Persius/hicric huggingface dataset:
Rumination disorder
Synonyms and keywords: Childhood rumination disorder; merycism, rumination syndrome

# Overview
Rumination is an eating disorder characterized by having the contents of the stomach drawn back up into the mouth, chewed for a second time, and swallowed again.  In some animals, known as ruminants, this is a natural and healthy part of digestion and is not considered an eating disorder. However, in other species (including humans), such behavior is atypical and potentially dangerous as the esophagus can be damaged by frequent exposure to stomach acids.  Rumination is also associated with eating disorders such as anorexia nervosa, and can be the result of one's apprehension and nervousness after eating a normal meal. For those with purging behaviors, rumination can take place when the option of getting rid of a meal via throwing up is not available (thus, one might feel worried and visibly upset).  Rumination has also been reported in developmentally normal children and adults who experience regurgitation of previously swallowed food, without disgust, nausea or an acidic taste. The food is either chewed and reswallowed or spat out. Remission of these episodes is seen in some cases while others persist. Many claim this as a pleasurable habit.

# Differential Diagnosis
Rumination syndrome should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include the following:

# Other differntials
Other differentials of rumination disorder include the following:
- Gastroesophageal reflux
- Hiatal hernia
- Pyloric stenosis
- Sandifer syndrome

# Epidemiology and Demographics

## Prevalence
- The prevalence of rumination syndrome is higher among subjects with intellectual disability compared to the overall population.

# Risk Factors
- Lack of stimulation
- Neglect
- Problems in the parent-child relationship
- Stressful life situations

# Natural History, Complications and Prognosis
Rumination disorder typically occurs within the first 3-12 months of age and can lead to the child becoming malnourished.
While rumination disorder may begin in childhood or infancy, adults may also have this chronic disorder, for which there is presently no known cure nor cause. While those diagnosed with this condition in childhood may  'grow out of it', it is by no means a medical fact that they are bound to do so by adolescence or adulthood.
Remission of these episodes is seen in some cases while others persist.

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Rumination Disorder
Children's hospital

# Overview
A children's hospital is a hospital which offers its services exclusively to children. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties. Children's hospitals are characterized by greater attention to the psychosocial support of children and their families.
In addition to the psychosocial support of children and families, Children's Hospitals have the added benefit of being staffed by professionals who are trained in treating children.  While many normal hospitals can treat children adequately, pediatric specialists may be a better choice when it comes to treating rare afflictions that may prove fatal or severely detrimental to young children, in some cases before birth.  Also, many children's hospitals will continue to see children with rare illnesses into adulthood, allowing for a continuity of care.

# Ranking
Every year US News ranks the top children's hospitals in the country.  For the year 2007, the top 10 Pediatric Hospitals were:
- Children's Hospital of Philadelphia
- Children's Hospital Boston
- Johns Hopkins Hospital
- Children's Hospital (Colorado)
- Rainbow Babies & Children's Hospital
- Texas Children's Hospital
- Cincinnati Children's Hospital Medical Center
- New York-Presbyterian Hospital
- Children's Hospital and Regional Medical Center (Seattle)
- Lucile Packard Children's Hospital
The ranking system used by US News & World Report depends on a variety of factors.  In past years (2007 is the 18th year of Pediatric Ranking), ranking of hospitals has been done solely on the basis of reputation, gauged by random sampling and surveying of pediatricians and pediatric specialists throughout the country.
In the 2007 Best Hospitals edition, the first phase of a planned 3-5 year process of reworking the Pediatric Ranking process was introduced.  While reputation still does count for a sizeable (2/3) amount of overall score, components such as death rate in key procedures and care related factors (1/3 of total score each) are now being included for the first time.  Key procedures used in terms of quantifying death rate were tetralogy of Fallot repair, bone marrow transplantation, and cancerous brain tumor removal.  Care related factors measured included whether or not a hosptial had attained Nursing Magnate Status, the level of cutting edge technologies used at the institution, and the presence of an established Palliative Care Program.
In future editions, it is hoped that reputation will begin to count for even less of an institution's total score, and that factors such as subspecialty rankings will begin to take on more importance.
Chimaphila maculata
Chimaphila maculata (Spotted Wintergreen, also called striped wintergreen and striped prince's pine)  is a small (10-25 cm tall), perennial evergreen herb native to eastern North America and Central America, from southern Quebec west to Illinois, and south to Florida and Panama.
It has dark green, variegated leaves 2-7 cm in length, and 6-26 mm in width. The stems emerge from creeping rhizomes. The nearly round flowers, which appear in late July to early August, are found on top of tall stalks. They are white or pinkish and are insect pollinated. The flowers mature to small (6 to 8 mm in diameter) capsules baring the seeds of the plant, which are dispersed by the wind.
It requires sandy habitats in dry-mesic oak-pine woods.

# Conservation status
Spotted wintergreen is endangered in Canada, as there are four living populations in southern Ontario, and there is one extremely small extant population in Quebec. It is also endangered in Illinois and Maine. In New York it is considered Exploitably Vulnerable.
Chlorofluoromethane

# Overview
Chlorofluoromethane or Freon 31 is a gaseous mixed halomethane (hydrochlorofluorocarbon - HCFC).
Its crystal structure is monoclinic with space group P21 and lattice constants a = 6.7676, b = 4.1477, c = 5.0206 (.10-1 nm),  = 108.205.
In altitude of 22 km traces of chlorofluoromethane occur (148 ppt)
It is used as a refrigerant with ozone depletion potential 0.02.
Guidewire Choice PT

# Overview
The ChoICE PT family of wires have design specifications that facilitate crossing tight lesions tortuos vessels.

# ChoICE PT
- Excellent in crossing moderately difficult lesions and negotiating tortuous lesions.
- Unibody stainless steel
- Polymer tip
- Hydrophilic ICE coating
- Radioopaque length 35 cm
- Outside diameter 0.014
- Available lengths 182cm, 300 cm
- Compatible with magnet Exchange Device
- Excellent crossingguide wire with light rail support.

## Structure

# ChoICE PT Extra support
- This is an excellent crossing guide wire with extra rail support
- Unibody stainless steel
- Polymer tip
- Hydrophilic ICE coating
- Radioopaque length 35 cm
- Outside diameter 0.014
- Available lengths 182 cm, 300 cm
- Compatible with Magnet Exchange Device

# ChoICE Floppy Guide Wire
- Relatively atraumatic guide wire with light rail support.
- Unibody stainless steel
- Spring tip, polymer sleeve
- ICE hydrophilic coating
- Radioopaque length 3 cm
- Outside diameter 0.014
- Available lengths 182cm, 300 cm
- Compatible with Magnet Exchange Device

# ChoICE Extra Support
- Delivery support wire with extra rail support.
- Unibody stainless steel core
- Spring tip, Polymer sleeve
- ICE hydrophilic coating
- Radioopaque length 3 cm
- Outside diameter 0.014
- Available lengths 182cm, 300 cm
- Compatible with Magnet Exchange Device

## Structure
Choline alfoscerate

# Overview
L-Alpha glycerylphosphorylcholine (alpha-GPC, choline alfoscerate) is a natural choline compound found in the brain. It is also a parasympathomimetic acetylcholine precursor which may have potential for the treatment of Alzheimer's disease and dementia.
Alpha-GPC rapidly delivers choline to the brain across the bloodbrain barrier and is a biosynthetic precursor of the acetylcholine neurotransmitter. It is a non-prescription drug in most countries and in the United States it is classified as generally recognized as safe (GRAS).

# Efficacy
Studies have investigated the efficacy of alpha-GPC for cognitive disorders including stroke and Alzheimers disease. An Italian multicentre clinical trial on 2,044 patients suffering from recent stroke were supplied alpha-GPC in doses of 1,000 mg/day for 28 days and 400 mg three times per day for the five ensuing months. The trial confirmed the therapeutic role of alpha-GPC on the cognitive recovery of patients based on four measurement scales, three of which reached statistical significance. Commonly used doses are 300 to 1,200 mg daily.

# Production
Industrially, alpha-GPC is produced by the chemical or enzymatic deacylation of phosphatidylcholine enriched soya phospholipids followed by chromatographic purification. Alpha-GPC may also be derived in small amounts from highly purified soy lecithin.

# Storage
Many users report degradation of alpha-GPC when stored openly or for long periods of time. Alpha-GPC is hygroscopic and will pull moisture in from the surrounding air. This will cause the powder to turn into what appears to be a gel. Alpha-GPC with >99% purity will undergo this process at a visible rate (seconds to minutes) and thus requires minimized exposure to the air. This hygroscopic quality can cause gel capsules not fully packed with alpha-GPC to dissolve. Proper storage methods need to be used with alpha-GPC and include removing all air from the container, double bagging with plastic bags rated for chemicals (less likely to leak air), and storing bulk/excess inside the freezer. Vacuum sealed bags are highly recommended. For people accessing alpha-GPC daily it is advisable to separate a month's supply from excess and storing the excess as best as possible. Vacuum sealing a large supply into many 1 month dividends is a method positively reported by many users. It is important to note that hygroscopy is not degradation and leaves the substance still usable, however, the ability to accurately weigh a dose is no longer possible as the substance being weighed will be a mixture of powder and water. Liquefied or gelled alpha-GPC may also be indicative of poor storage and thus have an increased likelihood of actual degradation.
Chop Chop (Tobacco)
Chop Chop is an Australian term for home grown or untaxed, illegal tobacco. Producers of "chop-chop" tobacco avoid excise and taxation levies. "Chop-chop" is not produced under the legal restrictions and health regulations or any guidelines.

## Health concerns
Chop Chop is sometimes view as being more healthy than normal, branded tobacco. However research has shown that it can contain contaminants such as twigs and pulp from raw cotton, hay, cabbage leaves, grass clippings and chloride products. Mould and fungi are also commonly found in "chop-chop" samples.
Smoking "chop-chop" has the potential to cause greater illness, than branded tobacco and possible fatality in those who use it. This is due, largly, to the dense volume of fungal contamination that is usually found in samples of "chop-chop". These fungi can cause toxic responses in the lungs, liver, kidneys and skin. The illnesses may range from allergic reactions, chronic bronchitis and asthma to lung cancer or legionnaires disease.
Smoking "chop-chop", like smoking manufactured tobacco products, has a cancerous or contaminating effect on every single organ or system in the human body.

# Trafficing
Because of its illegal nature, Chop Chop is often transported and stored in a clandestine manner. A recent example was the discovery of hundreds of kilograms of Chop Chop in an underground bunker in Mareeba, Queensland. The bunker had a hydraulically operated steel trapdoor that was openable from the owners bedroom. The bunker was discovered when a taxation officer noticed that the bedroom's floor sounded hollow. .
Christine K. Cassel
Christine K. Cassel, MD, President and CEO of the American Board of Internal Medicine and ABIM Foundation, was previously Dean of the School of Medicine and Vice President for Medical Affairs at Oregon Health & Science University in Portland, Oregon. She is a leading expert in geriatric medicine, medical ethics and quality of care.
Among her many professional leadership positions, Dr. Cassel is past-Chair of the ABIM Board of Directors and ABIM Foundation, served as Chair of the Board of the Greenwall Foundation, which supports work in bioethics; is immediate past-President of the American Federation for Aging Research; and was a member of the Advisory Committee to the Director at the National Institutes of Health. She is a member of the Institute of Medicine (IOM) Governing Council and has served on previous IOM committees responsible for influential reports on quality of care and medical errors, chaired a recent report on end-of-life care, and co-chaired a report on public health. In 1997-98, Dr. Cassel served on the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
Dr. Cassel was formerly Chair of the Department of Geriatrics and Adult Development and Professor of Geriatrics and Medicine at Mount Sinai School of Medicine in New York City. During 10 years at the University of Chicago Pritzker School of Medicine, Dr. Cassel was Chief of the Section of General Internal Medicine, Professor of Geriatrics and Medicine, Founding Director of the Robert Wood Johnson Clinical Scholars Program, and Founding Director of the Center for Health Policy Research.

# Books
She has edited and authored a number of books, including Medicare Matters: What Geriatric Medicine Can Teach American Health Care (2005), Ethical Patient Care (2000), Geriatric Medicine (Fourth Edition), A Practical Guide to Aging (1997), Approaching Death (1997), Encyclopedia of Bioethics (1995), Ethical Dimensions in the Health Professions (1993), and Nuclear Weapons and Nuclear War: A Sourcebook for Health Professionals (1984).

# Education
Dr. Cassel received her medical degree from the University of Massachusetts Medical School and completed a residency in internal medicine at the Children's Hospital of San Francisco and a fellowship in geriatrics at the Veterans Administration Medical Center in Portland, Oregon. Additionally, she completed a bioethics health policy fellowship program at the University of California, San Francisco.  Dr. Cassel is board certified in internal medicine and geriatric medicine.
Chromium(III) oxide
Chromium(III) oxide is the inorganic compound of the formula Cr2O3.  It is one of principal oxides of chromium. it is a widely used precursor to other chromium compounds. In the nature it is known as rare mineral eskolaite. Very rare chromium oxyhydroxide minerals, CrO(OH) (bracewellite, guyanaite and grimaldiite) are also known.

# Structure and properties
Cr2O3 adopts the corundum structure, consisting of cubic close packed oxides with 2/3 of the octahedral holes occupied by chromium. It is antiferromagnetic up to 307 K, the Neel temperature.  It is an amphoteric oxide, dissolving in acids to give chromium(III) salts and in molten alkali to give chromites.

# Production
The Parisians Pannetier and Binet first prepared Cr2O3 in 1838 via a secret process.  It is manufactured from the mineral chromite, (Fe,Mg)Cr2O4, which is mined in southern Africa, Asia, Turkey, and Cuba. The conversion of chromite to chromia entails air oxidation to Na2Cr2O7, which is subsequently reduced with carbon or sulfur.
Chromium oxide can be converted into elemental chromium metal through the thermite reaction, although this metal oxide is much less commonly used than Fe2O3 and Fe3O4.  Unlike iron oxide thermites, chromium oxide thermite creates little or no sparks, smoke or sound, but it glows with a blinding light.  Because of the very high melting point of chromium, chromium thermite casting is impractical.

# Pigment
It is commonly called chrome green or institutional green when used as a pigment; however it was referred to as viridian when it was first discovered.
Hexavalent chromium

# Overview
Hexavalent chromium or Cr(VI) compounds are those which contain the element chromium in the +6 oxidation state. Chromates are often used as pigments for photography, and in pyrotechnics, dyes, paints, inks, and plastics. They can also be used for stainless steel production, textile dyes, wood preservation, leather tanning, and as anti-corrosion and conversion coatings. They are used as corrosion inhibitors, but due to their toxicity they are being replaced by alternatives.
Hexavalent chromium is recognized as a human carcinogen via inhalation.  Workers in many different occupations are exposed to hexavalent chromium. Occupational exposures occur mainly among workers who:
- handle dry chromate-containing pigments
- spray chromate-containing paints and coatings
- operate chrome plating baths
- weld, cut or grind chromium-containing metals such as stainless steel.

# Toxicity
In an organism's cells, hexavalent chromium undergoes reduction, first to metastable pentavalent chromium, then to trivalent chromium. Trivalent chromium binds to proteins and creates haptens which trigger immune system reaction. Once developed, chrome sensitivity becomes fairly persistent; in such cases, even contact with chromate-dyed textiles or wearing of chromate-tanned leather shoes can cause or exacerbate contact dermatitis.
Hexavalent chromium compounds are genotoxic carcinogens. Chronic inhalation of hexavalent chromium compounds increases risk of lung cancer (lungs are especially vulnerable, followed by fine capillaries in kidneys and intestine). It appears that the mechanism of genotoxicity relies on pentavalent or trivalent chromium. According to some researchers, the damage is caused by hydroxyl radicals, produced during reoxidation of pentavalent chromium by hydrogen peroxide molecules present in the cell. Zinc chromate is the strongest carcinogen of the chromates used in industry. Soluble compounds, like chromic acid, are much weaker carcinogens.
In some parts of Russia, pentavalent chromium was reported as one of the factors of incidence of premature senility. 

# Permissible Exposure Limit (PEL or OSHA PEL)
The OSHA PEL for airborne exposures to hexavalent chromium is 5 g/m3 (0.005 mg/m3).

# Vitamin C
Researchers have recently reported discovering that vitamin C reacts inside human lung cells with chromium 6, causing massive DNA damage. Low doses of chromium 6, combined with vitamin C, produce up to 15 times as many chromosomal breaks and up to 10 times more mutations, compared with cells lacking vitamin C. Outside cells, vitamin C actually protects against the cellular damage caused by hexavalent chromium. 

# Erin Brockovich
Hexavalent chromium is the substance against which Erin Brockovich campaigned. It was found in drinking water in the Southern California town of Hinkley.
Cloaca (embryology)

# Overview
The cloaca is a structure in the development of the urinary and reproductive organs.
The hind-gut is at first prolonged backward into the body-stalk as the tube of the allantois; but, with the growth and flexure of the tail-end of the embryo, the body-stalk, with its contained allantoic tube, is carried forward to the ventral aspect of the body, and consequently a bend is formed at the junction of the hind-gut and allantois.
This bend becomes dilated into a pouch, which constitutes the entodermal cloaca; into its dorsal part the hind-gut opens, and from its ventral part the allantois passes forward.
At a later stage the Wolffian duct and Mullerian duct open into its ventral portion.
The cloaca is, for a time, shut off from the anterior by a membrane, the cloacal membrane, formed by the apposition of the ectoderm and entoderm, and reaching, at first, as far forward as the future umbilicus.
Behind the umbilicus, however, the mesoderm subsequently extends to form the lower part of the abdominal wall and symphysis pubis.
By the growth of the surrounding tissues the cloacal membrane comes to lie at the bottom of a depression, which is lined by ectoderm and named the ectodermal cloaca.

# Additional images
- Human embryo about fifteen days old.
- Front view of two successive stages in the development of the digestive tube.
- Tail end of human embryo from fifteen to eighteen days old.
- Cloaca of human embryo from twenty-five to twenty-seven days old.
- Tail end of human embryo twenty-five to twenty-nine days old.
- Primitive kidney and bladder, from a reconstruction.
- Stages in the development of the external sexual organs in the male and female.
Clonazepam overdose

# Overdosage topics
Symptoms
Overdose management
Flumazenil

## Symptoms
Symptoms of Clonazepam overdosage, like those produced by other CNS depressants, include somnolence, confusion, coma and diminished reflexes. Return to top

## Overdose management
Treatment includes monitoring of respiration, pulse and blood pressure, general supportive measures and immediate gastric lavage. Intravenous fluids should be administered and an adequate airway maintained. Hypotension may be combated by the use of levarterenol or metaraminol. Dialysis is of no known value.   Return to top

## Flumazenil
Flumazenil, a specific benzodiazepine-receptor antagonist, is indicated for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in situations when an overdose with a benzodiazepine is known or suspected. Prior to the administration of flumazenil, necessary measures should be instituted to secure airway, ventilation and intravenous access. Flumazenil is intended as an adjunct to, not as a substitute for, proper management of benzodiazepine overdose. Patients treated with flumazenil should be monitored for resedation, respiratory depression and other residual benzodiazepine effects for an appropriate period after treatment. The prescriber should be aware of a risk of seizure in association with flumazenil treatment, particularly in long-term benzodiazepine users and in cyclic antidepressant overdose. 
Flumazenil is not indicated in patients with epilepsy who have been treated with benzodiazepines. Antagonism of the benzodiazepine effect in such patients may provoke seizures. Serious sequelae are rare unless other drugs or alcohol have been taken concomitantly.   Return to top
Adapted from the FDA Package Insert.
Codonopsis pilosula
Codonopsis pilosula (; pinyin: dangshen), also known as dang shen or poor man's ginseng, is a perennial species of flowering plant native to Northeast Asia and Korea and usually found growing around streambanks and forest openings under the shade of trees. The plant is shrubby and dense and has a tendency to climb, producing heart shaped leaves, light green five pointed bell shaped flowers with prominent yellow or light purple veins. The plant can grow up to 8-10 feet in height with roots 1-3  cm thick.

# Uses
The roots of C. pilosula (radix) are used in traditional Chinese medicine to lower blood pressure, increase red and white blood cell count, cure appetite loss, strengthen the immune system, and replenish qi. The roots are harvested from the plant during the third or fourth year of growth and dried prior to sale.
The root is also used as a gentler and more economical substitute for Panax ginseng.

# Varieties
- Codonopsis pilosula var. handeliana - ()
- Codonopsis pilosula var. modesta - ()
- Codonopsis pilosula var. volubilis - ()