In this task, you are given a context, a subject, a relation, and many options. Based on the context, from the options select the object entity that has the given relation with the subject. Answer with text (not indexes).

Example Input: Context: Russia (from the  Rus'), also officially known as the Russian Federation, is a country in Eurasia. At , Russia is the largest country in the world by surface area, covering more than one-eighth of the Earth's inhabited land area, and the ninth most populous, with over 140 million people at the end of March 2016. The European western part of the country is much more populated and urbanised than the eastern, about 77% of the population live in European Russia. Russia's capital Moscow is one of the largest cities in the world, other major urban centers include Saint Petersburg, Novosibirsk, Yekaterinburg, Nizhny Novgorod and Samara., Kainuu is one of the 19 regions of Finland ("maakunta" / "landskap") . There are 18 regions in mainland Finland, and the autonomous Åland Islands. Kainuu borders the regions of Northern Ostrobothnia, North Karelia and Northern Savonia. In the east it also borders Russia., Oulujoki ( in modern Finnish literally `` Oulu River '' , originally in old Northern Ostrobothnian dialect literally `` Flood River '' , Swedish : Ule älv ) is a river in Oulu province , Finland . Its origin is Oulujärvi and its watershed area covers a significant part of Kainuu region . It flows into the Bothnian Bay at Oulu . Port of Oulu is located at the mouth of the river ., Finland , officially the Republic of Finland, is a sovereign state in Northern Europe. A peninsula with the Gulf of Finland to the south and the Gulf of Bothnia to the west, the country has land borders with Sweden to the northwest, Norway to the north, and Russia to the east. Estonia is south of the country across the Gulf of Finland. Finland is a Nordic country situated in the geographical region of Fennoscandia, which also includes Scandinavia. Finland's population is 5.5 million (2014), staying roughly on the same level over the past two decades. The majority of the population is concentrated in the southern region. In terms of area, it is the eighth largest country in Europe and the most sparsely populated country in the European Union., Norway (; Norwegian: (Bokmål) or (Nynorsk); Sami: "Norgga"), officially the Kingdom of Norway, is a sovereign and unitary monarchy whose territory comprises the western portion of the Scandinavian Peninsula plus the island Jan Mayen and the archipelago of Svalbard. The Antarctic Peter I Island and the sub-Antarctic Bouvet Island are dependent territories and thus not considered part of the Kingdom. Norway also lays claim to a section of Antarctica known as Queen Maud Land. Until 1814, the Kingdom included the Faroe Islands (since 1035), Greenland (1261), and Iceland (1262). It also included Shetland and Orkney until 1468. It also included the following provinces, now in Sweden: Jämtland, Härjedalen and Bohuslän., Scandinavia is a historical and cultural region in Northern Europe characterized by a common ethnocultural North Germanic heritage and mutually intelligible North Germanic languages., Sweden, officially the Kingdom of Sweden (Swedish: ), is a Scandinavian country in Northern Europe. It borders Norway to the west and Finland to the east, and is connected to Denmark in the southwest by a bridge-tunnel across the Öresund. At , Sweden is the third-largest country in the European Union by area, with a total population of 10.0 million. Sweden consequently has a low population density of , with the highest concentration in the southern half of the country. Approximately 85% of the population lives in urban areas., Fennoscandia , Fenno-Scandinavia, or the Fennoscandian Peninsula, is the geographical peninsula of the Nordic region comprising the Scandinavian Peninsula, Finland, Karelia, and the Kola Peninsula. It encompasses Finland, Norway and Sweden, as well as Murmansk Oblast, much of the Republic of Karelia and parts of northern Leningrad Oblast in Russia. Its name comes from the Latin words "Fennia" (Finland) and "Scandia" (Scandinavian). The term was first used by the Finnish geologist Wilhelm Ramsay in 1898. Geologically, the area is distinct because its bedrock is Archaean granite and gneiss with very little limestone, in contrast to neighboring areas in Europe., Port of Oulu ("Oulun satama" in Finnish) is a complex of three separate harbours located at the mouth of Oulujoki river in Oulu, Finland. Port of Oulu is a corporation owned by the City of Oulu. Annual average of 3 million tons of cargo is shipped on 500 vessels. Two of the ports, Nuottasaari and Oritkari, are also rail-served., Northern Europe is the northern part or region of Europe. Although no definitive borders or definition exists for the term, geographically, Northern Europe may be considered to consist approximately of all of Europe above the 52nd parallel north; which includes (from west to east) most or all of: Iceland, the Republic of Ireland, the Isle of Man, the United Kingdom, the Faroe Islands, the Netherlands, northern Germany, Denmark, Norway, Sweden, northern Poland, Finland, Estonia, Latvia, Lithuania and northwest Russia. However, narrower definitions may also be used based on other geographical factors, such as climate and ecology. Greenland, geographically a part of North America, is politically a part of the Kingdom of Denmark, and may be included depending on the definition., The European Union (EU) is a political and economic union of member states that are located primarily in Europe. It has an area of , and an estimated population of over 510 million. The EU has developed an internal single market through a standardised system of laws that apply in all member states. EU policies aim to ensure the free movement of people, goods, services, and capital within the internal market, enact legislation in justice and home affairs, and maintain common policies on trade, agriculture, fisheries, and regional development. Within the Schengen Area, passport controls have been abolished. A monetary union was established in 1999 and came into full force in 2002, and is composed of 19 EU member states which use the euro currency., Oulu is a city and municipality of inhabitants in the region of Northern Ostrobothnia, Finland. It is the most populous city in Northern Finland and the fifth most populous city in the country. There are no larger cities (outside of Russia) that are more northerly than Oulu. It is also considered one of Europe's "living labs", where residents experiment with new technology (such as NFC tags and ubi-screens) at a community-wide scale., Subject: oulujoki, Relation: continent, Options: (A) antarctica (B) eurasia (C) europe
Example Output: europe

Example Input: Context: The Franklin stove is a metal-lined fireplace named after Benjamin Franklin, who invented it in 1741. It had a hollow baffle near the rear (to transfer more heat from the fire to a room's air) and relied on an "inverted siphon" to draw the fire's hot fumes around the baffle. It was intended to produce more heat and less smoke than an ordinary open fireplace. It is also known as a "circulating stove" or the "Pennsylvania fireplace"., Lightning is a sudden electrostatic discharge that occurs during an electrical storm. This discharge occurs between electrically charged regions of a cloud (called intra-cloud lightning or IC), between two clouds (CC lightning), or between a cloud and the ground (CG lightning). The charged regions in the atmosphere temporarily equalize themselves through this discharge referred to as a "strike" if it hits an object on the ground, and a flash, if it occurs within a cloud. Lightning causes light in the form of plasma, and sound in the form of thunder. Lightning may be seen and not heard when it occurs at a distance too great for the sound to carry as far as the light from the strike or flash., The American Enlightenment is a period of intellectual ferment in the thirteen American colonies in the period 17141818, which led to the American Revolution, and the creation of the American Republic. Influenced by the 18th-century European Enlightenment and its own native American philosophy, the American Enlightenment applied scientific reasoning to politics, science, and religion, promoted religious tolerance, and restored literature, the arts, and music as important disciplines and professions worthy of study in colleges. The "new-model" American style colleges of King's College New York (now Columbia University), and the College of Philadelphia (now Penn) were founded, Yale College and the College of William & Mary were reformed, and a non-denominational moral philosophy replaced theology in many college curricula; even Puritan colleges such as the College of New Jersey (now Princeton University) and Harvard University reformed their curricula to include natural philosophy (science), modern astronomy, and mathematics. , Delaware is a state located in the Mid-Atlantic and/or Northeastern regions of the United States. It is bordered to the south and west by Maryland, to the northeast by New Jersey, and to the north by Pennsylvania. The state takes its name from Thomas West, 3rd Baron De La Warr, an English nobleman and Virginia's first colonial governor., The French Revolution was a period of far-reaching social and political upheaval in France that lasted from 1789 until 1799, and was partially carried forward by Napoleon during the later expansion of the French Empire. The Revolution overthrew the monarchy, established a republic, experienced violent periods of political turmoil, and finally culminated in a dictatorship under Napoleon that rapidly brought many of its principles to Western Europe and beyond. Inspired by liberal and radical ideas, the Revolution profoundly altered the course of modern history, triggering the global decline of absolute monarchies while replacing them with republics and liberal democracies. Through the Revolutionary Wars, it unleashed a wave of global conflicts that extended from the Caribbean to the Middle East. Historians widely regard the Revolution as one of the most important events in human history., J.A. Leo Lemay ( January 17 , 1935 -- October 15 , 2008 ) was du Pont Winterthur Professor of English at the University of Delaware . Commonly known simply as `` Leo Lemay , '' he was most renowned for his lifelong fascination with Benjamin Franklin , although he wrote on many topics , including Edgar Allan Poe , Ebenezer Cooke , and Joel Barlow . Lemay was a 1953 graduate of Baltimore City College in Baltimore , Maryland . Lemay was also a graduate of the University of Maryland , where he earned his master 's degree , and obtained his doctorate from the University of Pennsylvania . He died on October 15 , 2008 , at home , shortly after returning home from a hospital stay . Lemay was selected by Library of America to edit two of its selections on Franklin . His edition of The Autobiography of Benjamin Franklin , co-edited with Paul Zall , is generally recognized as the most authoritative . In the 1990s , he put up the first substantial web resource to share with Franklin scholars and biographers in `` Benjamin Franklin : A Documentary History . '' The Documentary History was preparation for arguably his greatest investigation , a projected seven - volume biography of Franklin . Two of the volumes were published in 2006 , by the University of Pennsylvania Press , in time for Franklin 's Tercentennial . The American Historical Review ( Feb. 2007 ) called his first two volumes , `` a labor of love balanced by thoughtful criticism . There is nothing like it . '', The Founding Fathers of the United States are the individuals of the Thirteen British Colonies in North America who led the American Revolution against the authority of the British Crown and established the United States of America. The term is also used more narrowly, referring specifically to those who either signed the Declaration of Independence in 1776 or who were delegates to the 1787 Constitutional Convention and took part in drafting the proposed Constitution of the United States. A further subset includes those who signed the Continental Association or the Articles of Confederation. During much of the 19th century, they were referred to as either the "Founders" or the "Fathers"., The University of Pennsylvania (commonly known as Penn or UPenn) is a private, Ivy League university located in Philadelphia, Pennsylvania, United States. Incorporated as "The Trustees of the University of Pennsylvania", Penn is one of 14 founding members of the Association of American Universities and one of the nine original colonial colleges., Philadelphia is the largest city in the Commonwealth of Pennsylvania and the fifth-most populous city in the United States, with an estimated population of 1,567,442 and more than 6 million in the seventh-largest metropolitan statistical area, . Philadelphia is the economic and cultural anchor of the Delaware Valleya region located in the Northeastern United States at the confluence of the Delaware and Schuylkill rivers with 7.2 million people residing in the eighth-largest combined statistical area in the United States., Benjamin Franklin (April 17, 1790) was one of the Founding Fathers of the United States. Franklin was a renowned polymath and a leading author, printer, political theorist, politician, freemason, postmaster, scientist, inventor, civic activist, statesman, and diplomat. As a scientist, he was a major figure in the American Enlightenment and the history of physics for his discoveries and theories regarding electricity. As an inventor, he is known for the lightning rod, bifocals, and the Franklin stove, among other inventions. He facilitated many civic organizations, including Philadelphia's fire department and The University of Pennsylvania, an Ivy League institution., The University of Delaware (colloquially "UD") is the largest university in Delaware. The main campus is in Newark, with satellite campuses in Dover, Wilmington, Lewes, and Georgetown. It is medium-sized  approximately 18,500 undergraduate and 4,500 graduate students. UD is a privately governed university which receives public funding for being a land-grant, sea-grant, space-grant and urban-grant state-supported research institution., Physics (from the Ancient Greek  "physis" meaning "nature") is the fundamental branch of science that developed out of the study of nature and philosophy known, until around the end of the 19th century, as "natural philosophy". Today, physics is ultimately defined as the study of matter, energy and the relationships between them. Physics is, in some senses, the oldest and most basic pure science; its discoveries find applications throughout the natural sciences, since matter and energy are the basic constituents of the natural world. The other sciences are generally more limited in their scope and may be considered branches that have split off from physics to become sciences in their own right. Physics today may be divided loosely into classical physics and modern physics., The Ivy League is a collegiate athletic conference comprising sports teams from eight private institutions of higher education in the Northeastern United States. The conference name is also commonly used to refer to those eight schools as a group beyond the sports context. The eight institutions are Brown University, Columbia University, Cornell University, Dartmouth College, Harvard University, the University of Pennsylvania, Princeton University, and Yale University. The term "Ivy League" has connotations of academic excellence, selectivity in admissions, and social elitism., Joel Barlow (March 24, 1754  December 26, 1812) was an American poet, diplomat, and politician. In politics, he supported the French Revolution and was an ardent Jeffersonian., Science fiction (often shortened to SF, sci-fi or scifi) is a genre of speculative fiction, typically dealing with imaginative concepts such as futuristic science and technology, space travel, time travel, faster than light travel, parallel universes, and extraterrestrial life. Science fiction often explores the potential consequences of scientific and other innovations, and has been called a "literature of ideas." It usually avoids the supernatural, and unlike the related genre of fantasy, historically science fiction stories were intended to have a grounding in science-based fact or theory at the time the story was created, but this connection is now limited to hard science fiction., Romanticism (also the Romantic era or the Romantic period) was an artistic, literary, musical and intellectual movement that originated in Europe toward the end of the 18th century and in most areas was at its peak in the approximate period from 1800 to 1850. Romanticism was characterized by its emphasis on emotion and individualism as well as glorification of all the past and nature, preferring the medieval rather than the classical. It was partly a reaction to the Industrial Revolution, the aristocratic social and political norms of the Age of Enlightenment, and the scientific rationalization of nature. It was embodied most strongly in the visual arts, music, and literature, but had a major impact on historiography, education, and the natural sciences. It had a significant and complex effect on politics, and while for much of the Romantic period it was associated with liberalism and radicalism, its long-term effect on the growth of nationalism was perhaps more significant., Edgar Allan Poe (born Edgar Poe; January 19, 1809  October 7, 1849) was an American writer, editor, and literary critic. Poe is best known for his poetry and short stories, particularly his tales of mystery and the macabre. He is widely regarded as a central figure of Romanticism in the United States and American literature as a whole, and he was one of the country's earliest practitioners of the short story. Poe is generally considered the inventor of the detective fiction genre and is further credited with contributing to the emerging genre of science fiction. He was the first well-known American writer to try to earn a living through writing alone, resulting in a financially difficult life and career., Subject: leo lemay, Relation: place_of_death, Options: (A) baron (B) best (C) caribbean (D) central (E) columbia (F) dartmouth (G) delaware (H) france (I) franklin (J) georgetown (K) hard (L) intra (M) march (N) middle east (O) most (P) napoleon (Q) new jersey (R) newark (S) north america (T) penn (U) pennsylvania (V) philadelphia (W) split (X) united states of america (Y) wilmington (Z) york
Example Output: newark

Example Input: Context: A disease is a particular abnormal condition, a disorder of a structure or function, that affects part or all of an organism. The study of disease is called pathology which includes the causal study of etiology. Disease is often construed as a medical condition associated with specific symptoms and signs. It may be caused by external factors such as pathogens, or it may be caused by internal dysfunctions particularly of the immune system such as an immunodeficiency, or a hypersensitivity including allergies and autoimmunity., Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radiation therapy may be curative in a number of types of cancer if they are localized to one area of the body. It may also be used as part of adjuvant therapy, to prevent tumor recurrence after surgery to remove a primary malignant tumor (for example, early stages of breast cancer). Radiation therapy is synergistic with chemotherapy, and has been used before, during, and after chemotherapy in susceptible cancers. The subspecialty of oncology concerned with radiotherapy is called radiation oncology., Menopause, also known as the climacteric, is the time in most women's lives when menstrual periods stop permanently, and they are no longer able to bear children. Menopause typically occurs between 49 and 52 years of age. Medical professionals often define menopause as having occurred when a woman has not had any vaginal bleeding for a year. It may also be defined by a decrease in hormone production by the ovaries. In those who have had surgery to remove their uterus but they still have ovaries, menopause may be viewed to have occurred at the time of the surgery or when their hormone levels fell. Following the removal of the uterus, symptoms typically occur earlier, at an average of 45 years of age.
Before menopause, a woman's periods typically become irregular, which means that periods may be longer or shorter in duration or be lighter or heavier in the amount of flow. During this time, women often experience hot flashes; these typically last from 30 seconds to ten minutes and may be associated with shivering, sweating, and reddening of the skin. Hot flashes often stop occurring after a year or two. Other symptoms may include vaginal dryness, trouble sleeping, and mood changes. The severity of symptoms varies between women. While menopause is often thought to be linked to an increase in heart disease, this primarily occurs due to increasing age and does not have a direct relationship with menopause. In some women, problems that were present like endometriosis or painful periods will improve after menopause.
Menopause is usually a natural change. It can occur earlier in those who smoke tobacco. Other causes include surgery that removes both ovaries or some types of chemotherapy. At the physiological level, menopause happens because of a decrease in the ovaries' production of the hormones estrogen and progesterone. While typically not needed, a diagnosis of menopause can be confirmed by measuring hormone levels in the blood or urine. Menopause is the opposite of menarche, the time when a girl's periods start.
Specific treatment is not usually needed. Some symptoms, however, may be improved with treatment. With respect to hot flashes, avoiding smoking, caffeine, and alcohol is often recommended. Sleeping in a cool room and using a fan may help. The following medications may help: menopausal hormone therapy (MHT), clonidine, gabapentin, or selective serotonin reuptake inhibitors. Exercise may help with sleeping problems. While MHT was once routinely prescribed, it is now only recommended in those with significant symptoms, as there are concerns about side effects. High-quality evidence for the effectiveness of alternative medicine has not been found. There is tentative evidence for soy isoflavones., Fibromyalgia (FM) is a medical condition characterised by chronic widespread pain and a heightened pain response to pressure. Other symptoms include feeling tired to a degree that normal activities are affected, sleep problems, and troubles with memory. Some people also report restless legs syndrome, bowel or bladder problems, numbness and tingling, and sensitivity to noise, lights or temperature. Fibromyalgia is frequently associated with depression, anxiety, and posttraumatic stress disorder. Other types of chronic pain are also frequently present.
The cause of fibromyalgia is unknown; however, it is believed to involve a combination of genetic and environmental factors with half the risk attributed to each. The condition runs in families and many genes are believed to be involved. Environmental factors may include psychological stress, trauma, and certain infections. The pain appears to result from processes in the central nervous system and the condition is referred to as a "central sensitization syndrome". Fibromyalgia is recognized as a disorder by the US National Institutes of Health and the American College of Rheumatology. There is no specific diagnostic test. Diagnosis involves first ruling out other potential causes and verifying that a set number of symptoms are present.
The treatment of fibromyalgia can be difficult. Recommendations often include getting enough sleep, exercising regularly, and eating a healthy diet. Cognitive behavioral therapy may also be helpful. The medications duloxetine, milnacipran, or pregabalin may be used. Use of opioid pain medication is controversial with some stating their use is poorly supported by evidence and others saying that weak opioids may be reasonable if other medications are not effective. Dietary supplements also lack evidence to support their use. While fibromyalgia can last a long time, it does not result in death or tissue damage.
Fibromyalgia is estimated to affect 28% of the population. Females are affected about twice as often as males. Rates appear similar in different areas of the world and among different cultures. Fibromyalgia was first defined in 1990 with updated criteria in 2011. There is controversy about the classification, diagnosis, and treatment of fibromyalgia. While some feel the diagnosis of fibromyalgia may negatively affect a person, other research finds it to be beneficial. The term "fibromyalgia" is from New Latin, "fibro-", meaning "fibrous tissues", Greek  "myo-", "muscle", and Greek  "algos", "pain"; thus the term literally means "muscle and fibrous connective tissue pain"., Plasmacytoma refers to plasma cell tumor growing within soft tissue or within the axial skeleton. There are three distind by the International Myeloma Working Group: solitary plasmacytoma of bone (SPB), extramedullary plasmacytoma (EP) and multiple plasmacytomas that are either primary or recurrent. The most common of these is SPB, accounting for 35% of all plasma cell malignancies. SPBs occur as lytic lesions within the axial skeleton and extramedullary plasmacytomas most often occur in the upper respiratory tract (85%), but can occur in any soft tissue. Approximately half of all cases produce paraproteinemia. SPBs and extramedullary plasmacytomas are mostly treated with radiotherapy, but surgery is used in some cases of extramedullary plasmacytoma. The skeletal forms frequently progress to multiple myeloma over the course of 24 years. Due to their cellular similarity, plasmacytomas have to be differentiated from multiple myeloma. For SPB and extramedullary plasmacytoma the distinction is the presence of only one lesion (either in bone or soft tissue), normal bone marrow (<5% plasma cells), normal skeletal survey, absent or low paraprotein and no end organ damage., Osteoporosis is a disease where decreased bone strength increases the risk of a broken bone. It is the most common reason for a broken bone among the elderly. Bones that commonly break include the back bones, the bones of the forearm, and the hip. Until a broken bone occurs there are typically no symptoms. Bones may weaken to such a degree that a break may occur with minor stress or spontaneously. Chronic pain and a decreased ability to carry out normal activities may occur following a broken bone.
Osteoporosis may be due to lower than normal peak bone mass and greater than normal bone loss. Bone loss increases after menopause due to lower levels of estrogen. Osteoporosis may also occur due to a number of diseases or treatments including alcoholism, anorexia, hyperthyroidism, surgical removal of the ovaries, and kidney disease. Certain medications increase the rate of bone loss including some antiseizure medications, chemotherapy, proton pump inhibitors, selective serotonin reuptake inhibitors, and steroids. Not enough exercise and smoking are also risk factors. Osteoporosis is defined as a bone density of 2.5 standard deviations below that of a young adult. This is typically measured by dual-energy X-ray absorptiometry at the hip.
Prevention of osteoporosis includes a proper diet during childhood and efforts to avoid medications that cause the condition. Efforts to prevent broken bones in those with osteoporosis include a good diet, exercise, and fall prevention. Lifestyle changes such as stopping smoking and not drinking alcohol may help. Medication of the bisphosphonate type are useful in those with previous broken bones due to osteoporosis. In those with osteoporosis but no previous broken bones they are less effective. A number of other medications may also be useful.
Osteoporosis becomes more common with age. About 15% of white people in their 50s and 70% of those over 80 are affected. It is more common in women than men. In the developed world, depending on the method of diagnosis, 2% to 8% of males and 9% to 38% of females are affected. Rates of disease in the developing world are unclear. About 22 million women and 5.5 million men in the European Union had osteoporosis in 2010. In the United States in 2010 about eight million women and one to two million men had osteoporosis. White and Asian people are at greater risk. The word osteoporosis is from the Greek terms for "porous bones"., Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a category of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents) as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent (which almost always involves combinations of drugs), or it may aim to prolong life or to reduce symptoms (palliative chemotherapy). Chemotherapy is one of the major categories of medical oncology (the medical discipline specifically devoted to pharmacotherapy for cancer)., Alcoholism, also known as alcohol use disorder (AUD), is a broad term for any drinking of alcohol that results in problems. It was previously divided into two types: alcohol abuse and alcohol dependence. In a medical context, alcoholism is said to exist when two or more of the following conditions is present: a person drinks large amounts over a long time period, has difficulty cutting down, acquiring and drinking alcohol takes up a great deal of time, alcohol is strongly desired, usage results in not fulfilling responsibilities, usage results in social problems, usage results in health problems, usage results in risky situations, withdrawal occurs when stopping, and alcohol tolerance has occurred with use. Risky situations include drinking and driving or having unsafe sex among others. Alcohol use can affect all parts of the body but particularly affects the brain, heart, liver, pancreas, and immune system. This can result in mental illness, WernickeKorsakoff syndrome, an irregular heart beat, liver failure, and an increase in the risk of cancer, among other diseases. Drinking during pregnancy can cause damage to the baby resulting in fetal alcohol spectrum disorders. Generally women are more sensitive to alcohol's harmful physical and mental effects than men.
Both environmental factors and genetics are associated with alcoholism with about half the risk attributed to each. A person with a parent or sibling with alcoholism is three to four times more likely to be alcoholic themselves. Environmental factors include social, cultural, and behavioral influences. High stress levels, anxiety, as well as inexpensive easily accessible alcohol increases risk. People may continue to drink partly to prevent or improve symptoms of withdrawal. A low level of withdrawal may last for months following stopping. Medically, alcoholism is considered both a physical and mental illness. Both questionnaires and certain blood tests may detect people with possible alcoholism. Further information is then collected to confirm the diagnosis.
Prevention of alcoholism may be attempted by regulating and limiting the sale of alcohol, taxing alcohol to increase its cost, and providing inexpensive treatment. Treatment may take several steps. Because of the medical problems that can occur during withdrawal, alcohol detoxification should be carefully controlled. One common method involves the use of benzodiazepine medications, such as diazepam. This can be either given while admitted to a health care institution or occasionally while a person remains in the community with close supervision. Other addictions or mental illness may complicate treatment. After detoxification support such as group therapy or support groups are used to help keep a person from returning to drinking. One commonly used form of support is the group Alcoholics Anonymous. The medications acamprosate, disulfiram, or naltrexone may also be used to help prevent further drinking.
The World Health Organization estimates that as of 2010 there were 208 million people with alcoholism worldwide (4.1% of the population over 15 years of age). In the United States about 17 million (7%) of adults and 0.7 million (2.8%) of those age 12 to 17 years of age are affected. It is more common among males and young adults, becoming less common in middle and old age. It is the least common in Africa at 1.1% and has the highest rates in Eastern Europe at 11%. Alcoholism directly resulted in 139,000 deaths in 2013 up from 112,000 deaths in 1990. A total of 3.3 million deaths (5.9% of all deaths) are believed to be due to alcohol. It often reduces a person's life expectancy by around ten years. In the United States it resulted in economic costs of $224 billion USD in 2006. Many terms, some insulting and others informal, have been used to refer to people affected by alcoholism including: tippler, drunkard, dipsomaniac, and souse. In 1979, the World Health Organization discouraged the use of "alcoholism" due to its inexact meaning, preferring "alcohol dependence syndrome".
Signs and symptoms.
Early signs.
The risk of alcohol dependence begins at low levels of drinking and increases directly with both the volume of alcohol consumed and a pattern of drinking larger amounts on an occasion, to the point of intoxication, which is sometimes called "binge drinking". Young adults are particularly at risk of engaging in binge drinking., Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over , with the range defined as overweight. Some East Asian countries use lower values. Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis.
Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity, and genetic susceptibility. A few cases are caused primarily by genes, endocrine disorders, medications, or mental illness. The view that obese people eat little yet gain weight due to a slow metabolism is not generally supported. On average, obese people have a greater energy expenditure than their thin counterparts due to the energy required to maintain an increased body mass.
Obesity is mostly preventable through a combination of social changes and personal choices. Changes to diet and exercising are the main treatments. Diet quality can be improved by reducing the consumption of energy-dense foods, such as those high in fat and sugars, and by increasing the intake of dietary fiber. Medications may be taken, along with a suitable diet, to reduce appetite or decrease fat absorption. If diet, exercise, and medication are not effective, a gastric balloon or surgery may be performed to reduce stomach volume or bowel length, leading to feeling full earlier or a reduced ability to absorb nutrients from food.
Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. In 2014, 600 million adults (13%) and 42 million children under the age of five were obese. Obesity is more common in women than men. Authorities view it as one of the most serious public health problems of the 21st century. Obesity is stigmatized in much of the modern world (particularly in the Western world), though it was seen as a symbol of wealth and fertility at other times in history and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease., Kyphosis ( from Greek  kyphos , a hump ) refers to the abnormally excessive convex kyphotic curvature of the spine as it occurs in the thoracic and sacral regions . ( Inward concave curving of the cervical and lumbar regions of the spine is called lordosis . ) Kyphosis can be called roundback or Kelso 's hunchback . It can result from degenerative diseases such as arthritis ; developmental problems , most commonly Scheuermann 's disease ; osteoporosis with compression fractures of the vertebra ; Multiple myeloma or trauma . A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphotic angle , ranging from 20 ° to 45 ° . When the `` roundness '' of the upper spine increases past 45 ° it is called kyphosis or `` hyperkyphosis '' . Scheuermann 's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence . The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females . In the sense of a deformity , it is the pathological curving of the spine , where parts of the spinal column lose some or all of their lordotic profile . This causes a bowing of the back , seen as a slouching posture . While most cases of kyphosis are mild and only require routine monitoring , serious cases can be debilitating . High degrees of kyphosis can cause severe pain and discomfort , breathing and digestion difficulties , cardiovascular irregularities , neurological compromise and , in the more severe cases , significantly shortened life spans . These types of high - end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery , which can successfully restore the body 's natural degree of curvature . The Cobb angle is the preferred method of measuring kyphosis ., White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body against both infectious disease and foreign invaders. All white blood cells are produced and derived from multipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are found throughout the body, including the blood and lymphatic system., Osteoarthritis (OA) is a type of joint disease that results from breakdown of joint cartilage and underlying bone. The most common symptoms are joint pain and stiffness. Initially, symptoms may occur only following exercise, but over time may become constant. Other symptoms may include joint swelling, decreased range of motion, and when the back is affected weakness or numbness of the arms and legs. The most commonly involved joints are those near the ends of the fingers, at the base of the thumb, neck, lower back, knee, and hips. Joints on one side of the body are often more affected than those on the other. Usually the symptoms come on over years. It can affect work and normal daily activities. Unlike other types of arthritis, only the joints are typically affected.
Causes include previous joint injury, abnormal joint or limb development, and inherited factors. Risk is greater in those who are overweight, have one leg of a different length, and have jobs that result in high levels of joint stress. Osteoarthritis is believed to be caused by mechanical stress on the joint and low grade inflammatory processes. It develops as cartilage is lost and the underlying bone becomes affected. As pain may make it difficult to exercise, muscle loss may occur. Diagnosis is typically based on signs and symptoms, with medical imaging and other tests occasionally used to either support or rule out other problems. In contrast to rheumatoid arthritis, which is primarily an inflammatory condition, in osteoarthritis, the joints do not typically become hot or red.
Treatment includes exercise, efforts to decrease joint stress, support groups, and pain medications. Efforts to decrease joint stress include resting and the use of a cane. Weight loss may help in those who are overweight. Pain medications may include paracetamol (acetaminophen) as well as NSAIDs such as naproxen or ibuprofen. Long-term opioid use is generally discouraged due to lack of information on benefits as well as risks of addiction and other side effects. If pain interferes with normal life despite other treatments, joint replacement surgery may help. An artificial joint typically lasts 10 to 15 years.
Osteoarthritis is the most common form of arthritis with disease of the knee and hip affecting about 3.8% of people as of 2010. Among those over 60 years old, about 10% of males and 18% of females are affected. It is the cause of about 2% of years lived with disability. In Australia, about 1.9 million people are affected, and in the United States, 30 to 52.5 million people are affected. It becomes more common in both sexes as people become older., Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.
While the cause of rheumatoid arthritis is not clear, it is believed to involve a combination of genetic and environmental factors. The underlying mechanism involves the body's immune system attacking the joints. This results in inflammation and thickening of the joint capsule. It also affects the underlying bone and cartilage. The diagnosis is made mostly on the basis of a person's signs and symptoms. X-rays and laboratory testing may support a diagnosis or exclude other diseases with similar symptoms. Other diseases that may present similarly include systemic lupus erythematosus, psoriatic arthritis, and fibromyalgia among others.
The goal of treatment is to reduce pain, decrease inflammation, and improve a person's overall functioning. This may be helped by balancing rest and exercise, the use of splints and braces, or the use of assistive devices. Pain medications, steroids, and NSAIDs are frequently used to help with symptoms. A group of medications called disease-modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine and methotrexate, may be used to try to slow the progression of disease. Biological DMARDs may be used when disease does not respond to other treatments. However, they may have a greater rate of adverse effects. Surgery to repair, replace, or fuse joints may help in certain situations. Most alternative medicine treatments are not supported by evidence.
RA affects between 0.5 and 1% of adults in the developed world with between 5 and 50 per 100,000 people newly developing the condition each year. Onset is most frequent during middle age and women are affected 2.5 times as frequently as men. In 2013, it resulted in 38,000 deaths up from 28,000 deaths in 1990. The first recognized description of RA was made in 1800 by Dr. Augustin Jacob Landré-Beauvais (17721840) of Paris. The term "rheumatoid arthritis" is based on the Greek for watery and inflamed joints.
Signs and symptoms.
RA primarily affects joints, but it also affects other organs in more than 1525% of individuals., Multiple myeloma, also known as plasma cell myeloma, is a cancer of plasma cells, a type of white blood cell normally responsible for producing antibodies. Initially, often no symptoms are noticed. When advanced, bone pain, bleeding, frequent infections, and anemia may occur. Complications may include amyloidosis.
The cause is generally unknown. Risk factors include drinking alcohol and obesity. The underlying mechanism involves abnormal plasma cells producing abnormal antibodies which can cause kidney problems and overly thick blood. The plasma cells can also form a mass in the bone marrow or soft tissue. When only one mass is present, it is known as a plasmacytoma while more than one is known as multiple myeloma. Multiple myeloma is diagnosed based on blood or urine tests finding abnormal antibodies, bone marrow biopsy finding cancerous plasma cells, and medical imaging finding bone lesions. Another common finding is high blood calcium levels.
Multiple myeloma is considered treatable but generally incurable. Remissions may be brought about with steroids, chemotherapy, thalidomide or lenalidomide, and stem cell transplant. Bisphosphonates and radiation therapy are sometimes used to reduce pain from bone lesions.
Multiple myeloma affected about 427,000 people in 2013 and resulted in 79,000 deaths. In the United States it develops in 6.5 per 100,000 people per year and 0.7% of people are affected at some point in their life. It usually occurs around the age of 61 and is more common in men than women. Without treatment, typical survival is seven months. With current treatments, survival is usually 45 years. This gives a five-year survival rate of about 49%. The word myeloma is from the Greek "myelo-" meaning "marrow" and "-oma" meaning "tumor"., Medical imaging is the technique and process of creating visual representations of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs or tissues (physiology). Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to diagnose and treat disease. Medical imaging also establishes a database of normal anatomy and physiology to make it possible to identify abnormalities. Although imaging of removed organs and tissues can be performed for medical reasons, such procedures are usually considered part of pathology instead of medical imaging., Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. Some, however, use the terms interchangeably. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems, a fast heartbeat, heat intolerance, diarrhea, enlargement of the thyroid, and weight loss. Symptoms are typically less in the old and during pregnancy. An uncommon complication is thyroid storm in which an event such as an infection results in worsening symptoms such as confusion and a high temperature and often results in death. The opposite is hypothyroidism, when the thyroid gland does not make enough thyroid hormone.
Graves' disease is the cause of about 50% to 80% of the cases of hyperthyroidism in the United States. Other causes include multinodular goiter, toxic adenoma, inflammation of the thyroid, eating too much iodine, and too much synthetic thyroid hormone. A less common cause is a pituitary adenoma. The diagnosis may be suspected based on signs and symptoms and then confirmed with blood tests. Typically blood tests show a low thyroid stimulating hormone (TSH) and raised T or T. Radioiodine uptake by the thyroid, thyroid scan, and TSI antibodies may help determine the cause.
Treatment depends partly on the cause and severity of disease. There are three main treatment options: radioiodine therapy, medications, and thyroid surgery. Radioiodine therapy involves taking iodine-131 by mouth which is then concentrated in and destroys the thyroid over weeks to months. The resulting hypothyroidism is treated with synthetic thyroid hormone. Medications such as beta blockers may control the symptoms, and anti-thyroid medications such as methimazole may temporarily help people while other treatments are having effect. Surgery to remove the thyroid is another option. This may be used in those with very large thyroids or when cancer is a concern. In the United States hyperthyroidism affects about 1.2% of the population. It occurs between two and ten times more often in women. Onset is commonly between 20 and 50 years of age. Overall the disease is more common in those over the age of 60 years., Replacement arthroplasty (from Greek "arthron", joint, limb, articulate, + "plassein", to form, mould, forge, feign, make an image of), or joint replacement surgery, is a procedure of orthopedic surgery in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. During the latter half of the 20th century, rheumasurgery developed as a subspecialty focused on these and a few other procedures in patients with rheumatic diseases., Septic arthritis, also known as infectious arthritis or joint infection, is the purulent invasion of a joint by an infectious agent which produces arthritis. People with artificial joints are more at risk than the general population but have slightly different symptoms, are infected with different organisms and require different treatment. Septic arthritis is considered a medical emergency. If untreated, it may destroy the joint in a period of days. The infection may also spread to other parts of the body., Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types other organs are also affected. Onset can be gradual or sudden.
There are over 100 types of arthritis. The most common forms are osteoarthritis (degenerative joint disease) and rheumatoid arthritis. Osteoarthritis usually occurs with age and affects the fingers, knees, and hips. Rheumatoid arthritis is an autoimmune disorder that often affects the hands and feet. Other types include gout, lupus, fibromyalgia, and septic arthritis. They are all types of rheumatic disease.
Treatment may include resting the joint and alternating between applying ice and heat. Weight loss and exercise may also be useful. Pain medications such as ibuprofen and paracetamol (acetaminophen) may be used. In some a joint replacement may be useful.
Osteoarthritis affects more than 3.8% of people while rheumatoid arthritis affects about 0.24% of people. Gout affects about 1 to 2% of the Western population at some point in their lives. In Australia about 15% of people are affected, while in the United States more than 20% of have a type of arthritis. Overall the disease becomes more common with age. Arthritis is a common reason that people miss work and can result in a decreased quality of life. The term is from Greek "arthro-" meaning joint and "-itis" meaning inflammation., Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. Not all tumors are cancerous; benign tumors do not spread to other parts of the body. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss and a change in bowel movements. While these symptoms may indicate cancer, they may have other causes. Over 100 types of cancers affect humans.
Tobacco use is the cause of about 22% of cancer deaths. Another 10% is due to obesity, poor diet, lack of physical activity and drinking alcohol. Other factors include certain infections, exposure to ionizing radiation and environmental pollutants. In the developing world nearly 20% of cancers are due to infections such as hepatitis B, hepatitis C and human papillomavirus (HPV). These factors act, at least partly, by changing the genes of a cell. Typically many genetic changes are required before cancer develops. Approximately 510% of cancers are due to inherited genetic defects from a person's parents. Cancer can be detected by certain signs and symptoms or screening tests. It is then typically further investigated by medical imaging and confirmed by biopsy.
Many cancers can be prevented by not smoking, maintaining a healthy weight, not drinking too much alcohol, eating plenty of vegetables, fruits and whole grains, vaccination against certain infectious diseases, not eating too much processed and red meat, and avoiding too much sunlight exposure. Early detection through screening is useful for cervical and colorectal cancer. The benefits of screening in breast cancer are controversial. Cancer is often treated with some combination of radiation therapy, surgery, chemotherapy, and targeted therapy. Pain and symptom management are an important part of care. Palliative care is particularly important in people with advanced disease. The chance of survival depends on the type of cancer and extent of disease at the start of treatment. In children under 15 at diagnosis the five-year survival rate in the developed world is on average 80%. For cancer in the United States the average five-year survival rate is 66%.
In 2012 about 14.1 million new cases of cancer occurred globally (not including skin cancer other than melanoma). It caused about 8.2 million deaths or 14.6% of human deaths. The most common types of cancer in males are lung cancer, prostate cancer, colorectal cancer and stomach cancer. In females, the most common types are breast cancer, colorectal cancer, lung cancer and cervical cancer. If skin cancer other than melanoma were included in total new cancers each year it would account for around 40% of cases. In children, acute lymphoblastic leukaemia and brain tumors are most common except in Africa where non-Hodgkin lymphoma occurs more often. In 2012, about 165,000 children under 15 years of age were diagnosed with cancer. The risk of cancer increases significantly with age and many cancers occur more commonly in developed countries. Rates are increasing as more people live to an old age and as lifestyle changes occur in the developing world. The financial costs of cancer were estimated at $1.16 trillion US dollars per year as of 2010.
Definitions.
Cancers are a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. They form a subset of neoplasms. A neoplasm or tumor is a group of cells that have undergone unregulated growth and will often form a mass or lump, but may be distributed diffusely., Subject: kyphosis, Relation: medical_specialty, Options: (A) genetics (B) infection (C) infectious disease (D) oncology (E) pathology (F) rheumatology (G) surgery
Example Output:
rheumatology