Persius/hicric huggingface dataset:
David Hendricks Bergey
David Hendricks Bergey was an American bacteriologist, born December 27, 1860 in Skippack, Pennsylvania, died September 5, 1937 in Philadelphia, Pennsylvania.
He studied at Pennsylvania University, where he obtained his Bachelor of Sciences and Doctor of Medicine degrees in 1884. He practiced medicine until 1893. He then joined the university's hygiene laboratory, where he taught hygiene and bacteriology. He led the laboratory from 1929 until his retirement in 1932.
He was the first doctor to isolate a bacteria called Actinomyces on a human being in 1907.
Leg length discrepancy
Synonyms and keywords: Unequal leg length, leg length inequality, leg length alignment asymmetry

# Overview
Leg length discrepancy is a medical condition where the legs are of different sizes.  There are two main types of leg length inequalities.  The first type is caused by the legs themselves being measurably different in length as seen in birth defects, broken leg or serious infection.  The other, more common, type is refereed to as leg length alignment asymmetry, a condition where the short leg is unequal in length while in a supine or prone position.  Leg length alignment asymmetry can be the result of hypertonicity in the musculature of the pelvis or leg.

# Classification

## Structural Leg Length Discrepancy
Structural leg length discrepancy is caused by the legs themselves being measurably different in length, usually due to differences in the length of the femur in the thigh or the tibia and fibula bones in the lower leg.  This may be a birth defect or it may occur after a broken leg, serious infection, or local damage to one of the growth plates in a leg.

## Functional Leg Length Discrepancy
The other, more common, type is seen when the legs themselves are the same length, but due to neuromuscular injuries in the pelvis or upper leg, one leg or hip is held higher and tighter than the other (hypertonicity in the musculature of the pelvis or leg).  These unequally tightened muscles cause the legs to seem to be different lengths, even though careful measurement would show equal lengths of the actual leg.  This is called leg length alignment asymmetry and can be seen while lying down.

# Causes

## Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Appendicitis
- Leriche syndrome
- Meningitis
- Osteomyelitis
- Pelvic abscess
- Psoas abscess
- Septic arthritis
- Testicular torsion

## Common Causes
- Avascular necrosis of the hip
- Cerebral palsy
- Congenital dysplasia of the hip
- Discitis
- Femur fracture
- Hip contractures
- Legg-Calve-Perthes syndrome
- Lumbar scoliosis
- Malignant bone tumors
- Osteochondritis dissecans
- Osteomyelitis
- Salter-Harris fracture
- Septic arthritis
- Slipped capital femoral epiphysis
- Transient synovitis of the hip

## Causes by Organ System

## Causes in Alphabetical Order
Pancreatic polypeptide
Pancreatic polypeptide (PP) is a polypeptide secreted by PP cells in the endocrine pancreas predominantly in the head of the pancreas. It consists of 36 amino acids and has molecular weight about 4200 Da.
The function of PP is to self-regulate pancreatic secretion activities (endocrine and exocrine). It also has effects on hepatic glycogen levels and gastrointestinal secretions.
Its secretion in humans is increased after a protein meal, fasting, exercise, and acute hypoglycemia, and is decreased by somatostatin and intravenous glucose.
Plasma PP has been shown to be reduced in conditions associated with increased food intake and elevated in anorexia nervosa. In addition, peripheral administration of PP has been shown to decrease food intake in rodents. PP is secreted by PP pancreatic cells of Langerhans islets. It stimulates the gastric juice secretion, but inhibits the gastric secretion induced by pentagastrine. It is the antagonist of cholecystokinin and inhibits the pancreatic secretion which is stimulated by cholecystokinin. On fasting, PP seric concentration is 80 pg/ml; after the meal, it rises up from 8 to 10 times more; glucose and fats also induce PP's level increase, but on parenteral introduction of those substances, the level of hormones doesn't change. The administration of atropine, the vagotomy, blocks the PP's after-meal secretion. The excitation of the vagus nerve, the administration of gastrin, secretin or cholecystokinin induce PP secretion.
The augmentation of PP secretion has been observed in hormonal-active pancreatic tumors (insulin, glucagon), in Verner-Morrison syndrome, and in gastrinomas.
The PPY gene encodes an unusually short protein precursor that is cleaved to produce PP, as well as pancreatic icosapeptide and a 5- to 7- amino-acid oligopeptide.
Obstetrical hemorrhage

# Overview
Obstetrical hemorrhage refers to heavy bleeding during pregnancy, labor, or the puerperium. Bleeding may be vaginal and external, or, less commonly but more dangerously, internal, into the abdominal cavity. Typically bleeding is related to the pregnancy itself, but some forms of bleeding are caused by other events.
Obstetrical hemorrhage is a major cause of maternal mortality.

# Classification

## Antepartum Hemorrhage

### Early Pregnancy Bleeding
The most common bleeding event is the loss of a  pregnancy, a miscarriage, medically also called an abortion. Bleeding from an early miscarriages may be similar to that of a heavy menstruation, but later on, a pregnancy loss may be accompanied but excessive or prolonged bleeding. A physician may propose to perform a D&C for treatment. An ectopic pregnancy may lead to bleeding, often internally, that could be fatal if untreated.

### Late Pregnancy Bleeding
The primary consideration is the presence of a placenta previa, a condition that usually needs to be resolved by delivering the baby via cesarian section. Also a placental  abruption can lead to obstetrical hemorrhage, some times concealed.

### Bleeding During Labor
Beside placenta previa and placental abruption, uterine rupture can occur as a very serious condition leading to internal or external bleeding. Bleeding from the fetus is rare, usually not heavy, but always very serious for the baby.

## Postpartum Hemorrhage
Trauma from the delivery may tear tissue and vessels leading to significant postpartum bleeding. Uterine atony refers to the inability of the uterus to contract and may lead to continuous bleeding. Retained placental tissue and infection may contribute to uterine atony (Bleeding from the birth canal >500mL after vaginal delivery and >1000mL after cesarean section delivery).

## Unrelated Bleeding
Pregnant patients may have bleeding from the reproductive tract due to trauma, including sexual assault, neoplasm, most commonly cervical cancer, and hematologic disorders.

# Causes

## Common Causes
- Abruptio placentae
- Cervical laceration
- Chorioamnionitis
- Disorders of coagulation
- Drugs- Oxytocin
- Excessive uterine distension
- Multiparity
- Placenta accreta
- Placenta previa
- Rapid or prolonged labor
- Retained placenta
- Thrombocytopenia
- Uterine inversion
- Uterine rupture
- Vaginal hematoma

# Diagnosis
The success of modern obstetrics is based to a good degree on the ability to recognize risk patients for obstetrical hemorrhage and their appropriate management.

## Ultrasound
- Obstetric ultrasonography

# Treatment

## Medical Therapy
- Blood transfusion and pharmacological support

## Surgery
- Surgical obstetrics

# Related Chapters
- Gynecologic hemorrhage
- Antepartum haemorrhage
Deep temporal arteries
The deep temporal arteries, two in number, anterior and posterior, ascend between the Temporalis and the pericranium.
They supply the muscle, and anastomose with the middle temporal artery.
The anterior communicates with the lacrimal artery by means of small branches which perforate the zygomatic bone and great wing of the sphenoid.
Deferred gratification
Deferred gratification or delayed gratification is the ability to wait in order to obtain something that one wants. This ability is usually considered to be a personality trait which is important for life success. Daniel Goleman has suggested that it is an important component of emotional intelligence. People who lack this trait are said to need instant gratification and may suffer from poor impulse control.
Psychoanalysts have argued that people with poor impulse control suffer from "weak ego boundaries". The term comes from Sigmund Freud's theory of personality where the id is the pleasure principle, the superego is the morality principle, and the ego is the reality principle. The ego's job is to satisfy the needs of the id while respecting other people's needs. According to this theory, a person who is unable to delay gratification may possess an unbalanced id that the ego and superego are unable to control.
Poor impulse control may be related to biological factors in the brain. Researchers have found that children with fetal alcohol syndrome are less able to delay gratification.
The marshmallow experiment is a famous test of this concept conducted by Walter Mischel at Stanford University and discussed by Daniel Goleman in his popular work. In the 1960s a group of four-year olds were tested by being given a marshmallow and promised another, only if they could wait 20 minutes before eating the first one. Some children could wait and others could not. The researchers then followed the progress of each child into adolescence, and demonstrated that those with the ability to wait were better adjusted and more dependable (determined via surveys of their parents and teachers), and scored an average of 210 points higher on the Scholastic Aptitude Test.
Another famous impulse control test is the "gift delay," in which children were shown a nicely wrapped gift but told they must complete a puzzle before opening it. Researchers then calculated a "delay score" based on how long the kids hold out. When independent examiners interviewed the test subject years later, they found that boys who had not delayed were "irritable" and that the girls were "sulky." In contrast, the patient boys were "attentive" and the girls "competent."
Currently, a free self-report Delaying Gratification Inventory is available online as a part of a research project conducted by Central Michigan University.  The survey describes trait differences in the tendency to delay gratification along six categories as well as a global domain. The survey provides custom personality feedback on this trait.
Defibrination syndrome

# Overview
Fibrinolysis syndrome (also known as "Defibrinating syndrome") is characterized by an acute hemorrhagic state brought about by inability of the blood to clot, with massive hemorrhages into the skin producing blackish, purplish swellings and sloughing.:826

# Cause
The cause for Fibrinolysis syndrome, is the inability of the body to produce blood-coagulates to stop bleeding. What causes the body to not produce blood-coagulates are the low levels of fibrin, or therefore non-existent fibrin.

# Symptoms
Hemorrhages (this includes severe bleeding of any particular area. Be it: nasal, rectal, oral, it also includes bleeding from scrapes, cuts, bruises (big bruises that do not disappear in the first two to three days).
Degree of unsaturation
The degree of unsaturation (also known as the Index of Hydrogen Deficiency or IHD) formula is used in organic chemistry to help draw chemical structures. The formula lets the user determine how many rings, double bonds, and triple bonds are present in the compound to be drawn. It does not give the exact number of rings or double or triple bonds, but rather the sum of the number of rings and double bonds plus twice the number of triple bonds. The final structure is verified with use of NMR, mass and IR spectroscopy, as well as inspection. The formula for degree of unsaturation is
where C is the numbers of carbon atoms, H is the numbers of hydrogen atoms, X is the numbers of halide atoms, and N is the numbers of nitrogen atoms. Do not count group VI elements such as oxygen and sulfur atoms (but count H groups attached to oxygen atoms, such as hydroxyl groups). Halide atoms count as 'hydrogen' atoms for degree of unsaturation calculations.
The degree of unsaturation is used to calculate the number of rings and pi bonds, where
- Rings count as one degree of unsaturation
- Double bonds count as one degree of unsaturation
- Triple bonds count as two degrees of unsaturation
Deinstitutionalisation

# Overview
Deinstitutionalisation is the practice of moving people (especially those with developmental disability) from mental institutions into community-based or family-based environments.
The idea took hold in various countries in the 1950s and 1960s , possibly as part of the anti-psychiatry movement, which saw incarceration of the mentally ill as often unnecessary and/or inhumane. It was also introduced as a cost saving measure, or a sensible alternative to state hospitals, as long as the discharged patients were serviced in their new
community health centers and were able to take their necessary medications. New psychiatric medications were thought to have made it also possible to release this population into the community safely. 

# In the United States
In the early part of the 20th century, people with mental retardation and other developmental disabilities received services in large public institutions or were cared for by their families with very little financial and social support from the government. In the 1960s, due largely to a series of class action lawsuits and the scrutiny of institutions through disability activism, the appalling conditions and the poor treatment of patients in these institutions were revealed.
This led to a debate about deinstitutionalizing those who are capable of living in the community and developing a more flexible service delivery system to serve them.
A significant catalyst in the United States was the Community Mental Health Act of 1963.
It has been used by some governments and their agencies to save money by closing down, scaling back or merging psychiatric inpatient units. One possible result of this could be that patients who need to, and often want to be admitted to hospital cannot find beds or are discharged before they have fully recovered. Community support services for the mentally ill are a partial solution to this problem, providing care without institutionalisation where possible, although this too can become problematic as it is not necessarily a cheaper option or always an effective one.
In 1999, the Supreme Court of the United States ruled in L.C. & E.W. v. Olmstead that states are required to provide community-based services for people with mental disabilities if treatment professionals determine that it is appropriate and the affected individuals do not object to such placement.
Deinstitutionalisation is thought to have caused widespread homelessness in the United States and some other countries.
Dermatome (instrument)
A dermatome is a surgical instrument used to produce thin slices of skin from a donor area, in order to use them for making skin grafts. One of its main applications is for reconstituting skin areas damaged by grade 3 burns or trauma.
Dermatomes can be operated either manually or electrically. The first drum dermatomes, developed in the 1930s, were manually operated. Afterwards, dermatomes which were operated by air pressure, such as the Brown dermatome, achieved higher speed and precision. Electrical dermatomes are better for cutting out thinner and longer strips of skin with a more homogeneous thickness.
There are several types of dermatomes, usually named after its inventors. The best known and used are:
- Brown dermatome, the first with powered rotation to be developed, used mostly for large skin grafts. It is electrically operated;
- Castroviejo dermatome,   also electrically operated, is a precision dermatome with a small head and controllable thickness, which is most used for mucous membrane grafts;
- Padgett dermatome, was the first rotary drum manual dermatome to be devised;
- Reese dermatome.
Descriptive statistics

# Measurements of central tendency
- Mean In general understanding, the mean is the average.  Suppose there are five people.  The people have, respectively, 1 TV in their house, 4 TVs, 2 TVs, no TVs and 3 TVs.  You would say that the 'mean' number of TVs in the house is 2 (1+4+2+0+3)/5=2.
- Median The median is the point at which half are above and half are below.  In the above example, the median is also 2, because in this group of 5 people, 2 people have more than 2 TVs in their house and 2 people have fewer than 2 TVs in their house.

# Measurements of variation
- Standard deviation (SD) is a measure of variation or scatter. The standard deviation does not change with sample size.
- Variance is the square of the standard deviation:
- Standard error of the mean (SEM) measures the how accurately you know the mean of a population and is always smaller than the SD. The SEM becomes smaller as the sample size increases. The sample standard devision (S) and SEM are related by:
- 95% confidence interval is + 1.96 - standard error.
- Coefficient of variation (CV) is the ratio of the standard deviation \ \sigma  to the mean \ \mu , c_{\rm v} = \frac{\sigma}{\mu}.. "Commonly, a CV of < 5% is deemed acceptable.
Diabetes Australia-NSW
Diabetes Australia-NSW  is the leading charity in Australia dealing with diabetes and the third oldest diabetes organisation in the world. It is the regional equivalent of the American Diabetes Association and Diabetes UK.
Founded in 1937 and based in Sydney, New South Wales (NSW), it helps Australians with diabetes by working to reduce the impact on their lives of the fastest growing chronic disease in the world.
It is a non-profit, non-government organisation, supported by members funds and donations. All funds raised are spent on research, education programs, public awareness and advocacy.
The Diabetes Australia-NSW Call Centre receives over 600 phone calls a day. Staff on-hand provide personalised and practical assistance to benefit people with diabetes and their carers. Diabetes Australia-NSW also administers the Australian governments National Diabetes Services Scheme, which provides subsidised products to Australians who have diabetes.
Diabetes Australia-NSW is part of a federation of twelve organisations comprising the eight State and Territory Associations of Diabetes Australia, the Australian Diabetes Society, the Australian Diabetes Educators Association, the Kellion Diabetes Foundation and the Diabetes Research Foundation-Western Australia.

# Diabetes statistics
In Australia
- More than three million Australians have diabetes or pre-diabetes.
- Diabetes is the fastest growing chronic disease, and is the sixth highest cause of death by disease in Australia.
- One in four Australian adults has either diabetes or impaired glucose metabolism.
- One Australian is diagnosed every seven minutes.
- In 2000-01, death rates from diabetes among Indigenous Australians were almost 15 times higher than other Australians.
- Certain overseas-born Australians have a higher prevalence of diabetes than people born in Australia.
In New South Wales
- More than 542,000 people in NSW have diabetes, but half of them dont know it.
- The number has increased 300 per cent in the last 10 years.
- The number of people with type 2 diabetes  the so-called lifestyle disease  has doubled in just five years.
- The number of children with type 2 diabetes is increasing at between five and 10 per cent a year.
- Type 1 diabetes in children is increasing at three per cent a year.
Diabetic coma overview

# Overview
Diabetic coma is a medical emergency in which a person with diabetes mellitus is comatose (unconscious) because of one of the acute complications of diabetes. Severe diabetic hypoglycemia, diabetic ketoacidosis or Hyperosmolar nonketotic coma in which extreme hyperglycemia and dehydration alone are sufficient to cause unconsciousness, are the complications of diabetes.
In most medical contexts, the term diabetic coma refers to the diagnostic dilemma posed when a physician is confronted with an unconscious patient about whom nothing is known except that he has diabetes. An example might be a physician working in an emergency department who receives an unconscious patient wearing a medical identification tag saying DIABETIC. Paramedics may be called to rescue an unconscious person by friends who identify him as diabetic. Brief descriptions of the three major conditions are followed by a discussion of the diagnostic process used to distinguish among them, as well as  a few other conditions which must be considered.

# Classification
Dabetic coma can be classified as coma due to Severe diabetic hypoglycemia, diabetic ketoacidosis or Hyperosmolar nonketotic coma.

# Risk Factors
Anyone who has diabetes is at risk of a diabetic coma.

# Natural History, Complications and Prognosis
Left untreated, a diabetic coma can be fatal. Prognosis of diabetic coma depends on whether the patient is treated promptly and properly.

# Diagnosis

## Laboratory Findings
Tests, including blood sugar level, ketone level in blood and urine, blood level of nitrogen or creatinine and potassium in your blood, may be helpful for the diagnosis of the cause.

# Treatment

## Medical Therapy
The treatment of diabetic coma consists of insulin and gradual rehydration with intravenous fluids. Treatment of DKA consists of isotonic fluids to rapidly stabilize the circulation, continued intravenous saline with potassium and other electrolytes to replace deficits, insulin to reverse the ketoacidosis, and careful monitoring for complications.

## Primary Prevention
Controlling diabetes and recognizing the early signs of dehydration and infection can help prevent this condition.
Diagnosis of exclusion
The term diagnosis of exclusion (per exclusionem) refers to a medical condition whose presence cannot be established with complete confidence from examination or testing. Diagnosis is therefore by elimination of other reasonable possibilities.
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.
Perhaps 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 pre-requisite for making a functional 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. As a specific diagnosis cannot be confirmed a fall back position is to exclude that group of known causes that may cause a similar clinical presentation