, and hence "trivial".
+
+== In mathematical reasoning ==
+Trivial may also refer to any easy case of a proof, which for the sake of completeness cannot be ignored. For instance, proofs by mathematical induction have two parts: the "base case" which shows that the theorem is true for a particular initial value (such as n = 0 or n = 1), and the inductive step which shows that if the theorem is true for a certain value of n, then it is also true for the value n + 1. The base case is often trivial and is identified as such, although there are situations where the base case is difficult but the inductive step is trivial. Similarly, one might want to prove that some property is possessed by all members of a certain set. The main part of the proof will consider the case of a nonempty set, and examine the members in detail; in the case where the set is empty, the property is trivially possessed by all the members of the empty set, since there are none (see vacuous truth for more).
+The judgement of whether a situation under consideration is trivial or not depends on who considers it since the situation is obviously true for someone who has sufficient knowledge or experience of it while to someone who has never seen this, it may be even hard to be understood so not trivial at all. And there can be an argument about how quickly and easily a problem should be recognized for the problem to be treated as trivial. The following examples show the subjectivity and ambiguity of the triviality judgement.
+Triviality also depends on context. A proof in functional analysis would probably, given a number, trivially assume the existence of a larger number. However, when proving basic results about the natural numbers in elementary number theory, the proof may very well hinge on the remark that any natural number has a successor – a statement which should itself be proved or be taken as an axiom so is not trivial (for more, see Peano's axioms).
+
+=== Trivial proofs ===
+In some texts, a trivial proof refers to a statement involving a material implication P→Q, where the consequent Q, is always true. Here, the proof follows immediately by virtue of the definition of material implication in which as the implication is true regardless of the truth value of the antecedent P if the consequent is fixed as true.
+A related concept is a vacuous truth, where the antecedent P in a material implication P→Q is false. In this case, the implication is always true regardless of the truth value of the consequent Q – again by virtue of the definition of material implication.
+
+== Humor ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Triviality_(mathematics)-1.md b/data/en.wikipedia.org/wiki/Triviality_(mathematics)-1.md
new file mode 100644
index 000000000..4b0255cdc
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Triviality_(mathematics)-1.md
@@ -0,0 +1,171 @@
+---
+title: "Triviality (mathematics)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Triviality_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:21.450294+00:00"
+instance: "kb-cron"
+---
+
+A common joke in the mathematical community is to say that "trivial" is synonymous with "proved"—that is, any theorem can be considered "trivial" once it is known to be proved as true.
+Two mathematicians who are discussing a theorem: the first mathematician says that the theorem is "trivial". In response to the other's request for an explanation, he then proceeds with twenty minutes of exposition. At the end of the explanation, the second mathematician agrees that the theorem is trivial. But can we say that this theorem is trivial even if it takes a lot of time and effort to prove it?
+When a mathematician says that a theorem is trivial, but he is unable to prove it by himself at the moment that he pronounces it as trivial, is the theorem trivial?
+Often, as a joke, a problem is referred to as "intuitively obvious". For example, someone experienced in calculus would consider the following statement trivial:
+  
+    
+      
+        
+          ∫
+          
+            0
+          
+          
+            1
+          
+        
+        
+          x
+          
+            2
+          
+        
+        
+        d
+        x
+        =
+        
+          
+            1
+            3
+          
+        
+        .
+      
+    
+    {\displaystyle \int _{0}^{1}x^{2}\,dx={\frac {1}{3}}.}
+  
+However, to someone with no knowledge of integral calculus, this is not obvious, so it is not trivial.
+
+== Examples ==
+In number theory, it is often important to find factors of an integer number N. Any number N has four obvious factors: ±1 and ±N. These are called "trivial factors". Any other factor, if it exists, would be called "nontrivial".
+The homogeneous matrix equation 
+  
+    
+      
+        A
+        
+          x
+        
+        =
+        
+          0
+        
+      
+    
+    {\displaystyle A\mathbf {x} =\mathbf {0} }
+  
+, where 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+ is a fixed matrix, 
+  
+    
+      
+        
+          x
+        
+      
+    
+    {\displaystyle \mathbf {x} }
+  
+ is an unknown vector, and 
+  
+    
+      
+        
+          0
+        
+      
+    
+    {\displaystyle \mathbf {0} }
+  
+ is the zero vector, has an obvious solution 
+  
+    
+      
+        
+          x
+        
+        =
+        
+          0
+        
+      
+    
+    {\displaystyle \mathbf {x} =\mathbf {0} }
+  
+. This is called the "trivial solution". Any other solutions, with 
+  
+    
+      
+        
+          x
+        
+        ≠
+        
+          0
+        
+      
+    
+    {\displaystyle \mathbf {x} \neq \mathbf {0} }
+  
+, are called "nontrivial".
+In group theory, there is a very simple group with just one element in it; this is often called the "trivial group". All other groups, which are more complicated, are called "nontrivial".
+In graph theory, the trivial graph is a graph which has only 1 vertex and no edge.
+Database theory has a concept called functional dependency, written 
+  
+    
+      
+        X
+        →
+        Y
+      
+    
+    {\displaystyle X\to Y}
+  
+. The dependence 
+  
+    
+      
+        X
+        →
+        Y
+      
+    
+    {\displaystyle X\to Y}
+  
+ is true if Y is a subset of X, so this type of dependence is called "trivial". All other dependences, which are less obvious, are called "nontrivial".
+It can be shown that Riemann's zeta function has zeros at the negative even numbers −2, −4, … Though the proof is comparatively easy, this result would still not normally be called trivial; however, it is in this case, for its other zeros are generally unknown and have important applications and involve open questions (such as the Riemann hypothesis). Accordingly, the negative even numbers are called the trivial zeros of the function, while any other zeros are considered to be non-trivial.
+
+== See also ==
+Degeneracy
+Initial and terminal objects
+List of mathematical jargon
+Pathological
+Trivialism
+Trivial measure
+Trivial representation
+Trivial topology
+
+== References ==
+
+== External links ==
+
+Trivial entry at MathWorld
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Undefined_(mathematics)-0.md b/data/en.wikipedia.org/wiki/Undefined_(mathematics)-0.md
new file mode 100644
index 000000000..fcbd3f9bb
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Undefined_(mathematics)-0.md
@@ -0,0 +1,421 @@
+---
+title: "Undefined (mathematics)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Undefined_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:22.620521+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, the term undefined refers to a value, function, or other expression that cannot be assigned a meaning within a specific formal system. 
+Attempting to assign or use an undefined value within a particular formal system, may produce contradictory or meaningless results within that system. In practice, mathematicians may use the term undefined to warn that a particular calculation or property can produce mathematically inconsistent results, and therefore, it should be avoided.  Caution must be taken to avoid the use of such undefined values in a deduction or proof.
+Whether a particular function or value is undefined, depends on the rules of the formal system in which it is used.  For example, the imaginary number 
+  
+    
+      
+        
+          
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle {\sqrt {-1}}}
+  
+ is undefined within the set of real numbers.  So it is meaningless to reason about the value, solely within the discourse of real numbers.  However, defining the imaginary number 
+  
+    
+      
+        i
+      
+    
+    {\displaystyle i}
+  
+ to be equal to  
+  
+    
+      
+        
+          
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle {\sqrt {-1}}}
+  
+, allows there to be a consistent set of mathematics referred to as the complex number plane.  Therefore, within the discourse of complex numbers, 
+  
+    
+      
+        
+          
+            −
+            1
+          
+        
+      
+    
+    {\displaystyle {\sqrt {-1}}}
+  
+ is in fact defined.
+Many new fields of mathematics have been created, by taking previously undefined functions and values, and assigning them new meanings.  Most mathematicians generally consider these innovations significant, to the extent that they are both internally consistent and practically useful.  For example, Ramanujan summation may seem unintuitive, as it works upon divergent series that assign finite values to apparently infinite sums such as 1 + 2 + 3 + 4 + ⋯. However, Ramanujan summation is useful for modelling a number of real-world phenomena, including the Casimir effect and bosonic string theory.
+A function may be said to be undefined, outside of its domain.  As one example, 
+  
+    
+      
+        f
+        (
+        x
+        )
+        =
+        
+          
+            1
+            x
+          
+        
+      
+    
+    {\textstyle f(x)={\frac {1}{x}}}
+  
+ is undefined when 
+  
+    
+      
+        x
+        =
+        0
+      
+    
+    {\displaystyle x=0}
+  
+.  As division by zero is undefined in algebra, 
+  
+    
+      
+        x
+        =
+        0
+      
+    
+    {\displaystyle x=0}
+  
+ is not part of the domain of 
+  
+    
+      
+        f
+        (
+        x
+        )
+      
+    
+    {\displaystyle f(x)}
+  
+.
+
+== Other shades of meaning ==
+In some mathematical contexts, undefined can refer to a primitive notion which is not defined in terms of simpler concepts.  For example, in Elements, Euclid defines a point merely as "that of which there is no part", and a line merely as "length without breadth". Although these terms are not further defined, Euclid uses them to construct more complex geometric concepts.
+Contrast also the term undefined behavior in computer science, in which the term indicates that a function may produce or return any result, which may or may not be correct.
+
+== Common examples of undefined expressions ==
+Many fields of mathematics refer to various kinds of expressions as undefined. Therefore, the following examples of undefined expressions are not exhaustive.
+
+=== Division by zero ===
+In arithmetic, and therefore algebra, division by zero is undefined.  Use of a division by zero in an arithmetical calculation or proof, can produce absurd or meaningless results.
+Assuming that division by zero exists, can produce inconsistent logical results, such as the following fallacious "proof" that one is equal to two:
+
+The above "proof" is not meaningful.  Since we know that 
+  
+    
+      
+        x
+        =
+        y
+      
+    
+    {\displaystyle x=y}
+  
+, if we divide both sides of the equation by 
+  
+    
+      
+        x
+        −
+        y
+      
+    
+    {\displaystyle x-y}
+  
+, we divide both sides of the equation by zero.  This operation is undefined in arithmetic, and therefore deductions based on division by zero can be contradictory.
+If we assume that a non-zero answer 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+ exists, when some number 
+  
+    
+      
+        k
+        ∣
+        k
+        ≠
+        0
+      
+    
+    {\displaystyle k\mid k\neq 0}
+  
+ is divided by zero, then that would imply that 
+  
+    
+      
+        k
+        =
+        n
+        ×
+        0
+      
+    
+    {\displaystyle k=n\times 0}
+  
+.  But there is no number, which when multiplied by zero, produces a number that is not zero.  Therefore, our assumption is incorrect.
+
+=== Zero to the power of zero ===
+Depending on the particular context, mathematicians may refer to zero to the power of zero as undefined, indefinite, or equal to 1.  Controversy exists as to which definitions are mathematically rigorous, and under what conditions.
+
+=== The square root of a negative number ===
+When restricted to the field of real numbers, the square root of a negative number is undefined, as no real number exists which, when squared, equals a negative number.  Mathematicians, including Gerolamo Cardano, John Wallis, Leonhard Euler, and Carl Friedrich Gauss, explored formal definitions for the square roots of negative numbers, giving rise to the field of complex analysis.
+
+=== In trigonometry ===
+In trigonometry, for all 
+  
+    
+      
+        n
+        ∈
+        
+          Z
+        
+      
+    
+    {\displaystyle n\in \mathbb {Z} }
+  
+, the functions 
+  
+    
+      
+        tan
+        ⁡
+        θ
+      
+    
+    {\displaystyle \tan \theta }
+  
+ and 
+  
+    
+      
+        sec
+        ⁡
+        θ
+      
+    
+    {\displaystyle \sec \theta }
+  
+ are undefined for 
+  
+    
+      
+        θ
+        =
+        π
+        
+          (
+          
+            n
+            −
+            
+              
+                1
+                2
+              
+            
+          
+          )
+        
+      
+    
+    {\textstyle \theta =\pi \left(n-{\frac {1}{2}}\right)}
+  
+, while the functions 
+  
+    
+      
+        cot
+        ⁡
+        θ
+      
+    
+    {\displaystyle \cot \theta }
+  
+ and 
+  
+    
+      
+        csc
+        ⁡
+        θ
+      
+    
+    {\displaystyle \csc \theta }
+  
+ are undefined for all 
+  
+    
+      
+        θ
+        =
+        π
+        n
+      
+    
+    {\displaystyle \theta =\pi n}
+  
+.  This is a consequence of the identities of these functions, which would imply a division by zero at those points.
+Also, 
+  
+    
+      
+        arcsin
+        ⁡
+        k
+      
+    
+    {\displaystyle \arcsin k}
+  
+ and 
+  
+    
+      
+        arccos
+        ⁡
+        k
+      
+    
+    {\displaystyle \arccos k}
+  
+ are both undefined when 
+  
+    
+      
+        k
+        >
+        1
+      
+    
+    {\displaystyle k>1}
+  
+ or 
+  
+    
+      
+        k
+        <
+        −
+        1
+      
+    
+    {\displaystyle k<-1}
+  
+, because the range of the 
+  
+    
+      
+        sin
+      
+    
+    {\displaystyle \sin }
+  
+ and 
+  
+    
+      
+        cos
+      
+    
+    {\displaystyle \cos }
+  
+ functions is between 
+  
+    
+      
+        −
+        1
+      
+    
+    {\displaystyle -1}
+  
+ and 
+  
+    
+      
+        1
+      
+    
+    {\displaystyle 1}
+  
+ inclusive.
+
+=== In complex analysis ===
+In complex analysis, a point 
+  
+    
+      
+        z
+      
+    
+    {\displaystyle z}
+  
+ on the complex plane where a holomorphic function is undefined, is called a singularity. Some different types of singularities include:
+
+Removable singularities - in which the function can be extended holomorphically to 
+  
+    
+      
+        z
+      
+    
+    {\displaystyle z}
+  
+
+Poles - in which the function can be extended meromorphically to 
+  
+    
+      
+        z
+      
+    
+    {\displaystyle z}
+  
+
+Essential singularities - in which no meromorphic extension to 
+  
+    
+      
+        z
+      
+    
+    {\displaystyle z}
+  
+ can exist
+
+== Related terms ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Undefined_(mathematics)-1.md b/data/en.wikipedia.org/wiki/Undefined_(mathematics)-1.md
new file mode 100644
index 000000000..5c35af294
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Undefined_(mathematics)-1.md
@@ -0,0 +1,29 @@
+---
+title: "Undefined (mathematics)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Undefined_(mathematics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:22.620521+00:00"
+instance: "kb-cron"
+---
+
+=== Indeterminate ===
+The term undefined should be contrasted with the term indeterminate.  In the first case, undefined generally indicates that a value or property can have no meaningful definition.  In the second case, indeterminate generally indicates that a value or property can have many meaningful definitions.  Additionally, it seems to be generally accepted that undefined values may not be safely used within a particular formal system, whereas indeterminate values might be, depending on the relevant rules of the particular formal system.
+
+== See also ==
+Analytic function - a function locally given by a convergent power series, which may be useful for dealing with otherwise undefined values
+L'Hôpital's rule - a method in calculus for evaluating indeterminate forms
+Indeterminate form - a mathematical expression for which many assignments exist
+NaN - the IEEE-754 expression indicating that the result of a calculation is not a number
+Primitive notion - a concept that is not defined in terms of previously defined concepts
+Singularity - a point at which a mathematical function ceases to be well-behaved
+
+== References ==
+
+== Further reading ==
+Smart, James R. (1988). Modern Geometries (3rd ed.). Brooks/Cole. ISBN 0-534-08310-2.
+Lo Bello, Anthony (2013). Origins of Mathematical Words. Johns Hopkins University Press. ISBN 978-1-4214-1098-2.
+
+== External links ==
+Undefined and indeterminate - Functions and their graphs - Algebra II - Khan Academy on YouTube
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Uniqueness_quantification-0.md b/data/en.wikipedia.org/wiki/Uniqueness_quantification-0.md
new file mode 100644
index 000000000..3b83a33a1
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Uniqueness_quantification-0.md
@@ -0,0 +1,489 @@
+---
+title: "Uniqueness quantification"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Uniqueness_quantification"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:23.930015+00:00"
+instance: "kb-cron"
+---
+
+In mathematics and logic, the term "uniqueness" refers to the property of being the one and only object satisfying a certain condition. This sort of quantification is known as uniqueness quantification or unique existential quantification, and is often denoted with the symbols "∃!" or "∃=1". It is defined to mean there exists an object with the given property, and all objects with this property are equal.
+For example, the formal statement
+
+  
+    
+      
+        ∃
+        !
+        n
+        ∈
+        
+          N
+        
+        
+        (
+        n
+        −
+        2
+        =
+        4
+        )
+      
+    
+    {\displaystyle \exists !n\in \mathbb {N} \,(n-2=4)}
+  
+
+may be read as "there is exactly one natural number 
+  
+    
+      
+        n
+      
+    
+    {\displaystyle n}
+  
+ such that ⁠
+  
+    
+      
+        n
+        −
+        2
+        =
+        4
+      
+    
+    {\displaystyle n-2=4}
+  
+⁠".
+
+
+== Proving uniqueness ==
+The most common technique to prove the unique existence of an object is to first prove the existence of the entity with the desired condition, and then to prove that any two such entities (say, 
+  
+    
+      
+        a
+      
+    
+    {\displaystyle a}
+  
+ and ⁠
+  
+    
+      
+        b
+      
+    
+    {\displaystyle b}
+  
+⁠) must be equal to each other (i.e. ⁠
+  
+    
+      
+        a
+        =
+        b
+      
+    
+    {\displaystyle a=b}
+  
+⁠).
+For example, to show that the equation 
+  
+    
+      
+        x
+        +
+        2
+        =
+        5
+      
+    
+    {\displaystyle x+2=5}
+  
+ has exactly one solution, one would first start by establishing that at least one solution exists, namely 3; the proof of this part is simply the verification that the equation below holds:
+
+  
+    
+      
+        3
+        +
+        2
+        =
+        5.
+      
+    
+    {\displaystyle 3+2=5.}
+  
+
+To establish the uniqueness of the solution, one would proceed by assuming that there are two solutions, namely 
+  
+    
+      
+        a
+      
+    
+    {\displaystyle a}
+  
+ and ⁠
+  
+    
+      
+        b
+      
+    
+    {\displaystyle b}
+  
+⁠, satisfying ⁠
+  
+    
+      
+        x
+        +
+        2
+        =
+        5
+      
+    
+    {\displaystyle x+2=5}
+  
+⁠. That is,
+
+  
+    
+      
+        a
+        +
+        2
+        =
+        5
+        
+           and 
+        
+        b
+        +
+        2
+        =
+        5.
+      
+    
+    {\displaystyle a+2=5{\text{ and }}b+2=5.}
+  
+
+Then since equality is a transitive relation, 
+
+  
+    
+      
+        a
+        +
+        2
+        =
+        b
+        +
+        2.
+      
+    
+    {\displaystyle a+2=b+2.}
+  
+
+Subtracting 2 from both sides then yields
+
+  
+    
+      
+        a
+        =
+        b
+        ,
+      
+    
+    {\displaystyle a=b,}
+  
+
+which completes the proof that 3 is the unique solution of 
+  
+    
+      
+        x
+        +
+        2
+        =
+        5
+      
+    
+    {\displaystyle x+2=5}
+  
+.
+In general, both existence (there exists at least one object) and uniqueness (there exists at most one object) must be proven, in order to conclude that there exists exactly one object satisfying a said condition.
+An alternative way to prove uniqueness is to prove that there exists an object 
+  
+    
+      
+        a
+      
+    
+    {\displaystyle a}
+  
+ satisfying the condition, and then to prove that every object satisfying the condition must be equal to ⁠
+  
+    
+      
+        a
+      
+    
+    {\displaystyle a}
+  
+⁠.
+
+
+== Reduction to ordinary existential and universal quantification ==
+Uniqueness quantification can be expressed in terms of the existential and universal quantifiers of predicate logic, by defining the formula 
+  
+    
+      
+        ∃
+        !
+        x
+        (
+        P
+        (
+        x
+        )
+        )
+      
+    
+    {\displaystyle \exists !x(P(x))}
+  
+ to mean
+
+  
+    
+      
+        ∃
+        x
+        
+        (
+        P
+        (
+        x
+        )
+        
+        ∧
+        ¬
+        ∃
+        y
+        
+        (
+        P
+        (
+        y
+        )
+        ∧
+        y
+        ≠
+        x
+        )
+        )
+        ,
+      
+    
+    {\displaystyle \exists x\,(P(x)\,\wedge \neg \exists y\,(P(y)\wedge y\neq x)),}
+  
+
+which is logically equivalent to
+
+  
+    
+      
+        ∃
+        x
+        
+        (
+        P
+        (
+        x
+        )
+        ∧
+        ∀
+        y
+        
+        (
+        P
+        (
+        y
+        )
+        →
+        y
+        =
+        x
+        )
+        )
+        .
+      
+    
+    {\displaystyle \exists x\,(P(x)\wedge \forall y\,(P(y)\to y=x)).}
+  
+
+An equivalent definition that separates the notions of existence and uniqueness into two clauses, at the expense of brevity, is
+
+  
+    
+      
+        ∃
+        x
+        
+        P
+        (
+        x
+        )
+        ∧
+        ∀
+        y
+        
+        ∀
+        z
+        
+        [
+        (
+        P
+        (
+        y
+        )
+        ∧
+        P
+        (
+        z
+        )
+        )
+        →
+        y
+        =
+        z
+        ]
+        .
+      
+    
+    {\displaystyle \exists x\,P(x)\wedge \forall y\,\forall z\,[(P(y)\wedge P(z))\to y=z].}
+  
+
+
+== Generalizations ==
+The uniqueness quantification can be generalized into counting quantification (or numerical quantification). This includes both quantification of the form "exactly k objects exist such that ..." as well as "infinitely many objects exist such that ..." and "only finitely many objects exist such that ...". The first of these forms is expressible using ordinary quantifiers, but the latter two cannot be expressed in ordinary first-order logic.
+Uniqueness depends on a notion of equality. Loosening this to a coarser equivalence relation yields quantification of uniqueness up to that equivalence (under this framework, regular uniqueness is "uniqueness up to equality"). This is called essentially unique. For example, many concepts in category theory are defined to be unique up to isomorphism.
+The exclamation mark 
+  
+    
+      
+        !
+      
+    
+    {\displaystyle !}
+  
+ can be also used as a separate quantification symbol, so ⁠
+  
+    
+      
+        (
+        ∃
+        !
+        x
+        .
+        P
+        (
+        x
+        )
+        )
+        ↔
+        (
+        (
+        ∃
+        x
+        .
+        P
+        (
+        x
+        )
+        )
+        ∧
+        (
+        !
+        x
+        .
+        P
+        (
+        x
+        )
+        )
+        )
+      
+    
+    {\displaystyle (\exists !x.P(x))\leftrightarrow ((\exists x.P(x))\land (!x.P(x)))}
+  
+⁠, where ⁠
+  
+    
+      
+        (
+        !
+        x
+        .
+        P
+        (
+        x
+        )
+        )
+        :=
+        (
+        ∀
+        a
+        ∀
+        b
+        .
+        P
+        (
+        a
+        )
+        ∧
+        P
+        (
+        b
+        )
+        →
+        a
+        =
+        b
+        )
+      
+    
+    {\displaystyle (!x.P(x)):=(\forall a\forall b.P(a)\land P(b)\rightarrow a=b)}
+  
+⁠. For example, it can be safely used in the replacement axiom, instead of 
+  
+    
+      
+        ∃
+        !
+      
+    
+    {\displaystyle \exists !}
+  
+.
+
+
+== See also ==
+Essentially unique
+Extension by definition
+One-hot
+Singleton (mathematics)
+Uniqueness theorem
+
+
+== References ==
+
+
+== Bibliography ==
+Kleene, Stephen (1952). Introduction to Metamathematics. Ishi Press International. p. 199.
+Andrews, Peter B. (2002). An introduction to mathematical logic and type theory to truth through proof (2nd ed.). Dordrecht: Kluwer Acad. Publ. p. 233. ISBN 1-4020-0763-9.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Uniqueness_theorem-0.md b/data/en.wikipedia.org/wiki/Uniqueness_theorem-0.md
new file mode 100644
index 000000000..ce4d662ce
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Uniqueness_theorem-0.md
@@ -0,0 +1,35 @@
+---
+title: "Uniqueness theorem"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Uniqueness_theorem"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:25.125766+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a uniqueness theorem, also called a unicity theorem, is a theorem asserting the uniqueness of an object satisfying certain conditions, or the equivalence of all objects satisfying the said conditions. Examples of uniqueness theorems include:
+
+Cauchy's rigidity theorem and Alexandrov's uniqueness theorem for three-dimensional polyhedra.
+Black hole uniqueness theorem
+Cauchy–Kowalevski theorem is the main local existence and uniqueness theorem for analytic partial differential equations associated with Cauchy initial value problems.
+Cauchy–Kowalevski–Kashiwara theorem is a wide generalization of the Cauchy–Kowalevski theorem for systems of linear partial differential equations with analytic coefficients.
+Division theorem, the uniqueness of quotient and remainder under Euclidean division.
+Fundamental theorem of arithmetic, the uniqueness of prime factorization.
+Holmgren's uniqueness theorem for linear partial differential equations with real analytic coefficients.
+Picard–Lindelöf theorem, the uniqueness of solutions to first-order differential equations.
+Thompson uniqueness theorem in finite group theory.
+Uniqueness theorem for Poisson's equation.
+Electromagnetism uniqueness theorem for the solution of Maxwell's equation.
+Uniqueness case in finite group theory.
+The word unique is sometimes replaced by essentially unique, whenever one wants to stress that the uniqueness is only referred to the underlying structure, whereas the form may vary in all ways that do not affect the mathematical content.
+A uniqueness theorem (or its proof) is, at least within the mathematics of differential equations, often combined with an existence theorem (or its proof) to a combined existence and uniqueness theorem (e.g., existence and uniqueness of solution to first-order differential equations with boundary condition).
+
+
+== See also ==
+Existence theorem
+Rigidity (mathematics)
+Uniqueness quantification
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Univariate-0.md b/data/en.wikipedia.org/wiki/Univariate-0.md
new file mode 100644
index 000000000..ed4637519
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Univariate-0.md
@@ -0,0 +1,22 @@
+---
+title: "Univariate"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Univariate"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:26.386149+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a univariate object is an expression, equation, function or polynomial involving only one variable. Objects involving more than one variable are multivariate. In some cases the distinction between the univariate and multivariate cases is fundamental; for example, the fundamental theorem of algebra and Euclid's algorithm for polynomials are fundamental properties of univariate polynomials that cannot be generalized to multivariate polynomials.
+In statistics, a univariate distribution characterizes one variable, although it can be applied in other ways as well. For example, univariate data are composed of a single scalar component. In time series analysis, the whole time series is the "variable": a univariate time series is the series of values over time of a single quantity. Correspondingly, a "multivariate time series" characterizes the changing values over time of several quantities. In some cases, the terminology is ambiguous, since the values within a univariate time series may be treated using certain types of multivariate statistical analyses and may be represented using multivariate distributions.
+In addition to the question of scaling, a criterion (variable) in univariate statistics can be described by two important measures (also key figures or parameters): Location & Variation.
+
+Measures of Location Scales (e.g. mode, median, arithmetic mean) describe in which area the data is arranged centrally.
+Measures of Variation (e.g. span, interquartile distance, standard deviation) describe how similar or different the data are scattered.
+
+
+== See also ==
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Univariate_(statistics)-0.md b/data/en.wikipedia.org/wiki/Univariate_(statistics)-0.md
new file mode 100644
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Univariate_(statistics)-0.md
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+---
+title: "Univariate (statistics)"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Univariate_(statistics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:27.600546+00:00"
+instance: "kb-cron"
+---
+
+Univariate is a term commonly used in statistics to describe a type of data which consists of observations on only a single characteristic or attribute. A simple example of univariate data would be the salaries of workers in industry. Similar to other data, univariate data can be visualized using graphs, images, or other analysis tools after the data are measured, collected, reported, and analyzed.
+
+== Data types ==
+Some univariate data consist of numbers (such as the height of 1.65 m, or the mass of 70 kg), whilst others are non-numerical (such as eye colors of brown or blue). Generally, the terms categorical univariate data and numerical univariate data are used to distinguish between these types.
+
+=== Categorical univariate data ===
+Categorical univariate data consists of non-numerical observations that may be placed in categories. It includes labels or names used to identify an attribute of each element. Categorical univariate data usually use either nominal or ordinal scale of measurement.
+
+=== Numerical univariate data ===
+Numerical univariate data consists of observations that are numbers. They are obtained using either interval or ratio scale of measurement. This type of univariate data can be classified even further into two subcategories: discrete and continuous. A numerical univariate data is discrete if the set of all possible values is finite or countably infinite. Discrete univariate data are usually associated with counting (such as the number of books read by a person). A numerical univariate data is continuous if the set of all possible values is an interval of numbers. Continuous univariate data are typically associated with measuring (such as the weights of people).
+
+== Data analysis and applications ==
+Univariate analysis is the simplest form of analyzing data. Uni means "one", so the data has only one variable (univariate). Univariate data requires analyzing each variable separately. Data is gathered for the purpose of answering a question, or more specifically, a research question. Univariate data does not answer research questions about relationships between variables. Instead, it is used to describe one characteristic or attribute that varies from observation to observation. Typically, there are two purposes that a researcher can look for. The first one is to answer a research question with descriptive study and the second one is to get knowledge about how attribute varies with individual effect of a variable in regression analysis. There are some ways to describe patterns found in univariate data, which include graphical methods, measures of central tendency and measures of variability.
+Like other forms of statistics, it can be inferential or descriptive. The key fact is that only one variable is involved.
+Univariate analysis can yield misleading results in cases in which multivariate analysis is more appropriate.
+
+=== Measures of central tendency ===
+Central tendency is one of the most common numerical descriptive measures. It is used to estimate the central location of the univariate data by the calculation of mean, median and mode. Each of these calculations has its own advantages and limitations. The mean has the advantage that its calculation includes each value of the data set, but it is particularly susceptible to the influence of outliers. The median is a better measure when the data set contains outliers. The mode is simple to locate. 
+One is not restricted to using only one of these measures of central tendency. If the data being analyzed are categorical, then the only measure of central tendency that can be used is the mode. However, if the data is numerical in nature (ordinal or interval/ratio) then the mode, median, or mean can all be used to describe the data. Using more than one of these measures provides a more accurate descriptive summary of central tendency for the univariate.
+
+=== Measures of variability ===
+A measure of variability or dispersion (deviation from the mean) of a univariate data set can reveal the shape of a univariate data distribution more sufficiently. It will provide some information about the variation among data values. The measures of variability together with the measures of central tendency give a better picture of the data than the measures of central tendency alone. The three most frequently used measures of variability are range, variance and standard deviation. The appropriateness of each measure would depend on the type of data, the shape of the distribution of data and which measure of central tendency is being used. If the data is categorical, then there is no measure of variability to report. For data that is numerical, all three measures are possible. If the distribution of data is symmetrical, then the measures of variability are usually the variance and standard deviation. However, if the data are skewed, then the measure of variability that would be appropriate for that data set is the range.
+
+=== Descriptive methods ===
+Descriptive statistics describe a sample or population. They can be part of exploratory data analysis.
+The appropriate statistic depends on the level of measurement. For nominal variables, a frequency table and a listing of the mode(s) is sufficient. For ordinal variables, the median can be calculated as a measure of central tendency and the range (and variations of it) as a measure of dispersion. For interval level variables, the arithmetic mean (average) and standard deviation are added to the toolbox and, for ratio level variables, the geometric mean and harmonic mean are added, as measures of central tendency, and the coefficient of variation as a measure of dispersion.
+For interval and ratio level data, further descriptors include the variable's skewness and kurtosis.
+
+=== Inferential methods ===
+Inferential methods allow us to infer from a sample to a population. For a nominal variable a one-way chi-square (goodness of fit) test can help determine if our sample matches that of some population. For interval and ratio level data, a one-sample t-test can let us infer whether the mean in our sample matches some proposed number (typically 0). Other available tests of location include the one-sample sign test and Wilcoxon signed rank test.
+
+== Graphical methods ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Univariate_(statistics)-1.md b/data/en.wikipedia.org/wiki/Univariate_(statistics)-1.md
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--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Univariate_(statistics)-1.md
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+---
+title: "Univariate (statistics)"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Univariate_(statistics)"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:27.600546+00:00"
+instance: "kb-cron"
+---
+
+The most frequently used graphical illustrations for univariate data are:
+
+=== Frequency distribution tables ===
+Frequency is how many times a number occurs. The frequency of an observation in statistics indicates the number of times the observation occurs in the data. For example, in the following list of numbers {1, 2, 3, 4, 6, 9, 9, 8, 5, 1, 1, 9, 9, 0, 6, 9}, the frequency of the number 9 is 5 (because it occurs 5 times in this data set).
+
+=== Bar charts ===
+A bar chart is a graph consisting of rectangular bars. These bars actually represents number or percentage of observations of existing categories in a variable. The length or height of bars gives a visual representation of the proportional differences among categories.
+
+=== Histograms ===
+Histograms are used to estimate the distribution of the data, with the frequency of values assigned to a value range called a bin.
+
+=== Pie charts ===
+A pie chart is a circle divided into portions that represent the relative frequencies or percentages of a population or a sample belonging to different categories.
+
+== Distributions ==
+Univariate distribution is a dispersal type for a single random variable described either with a probability mass function (pmf) for discrete probability distribution, or probability density function (pdf) for continuous probability distribution. It is not to be confused with multivariate distribution.
+
+=== Common discrete distributions ===
+Uniform distribution (discrete)
+Bernoulli distribution
+Binomial distribution
+Geometric distribution
+Negative binomial distribution
+Poisson distribution
+Hypergeometric distribution
+Zeta distribution
+
+=== Common continuous distributions ===
+Uniform distribution (continuous)
+Normal distribution
+Gamma distribution
+Exponential distribution
+Weibull distribution
+Cauchy distribution
+Beta distribution
+
+== See also ==
+Univariate
+Univariate distribution
+Bivariate analysis
+Multivariate analysis
+List of probability distributions
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_property-0.md b/data/en.wikipedia.org/wiki/Universal_property-0.md
new file mode 100644
index 000000000..bb1ff3317
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_property-0.md
@@ -0,0 +1,517 @@
+---
+title: "Universal property"
+chunk: 1/5
+source: "https://en.wikipedia.org/wiki/Universal_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:54.601173+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, more specifically in category theory, a universal property is a  property that characterizes up to an isomorphism the result of some constructions. Thus, universal properties can be used for defining some objects independently from the method chosen for constructing them. For example, the definitions of the integers from the natural numbers, of the rational numbers from the integers, of the real numbers from the rational numbers, and of polynomial rings from the field of their coefficients can all be done in terms of universal properties. In particular, the concept of universal property allows a simple proof that all constructions of real numbers are equivalent: it suffices to prove that they satisfy the same universal property. 
+Technically, a universal property is defined in terms of categories and functors by means of a universal morphism (see § Formal definition, below). Universal morphisms can also be thought more abstractly as initial or terminal objects of a comma category (see § Connection with comma categories, below). 
+Universal properties occur almost everywhere in mathematics, and the use of the concept allows the use of general properties of universal properties for easily proving some properties that would need boring verifications otherwise. For example, given a commutative ring R, the field of fractions of the quotient ring of R by a prime ideal p can be identified with the residue field of the localization of R at p; that is 
+  
+    
+      
+        
+          R
+          
+            p
+          
+        
+        
+          /
+        
+        p
+        
+          R
+          
+            p
+          
+        
+        ≅
+        Frac
+        ⁡
+        (
+        R
+        
+          /
+        
+        p
+        )
+      
+    
+    {\displaystyle R_{p}/pR_{p}\cong \operatorname {Frac} (R/p)}
+  
+ (all these constructions can be defined by universal properties).
+Other objects that can be defined by universal properties include: all free objects, direct products and direct sums, free groups, free lattices, Grothendieck group, completion of a metric space, completion of a ring, Dedekind–MacNeille completion, product topologies, Stone–Čech compactification, tensor products, inverse limit and direct limit, kernels and cokernels, quotient groups, quotient vector spaces, and other quotient spaces.
+
+== Motivation ==
+Before giving a formal definition of universal properties, we offer some motivation for studying such constructions.
+
+The concrete details of a given construction may be messy, but if the construction satisfies a universal property, one can forget all those details: all there is to know about the construction is already contained in the universal property. Proofs often become short and elegant if the universal property is used rather than the concrete details. For example, the tensor algebra of a vector space is slightly complicated to construct, but much easier to deal with by its universal property.
+Universal properties define objects uniquely up to a unique isomorphism. Therefore, one strategy to prove that two objects are isomorphic is to show that they satisfy the same universal property.
+Universal constructions are functorial in nature: if one can carry out the construction for every object in a category C then one obtains a functor on C. Furthermore, this functor is a right or left adjoint to the functor U used in the definition of the universal property.
+Universal properties occur everywhere in mathematics. By understanding their abstract properties, one obtains information about all these constructions and can avoid repeating the same analysis for each individual instance.
+
+== Formal definition ==
+To understand the definition of a universal construction, it is important to look at examples. Universal constructions were not defined out of thin air, but were rather defined after mathematicians began noticing a pattern in many mathematical constructions (see Examples below). Hence, the definition may not make sense to one at first, but will become clear when one reconciles it with concrete examples.
+Let 
+  
+    
+      
+        F
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle F:{\mathcal {C}}\to {\mathcal {D}}}
+  
+ be a functor between categories 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ and 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+. In what follows, let 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ be an object of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+, 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+ and 
+  
+    
+      
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle A'}
+  
+ be objects of 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+, and 
+  
+    
+      
+        h
+        :
+        A
+        →
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle h:A\to A'}
+  
+ be a morphism in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+. 
+Then, the functor 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ maps 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+, 
+  
+    
+      
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle A'}
+  
+ and 
+  
+    
+      
+        h
+      
+    
+    {\displaystyle h}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ to 
+  
+    
+      
+        F
+        (
+        A
+        )
+      
+    
+    {\displaystyle F(A)}
+  
+, 
+  
+    
+      
+        F
+        (
+        
+          A
+          ′
+        
+        )
+      
+    
+    {\displaystyle F(A')}
+  
+ and 
+  
+    
+      
+        F
+        (
+        h
+        )
+      
+    
+    {\displaystyle F(h)}
+  
+ in 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+.
+A universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ is a unique pair 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        :
+        X
+        →
+        F
+        (
+        A
+        )
+        )
+      
+    
+    {\displaystyle (A,u:X\to F(A))}
+  
+ which has the following property, commonly referred to as a universal property:
+For any morphism of the form 
+
+  
+    
+      
+        f
+        :
+        X
+        →
+        F
+        (
+        
+          A
+          ′
+        
+        )
+      
+    
+    {\displaystyle f:X\to F(A')}
+  
+ in 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+, there exists a unique morphism 
+  
+    
+      
+        h
+        :
+        A
+        →
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle h:A\to A'}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ such that the following diagram commutes:
+
+We can dualize this categorical concept. A universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ is a unique pair 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        :
+        F
+        (
+        A
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (A,u:F(A)\to X)}
+  
+ that satisfies the following universal property:
+For any morphism of the form 
+  
+    
+      
+        f
+        :
+        F
+        (
+        
+          A
+          ′
+        
+        )
+        →
+        X
+      
+    
+    {\displaystyle f:F(A')\to X}
+  
+ in 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+, there exists a unique morphism 
+  
+    
+      
+        h
+        :
+        
+          A
+          ′
+        
+        →
+        A
+      
+    
+    {\displaystyle h:A'\to A}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ such that the following diagram commutes:
+
+Note that in each definition, the arrows are reversed. Both definitions are necessary to describe universal constructions which appear in mathematics; but they also arise due to the inherent duality present in category theory.
+In either case, we say that the pair 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ which behaves as above satisfies a universal property.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_property-1.md b/data/en.wikipedia.org/wiki/Universal_property-1.md
new file mode 100644
index 000000000..476fc7aca
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_property-1.md
@@ -0,0 +1,994 @@
+---
+title: "Universal property"
+chunk: 2/5
+source: "https://en.wikipedia.org/wiki/Universal_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:54.601173+00:00"
+instance: "kb-cron"
+---
+
+== Connection with comma categories ==
+Universal morphisms can be described more concisely as initial and terminal objects in a comma category (i.e. one where morphisms are seen as objects in their own right).
+Let 
+  
+    
+      
+        F
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle F:{\mathcal {C}}\to {\mathcal {D}}}
+  
+ be a functor and 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ an object of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+. Then recall that the comma category 
+  
+    
+      
+        (
+        X
+        ↓
+        F
+        )
+      
+    
+    {\displaystyle (X\downarrow F)}
+  
+ is the category where 
+
+Objects are pairs of the form 
+  
+    
+      
+        (
+        B
+        ,
+        f
+        :
+        X
+        →
+        F
+        (
+        B
+        )
+        )
+      
+    
+    {\displaystyle (B,f:X\to F(B))}
+  
+, where 
+  
+    
+      
+        B
+      
+    
+    {\displaystyle B}
+  
+ is an object in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+
+A morphism from 
+  
+    
+      
+        (
+        B
+        ,
+        f
+        :
+        X
+        →
+        F
+        (
+        B
+        )
+        )
+      
+    
+    {\displaystyle (B,f:X\to F(B))}
+  
+ to 
+  
+    
+      
+        (
+        
+          B
+          ′
+        
+        ,
+        
+          f
+          ′
+        
+        :
+        X
+        →
+        F
+        (
+        
+          B
+          ′
+        
+        )
+        )
+      
+    
+    {\displaystyle (B',f':X\to F(B'))}
+  
+ is given by a morphism 
+  
+    
+      
+        h
+        :
+        B
+        →
+        
+          B
+          ′
+        
+      
+    
+    {\displaystyle h:B\to B'}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ such that the diagram commutes:
+
+Now suppose that the object 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        :
+        X
+        →
+        F
+        (
+        A
+        )
+        )
+      
+    
+    {\displaystyle (A,u:X\to F(A))}
+  
+ in 
+  
+    
+      
+        (
+        X
+        ↓
+        F
+        )
+      
+    
+    {\displaystyle (X\downarrow F)}
+  
+ is initial. Then
+for every object 
+  
+    
+      
+        (
+        
+          A
+          ′
+        
+        ,
+        f
+        :
+        X
+        →
+        F
+        (
+        
+          A
+          ′
+        
+        )
+        )
+      
+    
+    {\displaystyle (A',f:X\to F(A'))}
+  
+, there exists a unique morphism 
+  
+    
+      
+        h
+        :
+        A
+        →
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle h:A\to A'}
+  
+ such that the following diagram commutes. 
+
+Note that the equality here simply means the diagrams are the same. Also note that the diagram on the right side of the equality is the exact same as the one offered in defining a universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+. Therefore, we see that a universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ is equivalent to an initial object in the comma category 
+  
+    
+      
+        (
+        X
+        ↓
+        F
+        )
+      
+    
+    {\displaystyle (X\downarrow F)}
+  
+.
+Conversely, recall that the comma category 
+  
+    
+      
+        (
+        F
+        ↓
+        X
+        )
+      
+    
+    {\displaystyle (F\downarrow X)}
+  
+ is the category where 
+
+Objects are pairs of the form 
+  
+    
+      
+        (
+        B
+        ,
+        f
+        :
+        F
+        (
+        B
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (B,f:F(B)\to X)}
+  
+ where 
+  
+    
+      
+        B
+      
+    
+    {\displaystyle B}
+  
+ is an object in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+
+A morphism from 
+  
+    
+      
+        (
+        B
+        ,
+        f
+        :
+        F
+        (
+        B
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (B,f:F(B)\to X)}
+  
+ to 
+  
+    
+      
+        (
+        
+          B
+          ′
+        
+        ,
+        
+          f
+          ′
+        
+        :
+        F
+        (
+        
+          B
+          ′
+        
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (B',f':F(B')\to X)}
+  
+ is given by a morphism 
+  
+    
+      
+        h
+        :
+        B
+        →
+        
+          B
+          ′
+        
+      
+    
+    {\displaystyle h:B\to B'}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ such that the diagram commutes:
+
+Suppose 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        :
+        F
+        (
+        A
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (A,u:F(A)\to X)}
+  
+ is a terminal object in 
+  
+    
+      
+        (
+        F
+        ↓
+        X
+        )
+      
+    
+    {\displaystyle (F\downarrow X)}
+  
+. Then for every object 
+  
+    
+      
+        (
+        
+          A
+          ′
+        
+        ,
+        f
+        :
+        F
+        (
+        
+          A
+          ′
+        
+        )
+        →
+        X
+        )
+      
+    
+    {\displaystyle (A',f:F(A')\to X)}
+  
+, 
+there exists a unique morphism 
+  
+    
+      
+        h
+        :
+        
+          A
+          ′
+        
+        →
+        A
+      
+    
+    {\displaystyle h:A'\to A}
+  
+ such that the following diagrams commute. 
+
+The diagram on the right side of the equality is the same diagram pictured when defining a universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+. Hence, a universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ corresponds with a terminal object in the comma category 
+
+  
+    
+      
+        (
+        F
+        ↓
+        X
+        )
+      
+    
+    {\displaystyle (F\downarrow X)}
+  
+.
+
+== Examples ==
+Below are a few examples, to highlight the general idea. The reader can construct numerous other examples by consulting the articles mentioned in the introduction.
+
+=== Tensor algebras ===
+Let 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ be the category of vector spaces 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+-Vect over a field 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+ and let 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+ be the category of algebras 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+-Alg over 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+ (assumed to be unital and associative). Let
+
+  
+    
+      
+        U
+        :
+        K
+        
+          -
+        
+        
+          A
+          l
+          g
+        
+        →
+        K
+        
+          -
+        
+        
+          V
+          e
+          c
+          t
+        
+      
+    
+    {\displaystyle U:K{\text{-}}\mathbf {Alg} \to K{\text{-}}\mathbf {Vect} }
+  
+
+be the forgetful functor which assigns to each algebra its underlying vector space.
+Given any vector space 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ over 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+ we can construct the tensor algebra 
+  
+    
+      
+        T
+        (
+        V
+        )
+      
+    
+    {\displaystyle T(V)}
+  
+. The tensor algebra is characterized by the fact:
+
+“Any linear map from 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ to an algebra 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+ can be uniquely extended to an algebra homomorphism from 
+  
+    
+      
+        T
+        (
+        V
+        )
+      
+    
+    {\displaystyle T(V)}
+  
+ to 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+.”
+This statement is an initial property of the tensor algebra since it expresses the fact that the pair 
+  
+    
+      
+        (
+        T
+        (
+        V
+        )
+        ,
+        i
+        )
+      
+    
+    {\displaystyle (T(V),i)}
+  
+, where 
+  
+    
+      
+        i
+        :
+        V
+        →
+        U
+        (
+        T
+        (
+        V
+        )
+        )
+      
+    
+    {\displaystyle i:V\to U(T(V))}
+  
+ is the inclusion map, is a universal morphism from the vector space 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+ to the functor 
+  
+    
+      
+        U
+      
+    
+    {\displaystyle U}
+  
+.
+Since this construction works for any vector space 
+  
+    
+      
+        V
+      
+    
+    {\displaystyle V}
+  
+, we conclude that 
+  
+    
+      
+        T
+      
+    
+    {\displaystyle T}
+  
+ is a functor from  
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+-Vect to 
+  
+    
+      
+        K
+      
+    
+    {\displaystyle K}
+  
+-Alg.  This means that 
+  
+    
+      
+        T
+      
+    
+    {\displaystyle T}
+  
+ is left adjoint to the forgetful functor 
+  
+    
+      
+        U
+      
+    
+    {\displaystyle U}
+  
+ (see the section below on relation to adjoint functors).
+
+=== Products ===
+A categorical product can be characterized by a universal construction. For concreteness, one may consider the Cartesian product in Set, the direct product in Grp, or the product topology in Top, where products exist.
+Let 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ and 
+  
+    
+      
+        Y
+      
+    
+    {\displaystyle Y}
+  
+ be objects of a category 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ with finite products. The product of 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ and 
+  
+    
+      
+        Y
+      
+    
+    {\displaystyle Y}
+  
+ is an object 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ × 
+  
+    
+      
+        Y
+      
+    
+    {\displaystyle Y}
+  
+ together with two morphisms
+
+  
+    
+      
+        
+          π
+          
+            1
+          
+        
+      
+    
+    {\displaystyle \pi _{1}}
+  
+ : 
+  
+    
+      
+        X
+        ×
+        Y
+        →
+        X
+      
+    
+    {\displaystyle X\times Y\to X}
+  
+
+  
+    
+      
+        
+          π
+          
+            2
+          
+        
+      
+    
+    {\displaystyle \pi _{2}}
+  
+ : 
+  
+    
+      
+        X
+        ×
+        Y
+        →
+        Y
+      
+    
+    {\displaystyle X\times Y\to Y}
+  
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_property-2.md b/data/en.wikipedia.org/wiki/Universal_property-2.md
new file mode 100644
index 000000000..0a1e79315
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_property-2.md
@@ -0,0 +1,1114 @@
+---
+title: "Universal property"
+chunk: 3/5
+source: "https://en.wikipedia.org/wiki/Universal_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:54.601173+00:00"
+instance: "kb-cron"
+---
+
+such that for any other object 
+  
+    
+      
+        Z
+      
+    
+    {\displaystyle Z}
+  
+ of 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ and morphisms 
+  
+    
+      
+        f
+        :
+        Z
+        →
+        X
+      
+    
+    {\displaystyle f:Z\to X}
+  
+ and 
+  
+    
+      
+        g
+        :
+        Z
+        →
+        Y
+      
+    
+    {\displaystyle g:Z\to Y}
+  
+ there exists a unique morphism 
+  
+    
+      
+        h
+        :
+        Z
+        →
+        X
+        ×
+        Y
+      
+    
+    {\displaystyle h:Z\to X\times Y}
+  
+ such that 
+  
+    
+      
+        f
+        =
+        
+          π
+          
+            1
+          
+        
+        ∘
+        h
+      
+    
+    {\displaystyle f=\pi _{1}\circ h}
+  
+ and 
+  
+    
+      
+        g
+        =
+        
+          π
+          
+            2
+          
+        
+        ∘
+        h
+      
+    
+    {\displaystyle g=\pi _{2}\circ h}
+  
+.
+To understand this characterization as a universal property, take the category 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+ to be the product category 
+  
+    
+      
+        
+          
+            C
+          
+        
+        ×
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}\times {\mathcal {C}}}
+  
+ and define the diagonal functor
+
+  
+    
+      
+        Δ
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            C
+          
+        
+        ×
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle \Delta :{\mathcal {C}}\to {\mathcal {C}}\times {\mathcal {C}}}
+  
+
+by 
+  
+    
+      
+        Δ
+        (
+        X
+        )
+        =
+        (
+        X
+        ,
+        X
+        )
+      
+    
+    {\displaystyle \Delta (X)=(X,X)}
+  
+ and 
+  
+    
+      
+        Δ
+        (
+        f
+        :
+        X
+        →
+        Y
+        )
+        =
+        (
+        f
+        ,
+        f
+        )
+      
+    
+    {\displaystyle \Delta (f:X\to Y)=(f,f)}
+  
+. Then 
+  
+    
+      
+        (
+        X
+        ×
+        Y
+        ,
+        (
+        
+          π
+          
+            1
+          
+        
+        ,
+        
+          π
+          
+            2
+          
+        
+        )
+        )
+      
+    
+    {\displaystyle (X\times Y,(\pi _{1},\pi _{2}))}
+  
+ is a universal morphism from 
+  
+    
+      
+        Δ
+      
+    
+    {\displaystyle \Delta }
+  
+ to the object 
+  
+    
+      
+        (
+        X
+        ,
+        Y
+        )
+      
+    
+    {\displaystyle (X,Y)}
+  
+ of 
+  
+    
+      
+        
+          
+            C
+          
+        
+        ×
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}\times {\mathcal {C}}}
+  
+: if 
+  
+    
+      
+        (
+        f
+        ,
+        g
+        )
+      
+    
+    {\displaystyle (f,g)}
+  
+ is any morphism from 
+  
+    
+      
+        (
+        Z
+        ,
+        Z
+        )
+      
+    
+    {\displaystyle (Z,Z)}
+  
+ to 
+  
+    
+      
+        (
+        X
+        ,
+        Y
+        )
+      
+    
+    {\displaystyle (X,Y)}
+  
+, then it must equal
+a morphism 
+  
+    
+      
+        Δ
+        (
+        h
+        :
+        Z
+        →
+        X
+        ×
+        Y
+        )
+        =
+        (
+        h
+        ,
+        h
+        )
+      
+    
+    {\displaystyle \Delta (h:Z\to X\times Y)=(h,h)}
+  
+ from 
+  
+    
+      
+        Δ
+        (
+        Z
+        )
+        =
+        (
+        Z
+        ,
+        Z
+        )
+      
+    
+    {\displaystyle \Delta (Z)=(Z,Z)}
+  
+
+to 
+  
+    
+      
+        Δ
+        (
+        X
+        ×
+        Y
+        )
+        =
+        (
+        X
+        ×
+        Y
+        ,
+        X
+        ×
+        Y
+        )
+      
+    
+    {\displaystyle \Delta (X\times Y)=(X\times Y,X\times Y)}
+  
+ followed by 
+  
+    
+      
+        (
+        
+          π
+          
+            1
+          
+        
+        ,
+        
+          π
+          
+            2
+          
+        
+        )
+      
+    
+    {\displaystyle (\pi _{1},\pi _{2})}
+  
+. As a commutative diagram:
+
+For the example of the Cartesian product in Set, the morphism 
+  
+    
+      
+        (
+        
+          π
+          
+            1
+          
+        
+        ,
+        
+          π
+          
+            2
+          
+        
+        )
+      
+    
+    {\displaystyle (\pi _{1},\pi _{2})}
+  
+ comprises the two projections 
+  
+    
+      
+        
+          π
+          
+            1
+          
+        
+        (
+        x
+        ,
+        y
+        )
+        =
+        x
+      
+    
+    {\displaystyle \pi _{1}(x,y)=x}
+  
+ and 
+  
+    
+      
+        
+          π
+          
+            2
+          
+        
+        (
+        x
+        ,
+        y
+        )
+        =
+        y
+      
+    
+    {\displaystyle \pi _{2}(x,y)=y}
+  
+. Given any set 
+  
+    
+      
+        Z
+      
+    
+    {\displaystyle Z}
+  
+ and functions 
+  
+    
+      
+        f
+        ,
+        g
+      
+    
+    {\displaystyle f,g}
+  
+ the unique map such that the required diagram commutes is given by 
+  
+    
+      
+        h
+        =
+        ⟨
+        x
+        ,
+        y
+        ⟩
+        (
+        z
+        )
+        =
+        (
+        f
+        (
+        z
+        )
+        ,
+        g
+        (
+        z
+        )
+        )
+      
+    
+    {\displaystyle h=\langle x,y\rangle (z)=(f(z),g(z))}
+  
+.
+
+=== Limits and colimits ===
+Categorical products are a particular kind of limit in category theory. One can generalize the above example to arbitrary limits and colimits.
+Let 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+ and 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ be categories with 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+ a small index category and let 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+          
+            
+              J
+            
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}^{\mathcal {J}}}
+  
+ be the corresponding functor category. The diagonal functor
+
+  
+    
+      
+        Δ
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            
+              C
+            
+          
+          
+            
+              J
+            
+          
+        
+      
+    
+    {\displaystyle \Delta :{\mathcal {C}}\to {\mathcal {C}}^{\mathcal {J}}}
+  
+
+is the functor that maps each object 
+  
+    
+      
+        N
+      
+    
+    {\displaystyle N}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ to the constant functor 
+  
+    
+      
+        Δ
+        (
+        N
+        )
+        :
+        
+          
+            J
+          
+        
+        →
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle \Delta (N):{\mathcal {J}}\to {\mathcal {C}}}
+  
+ (i.e. 
+  
+    
+      
+        Δ
+        (
+        N
+        )
+        (
+        X
+        )
+        =
+        N
+      
+    
+    {\displaystyle \Delta (N)(X)=N}
+  
+ for each 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ in 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+ and 
+  
+    
+      
+        Δ
+        (
+        N
+        )
+        (
+        f
+        )
+        =
+        
+          1
+          
+            N
+          
+        
+      
+    
+    {\displaystyle \Delta (N)(f)=1_{N}}
+  
+ for each 
+  
+    
+      
+        f
+        :
+        X
+        →
+        Y
+      
+    
+    {\displaystyle f:X\to Y}
+  
+ in 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+) and each morphism 
+  
+    
+      
+        f
+        :
+        N
+        →
+        M
+      
+    
+    {\displaystyle f:N\to M}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ to the natural transformation 
+  
+    
+      
+        Δ
+        (
+        f
+        )
+        :
+        Δ
+        (
+        N
+        )
+        →
+        Δ
+        (
+        M
+        )
+      
+    
+    {\displaystyle \Delta (f):\Delta (N)\to \Delta (M)}
+  
+ in 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+          
+            
+              J
+            
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}^{\mathcal {J}}}
+  
+ defined as, for every object 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ of 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+, the component 
+  
+    
+      
+        Δ
+        (
+        f
+        )
+        (
+        X
+        )
+        :
+        Δ
+        (
+        N
+        )
+        (
+        X
+        )
+        →
+        Δ
+        (
+        M
+        )
+        (
+        X
+        )
+        =
+        f
+        :
+        N
+        →
+        M
+      
+    
+    {\displaystyle \Delta (f)(X):\Delta (N)(X)\to \Delta (M)(X)=f:N\to M}
+  
+
+at 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+. In other words, the natural transformation is the one defined by having constant component 
+  
+    
+      
+        f
+        :
+        N
+        →
+        M
+      
+    
+    {\displaystyle f:N\to M}
+  
+ for every object of 
+  
+    
+      
+        
+          
+            J
+          
+        
+      
+    
+    {\displaystyle {\mathcal {J}}}
+  
+.
+Given a functor 
+  
+    
+      
+        F
+        :
+        
+          
+            J
+          
+        
+        →
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle F:{\mathcal {J}}\to {\mathcal {C}}}
+  
+ (thought of as an object in 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+          
+            
+              J
+            
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}^{\mathcal {J}}}
+  
+), the limit of 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+, if it exists, is nothing but a universal morphism from 
+  
+    
+      
+        Δ
+      
+    
+    {\displaystyle \Delta }
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+. Dually, the colimit of 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ is a universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        Δ
+      
+    
+    {\displaystyle \Delta }
+  
+.
+
+== Properties ==
+
+=== Existence and uniqueness ===
+Defining a quantity does not guarantee its existence. Given a functor 
+  
+    
+      
+        F
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle F:{\mathcal {C}}\to {\mathcal {D}}}
+  
+ and an object 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+, 
+there may or may not exist a universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+.  If, however, a universal morphism 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ does exist, then it is essentially unique. 
+Specifically, it is unique up to a unique isomorphism: if 
+  
+    
+      
+        (
+        
+          A
+          ′
+        
+        ,
+        
+          u
+          ′
+        
+        )
+      
+    
+    {\displaystyle (A',u')}
+  
+ is another pair, then there exists a unique isomorphism 
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_property-3.md b/data/en.wikipedia.org/wiki/Universal_property-3.md
new file mode 100644
index 000000000..f867bf723
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_property-3.md
@@ -0,0 +1,1142 @@
+---
+title: "Universal property"
+chunk: 4/5
+source: "https://en.wikipedia.org/wiki/Universal_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:54.601173+00:00"
+instance: "kb-cron"
+---
+
+  
+    
+      
+        k
+        :
+        A
+        →
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle k:A\to A'}
+  
+ such that 
+  
+    
+      
+        
+          u
+          ′
+        
+        =
+        F
+        (
+        k
+        )
+        ∘
+        u
+      
+    
+    {\displaystyle u'=F(k)\circ u}
+  
+.
+This is easily seen by substituting 
+  
+    
+      
+        (
+        A
+        ,
+        
+          u
+          ′
+        
+        )
+      
+    
+    {\displaystyle (A,u')}
+  
+ in the definition of a universal morphism.
+It is the pair 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ which is essentially unique in this fashion. The object 
+  
+    
+      
+        A
+      
+    
+    {\displaystyle A}
+  
+ itself is only unique up to isomorphism. Indeed, if 
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ is a universal morphism and 
+  
+    
+      
+        k
+        :
+        A
+        →
+        
+          A
+          ′
+        
+      
+    
+    {\displaystyle k:A\to A'}
+  
+ is any isomorphism then the pair 
+  
+    
+      
+        (
+        
+          A
+          ′
+        
+        ,
+        
+          u
+          ′
+        
+        )
+      
+    
+    {\displaystyle (A',u')}
+  
+, where 
+  
+    
+      
+        
+          u
+          ′
+        
+        =
+        F
+        (
+        k
+        )
+        ∘
+        u
+      
+    
+    {\displaystyle u'=F(k)\circ u}
+  
+ is also a universal morphism.
+
+=== Equivalent formulations ===
+The definition of a universal morphism can be rephrased in a variety of ways. Let 
+  
+    
+      
+        F
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle F:{\mathcal {C}}\to {\mathcal {D}}}
+  
+ be a functor and let 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ be an object of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+. Then the following statements are equivalent:
+
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ is a universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ is an initial object of the comma category 
+  
+    
+      
+        (
+        X
+        ↓
+        F
+        )
+      
+    
+    {\displaystyle (X\downarrow F)}
+  
+
+  
+    
+      
+        (
+        A
+        ,
+        F
+        (
+        ∙
+        )
+        ∘
+        u
+        )
+      
+    
+    {\displaystyle (A,F(\bullet )\circ u)}
+  
+ is a representation of 
+  
+    
+      
+        
+          
+            Hom
+          
+          
+            
+              D
+            
+          
+        
+        (
+        X
+        ,
+        F
+        (
+        −
+        )
+        )
+      
+    
+    {\displaystyle {\text{Hom}}_{\mathcal {D}}(X,F(-))}
+  
+, where its components 
+  
+    
+      
+        (
+        F
+        (
+        ∙
+        )
+        ∘
+        u
+        
+          )
+          
+            B
+          
+        
+        :
+        
+          
+            Hom
+          
+          
+            
+              C
+            
+          
+        
+        (
+        A
+        ,
+        B
+        )
+        →
+        
+          
+            Hom
+          
+          
+            
+              D
+            
+          
+        
+        (
+        X
+        ,
+        F
+        (
+        B
+        )
+        )
+      
+    
+    {\displaystyle (F(\bullet )\circ u)_{B}:{\text{Hom}}_{\mathcal {C}}(A,B)\to {\text{Hom}}_{\mathcal {D}}(X,F(B))}
+  
+ are defined by
+
+  
+    
+      
+        (
+        F
+        (
+        ∙
+        )
+        ∘
+        u
+        
+          )
+          
+            B
+          
+        
+        (
+        f
+        :
+        A
+        →
+        B
+        )
+        :
+        X
+        →
+        F
+        (
+        B
+        )
+        =
+        F
+        (
+        f
+        )
+        ∘
+        u
+        :
+        X
+        →
+        F
+        (
+        B
+        )
+      
+    
+    {\displaystyle (F(\bullet )\circ u)_{B}(f:A\to B):X\to F(B)=F(f)\circ u:X\to F(B)}
+  
+
+for each object 
+  
+    
+      
+        B
+      
+    
+    {\displaystyle B}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+        .
+      
+    
+    {\displaystyle {\mathcal {C}}.}
+  
+
+The dual statements are also equivalent:
+
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ is a universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+
+  
+    
+      
+        (
+        A
+        ,
+        u
+        )
+      
+    
+    {\displaystyle (A,u)}
+  
+ is a terminal object of the comma category 
+  
+    
+      
+        (
+        F
+        ↓
+        X
+        )
+      
+    
+    {\displaystyle (F\downarrow X)}
+  
+
+  
+    
+      
+        (
+        A
+        ,
+        u
+        ∘
+        F
+        (
+        ∙
+        )
+        )
+      
+    
+    {\displaystyle (A,u\circ F(\bullet ))}
+  
+ is a representation of 
+  
+    
+      
+        
+          
+            Hom
+          
+          
+            
+              D
+            
+          
+        
+        (
+        F
+        (
+        −
+        )
+        ,
+        X
+        )
+      
+    
+    {\displaystyle {\text{Hom}}_{\mathcal {D}}(F(-),X)}
+  
+, where its components 
+  
+    
+      
+        (
+        u
+        ∘
+        F
+        (
+        ∙
+        )
+        
+          )
+          
+            B
+          
+        
+        :
+        
+          
+            Hom
+          
+          
+            
+              C
+            
+          
+        
+        (
+        B
+        ,
+        A
+        )
+        →
+        
+          
+            Hom
+          
+          
+            
+              D
+            
+          
+        
+        (
+        F
+        (
+        B
+        )
+        ,
+        X
+        )
+      
+    
+    {\displaystyle (u\circ F(\bullet ))_{B}:{\text{Hom}}_{\mathcal {C}}(B,A)\to {\text{Hom}}_{\mathcal {D}}(F(B),X)}
+  
+ are defined by
+
+  
+    
+      
+        (
+        u
+        ∘
+        F
+        (
+        ∙
+        )
+        
+          )
+          
+            B
+          
+        
+        (
+        f
+        :
+        B
+        →
+        A
+        )
+        :
+        F
+        (
+        B
+        )
+        →
+        X
+        =
+        u
+        ∘
+        F
+        (
+        f
+        )
+        :
+        F
+        (
+        B
+        )
+        →
+        X
+      
+    
+    {\displaystyle (u\circ F(\bullet ))_{B}(f:B\to A):F(B)\to X=u\circ F(f):F(B)\to X}
+  
+
+for each object 
+  
+    
+      
+        B
+      
+    
+    {\displaystyle B}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+        .
+      
+    
+    {\displaystyle {\mathcal {C}}.}
+  
+
+=== Relation to adjoint functors ===
+Suppose 
+  
+    
+      
+        (
+        
+          A
+          
+            1
+          
+        
+        ,
+        
+          u
+          
+            1
+          
+        
+        )
+      
+    
+    {\displaystyle (A_{1},u_{1})}
+  
+ is a universal morphism from 
+  
+    
+      
+        
+          X
+          
+            1
+          
+        
+      
+    
+    {\displaystyle X_{1}}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ and 
+  
+    
+      
+        (
+        
+          A
+          
+            2
+          
+        
+        ,
+        
+          u
+          
+            2
+          
+        
+        )
+      
+    
+    {\displaystyle (A_{2},u_{2})}
+  
+ is a universal morphism from 
+  
+    
+      
+        
+          X
+          
+            2
+          
+        
+      
+    
+    {\displaystyle X_{2}}
+  
+ to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+. 
+By the universal property of universal morphisms, given any morphism 
+  
+    
+      
+        h
+        :
+        
+          X
+          
+            1
+          
+        
+        →
+        
+          X
+          
+            2
+          
+        
+      
+    
+    {\displaystyle h:X_{1}\to X_{2}}
+  
+ there exists a unique morphism 
+  
+    
+      
+        g
+        :
+        
+          A
+          
+            1
+          
+        
+        →
+        
+          A
+          
+            2
+          
+        
+      
+    
+    {\displaystyle g:A_{1}\to A_{2}}
+  
+ such that the following diagram commutes:
+
+If every object 
+  
+    
+      
+        
+          X
+          
+            i
+          
+        
+      
+    
+    {\displaystyle X_{i}}
+  
+ of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+ admits a universal morphism to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+, then the assignment 
+  
+    
+      
+        
+          X
+          
+            i
+          
+        
+        ↦
+        
+          A
+          
+            i
+          
+        
+      
+    
+    {\displaystyle X_{i}\mapsto A_{i}}
+  
+ and 
+  
+    
+      
+        h
+        ↦
+        g
+      
+    
+    {\displaystyle h\mapsto g}
+  
+ defines a functor 
+  
+    
+      
+        G
+        :
+        
+          
+            D
+          
+        
+        →
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle G:{\mathcal {D}}\to {\mathcal {C}}}
+  
+. The maps 
+  
+    
+      
+        
+          u
+          
+            i
+          
+        
+      
+    
+    {\displaystyle u_{i}}
+  
+ then define a natural transformation from 
+  
+    
+      
+        
+          1
+          
+            
+              D
+            
+          
+        
+      
+    
+    {\displaystyle 1_{\mathcal {D}}}
+  
+ (the identity functor on 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+) to 
+  
+    
+      
+        F
+        ∘
+        G
+      
+    
+    {\displaystyle F\circ G}
+  
+. The functors 
+  
+    
+      
+        (
+        F
+        ,
+        G
+        )
+      
+    
+    {\displaystyle (F,G)}
+  
+ are then a pair of adjoint functors, with 
+  
+    
+      
+        G
+      
+    
+    {\displaystyle G}
+  
+ left-adjoint to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ and 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ right-adjoint to 
+  
+    
+      
+        G
+      
+    
+    {\displaystyle G}
+  
+.
+Similar statements apply to the dual situation of terminal morphisms from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+. If such morphisms exist for every 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ one obtains a functor 
+  
+    
+      
+        G
+        :
+        
+          
+            C
+          
+        
+        →
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle G:{\mathcal {C}}\to {\mathcal {D}}}
+  
+ which is right-adjoint to 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ (so 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ is left-adjoint to 
+  
+    
+      
+        G
+      
+    
+    {\displaystyle G}
+  
+).
+Indeed, all pairs of adjoint functors arise from universal constructions in this manner. Let 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ and 
+  
+    
+      
+        G
+      
+    
+    {\displaystyle G}
+  
+ be a pair of adjoint functors with unit 
+  
+    
+      
+        η
+      
+    
+    {\displaystyle \eta }
+  
+ and co-unit 
+  
+    
+      
+        ϵ
+      
+    
+    {\displaystyle \epsilon }
+  
+ 
+(see the article on adjoint functors for the definitions). Then we have a universal morphism for each object in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ and 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_property-4.md b/data/en.wikipedia.org/wiki/Universal_property-4.md
new file mode 100644
index 000000000..8a51aa385
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_property-4.md
@@ -0,0 +1,264 @@
+---
+title: "Universal property"
+chunk: 5/5
+source: "https://en.wikipedia.org/wiki/Universal_property"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:24:54.601173+00:00"
+instance: "kb-cron"
+---
+
+For each object 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ in 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+, 
+  
+    
+      
+        (
+        F
+        (
+        X
+        )
+        ,
+        
+          η
+          
+            X
+          
+        
+        )
+      
+    
+    {\displaystyle (F(X),\eta _{X})}
+  
+ is a universal morphism from 
+  
+    
+      
+        X
+      
+    
+    {\displaystyle X}
+  
+ to 
+  
+    
+      
+        G
+      
+    
+    {\displaystyle G}
+  
+. That is, for all 
+  
+    
+      
+        f
+        :
+        X
+        →
+        G
+        (
+        Y
+        )
+      
+    
+    {\displaystyle f:X\to G(Y)}
+  
+ there exists a unique 
+  
+    
+      
+        g
+        :
+        F
+        (
+        X
+        )
+        →
+        Y
+      
+    
+    {\displaystyle g:F(X)\to Y}
+  
+ for which the following diagrams commute.
+For each object 
+  
+    
+      
+        Y
+      
+    
+    {\displaystyle Y}
+  
+ in 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+, 
+  
+    
+      
+        (
+        G
+        (
+        Y
+        )
+        ,
+        
+          ϵ
+          
+            Y
+          
+        
+        )
+      
+    
+    {\displaystyle (G(Y),\epsilon _{Y})}
+  
+ is a universal morphism from 
+  
+    
+      
+        F
+      
+    
+    {\displaystyle F}
+  
+ to 
+  
+    
+      
+        Y
+      
+    
+    {\displaystyle Y}
+  
+. That is, for all 
+  
+    
+      
+        g
+        :
+        F
+        (
+        X
+        )
+        →
+        Y
+      
+    
+    {\displaystyle g:F(X)\to Y}
+  
+ there exists a unique 
+  
+    
+      
+        f
+        :
+        X
+        →
+        G
+        (
+        Y
+        )
+      
+    
+    {\displaystyle f:X\to G(Y)}
+  
+ for which the following diagrams commute.
+
+Universal constructions are more general than adjoint functor pairs: a universal construction is like an optimization problem; it gives rise to an adjoint pair if and only if this problem has a solution for every object of 
+  
+    
+      
+        
+          
+            C
+          
+        
+      
+    
+    {\displaystyle {\mathcal {C}}}
+  
+ (equivalently, every object of 
+  
+    
+      
+        
+          
+            D
+          
+        
+      
+    
+    {\displaystyle {\mathcal {D}}}
+  
+).
+
+== History ==
+Universal properties of various topological constructions were presented by Pierre Samuel in 1948. They were later used extensively by Bourbaki. The closely related concept of adjoint functors was introduced independently by Daniel Kan in 1958.
+
+== See also ==
+
+Free object
+Natural transformation
+Adjoint functor
+Monad (category theory)
+Variety of algebras
+Cartesian closed category
+
+== Notes ==
+
+== References ==
+Paul Cohn, Universal Algebra (1981), D.Reidel Publishing, Holland. ISBN 90-277-1213-1.
+Mac Lane, Saunders (1998). Categories for the Working Mathematician. Graduate Texts in Mathematics 5 (2nd ed.). Springer. ISBN 0-387-98403-8.
+Borceux, F. Handbook of Categorical Algebra: vol 1 Basic category theory (1994) Cambridge University Press, (Encyclopedia of Mathematics and its Applications) ISBN 0-521-44178-1
+N. Bourbaki, Livre II : Algèbre (1970), Hermann, ISBN 0-201-00639-1.
+Milies, César Polcino; Sehgal, Sudarshan K.. An introduction to group rings. Algebras and applications, Volume 1. Springer, 2002. ISBN 978-1-4020-0238-0
+Jacobson. Basic Algebra II. Dover. 2009. ISBN 0-486-47187-X
+Roman, Steven (2017). "Universality". An Introduction to the Language of Category Theory. Compact Textbooks in Mathematics. pp. 71–86. doi:10.1007/978-3-319-41917-6_3. ISBN 978-3-319-41916-9.
+Abramsky, S.; Tzevelekos, N. (2010). "Introduction to Categories and Categorical Logic". New Structures for Physics. Lecture Notes in Physics. Vol. 813. pp. 3–94. arXiv:1102.1313. doi:10.1007/978-3-642-12821-9_1. ISBN 978-3-642-12820-2.
+Leinster, Tom (2014). Basic Category Theory. arXiv:1612.09375. doi:10.1017/CBO9781107360068. ISBN 978-1-107-04424-1.
+
+== External links ==
+nLab, a wiki project on mathematics, physics and philosophy with emphasis on the n-categorical point of view
+André Joyal, CatLab, a wiki project dedicated to the exposition of categorical mathematics
+Hillman, Chris (2001). A Categorical Primer. CiteSeerX 10.1.1.24.3264: formal introduction to category theory.
+J. Adamek, H. Herrlich, G. Stecker, Abstract and Concrete Categories-The Joy of Cats
+Stanford Encyclopedia of Philosophy: "Category Theory"—by Jean-Pierre Marquis. Extensive bibliography.
+List of academic conferences on category theory
+Baez, John, 1996,"The Tale of n-categories." An informal introduction to higher order categories.
+WildCats is a category theory package for Mathematica. Manipulation and visualization of objects, morphisms, categories, functors, natural transformations, universal properties.
+The catsters, a YouTube channel about category theory.
+Video archive of recorded talks relevant to categories, logic and the foundations of physics.
+Interactive Web page which generates examples of categorical constructions in the category of finite sets.
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Universal_space-0.md b/data/en.wikipedia.org/wiki/Universal_space-0.md
new file mode 100644
index 000000000..6fc87d479
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Universal_space-0.md
@@ -0,0 +1,879 @@
+---
+title: "Universal space"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Universal_space"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:28.849483+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a universal space is a certain metric space that contains all metric spaces whose dimension is bounded by some fixed constant. A similar definition exists in topological dynamics.
+
+
+== Definition ==
+Given a class 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ of topological spaces, 
+  
+    
+      
+        
+          
+            U
+          
+          ∈
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle \mathbb {U} \in {\mathcal {C}}}
+  
+ is universal for 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ if each member of 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ embeds in 
+  
+    
+      
+        
+          
+            U
+          
+        
+      
+    
+    {\displaystyle \textstyle \mathbb {U} }
+  
+. Menger stated and proved the case 
+  
+    
+      
+        
+          d
+          =
+          1
+        
+      
+    
+    {\displaystyle \textstyle d=1}
+  
+ of the following theorem. The theorem in full generality was proven by Nöbeling.
+Theorem:
+The 
+  
+    
+      
+        
+          (
+          2
+          d
+          +
+          1
+          )
+        
+      
+    
+    {\displaystyle \textstyle (2d+1)}
+  
+-dimensional cube 
+  
+    
+      
+        
+          [
+          0
+          ,
+          1
+          
+            ]
+            
+              2
+              d
+              +
+              1
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle [0,1]^{2d+1}}
+  
+ is universal for the class of compact metric spaces  whose Lebesgue covering dimension is less than 
+  
+    
+      
+        
+          d
+        
+      
+    
+    {\displaystyle \textstyle d}
+  
+.
+Nöbeling went further and proved:
+Theorem: The subspace of 
+  
+    
+      
+        
+          [
+          0
+          ,
+          1
+          
+            ]
+            
+              2
+              d
+              +
+              1
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle [0,1]^{2d+1}}
+  
+ consisting of set of points, at most 
+  
+    
+      
+        
+          d
+        
+      
+    
+    {\displaystyle \textstyle d}
+  
+ of whose coordinates are rational, is universal for the class of separable metric spaces whose Lebesgue covering dimension is less than 
+  
+    
+      
+        
+          d
+        
+      
+    
+    {\displaystyle \textstyle d}
+  
+.
+The last theorem was generalized by Lipscomb to the class of metric spaces of weight 
+  
+    
+      
+        
+          α
+        
+      
+    
+    {\displaystyle \textstyle \alpha }
+  
+, 
+  
+    
+      
+        
+          α
+          >
+          
+            ℵ
+            
+              0
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle \alpha >\aleph _{0}}
+  
+: There exist a one-dimensional metric space 
+  
+    
+      
+        
+          
+            J
+            
+              α
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle J_{\alpha }}
+  
+ such that the subspace of 
+  
+    
+      
+        
+          
+            J
+            
+              α
+            
+            
+              2
+              d
+              +
+              1
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle J_{\alpha }^{2d+1}}
+  
+ consisting of set of points, at most 
+  
+    
+      
+        
+          d
+        
+      
+    
+    {\displaystyle \textstyle d}
+  
+ of whose coordinates are "rational" (suitably defined), is universal for the class of metric spaces whose Lebesgue covering dimension is less than 
+  
+    
+      
+        
+          d
+        
+      
+    
+    {\displaystyle \textstyle d}
+  
+ and whose weight is less than 
+  
+    
+      
+        
+          α
+        
+      
+    
+    {\displaystyle \textstyle \alpha }
+  
+.
+
+
+== Universal spaces in topological dynamics ==
+Consider the category of topological dynamical systems 
+  
+    
+      
+        
+          (
+          X
+          ,
+          T
+          )
+        
+      
+    
+    {\displaystyle \textstyle (X,T)}
+  
+ consisting of a compact metric space 
+  
+    
+      
+        
+          X
+        
+      
+    
+    {\displaystyle \textstyle X}
+  
+ and a homeomorphism 
+  
+    
+      
+        
+          T
+          :
+          X
+          →
+          X
+        
+      
+    
+    {\displaystyle \textstyle T:X\rightarrow X}
+  
+. The topological dynamical system 
+  
+    
+      
+        
+          (
+          X
+          ,
+          T
+          )
+        
+      
+    
+    {\displaystyle \textstyle (X,T)}
+  
+ is called minimal if it has no proper non-empty closed 
+  
+    
+      
+        
+          T
+        
+      
+    
+    {\displaystyle \textstyle T}
+  
+-invariant subsets. It is called infinite if 
+  
+    
+      
+        
+          
+            |
+          
+          X
+          
+            |
+          
+          =
+          ∞
+        
+      
+    
+    {\displaystyle \textstyle |X|=\infty }
+  
+. A topological dynamical system 
+  
+    
+      
+        
+          (
+          Y
+          ,
+          S
+          )
+        
+      
+    
+    {\displaystyle \textstyle (Y,S)}
+  
+ is called a factor of 
+  
+    
+      
+        
+          (
+          X
+          ,
+          T
+          )
+        
+      
+    
+    {\displaystyle \textstyle (X,T)}
+  
+ if there exists a continuous surjective mapping 
+  
+    
+      
+        
+          φ
+          :
+          X
+          →
+          Y
+        
+      
+    
+    {\displaystyle \textstyle \varphi :X\rightarrow Y}
+  
+ which is equivariant, i.e. 
+  
+    
+      
+        
+          φ
+          (
+          T
+          x
+          )
+          =
+          S
+          φ
+          (
+          x
+          )
+        
+      
+    
+    {\displaystyle \textstyle \varphi (Tx)=S\varphi (x)}
+  
+ for all 
+  
+    
+      
+        
+          x
+          ∈
+          X
+        
+      
+    
+    {\displaystyle \textstyle x\in X}
+  
+.
+Similarly to the definition above, given a class 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ of topological dynamical systems, 
+  
+    
+      
+        
+          
+            U
+          
+          ∈
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle \mathbb {U} \in {\mathcal {C}}}
+  
+ is universal for 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ if each member of 
+  
+    
+      
+        
+          
+            
+              C
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\mathcal {C}}}
+  
+ embeds in 
+  
+    
+      
+        
+          
+            U
+          
+        
+      
+    
+    {\displaystyle \textstyle \mathbb {U} }
+  
+ through an equivariant continuous mapping. Lindenstrauss proved the following theorem:
+Theorem: Let 
+  
+    
+      
+        
+          d
+          ∈
+          
+            N
+          
+        
+      
+    
+    {\displaystyle \textstyle d\in \mathbb {N} }
+  
+. The compact metric topological dynamical system 
+  
+    
+      
+        
+          (
+          X
+          ,
+          T
+          )
+        
+      
+    
+    {\displaystyle \textstyle (X,T)}
+  
+ where 
+  
+    
+      
+        
+          X
+          =
+          (
+          [
+          0
+          ,
+          1
+          
+            ]
+            
+              d
+            
+          
+          
+            )
+            
+              
+                Z
+              
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle X=([0,1]^{d})^{\mathbb {Z} }}
+  
+ and 
+  
+    
+      
+        
+          T
+          :
+          X
+          →
+          X
+        
+      
+    
+    {\displaystyle \textstyle T:X\rightarrow X}
+  
+ is the shift homeomorphism 
+
+  
+    
+      
+        
+          (
+          …
+          ,
+          
+            x
+            
+              −
+              2
+            
+          
+          ,
+          
+            x
+            
+              −
+              1
+            
+          
+          ,
+          
+            
+              x
+              
+                0
+              
+            
+          
+          ,
+          
+            x
+            
+              1
+            
+          
+          ,
+          
+            x
+            
+              2
+            
+          
+          ,
+          …
+          )
+          →
+          (
+          …
+          ,
+          
+            x
+            
+              −
+              1
+            
+          
+          ,
+          
+            x
+            
+              0
+            
+          
+          ,
+          
+            
+              x
+              
+                1
+              
+            
+          
+          ,
+          
+            x
+            
+              2
+            
+          
+          ,
+          
+            x
+            
+              3
+            
+          
+          ,
+          …
+          )
+        
+      
+    
+    {\displaystyle \textstyle (\ldots ,x_{-2},x_{-1},\mathbf {x_{0}} ,x_{1},x_{2},\ldots )\rightarrow (\ldots ,x_{-1},x_{0},\mathbf {x_{1}} ,x_{2},x_{3},\ldots )}
+  
+
+is universal for the class of compact metric topological dynamical systems whose mean dimension is strictly less than 
+  
+    
+      
+        
+          
+            
+              d
+              36
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle {\frac {d}{36}}}
+  
+ and which possess an infinite minimal factor.
+In the same article Lindenstrauss asked what is the largest constant 
+  
+    
+      
+        
+          c
+        
+      
+    
+    {\displaystyle \textstyle c}
+  
+ such that a compact metric topological dynamical system whose mean dimension is strictly less than 
+  
+    
+      
+        
+          c
+          d
+        
+      
+    
+    {\displaystyle \textstyle cd}
+  
+ and which possesses an infinite minimal factor embeds into 
+  
+    
+      
+        
+          (
+          [
+          0
+          ,
+          1
+          
+            ]
+            
+              d
+            
+          
+          
+            )
+            
+              
+                Z
+              
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle ([0,1]^{d})^{\mathbb {Z} }}
+  
+. The results above implies  
+  
+    
+      
+        
+          c
+          ≥
+          
+            
+              1
+              36
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle c\geq {\frac {1}{36}}}
+  
+. The question was answered by Lindenstrauss and Tsukamoto who showed that  
+  
+    
+      
+        
+          c
+          ≤
+          
+            
+              1
+              2
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle c\leq {\frac {1}{2}}}
+  
+ and Gutman and Tsukamoto who showed that  
+  
+    
+      
+        
+          c
+          ≥
+          
+            
+              1
+              2
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle c\geq {\frac {1}{2}}}
+  
+. Thus the answer is  
+  
+    
+      
+        
+          c
+          =
+          
+            
+              1
+              2
+            
+          
+        
+      
+    
+    {\displaystyle \textstyle c={\frac {1}{2}}}
+  
+.
+
+
+== See also ==
+Universal property
+Urysohn universal space
+Mean dimension
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Up_to-0.md b/data/en.wikipedia.org/wiki/Up_to-0.md
new file mode 100644
index 000000000..d8cec02e6
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Up_to-0.md
@@ -0,0 +1,66 @@
+---
+title: "Up to"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Up_to"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:29.989667+00:00"
+instance: "kb-cron"
+---
+
+Two mathematical objects a and b are called "equal up to an equivalence relation R"
+if a and b are related by R, that is,
+if aRb holds, that is,
+if the equivalence classes of a and b with respect to R are equal.
+This figure of speech is mostly used in connection with expressions derived from equality, such as uniqueness or count.
+For example, "x is unique up to R" means that all objects x under consideration are in the same equivalence class with respect to the relation R.
+Moreover, the equivalence relation R is often designated rather implicitly by a generating condition or transformation.
+
+For example, the statement "an integer's prime factorization is unique up to ordering" is a concise way to say that any two lists of prime factors of a given integer are equivalent with respect to the relation R that relates two lists if one can be obtained by reordering (permuting) the other.
+As another example, the statement "the solution to an indefinite integral is sin(x), up to addition of a constant" tacitly employs the equivalence relation R between functions, defined by fRg if the pointwise difference f−g is a constant function, and means that the solution and the function sin(x) are equal up to this R.
+In the picture, "there are 4 partitions up to rotation" means that the set P has 4 equivalence classes with respect to R defined by aRb if b can be obtained from a by rotation; one representative from each class is shown in the bottom left picture part.
+Equivalence relations are often used to disregard possible differences of objects, so "up to R" can be understood informally as "ignoring the same subtleties as R ignores".
+In the factorization example, "up to ordering" means "ignoring the particular ordering".
+Further examples include "up to isomorphism", "up to permutations", and "up to rotations", which are described in the Examples section.
+In informal contexts, mathematicians often use the word modulo (or simply mod) for similar purposes, as in "modulo isomorphism".
+Objects that are distinct up to an equivalence relation defined by a group action, such as rotation, reflection, or permutation, can be counted using Burnside's lemma or its generalization, Pólya enumeration theorem.
+
+
+== Examples ==
+
+
+=== Tetris ===
+
+Consider the seven Tetris pieces (I, J, L, O, S, T, Z), known mathematically as the tetrominoes. If you consider all the possible rotations of these pieces — for example, if you consider the "I" oriented vertically to be distinct from the "I" oriented horizontally — then you find there are 19 distinct possible shapes to be displayed on the screen. (These 19 are the so-called "fixed" tetrominoes.) But if rotations are not considered distinct — so that we treat both "I vertically" and "I horizontally" indifferently as "I" — then there are only seven. We say that "there are seven tetrominoes, up to rotation". One could also say that "there are five tetrominoes, up to rotation and reflection", which accounts for the fact that L reflected gives J, and S reflected gives Z.
+
+
+=== Eight queens ===
+
+In the eight queens puzzle, if the queens are considered to be distinct (e.g. if they are colored with eight different colors), then there are 3709440 distinct solutions. Normally, however, the queens are considered to be interchangeable, and one usually says "there are 3,709,440 / 8! = 92 unique solutions up to permutation of the queens", or that "there are 92 solutions modulo the names of the queens", signifying that two different arrangements of the queens are considered equivalent if the queens have been permuted, as long as the set of occupied squares remains the same.
+If, in addition to treating the queens as identical, rotations and reflections of the board were allowed, we would have only 12 distinct solutions "up to symmetry and the naming of the queens". For more, see Eight queens puzzle § Solutions.
+
+
+=== Polygons ===
+The regular n-gon, for a fixed n, is unique up to similarity. In other words, the "similarity" equivalence relation over the regular n-gons (for a fixed n) has only one equivalence class; it is impossible to produce two regular n-gons which are not similar to each other.
+
+
+=== Group theory ===
+In group theory, one may have a group G acting on a set X, in which case, one might say that two elements of X are equivalent "up to the group action"—if they lie in the same orbit.
+Another typical example is the statement that "there are two different groups of order 4 up to isomorphism", or "modulo isomorphism, there are two groups of order 4". This means that, if one considers isomorphic groups "equivalent", there are only two equivalence classes of groups of order 4, prototypically the cyclic group of order 4 and the Klein four-group.
+
+
+=== Nonstandard analysis ===
+A hyperreal x and its standard part st(x) are equal up to an infinitesimal difference.
+
+
+== See also ==
+
+Abuse of notation
+Adequality
+Essentially unique
+List of mathematical jargon
+Quotient group
+Quotient set
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Upper_and_lower_bounds-0.md b/data/en.wikipedia.org/wiki/Upper_and_lower_bounds-0.md
new file mode 100644
index 000000000..1a83b7dc3
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Upper_and_lower_bounds-0.md
@@ -0,0 +1,45 @@
+---
+title: "Upper and lower bounds"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Upper_and_lower_bounds"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:31.217787+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, particularly in order theory, an upper bound or majorant of a subset S of some preordered set (K, ≤) is an element of K that is greater than or equal to every element of S. 
+Dually, a lower bound or minorant of S is defined to be an element of K that is less than or equal to every element of S. 
+A set with an upper (respectively, lower) bound is said to be bounded from above or majorized (respectively bounded from below or minorized) by that bound. 
+The terms bounded above (bounded below) are also used in the mathematical literature for sets that have upper (respectively lower) bounds.
+
+
+== Examples ==
+For example, 5 is a lower bound for the set S = {5, 8, 42, 34, 13934} (as a subset of the integers or of the real numbers, etc.), and so is 4. On the other hand, 6 is not a lower bound for S since it is not smaller than every element in S. 13934 and other numbers x such that x ≥ 13934 would be an upper bound for S.
+The set S = {42} has 42 as both an upper bound and a lower bound; all other numbers are either an upper bound or a lower bound for that S.
+Every subset of the natural numbers has a lower bound since the natural numbers have a least element (0 or 1, depending on convention). An infinite subset of the natural numbers cannot be bounded from above. An infinite subset of the integers may be bounded from below or bounded from above, but not both. An infinite subset of the rational numbers may or may not be bounded from below, and may or may not be bounded from above.
+Every finite subset of a non-empty totally ordered set has both upper and lower bounds.
+
+
+== Bounds of functions ==
+The definitions can be generalized to functions and even to sets of functions.
+Given a function f with domain D and a preordered set (K, ≤) as codomain, an element y of K is an upper bound of f if y ≥ f(x) for each x in D. The upper bound is called sharp if equality holds for at least one value of x. It indicates that the constraint is optimal, and thus cannot be further reduced without invalidating the inequality.
+Similarly, a function g defined on domain D and having the same codomain (K, ≤) is an upper bound of f, if g(x) ≥ f(x) for each x in D. The function g is further said to be an upper bound of a set of functions, if it is an upper bound of each function in that set.
+The notion of lower bound for (sets of) functions is defined analogously, by replacing ≥ with ≤.
+
+
+== Tight bounds ==
+An upper bound is said to be a tight upper bound, a least upper bound, or a supremum, if no smaller value is an upper bound. Similarly, a lower bound is said to be a tight lower bound, a greatest lower bound, or an infimum, if no greater value is a lower bound.
+
+
+== Exact upper bounds ==
+An upper bound u of a subset S of a preordered set (K, ≤) is said to be an exact upper bound for S if every element of K that is strictly majorized by u is also majorized by some element of S. Exact upper bounds of reduced products of linear orders play an important role in PCF theory.
+
+
+== See also ==
+Greatest element and least element
+Infimum and supremum
+Maximal and minimal elements
+
+
+== References ==
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Well-defined_expression-0.md b/data/en.wikipedia.org/wiki/Well-defined_expression-0.md
new file mode 100644
index 000000000..95e3b7526
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Well-defined_expression-0.md
@@ -0,0 +1,904 @@
+---
+title: "Well-defined expression"
+chunk: 1/2
+source: "https://en.wikipedia.org/wiki/Well-defined_expression"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:32.423393+00:00"
+instance: "kb-cron"
+---
+
+In mathematics, a well-defined expression or unambiguous expression is an expression whose definition assigns it a unique interpretation or value. Otherwise, the expression is said to be not well defined, ill-defined or ambiguous. A function is well defined if it gives the same result when the representation of the input is changed without changing the value of the input. For instance, if 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ takes real numbers as input, and if 
+  
+    
+      
+        f
+        (
+        0.5
+        )
+      
+    
+    {\displaystyle f(0.5)}
+  
+ does not equal 
+  
+    
+      
+        f
+        (
+        1
+        
+          /
+        
+        2
+        )
+      
+    
+    {\displaystyle f(1/2)}
+  
+ then 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is not well defined (and thus not a function). The term well-defined can also be used to indicate that a logical expression is unambiguous or uncontradictory.
+A function that is not well defined is not the same as a function that is undefined. For example, if 
+  
+    
+      
+        f
+        (
+        x
+        )
+        =
+        
+          
+            1
+            x
+          
+        
+      
+    
+    {\displaystyle f(x)={\frac {1}{x}}}
+  
+, then even though 
+  
+    
+      
+        f
+        (
+        0
+        )
+      
+    
+    {\displaystyle f(0)}
+  
+ is undefined, this does not mean that the function is not well defined; rather, 0 is not in the domain of 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+.
+
+== Example ==
+Let 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        ,
+        
+          A
+          
+            1
+          
+        
+      
+    
+    {\displaystyle A_{0},A_{1}}
+  
+ be sets, let 
+  
+    
+      
+        A
+        =
+        
+          A
+          
+            0
+          
+        
+        ∪
+        
+          A
+          
+            1
+          
+        
+      
+    
+    {\displaystyle A=A_{0}\cup A_{1}}
+  
+ and "define" 
+  
+    
+      
+        f
+        :
+        A
+        →
+        {
+        0
+        ,
+        1
+        }
+      
+    
+    {\displaystyle f:A\rightarrow \{0,1\}}
+  
+ as 
+  
+    
+      
+        f
+        (
+        a
+        )
+        =
+        0
+      
+    
+    {\displaystyle f(a)=0}
+  
+ if 
+  
+    
+      
+        a
+        ∈
+        
+          A
+          
+            0
+          
+        
+      
+    
+    {\displaystyle a\in A_{0}}
+  
+ and 
+  
+    
+      
+        f
+        (
+        a
+        )
+        =
+        1
+      
+    
+    {\displaystyle f(a)=1}
+  
+ if 
+  
+    
+      
+        a
+        ∈
+        
+          A
+          
+            1
+          
+        
+      
+    
+    {\displaystyle a\in A_{1}}
+  
+.
+Then 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is well defined if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+        =
+        ∅
+        
+      
+    
+    {\displaystyle A_{0}\cap A_{1}=\emptyset \!}
+  
+. For example, if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        :=
+        {
+        2
+        ,
+        4
+        }
+      
+    
+    {\displaystyle A_{0}:=\{2,4\}}
+  
+ and 
+  
+    
+      
+        
+          A
+          
+            1
+          
+        
+        :=
+        {
+        3
+        ,
+        5
+        }
+      
+    
+    {\displaystyle A_{1}:=\{3,5\}}
+  
+, then 
+  
+    
+      
+        f
+        (
+        a
+        )
+      
+    
+    {\displaystyle f(a)}
+  
+ would be well defined and equal to 
+  
+    
+      
+        mod
+        ⁡
+        (
+        a
+        ,
+        2
+        )
+      
+    
+    {\displaystyle \operatorname {mod} (a,2)}
+  
+.
+However, if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+        ≠
+        ∅
+      
+    
+    {\displaystyle A_{0}\cap A_{1}\neq \emptyset }
+  
+, then 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ would not be well defined because 
+  
+    
+      
+        f
+        (
+        a
+        )
+      
+    
+    {\displaystyle f(a)}
+  
+ is "ambiguous" for 
+  
+    
+      
+        a
+        ∈
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+      
+    
+    {\displaystyle a\in A_{0}\cap A_{1}}
+  
+. For example, if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        :=
+        {
+        2
+        }
+      
+    
+    {\displaystyle A_{0}:=\{2\}}
+  
+ and 
+  
+    
+      
+        
+          A
+          
+            1
+          
+        
+        :=
+        {
+        2
+        }
+      
+    
+    {\displaystyle A_{1}:=\{2\}}
+  
+, then 
+  
+    
+      
+        f
+        (
+        2
+        )
+      
+    
+    {\displaystyle f(2)}
+  
+ would have to be both 0 and 1, which makes it ambiguous. As a result, the latter 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is not well defined and thus not a function.
+
+== "Definition" as anticipation of definition ==
+In order to avoid the quotation marks around "define" in the previous simple example, the "definition" of 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ could be broken down into two logical steps:
+
+While the definition in step 1 is formulated with the freedom of any definition and is certainly effective (without the need to classify it as "well defined"), the assertion in step 2 has to be proven. That is, 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is a function if and only if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+        =
+        ∅
+      
+    
+    {\displaystyle A_{0}\cap A_{1}=\emptyset }
+  
+, in which case 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ – as a function – is well defined.
+
+On the other hand, if 
+  
+    
+      
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+        ≠
+        ∅
+      
+    
+    {\displaystyle A_{0}\cap A_{1}\neq \emptyset }
+  
+, then for an 
+  
+    
+      
+        a
+        ∈
+        
+          A
+          
+            0
+          
+        
+        ∩
+        
+          A
+          
+            1
+          
+        
+      
+    
+    {\displaystyle a\in A_{0}\cap A_{1}}
+  
+, we would have that 
+  
+    
+      
+        (
+        a
+        ,
+        0
+        )
+        ∈
+        f
+      
+    
+    {\displaystyle (a,0)\in f}
+  
+ and 
+  
+    
+      
+        (
+        a
+        ,
+        1
+        )
+        ∈
+        f
+      
+    
+    {\displaystyle (a,1)\in f}
+  
+, which makes the binary relation 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ not functional (as defined in Binary relation § Types of binary relations) and thus not well defined as a function. Colloquially, the "function" 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is also called ambiguous at point 
+  
+    
+      
+        a
+      
+    
+    {\displaystyle a}
+  
+ (although there is per definitionem never an "ambiguous function"), and the original "definition" is pointless.
+
+Despite these subtle logical problems, it is quite common to use the term definition (without apostrophes) for "definitions" of this kind, for three reasons:
+
+It provides a handy shorthand of the two-step approach.
+The relevant mathematical reasoning (i.e., step 2) is the same in both cases.
+In mathematical texts, the assertion is "up to 100%" true.
+
+== Independence of representative ==
+Questions regarding the well-definedness of a function often arise when the defining equation of a function refers not only to the arguments themselves, but also to elements of the arguments, serving as representatives. This is sometimes unavoidable when the arguments are cosets and when the equation refers to coset representatives. The result of a function application must then not depend on the choice of representative.
+
+=== Functions with one argument ===
+For example, consider the following function:
+
+  
+    
+      
+        
+          
+            
+              
+                f
+                :
+              
+              
+                
+                  Z
+                
+                
+                  /
+                
+                8
+                
+                  Z
+                
+              
+              
+                →
+              
+              
+                
+                  Z
+                
+                
+                  /
+                
+                4
+                
+                  Z
+                
+              
+            
+            
+              
+              
+                
+                  
+                    
+                      n
+                      ¯
+                    
+                  
+                  
+                    8
+                  
+                
+              
+              
+                ↦
+              
+              
+                
+                  
+                    
+                      n
+                      ¯
+                    
+                  
+                  
+                    4
+                  
+                
+                ,
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{matrix}f:&\mathbb {Z} /8\mathbb {Z} &\to &\mathbb {Z} /4\mathbb {Z} \\&{\overline {n}}_{8}&\mapsto &{\overline {n}}_{4},\end{matrix}}}
+  
+
+where 
+  
+    
+      
+        n
+        ∈
+        
+          Z
+        
+        ,
+        m
+        ∈
+        {
+        4
+        ,
+        8
+        }
+      
+    
+    {\displaystyle n\in \mathbb {Z} ,m\in \{4,8\}}
+  
+ and 
+  
+    
+      
+        
+          Z
+        
+        
+          /
+        
+        m
+        
+          Z
+        
+      
+    
+    {\displaystyle \mathbb {Z} /m\mathbb {Z} }
+  
+ are the integers modulo m and 
+  
+    
+      
+        
+          
+            
+              n
+              ¯
+            
+          
+          
+            m
+          
+        
+      
+    
+    {\displaystyle {\overline {n}}_{m}}
+  
+ denotes the congruence class of n mod m.
+N.B.: 
+  
+    
+      
+        
+          
+            
+              n
+              ¯
+            
+          
+          
+            4
+          
+        
+      
+    
+    {\displaystyle {\overline {n}}_{4}}
+  
+ is a reference to the element 
+  
+    
+      
+        n
+        ∈
+        
+          
+            
+              n
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle n\in {\overline {n}}_{8}}
+  
+, and 
+  
+    
+      
+        
+          
+            
+              n
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle {\overline {n}}_{8}}
+  
+ is the argument of 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+.
+The function 
+  
+    
+      
+        f
+      
+    
+    {\displaystyle f}
+  
+ is well defined, because:
+
+  
+    
+      
+        n
+        ≡
+        
+          n
+          ′
+        
+        
+          mod
+          
+            8
+          
+        
+        
+        ⇔
+        
+        8
+        
+           divides 
+        
+        (
+        n
+        −
+        
+          n
+          ′
+        
+        )
+        ⇒
+        
+        4
+        
+           divides 
+        
+        (
+        n
+        −
+        
+          n
+          ′
+        
+        )
+        
+        ⇔
+        
+        n
+        ≡
+        
+          n
+          ′
+        
+        
+          mod
+          
+            4
+          
+        
+        .
+      
+    
+    {\displaystyle n\equiv n'{\bmod {8}}\;\Leftrightarrow \;8{\text{ divides }}(n-n')\Rightarrow \;4{\text{ divides }}(n-n')\;\Leftrightarrow \;n\equiv n'{\bmod {4}}.}
+  
+
+As a counter example, the converse definition:
\ No newline at end of file
diff --git a/data/en.wikipedia.org/wiki/Well-defined_expression-1.md b/data/en.wikipedia.org/wiki/Well-defined_expression-1.md
new file mode 100644
index 000000000..4e78fac42
--- /dev/null
+++ b/data/en.wikipedia.org/wiki/Well-defined_expression-1.md
@@ -0,0 +1,494 @@
+---
+title: "Well-defined expression"
+chunk: 2/2
+source: "https://en.wikipedia.org/wiki/Well-defined_expression"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:32.423393+00:00"
+instance: "kb-cron"
+---
+
+  
+    
+      
+        
+          
+            
+              
+                g
+                :
+              
+              
+                
+                  Z
+                
+                
+                  /
+                
+                4
+                
+                  Z
+                
+              
+              
+                →
+              
+              
+                
+                  Z
+                
+                
+                  /
+                
+                8
+                
+                  Z
+                
+              
+            
+            
+              
+              
+                
+                  
+                    
+                      n
+                      ¯
+                    
+                  
+                  
+                    4
+                  
+                
+              
+              
+                ↦
+              
+              
+                
+                  
+                    
+                      n
+                      ¯
+                    
+                  
+                  
+                    8
+                  
+                
+                ,
+              
+            
+          
+        
+      
+    
+    {\displaystyle {\begin{matrix}g:&\mathbb {Z} /4\mathbb {Z} &\to &\mathbb {Z} /8\mathbb {Z} \\&{\overline {n}}_{4}&\mapsto &{\overline {n}}_{8},\end{matrix}}}
+  
+
+does not lead to a well-defined function, since e.g. 
+  
+    
+      
+        
+          
+            
+              1
+              ¯
+            
+          
+          
+            4
+          
+        
+      
+    
+    {\displaystyle {\overline {1}}_{4}}
+  
+ equals 
+  
+    
+      
+        
+          
+            
+              5
+              ¯
+            
+          
+          
+            4
+          
+        
+      
+    
+    {\displaystyle {\overline {5}}_{4}}
+  
+ in 
+  
+    
+      
+        
+          Z
+        
+        
+          /
+        
+        4
+        
+          Z
+        
+      
+    
+    {\displaystyle \mathbb {Z} /4\mathbb {Z} }
+  
+, but the first would be mapped by 
+  
+    
+      
+        g
+      
+    
+    {\displaystyle g}
+  
+ to 
+  
+    
+      
+        
+          
+            
+              1
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle {\overline {1}}_{8}}
+  
+, while the second would be mapped to 
+  
+    
+      
+        
+          
+            
+              5
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle {\overline {5}}_{8}}
+  
+, and 
+  
+    
+      
+        
+          
+            
+              1
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle {\overline {1}}_{8}}
+  
+ and 
+  
+    
+      
+        
+          
+            
+              5
+              ¯
+            
+          
+          
+            8
+          
+        
+      
+    
+    {\displaystyle {\overline {5}}_{8}}
+  
+ are unequal in 
+  
+    
+      
+        
+          Z
+        
+        
+          /
+        
+        8
+        
+          Z
+        
+      
+    
+    {\displaystyle \mathbb {Z} /8\mathbb {Z} }
+  
+.
+
+=== Operations ===
+In particular, the term well-defined is used with respect to (binary) operations on cosets. In this case, one can view the operation as a function of two variables, and the property of being well-defined is the same as that for a function. For example, addition on the integers modulo some n can be defined naturally in terms of integer addition. 
+
+  
+    
+      
+        [
+        a
+        ]
+        ⊕
+        [
+        b
+        ]
+        =
+        [
+        a
+        +
+        b
+        ]
+      
+    
+    {\displaystyle [a]\oplus [b]=[a+b]}
+  
+
+The fact that this is well-defined follows from the fact that we can write any representative of 
+  
+    
+      
+        [
+        a
+        ]
+      
+    
+    {\displaystyle [a]}
+  
+ as 
+  
+    
+      
+        a
+        +
+        k
+        n
+      
+    
+    {\displaystyle a+kn}
+  
+, where 
+  
+    
+      
+        k
+      
+    
+    {\displaystyle k}
+  
+ is an integer. Therefore,
+
+  
+    
+      
+        [
+        a
+        ]
+        ⊕
+        [
+        b
+        ]
+        =
+        [
+        a
+        +
+        k
+        n
+        ]
+        ⊕
+        [
+        b
+        ]
+        =
+        [
+        (
+        a
+        +
+        k
+        n
+        )
+        +
+        b
+        ]
+        =
+        [
+        (
+        a
+        +
+        b
+        )
+        +
+        k
+        n
+        ]
+        =
+        [
+        a
+        +
+        b
+        ]
+        ;
+      
+    
+    {\displaystyle [a]\oplus [b]=[a+kn]\oplus [b]=[(a+kn)+b]=[(a+b)+kn]=[a+b];}
+  
+
+similar holds for any representative of 
+  
+    
+      
+        [
+        b
+        ]
+      
+    
+    {\displaystyle [b]}
+  
+, thereby making 
+  
+    
+      
+        [
+        a
+        +
+        b
+        ]
+      
+    
+    {\displaystyle [a+b]}
+  
+ the same, irrespective of the choice of representative.
+
+== Well-defined notation ==
+For real numbers, the product 
+  
+    
+      
+        a
+        ×
+        b
+        ×
+        c
+      
+    
+    {\displaystyle a\times b\times c}
+  
+ is unambiguous because 
+  
+    
+      
+        (
+        a
+        ×
+        b
+        )
+        ×
+        c
+        =
+        a
+        ×
+        (
+        b
+        ×
+        c
+        )
+      
+    
+    {\displaystyle (a\times b)\times c=a\times (b\times c)}
+  
+; hence the notation is said to be well defined. This property, also known as associativity of multiplication, guarantees the result does not depend on the sequence of multiplications; therefore, a specification of the sequence can be omitted. The subtraction operation is non-associative; despite that, there is a convention that 
+  
+    
+      
+        a
+        −
+        b
+        −
+        c
+      
+    
+    {\displaystyle a-b-c}
+  
+ is shorthand for 
+  
+    
+      
+        (
+        a
+        −
+        b
+        )
+        −
+        c
+      
+    
+    {\displaystyle (a-b)-c}
+  
+, thus it is considered "well-defined". On the other hand, division is non-associative, and in the case of 
+  
+    
+      
+        a
+        
+          /
+        
+        b
+        
+          /
+        
+        c
+      
+    
+    {\displaystyle a/b/c}
+  
+, parenthesization conventions are not well established; therefore, this expression is often considered ill-defined.
+Unlike with functions, notational ambiguities can be overcome by means of additional definitions (e.g., rules of precedence, associativity of the operator). For example, in the programming language C, the operator - for subtraction is left-to-right-associative, which means that a-b-c is defined as (a-b)-c, and the operator = for assignment is right-to-left-associative, which means that a=b=c is defined as a=(b=c). In the programming language APL there is only one rule: from right to left – but parentheses first.
+
+== Other uses of the term ==
+A solution to a partial differential equation is said to be well-defined if it is continuously determined by boundary conditions as those boundary conditions are changed.
+
+== See also ==
+Equivalence relation § Well-definedness under an equivalence relation
+Definitionism
+Existence
+Pathological (mathematics)
+Uniqueness
+Uniqueness quantification
+Undefined
+Well-formed formula
+
+== References ==
+
+=== Notes ===
+
+=== Sources ===
+Contemporary Abstract Algebra, Joseph A. Gallian, 6th Edition, Houghlin Mifflin, 2006, ISBN 0-618-51471-6.
+Algebra: Chapter 0, Paolo Aluffi, ISBN 978-0821847817. Page 16.
+Abstract Algebra, Dummit and Foote, 3rd edition, ISBN 978-0471433347. Page 1.
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+---
+title: "Without loss of generality"
+chunk: 1/1
+source: "https://en.wikipedia.org/wiki/Without_loss_of_generality"
+category: "reference"
+tags: "science, encyclopedia"
+date_saved: "2026-05-05T07:25:33.661377+00:00"
+instance: "kb-cron"
+---
+
+Without loss of generality (often abbreviated to WOLOG, WLOG or w.l.o.g.; less commonly stated as without any loss of generality or with no loss of generality) is a frequently used expression in mathematics. The term is used to indicate the assumption that what follows is chosen arbitrarily, narrowing the premise to a particular case, but does not affect the validity of the proof in general. The other cases are sufficiently similar to the one presented that proving them follows by essentially the same logic. As a result, once a proof is given for the particular case, it is trivial to adapt it to prove the conclusion in all other cases.
+In many scenarios, the use of "without loss of generality" is made possible by the presence of symmetry. For example, if some property P(x,y) of real numbers is known to be symmetric in x and y, namely that P(x,y) is equivalent to P(y,x), then in proving that P(x,y) holds for every x and y, one may assume "without loss of generality" that x ≤ y. There is no loss of generality in this assumption, since once the case x ≤ y ⇒ P(x,y) has been proved, the other case follows by interchanging x and y: y ≤ x ⇒ P(y,x), and by symmetry of P, this implies P(x,y), thereby showing that P(x,y) holds for all cases.
+On the other hand, if neither such a symmetry nor another form of equivalence can be established, then the use of "without loss of generality" is incorrect and can amount to an instance of proof by example – a logical fallacy of proving a claim by proving a non-representative example.
+
+
+== Example ==
+Consider the following theorem (which is a case of the pigeonhole principle):
+
+If three objects are each painted either red or blue, then there must be at least two objects of the same color. 
+A proof: 
+
+Assume, without loss of generality, that the first object is red. If either of the other two objects is red, then we are finished; if not, then the other two objects must both be blue and we are still finished.
+The above argument works because the same reasoning could be applied if the alternative assumption, namely, that the first object is blue, were made, or, similarly, that the words 'red' and 'blue' can be freely exchanged in the wording of the proof. As a result, the use of "without loss of generality" is valid in this case.
+
+
+== See also ==
+Mathematical jargon
+Up to
+
+
+== References ==
+
+
+== External links ==
+WLOG at PlanetMath.
+"Without Loss of Generality" by John Harrison - discussion of formalizing "WLOG" arguments in an automated theorem prover.
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