Medicine.kif

;; Medicine.kif
;; Basic medical equipment and actions
;  from Wikipedia 

;; Access to and use of these products is governed by the GNU General Public 
;; License <http://www.gnu.org/copyleft/gpl.html>. 
;; By using these products, you agree to be bound by the terms 
;; of the GPL.

;; Author: Adam Pease

 ;; Note that SUMO's medical content is informational only and should in no case
 ;; be used for medical advice.

(attribute Tourniquet RelationalAttribute)
(documentation Tourniquet EnglishLanguage "Any object used to stop or reduce &%Bleeding.")
(termFormat EnglishLanguage Tourniquet "tourniquet")

; a tourniquet has the purpose of stopping bleeding
(=>
  (holdsDuring ?TIME
    (attribute ?T Tourniquet))
  (exists (?P ?B ?A)
    (and
      (instance ?P Human)
      (instance ?B Bleeding)
      (instance ?A Attaching)
      (experiencer ?B ?P)
      (destination ?A ?P)
      (objectTransferred ?A ?T)
      (hasPurpose ?T
        (not
          (exists (?B2)
            (and
              (instance ?B2 Bleeding)
              (overlapsTemporally 
                (WhenFn ?B2) 
                (ImmediateFutureFn (WhenFn ?A)))
              (experiencer ?B2 ?P))))))))
   
; If a person is likely to bleed to death, any nearby person has an obligation to 
; apply a tourniquet
              
(=>
  (and
    (instance ?B Bleeding)
    (instance ?D Death)
    (instance ?H Human)
    (instance ?P Human)
    (experiencer ?B ?P)
    (orientation ?H ?P Near)
    (modalAttribute
      (causes ?B ?D) Likely))
  (holdsObligation ?H
    (exists (?A)
      (and
        (instance ?A Attaching)
        (agent ?A ?H)
        (destination ?A ?P)))))
                
(subclass ApplyingTourniquet Attaching)
(subclass ApplyingTourniquet TherapeuticProcess)
(documentation ApplyingTourniquet EnglishLanguage "The process of applying a tourniquet
to an injured mammal.")  
(termFormat EnglishLanguage ApplyingTourniquet "applying a tourniquet")

(=>
  (instance ?AT ApplyingTourniquet)
  (exists (?A ?P ?T)
    (and
      (instance ?A Agent)
      (instance ?P Mammal)
      (holdsDuring 
        (WhenFn ?AT)
        (attribute ?T Tourniquet))
      (destination ?AT ?P)
      (agent ?AT ?A)
      (objectTransferred ?AT ?T))))
      
(=>
  (and
    (instance ?B Bleeding)      
    (experiencer ?B ?H))
  (exists (?VA ?D)
    (and
      (or
        (instance ?VA Vein)
        (instance ?VA Artery))
      (part ?VA ?H)
      (instance ?D Damaging)
      (earlier 
        (WhenFn ?D) 
        (WhenFn ?B))
      (patient ?D ?VA))))
      
; in SUMO: systolicBloodPressure, diastolicBloodPressure,  heartRate, breathingRate
; injury types - caused by artillery, blunt trauma, burns, falls, grenades
            
(instance Injury DiseaseOrSyndrome)
(documentation Injury EnglishLanguage "Damange to an &%Organism that is the result of
an &%Injuring.")
(termFormat EnglishLanguage Injury "injury")

(=>
  (and
    (instance ?I Injuring)
    (experiencer ?I ?A))
  (holdsDuring
    (ImmediateFutureFn 
      (WhenFn ?I))
    (attribute ?A Injury)))
    
(instance restingHeartRate BinaryPredicate)
(domain restingHeartRate 1 Mammal)
(domain restingHeartRate 2 Integer)
(documentation restingHeartRate EnglishLanguage "The heart rate at rest
of a human, in beats per minute.  ")
(format EnglishLanguage restingHeartRate "the &%resting heart rate of %1 is %2")
(termFormat EnglishLanguage restingHeartRate "resting heart rate")
(termFormat EnglishLanguage restingHeartRate "baseline heart rate")

(=>
  (and
    (restingHeartRate ?H ?R)
    (instance ?HEART Heart)
    (part ?HEART ?H))
  (exists (?T)
    (and
      (not
        (exists (?REC)
          (and
            (instance ?REC RecreationOrExercise)
            (agent ?REC ?H)
            (during ?T (WhenFn ?REC)))))
      (instance ?T Minute)
      (heartRate ?H ?T ?R))))

(instance Anemia DiseaseOrSyndrome)
(documentation Anemia EnglishLanguage "Anemia or anaemia (British English) is a blood
disorder in which the blood has a reduced ability to carry &%Oxygen due to a lower than
normal number of &%RedBloodCells, or a reduction in the amount of &%Hemoglobin.
When anemia comes on slowly, the symptoms are often vague, such as tiredness, weakness,
shortness of breath, headaches, and a reduced ability to exercise. When anemia is
acute, symptoms may include confusion, feeling like one is going to pass out, loss
of consciousness, and increased thirst. Anemia must be significant before a person
becomes noticeably pale. Symptoms of anemia depend on how quickly hemoglobin
decreases. Additional symptoms may occur depending on the underlying cause.
Preoperative anemia can increase the risk of needing a blood transfusion following
surgery. Anemia can be temporary or long term and can range from mild to severe.
in men is based on a hemoglobin of less than 130 to 140 g/L;
in women, it is less than 120 to 130 g/L. [from Wikipedia]")
(termFormat EnglishLanguage Anemia "anemia")
(termFormat EnglishLanguage Anemia "anaemia")

(=>
  (and
    (attribute ?H Anemia)
    (instance ?B Blood)
    (part ?B ?H)
    (attribute ?H Male)
    (measure ?B (MeasureFn 0.1 Liter))
    (instance ?HE Hemoglobin)
    (part ?HE ?B)
    (not
      (instance ?HE2 Hemoglobin))
    (not
      (equal ?HE ?HE2))
    (part ?H2 ?B)
    (measure ?HE (MeasureFn ?N Gram)))
  (lessThan ?N 13))

(=>
  (and
    (attribute ?H Anemia)
    (instance ?B Blood)
    (part ?B ?H)
    (attribute ?H Female)
    (measure ?B (MeasureFn 0.1 Liter))
    (instance ?HE Hemoglobin)
    (part ?HE ?B)
    (not
      (instance ?HE2 Hemoglobin))
    (not
      (equal ?HE ?HE2))
    (part ?H2 ?B)
    (measure ?HE (MeasureFn ?N Gram)))
  (lessThan ?N 12))

(=>
  (and
    (not (attribute ?H Anemia))
    (instance ?B Blood)
    (part ?B ?H)
    (attribute ?H Male)
    (measure ?B (MeasureFn 0.1 Liter))
    (instance ?HE Hemoglobin)
    (part ?HE ?B)
    (not
      (instance ?HE2 Hemoglobin))
    (not
      (equal ?HE ?HE2))
    (part ?H2 ?B)
    (measure ?HE (MeasureFn ?N Gram)))
  (greaterThan ?N 13))

(=>
  (and
    (not (attribute ?H Anemia))
    (instance ?B Blood)
    (part ?B ?H)
    (attribute ?H Female)
    (measure ?B (MeasureFn 0.1 Liter))
    (instance ?HE Hemoglobin)
    (part ?HE ?B)
    (not
      (instance ?HE2 Hemoglobin))
    (not
      (equal ?HE ?HE2))
    (part ?H2 ?B)
    (measure ?HE (MeasureFn ?N Gram)))
  (greaterThan ?N 12))

(instance concentration QuaternaryPredicate)
(domain concentration 1 Quantity)
(domainSubclass concentration 2 Substance)
(domain concentration 3 Quantity)
(domain concentration 4 Mixture)
(documentation concentration EnglishLanguage "The concentration of a
&%Substance in a &%Mixture. ")
; TODO handle the issue of granularity of the substance
(format EnglishLanguage concentration "the &%concentration of %2 in %4 is %1 per %3")
(termFormat EnglishLanguage concentration "concentration")

(=>
  (and
    (concentration
      (MeasureFn ?N1 ?U) ?S
      (MeasureFn ?N2 ?U2) ?M)
    (instance ?SI ?S)
    (part ?SI ?M)
    (measure ?SI (MeasureFn ?N3 ?U3))
    (part ?SI ?M)
    (not
      (instance ?SI2 ?S))
    (not
      (equal ?SI ?SIE2))
    (part ?SI2 ?M)
    (measure ?M (MeasureFn ?N2 ?U2)))
  (approximateValue ?N1 ?N3))

(subclass Hemoglobin Protein)
(documentation Anemia EnglishLanguage "Hemoglobin (haemoglobin in British
English), abbreviated Hb or Hgb, is the iron-containing &%Oxygen-transport
&%Protein present in &%RedBloodCells (erythrocytes) of almost all &%Vertebrates
(the exception being the fish family Channichthyidae) as well as the &%Tissues
of some &%Invertebrate &%Animals. Hemoglobin in &%Blood carries oxygen from the
respiratory &%Organs (&%Lungs or &%Gills) to the other tissues of the body, where it
releases the oxygen to enable aerobic respiration which powers the animal's
metabolism. A healthy &%Human has 12 to 20 grams of hemoglobin in every 100 mL of
blood. Hemoglobin is a metalloprotein and chromoprotein.[from Wikipedia]")
(termFormat EnglishLanguage Hemoglobin "hemoglobin")

(documentation Gills EnglishLanguage "A respiratory organ of &%Fish. Its
function is to furnish the blood with oxygen and to remove carbon dioxide.")
(subclass Gills AnimalAnatomicalStructure)
(subclass Gills VitalOrgan)
(termFormat EnglishLanguage Gills "gills")

(subclass LeftAtrium BodyCavity)
(documentation LeftAtrium EnglishLanguage "One of the four chambers of the &%Heart
in &%Primates.")
(termFormat EnglishLanguage LeftAtrium "left atrium")
(externalImage LeftAtrium "https://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Diagram_of_the_human_heart_%28cropped%29.svg/800px-Diagram_of_the_human_heart_%28cropped%29.svg.png")

(=>
  (and
    (instance ?LA LeftAtrium)
    (part ?LA ?H))
  (exists (?H ?HEART)
    (and
      (equal ?HEART (HoleHostFn ?LA))
      (part ?HEART ?H)
      (instance ?HEART Heart))))

(subclass LeftVentricle BodyCavity)
(documentation LeftVentricle EnglishLanguage "One of the four chambers of the &%Heart
in &%Primates.")
(termFormat EnglishLanguage LeftVentricle "left ventricle")
(externalImage LeftVentricle "https://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Diagram_of_the_human_heart_%28cropped%29.svg/800px-Diagram_of_the_human_heart_%28cropped%29.svg.png")

(=>
  (and
    (instance ?LA LeftVentricle)
    (part ?LA ?H))
  (exists (?H ?HEART)
    (and
      (equal ?HEART (HoleHostFn ?LA))
      (part ?HEART ?H)
      (instance ?HEART Heart))))

(subclass RightAtrium BodyCavity)
(documentation RightAtrium EnglishLanguage "One of the four chambers of the &%Heart
in &%Primates.")
(termFormat EnglishLanguage RightAtrium "right atrium")
(externalImage RightAtrium "https://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Diagram_of_the_human_heart_%28cropped%29.svg/800px-Diagram_of_the_human_heart_%28cropped%29.svg.png")

(=>
  (and
    (instance ?LA RightAtrium)
    (part ?LA ?H))
  (exists (?H ?HEART)
    (and
      (equal ?HEART (HoleHostFn ?LA))
      (part ?HEART ?H)
      (instance ?HEART Heart))))

(subclass RightVentricle BodyCavity)
(documentation RightVentricle EnglishLanguage "One of the four chambers of the &%Heart
in &%Primates.")
(termFormat EnglishLanguage RightVentricle "right ventricle")
(externalImage RightVentricle "https://upload.wikimedia.org/wikipedia/commons/thumb/e/e5/Diagram_of_the_human_heart_%28cropped%29.svg/800px-Diagram_of_the_human_heart_%28cropped%29.svg.png")

(=>
  (and
    (instance ?LA RightVentricle)
    (part ?LA ?H))
  (exists (?H ?HEART)
    (and
      (equal ?HEART (HoleHostFn ?LA))
      (part ?HEART ?H)
      (instance ?HEART Heart))))

(instance restingBreathingRate BinaryPredicate)
(domain restingBreathingRate 1 Mammal)
(domain restingBreathingRate 2 Integer)
(documentation restingBreathingRate EnglishLanguage "The breathing rate at rest
of a human, in beats per minute.  ")
(format EnglishLanguage restingBreathingRate "the &%resting breathing rate of %1 is %2")
(termFormat EnglishLanguage restingBreathingRate "resting breathing rate")
(termFormat EnglishLanguage restinrestingBreathingRategHeartRate "baseline breathing rate")

(=>
  (and
    (restingBreathingRate ?H ?R)
    (instance ?L Lung)
    (part ?L ?H))
  (exists (?T)
    (and
      (not
        (exists (?REC)
          (and
            (instance ?REC RecreationOrExercise)
            (agent ?REC ?H)
            (during ?T
              (WhenFn ?REC)))))
      (instance ?T Minute)
      (breathingRate ?H ?T ?R))))

(=>
  (and
    (attribute ?H Healthy)
    (restingBreathingRate ?H ?R))
  (and
    (greaterThanOrEqualTo ?R 12)
    (greaterThanOrEqualTo 16 ?R)))

(=>
  (and
    (breathingRate ?H ?T ?R)
    (instance ?T Minute)
    (not
      (exists (?R)
        (and
          (instance ?R RecreationOrExercise)
          (agent ?R ?H)
          (during ?T
            (WhenFn ?R)))))
    (holdsDuring ?T
      (attribute ?H HumanAdult))
    (or
      (greaterThan ?R 16)
      (lessThan ?R 12)))
  (holdsDuring ?T
    (not
      (attribute ?H Healthy))))

(instance Ambulatory BiologicalAttribute)
(documentation Ambulatory EnglishLanguage "The &%capability of &%Walking.")
(termFormat EnglishLanguage Ambulatory "ambulatory")
(=>
  (holdsDuring ?T
    (attribute ?H Ambulatory))
  (holdsDuring ?T
    (capability Walking agent ?H)))

(instance InjuryCausedFn UnaryFunction)
(documentation InjuryCausedFn EnglishLanguage "A &%Function that denotes an
&%Injury resulting from a specific kind of &%Process.")
(range InjuryCausedFn Injury)
(domainSubclass InjuryCausedFn 1 Process)
(format EnglishLanguage InjuryCausedFn "an &%injury caused by %1")

(=>
  (attribute ?H (InjuryCausedFn ?PC))
  (exists (?I ?P)
    (and
      (instance ?I Injuring)
      (patient ?I ?H)
      (instance ?P ?PC)
      (causes ?P ?I))))

(instance Bruise DiseaseOrSyndrome)
(subAttribute Bruise Injury)
(documentation Bruise EnglishLanguage "Colloquially, a &%Bruise is an area of &%Skin where
burst &%BloodVessels are visible just below the surface. A bruise, also known as a contusion,
is a type of hematoma of &%issue, the most common cause being capillaries damaged by trauma,
causing localized &%Bleeding that extravasates into the surrounding interstitial tissues. Most
bruises occur close enough to the epidermis such that the bleeding causes a visible discoloration.
The bruise then remains visible until the &%Blood is either absorbed by tissues or cleared by
immune system action. [from Wikipedia]")
(termFormat EnglishLanguage Bruise "bruise")
(termFormat EnglishLanguage Bruise "contusion")
(termFormat EnglishLanguage Bruise "hematoma")

(=>
  (attribute ?H Bruise)
  (exists (?I ?P)
    (and
      (instance ?I Injuring)
      (patient ?I ?H)
      (instance ?P Bleeding)
      (causes ?P ?I))))

(instance Conscious ConsciousnessAttribute)
(contraryAttribute Conscious Unconscious)
(documentation Conscious EnglishLanguage "Unlike an &%Unconscious &%Human, a conscious one
is able to perform at least some sort of &%IntentionalProcess, even if very minimal, such
as &%Blinking of the &%Eye of someone who is suffereing from a profound &%Paralysis.")
(termFormat EnglishLanguage Conscious "conscious")

(=>
  (holdsDuring ?T
    (attribute ?H Conscious))
  (holdsDuring ?T
    (capability IntentionalProcess agent ?H)))

(subclass Blinking BodyMotion)
(documentation Blinking EnglishLanguage "Blinking is a rapid &%Closing and &%Opening of
the &%Eye done by the &%Eyelid.")
(termFormat EnglishLanguage Blinking "blinking")

(=>
  (instance ?B Blinking)
  (exists (?CE ?OE)
    (and
      (instance ?CE ClosingEyes)
      (instance ?OE OpeningEyes)
      (subProcess ?CE ?B)
      (subProcess ?OE ?B))))

(subclass MeasuringBreathing DiagnosticProcess)
(documentation MeasuringBreathing EnglishLanguage "The &%DiagnosticProcess of determining whether
and how frequently someone is &%Breathing.")
(termFormat EnglishLanguage MeasuringBreathing "measuring breathing")

(=>
  (and
    (instance ?MB MeasuringBreathing)
    (agent ?MB ?A)
    (instance ?L Lung)
    (part ?L ?P)
    (instance ?T TimeInterval)
    (during ?T
      (WhenFn ?MB))
    (duration ?T MinuteDuration)
    (patient ?MB ?P))
  (holdsDuring
    (ImmediateFutureFn
      (WhenFn ?MB))
    (exists (?BR)
      (knows ?A
        (breathingRate ?L ?T ?BR)))))

(subclass BloodCirculation LiquidMotion)
(documentation BloodCirculation EnglishLanguage "The &%LiquidMotion of &%Blood through
the &%Veins and &%Arteries of an &%Animal.   The &%Motion is caused by the
&%Heart. Note that this is disjoint from non-circulatory motion of blood such
as &%Bleeding from an &%Injury.")
(termFormat EnglishLanguage BloodCirculation "blood circulation")

(=>
  (instance ?BC BloodCirculation)
  (exists (?O ?V ?A ?B)
    (and
      (instance ?O Animal)
      (instance ?B Blood)
      (moves ?BC ?B)
      (instance ?A Artery)
      (instance ?V Vein)
      (part ?A ?O)
      (part ?V ?O)
      (path ?BC ?A)
      (path ?BC ?V))))

(instance coreBodyTemp BinaryPredicate)
(domain coreBodyTemp 1 Organism)
(domain coreBodyTemp 2 TemperatureMeasure)
(documentation coreBodyTemp EnglishLanguage "Core temperature, also called core body temperature,
is the operating temperature of an &%Organism, specifically in deep structures of the body such as
the &%Liver, in comparison to temperatures of peripheral tissues. Core temperature is normally
maintained within a narrow range so that essential enzymatic reactions can occur. Significant
core temperature elevation (&%Hyperthermia) or depression (&%Hypothermia) over more than a brief
period of time is incompatible with &%Human life. Temperature examination in the &%Heart, using a
catheter, is the traditional gold standard measurement used to estimate core temperature (oral
temperature is affected by hot or cold drinks, ambient temperature fluctuations as well as
mouth-breathing). Since catheters are highly invasive, the generally accepted alternative for
measuring core body temperature is through measurements in the &%Rectum. [from Wikipedia]")

(=>
  (and
    (instance ?H Human)
    (instance ?R Rectum)
    (part ?R ?H)
    (holdsDuring ?T
      (and
        (coreBodyTemp ?H
          (MeasureFn ?N ?U))
        (measure ?R
          (MeasureFn ?N2 ?U)))))
  (approximateValue ?N ?N2))

(subclass Catheter MedicalDevice)
(subclass Catheter Tube)
(documentation Catheter EnglishLanguage "In medicine, a catheter is a thin tube made from medical
grade materials serving a broad range of functions. Catheters are &%MedicalDevices that can be
inserted in the body to treat diseases or perform a surgical procedure. Catheters are manufactured
for specific applications, such as cardiovascular, urological, gastrointestinal, neurovascular and
ophthalmic procedures. The process of inserting a catheter is &%Catheterization.
Catheters can be inserted into a &%BodyCavity, duct, or vessel, &%Brain, &%Skin or adipose tissue.
Functionally, they allow drainage, administration of &%Fluids or &%Gases, access by surgical instruments,
and also perform a wide variety of other tasks depending on the type of catheter. Special types of
catheters, also called probes, are used in preclinical or clinical research for sampling of lipophilic
and hydrophilic compounds, protein-bound and unbound drugs, neurotransmitters, peptides and
&%Proteins, &%Antibodies, nanoparticles and nanocarriers, &%Enzymes and vesicles.[from Wikipedia]")
(termFormat EnglishLanguage Catheter "catheter")
(termFormat EnglishLanguage Catheter "cannula")

(=>
  (instance ?C Catheter)
  (hasPurpose ?C
    (exists (?M ?O ?OBJ ?L)
      (and
        (instance ?O Organism)
        (instance ?M Motion)
        (moves ?M ?OBJ)
        (orientation ?L ?O Outside)
        (path ?M ?C)
        (or
          (and
            (origin ?M ?L)
            (destination ?M ?O))
          (and
            (origin ?M ?O)
            (destination ?M ?L)))))))

(subclass Catheterization Inserting)
(documentation Catheterization EnglishLanguage "The &%Process of &%Inserting a &%Catheter into an &%Organism.")
(termFormat EnglishLanguage Catheterization "catheterization")

(=>
  (instance ?C Catheterization)
  (exists (?CATH ?O)
    (and
      (instance ?CATH Catheter)
      (instance ?O Organism)
      (objectTransferred ?C ?CATH)
      (destination ?C ?O))))

(subclass CPR TherapeuticProcess)
(termFormat EnglishLanguage CPR "cardio-pulmonary resuscitation")
(documentation CPR EnglishLanguage "Cardiopulmonary resuscitation (CPR) is an emergency procedure
consisting of chest compressions often combined with artificial ventilation, or &%Mouth to mouth in an
effort to manually preserve intact &%Brain function until further measures are taken to restore spontaneous
&%BloodCirculation and &%Breathing in a person who is in cardiac arrest. It is recommended for those who are
unresponsive with no breathing or abnormal &%Breathing, for example, agonal respirations.
CPR involves chest compressions for adults between 5 cm (2.0 in) and 6 cm (2.4 in) deep and at a rate of
at least 100 to 120 per minute. The rescuer may also provide artificial ventilation by either &%Exhaling
air into the subject's mouth or &%Nose (mouth-to-mouth resuscitation) or using a device that pushes air into
the subject's &%Lungs (mechanical ventilation). Current recommendations place emphasis on early and high-
quality chest compressions over artificial ventilation; a simplified CPR method involving only chest
compressions is recommended for untrained rescuers.
CPR alone is unlikely to restart the heart. Its main purpose is to restore the partial flow of oxygenated
blood to the &%Brain and &%Heart. The objective is to delay &%Tissue &%Death and to extend the brief window of
opportunity for a successful resuscitation without permanent &%Brain damage. Administration of an electric
shock to the subject's &%Heart, termed &%Defibrillation, is usually needed to restore a viable, or 'perfusing',
heart rhythm.  In general, CPR is
continued until the person has a return of spontaneous circulation (ROSC) or is declared &%Dead.[from Wikipedia]")

(=>
  (instance ?CPR CPR)
  (hasPurpose ?CPR
    (exists (?O ?HB)
      (and
        (instance ?O Human)
        (instance ?HB HeartBeat)
        (located ?HB ?O)
        (causes ?CPR ?HB)))))

(=>
  (instance ?CPR CPR)
  (exists (?C ?CH ?O)
    (and
      (instance ?C Compressing)
      (patient ?CPR ?O)
      (instance ?CH Chest)
      (part ?CH ?O)
      (patient ?C ?CH)
      (subProcess ?C ?CPR))))

(=>
  (and
    (instance ?CPR CPR)
    (instance ?C Compressing)
    (path ?C ?P)
    (subProcess ?C ?CPR)
    (length ?P
      (MeasureFn ?L Centimeter)))
  (and
    (greaterThan ?L 5.0)
    (lessThan ?L 6.0)))

(subclass Defibrillation TherapeuticProcess)
(documentation Defibrillation EnglishLanguage "Administering an electric shock to restart the &%Heart")

(instance Hypothermia DiseaseOrSyndrome)
(documentation Hypothermia EnglishLanguage "Hypothermia is defined as a body core temperature
below 35.0 degC (95.0 degF) in humans. Symptoms depend on the temperature. In mild hypothermia,
there is shivering and mental confusion. In moderate hypothermia, shivering stops and confusion
increases. In severe hypothermia, there may be hallucinations and paradoxical undressing, in
which a person removes their clothing, as well as an increased risk of the heart stopping.
The treatment of mild hypothermia involves warm drinks, warm clothing, and voluntary physical
activity. In those with moderate hypothermia, heating blankets and warmed intravenous fluids
are recommended. People with moderate or severe hypothermia should be moved gently. In severe
hypothermia, extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass may be useful.
In those without a pulse, cardiopulmonary resuscitation (CPR) is indicated along with the above
measures. Rewarming is typically continued until a person's temperature is greater than 32 degC
(90 °F). If there is no improvement at this point or the blood potassium level is greater than
12 mmol/liter at any time, resuscitation may be discontinued. [from Wikipedia]")
(termFormat EnglishLanguage Hypothermia "hypothermia")

(=>
  (and
    (instance ?H Human)
    (holdsDuring ?T
      (and
        (attribute ?T Hypothermia)
        (coreBodyTemp ?H
          (MeasureFn ?N CelsiusDegree)))))
  (lessThan ?N 35.0))

(subclass MedicalDevice Device)
(documentation MedicalDevice EnglishLanguage "A &%Device that is intended to be used
in a &%DiagnosticProcess or a &%TherpeuticProcess.")
(termFormat EnglishLanguage MedicalDevice "medical device")

(=>
  (instance ?MD MedicalDevice)
  (hasPurpose ?MD
    (exists (?TP ?DP)
      (and
        (instance ?TP TherapeuticProcess)
        (instance ?DP DiagnosticProcess)
        (or
          (instrument ?TP ?MD)
          (instrument ?DP ?MD))))))

(instance Hyperthermia DiseaseOrSyndrome)
(documentation Hyperthermia EnglishLanguage "In humans, hyperthermia is defined as a temperature
greater than 37.5–38.3 degC (99.5–100.9 degF), depending on the reference used, that occurs without
a change in the body's temperature set point. The normal human body temperature can be as high
as 37.7 degC (99.9 degF) in the late afternoon. Hyperthermia requires an elevation from the
temperature that would otherwise be expected. Such elevations range from mild to extreme; body
temperatures above 40 degC (104 degF) can be life-threatening.[from Wikipedia]")
(termFormat EnglishLanguage Hyperthermia "hyperthermia")

(=>
  (and
    (instance ?H Human)
    (holdsDuring ?T
      (and
        (attribute ?T Hyperthermia)
        (coreBodyTemp ?H
          (MeasureFn ?N CelsiusDegree)))))
  (greaterThan ?N 38.3))

; injuries to the Airway are often caused by facial trauma or burns

(=>
  (and
    (instance ?V ViolentContest)
    (patient ?V ?H)
    (attribute ?H
       (InjuryCausedFn ?PC))
    (attribute ?H
      (ImpairedBodyPartFn Airway)))
  (modalAttribute
    (or
      (subclass ?PC Combustion)
      (exists (?FI)
        (and
          (instance ?I Injuring)
          (located ?I ?F)
          (instance ?F Face)
          (patient ?I ?H))))
    Likely))

(subclass NasopharyngealAirway Catheter)
(termFormat EnglishLanguage NasopharyngealAirway "nasopharyngeal airway")
(termFormat EnglishLanguage NasopharyngealAirway "NPA")
(termFormat EnglishLanguage NasopharyngealAirway "nasal trumpet")
(termFormat EnglishLanguage NasopharyngealAirway "nose hose")
(documentation NasopharyngealAirway EnglishLanguage "In medicine, a nasopharyngeal airway, also known as an NPA,
nasal trumpet (because of its flared end), or nose hose, is a type of airway adjunct, a tube that is designed
to be inserted through the nasal passage down into the posterior pharynx to secure an open airway.  When a
patient becomes &%Jnconscious, the &%Muscles in the &%Jaw commonly relax and can allow the &%Tongue to slide
back and obstruct the &%Airway. This makes airway management necessary, and an NPA is one of the available
tools. The purpose of the flared end is to prevent the device from becoming lost inside the patient's nose.
[from Wikipedia]")

(=>
  (instance ?NA NasopharyngealAirway)
  (hasPurpose ?NA
    (exists (?H ?B)
      (and
        (instance ?B Breathing)
        (located ?B ?H)
        (holdsDuring
          (WhenFn ?B)
          (attribute ?H Unconscious))
        (path ?B ?NA)))))

(subclass Cricothyroidotomy Surgery)
(documentation Cricothyroidotomy EnglishLanguage "A cricothyrotomy (also called cricothyroidotomy) is an
incision made through the &%Skin and cricothyroid membrane to establish a patient &%Airway during certain
life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive facial
trauma. Cricothyrotomy is nearly always performed as a last resort in cases where other means of tracheal
intubation are impossible or impractical. Compared with tracheotomy, cricothyrotomy is quicker and easier
to perform, does not require manipulation of the cervical spine, and is associated with fewer complications.
However, while cricothyrotomy may be life-saving in extreme circumstances, this technique is only intended
to be a temporizing measure until a definitive airway can be established.[from Wikipedia]")
(termFormat EnglishLanguage Cricothyroidotomy "cricothyroidotomy")
(termFormat EnglishLanguage Cricothyroidotomy "cricothyrotomy")

(=>
  (and
    (instance ?C Cricothyroidotomy)
    (patient ?C ?O))
  (holdsDuring
    (EndFn (WhenFn ?C))
    (exists (?H)
      (and
        (instance ?H HoleRegion)
        (equal ?T (HoleHostFn ?H))
        (instance ?T Throat)
        (part ?T ?O)))))

(=>
  (and
    (instance ?C Cricothyroidotomy)
    (patient ?C ?O))
  (hasPurpose ?C
    (and
      (holdsDuring
        (ImmediatePastFn (WhenFn ?C))
        (exists (?B)
          (and
            (instance ?B (ImpairmentFn Breathing))
            (patient ?B ?O))))
      (not
        (holdsDuring
          (ImmediateFutureFn (WhenFn ?C))
          (exists (?B)
            (and
              (instance ?B (ImpairmentFn Breathing))
              (patient ?B ?O))))))))

(instance Pneumothorax DiseaseOrSyndrome)
(documentation Pneumothorax EnglishLanguage "A pneumothorax is an abnormal collection of &%Air in the
pleural space between the &%Lung and the &%Chest wall. Symptoms typically include sudden onset of
sharp, one-sided chest &%Pain and shortness of &%Breath. In a minority of cases, a one-way &%Valve is
formed by an area of damaged &%Tissue, and the amount of air in the space between chest wall and lungs
increases; this is called a tension pneumothorax. This can cause a steadily worsening &%Oxygen
shortage and low blood pressure. This leads to a type of shock called obstructive shock, which can
be fatal unless reversed. Very rarely, both lungs may be affected by a pneumothorax. It is often
called a 'collapsed lung', although that term may also refer to atelectasis.[from Wikipedia]")
(termFormat EnglishLanguage Pneumothorax "pneumothorax")
(termFormat EnglishLanguage Pneumothorax "collapsed lung")

(=>
  (holdsDuring ?T
    (attribute ?H Pneumothorax))
  (holdsDuring ?T
    (exists (?A)
      (and
        (instance ?A Air)
        (instance ?L Lung)
        (instance ?C Chest)
        (part ?L ?H)
        (part ?C ?H)
        (between ?L ?A ?C)))))

(=>
  (holdsDuring ?T
    (attribute ?H Pneumothorax))
  (exists (?I)
    (and
      (instance ?I
        (ImpairmentFn Breathing))
      (patient ?I ?H)
      (during ?T
        (WhenFn ?I)))))

(subclass ChestSeal MedicalDevice)
(documentation ChestSeal EnglishLanguage "A &%MedicalDevice designed to seal a wound in the
&%Chest, preventing, or ameliorating, a &%Pneumothorax.")
(termFormat EnglishLanguage ChestSeal "chest seal")

(=>
  (instance ?CS ChestSeal)
  (hasPurpose ?CS
    (exists (?C ?CH ?I ?H)
      (and
        (instance ?C Closing)
        (instrument ?C ?CS)
        (located ?C ?CH)
        (instance ?CH Chest)
        (instance ?H HoleRegion)
        (equal ?CH
          (HoleHostFn ?H))
        (instance ?I Injuring)
        (located ?I ?CH)
        (earlier
          (WhenFn ?I)
          (WhenFn ?C))))))

(subclass VentedChestSeal ChestSeal)
(documentation VentedChestSeal EnglishLanguage "A &%ChestSeal designed to seal a wound in the
&%Chest, ameliorating a &%Pneumothorax, by allowing &%Air to escape through the wound but
not reenter it.")
(partType Valve VentedChestSeal)
(termFormat EnglishLanguage VentedChestSeal "vented chest seal")

(=>
  (and
    (instance ?VCS VentedChestSeal)
    (instance ?A Attaching)
    (objectTransferred ?A ?VCS)
    (destination ?A ?H))
  (hasPurpose ?VCS
    (exists (?A ?L ?C ?H)
      (and
        (instance ?A Air)
        (instance ?L Lung)
        (instance ?C Chest)
        (part ?L ?H)
        (part ?C ?H)
        (holdsDuring
          (ImmediatePastFn
            (WhenFn ?A))
          (between ?L ?A ?C))
        (hasPurpose ?VCS
          (holdsDuring
            (ImmediateFutureFn
              (WhenFn ?A))
            (orientation ?A ?H Outside)))))))

(subclass Thoracentesis TherapeuticProcess)
(subclass Thoracentesis Removing)
(documentation Thoracentesis EnglishLanguage "Thoracentesis, also known as thoracocentesis
pleural tap, needle thoracostomy, or needle decompression (often used term),
is an invasive medical procedure to remove &%Fluid or &%Air from the pleural space
for diagnostic or therapeutic purposes. A cannula, or hollow needle, is carefully
introduced into the thorax, generally after administration of local &%Anesthesia.
The recommended location varies depending upon the source. Some sources recommend the
midaxillary line, in the eighth, ninth, or tenth intercostal space. Whenever possible, the
procedure should be performed under ultrasound guidance, which has shown to reduce complications.
Tension &%Pneumothorax is a medical emergency that requires needle decompression before a chest
tube is placed.[from Wikipedia]")
(termFormat EnglishLanguage Thoracentesis "thoracentesis")
(termFormat EnglishLanguage Thoracentesis "thoracocentesis")
(termFormat EnglishLanguage Thoracentesis "pleural tap")
(termFormat EnglishLanguage Thoracentesis "needle thoracostomy")
(termFormat EnglishLanguage Thoracentesis "needle decompression")

(=>
  (and
    (instance ?T Thoracentesis)
    (patient ?T ?H))
  (exists (?I ?O ?IN ?L ?C ?F)
    (and
      (instance ?I Inserting)
      (subProcess ?I ?T)
      (objectTransferred ?I ?N)
      (origin ?I ?O)
      (destination ?I ?IN)
      (instance ?N Needle)
      (attribute ?F Fluid)
      (objectTransferred ?T ?F)
      (destination ?F ?O)
      (instance ?L Lung)
      (instance ?C Chest)
      (part ?L ?H)
      (part ?C ?H)
      (origin ?T ?IN)
      (destination ?T ?O)
      (between ?L ?IN ?C)
      (orientation ?O ?H Outside))))

(subclass Needle MedicalDevice)
(documentation Needle EnglishLanguage "A needle is a &%MedicalDevice intended for &%Inserting or
&%Removing a &%Fluid &%Inside a &%patient.")
(termFormat EnglishLanguage Needle "needle")

(=>
  (instance ?N Needle)
  (hasPurpose ?N
    (exists (?H ?TP ?F ?RI)
      (and
        (instance ?H Animal)
        (instance ?TP TherapeuticProcss)
        (attribute ?F Fluid)
        (patient ?TP ?H)
        (instrument ?TP ?N)
        (or
          (instance ?RI Removing)
          (instance ?RI Inserting))
        (subProcess ?RI ?TP)
        (objectTransferred ?RI ?F)))))

(subclass Anesthetizing TherapeuticProcess)
(documentation Anesthetizing EnglishLanguage "Being under &%Anesthesia is a state of controlled, temporary
loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or
all of analgesia (relief from or prevention of pain), &%Paralysis (muscle relaxation), amnesia (loss of memory),
and &%Unconsciousness. Anesthesia enables the painless performance of procedures that would otherwise require
physical restraint in a non-anesthetized individual, or would otherwise be technically unfeasible. Three broad
categories of anesthesia exist: &%GeneralAnesthetizing, &%Sedation and &%LocalAnesthetizing. [from Wikipedia]")
(termFormat EnglishLanguage Anesthetizing "anesthetizing")

(=>
  (and
    (instance ?A Anesthetizing)
    (patient ?A ?P))
  (holdsDuring
    (WhenFn ?A)
    (or
      (attribute ?P Unconscious)
      (not
        (attribute ?P Pain)))))

(subclass GeneralAnesthetizing Anesthetizing)
(documentation GeneralAnesthetizing EnglishLanguage "General anesthesia suppresses central nervous system
activity and results in unconsciousness and total lack of sensation, using either injected or inhaled drugs.
[from Wikipedia]")
(termFormat EnglishLanguage GeneralAnesthetizing "general anesthetizing")

(=>
  (and
    (instance ?A Anesthetizing)
    (patient ?A ?P))
  (holdsDuring
    (WhenFn ?A)
    (and
      (attribute ?P Unconscious)
      (not
        (attribute ?P Pain)))))

(subclass Sedating Anesthetizing)
(documentation Sedating EnglishLanguage "Sedation suppresses the central nervous system to a lesser degree,
inhibiting both anxiety and creation of long-term memories without resulting in unconsciousness.
[from Wikipedia]")
(termFormat EnglishLanguage Sedation "sedating")

(=>
  (and
    (instance ?A Sedating)
    (patient ?A ?P))
  (holdsDuring
    (WhenFn ?A)
    (and
      (attribute ?P Conscious)
      (not
        (attribute ?P Anxiety)))))

(subclass LocalAnesthetizing Anesthetizing)
(documentation LocalAnesthetizing EnglishLanguage "Regional and local
anesthesia, which blocks transmission of &%Nerve impulses from a specific part
of the body. Depending on the situation, this may be used either on its own (in
which case the individual remains fully conscious), or in combination with
general anesthesia or sedation. Local anesthesia is simple infiltration by the
clinician directly onto the region of interest (e.g. numbing a &%Tooth for
dental work). Peripheral nerve blocks use drugs targeted at peripheral nerves to
anesthetize an isolated part of the body, such as an entire &%Limb. Neuraxial
blockade , mainly epidural and spinal anesthesia, can be performed in the region
of the central nervous system itself, suppressing all incoming sensation from
nerves supplying the area of the block. [from Wikipedia]")
(termFormat EnglishLanguage LocalAnesthetizing "local anesthetizing")

(=>
  (and
    (instance ?A LocalAnesthetizing)
    (located ?A ?BP)
    (instance ?BP BodyPart)
    (part ?BP ?P)
    (patient ?A ?P))
  (holdsDuring
    (WhenFn ?A)
    (not
      (attribute ?P
        (PainFn ?BP)))))

(subclass Anesthesia Medicine)
(documentation Anesthesia EnglishLanguage "The &%BiologicallyActiveSubstance used in
&%Anesthetizing.")
(termFormat EnglishLanguage Anesthesia "anesthesia")

(=>
  (instance ?A Anesthetizing)
  (exists (?DRUG)
    (and
      (instance ?DRUG Anesthesia)
      (resource ?DRUB ?A))))

(=>
  (instance ?A Anesthesia)
  (hasPurpose ?A
    (exists (?P)
      (and
        (instance ?P Anesthetizing)
        (resource ?P ?A)))))

(subclass TranexamicAcid Medicine)
(documentation TranexamicAcid EnglishLanguage "Tranexamic acid (TXA) is a medication used to treat or
prevent excessive &%Blood loss from major trauma, postpartum &%Bleeding, &%Surgery, &%Tooth removal, nosebleeds,
and heavy menstruation. It is also used for hereditary angioedema. It is taken either orally or by injection
into a &%Vein. It serves as an antifibrinolytic. Antifibrinolytics are a class of medication that are
inhibitors of fibrinolysis. Fibrinolysis is a process that prevents blood clots from growing and becoming
problematic. Tranexamic acid is a synthetic analog of the amino acid lysine. [from Wikipedia]")
(termFormat EnglishLanguage TranexamicAcid "tranexamic acid")

(=>
  (instance ?TA TranexamicAcid)
  (hasPurpose ?TA
    (exists (?P)
      (and
        (instance ?P Human)
        (decreasesLikelihood
          (exists (?I)
            (and
              (instance ?I Ingesting)
              (objectTransferred ?I ?TA)
              (destination ?I ?P)))
          (exists (?P ?B)
            (and
              (instance ?P Human)
              (instance ?B Bleeding)
              (origin ?B ?P))))))))

(subclass IVTherapy Ingesting)
(subclass IVTherapy TherapeuticProcess)
(documentation IVTherapy EnglishLanguage "Intravenous therapy is a medical technique that administers
&%Fluids, &%Medicine and/or nutrients directly into a person's &%Vein. The intravenous route of administration
is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced
mental states or otherwise—consume food or water by &%Mouth. It may also be used to administer medications
or other medical therapy such as &%Blood products or &%Electrolytes to correct electrolyte imbalances.
[from Wikipedia].")
(termFormat EnglishLanguage IVTherapy "IV Therapy")

(=>
  (instance ?IVT IVTherapy)
  (exists (?P ?V ?T)
    (and
      (instance ?T IVLine)
      (path ?IVT ?T)
      (instance ?V Vein)
      (destination ?IVT ?V))))

(subclass IVLine Catheter)
(documentation IVLine EnglishLanguage "A &%Tube designed to be used in &%IVTherapy.")
(termFormat EnglishLanguage IVLine "IV Line")

(=>
  (instance ?IVL IVLine)
  (hasPurpose ?IVL
    (exists (?IVT)
      (and
        (instance ?IVT IVTherapy)
        (instrument ?IVT ?IVL)))))

(subclass SalineLock Valve)
(subclass SalineLock MedicalDevice)
(documentation SalineLock EnglishLanguage "A saline lock is a valve that is intended to be connected to an
&%IVLine.  It is pre-filled with a &%SalineSolution since that has a neutral effect (it is isotonic) on the
&%Blood.")
(termFormat EnglishLanguage SalineLock "saline lock")

(=>
  (instance ?SL SalineLock)
  (exists (?S)
    (and
      (instance ?S SalineSolution)
      (contains ?SL ?S))))

(=>
  (instance ?SL SalineLock)
  (hasPurpose ?SL
    (exists (?IVL)
      (and
        (instance ?IVL IVLine)
        (connected ?SL ?IVL)))))

(instance tonicity TernaryPredicate)
(domain tonicity 1 Object)
(domain tonicity 2 Object)
(domain tonicity 3 PressureMeasure)
(termFormat EnglishLanguage tonicity "tonicity")
(format EnglishLanguage tonicity "the &%tonicity of %1 with respect to %2 is %3")

(documentation tonicity EnglishLanguage "A measure of the osmotic pressure on the first argument
with respect to the second.  This is typically measured in &%Pascals.  Osmotic pressure is the minimum
pressure which needs to be applied to a solution (the first argument) to prevent the inward flow of its pure solvent across
a semipermeable membrane (from the second argument). If there is potential flow from the first to the second
argument then the measure in this relation will be negative. It is also defined as the measure of the tendency of a solution to take in
its pure solvent by osmosis. Potential osmotic pressure is the maximum osmotic pressure that could
develop in a solution if it were separated from its pure solvent by a semipermeable membrane.
Osmosis occurs when two solutions containing different concentrations of solute are separated by a
selectively permeable membrane. Solvent molecules pass preferentially through the membrane from the
low-concentration solution to the solution with higher solute concentration. The transfer of solvent
molecules will continue until equilibrium is attained.[from Wikipedia].")

(subclass BloodPlasma BodySubstance)
(documentation BloodPlasma EnglishLanguage "Blood plasma is a light amber-colored liquid component of blood
in which blood cells are absent, but which contains proteins and other constituents of whole blood in
suspension. It makes up about 55% of the body's total blood volume. It is the intravascular part of
extracellular fluid (all body fluid outside cells). It is mostly water (up to 95% by volume), and
contains important dissolved proteins (6–8%; e.g., serum albumins, globulins, and fibrinogen),
glucose, clotting factors, electrolytes (Na+, Ca2+, Mg2+, HCO3−, Cl−, etc.), hormones, carbon dioxide
(plasma being the main medium for excretory product transportation), and oxygen. It plays a vital
role in an intravascular osmotic effect that keeps electrolyte concentration balanced and protects
the body from infection and other blood-related disorders.[from Wikipedia]")
(termFormat EnglishLanguage BloodPlasma "blood plasma")

(=>
  (instance ?B Blood)
  (exists (?BP)
    (and
      (instance ?BP BloodPlasma)
      (part ?BP ?B))))

(=>
  (instance ?BP BloodPlasma)
  (not
    (exists (?WBC ?RBC)
      (and
        (instance ?WBC WhiteBloodCell)
        (instance ?RBC RedBloodCell)
        (part ?WBC ?BP)
        (part ?RBC ?BP)))))

(subclass IntraosseousInfusion Transfer)
(subclass IntraosseousInfusion TherapeuticProcess)
(documentation IntraosseousInfusion EnglishLanguage "Intraosseous infusion (IO) is the process of
injecting &%Medicine, &%fluids, or &%BloodProducts directly into the &%BoneMarrow; this provides
a non-collapsible entry point into the systemic venous system.
The IO route of fluid and medication administration is an alternative to the
preferred intravascular route (such as &%IVTherapy) when the latter cannot be established in a
timely manner in emergency situations. [from Wikipedia]")
(termFormat EnglishLanguage IntraosseousInfusion "intraosseous infusion")

(=>
  (and
    (instance ?II IntraosseousInfusion)
    (patient ?II ?H))
  (exists (?B)
    (and
      (instance ?B BoneMarrow)
      (destination ?II ?B)
      (part ?B ?H))))

(subclass IntraosseousDevice Catheter)
(documentation IntraosseousDevice EnglishLanguage "A &%Tube designed to be used in &%IntraosseousInfusion.")
(termFormat EnglishLanguage IntraosseousDevice "intraosseous device")

(=>
  (instance ?ID IntraosseousDevice)
  (hasPurpose ?ID
    (exists (?II)
      (and
        (instance ?II IntraosseousInfusion)
        (instrument ?II ?ID)))))

(subclass BoneMarrow Tissue)
(documentation BoneMarrow EnglishLanguage "Bone marrow is a semi-solid &%Tissue found within the spongy
(also known as cancellous) portions of &%Bones. In &%Birds and &%Mammals, bone marrow is the primary site of
new &%BloodCell production (or haematopoiesis). It is composed of hematopoietic cells, marrow adipose
tissue, and supportive stromal cells. In adult &%Humans, bone marrow is primarily located in the &%Ribs,
&%Vertebrae, &%Sternum, and bones of the &%Pelvis. Bone marrow comprises approximately 5% of total body
mass in healthy adult humans, such that a man weighing 73 kg (161 lbs) will have around 3.7 kg (8 lbs)
of bone marrow. [from Wikipedia].")
(termFormat EnglishLanguage BoneMarrow "bone marrow")

(=>
  (instance ?BC BloodCell)
  (holdsDuring
    (BeginFn
      (WhenFn ?BC))
    (exists (?BM)
      (and
        (instance ?BM BoneMarrow)
        (located ?BC ?BM)))))

(initialPart BoneMarrow Bone)

; hypoxia

(instance oxygenSaturation BinaryPredicate)
(domain oxygenSaturation 1 Human)
(domain oxygenSaturation 2 RealNumber)
(documentation oxygenSaturation EnglishLanguage "A measurement of the oxygen saturation in &%Human &%Blood,
expressed as a percentage of red blood cells that are fully oxygenated.  This is often measured by a
&%PuleOximeter.")
(termFormat EnglishLanguage oxygenSaturation "oxygen saturation")
(format EnglishLanguage oxygenSaturation "the &%oxygen saturation of %1 is %2 percent")

(=>
  (oxygenSaturation ?H ?N)
  (and
    (greaterThan ?N 0.0)
    (lessThan ?N 100.0)))

(=>
  (holdsDuring ?T
    (and
      (oxygenSaturation ?H ?N)
      (lessThan ?N 92.0)))
  (holdsDuring ?T
    (attribute ?H Hypoxia)))

(subclass PulseOximeter MedicalDevice)
(documentation PulseOximeter EnglishLanguage "Pulse oximetry is a noninvasive method for monitoring a
person's &%Blood &%Oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2%
accuracy (within 4% accuracy in 95% of cases) of the more accurate (and invasive) reading of arterial
oxygen saturation (SaO2) from arterial blood gas analysis. The most common approach is transmissive pulse
oximetry. In this approach, a sensor device is placed on a thin part of the patient's body, usually a
fingertip or earlobe, or an infant's foot. The device passes two wavelengths of light through the
&%BodyPart to a photodetector. It measures the changing absorbance at each of the wavelengths, allowing
it to determine the absorbances due to the pulsing arterial blood alone, excluding venous blood, skin,
&%Bone, &%Muscle, &%FatTissue, and, in most cases, nail polish. [from Wikipedia] ")
(termFormat EnglishLanguage PulseOximeter "pulse oximeter")

(=>
  (and
    (instance ?M Measuring)
    (instrument ?M ?PO)
    (agent ?M ?A)
    (patient ?M ?P)
    (instance ?PO PulseOximeter))
  (exists (?N)
    (knows ?A
      (oxygenSaturation ?P ?N))))

(=>
  (instance ?PO PulseOximeter)
  (hasPurpose ?PO
    (exists (?M ?A ?P)
      (and
        (instance ?M Measuring)
        (instrument ?M ?PO)
        (agent ?M ?A)
        (patient ?M ?P)
        (instance ?PO PulseOximeter)))))

(subclass TraumaticBrainInjury DiseaseOrSyndrome)
(documentation TraumaticBrainInjury EnglishLanguage "A traumatic brain injury (TBI), also known as an
intracranial injury, is an injury to the &%Brain caused by an external force. TBI can be classified based
on severity ranging from mild traumatic brain injury (mTBI/&%Concussion) to severe traumatic brain injury.
TBI can also be characterized based on mechanism (closed or penetrating head injury) or other features
(e.g., occurring in a specific location or over a widespread area). &%Head injury is a broader category
that may involve damage to other structures such as the scalp and &%Skull. TBI can result in physical,
cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to
permanent disability or &%Death.[from Wikipedia]")
(termFormat EnglishLanguage TraumaticBrainInjury "traumatic brain injury")
(termFormat EnglishLanguage TraumaticBrainInjury "TBI")

(=>
  (holdsDuring ?T
    (attribute ?H TraumaticBrainInjury))
  (holdsDuring ?T
    (attribute ?H
      (ImpairedBodyPartFn Brain))))

(subAttribute Concussion TraumaticBrainInjury)
(documentation Concussion EnglishLanguage "A concussion, also known as a mild traumatic brain injury
(mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of
consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea;
blurred vision; dizziness; sleep disturbances, and mood changes. Any of these symptoms may begin
immediately, or appear days after the injury. Concussion should be suspected if a person indirectly
or directly hits their head and experiences any of the symptoms of concussion. Symptoms of a
concussion may be delayed by 1-2 days after the accident. It is not unusual for symptoms to last 2
weeks in adults and 4 weeks in children. Fewer than 10% of sports-related concussions among
children are associated with loss of consciousness.[from Wikipedia]")
(termFormat EnglishLanguage Concussion "concussion")
(termFormat EnglishLanguage Concussion "mild traumatic brain injury")

(=>
  (and
    (not
      (holdsDuring ?T1
        (attribute ?H Concussion)))
    (holdsDuring ?T2
      (attribute ?H Concussion))
    (meetsTemporally ?T1 ?T2))
  (modalAttribute
    (holdsDuring
      (BeginFn ?T2)
      (attribute ?H Unconscious))
    Likely))

(=>
  (and
    (instance ?I Impacting)
    (patient ?I ?H)
    (holdsDuring
      (ImmediateFutureFn ?I)
      (attribute ?H
        (ImpairedBodyPartFn Brain))))
  (modalAttribute
    (holdsDuring
      (ImmediateFutureFn ?I)
      (attribute ?H Concussion))
    Likely))

(subclass InjectedAntibiotic Antibiotic)
(documentation InjectedAntibiotic EnglishLanguage "An &%Antibiotic that is meant for &%Injecting
into a patient.")
(termFormat EnglishLanguage InjectedAntibiotic "injected antibiotic")

(=>
  (instance ?A InjectedAntibiotic)
  (hasPurpose ?A
    (exists (?I)
      (and
        (instance ?I Injecting)
        (objectTransferred ?I ?A)))))

(subclass CarbapenemAntibiotic Antibiotic)
(documentation CarbapenemAntibiotic EnglishLanguage "Carbapenems are a class of very effective &%Antibiotic agents most
commonly used for the treatment of severe bacterial infections. This class of antibiotics is usually
reserved for known or suspected &%MultiDrugResistantBacterium. Similar to &%Penicillins
and cephalosporins, carbapenems are members of the beta-lactam antibiotics drug class, which kill
bacteria by binding to penicillin-binding &%Proteins, thus inhibiting bacterial &%CellWall synthesis.
However, these agents individually exhibit a broader spectrum of activity compared to most
cephalosporins and penicillins. Furthermore, carbapenems are typically unaffected by emerging
antibiotic resistance, even to other beta-lactams.[from Wikipedia]")
(externalImage CarbapenemAntibiotic "https://en.wikipedia.org/wiki/Carbapenem#/media/File:Carbapenems_structure.svg")
(termFormat EnglishLanguage CarbapenemAntibiotic "carbapenem antibiotic")

(subclass Ertapenem CarbapenemAntibiotic)
(documentation Ertapenem EnglishLanguage "Ertapenem, sold under the brand name Invanz, is a &%Carbapenem
&%Antibiotic &%Medicine used for the treatment of infections of the &%Abdomen, the &%Lungs, the upper part of
the female reproductive system, and the diabetic &%Foot.[from Wikipedia]")
(externalImage Ertapenem "https://en.wikipedia.org/wiki/Ertapenem#/media/File:Ertapenem_Formula_V.1.svg")
(termFormat EnglishLanguage Ertapenem "ertapenem")

(=>
  (holdsDuring ?T
    (and
      (attribute ?H InfectiousDisease)
      (attribute ?H Diabetes)
      (attribute ?H (ImpairedBodyPartFn Foot))))
  (holdsDuring ?T
    (diseaseMedicine InfectiousDisease Ertapenem Injecting)))

(instance Diabetes DiseaseOrSyndrome)
(documentation Diabetes EnglishLanguage "Diabetes, also known as diabetes mellitus, is a group of
common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to
either the &%Pancreas not producing enough insulin, or the &%Cells of the body not responding properly
to the &%Insulin produced. Diabetes, if left untreated, leads to many health complications.
Untreated or poorly treated diabetes accounts for approximately 1.5 million &%Deaths per year.
There is no widely accepted cure for most cases of diabetes. The most common treatment for type 1
diabetes is insulin replacement therapy (insulin injections). Anti-diabetic medications such as
metformin and semaglutide, as well as lifestyle modifications, can be used to prevent or respond
to type 2 diabetes. Gestational diabetes normally resolves shortly after delivery.[from Wikipedia]")


(documentation EpsteinBarrVirus EnglishLanguage "The Epstein–Barr
virus (EBV), formally called Human gammaherpesvirus 4, is one of the
nine known human herpesvirus types in the herpes family, and is one of
the most common viruses in humans. [from Wikipedia]")
(subclass EpsteinBarrVirus HerpesVirus)
(termFormat EnglishLanguage EpsteinBarrVirus "Epstein–Barr virus")
(termFormat EnglishLanguage EpsteinBarrVirus "Human gammaherpesvirus 4")
(termFormat EnglishLanguage EpsteinBarrVirus "EBV")

(instance LymeDisease BacterialDisease)

(documentation LymeDisease EnglishLanguage "Lyme disease, also known
as Lyme borreliosis, is a vector-borne disease caused by the Borrelia
bacterium which is spread by &%Ticks in the genus Ixodes. The
most common sign of infection is an expanding red rash, known as
erythema migrans, that appears at the site of the tick bite about a
week after it occurred. The rash is typically neither itchy nor
painful. Approximately 70–80% of infected people develop a &%SkinRash.
Other early symptoms may include &%Fever, &%Headache and tiredness. If
untreated, symptoms may include loss of the ability to move one or
both sides of the &%Face, joint pains, severe &%Headaches with &%Neck
stiffness, or &%Heart palpitations, among others. Months to years
later, repeated episodes of joint &%Pain and swelling may occur.
Occasionally, people develop shooting pains or tingling in their &%Arms
and &%Legs. Despite appropriate treatment, about 10 to 20% of people
develop joint pains, memory problems, and tiredness for at least six
months.[from Wikipedia]")
(biochemicalAgentSyndrome Borrelia LymeDisease)
(termFormat EnglishLanguage LymeDisease "Lyme disease")

(diseaseSymptom LymeDisease SkinRash)

(subclass Borrelia Bacteria)
(biologicalAgentCarrier Borrelia Tick)
(biologicalAgentCarrier Borrelia Louse)
(termFormat EnglishLanguage Borrelia "borrelia")
(documentation Borrelia EnglishLanguage "Borrelia is a genus of
bacteria of the spirochete phylum. It causes Lyme disease, also
called Lyme borreliosis, a zoonotic, vector-borne disease transmitted
primarily by ticks and by lice, depending on the species of bacteria.
Of 52 known species of Borrelia, 20 are members of the Lyme disease
group (with an additional 3 proposed), 29 belong to the relapsing
fever group, and two are members of a genetically distinct third group
typically found in reptiles. This bacterium uses hard and soft &%Ticks
and lice as vectors. Testing for the presence of the bacteria in a
human includes two-tiered serological testing, including immunoassays
and immunoblotting.[from Wikipedia]")

(subclass Cytomegalovirus HerpesVirus)
(documentation Cytomegalovirus EnglishLanguage "Cytomegalovirus (CMV)
is a genus of viruses in the order Herpesvirales, in the family
Herpesviridae, in the subfamily Betaherpesvirinae. Humans and monkeys
serve as natural hosts. The 11 species in this genus include human
betaherpesvirus 5 (HCMV, human cytomegalovirus, HHV-5), which is the
species that infects humans. Diseases associated with HHV-5 include
mononucleosis, and pneumonia. In the medical literature, most mentions
of CMV without further specification refer implicitly to human CMV.
Human CMV is the most studied of all cytomegaloviruses.[from Wikipedia]")

(termFormat EnglishLanguage Cytomegalovirus "CMV")
(termFormat EnglishLanguage Cytomegalovirus "cytomegalovirus")

(instance PostExertionalMalaise DiseaseOrSyndrome)

(documentation PostExertionalMalaise EnglishLanguage "Post-exertional
malaise (PEM) is the worsening of symptoms following even minor
physical or mental exertion, with symptoms typically worsening 12 to
48 hours after activity and lasting for days or even weeks. [from
cdc.gov]")

(termFormat EnglishLanguage PostExertionalMalaise "Post-exertional
malaise")
(termFormat EnglishLanguage PostExertionalMalaise "PEM")

(=>
  (holdsDuring ?T
    (attribute ?P PostExertionalMalaise))
  (exists (?R)
    (and
      (instance ?R RecreationOrExercise)
      (agent ?R ?A)
      (earlier
        (WhenFn ?R) ?T))))

(instance ChronicFatigueSyndrome DiseaseOrSyndrome)

(documentation ChronicFatigueSyndrome EnglishLanguage "Chronic fatigue
syndrome (CFS), also called myalgic encephalomyelitis (ME) and ME/CFS,
is a complex, fatiguing, long-term medical condition diagnosed by
required primary symptoms and criteria, and often involves a broad
range of symptoms. Distinguishing core symptoms are lengthy
exacerbations or 'flares' of the illness after ordinary minor physical
or mental activity, known as post-exertional malaise (PEM); greatly
diminished capacity to accomplish tasks that were routine before the
illness; and sleep disturbances. Orthostatic intolerance (difficulty
sitting and standing upright) and cognitive dysfunction are also
diagnostic. Other common symptoms may involve numerous body systems,
and chronic pain is common. [from Wikipedia]")

(termFormat EnglishLanguage ChronicFatigueSyndrome "Chronic fatigue
syndrome")
(termFormat EnglishLanguage ChronicFatigueSyndrome "CFS")
(termFormat EnglishLanguage ChronicFatigueSyndrome "myalgic encephalomyelitis")
(termFormat EnglishLanguage ChronicFatigueSyndrome "ME/CFS")

(=>
  (and
    (holdsDuring ?T
      (attribute ?H ChronicFatigueSyndrome))
    (instance ?R RecreationOrExercise)
    (agent ?R ?H)
    (during (WhenFn ?R) ?T))
  (modalAttribute
    (and
      (holdsDuring ?T2
      (attribute ?H PostExertionalMalaise))
      (earlier (WhenFn ?R) ?T2))
    Likely))

(instance WeekBeforeMenstruationFn UnaryFn)
(domain WeekBeforeMenstruationFn 1 Woman)
(range WeekBeforeMenstruationFn Class)
(documentation WeekBeforeMenstruationFn EnglishLanguage "The a &%Function
that returns the &%Class of all &%Weeks immediately before the start
of &%Menstruation for a particular &%Woman.")

(=>
  (equal ?WKBMC
    (WeekBeforeMenstruationFn ?W))
  (equal ?WKBC
    (KappaFn ?C
      (and
        (instance ?C Week)
        (exists (?M)
          (and
            (instance ?M Menstruation)
            (experiencer ?M ?W)
            (equal ?C
              (WeekBeforeFn
                (WhenFn ?M)))))))))

(subclass Anaphylaxis AllergicReaction)

(documentation Anaphylaxis EnglishLanguage "Anaphylaxis is a serious
allergic reaction that is rapid in onset and may cause &%Death. It
typically causes more than one of the following: an itchy &%SkinRash, &%Throat
or &%Tongue swelling (&%Edema), shortness of &%Breath, &%Vomiting, lightheadedness,
&%LowBloodPressure. These symptoms typically come on over minutes to
hours.[from Wikipedia]")

(=>
  (and
    (instance ?A Anaphylaxis)
    (experiencer ?A ?H))
  (modalAttribute
    (exists (?D)
      (and
        (instance ?D Death)
        (experiencer ?D ?H)
        (causes ?A ?D)))
    Possibility))

(termFormat EnglishLanguage Anaphylaxis "anaphylaxis")

(subclass RTPCRTest MeasuringDevice)
(documentation RTPCRTest EnglishLanguage "Reverse transcription
polymerase chain reaction (RT-PCR) is a laboratory technique combining
reverse transcription of RNA into DNA (in this context called
complementary DNA or cDNA) and amplification of specific DNA targets
using polymerase chain reaction (PCR). It is primarily used to
measure the amount of a specific RNA. This is achieved by monitoring
the amplification reaction using fluorescence, a technique called
real-time PCR or quantitative PCR (qPCR). Combined RT-PCR and qPCR are
routinely used for analysis of gene expression and quantification of
viral RNA in research and clinical settings.[from Wikipedia]")

(termFormat EnglishLanguage RTPCRTest "RT-PCR test")
(termFormat EnglishLanguage RTPCRTest "RT-PCR")
(termFormat EnglishLanguage RTPCRTest "Reverse transcription polymerase chain reaction")

(=>
  (instance ?R RTPCRTest)
  (hasPurpose ?R
    (exists (?M ?A ?T ?MEAS)
      (and
        (instance ?M Measuring)
        (patient ?M ?RNA)
        (instance ?RNA RNAMolecule)
        (holdsDuring ?T
          (measure ?RNA ?MEAS))
        (knows ?A
          (holdsDuring ?T
            (measure ?RNA ?MEAS)))))))

(=>
  (and
    (instance ?M Measuring)
    (instrument ?M ?R)
    (instance ?R RTPCRTest))
  (exists (?E)
    (and
      (instance ?E RadiatingLight)
      (origin ?E ?R))))

(subclass Seizure PathologicalProcess)
(termFormat EnglishLanguage Seizure "seizure")
(termFormat EnglishLanguage Seizure "epileptic seizure")
(documentation Seizure EnglishLanguage "A seizure, formally known as
an epileptic seizure, is a period of symptoms due to abnormally
excessive or synchronous neuronal activity in the brain. Outward
effects vary from uncontrolled shaking movements involving much of the
body with loss of consciousness (tonic-clonic seizure), to shaking
movements involving only part of the body with variable levels of
consciousness (focal seizure), to a subtle momentary loss of awareness
(absence seizure). Most of the time these episodes last less than
two minutes and it takes some time to return to normal. Loss of
bladder control may occur.[from Wikipedia]")

(=>
  (and
    (instance ?S Seizure)
    (experiencer ?S ?A))
  (exists (?B)
    (and
      (instance ?B Brain)
      (part ?B ?A)
      (located ?S ?B))))

(subclass TonicClonicSeizure Seizure)

(documentation TonicClonicSeizure EnglishLanguage "A generalized tonic–clonic
seizure, commonly known as a grand mal seizure or GTCS, is a type
of generalized seizure that produces bilateral, convulsive tonic and
clonic muscle contractions. Tonic–clonic seizures are the seizure type
most commonly associated with epilepsy and seizures in general and the
most common seizure associated with metabolic imbalances. It is a
misconception that they are the sole type of seizure, as they are the
main seizure type in approximately 10% of those with epilepsy.[from
Wikipedia]")

(termFormat EnglishLanguage TonicClonicSeizure "tonic-clonic seizure")
(termFormat EnglishLanguage TonicClonicSeizure "grand mal seizure")
(termFormat EnglishLanguage TonicClonicSeizure "GTCS")

(=>
  (and
    (instance ?S TonicClonicSeizure)
    (experiencer ?S ?A))
  (holdsDuring
    (WhenFn ?S)
    (not
      (attribute ?A Conscious))))

(subclass FocalSeizure Seizure)

(documentation FocalSeizure EnglishLanguage "Focal seizures (also
called partial seizures and localized seizures) are seizures which
affect initially only one hemisphere of the brain. The brain is
divided into two hemispheres, each consisting of four lobes – the
frontal, temporal, parietal and occipital lobes. A focal seizure is
generated in and affects just one part of the brain – a whole
hemisphere or part of a lobe. Symptoms will vary according to where
the seizure occurs. When seizures occur in the frontal lobe the
patient may experience a wave-like sensation in the head. When
seizures occur in the temporal lobe, a feeling of déjà vu may be
experienced. When seizures are localized to the parietal lobe, a
numbness or tingling may occur. With seizures occurring in the
occipital lobe, visual disturbances or hallucinations have been
reported.[from Wikipedia]")

(termFormat EnglishLanguage FocalSeizure "focal seizure")
(termFormat EnglishLanguage FocalSeizure "localized seizure")
(termFormat EnglishLanguage FocalSeizure "partial seizure")

(=>
  (and
    (instance ?S FocalSeizure)
    (experiencer ?S ?A))
  (holdsDuring
    (WhenFn ?S)
    (attribute ?A Conscious)))

(subclass AbsenceSeizure Seizure)

(documentation AbsenceSeizure EnglishLanguage "Absence seizures are
one of several kinds of generalized seizures. These seizures are
sometimes referred to as petit mal seizures (from the French for
'little illness', a term dating from the late 18th century).
Absence seizures are characterized by a brief loss and return of
consciousness, generally not followed by a period of lethargy (i.e.
without a notable postictal state).[from Wikipedia]")

(termFormat EnglishLanguage AbsenceSeizure "absence seizure")
(termFormat EnglishLanguage AbsenceSeizure "petit mal seizure")

(=>
  (and
    (instance ?S AbsenceSeizure)
    (experiencer ?S ?A))
  (holdsDuring
    (WhenFn ?S)
    (not
      (attribute ?A Conscious))))

(subclass SnellenChart MeasuringDevice)
(documentation SnellenChart EnglishLanguage "A chart of letters, that
appear random, used for measuring visual acuity.")
(termFormat EnglishLanguage SnellenChart "Snellen chart")

(instance visualAcuity TernaryPredicate)
(domain visualAcuity 1 Human)
(domain visualAcuity 2 Integer)
(domain visualAcuity 3 Integer)
(termFormat EnglishLanguage visualAcuity "visual acuity")
(format EnglishLanguage visualAcuity "%1 has %2/%3 eyesight")

(documentation visualAcuity EnglishLanguage "A &%Measuring of visual
acuity stated as a ratio. The ratio is of at how many feet the subject
can see the same information as a normal person. For an example of
someone with slightly impaired vision, 20/40 vision means that the
subject has to be at 20 feet to see what a 'normal' person would be
able to see at 40 feet.")

(=>
  (visualAcuity ?H1 ?I1 ?I2)
  (exists (?H2)
    (and
      (not
        (attribute ?H2 (ImpairedBodyPartFn Eye)))
      (visualAcuity ?H2 ?I2 ?I2))))

(=>
  (visualAcuity ?H1 ?I1 ?I2)
  (exists (?S ?L)
    (and
      (instance ?S SnellenChart)
      (instance ?L Looking)
      (destination ?L ?S)
      (agent ?L ?H1))))

(instance hearingAcuity BinaryPredicate)
(domain hearingAcuity 1 Human)
(domain hearingAcuity 2 ConstantQuantity)
(domain hearingAcuity 3 ConstantQuantity)

(=>
  (hearingAcuity ?H
    (MeasureFn ?N1 ?U)
    (MeasureFn ?N2 ?U))
  (instance ?U SoundPressureLevelUnit))

(termFormat EnglishLanguage hearingAcuity "visual acuity")
(format EnglishLanguage hearingAcuity "%1 can hear frequency of %2 at %3 decibels")

(documentation hearingAcuity EnglishLanguage "A &%Measuring of
auditory acuity defined as the ability to hear frequencies from
250 to 8000 &%Hertz at a certain sound pressure level.")

(=>
  (and
    (instance ?MT MusicalTone)
    (soundFrequency ?MT
      (MeasureFn ?FREQ Hertz))
    (loudness ?MT
      (MeasureFn ?LLB Decibel))
    (located ?MT
      (WhereFn ?H
        (BeginFn
          (WhenFn ?MT))))
    (greaterThan ?LLIMIT ?LLB)
    (greaterThan ?LLB ?ULIMIT)
    (greaterThan ?FREQ 250)
    (greaterThan 8000 ?FREQ)
    (instance ?H Human)
    (instance ?L Listening)
    (agent ?L ?H))
  (hearingAcuity ?H
    (MeasureFn ?LLIMIT Decibel)
    (MeasureFn ?ULIMIT Decibel)))

(subclass AuditoryAcuityAttribute BiologicalAttribute)
(termFormat EnglishLanguage AuditoryAcuityAttribute "auditory acuity attribute")

(documentation NormalHearingSensitivity EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between –10 and 15 dB.")
(instance NormalHearingSensitivity AuditoryAcuityAttribute)
(termFormat EnglishLanguage NormalHearingSensitivity "normal hearing sensitivity")

(<=>
  (hearingAcuity ?H
    (MeasureFn -10 Decibel)
    (MeasureFn 15 Decibel))
  (attribute ?H NormalHearingSensitivity))

(documentation BorderlineHearingSensitivity EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 16 and 25 dB.")
(instance BorderlineHearingSensitivity AuditoryAcuityAttribute)
(termFormat EnglishLanguage BorderlineHearingSensitivity "borderline hearing sensitivity")

(<=>
  (hearingAcuity ?H
    (MeasureFn 16 Decibel)
    (MeasureFn 25 Decibel))
  (attribute ?H BorderlineHearingSensitivity))

(documentation MildHearingLoss EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 26 and 40 dB.")
(instance MildHearingLoss AuditoryAcuityAttribute)
(termFormat EnglishLanguage MildHearingLoss "mild hearing loss")

(<=>
  (hearingAcuity ?H
    (MeasureFn 26 Decibel)
    (MeasureFn 40 Decibel))
  (attribute ?H MildHearingLoss))

(documentation ModerateHearingLoss EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 41 and 55 dB.")
(instance ModerateHearingLoss AuditoryAcuityAttribute)
(termFormat EnglishLanguage ModerateHearingLoss "moderate hearing loss")
(<=>
  (hearingAcuity ?H
    (MeasureFn 41 Decibel)
    (MeasureFn 55 Decibel))
  (attribute ?H ModerateHearingLoss))

(documentation ModeratelySevereHearingLoss EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 56 and 70 dB.")
(instance ModeratelySevereHearingLoss AuditoryAcuityAttribute)
(termFormat EnglishLanguage ModeratelySevereHearingLoss "moderately severe hearing loss")

(<=>
  (hearingAcuity ?H
    (MeasureFn 56 Decibel)
    (MeasureFn 70 Decibel))
  (attribute ?H ModeratelySevereHearingLoss))

(documentation SevereHearingLoss EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 71 and 90 dB.")
(instance SevereHearingLoss AuditoryAcuityAttribute)
(termFormat EnglishLanguage SevereHearingLoss "severe hearing loss")

(<=>
  (hearingAcuity ?H
    (MeasureFn 71 Decibel)
    (MeasureFn 90 Decibel))
  (attribute ?H SevereHearingLoss))

(documentation ProfoundHearingLoss EnglishLanguage "Hearing
thresholds from 250 to 8,000 Hz between 91 and 200 dB.")
(instance ProfoundHearingLoss AuditoryAcuityAttribute)
(termFormat EnglishLanguage ProfoundHearingLoss "profound hearing loss")

(<=>
  (hearingAcuity ?H
    (MeasureFn 91 Decibel)
    (MeasureFn 200 Decibel))
  (attribute ?H ProfoundHearingLoss))

(subclass FacialParalysis (ParalysisFn Face))
(documentation FacialParalysis EnglishLanguage "&%Paralysis of
the &%Face.")
(termFormat EnglishLanguage FacialParalysis "paralysis of
the face")

(instance EKGNormal RelationalAttribute)
(documentation EKGNormal EnglishLanguage "An &%Attribute of an &%Electrocardiogram that measures
activity of the &%Heart and shows that it is within normal parameters.")
(termFormat EnglishLanguage EKGNormal "normal EKG")

(=>
  (and
    (instance ?EKG Electrocardiogram)
    (attribute ?EKG EKGNormal)
    (refers ?EKG ?H)
    (part ?H ?P)
    (instance ?H Heart))
  (modalAttribute
    (not
      (attribute ?P (ImpairedBodyPartFn Heart)))
    Likely))

(instance EKGAbnormal RelationalAttribute)
(documentation EKGAbnormal EnglishLanguage "An &%Attribute of an &%Electrocardiogram that measures
activity of the &%Heart and shows that it is outside of normal parameters.")
(termFormat EnglishLanguage EKGAbnormal "abnormal EKG")

(=>
  (and
    (instance ?EKG Electrocardiogram)
    (attribute ?EKG EKGAbnormal)
    (refers ?EKG ?H)
    (part ?H ?P)
    (instance ?H Heart))
  (modalAttribute
    (attribute ?P (ImpairedBodyPartFn Heart))
    Likely))

(subclass GERefluxDisease PathologicProcess)

(documentation GERefluxDisease EnglishLanguage "Gastroesophageal
reflux disease (GERD), is a chronic condition in which &%Stomach
contents rise up into the &%Esophagus, resulting in either symptoms or
complications. Symptoms include the taste of acid in the back of
the mouth, heartburn, bad breath, &%ChestPain, regurgitation, &%Breathing
problems, and wearing away of the &%Teeth. Complications include
esophagitis, esophageal stricture, and Barrett's esophagus. Risk
factors include obesity, pregnancy, smoking, hiatal hernia, and taking
certain medicines. Medications that may cause or worsen the disease
include &%Benzodiazepines, calcium channel blockers, tricyclic
&%Antidepressants, &%NSAIDs, certain &%Asthma medicine. Acid reflux is due
to poor closure of the lower esophageal sphincter, which is at the
junction between the stomach and the esophagus. Diagnosis among those
who do not improve with simpler measures may involve gastroscopy,
upper GI series, esophageal pH monitoring, or esophageal manometry.
Treatment options include lifestyle changes, medications, and
sometimes &%Surgery for those who do not improve with the first two
measures.[from Wikipedia]")
(termFormat EnglishLanguage GERefluxDisease "Gastroesophageal reflux disease")
(termFormat EnglishLanguage GERefluxDisease "GERD")

(=>
  (and
    (instance ?GERD GERefluxDisease)
    (experiencer ?GERD ?H))
  (exists (?T ?S ?E)
    (and
      (instance ?T Transfer)
      (origin ?T ?S)
      (instance ?S Stomach)
      (instance ?E Esophagus)
      (destination ?T ?E)
      (part ?S ?H)
      (part ?E ?H)
      (subProcess ?T ?GERD))))

(instance diseaseCandidate BinaryPredicate)
(domain diseaseCandidate 1 Human)
(domain diseaseCandidate 2 DiseaseOrSyndrome)
(documentation diseaseCandidate EnglishLanguage "A summary predicate for a modal statement.
This means that some &%Agent &%believes that a given &%Human may have a &%DiseaseOrSyndrome.")
(format EnglishLanguage diseaseCandidate "%1 may have %2")
(relatedInternalConcept diseaseCandidate pathologyCandidate)

(=>
  (diseaseCandidate ?H ?D)
  (exists (?DOC)
    (believes ?DOC
      (modalAttribute
        (attribute ?H ?D)
        Possibility))))

(instance pathologyCandidate BinaryPredicate)
(domain pathologyCandidate 1 Human)
(domainSubclass pathologyCandidate 2 PathologicProcess)
(documentation diseaseCandidate EnglishLanguage "A summary predicate for a modal statement.
This means that some &%Agent &%believes that a given &%Human may have a &%PathologicProcess.")
(format EnglishLanguage pathologyCandidate "%1 may have %2")

(=>
  (pathologyCandidate ?H ?D)
  (exists (?DOC ?DI)
    (and
      (instance ?DI ?D)
      (believes ?DOC
        (modalAttribute
          (experiencer ?D ?H)
          Possibility)))))

(subclass Cephalosporin Antibiotic)
(documentation Cephalosporin EnglishLanguage "The cephalosporins are a class of β-lactam
&%Antibiotics originally derived from the fungus Acremonium, which was previously known as
Cephalosporium.  Together with cephamycins, they constitute a subgroup of β-lactam
antibiotics called cephems. First-generation cephalosporins are active predominantly
against Gram-positive bacteria, such as &%Staphylococcus and &%Streptococcus. They are
therefore used mostly for &%Skin and soft &%Tissue &%InfectiousDiseases and the prevention of
hospital-acquired surgical infections.[from Wikipedia]")

(subclass Cefotetan Cephalosporin)
(documentation Cefotetan EnglishLanguage "Cefotetan is an injectable &%Antibiotic of the cephamycin
type for prophylaxis and treatment of bacterial infections. It is often grouped together with
second-generation &%Cephalosporins and has a similar antibacterial spectrum, but with additional
anti-anaerobe coverage.[from Wikipedia]")

(subclass Staphylococcus Bacterium)
(documentation Staphylococcus EnglishLanguage "Staphylococcus is a genus of Gram-positive bacteria in the family Staphylococcaceae from the order Bacillales. Under the microscope, they appear spherical (cocci), and form in grape-like clusters. Staphylococcus species are facultative anaerobic organisms (capable of growth both aerobically and anaerobically).
Staphylococcus was one of the leading infections in hospitals and many strains of this bacterium have become antibiotic resistant. Despite strong attempts to get rid of them, staph bacteria stay present in hospitals, where they can infect people who are most at risk of infection.[4]
Staphylococcus includes at least 43 species. Of these, nine have two subspecies, one has three subspecies, and one has four subspecies.[5] Many species cannot cause disease and reside normally on the skin and mucous membranes of humans and other animals. Staphylococcus species have been found to be nectar-inhabiting microbes.[6] They are also a small component of the soil microbiome.[7]")

(documentation MRSA EnglishLanguage "Methicillin-resistant Staphylococcus aureus (MRSA) is a group o
bacteria that are genetically distinct from other strains of &%Staphylococcus aureus. MRSA is
responsible for several difficult-to-treat infections in humans. It caused more than 100,000 deaths
attributable to antimicrobial resistance in 2019. MRSA is any strain of S. aureus that has developed
(through natural selection) or acquired (through horizontal gene transfer) a multiple drug resistance
to beta-lactam antibiotics.
MRSA is common in &%HospitalBuildings, &%Prisons, and nursing homes, where people with open wounds, invasive devices
such as catheters, and weakened immune systems are at greater risk of healthcare associated infection. MRSA
began as a hospital-acquired infection but has become community-acquired, as well as &%Livestock -acquired. The
terms HA-MRSA (healthcare-associated or hospital-acquired MRSA), CA-MRSA (community-associated MRSA), and
LA-MRSA (livestock-associated MRSA) reflect this.[from Wikipedia]")
(subclass MRSA Staphylococcus)

(subclass InfectionFn UnaryFunction)
(documentation InfectionFn EnglishLanguage "Denotes the &%InfectiousDisease caused by the given
&%Microorganism.")
(domainSubclass InfectionFn 1 Microorganism)
(range InfectionFn InfectiousDisease)

(=>
  (equal ?ID (InfectionFn ?M))
  (biologicalAgentCarrier ?ID ?M))

(=>
  (biologicalAgentCarrier ?ID ?M)
  (equal ?ID (InfectionFn ?M)))

(subclass JointPain (PainFn BodyJoint))
(documentation JointPain EnglishLanguage "&%Pain in a &$BodyJoint of
an &%Animal.")
(termFormat EnglishLanguage JointPain "joint pain")

(subclass ChestPain (PainFn Chest))
(documentation ChestPain EnglishLanguage "&%Pain in the &$Chest of
an &%Animal.")
(termFormat EnglishLanguage ChestPain "chest pain")

(subclass Anosmia (SenseImpairmentFn Smelling))
(documentation Anosmia EnglishLanguage "Loss of the sense of &%Smelling,
whether whole or partial.")
(termFormat EnglishLanguage Anosmia "anosmia")
(termFormat EnglishLanguage Anosmia "loss of smell")

(subclass Dysgeusia (SenseImpairmentFn Tasting))
(documentation Dysgeusia EnglishLanguage "Loss of the sense of &%Tasting,
whether whole or partial.")
(termFormat EnglishLanguage Dysgeusia "dysgeusia")
(termFormat EnglishLanguage Dysgeusia "loss of taste")

(subclass MemoryLoss (ImpairmentFn Remembering))
(documentation MemoryLoss EnglishLanguage "Difficulty &%Rembering.")
(termFormat EnglishLanguage MemoryLoss "memory loss")

(subclass BreathingDifficulty (ImpairmentFn Breathing))
(documentation BreathingDifficulty EnglishLanguage "Difficulty &%Breathing.")
(termFormat EnglishLanguage BreathingDifficulty "breathing difficulty")

(subclass ThinkingDifficulty (ImpairmentFn PsychologicalProcess))
(documentation ThinkingDifficulty EnglishLanguage "Difficulty in one or
more &%PsychologicalProcesses.")
(termFormat EnglishLanguage ThinkingDifficulty "thinking difficulty")
(termFormat EnglishLanguage ThinkingDifficulty "brain fog")

(subclass HeartPalpitations PathologicProcess)
(documentation HeartPalpitations EnglishLanguage "Palpitations are
perceived abnormalities of the heartbeat characterized by awareness of
cardiac muscle contractions in the chest, which is further
characterized by the hard, fast and/or irregular beatings of the
heart. Symptoms include a rapid pulsation, an abnormally rapid or
irregular beating of the heart. Palpitations are a sensory symptom and
are often described as a skipped beat, rapid fluttering in the chest,
pounding sensation in the chest or neck, or a flip-flopping in the
chest.[from Wikipedia]")
(termFormat EnglishLanguage HeartPalpitations "heart palpitations")
(termFormat EnglishLanguage HeartPalpitations "palpitations")

(=>
  (and
    (instance ?P HeartPalpitations)
    (experiencer ?P ?H)
    (instance ?HEART Heart)
    (part ?HEART ?H))
  (exists (?PER)
    (and
      (instance ?PER Perception)
      (experiencer ?PER ?H)
      (patient ?PER ?HEART))))

(=>
  (and
    (instance ?P HeartPalpitations)
    (experiencer ?P ?H))
  (exists (?HEART)
    (and
      (instance ?HEART Heart)
      (part ?HEART ?H)
      (located ?P ?HEART))))

(instance Insomnia DiseaseOrSyndrome)

(documentation Insomnia EnglishLanguage "Insomnia, also known as
sleeplessness, is a sleep disorder in which people have trouble
sleeping. They may have difficulty falling asleep, or staying
asleep as long as desired. Insomnia is typically followed by
daytime sleepiness, low energy, irritability, and a depressed mood.
It may result in an increased risk of motor vehicle collisions, as
well as problems focusing and learning. Insomnia can be short term,
lasting for days or weeks, or long term, lasting more than a
month.[from Wikipedia]")
(termFormat EnglishLanguage Insomnia "insomnia")

(=>
  (holdsDuring ?T
    (attribute ?H Insomnia))
  (holdsDuring ?T
    (and
      (desires ?H
        (attribute ?H Asleep))
      (not
        (attribute ?H Asleep)))))

(=>
  (holdsDuring ?T
    (attribute ?H Insomnia))
  (exists (?I)
    (and
      (instance ?I
        (ImpairmentFn Sleeping))
      (experiencer ?I ?H)
      (equal ?T
        (WhenFn ?I)))))

(subclass GastroIntestinalIssue (ImpairmentFn Digesting))
(documentation GastroIntestinalIssue EnglishLanguage "Difficulty with
&%Digesting.")
(termFormat EnglishLanguage GastroIntestinalIssue "gastro-intestinal issue")

(subclass Diabetes DiseaseOrSyndrome)

(documentation Diabetes EnglishLanguage "Diabetes mellitus (DM),
commonly known as just diabetes, is a group of metabolic disorders
characterized by a high blood sugar level over a prolonged period of
time. Symptoms often include frequent urination, increased thirst
and increased appetite. If left untreated, diabetes can cause many
health complications. Acute complications can include diabetic
ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious
long-term complications include cardiovascular disease, stroke,
chronic kidney disease, foot ulcers, damage to the nerves, damage to
the eyes and cognitive impairment.[from Wikipedia]")
(termFormat EnglishLanguage Diabetes "diabetes")
(termFormat EnglishLanguage Diabetes "diabetes mellitus")

(instance DiabetesType1 Diabetes)
(documentation DiabetesType1 EnglishLanguage "Type 1 diabetes results
from failure of the pancreas to produce enough insulin due to loss of
beta cells. This form was previously referred to as
'insulin-dependent diabetes mellitus' (IDDM) or 'juvenile
diabetes'. The loss of beta cells is caused by an autoimmune
response. The cause of this autoimmune response is unknown.[from
Wikipedia]")
(termFormat EnglishLanguage DiabetesType1 "type 1 diabetes")
(termFormat EnglishLanguage DiabetesType1 "insulin-dependent diabetes mellitus")
(termFormat EnglishLanguage DiabetesType1 "IDDM")
(termFormat EnglishLanguage DiabetesType1 "juvenile diabetes")

(=>
  (attribute ?H DiabetesType1)
  (exists (?A)
    (and
      (instance ?A AutoImmuneDisorder)
      (experiencer ?A ?H))))

(=>
  (attribute ?H DiabetesType1)
  (exists (?I)
    (and
      (instance ?I Insulin)
      (lacks ?H ?I))))

(instance DiabetesType2 Diabetes)
(documentation DiabetesType2 EnglishLanguage "Type 2 diabetes begins
with insulin resistance, a condition in which cells fail to respond to
insulin properly. As the disease progresses, a lack of insulin may
also develop. This form was previously referred to as 'non
insulin-dependent diabetes mellitus' (NIDDM) or 'adult-onset
diabetes'. The most common cause is a combination of excessive body
weight and insufficient exercise.[from Wikipedia]")
(termFormat EnglishLanguage DiabetesType2 "non-insulin-dependent diabetes mellitus")
(termFormat EnglishLanguage DiabetesType2 "NIDDM")
(termFormat EnglishLanguage DiabetesType2 "non-juvenile diabetes")
(termFormat EnglishLanguage DiabetesType2 "adult onset diabetes")

(instance DiabetesGestational Diabetes)
(documentation DiabetesGestational EnglishLanguage "Diabetes mellitus (DM),
commonly known as just diabetes, is a group of metabolic disorders
characterized by a high blood sugar level over a prolonged period of
time. Symptoms often include frequent urination, increased thirst
and increased appetite. If left untreated, diabetes can cause many
health complications. Acute complications can include diabetic
ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious
long-term complications include cardiovascular disease, stroke,
chronic kidney disease, foot ulcers, damage to the nerves, damage to
the eyes and cognitive impairment.[from Wikipedia]")

(=>
  (holdsDuring ?T
    (attribute ?H DiabetesGestational))
  (holdsDuring ?T
    (attribute ?H Pregnant)))

(subclass AutoImmuneDisorder PathologicProcess)
(documentation AutoImmuneDisorder EnglishLanguage "A condition in which
the immune system attacks healthy parts of the body in error.")
(termFormat EnglishLanguage AutoImmuneDisorder "auto-immune disorder")
(termFormat EnglishLanguage AutoImmuneDisorder "auto-immune disease")

(=>
  (and
    (instance ?AI AutoImmuneDisorder)
    (experiencer ?AI ?H))
  (exists (?A ?D ?C)
    (and
      (instance ?A Antibody)
      (part ?A ?H)
      (instance ?C Cell)
      (part ?C ?H)
      (instance ?D Destruction)
      (instrument ?D ?A)
      (not
        (desires ?H
          (and
            (instance ?D Destruction)
            (instrument ?D ?A)))))))

(subclass Arthritis (PainFn BodyJoint))
(documentation Arthritis EnglishLanguage "&%Pain in the joints that
may be cause either by degeneration of the joints with age, or an
&%AutoImmuneDisorder.")
(termFormat EnglishLanguage Arthritis "arthritis")

(subclass RheumatoidArthritis AutoImmuneDisorder)
(subclass RheumatoidArthritis Arthritis)
(documentation RheumatoidArthritis EnglishLanguage "An &%AutoImmuneDisorder in which
the immune system attacks the joints. ")
(termFormat EnglishLanguage RheumatoidArthritis "rheumatoid arthritis")

(=>
  (and
    (instance ?A RheumatoidArthritis)
    (experiencer ?A ?H))
  (modalAttribute
    (exists (?JP)
      (and
        (instance ?JP JointPain)
        (causes ?A ?JP)))
    Likely))

(subclass Psoriasis AutoImmuneDisorder)
(subclass Psoriasis SkinRash)
(documentation Psoriasis EnglishLanguage "A &%SkinRash that is an
&%AutoImmuneDisorder.")
(termFormat EnglishLanguage Psoriasis "psoriasis")

(subclass MultipleSclerosis AutoImmuneDisorder)
(termFormat EnglishLanguage MultipleSclerosis "multiple sclerosis")
(termFormat EnglishLanguage MultipleSclerosis "MS")

(=>
  (and
    (instance ?MS MultipleSclerosis)
    (experiencer ?MS ?H))
  (attribute ?H
    (ImpairedBodyPartFn NervousSystem)))

(subclass Lupus AutoImmuneDisorder)
(documentation Lupus EnglishLanguage "An &%AutoImmuneDisorder that often
causes a &%SkinRash but can also cause problems in the &%BodyJoints,
&%Heart, &%Brain and &%Kidneys.")
(termFormat EnglishLanguage Lupus "systemic lupus erythematosus")
(termFormat EnglishLanguage Lupus "lupus")

(=>
  (and
    (instance ?L Lupus)
    (experiencer ?L ?H))
  (modalAttribute
    (exists (?SR)
      (and
        (instance ?SR SkinRash)
        (experiencer ?SR ?H)))
    Likely))

(subclass InflammatoryBowelDisease AutoImmuneDisorder)
(documentation InflammatoryBowelDisease EnglishLanguage "An
&%AutoImmuneDisorder that affects the gastrointestinal tract. It
primarily inflames the lining of the intestinal wall.")
(termFormat EnglishLanguage InflammatoryBowelDisease "inflammatory bowel disease")

(=>
  (and
    (instance ?IBD InflammatoryBowelDisease)
    (experiencer ?IBD ?H))
  (attribute ?H
    (ImpairedBodyPartFn GastroIntestinalTract)))

(subclass CrohnsDisease InflammatoryBowelDisease)
(documentation CrohnsDisease EnglishLanguage "An
&%AutoImmuneDisorder that affects the gastrointestinal tract. It
primarily inflames the small intestine and colon.")
(termFormat EnglishLanguage CrohnsDisease "Crohn's disease")

(subclass UlcerativeColitis InflammatoryBowelDisease)
(documentation UlcerativeColitis EnglishLanguage "An
&%AutoImmuneDisorder that affects the gastrointestinal tract. It
primarily inflames the lining of the intestinal wall.")
(termFormat EnglishLanguage UlcerativeColitis "ulcerative colitis")

(=>
  (and
    (instance ?IBD UlcerativeColitis)
    (experiencer ?IBD ?H))
  (or
    (attribute ?H
      (ImpairedBodyPartFn LargeIntestine))
    (attribute ?H
      (ImpairedBodyPartFn Rectum))))

(subclass AddisonsDisease AutoImmuneDisorder)
(documentation AddisonsDisease EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%AdrenalGlands.")
(termFormat EnglishLanguage AddisonsDisease "Addison's disease")

(=>
  (and
    (instance ?IBD AddisonsDisease)
    (experiencer ?IBD ?H))
  (attribute ?H
    (ImpairedBodyPartFn AdrenalGland)))

(subclass GravesDisease AutoImmuneDisorder)
(documentation GravesDisease EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%Thyroid, causing it to
produce too much of its hormones.")
(termFormat EnglishLanguage GravesDisease "Graves' disease")

(=>
  (and
    (instance ?IBD GravesDisease)
    (experiencer ?IBD ?H))
  (attribute ?H
    (ImpairedBodyPartFn ThyroidGland)))

(=>
  (and
    (instance ?IBD GravesDisease)
    (experiencer ?IBD ?H1)
    (instance ?H1 Human)
    (instance ?T1 ThyroidHormone)
    (part ?T1 ?H1)
    (measure ?T1
      (MeasureFn ?N1 ?U))
    (instance ?H2 Human)
    (instance ?T2 ThyroidHormone)
    (part ?T2 ?H2)
    (measure ?T2
      (MeasureFn ?N2 ?U))
    (attribute ?H2 Healthy))
  (greaterThan ?N1 ?N2))

(subclass SjogrensSyndrome AutoImmuneDisorder)
(documentation SjogrensSyndrome EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%Glands provding moisture to the &%Mouth
and &%Eye.")
(termFormat EnglishLanguage SjogrensSyndrome "Sjogrens syndrome")

(=>
  (and
    (instance ?SS SjogrensSyndrome)
    (experiencer ?SS ?H))
  (or
    (attribute ?H
      (ImpairedBodyPartFn SalivaryGland))
    (attribute ?H
      (ImpairedBodyPartFn TearGland))))

(subclass HashimotosThyroiditis AutoImmuneDisorder)
(documentation HashimotosThyroiditis EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%Thyroid, causing it to
produce too little of its hormones.")
(termFormat EnglishLanguage HashimotosThyroiditis "Hashimoto's thyroiditis")

(=>
  (and
    (instance ?IBD HashimotosThyroiditis)
    (experiencer ?IBD ?H))
  (attribute ?H
    (ImpairedBodyPartFn ThyroidGland)))

(=>
  (and
    (instance ?IBD HashimotosThyroiditis)
    (experiencer ?IBD ?H1)
    (instance ?H1 Human)
    (instance ?T1 ThyroidHormone)
    (part ?T1 ?H1)
    (measure ?T1
      (MeasureFn ?N1 ?U))
    (instance ?H2 Human)
    (instance ?T2 ThyroidHormone)
    (part ?T2 ?H2)
    (measure ?T2
      (MeasureFn ?N2 ?U))
    (attribute ?H2 Healthy))
  (greaterThan ?N2 ?N1))

(subclass MyastheniaGravis AutoImmuneDisorder)
(documentation MyastheniaGravis EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%Nerves, most
often in the face and throat, resulting in weakness of
the &%Muscles.")
(termFormat EnglishLanguage MyastheniaGravis "myasthenia gravis")

(=>
  (and
    (instance ?SS MyastheniaGravis)
    (experiencer ?SS ?H))
  (attribute ?H
    (ImpairedBodyPartFn NerveCell)))

(subclass AutoimmuneVasculitis AutoImmuneDisorder)
(documentation AutoimmuneVasculitis EnglishLanguage "An
&%AutoImmuneDisorder that affects the &%BloodVessels.")
(termFormat EnglishLanguage AutoimmuneVasculitis "autoimmune vasculitis")

(=>
  (and
    (instance ?SS AutoimmuneVasculitis)
    (experiencer ?SS ?H))
  (attribute ?H
    (ImpairedBodyPartFn BloodVessel)))

(=>
  (and
    (instance ?SS AutoimmuneVasculitis)
    (experiencer ?SS ?H))
  (exists (?B ?I)
    (and
      (instance ?B BloodVessel)
      (part ?B ?H)
      (instance ?I Inflammation)
      (patient ?I ?B))))

(subclass VitaminA Vitamin)
(documentation VitaminA EnglishLanguage "Vitamin A is a group of
unsaturated nutritional organic compounds that includes retinol,
retinal, and several provitamin A carotenoids (most notably
beta-carotene). Vitamin A has multiple functions: it is
important for growth and development, for the maintenance of the
immune system, and for good vision. Vitamin A is needed by the
retina of the eye in the form of retinal, which combines with protein
opsin to form rhodopsin, the light-absorbing molecule necessary for
both low-light (scotopic vision) and color vision.[from Wikipedia]")
(termFormat EnglishLanguage VitaminA "vitamin A")

(subclass VitaminBComplex Vitamin)
(termFormat EnglishLanguage VitaminBComplex "vitamin B complex")
(termFormat EnglishLanguage VitaminBComplex "B complex vitamin")

(subclass VitaminB1 VitaminBComplex)
(documentation VitaminB1 EnglishLanguage "Thiamine, also known as
thiamin or vitamin B1, is a vitamin found in food and manufactured as
a dietary supplement and medication. Food sources of thiamine
include whole grains, legumes, and some meats and fish. Grain
processing removes much of the thiamine content, so in many countries
cereals and flours are enriched with thiamine. Supplements and
medications are available to treat and prevent thiamine deficiency and
disorders that result from it, including beriberi and Wernicke
encephalopathy. Other uses include the treatment of maple syrup
urine disease and Leigh syndrome. They are typically taken by
mouth, but may also be given by intravenous or intramuscular
injection.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB1 "vitamin B1")
(termFormat EnglishLanguage VitaminB1 "thiamine")

(instance Beriberi DiseaseOrSyndrome)
(diseaseMedicine Beriberi VitaminB1 Ingesting)

(subclass VitaminB2 VitaminBComplex)
(documentation VitaminB2 EnglishLanguage "Riboflavin, also known as
vitamin B2, is a vitamin found in food and used as a dietary
supplement. It is required by the body for cellular
respiration. Food sources include eggs, green vegetables, milk and
other dairy products, meat, mushrooms, and almonds. Some countries
require its addition to grains. As a supplement it is used to
prevent and treat riboflavin deficiency. At amounts far in excess of
what is needed to meet dietary needs as a nutrient, riboflavin may
prevent migraines. Riboflavin may be given by mouth or
injection. It is nearly always well tolerated. Normal doses are
safe during pregnancy.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB2 "vitamin B2")
(termFormat EnglishLanguage VitaminB2 "riboflavin")

(subclass VitaminB3 VitaminBComplex)
(documentation VitaminB3 EnglishLanguage "Niacin, also known as
nicotinic acid, is an organic compound and a form of vitamin B3, an
essential human nutrient. It can be manufactured by plants and
animals from the amino acid tryptophan. Niacin is obtained in the
diet from a variety of whole and processed foods, with highest
contents in fortified packaged foods, meat, poultry, red fish such as
tuna and salmon, lesser amounts in nuts, legumes and seeds.
Niacin as a dietary supplement is used to treat pellagra, a disease
caused by niacin deficiency. Signs and symptoms of pellagra include
skin and mouth lesions, anemia, headaches, and tiredness. Many
countries mandate its addition to wheat flour or other food grains,
thereby reducing the risk of pellagra.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB3 "vitamin B3")
(termFormat EnglishLanguage VitaminB3 "niacin")

(subclass Pellagra DiseaseOrSyndrome)
(documentation Pellagra EnglishLanguage "Pellagra is a disease caused
by a lack of the vitamin niacin (vitamin B3). Symptoms include
inflamed skin, diarrhea, dementia, and sores in the mouth. Areas of
the skin exposed to either sunlight or friction are typically affected
first. Over time affected skin may become darker, stiffen, peel, or
bleed. There are two main types of pellagra, primary and
secondary. Primary pellagra is due to a diet that does not contain
enough niacin and tryptophan. Secondary pellagra is due to a poor
ability to use the niacin within the diet. This can occur as a
result of alcoholism, long-term diarrhea, carcinoid syndrome, Hartnup
disease, and a number of medications such as isoniazid. Diagnosis
is typically based on symptoms and may be assisted by urine
testing. Treatment is with either niacin or nicotinamide
supplementation. Improvements typically begin within a couple of
days. General improvements in diet are also frequently
recommended. Decreasing sun exposure via sunscreen and proper
clothing is important while the skin heals. Without treatment death
may occur. The disease occurs most commonly in the developing
world, specifically sub-Saharan Africa.[from Wikipedia]")
(diseaseMedicine Pellagra VitaminB3 Ingesting)
(termFormat EnglishLanguage Pellagra "pellagra")

(subclass VitaminB5 VitaminBComplex)
(documentation VitaminB5 EnglishLanguage "Pantothenic acid, also
called vitamin B5 is a water-soluble B vitamin and therefore an
essential nutrient. All animals require pantothenic acid in order
to synthesize coenzyme A (CoA) – essential for fatty acid metabolism –
as well as to, in general, synthesize and metabolize proteins,
carbohydrates, and fats. Pantothenic acid is the combination of
pantoic acid and β-alanine. Its name derives from the Greek pantos,
meaning 'from everywhere', as minimally, at least small quantities of
pantothenic acid are found in nearly every food. Human
deficiency is very rare. As a dietary supplement or animal feed
ingredient, the form commonly used is calcium pantothenate because of
chemical stability, and hence long product shelf life, compared to
sodium pantothenate or free pantothenic acid.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB5 "vitamin B5")
(termFormat EnglishLanguage VitaminB5 "pantothenic acid")

(subclass VitaminB6 VitaminBComplex)
(documentation VitaminB6 EnglishLanguage "Pyridoxine, also known as
vitamin B6, is a form of vitamin B6 found commonly in food and used as
a dietary supplement. As a supplement it is used to treat and prevent
pyridoxine deficiency, sideroblastic anaemia, pyridoxine-dependent
epilepsy, certain metabolic disorders, side effects or complications
of isoniazid use, and certain types of mushroom poisoning. It is
used by mouth or by injection. It is usually well tolerated.
Occasionally side effects include headache, numbness, and
sleepiness. Normal doses are safe during pregnancy and
breastfeeding. Pyridoxine is in the vitamin B family of
vitamins. It is required by the body to metabolise amino acids,
carbohydrates, and lipids. Sources in the diet include fruit,
vegetables, and grain.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB6 "vitamin B6")
(termFormat EnglishLanguage VitaminB6 "pyridoxine")

(subclass VitaminB7 VitaminBComplex)
(documentation VitaminB7 EnglishLanguage "Biotin, also called vitamin
B7, is one of the B vitamins. It is involved in a wide range
of metabolic processes, both in humans and in other organisms,
primarily related to the utilization of fats, carbohydrates, and amino
acids. The name biotin derives from the Greek word “bios” (to live)
and the suffix “-in” (a general chemical suffix used in organic
chemistry).[from Wikipedia]")
(termFormat EnglishLanguage VitaminB7 "vitamin B7")
(termFormat EnglishLanguage VitaminB7 "biotin")

(subclass VitaminB9 VitaminBComplex)
(documentation VitaminB9 EnglishLanguage "Folate, also known as
vitamin B9 and folacin, is one of the B vitamins. Manufactured
folic acid, which is converted into folate by the body, is used as a
dietary supplement and in food fortification as it is more stable
during processing and storage. Folate is required for the body to
make DNA and RNA and metabolise amino acids necessary for cell
division. As humans cannot make folate, it is required in the
diet, making it an essential nutrient. It occurs naturally in many
foods. The recommended adult daily intake of folate in the U.S.
is 400 micrograms from foods or dietary supplements. Folate in the
form of folic acid is used to treat anemia caused by folate
deficiency. Folic acid is also used as a supplement by women during
pregnancy to reduce the risk of neural tube defects (NTDs) in the
baby. Low levels in early pregnancy are believed to be the
cause of more than half of babies born with NTDs. More than 80
countries use either mandatory or voluntary fortification of certain
foods with folic acid as a measure to decrease the rate of NTDs.
Long-term supplementation with relatively large amounts of folic acid
is associated with small reduction in the risk of stroke and an
increased risk of prostate cancer. There are concerns that large
amounts of supplemental folic acid can hide &%VitaminB12
deficiency.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB9 "vitamin B9")
(termFormat EnglishLanguage VitaminB9 "folate")
(termFormat EnglishLanguage VitaminB9 "folacin")


(subclass VitaminB12 VitaminBComplex)
(documentation VitaminB12 EnglishLanguage "Vitamin B12, also known as
cobalamin, is a water-soluble vitamin involved in metabolism. It
is one of eight B vitamins. It is a cofactor in DNA synthesis, in both
fatty acid and amino acid metabolism. It is important in the normal
functioning of the nervous system via its role in the synthesis of
myelin, and in the maturation of red blood cells in the bone
marrow.[from Wikipedia]")
(termFormat EnglishLanguage VitaminB12 "vitamin B12")
(termFormat EnglishLanguage VitaminB12 "B12 vitamin")
(termFormat EnglishLanguage VitaminB12 "cobalamin")

(subclass VitaminC Vitamin)
(documentation VitaminC EnglishLanguage "Vitamin C (also known as
ascorbic acid and ascorbate) is a vitamin found in various foods and
sold as a dietary supplement. It is used to prevent and treat
scurvy. Vitamin C is an essential nutrient involved in the repair
of tissue and the enzymatic production of certain
neurotransmitters. It is required for the functioning of
several enzymes and is important for immune system function.
It also functions as an antioxidant. Most animals are able to
synthesize their own vitamin C, although humans, the other great and
lesser apes, monkeys (but not all primates), most bats, some rodents,
and certain other animals must acquire it from dietary sources.[from
Wikipedia]")
(termFormat EnglishLanguage VitaminC "vitamin C")
(termFormat EnglishLanguage VitaminC "ascorbic acid")

(subclass Scurvy DiseaseOrSyndrome)
(diseaseMedicine Scurvy VitaminC Ingesting)

(subclass VitaminD Vitamin)
(documentation VitaminD EnglishLanguage "Vitamin D is a group of
fat-soluble secosteroids responsible for increasing intestinal
absorption of calcium, magnesium, and phosphate, and many other
biological effects. In humans, the most important compounds in
this group are vitamin D3 (also known as cholecalciferol) and vitamin
D2 (ergocalciferol). The major natural source of the vitamin
is synthesis of cholecalciferol in the lower layers of skin epidermis
through a chemical reaction that is dependent on sun exposure
(specifically UVB radiation). Cholecalciferol and ergocalciferol
can be ingested from the diet and from supplements. Only a few
foods, such as the flesh of fatty fish, naturally contain significant
amounts of vitamin D. In the U.S. and other countries, cow's
milk and plant-derived milk substitutes are fortified with vitamin D,
as are many breakfast cereals. Mushrooms exposed to ultraviolet light
contribute useful amounts of vitamin D Dietary recommendations
typically assume that all of a person's vitamin D is taken by mouth,
as sun exposure in the population is variable and recommendations
about the amount of sun exposure that is safe are uncertain in view of
the skin cancer risk.[from Wikipedia]")
(termFormat EnglishLanguage VitaminD "vitamin D")
(termFormat EnglishLanguage VitaminD "calciferol")

(subclass Rickets DiseaseOrSyndrome)
(diseaseMedicine Rickets VitaminD Ingesting)

(subclass VitaminE Vitamin)
(documentation VitaminE EnglishLanguage "Vitamin E is a group of eight
fat soluble compounds that include four tocopherols and four
tocotrienols. Vitamin E deficiency, which is rare and usually
due to an underlying problem with digesting dietary fat rather than
from a diet low in vitamin E, can cause nerve problems. Vitamin
E is a fat-soluble antioxidant protecting cell membranes from reactive
oxygen species. [from Wikipedia]")
(termFormat EnglishLanguage VitaminE "vitamin E")

(subclass VitaminK Vitamin)
(documentation VitaminK EnglishLanguage "Vitamin K refers to
structurally similar, fat-soluble vitamers found in foods and marketed
as dietary supplements. The human body requires vitamin K for
post-synthesis modification of certain proteins that are required for
blood coagulation (K from koagulation, Danish for 'coagulation') or
for controlling binding of calcium in bones and other tissues. The
complete synthesis involves final modification of these so-called 'Gla
proteins' by the enzyme gamma-glutamyl carboxylase that uses vitamin K
as a cofactor. The presence of uncarboxylated proteins indicates a
vitamin K deficiency. Carboxylation allows them to bind (chelate)
calcium ions, which they cannot do otherwise. Without vitamin K,
blood coagulation is seriously impaired, and uncontrolled bleeding
occurs. Research suggests that deficiency of vitamin K may also weaken
bones, potentially contributing to osteoporosis, and may promote
calcification of arteries and other soft tissues.[from Wikipedia]")
(termFormat EnglishLanguage VitaminK "vitamin K")


(subclass PerniciousAnemia AutoImmuneDisorder)
(documentation PerniciousAnemia EnglishLanguage "Pernicious anemia
(PA) is a disease in which not enough red blood cells
are produced due to a deficiency of vitamin B12. The most common
initial symptom is feeling tired. Other symptoms may include
shortness of breath, pale skin, chest pain, numbness in the hands and
feet, poor balance, a smooth red tongue, poor reflexes, depression and
confusion. Without treatment some of these problems may become
permanent. [from Wikipedia].")
(termFormat EnglishLanguage PerniciousAnemia "pernicious anemia")

(=>
  (and
    (instance ?P PerniciousAnemia)
    (experiencer ?P ?H1)
    (amount VitaminB12 ?H1 (MeasureFn ?N1 ?U))
    (amount VitaminB12 ?H2 (MeasureFn ?N2 ?U))
    (attribute ?H2 Healthy)
    (not
      (equal ?H1 ?H2)))
  (greaterThan ?N2 ?N1))

(subclass CeliacDisease AutoImmuneDisorder)

(documentation CeliacDisease EnglishLanguage "Coeliac disease or
celiac disease is a long-term &%AutoImmuneDisorder that primarily
affects the &%SmallIntestine. Classic symptoms include gastrointestinal
problems such as chronic &%Diarrhoea, abdominal distention,
malabsorption, loss of appetite, and among children failure to grow
normally. This often begins between six months and two years of age.
Non-classic symptoms are more common, especially in people older than
two years. There may be mild or absent gastrointestinal symptoms, a
wide number of symptoms involving any part of the body, or no obvious
symptoms. Coeliac disease was first described in childhood; however,
it may develop at any age. It is associated with other autoimmune
diseases, such as &%DiabetesType1 and &%HashimotosThyroiditis, among
others. [from Wikipedia].")

(termFormat EnglishLanguage CeliacDisease "celiac disease")
(termFormat EnglishLanguage CeliacDisease "coeliac disease")

(=>
  (and
    (instance ?P CeliacDisease)
    (experiencer ?P ?H1)
    (instance ?SI SmallIntestine)
    (part ?SI ?H1))
  (modalAttribute
    (located ?P ?SI)
    Likely))

(=>
  (and
    (instance ?P CeliacDisease)
    (experiencer ?P ?H1)
    (instance ?SI SmallIntestine)
    (part ?SI ?H1))
  (modalAttribute
    (exists (?D)
      (and
        (instance ?D Diarrhoea)
        (experiencer ?D ?H1)
        (causes ?P ?D)))
    Likely))


(subclass AntibodyCOVIDTest MeasuringDevice)

(documentation AntibodyCOVIDTest EnglishLanguage "An antigen is the
part of a pathogen that elicits an immune response. Antigen tests look
for antigen proteins from the viral surface. In the case of a
coronavirus, these are usually proteins from the surface spikes.
SARS-CoV-2 antigens can be detected before onset of COVID-19 symptoms
(as soon as SARS-CoV-2 virus particles) with more rapid test results,
but with less sensitivity than PCR tests for the virus.[from
Wikipedia]")
(termFormat EnglishLanguage AntibodyCOVIDTest "antibody COVID test")
(termFormat EnglishLanguage AntibodyCOVIDTest "antigen COVID test")

(=>
  (and
    (instance ?A AntibodyCOVIDTest)
    (instrument ?M ?A)
    (instance ?M Measuring)
    (patient ?M ?H)
    (instance ?CA COVIDAntibody)
    (part ?CA ?H))
  (modalAttribute
    (knows ?H
      (exists (?CA)
        (and
          (instance ?CA COVIDAntibody)
          (part ?CA ?H))))
    Likely))

(subclass COVIDAntibody Antibody)
(documentation COVIDAntibody EnglishLanguage "An &%Antibody that
the body produces to combat &%Covid19.")
(termFormat EnglishLanguage COVIDAntibody "COVID antibody")

(=>
  (and
    (instance ?CA COVIDAntibody)
    (holdsDuring ?T
      (and
        (not
          (attribute ?H Covid19))
        (part ?CA ?H))))
  (holdsDuring
    (ImmediateFutureFn ?T)
    (modalAttribute
      (attribute ?H Covid19)
      Unlikely)))

(=>
  (holdsDuring ?T
    (attribute ?H Covid19))
  (modalAttribute
    (holdsDuring
      (ImmediateFutureFn ?T)
      (and
        (instance ?CA COVIDAntibody)
        (part ?CA ?H)))
    Likely))

(subclass Tachycardia OrganOrTissueProcess)
(termFormat EnglishLanguage Tachycardia "tachycardia")
(termFormat EnglishLanguage Tachycardia "tachyarrhythmia")
(documentation Tachycardia EnglishLanguage "Tachycardia, also called
tachyarrhythmia, is a heart rate that exceeds the normal resting
rate. In general, a resting heart rate over 100 beats per minute is
accepted as tachycardia in adults. Heart rates above the resting
rate may be normal (such as with exercise) or abnormal (such as with
electrical problems within the heart). [from Wikipedia]")

(=>
  (and
    (instance ?T Tachycardia)
    (experiencer ?T ?P)
    (instance ?H Heart)
    (part ?H ?P)
    (instance ?I Minute)
    (heartRate ?H ?I ?N))
  (greaterThan ?N 100))

(subclass Bradycardia OrganOrTissueProcess)
(termFormat EnglishLanguage Bradycardia "Bradycardia")

(documentation Bradycardia EnglishLanguage "Bradycardia is a condition
typically defined wherein an individual has a resting heart rate of
under 60 beats per minute (BPM) in adults, although some studies use a
heart rate of less than 50 BPM. Bradycardia typically does not
cause symptoms until the rate drops below 40 bpm. When symptomatic, it
may cause fatigue, weakness, dizziness, sweating, and at very low
rates, fainting. During sleep, a slow heartbeat with rates around
40–50 BPM is common, and is considered normal.[citation needed] Highly
trained athletes may also have athletic heart syndrome, a very slow
resting heart rate that occurs as a sport adaptation and helps prevent
tachycardia during training. The term 'relative bradycardia' is
used to refer to a heart rate that, although not actually below 60
BPM, is still considered too slow for the individual's current medical
condition. [from Wikipedia]")

(=>
  (and
    (instance ?T Bradycardia)
    (experiencer ?T ?P)
    (instance ?H Heart)
    (part ?H ?P)
    (instance ?I Minute)
    (heartRate ?H ?I ?N))
  (greaterThan 50 ?N))

(documentation LeftArm EnglishLanguage "The &%Left &%Arm of an &%Animal.")
(subclass LeftArm (BodySideFn Left Arm))
(termFormat EnglishLanguage LeftArm "left arm")

(subclass RightArm (BodySideFn Right Arm))
(termFormat EnglishLanguage RightArm "right arm")

(subclass LeftElbow (BodySideFn Left Elbow))
(termFormat EnglishLanguage LeftElbow  "left elbow")

(subclass RightElbow (BodySideFn Right Elbow))
(termFormat EnglishLanguage RightElbow "right elbow")

(subclass LeftShoulder (BodySideFn Left Shoulder))
(termFormat EnglishLanguage LeftShoulder "left shoulder")

(subclass RightElbow (BodySideFn Right Shoulder))
(termFormat EnglishLanguage RightShoulder "right shoulder")

(subclass LeftEar (BodySideFn Left Ear))
(termFormat EnglishLanguage LeftEar "left ear")

(subclass RightEar (BodySideFn Right Ear))
(termFormat EnglishLanguage RightEar "right ear")

(subclass LeftEye (BodySideFn Left Eye))
(termFormat EnglishLanguage LeftEye "left eye")

(subclass RightEye (BodySideFn Right Eye))
(termFormat EnglishLanguage RightEye "right eye")

(subclass LeftHand (BodySideFn Left Hand))
(termFormat EnglishLanguage LeftHand "left hand")

(subclass RightHand (BodySideFn Right Hand))
(termFormat EnglishLanguage RightHand "right hand")

(subclass LeftLung (BodySideFn Left Lung))
(termFormat EnglishLanguage LeftLung "left lung")

(subclass RightLung (BodySideFn Right Lung))
(termFormat EnglishLanguage RightLung "right lung")

(subclass LeftKidney (BodySideFn Left Kidney))
(termFormat EnglishLanguage LeftKidney "left kidney")

(subclass RightKidney (BodySideFn Right Kidney))
(termFormat EnglishLanguage RightKidney "right kidney")

(subclass LeftLeg (BodySideFn Left Leg))
(termFormat EnglishLanguage LeftLeg "left leg")

(subclass RightLeg (BodySideFn Right Leg))
(termFormat EnglishLanguage RightLeg "right leg")

(subclass LeftKnee (BodySideFn Left Knee))
(termFormat EnglishLanguage LeftKnee "left knee")

(subclass RightKnee (BodySideFn Right Knee))
(termFormat EnglishLanguage RightKnee "right knee")

(subclass LeftHip (BodySideFn Left Hip))
(termFormat EnglishLanguage LeftHip "left hip")

(subclass RightHip (BodySideFn Right Hip))
(termFormat EnglishLanguage RightHip "right hip")

(subclass LeftFoot (BodySideFn Left Foot))
(termFormat EnglishLanguage LeftFoot "left foot")

(subclass RightFoot (BodySideFn Right Foot))
(termFormat EnglishLanguage RightFoot "right foot")

(subclass LeftThigh (BodyAreaFn (BodySideFn Left ThighMuscle)))
(termFormat EnglishLanguage LeftThigh "left thigh")

(subclass RightThigh (BodyAreaFn (BodySideFn Right ThighMuscle)))
(termFormat EnglishLanguage RightThigh "right thigh")

(instance Pfizer Corporation)
(termFormat EnglishLanguage Pfizer "Pfizer")

(instance Moderna Corporation)
(termFormat EnglishLanguage Moderna "Moderna")

(instance JohnsonAndJohnson Corporation)
(termFormat EnglishLanguage JohnsonAndJohnson "JohnsonAndJohnson")

(instance BioNTech Corporation)
(termFormat EnglishLanguage BioNTech "BioNTech")

(instance SinoPharm Corporation)
(termFormat EnglishLanguage SinoPharm "SinoPharm")

(instance Roche Corporation)
(termFormat EnglishLanguage Roche "Roche")

(instance Novartis Corporation)
(termFormat EnglishLanguage Novartis "Novartis")

(instance Merck Corporation)
(termFormat EnglishLanguage Merck "Merck")

(instance GlaxoSmithKline Corporation)
(termFormat EnglishLanguage GlaxoSmithKline "GlaxoSmithKline")

(instance Sanofi Corporation)
(termFormat EnglishLanguage Sanofi "Sanofi")

(instance AbbVie Corporation)
(termFormat EnglishLanguage AbbVie "AbbVie")

(instance TakedaPharmaceuticals Corporation)
(termFormat EnglishLanguage TakedaPharmaceuticals "TakedaPharmaceuticals")

(instance ShanghaiPharmaceuticalsHolding Corporation)
(termFormat EnglishLanguage ShanghaiPharmaceuticalsHolding "ShanghaiPharmaceuticalsHolding")

(subclass BrainFog (ImpairmentFn Thinking))
(termFormat EnglishLanguage BrainFog "brain fog")

(subclass NeuroInflammation (InflammationFn NervousSystem))
(termFormat EnglishLanguage NeuroInflammation "neuro-inflammation")

(instance OrangeCounty County)
(termFormat EnglishLanguage OrangeCounty "Orange County")
(termFormat EnglishLanguage OrangeCounty "The O.C.")

(subclass Zyrtec Antihistamine)
(termFormat EnglishLanguage Zyrtec "Zyrtec")
(termFormat EnglishLanguage Zyrtec "Cetirizine")
(manufacturer Zyrtec JohnsonAndJohnson)

(subclass Pseudoephedrine Stimulant)
(termFormat EnglishLanguage Pseudoephedrine "pseudoephedrine")

(subclass PedalEdema (EdemaFn Foot))
(termFormat EnglishLanguage PedalEdema "pedal edema")

(subclass DeltaCovidVariant SARSCoV2)
(termFormat EnglishLanguage DeltaCovidVariant "delta variant")
(termFormat EnglishLanguage DeltaCovidVariant "delta")
(documentation DeltaCovidVariant EnglishLanguage "A variant of &%SARSCoV2
that arose in late 2020 that has proven more contagious and possibly
more virulent than the original virus to cause &%COVID19.")

(=>
  (holdsDuring ?T
    (and
      (instance ?D DeltaCovidVariant)
      (part ?D ?H)
      (attribute ?H Covid19)))
  (greaterThan ?T
    (MonthFn December
      (YearFn 2020))))

(instance NSFW ObjectiveNorm)
(termFormat EnglishLanguage NSFW "NSFW")
(termFormat EnglishLanguage NSFW "not safe for work")
(documentation NSFW EnglishLanguage "Some sort of messaging, such
as a &%Facebook or &%Twitter post that if sent by an &%employee of
an &%Organization and seen by another &%employee, would have some
negative repercussions for the posting employee. Even intentionally
&%Seeing such a post could have negative repercussions.")

(=>
  (and
    (employs ?ORG ?P)
    (employs ?ORG ?CO)
    (instance ?D DoNetworkMessaging)
    (result ?D ?MSG)
    (attribute ?MSG NSFW)
    (agent ?D ?P)
    (instance ?S Seeing)
    (patient ?S ?MSG)
    (agent ?S ?CO))
  (modalAttribute
    (exists (?PROC)
      (and
        (causes ?D ?PROC)
        (suffers ?PROC ?P)))
    Likely))

(=>
  (and
    (employs ?ORG ?CO)
    (instance ?D DoNetworkMessaging)
    (result ?D ?MSG)
    (attribute ?MSG NSFW)
    (instance ?S Seeing)
    (patient ?S ?MSG)
    (agent ?S ?CO))
  (modalAttribute
    (exists (?PROC)
      (and
        (causes ?S ?PROC)
        (suffers ?PROC ?CO)))
    Possibility))

(subclass AntiVaxxer BeliefGroup)
(termFormat EnglishLanguage AntiVaxxer "anti-vaxxer")
(documentation AntiVaxxer EnglishLanguage "Someone who &%believes
that &%Vaccines are harmful.")

(=>
  (member ?X AntiVaxxer)
  (believes ?X
    (=>
      (and
        (instance ?V Vaccination)
        (experiencer ?V ?H))
      (suffers ?V ?H))))

(subclass LungEpithelium EpithelialTissue)
(termFormat EnglishLanguage LungEpithelium "lung epithelium")
(documentation LungEpithelium EnglishLanguage "The &%EpitheliumTissue
lining the &%Lungs.")

(=>
  (instance ?LE LungEpithelium)
  (exists (?L)
    (and
      (instance ?L Lung)
      (meetsSpatially ?L ?LE))))

(subclass DrugCandidate Substance)
(termFormat EnglishLanguage DrugCandidate "drug candidate")
(documentation DrugCandidate EnglishLanguage "Any &%Substance that
a &%Organization, such as a &%University lab or &%Corporation is
developing and testing, hopes that it will be an effective and
approved &%Medicine.")

(=>
  (instance ?DC DrugCandidate)
  (exists (?O)
    (and
      (instance ?O Organization)
      (hasPurposeForAgent ?DC
        (instance ?DC Medicine)
        ?O))))

(instance Reddit WebSite)
(termFormat EnglishLanguage Reddit "Reddit")
(documentation Reddit EnglishLanguage "The Reddit discussion site where
different topics have their own portion of the site.")

(subclass VaccinationCard Certificate)
(termFormat EnglishLanguage VaccinationCard "VaccinationCard")
(documentation VaccinationCard EnglishLanguage "A &%Text that
specifies that a &%Human has had a particular &%Vaccination
(or several).")

(=>
  (instance ?VC VaccinationCard)
  (exists (?V)
    (and
      (instance ?V Vaccination)
      (refers ?VC ?V))))

(subclass HealthDepartment GovernmentOrganization)
(termFormat EnglishLanguage HealthDepartment "health department")
(documentation HealthDepartment EnglishLanguage "Any
&%GovernmentOrganization that has the purpose of address the health
and medical needs of its constituents.")

(=>
  (instance ?DS DrugStore)
  (modalAttribute
    (exists (?P)
      (and
        (attribute ?P Pharmacist)
        (employs ?DS ?P)))
    Likely))

(instance WalgreensCompany DrugStore)
(termFormat EnglishLanguage WalgreensCompany "Walgreens")

(instance CVSHealth DrugStore)
(termFormat EnglishLanguage CVSHealth "CVS Health")
(termFormat EnglishLanguage CVSHealth "CVS")
(termFormat EnglishLanguage CVSHealth "Consumer Value Stores")

(instance Walmart DrugStore)
(termFormat EnglishLanguage Walmart "Walmart")

(instance RiteAid DrugStore)
(termFormat EnglishLanguage RiteAid "RiteAid")

(instance KrogerCompany DrugStore)
(termFormat EnglishLanguage KrogerCompany "Kroger")

(instance Albertsons DrugStore)
(termFormat EnglishLanguage Albertsons "Albertsons")

(instance CalPoly University)
(termFormat EnglishLanguage CalPoly "CalPoly")
(termFormat EnglishLanguage CalPoly "California Polytecnic")

(instance AmericansWithDisabilitiesAct-US Proposition)
(termFormat EnglishLanguage AmericansWithDisabilitiesAct-US "Americans With Disabilities Act")
(termFormat EnglishLanguage AmericansWithDisabilitiesAct-US "ADA")
(documentation AmericansWithDisabilitiesAct-US EnglishLanguage "The
Americans with Disabilities Act of 1990 or ADA (42 U.S.C. § 12101) is
a civil rights law that prohibits discrimination based on disability.
It affords similar protections against discrimination to Americans
with disabilities as the Civil Rights Act of 1964, which made
discrimination based on race, religion, sex, national origin, and
other characteristics illegal, and later sexual orientation. In
addition, unlike the Civil Rights Act, the ADA also requires covered
employers to provide reasonable accommodations to employees with
disabilities, and imposes accessibility requirements on public
accommodations.[from Wikipedia]")

(modalAttribute AmericansWithDisabilitiesAct-US Law)

(subclass BreakthroughInfection Infecting)
(termFormat EnglishLanguage BreakthroughInfection "breakthrough infection")
(termFormat EnglishLanguage BreakthroughInfection "breakthrough case")
(documentation BreakthroughInfection EnglishLanguage "An case of a
disease &%Infecting someone who is already had &%Vaccination against
the disease.")

(=>
  (and
    (instance ?BI BreakthroughInfection)
    (objectTransferred ?BI ?V)
    (instance ?V ?VC)
    (experiencer ?BI ?H))
  (exists (?VAX)
    (and
      (instance ?VAX Vaccination)
      (experiencer ?VAX ?H)
      (vaccine ?VACCINECLASS ?VC)
      (instance ?VACCINE ?VACCINECLASS)
      (objectTransferred ?VAX ?VACCINE)
      (earlier
        (WhenFn ?VAX)
        (WhenFn ?BI)))))

(subclass Ivermectin Antiparasitic)
(documentation Ivermectin EnglishLanguage "Ivermectin is a medication
that is used to treat parasite infestations. In humans, this
includes head &%Lice, scabies, river blindness (onchocerciasis),
strongyloidiasis, trichuriasis, ascariasis, and lymphatic
filariasis. In veterinary medicine, it is used to prevent
and treat heartworm and acariasis, among other indications. It can
be taken by mouth or applied to the skin for external
infestations. It belongs to the avermectin family of
medications. It works through many mechanisms of action that result
in death of the targeted parasites.[from Wikipedia]")
(termFormat EnglishLanguage Ivermectin "Ivermectin")

(subclass CommunitySpread Infecting)
(documentation CommunitySpread EnglishLanguage "Community transmission
means that the source of infection for the spread of an illness is
unknown or a link in terms of contacts between patients and other
people is missing. It refers to the difficulty in grasping the
epidemiological link in the community beyond confirmed cases.[from
Wikipedia]")
(termFormat EnglishLanguage CommunitySpread "community spread")

(=>
  (instance ?C CommunitySpread)
  (not
    (exists (?H)
      (knows ?H
        (exists (?N)
          (and
            (origin ?C ?H)
            (names ?N ?H)))))))

(subclass SSRIDrug Antidepressant)
(documentation SSRIDrug EnglishLanguage "Selective serotonin reuptake
inhibitors (SSRIs) are a class of drugs that are typically used as
antidepressants in the treatment of major depressive disorder, anxiety
disorders, and other psychological conditions. SSRIs increase the
extracellular level of the neurotransmitter serotonin by limiting its
reabsorption (reuptake) into the presynaptic cell. They have
varying degrees of selectivity for the other monoamine transporters,
with pure SSRIs having strong affinity for the serotonin transporter
and only weak affinity for the norepinephrine and dopamine
transporters. SSRIs are the most widely prescribed antidepressants in
many countries. The efficacy of SSRIs in mild or moderate cases of
depression has been disputed and may be outweighed by side effects,
especially in adolescent populations.[from Wikipedia]")
(termFormat EnglishLanguage SSRIDrug "SSRI")
(termFormat EnglishLanguage SSRIDrug "selective serotonin reuptake inhibitor")

(subclass Singulair Medicine)
(medicine Singulair Asthma)
(documentation Singulair EnglishLanguage "Montelukast, sold under the
brand name Singulair among others, is a medication used in the
maintenance treatment of asthma. It is generally less preferred for
this use than inhaled corticosteroids. It is not useful for acute
asthma attacks. Other uses include allergic rhinitis and hives of
long duration. For allergic rhinitis it is a second-line
treatment. Common side effects include abdominal pain, cough, and
headache. Severe side effects may include allergic reactions, such
as anaphylaxis and eosinophilia. Use in pregnancy appears to be
safe. Montelukast is in the leukotriene receptor antagonist family
of medications. It works by blocking the action of leukotriene D4
in the lungs resulting in decreased inflammation and relaxation of
smooth muscle.[from Wikipedia]")
(termFormat EnglishLanguage Singulair "Singulair")
(termFormat EnglishLanguage Singulair "montelukast")

(subclass Vyvanse Stimulant)
(subclass Vyvanse Medicine)
(documentation Vyvanse EnglishLanguage "Lisdexamfetamine, sold under
the brand name Vyvanse among others, is a medication that is a
derivative of amphetamine. It is mainly used to treat attention
deficit hyperactivity disorder (ADHD) in people over the age of five
as well as moderate-to-severe binge eating disorder in adults.
Lisdexamfetamine is taken by mouth. In the United Kingdom, it
is usually less preferred than methylphenidate. Its effects
generally begin within 2 hours and last for up to 14 hours. Common
side effects of lisdexamfetamine include loss of appetite, anxiety,
diarrhea, trouble sleeping, irritability, and nausea. Rare but
serious side effects include mania, sudden cardiac death in those with
underlying heart problems, and psychosis. It has a high potential
for substance abuse per the DEA. Serotonin syndrome may occur
if used with certain other medications. Its use during pregnancy
may result in harm to the baby and use during breastfeeding is not
recommended by the manufacturer. Lisdexamfetamine is a
central nervous system (CNS) stimulant that works after being
converted by the body into dextroamphetamine. Chemically,
lisdexamfetamine is composed of the amino acid L-lysine, attached to
dextroamphetamine. Lisdexamfetamine was approved for medical use
in the United States in 2007. In 2018, it was the 82nd most
commonly prescribed medication in the United States, with more than 10
million prescriptions. It is a Schedule II controlled
substance in the United Kingdom and a Schedule II controlled substance
in the United States.[from Wikipedia]")
(termFormat EnglishLanguage Vyvanse "Vyvanse")
(termFormat EnglishLanguage Vyvanse "lisdexamfetamine")

(subclass ADHD PsychologicalDysfunction)
(documentation ADHD EnglishLanguage "Attention deficit hyperactivity
disorder (ADHD) is a mental, behavioral, and neurodevelopmental
disorder characterized by inattention, bouts of excessive energy,
hyper-fixation, and impulsivity, which are pervasive, impairing, and
otherwise age inappropriate. Some individuals with ADHD also
display difficulty regulating emotions or problems with executive
function. For a diagnosis, the symptoms have to be present for more
than six months, and cause problems in at least two settings (such as
school, home, work, or recreational activities). In children, problems
paying attention may result in poor school performance. Additionally,
it is associated with other mental disorders and substance use
disorders. Although it causes impairment, particularly in modern
society, many people with ADHD have sustained attention for tasks they
find interesting or rewarding, known as hyperfocus.[from Wikipedia]")
(termFormat EnglishLanguage ADHD "ADHD")
(termFormat EnglishLanguage ADHD "attention deficit hyperactivity disorder")
(medicine Vyvanse ADHD)

(subclass Antiseizure Medicine)
(documentation Antiseizure EnglishLanguage "A &%Medicine which
&%hasPurpose to reduce or eliminate &%Seizure.")
(termFormat EnglishLanguage Antiseizure "anti-seizure")

(=>
  (instance ?A Antiseizure)
  (hasPurpose ?A
    (exists (?H ?I ?T)
      (and
        (instance ?H Human)
        (instance ?I Ingesting)
        (objectTransferred ?I ?A)
        (agent ?I ?H)
        (earlier (WhenFn ?I) ?T)
        (holdsDuring ?T
          (not
            (exists (?S)
              (and
                (instance ?S Seizure)
                (experiencer ?S ?H)))))))))

(subclass Thyroxine BiologicallyActiveSubstance)
(termFormat EnglishLanguage Thyroxine "thyroxine")
(documentation Thyroxine EnglishLanguage "A &%Hormone that is
secreted by the &%ThyroidGland but can also be produced
synthetically.")
(secretesSubstance ThyroidGland Thyroxine)

(subclass Levothyroxine Thyroxine)
(documentation Levothyroxine EnglishLanguage "A synthetic form
of &%Thyroxine.")
(termFormat EnglishLanguage Levothyroxine "levothyroxine")

(subclass Tirosint Levothyroxine)
(termFormat EnglishLanguage Tirosint "Tirosint")

(subclass Lamotrigine Medicine)
(subclass Lamotrigine Antiseizure)
(documentation Lamotrigine EnglishLanguage "Lamotrigine, sold as the
brand name Lamictal among others, is an anticonvulsant medication used
to treat epilepsy and to delay or prevent the recurrence of depressive
episodes in bipolar disorder. For epilepsy, this includes focal
seizures, tonic-clonic seizures, and seizures in Lennox-Gastaut
syndrome. In bipolar disorder, lamotrigine has not been shown to
reliably treat acute depression; but for patients with bipolar
disorder who are not currently symptomatic, it appears to be effective
in reducing the risk of future episodes of depression. Common side
effects include nausea, sleepiness, headache, vomiting, trouble with
coordination, and rash. Serious side effects include lack of red
blood cells, increased risk of suicide, Stevens–Johnson syndrome, and
allergic reactions. Concerns exist that use during pregnancy or
breastfeeding may result in harm. Lamotrigine is a phenyltriazine,
making it chemically different from other anticonvulsants. Its
mechanism of action is not clear, but it appears to inhibit release of
excitatory neurotransmitters via voltage-sensitive sodium channels in
neurons. Lamotrigine was first marketed in the United Kingdom in
1991, and approved for use in the United States in 1994. It is
on the World Health Organization's List of Essential Medicines. In
2018, it was the 68th most commonly prescribed medication in the
United States, with more than 11 million prescriptions.[from
Wikipedia]")
(termFormat EnglishLanguage Lamotrigine "lamotrigine")
(termFormat EnglishLanguage Lamotrigine "Lamictal")

(subclass PayStub FinancialText)
(documentation PayStub EnglishLanguage "A &%Text may accompany a
&%Check from an &%Organization to a person it &%employs, stating the
amount of the pay due and information such as the hourly rate, any
deductions for &%Tax or insurance, and possibly any accrual of
various sorts of &%WorkLeave.")
(termFormat EnglishLanguage PayStub "pay stub")
(termFormat EnglishLanguage PayStub "paystub")

(=>
  (instance ?PS PayStub)
  (exists (?FT ?O ?E)
    (and
      (instance ?FT FinancialTransaction)
      (origin ?FT ?O)
      (destination ?FT ?E)
      (refers ?PS ?FT))))

(instance Asthma DiseaseOrSyndrome)

(documentation Asthma EnglishLanguage "Asthma is a long-term
inflammatory disease of the airways of the lungs. It is
characterized by variable and recurring symptoms, reversible airflow
obstruction, and easily triggered bronchospasms. Symptoms
include episodes of wheezing, coughing, chest tightness, and shortness
of breath. These may occur a few times a day or a few times per
week. Depending on the person, asthma symptoms may become worse at
night or with exercise. Asthma is thought to be caused by a
combination of genetic and environmental factors. Environmental
factors include exposure to air pollution and allergens. Other
potential triggers include medications such as aspirin and beta
blockers. Diagnosis is usually based on the pattern of symptoms,
response to therapy over time, and spirometry lung function
testing. Asthma is classified according to the frequency of
symptoms, forced expiratory volume in one second (FEV1), and peak
expiratory flow rate. It may also be classified as atopic or
non-atopic, where atopy refers to a predisposition toward developing a
type 1 hypersensitivity reaction.[from Wikipedia]")
(termFormat EnglishLanguage Asthma "asthma")

(=>
  (attribute ?H Asthma)
  (exists (?I)
    (and
      (instance ?I
        (ImpairmentFn Breathing))
      (experiencer ?I ?H))))

(subclass Electrocardiography DiagnosticProcess)
(documentation Electrocardiography EnglishLanguage
"Electrocardiography is the process of producing a graph of voltage
versus time of the electrical activity of the &%Heart using
electrodes placed on the &%Skin. These electrodes detect the small
electrical changes that are a consequence of cardiac muscle
depolarization followed by repolarization during each cardiac cycle
(heartbeat). Changes in the normal ECG pattern occur in numerous
cardiac abnormalities, including cardiac rhythm disturbances (such as
atrial fibrillation and ventricular tachycardia), inadequate
coronary artery blood flow (such as myocardial ischemia and
myocardial infarction), and electrolyte disturbances (such as
hypokalemia and hyperkalemia). In a conventional 12-lead ECG,
ten electrodes are placed on the patient's limbs and on the surface of
the chest. The overall magnitude of the heart's electrical potential
is then measured from twelve different angles ('leads') and is
recorded over a period of time (usually ten seconds). In this way, the
overall magnitude and direction of the heart's electrical
depolarization is captured at each moment throughout the cardiac
cycle.[from Wikipedia].")
(termFormat EnglishLanguage Electrocardiography "EKG")
(termFormat EnglishLanguage Electrocardiography "ECG")
(termFormat EnglishLanguage Electrocardiography "electrocardiography")

(=>
  (and
    (instance ?E Electrocardiography)
    (patient ?E ?H)
    (agent ?E ?D)
    (attribute ?D MedicalDoctor))
  (hasPurpose ?E
    (knows ?D
      (exists (?T)
        (truth
          (attribute ?H
            (ImpairedBodyPartFn Heart)) ?T)))))

(subclass Electrocardiogram FactualText)
(documentation Electrocardiogram EnglishLanguage "The &%result of
Electrocardiography - a graph of activity of the &%Heart.")
(termFormat EnglishLanguage Electrocardiogram "electrocardiogram")

(=>
  (instance ?E Electrocardiogram)
  (exists (?EP)
    (and
      (instance ?EP Electrocardiography)
      (result ?EP ?E))))

(subclass Sake AlcoholicBeverage)
(documentation Sake EnglishLanguage "An &%AlcoholicBeverage made
from the &%Fermentation of &%Rice.")
(termFormat EnglishLanguage Sake "sake")

(=>
  (instance ?S Sake)
  (exists (?R ?F)
    (and
      (instance ?F Fermentation)
      (resource ?F ?R)
      (instance ?R Rice)
      (result ?F ?S))))

(subclass NSAID AntiInflammatory)
(disjoint NSAID Steroid)
(documentation NSAID EnglishLanguage "A &%Medicine that is not a
&%Steriod and is intended to control &%Inflammation.")
(termFormat EnglishLanguage NSAID "NSAID")
(termFormat EnglishLanguage NSAID "non-steriodal anti-inflammatory")

(subclass Aspirin NSAID)
(termFormat EnglishLanguage Aspirin "aspirin")

(subclass Ibuprofen NSAID)
(termFormat EnglishLanguage Ibuprofen "ibuprofen")

(subclass Acetaminophen NSAID)
(termFormat EnglishLanguage Acetaminophen "acetaminophen")
(termFormat EnglishLanguage Acetaminophen "paracetamol")

(disjointDecomposition NSAID Aspirin Ibuprofen Acetaminophen)

(subclass Epidemic LargeGroupProcess)

(documentation Epidemic EnglishLanguage "A period where an unusual
number of people in a particular location have a particular
&%DiseaseOrSyndrome that has an unusual severity. For example, a
comparatively small group can form an epidemic of deadly &%Ebola,
versus a much larger group that would have to form an epidemic of a
relatively mild influenza.")
(termFormat EnglishLanguage Epidemic "epidemic")

(=>
  (and
    (instance ?E Epidemic)
    (involvedInEvent ?E ?H))
  (or
    (and
      (instance ?D DiseaseOrSyndrome)
      (attribute ?H ?D))
    (exists (?P)
      (and
        (instance ?P PathologicProcess)
        (experiencer ?P ?H)
        (subProcess ?P ?E)))))

(subclass Pandemic Epidemic)

(documentation Pandemic EnglishLanguage "An &%Epidemic that takes
place in at least two countries or continents.")
(termFormat EnglishLanguage Pandemic "pandemic")

(=>
  (instance ?E Pandemic)
  (exists (?H1 ?H2 ?N1 ?N2 ?C1 ?C2)
    (and
      (involvedInEvent ?E ?H1)
      (involvedInEvent ?E ?H2)
      (not
        (equal ?H1 ?H2))
      (instance ?N1 Nation)
      (instance ?N2 Nation)
      (not
        (equal ?N1 ?N2))
      (instance ?C1 Continent)
      (instance ?C2 Continent)
      (not
        (equal ?C1 ?C2))
      (holdsDuring
        (WhenFn ?E)
        (or
          (and
            (located ?H1 ?C1)
            (located ?H2 ?C2))
          (and
            (located ?H1 ?N1)
            (located ?H2 ?N2)))))))

(subclass Famotidine Antacid)

(documentation Famotidine EnglishLanguage "Famotidine, sold under the
brand name &%Pepcid among others, is an histamine H2 receptor
antagonist medication that decreases stomach acid production. It is
used to treat peptic ulcer disease, gastroesophageal reflux disease,
and Zollinger-Ellison syndrome. It is taken by mouth or by injection
into a vein. It begins working within an hour. Common side effects
include headache, intestinal upset, and dizziness.Serious side effects
may include pneumonia and seizures. Use in pregnancy appears safe but
has not been well studied while use during breastfeeding is not
recommended. It is a histamine H2 receptor antagonist.[from
Wikipedia].")

(termFormat EnglishLanguage Pepcid "famotidine")

(subclass Pepcid Famotidine)
(termFormat EnglishLanguage Pepcid "Pepcid")
(termFormat EnglishLanguage Pepcid "Pepcid AC")

(subclass Clarithromycin Antibiotic)

(documentation Clarithromycin EnglishLanguage "Clarithromycin, sold
under the brand name Biaxin among others, is an antibiotic used to
treat various bacterial infections. This includes strep throat,
pneumonia, skin infections, H. pylori infection, and Lyme disease,
among others. Clarithromycin can be taken by mouth as a pill or
liquid. Common side effects include nausea, vomiting, headaches, and
diarrhea. Severe allergic reactions are rare. Liver problems have been
reported. It may cause harm if taken during pregnancy. It is in the
macrolide class and works by decreasing protein production of some
bacteria.[from Wikipedia]") (termFormat EnglishLanguage Clarithromycin
"clarithromycin")

(diseaseMedicine LymeDisease Clarithromycin Ingesting)
(diseaseMedicine StrepThroat Clarithromycin Ingesting)
(diseaseMedicine BacterialPneumonia Clarithromycin Ingesting)
(sideEffect Clarithromycin Nausea)
(sideEffect Clarithromycin Vomiting)
(sideEffect Clarithromycin Headache)
(sideEffect Clarithromycin Diarrhea)

(subclass Adalimumab Medicine)

(documentation Adalimumab EnglishLanguage "Adalimumab, is a
disease-modifying antirheumatic drug and monoclonal antibody that
works by inactivating tumor necrosis factor-alpha (TNFα). It is sold
under the brand name Humira, among others. It is a medication used to
treat rheumatoid arthritis, psoriatic arthritis, ankylosing
spondylitis, &%CrohnsDisease, &%UlcerativeColitis, psoriasis,
hidradenitis suppurativa, uveitis, and juvenile idiopathic &%Arthritis.
Use is generally only recommended in people who have not responded to
other treatments. It is administered by injection under the skin.
Common side effects include upper respiratory tract infections, pain
at the site of injection, rash, and headache. Other side effects may
include serious infections, cancer, anaphylaxis, reactivation of
hepatitis B, multiple sclerosis, heart failure, liver failure, and
aplastic anemia. Use during pregnancy is not recommended, but some
sources show use during breastfeeding may be safe.[from Wikipedia]")
(termFormat EnglishLanguage Adalimumab "adalimumab")

(diseaseMedicine RheumatoidArthritis Clarithromycin Injecting)
(sideEffect Adalimumab SkinRash)
(sideEffect Adalimumab Headache)

(=>
  (and
    (instance ?I Injecting)
    (instance ?A Adalimumab)
    (objectTransferred ?I ?A)
    (located ?I ?BP)
    (instance ?BP BodyPart)
    (destination ?I ?H))
  (modalAttribute
    (exists (?T)
      (and
        (holdsDuring ?T
          (attribute ?H (PainFn ?BP)))
        (during ?T
          (FutureFn
            (WhenFn ?I)))))
     Likely))

(subclass Humira Adalimumab)
(termFormat EnglishLanguage Humira "Humira")

(subclass Gaslighting SocialInteraction)

(documentation Gaslighting EnglishLanguage "Gaslighting is a
colloquialism that is loosely defined as making someone question their
reality. The term is also used informally to describe someone (a
'gaslighter') who persistently puts forth a false narrative which
leads another person (or a group of people) to doubt their own
perceptions to the extent that they become disoriented and distressed.
This dynamic is generally only possible when the audience is
vulnerable such as in unequal power relationships or when the audience
is fearful of the losses associated with challenging the false
narrative. Gaslighting is not necessarily malicious or intentional,
although in some cases it is. [from Wikipedia]")

(termFormat EnglishLanguage Gaslighting "gaslighting")

(=>
  (and
    (instance ?G Gaslighting)
    (agent ?G ?A)
    (suffers ?G ?H))
  (exists (?P)
    (and
      (instance ?P Perception)
      (experiencer ?P ?H)
      (causesProposition
        (suffers ?G ?H)
        (not
          (knows ?H
            (result ?P ?R)))))))

(subclass SARSCoV1 Coronavirus)
(documentation SARSCoV1 EnglishLanguage "The &%Virus that caused the
original SARS that apparently originated in China in 2003.")
(termFormat EnglishLanguage SARSCoV1 "SARSCoV1")
(termFormat EnglishLanguage SARSCoV1 "SARS")

(subclass Loratadine Antihistamine)
(documentation Loratadine EnglishLanguage "Loratadine, sold under the
brand name Claritin among others, is a medication used to treat
allergies. This includes allergic rhinitis (hay fever) and
hives. It is also available in combination with pseudoephedrine, a
decongestant, known as loratadine/pseudoephedrine. It is taken by
mouth. Common side effects include sleepiness, dry mouth, and
headache. Serious side effects are rare and include allergic
reactions, seizures, and liver problems. Use during pregnancy
appears to be safe but has not been well studied. It is not
recommended in children less than two years old. It is in the
second-generation antihistamine family of medication.[from Wikipedia]")
(termFormat EnglishLanguage Loratadine "loratadine")
(sideEffect Loratadine Headache)

(subclass Claritin Loratadine)
(termFormat EnglishLanguage Claritin "Claritin")

(subclass Cetirizine Antihistamine)

(documentation Cetirizine EnglishLanguage "Cetirizine, sold under the
brand name Zyrtec among others, is a second-generation antihistamine
used to treat &%AllergicRhinitis (hay fever), dermatitis, and urticaria
(&%Hives). It is taken by mouth. Effects generally begin within an
hour and last for about a day. The degree of benefit is similar to
other &%Antihistamines such as diphenhydramine. Common side effects
include sleepiness, dry mouth, headache, and abdominal pain.[from Wikipedia]")
(sideEffect Cetirizine Headache)
(pathologicSideEffect Cetirizine (PainFn Abdomen))

(termFormat EnglishLanguage Cetirizine "cetirizine")

(subclass BetterBusinessBureau NonprofitOrganization)

(documentation BetterBusinessBureau EnglishLanguage "The Better
Business Bureau (BBB), founded in 1912, is a private, nonprofit
organization whose self-described mission is to focus on advancing
marketplace trust, consisting of 106 independently incorporated
local BBB organizations in the United States and Canada, coordinated
under the International Association of Better Business Bureaus (IABBB)
in Arlington, Virginia. The Better Business Bureau is not
affiliated with any governmental agency. [from Wikipedia]")
(termFormat EnglishLanguage BetterBusinessBureau "Better Business Bureau")
(termFormat EnglishLanguage BetterBusinessBureau "BBB")

(subclass Interleukin Protein)
(documentation Interleukin EnglishLanguage "Interleukins (ILs) are a
group of cytokines (secreted proteins and signal molecules) that were
first seen to be expressed by white blood cells (leukocytes). ILs can
be divided into four major groups based on distinguishing structural
features. However, their amino acid sequence similarity is rather weak
(typically 15–25% identity). The human genome encodes more than 50
interleukins and related proteins. The function of the immune
system depends in a large part on interleukins, and rare deficiencies
of a number of them have been described, all featuring autoimmune
diseases or immune deficiency. The majority of interleukins are
synthesized by helper CD4 T lymphocytes, as well as through monocytes,
macrophages, and endothelial cells. They promote the development and
differentiation of T and B lymphocytes, and hematopoietic cells. [from
Wikipedia]")

(termFormat EnglishLanguage Interleukin "Interleukin")
(secretesSubstance WhiteBlookCell Interleukin)

(=>
  (instance ?I Interleukin)
  (hasPurpose ?I
    (exists (?D ?BV ?H)
      (and
        (instance ?H Human)
        (or
          (instance ?BV Bacteria)
          (instance ?BV Virus))
        (instance ?D Destruction)
        (located ?D ?H)
        (instrument ?D ?I)
        (patient ?D ?BV)))))

(subclass Bupropion Antidepressant)
(documentation Bupropion EnglishLanguage "Bupropion, sold under the
brand names Wellbutrin and Zyban among others, is an atypical
antidepressant primarily used to treat major depressive disorder and
to support smoking cessation. Bupropion is an effective
antidepressant on its own, but it is also popular as an add-on
medication in the cases of incomplete response to the first-line
selective serotonin reuptake inhibitor (SSRI) antidepressant.
Bupropion has several features that distinguish it from other
antidepressants: it does not usually cause sexual dysfunction; it
is not associated with weight gain and sleepiness, and it is
more effective than SSRIs at improving symptoms of hypersomnia and
fatigue. Common adverse effects of bupropion with the greatest
difference from placebo are dry mouth, nausea, constipation, insomnia,
anxiety, tremor, and excessive sweating. Raised blood pressure is
notable. Rare but serious side effects include seizure, liver
toxicity, psychosis, and risk of overdose. Bupropion use
during pregnancy may be associated with increased odds of congenital
heart defects.[from Wikipedia]")

(termFormat EnglishLanguage Bupropion "bupropion")
(sideEffect Bupropion Nausea)

(subclass Wellbutrin Bupropion)
(termFormat EnglishLanguage Wellbutrin "Wellbutrin")

(subclass Zyban Bupropion)
(termFormat EnglishLanguage Zyban "Zyban")

(subclass Creatinine Substance)
(documentation Creatinine EnglishLanguage "Creatinine is a breakdown
product of creatine phosphate from muscle and protein metabolism. It
is released at a constant rate by the body (depending on muscle
mass).[from Wikipedia]")
(termFormat EnglishLanguage Creatinine "creatinine")

(subclass Doxycycline Antibiotic)

(documentation Doxycycline EnglishLanguage "Doxycycline is a
broad-spectrum tetracycline-class antibiotic used in the treatment of
infections caused by bacteria and certain parasites. It is used to
treat bacterial pneumonia, acne, chlamydia infections, Lyme disease,
cholera, typhus, and syphilis. It is also used to prevent malaria
in combination with quinine. Doxycycline may be taken by mouth or
by injection into a vein. Common side effects include diarrhea,
nausea, vomiting, and an increased risk of sunburn. [from
Wikipedia]")
(sideEffect Doxycycline Nausea)
(sideEffect Doxycycline Diarrhea)
(sideEffect Doxycycline Vomiting)

(instance Antivaxxer SocialRole)
(documentation Antivaxxer EnglishLanguage "Someone who believes that
some or all medically-approved vaccines are, on balance, harmful.")
(termFormat EnglishLanguage Antivaxxer "antivaxxer")
(termFormat EnglishLanguage Antivaxxer "anti-vaxxer")

(=>
  (holdsDuring ?T
    (attribute ?H Antivaxxer))
  (believes ?H
    (exists (?V ?D)
      (and
        (instance ?V Vaccination)
        (instance ?D Damaging)
        (causes ?V ?D)))))

(instance Chiropractor Profession)
(documentation Chiropractor EnglishLanguage "A practitioner of
the alternative medicine of chriropractic.  Practitioners believe
that manipulation of the spine can be an effective treatment for
back pain as well as many other conditions.")
(termFormat EnglishLanguage Chiropractor "chiropractor")
(termFormat EnglishLanguage Chiropractor "chiro")

(instance Valvoline Corporation)

(documentation Valvoline EnglishLanguage "Valvoline Inc. is an American
manufacturer and distributor of Valvoline-brand automotive oil,
additives, and lubricants. It also owns the Valvoline Instant Oil
Change and Valvoline Express Care chains of car repair centers. As of
2016, it is the second largest oil change service provider in the
United States with 10% market share and 1,050 locations.[from
Wikipedia]")
(manufacturer Valvoline MotorOil)
(termFormat EnglishLanguage Valvoline "Valvoline")

(instance AbbottLaboratories Corporation)

(documentation AbbottLaboratories EnglishLanguage "Abbott Laboratories
is an American multinational medical devices and health care company
with headquarters in Abbott Park, Illinois, United States. The company
was founded by Chicago physician Wallace Calvin Abbott in 1888 to
formulate known drugs; today, it sells medical devices, diagnostics,
branded generic medicines and nutritional products. It split off its
research-based pharmaceuticals business into AbbVie in 2013. Among its
well-known products across the medical devices, diagnostics, and
nutrition product divisions are Pedialyte, Similac, Ensure, Glucerna,
ZonePerfect, FreeStyle Libre, i-STAT and MitraClip.[from Wikipedia]")

(termFormat EnglishLanguage AbbottLaboratories "Abbott Laboratories")
(termFormat EnglishLanguage AbbottLaboratories "Abbott")

(subclass Benzodiazepine Depressant)

(documentation Benzodiazepine EnglishLanguage "Benzodiazepines
(BZD, BDZ, BZs), sometimes called 'benzos', are a class of
psychoactive drugs whose core chemical structure is the fusion of a
benzene ring and a diazepine ring. As depressants—drugs which lower
brain activity—they are prescribed to treat conditions such as
&%Anxiety, &%Insomnia, and &%Seizures. The first benzodiazepine,
chlordiazepoxide (Librium), was discovered accidentally by Leo
Sternbach in 1955 and was made available in 1960 by Hoffmann–La Roche,
which soon followed with diazepam (Valium) in 1963. By 1977,
benzodiazepines were the most prescribed medications globally; the
introduction of selective serotonin reuptake inhibitors (SSRIs), among
other factors, decreased rates of prescription, but they remain
frequently used worldwide.[from Wikipedia]")
(diseaseMedicine Anxiety Benzodiazepine Ingesting)
(diseaseMedicine Insomnia Benzodiazepine Ingesting)
(diseaseMedicine Seizure Benzodiazepine Ingesting)
(termFormat EnglishLanguage Benzodiazepine "benzodiazepine")

(subclass Chlordiazepoxide Benzodiazepine)
(termFormat EnglishLanguage Chlordiazepoxide "chlordiazepoxide")

(subclass Librium Chlordiazepoxide)
(termFormat EnglishLanguage Librium "Librium")

(subclass Diazepam Benzodiazepine)
(termFormat EnglishLanguage Diazepam "diazepam")

(subclass Valium Diazepam)
(termFormat EnglishLanguage Valium "Valium")

(subclass Sulfasalazine Medicine)
(documentation Sulfasalazine EnglishLanguage "Sulfasalazine (SSZ),
sold under the trade name Azulfidine among others, is a medication
used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's
disease. It is considered by some to be a first-line treatment in
rheumatoid arthritis. It is taken by mouth. Significant side
effects occur in about 25% of people. Commonly these include loss
of appetite, nausea, headache, and rash. Severe side effects
include bone marrow suppression, liver problems, Stevens–Johnson
syndrome, and kidney problems. It should not be used in
people allergic to aspirin or sulfonamide. Use during pregnancy
appears to be safe for the baby. Sulfasalazine is in the
disease-modifying antirheumatic drugs (DMARDs) family of
medications. It is unclear exactly how it works.[from Wikipedia]")
(termFormat EnglishLanguage Sulfasalazine "sulfasalazine")
(diseaseMedicine RheumatoidArthritis Sulfasalazine Ingesting)
(diseaseMedicine CrohnsDisease Sulfasalazine Ingesting)
(diseaseMedicine UlcerativeColitis Sulfasalazine Ingesting)
(sideEffect Sulfasalazine Nausea)
(sideEffect Sulfasalazine Headache)
(sideEffect Sulfasalazine SkinRash)

(subclass Azulfidine Sulfasalazine)
(termFormat EnglishLanguage Azulfidine "azulfidine")

(subclass Roflumilast Antiinflammatory)
(documentation Roflumilast EnglishLanguage "Roflumilast, sold under
the trade name Daxas among others, is a drug that acts as a selective,
long-acting inhibitor of the enzyme phosphodiesterase-4 (PDE-4). It
has anti-inflammatory effects and is used as an orally administered
drug for the treatment of inflammatory conditions of the lungs such as
chronic obstructive pulmonary disease (COPD) [from Wikipedia]")
(termFormat EnglishLanguage Roflumilast "roflumilast")
(diseaseMedicine ChronicObstructivePulmonaryDisease Roflumilast Ingesting)
(sideEffect Roflumilast Nausea)
(sideEffect Roflumilast Headache)
(sideEffect Roflumilast Diarrhea)

(subclass Daxas Roflumilast)
(termFormat EnglishLanguage Daxas "Daxas")

(subclass Troponin Protein)

(documentation Troponin EnglishLanguage "Troponin, or the troponin
complex, is a complex of three regulatory &%Proteins (troponin C,
troponin I, and troponin T) that are integral to muscle contraction
in skeletal &%Muscle and cardiac muscle, but not smooth muscle.
Measurements of cardiac-specific troponins I and T are extensively
used as diagnostic and prognostic indicators in the management of
myocardial infarction and acute coronary syndrome. Blood troponin
levels may be used as a diagnostic marker for stroke, although the
sensitivity of this measurement is low. [from Wikipedia]")

(termFormat EnglishLanguage Troponin "troponin")

(=>
  (and
    (instance ?C MuscularContraction)
    (moves ?C ?M)
    (or
      (instance ?M VoluntaryMuscle)
      (instance ?M HeartMuscle)))
  (exists (?T)
    (and
      (instance ?T Troponin)
      (resource ?C ?T))))

(subclass Lisdexamfetamine Medicine)
(subclass Lisdexamfetamine Stimulant)

(documentation Lisdexamfetamine EnglishLanguage "Lisdexamfetamine,
sold under the brand name Vyvanse among others, is a medication that
is a derivative of &%Amphetamine. It is mainly used to treat attention
deficit hyperactivity disorder (&%ADHD) in people over the age of five
as well as moderate-to-severe binge eating disorder in adults.
Lisdexamfetamine is taken by mouth. In the &%UnitedKingdom, it
is usually less preferred than methylphenidate. Its effects generally
begin within 2 hours and last for up to 14 hours. [from Wikipedia]")

(termFormat EnglishLanguage Lisdexamfetamine "lisdexamfetamine")
(diseaseMedicine AttentionDeficitHyperactivityDisorder Lisdexamfetamine Ingesting)

(subclass Vyvanse Lisdexamfetamine)
(termFormat EnglishLanguage Vyvanse "Vyvanse")

(=>
  (and
    (attribute ?H1 ADHD)
    (not
      (attribute ?H2 ADHD))
    (not
      (equal ?H1 ?H2))
    (instance ?I1 ?IC)
    (instance ?I2 ?IC)
    (subclass ?IC IntentionalPsychologicalProcess)
    (agent ?I1 ?H1)
    (agent ?I2 ?H2)
    (duration
      (WhenFn ?I1)
      ?D1)
    (duration
      (WhenFn ?I2)
      ?D2))
  (modalAttribute
    (greaterThan ?D2 ?D1)
    Likely))

(instance ObsessiveCompulsiveDisorder PsychologicalDysfunction)

(documentation ObsessiveCompulsiveDisorder EnglishLanguage
"Obsessive–compulsive disorder (OCD) is a mental and behavioral
disorder in which a person has certain thoughts repeatedly (called
'obsessions') and/or feels the need to perform certain routines
repeatedly (called 'compulsions') to an extent that generates distress
or impairs general functioning. The person is unable to control
either the thoughts or activities for more than a short period of
time. Common compulsions include excessive hand washing, the
counting of things, and checking to see if a door is locked. These
activities occur to such a degree that the person's daily life is
negatively affected, often taking up more than an hour a day.
Most adults realize that the behaviors do not make sense. The
condition is associated with tics, anxiety disorder, and an increased
risk of suicide. [from Wikipedia]")
(termFormat EnglishLanguage ObsessiveCompulsiveDisorder "OCD")
(termFormat EnglishLanguage ObsessiveCompulsiveDisorder "obsessive–compulsive disorder")

(=>
  (attribute ?H ObsessiveCompulsiveDisorder)
  (exists (?COL ?C)
    (and
      (memberType ?COL ?C)
      (or
        (subclass ?C Investigating)
        (subclass ?C Cleaning))
      (=>
        (instance ?CI ?C)
        (and
          (agent ?CI ?H)
          (not
            (wants ?H ?CI)))))))

(subclass Escitalopram SSRIDrug)
(documentation Escitalopram EnglishLanguage "Escitalopram, sold under
the brand names Cipralex and Lexapro, among others, is an
&%Antidepressant of the selective serotonin reuptake inhibitor (&%SSRIDrug)
class. Escitalopram is mainly used to treat major &%Depression
or generalized anxiety disorder. It is taken by mouth.
Common side effects include trouble sleeping, nausea, sexual problems,
and feeling tired. More serious side effects may include suicide in
people under the age of 25. [from Wikipedia]")

(termFormat EnglishLanguage Escitalopram "escitalopram")
(diseaseMedicine Depression Escitalopram Ingesting)
(sideEffect Nausea Escitalopram)
(sideEffect SexualDysfunction Escitalopram)
(sideEffect Anxiety Escitalopram)
(sideEffect Insomnia Escitalopram)
(sideEffect FeelingTired Escitalopram)

(subclass Cipralex Escitalopram)
(termFormat EnglishLanguage Cipralex "Cipralex")

(subclass Lexapro Escitalopram)
(termFormat EnglishLanguage Lexapro "Lexapro")

(instance Zocdoc Corporation)
(documentation Zocdoc EnglishLanguage "Zocdoc is a New York
City-based company offering an online service that allows people to
find and book in-person or telemedicine appointments for medical or
dental care.[from Wikipedia]")
(termFormat EnglishLanguage Zocdoc "Zocdoc")

(subclass BIPAPVentilator NonInvasiveVentilator)
(documentation BIPAPVentilator EnglishLanguage "A non-invasive
ventilator that provides breathing support administered through a face
mask, nasal mask, or a helmet. Air, usually with added oxygen, is
given through the mask under positive pressure; generally the amount
of pressure is alternated depending on whether someone is breathing in
or out. It is termed 'non-invasive' because it is delivered with a
mask that is tightly fitted to the face or around the head, but
without a need for tracheal &%Intubation (a tube through the mouth into
the windpipe). While there are similarities with regards to the
interface, NIV is not the same as a continuous positive airway pressure
(&%CPAPVentilator), which applies a single level of positive airway pressure
throughout the whole respiratory cycle; CPAP does not deliver
ventilation but is occasionally used in conditions also treated with
NIV. Non-invasive ventilation is used in acute respiratory failure
caused by a number of medical conditions, most prominently
&%ChronicObstructivePulmonaryDisease (COPD). [from Wikipedia]")
(termFormat EnglishLanguage BIPAPVentilator "non-invasive ventilator")
(termFormat EnglishLanguage BIPAPVentilator "bilevel positive airway pressure ventilator")
(termFormat EnglishLanguage BIPAPVentilator "BIPAP")

(subclass CPAPVentilator NonInvasiveVentilator)
(termFormat EnglishLanguage CPAPVentilator "BIPAP")
(termFormat EnglishLanguage CPAPVentilator "continuous positive airway pressure ventilator")

(disjoint NonInvasiveVentilator InvasiveVentilator)
(subclass NonInvasiveVentilator AirPump)
(documentation Intubation EnglishLanguage "A ventilator that does not require
&%Intubation.")

(subclass InvasiveVentilator AirPump)
(documentation InvasiveVentilator EnglishLanguage "A ventilator that requires
&%Intubation.")

(=>
  (and
    (instance ?IV InvasiveVentilator)
    (instance ?B Breathing)
    (experiencer ?B ?H)
    (instrument ?B ?IV))
  (exists (?IN)
    (and
      (instance ?IN Intubation)
      (destination ?IN ?H)
      (earlier
        (WhenFn ?IN)
        (WhenFn ?B)))))

(subclass Intubation Inserting)
(documentation Intubation EnglishLanguage "The process of &%Inserting
a &%Tube into the &%Trachea to support &%Breathing.")

(=>
  (and
    (instance ?I Intubation)
    (instance ?T Tube)
    (objectTransferred ?I ?T)
    (experiencer ?I ?H))
  (hasPurpose ?I
    (exists (?B)
      (and
        (instance ?B Breathing)
        (instrument ?B ?T)))))

(=>
  (and
    (instance ?I Intubation)
    (instance ?T Tube)
    (objectTransferred ?I ?T)
    (experiencer ?I ?H))
  (exists (?TH)
    (and
      (instance ?TH Trachea)
      (part ?TH ?H)
      (destination ?I ?TH))))

(instance SleepApnea DiseaseOrSyndrome)

(documentation SleepApnea EnglishLanguage "Sleep apnea, also spelled
sleep apnoea, is a sleep disorder in which pauses in &%Breathing or
periods of shallow breathing during &%Sleeping occur more often than
normal. Each pause can last for a few seconds to a few minutes and
they happen many times a night. In the most common form, this
follows loud snoring. There may be a &%Choking or snorting sound as
breathing resumes. Because the disorder disrupts normal sleep,
those affected may experience sleepiness or feel tired during the
day. In children, it may cause hyperactivity or problems in
school.[from Wikipedia]")
(termFormat EnglishLanguage SleepApnea "sleep apnea")

(=>
  (holdsDuring ?T
    (and
      (attribute ?H SleepApnea)
      (attribute ?H Sleeping)))
  (exists (?T2 ?B ?B2)
    (and
      (during ?T2 ?T)
      (not
        (exists (?B)
          (and
            (instance ?B Breathing)
            (during (WhenFn ?B) ?T2)
            (experiencer ?B ?H))))
      (holdsDuring ?T2
        (and
          (instance ?B2 Breathing)
          (needs ?H ?B2))))))

(subclass Misdiagnosing Stating)
(documentation Misdiagnosing EnglishLanguage "A &%Process whereby a
&%MedicalDoctor communicates that a patient has a &%DiseaseOrSyndrome
that he or she does not.  Note that this is done in good faith and the
doctor &%believes that the diagnosis is accurate - this is not a case
of &%TellingALie.")
(disjoint Misdiagnosis TellingALie)
(termFormat EnglishLanguage Misdiagnosing "misdiagnosing")

(=>
  (and
    (instance ?M Misdiagnosing)
    (agent ?M ?D))
  (instance ?D MedicalDoctor))

(=>
  (and
    (instance ?M Misdiagnosing)
    (agent ?M ?D)
    (refers ?M ?P)
    (instance ?P Human))
  (exists (?DIS)
    (and
      (containsFormula ?M
        (attribute ?P ?DIS))
      (instance ?DIS DiseaseOrSyndrome)
      (believes ?D
        (attribute ?P ?DIS))
      (truth
        (attribute ?P ?DIS)
        False))))

(subclass IntestinibacterBartlettii Bacteria)
(documentation IntestinibacterBartlettii EnglishLanguage "A
gram positive &%Bateria in the class Clostridia and family
Peptostreptococcaceae.")

(subclass Dysautonomia DiseaseOrSyndrome)
(documentation Dysautonomia EnglishLanguage "Dysautonomia or autonomic
dysfunction is a condition in which the autonomic nervous system (ANS)
does not work properly. This may affect the functioning of the &%Heart,
&%Bladder, &%Intestines, &%SweatGlands, &%Pupils, and &%BloodVessels.
Dysautonomia has many causes, not all of which may be classified as
neuropathic. A number of conditions can feature dysautonomia, such
as &%ParkinsonsDisease, multiple system atrophy, and dementia with
Lewy bodies, Ehlers-Danlos syndromes, autoimmune autonomic
ganglionopathy and autonomic neuropathy, HIV/AIDS, autonomic
failure, and postural orthostatic &%Tachycardia syndrome.[from Wikipedia]")
(termFormat EnglishLanguage Dysautonomia "dysautonomia")

(=>
  (attribute ?H Dysautonomia)
  (exists (?P)
    (and
      (experiencer ?P ?H)
      (instance ?P
        (ImpairmentFn AutonomicProcess)))))

(subclass ParkinsonsDisease ChronicDisease)
(documentation ParkinsonsDisease EnglishLanguage "Parkinson's
disease (PD), or simply Parkinson's, is a long-term degenerative
disorder of the central &%NervousSystem that mainly affects the motor
system. The symptoms usually emerge slowly, and as the disease
worsens, non-motor symptoms become more common. The most obvious
early symptoms are tremor, rigidity, slowness of movement, and
difficulty with &%Walking. Cognitive and behavioral problems may also
occur with &%Depression, &%Anxiety, and apathy occurring in many people
with PD. Parkinson's disease dementia becomes common in the
advanced stages of the disease. Those with Parkinson's can also have
problems with their sleep and sensory systems. The motor
symptoms of the disease result from the death of cells in the
substantia nigra, a region of the midbrain, leading to a dopamine
deficit. The cause of this cell death is poorly understood, but
involves the build-up of misfolded proteins into Lewy bodies in the
neurons. Collectively, the main motor symptoms are also known
as parkinsonism or a parkinsonian syndrome.[from Wikipedia]")
(termFormat EnglishLanguage ParkinsonsDisease "Parkinson's disease")
(termFormat EnglishLanguage ParkinsonsDisease "Parkinson's")
(diseaseSymptom ParkinsonsDisease (ImpairmentFn Walking))

(subclass Dopamine Neurotransmitter)
(documentation Dopamine EnglishLanguage "Dopamine (DA, a contraction
of 3,4-dihydroxyphenethylamine) is a &%Neurotransmitter that plays
several important roles in the brain and body. It is an organic
chemical of the catecholamine and phenethylamine families. Dopamine
constitutes about 80% of the catecholamine content in the brain. It is
an amine synthesized by removing a carboxyl group from a molecule of
its precursor chemical, L-DOPA, which is synthesized in the &%Brain and
&%Kidneys. Dopamine is also synthesized in plants and most animals.  The
anticipation of most types of rewards increases the level of dopamine
in the brain, and many addictive drugs increase dopamine release or
block its reuptake into neurons following release.[from Wikipedia]")
(termFormat EnglishLanguage Dopamine "dopamine")

(subclass Cetirizine Antihistamine)

(documentation Cetirizine EnglishLanguage "Cetirizine, sold under the
brand name Zyrtec among others, is a second-generation antihistamine
used to treat allergic rhinitis (hay fever), dermatitis, and urticaria
(hives). It is taken by mouth. Effects generally begin within an
hour and last for about a day. The degree of benefit is similar to
other antihistamines such as diphenhydramine. Common side effects
include sleepiness, dry mouth, headache, and abdominal pain.[from Wikipedia]")
(termFormat EnglishLanguage Cetirizine "cetirizine")
(sideEffect Cetirizine Headache)
(sideEffect Cetirizine Sleepy)
(sideEffect Cetirizine (PainFn Abdomen))

(subclass Zyrtec Cetirizine)
(termFormat EnglishLanguage Zyrtec "Zyrtec")

(subclass Carnitine BiologicallyActiveSubstance)

(documentation Carnitine EnglishLanguage "Carnitine is a quaternary
ammonium compound involved in metabolism in most &%Mammals, &%Plants, and
some &%Bacteria. In support of energy metabolism, carnitine
transports long-chain fatty acids into mitochondria to be oxidized for
energy production, and also participates in removing products of
metabolism from cells. Given its key metabolic roles, carnitine is
concentrated in tissues like skeletal and cardiac muscle that
metabolize fatty acids as an energy source. Healthy individuals,
including strict vegetarians, synthesize enough L-carnitine in vivo to
not require supplementation.[from Wikipedia]")
(termFormat EnglishLanguage Carnitine "carnitine")

(subclass AcetylLCarnitine Carnitine)
(termFormat EnglishLanguage AcetylLCarnitine "acetyl-L-carnitine")
(termFormat EnglishLanguage AcetylLCarnitine "ALCAR")

(instance Teladoc Corporation)
(documentation Teladoc EnglishLanguage "Teladoc Health, Inc. is a
multinational telemedicine and virtual healthcare company based in the
United States. Primary services include telehealth, medical
opinions, AI and analytics, telehealth devices and licensable
platform services. In particular, Teladoc Health uses telephone and
videoconferencing software as well as mobile apps to provide on-demand
remote medical care. Billed as the first and largest telemedicine
company in the United States, Teladoc Health was launched in 2002
and has acquired companies such as BetterHelp in 2015, Best
Doctors in 2017, and Advance Medical in 2018. It trades on the
NYSE and in 2019 was active in 130 countries and served around 40
million members in 2021.[from Wikipedia]")
(termFormat EnglishLanguage Teladoc "Teladoc")

(subclass HeartPalpitation PathologicProcess)
(subclass HeartPalpitation (ImpairmentFn HeartBeat))

(documentation HeartPalpitation EnglishLanguage "Palpitations are perceived
abnormalities of the &%HeartBeat characterized by awareness of cardiac
muscle contractions in the chest, which is further characterized by
the hard, fast and/or irregular beatings of the &%Heart.[from
Wikipedia]")
(termFormat EnglishLanguage HeartPalpitation "heart palpitation")
(termFormat EnglishLanguage HeartPalpitation "palpitations")

(subclass Pregabalin Antiseizure)
(documentation Pregabalin EnglishLanguage "Pregabalin, sold under the
brand name Lyrica among others, is an anticonvulsant and anxiolytic
medication used to treat epilepsy, neuropathic pain, fibromyalgia,
restless leg syndrome, and generalized anxiety disorder.
Its use in epilepsy is as an add-on therapy for partial seizures.
When used before surgery, it reduces pain but results in greater
sedation and visual disturbances. It is taken by mouth.[from
Wikipedia]")
(termFormat EnglishLanguage Pregabalin "pregabalin")

(subclass Lyrica Pregabalin)
(termFormat EnglishLanguage Lyrica "Lyrica")

(subclass Crisaborole Medicine)
(documentation Crisaborole EnglishLanguage "Crisaborole, sold under
the brand name Eucrisa among others, is a nonsteroidal topical
medication used for the treatment of mild-to-moderate atopic
dermatitis (eczema) in adults and children. The most common
side effects are reactions at the application site (including burning
or stinging).[from Wikipedia]")
(termFormat EnglishLanguage Crisaborole "crisaborole")

(subclass Eucrisa Crisaborole)
(termFormat EnglishLanguage Eucrisa "Eucrisa")

(instance Eczema DiseaseOrSyndrome)

(documentation Eczema EnglishLanguage "Atopic dermatitis (AD), also
known as atopic eczema, is a long-term type of inflammation of the
skin (dermatitis). It results in itchy, red, swollen, and cracked
skin. Clear fluid may come from the affected areas, which often
thickens over time. While the condition may occur at any age, it
typically starts in childhood, with changing severity over the
years. In children under one year of age, much of the body may
be affected. As children get older, the areas on the insides of the
knees and elbows are most commonly affected. In adults, the hands
and feet are most commonly affected. Scratching the affected areas
worsens the symptoms, and those affected have an increased risk of
skin infections. Many people with atopic dermatitis develop hay fever
or asthma.[from Wikipedia]")

(diseaseMedicine Eczema Crisaborole TopicalApplication)
(termFormat EnglishLanguage Eczema "eczema")
(termFormat EnglishLanguage Eczema "atopic eczema")
(termFormat EnglishLanguage Eczema "atopic dermatitis")

(=>
  (attribute ?H Eczema)
  (exists (?SR)
    (and
      (instance ?SR SkinRash)
      (experiencer ?SR ?H))))

(=>
  (attribute ?H Eczema)
  (exists (?SI)
    (and
      (instance ?SI
        (InflammationFn Skin))
      (experiencer ?SR ?H))))

(subclass LabCorp Corporation)
(documentation LabCorp EnglishLanguage "Laboratory Corporation of
America Holdings, more commonly known as Labcorp, is an American S&P
500 company headquartered in Burlington, &%NorthCarolina. It operates
one of the largest clinical laboratory networks in the world, with a
United States network of 36 primary laboratories. Before a merger with
National Health Laboratory in 1995, the company operated under the
name Roche BioMedical. Labcorp performs its largest volume of
specialty testing at its Center for Esoteric Testing in Burlington,
North Carolina, where the company is headquartered. As of 2018,
Labcorp processes 2.5 million lab tests weekly.[from Wikipedia]")
(headquartersOfOrganization LabCorp NorthCarolina)
(termFormat EnglishLanguage LabCorp "LabCorp")

(subclass Intestinimonas Bacterium)
(documentation Intestinimonas EnglishLanguage "A &%Baterium found in
the &%Intestine of &%Mammals.")
(termFormat EnglishLanguage Intestinimonas "intestinimonas")

(=>
  (instance ?I Intestinimonas)
  (modalAttribute
    (exists (?IN)
      (and
        (instance ?IN Intestine)
        (located ?I ?IN)))
    Likely))

(subclass Septoplasty Surgery)
(documentation Septoplasty EnglishLanguage "Septoplasty
 or alternatively submucous septal resection and
septal reconstruction, is a corrective surgical procedure done to
straighten a deviated &%NasalSeptum – the nasal septum being the
partition between the two &%NasalCavities. Ideally, the septum
should run down the center of the nose. When it deviates into one of
the cavities, it narrows that cavity and impedes airflow. Deviated
nasal septum or 'crooked' internal nose can occur at childbirth or as
the result of an injury or other trauma. If the wall that functions as
a separator of both sides of the nose is tilted towards one side at a
degree greater than 50%, it might cause difficulty breathing. Often
the inferior turbinate on the opposite side enlarges, which is termed
compensatory hypertrophy. Deviations of the septum can lead to nasal
obstruction. Most surgeries are completed in 60 minutes or less, while
the recovery time could be up to several weeks. Put simply,
septoplasty is a surgery that helps repair the passageways in the nose
making it easier to breathe. This surgery is usually performed on
patients with a deviated septum, recurrent rhinitis, or ossinus
issues. [from Wikipedia]")
(termFormat EnglishLanguage Septoplasty "septoplasty")

(=>
  (and
    (instance ?S Septoplasty)
    (experiencer ?S ?H))
  (exists (?SEPT)
    (and
      (instance ?SEPT NasalSeptum)
      (part ?SEPT ?H)
      (patient ?S ?SEPT))))

(subclass FitbitDevice WearableItem)
(subclass FitbitDevice MeasuringDevice)
(subclass FitbitDevice ElectricDevice)
(documentation FitbitDevice EnglishLanguage "A &%WearableItem made by
&%FitbitCompany.")
(termFormat EnglishLanguage FitbitDevice "Fitbit")
(manufacturer FitbitDevice FitbitCompany)

(instance FitbitCompany Corporation)
(documentation FitbitCompany EnglishLanguage "Fitbit is an American
consumer electronics and fitness company. It produces wireless-enabled
wearable technology physical fitness monitors and activity trackers
such as smartwatches, pedometers and monitors for heart rate, quality
of sleep, and stairs climbed as well as related software. It was
acquired by Google in 2021.")
(subOrganization FitbitCompany Google)
(termFormat EnglishLanguage FitbitCompany "Fitbit")

(subAttribute Pulmonologist MedicalDoctor)
(instance Pulmonologist Position)
(documentation Pulmonologist EnglishLanguage "A &%MedicalDoctor who
deals with diseases and disorders of the respiratory tract.")
(termFormat EnglishLanguage Pulmonologist "pulmonologist")

(=>
  (attribute ?H Pulmonologist)
  (exists (?P1 ?P2 ?PAT ?L)
    (and
      (subclass ?PROCESS1 DiagnosticProcess)
      (subclass ?PROCESS2 TherapeuticProcess)
      (patient ?P1 ?PAT)
      (patient ?P2 ?PAT)
      (instance ?L Lung)
      (part ?L ?PAT)
      (located ?P1 Lung)
      (located ?P2 Lung))))


(subclass Clonazepam Benzodiazepine)

(documentation Clonazepam EnglishLanguage "Clonazepam, sold under the
brand Klonopin among others, is a &%Medicine used to prevent and treat
&%Seizures, panic disorder, &%Anxiety, and the movement disorder known as
akathisia. It is a tranquilizer of the benzodiazepine class. It
is taken by mouth. Effects begin within one hour and last between
six and twelve hours. Common side effects include sleepiness, poor
coordination, and agitation. Long-term use may result in tolerance,
dependence, and withdrawal symptoms if stopped abruptly.[from Wikipedia] ")

(termFormat EnglishLanguage Clonazepam "clonazepam")

(subclass Klonopin Clonazepam)
(termFormat EnglishLanguage Klonopin "Klonopin")

(subclass Fexofenadine Antihistamine)
(documentation Fexofenadine EnglishLanguage "Fexofenadine, sold under
the brand name &%Allegra among others, is an antihistamine
pharmaceutical drug used in the treatment of allergy symptoms, such as
hay fever and urticaria.[from Wikipedia]")
(termFormat EnglishLanguage Fexofenadine "fexofenadine")

(subclass Allegra Fexofenadine)
(termFormat EnglishLanguage Allegra "Allegra")

(subclass Fibromyalgia DiseaseOrSyndrome)
(documentation Fibromyalgia EnglishLanguage "Fibromyalgia (FM) is a
medical condition characterized by chronic widespread pain and a
heightened pain response to pressure. Other symptoms include
tiredness to a degree that normal activities are affected, sleep
problems, and cognitive dysfunctions. Some people also
report restless legs syndrome, bowel or bladder problems, numbness and
tingling and sensitivity to noise, lights or temperature. Patients
with fibromyalgia are more likely to suffer from depression, anxiety
and posttraumatic stress disorder.[from Wikipedia]")
(termFormat EnglishLanguage Fibromyalgia "Fibromyalgia")

(=>
  (holdsDuring ?T
    (attribute ?H Fibromyalgia))
  (exists (?P)
    (and
      (instance ?P Pain)
      (experiencer ?P ?H)
      (during ?T
        (WhenFn ?P)))))

(instance Netflix Corporation)
(documentation Netflix EnglishLanguage "Netflix, Inc. is an
American over-the-top media service and original programming
production company. It offers subscription-based video on demand from
a library of films and television series, 40% of which is Netflix
original programming produced in-house. Netflix has also played a
prominent role in independent film distribution. As of July 2021,
Netflix had 209 million subscribers, including 72 million in the
United States and &%Canada. It is available worldwide except in
mainland China (due to local restrictions), Syria, North Korea, and
Crimea (due to US sanctions). Netflix is a member of the Motion
Picture Association (MPA).[from Wikipedia]")
(headquartersOfOrganization Netflix California)
(termFormat EnglishLanguage Netflix "Netflix")
(termFormat EnglishLanguage Netflix "Netflix Corp.")

(exists (?D ?M)
  (and
    (instance ?D Disseminating)
    (agent ?D Netflix)
    (patient ?D ?M)
    (instance ?M MotionPicture)))

(exists (?FM)
  (and
    (instance ?FM FilmMaking)
    (agent ?FM Netflix)))

(instance ProPublica Corporation)

(documentation ProPublica EnglishLanguage "ProPublica, legally Pro
Publica, Inc., is a nonprofit organization based in New York City. It
is a newsroom that aims to produce investigative journalism in the
public interest. In 2010, it became the first online news source to
win a Pulitzer Prize, for a piece written by one of its journalists
and published in The New York Times Magazine as well as on
ProPublica.org. ProPublica states that its investigations are
conducted by its staff of full-time investigative reporters, and the
resulting stories are distributed to news partners for publication or
broadcast. In some cases, reporters from both ProPublica and its
partners work together on a story. ProPublica has partnered with more
than 90 different news organizations, and it has won five Pulitzer
Prizes.[from Wikipedia]")
(headquartersOfOrganization ProPublica NewYorkCityUnitedStates)
(termFormat EnglishLanguage ProPublica "ProPublica")
(termFormat EnglishLanguage ProPublica "Pro Publica Inc.")

(exists (?H)
  (and
    (attribute ?H NewReporter)
    (employs ProPublica ?H)))

(subclass Immunosuppressive Medicine)
(documentation Immunosuppressive EnglishLanguage "Immunosuppression is a
reduction of the activation or efficacy of the immune system. Some
portions of the immune system itself have immunosuppressive effects on
other parts of the immune system, and immunosuppression may occur as
an adverse reaction to treatment of other conditions. In
general, deliberately induced immunosuppression is performed to
prevent the body from rejecting an organ transplant. Additionally,
it is used for treating graft-versus-host disease after a bone marrow
transplant, or for the treatment of auto-immune diseases such as
systemic &%Lupus erythematosus, &%RheumatoidArthritis, Sjögren's
syndrome, or &%CrohnsDisease. This is typically done using
medications, but may involve surgery (splenectomy), plasmapheresis, or
radiation. A person who is undergoing immunosuppression, or whose
immune system is weak for some other reasons (chemotherapy or HIV), is
said to be immunocompromised.[from Wikipedia]")
(termFormat EnglishLanguage Immunosuppressive "immunosuppressive")
(termFormat EnglishLanguage Immunosuppressive "immunosuppressant")

(=>
  (subclass ?I Immunosuppressive)
  (hasPurpose ?I
    (and
      (instance ?AID AutoImmuneDisorder)
      (diseaseMedicine ?AID ?I ?P))))

(subclass Benelysta Immunosuppressive)
(documentation Benelysta EnglishLanguage "An &%Immunosuppressive
used to treat &%Lupus.")
(diseaseMedicine Lupus Benelysta Ingesting)
(termFormat EnglishLanguage Benelysta "Benelysta")

(subclass OrganTransplant Surgery)
(documentation OrganTransplant EnglishLanguage "Taking an &%Organ from
a live or dead donor for implantation in a recipient who has lost use
of that corresponding organ due to disease or injury.")
(termFormat EnglishLanguage OrganTransplant "organ transplant")
(termFormat EnglishLanguage OrganTransplant "transplant")

(=>
  (instance ?OT OrganTransplant)
  (exists (?H ?O)
    (and
      (instance ?H Animal)
      (instance ?O Organ)
      (needs ?H ?O))))

(=>
  (instance ?OT OrganTransplant)
  (exists (?H ?O ?P)
    (and
      (instance ?H Animal)
      (instance ?O Organ)
      (instance ?P Putting)
      (subProcess ?P ?OT)
      (objectTransferred ?P ?O)
      (destination ?P ?H))))

(subclass Terfenadine Surgery)

(documentation Terfenadine EnglishLanguage "Terfenadine is an
antihistamine formerly used for the treatment of allergic conditions.
It was brought to market by Hoechst Marion Roussel (now
Sanofi-Aventis) and was marketed under various brand names, including
Seldane in the United States, Triludan in the United Kingdom, and
Teldane in Australia. It was superseded by fexofenadine in the
1990s due to the risk of a particular type of disruption of the
electrical rhythms of the heart (specifically cardiac arrhythmia
caused by QT interval prolongation) and has been withdrawn from
markets worldwide.[from Wikipedia]")

(termFormat EnglishLanguage Terfenadine "terfenadine")
(termFormat EnglishLanguage Terfenadine "Seldane")

(subclass BetaBlocker Medicine)

(documentation BetaBlocker EnglishLanguage "Beta blockers
(beta-blockers, β-blockers, etc.) are a class of medications that are
predominantly used to manage abnormal heart rhythms, and to protect
the heart from a second heart attack (myocardial infarction) after a
first heart attack (secondary prevention). They are also widely
used to treat high blood pressure (hypertension), although they are no
longer the first choice for initial treatment of most
patients.[from Wikipedia]")
(diseaseMedicine HeartAttack BetaBlocker Ingesting)
(diseaseMedicine HeartPalpitations BetaBlocker Ingesting)
(diseaseMedicine HighBloodPressure BetaBlocker Ingesting)
(termFormat EnglishLanguage BetaBlocker "beta blocker")

(subclass Propranolol BetaBlocker)

(documentation Propranolol EnglishLanguage "Propranolol, sold under
the brand name Inderal among others, is a medication of the beta
blocker class. It is used to treat high blood pressure, a number of
types of irregular heart rate, thyrotoxicosis, capillary hemangiomas,
performance anxiety, and essential tremors, as well to
prevent migraine headaches, and to prevent further heart problems in
those with angina or previous heart attacks. It can be taken by
mouth or by injection into a vein. The formulation that is taken by
mouth comes in short-acting and long-acting versions. Propranolol
appears in the blood after 30 minutes and has a maximum effect between
60 and 90 minutes when taken by mouth. Common side effects
include nausea, abdominal pain, and constipation. [from
Wikipedia]")
(termFormat EnglishLanguage Propranolol "propranolol")
(sideEffect Propranolol Nausea)

(subclass Inderal Propranolol)
(termFormat EnglishLanguage Inderal "Inderal")

(subclass Desloratadine Medicine)

(documentation Desloratadine EnglishLanguage "Desloratadine (trade
name &%Clarinex and &%Aerius) is a tricyclic H1 antagonist that is used to
treat allergies. It is an active metabolite of &%Loratadine.
Desloratadine is used to treat &%AllergicRhinitis, nasal congestion and
chronic idiopathic urticaria (&%Hives). It is the major metabolite of
loratadine and the two drugs are similar in safety and effectiveness.
Desloratadine is available in many dosage forms and under many trade
names worldwide. The most common side-effects are fatigue, dry mouth,
and headache.[from Wikipedia]")

(termFormat EnglishLanguage Desloratadine "desloratadine")

(subclass Clarinex Desloratadine)
(termFormat EnglishLanguage Clarinex "Clarinex")

(subclass Aerius Desloratadine)
(termFormat EnglishLanguage Aerius "Aerius")

(subclass MycophenolicAcid Immunosuppressive)

(documentation MycophenolicAcid EnglishLanguage "Mycophenolic acid (MPA)
is an immunosuppressant medication used to prevent rejection following
organ transplantation and to treat autoimmune conditions such as
Crohn's disease and lupus. Specifically it is used following
kidney, heart, and liver transplantation. It can be given by mouth
or by injection into a vein. It comes as mycophenolate sodium and
mycophenolate mofetil. Common side effects include nausea,
infections, and diarrhea. [from Wikipedia]")
(termFormat EnglishLanguage MycophenolicAcid "mycophenolic acid")
(diseaseMedicine CrohnsDisease MycophenolicAcid Ingesting)
(diseaseMedicine Lupus MycophenolicAcid Ingesting)
(sideEffect MycophenolicAcid Nausea)
(sideEffect MycophenolicAcid Diarrhea)

(subclass CellCept MycophenolicAcid)
(termFormat EnglishLanguage CellCept "CellCept")

(subclass Adderall Medicine)
(subclass Adderall Mixture)

(documentation Adderall EnglishLanguage "Adderall and Mydayis are
trade names for a combination drug containing four salts of
&%Amphetamine. The mixture is composed of equal parts racemic
amphetamine and dextroamphetamine, which produces a (3:1) ratio
between dextroamphetamine and levoamphetamine, the two enantiomers of
amphetamine. Both enantiomers are &%timulants, but differ enough to
give Adderall an effects profile distinct from those of racemic
amphetamine or dextroamphetamine, which are marketed as Evekeo
and Dexedrine/Zenzedi, respectively. Adderall is used in the
treatment of attention deficit hyperactivity disorder (&%ADHD) and
narcolepsy. It is also used as an athletic performance enhancer,
cognitive enhancer, appetite suppressant, and recreationally as an
aphrodisiac and euphoriant. It is a central nervous system (CNS)
stimulant of the phenethylamine class.[from Wikipedia]")

(ingredient Adderall Amphetamine)
(termFormat EnglishLanguage Adderall "Adderall")
(termFormat EnglishLanguage Adderall "Mydayis")
(diseaseMedicine ADHD Adderall Ingesting)
(diseaseMedicine Narcolepsy Adderall Ingesting)

(instance Narcolepsy DiseaseOrSyndrome)

(documentation Narcolepsy EnglishLanguage "Narcolepsy is a long-term
neurological disorder that involves a decreased ability to regulate
sleep-wake cycles. Symptoms often include periods of excessive daytime
sleepiness and brief involuntary sleep episodes. About 70% of those
affected also experience episodes of sudden loss of muscle strength,
known as cataplexy. These experiences can be brought on by strong
emotions. Less commonly, there may be vivid hallucinations or an
inability to move (sleep paralysis) while falling asleep or waking up.
People with narcolepsy tend to sleep about the same number of hours
per day as people without, but the quality of sleep tends to be
lessened. [from Wikipedia]")
(termFormat EnglishLanguage Narcolepsy "narcolepsy")

(=>
  (holdsDuring ?T
    (attribute ?H Narcolepsy))
  (exists (?S)
    (and
      (instance ?S Sleeping)
      (experiencer ?S ?H)
      (during
        (WhenFn ?S) ?T)
      (not
        (wants ?H ?S)))))

(instance AstraZeneca Corporation)

(documentation AstraZeneca EnglishLanguage "AstraZeneca plc
is a British-Swedish multinational pharmaceutical
and biotechnology company with its headquarters at the
Cambridge Biomedical Campus in Cambridge, England. It has a
portfolio of products for major diseases in areas including oncology,
cardiovascular, gastrointestinal, infection, neuroscience,
respiratory, and inflammation. It has been involved in developing the
Oxford-AstraZeneca COVID-19 vaccine. [from Wikipedia]")
(headquartersOfOrganization AstraZeneca England)
(termFormat EnglishLanguage AstraZeneca "AstraZeneca")

(subclass Pedialyte Beverage)
(documentation Pedialyte EnglishLanguage "Pedialyte is an oral
electrolyte solution manufactured by &%AbbottLaboratories and marketed
for use in children. It is designed to promote rehydration and
electrolyte replacement in ill children. [from Wikipedia]")
(manufacturer Pedialyte AbbottLaboratories)
(termFormat EnglishLanguage Pedialyte "Pedialyte")

(=>
  (instance ?P Pedialyte)
  (hasPurpose ?P
    (exists (?C ?D ?V ?DR)
      (and
        (instance ?C HumanChild)
        (instance ?D Diarrhea)
        (instance ?V Vomiting)
        (or
          (and
            (experiencer ?D ?C)
            (earlier (WhenFn ?D) (WhenFn ?DR)))
          (and
            (experiencer ?V ?C)
            (earlier (WhenFn ?V) (WhenFn ?DR))))
        (instance ?DR Drinking)
        (agent ?DR ?C)
        (objectTransferred ?DR ?P)))))

(subclass Anticoagulant Medicine)
(documentation Anticoagulant EnglishLanguage "Anticoagulants, commonly
known as &%Blood thinners, are chemical substances that prevent or
reduce coagulation of blood, prolonging the &%Clotting time. Some of
them occur naturally in blood-eating animals such as &%Leeches and
&%Mosquitoes, where they help keep the bite area unclotted long enough
for the animal to obtain some blood. As a class of medications,
anticoagulants are used in therapy for thrombotic disorders. Oral
anticoagulants (OACs) are taken by many people in pill or tablet form,
and various intravenous anticoagulant dosage forms are used in
&%HospitalOrganizations. Some anticoagulants are used in medical equipment,
such as sample tubes, blood transfusion bags, heart-lung machines, and
dialysis equipment. One of the first anticoagulants, &%Warfarin, was
initially approved as a rodenticide. [from Wikipedia]")

(termFormat EnglishLanguage Anticoagulant "anticoagulant")
(termFormat EnglishLanguage Anticoagulant "blood thinner")

(=>
  (instance ?A Anticoagulant)
  (hasPurpose ?A
    (exists (?M)
      (and
        (instance ?M Mammal)
        (experiencer ?M
          (ImpairmentFn Clotting))))))

(subclass Warfarin Anticoagulant)
(termFormat EnglishLanguage Warfarin "warfarin")

(subclass Coumadin Warfarin)
(termFormat EnglishLanguage Coumadin "Coumadin")

(subclass N95Mask Respirator)
(documentation N95Mask EnglishLanguage "An N95 filtering facepiece
&%Respirator, commonly abbreviated N95 respirator, is a
particulate-filtering facepiece respirator that meets the U.S.
National Institute for Occupational Safety and Health (NIOSH) N95
classification of air filtration, meaning that it filters at least 95%
of airborne particles.  The N95 type is the most common particulate-filtering
facepiece respirator. It is an example of a mechanical filter
respirator, which provides protection against particulates but not
against gases or vapors. It must have headbands instead of ear
loops. [from Wikipedia]")

(termFormat EnglishLanguage N95Mask "N95 mask")
(termFormat EnglishLanguage N95Mask "N95 respirator")

(subclass Ivabradine Medicine)
(documentation Ivabradine EnglishLanguage "Ivabradine, sold under the
brand name Procoralan among others, is a medication used for the
symptomatic management of stable heart-related chest pain and heart
failure not fully managed by beta blockers. [from Wikipedia]")

(termFormat EnglishLanguage Ivabradine "ivabradine")

(=>
  (instance ?I Ivabradine)
  (hasPurpose ?I
    (exists (?H ?IN ?P)
      (and
        (instance ?H Human)
        (instance ?P (PainFn Chest))
        (experiencer ?P ?H)
        (instance ?IN Ingesting)
        (agent ?IN ?H)
        (earlier
          (WhenFn ?P)
          (WhenFn ?IN))
        (not
          (exists (?P2)
            (and
              (instance ?P2 (PainFn Chest))
              (experiencer ?P2 ?H)
              (earlier
                (WhenFn ?IN)
                (WhenFn ?P2)))))))))

(subclass Corlanor Ivabradine)
(termFormat EnglishLanguage Corlanor "Corlanor")

(subclass Procoralan Ivabradine)
(termFormat EnglishLanguage Procoralan "Procoralan")

(subclass Ferritin Protein)
(documentation Ferritin EnglishLanguage "Ferritin is a universal
intracellular protein that stores &%Iron and releases it in a controlled
fashion. The protein is produced by almost all living &%Organisms,
including archaea, bacteria, algae, higher plants, and animals. It is
the primary intracellular iron-storage protein in both prokaryotes and
eukaryotes, keeping iron in a soluble and non-toxic form. In humans,
it acts as a buffer against iron deficiency and iron overload. [from
Wikipedia]")
(termFormat EnglishLanguage Ferritin "ferritin")

(instance Hyperferritinemia DiseaseOrSyndrome)
(documentation Hyperferritinemia EnglishLanguage "If ferritin is high, there is
iron in excess or else there is an acute inflammatory reaction in
which ferritin is mobilized without &%Iron excess. For example,
ferritins may be high in infection without signaling body iron
overload. [from Wikipedia]")
(termFormat EnglishLanguage Hyperferritinemia "hyperferritinemia")
(diseaseSymptom Hyperferritinemia Inflammation)

(instance PubMed SearchEngine)
(termFormat EnglishLanguage PubMed "PubMed")

(instance Medline Database)
(termFormat EnglishLanguage Medline "Medline")

(subclass Abatacept Immunosupressant)
(documentation Abatacept EnglishLanguage "Abatacept, sold under the
brand name Orencia, is a medication used to treat autoimmune diseases
like rheumatoid arthritis, by interfering with the immune activity of
T cells. It is a modified antibody.[from Wikipedia]")
(termFormat EnglishLanguage Abatacept "abatacept")
(diseaseMedicine Abatacept RheumatoidArthritis Ingesting)

(subclass Orencia Abatacept)
(termFormat EnglishLanguage Orencia "Orencia")

(subclass Nizatidine Medicine)
(documentation Nizatidine EnglishLanguage "Nizatidine is a histamine
H2 receptor antagonist that inhibits stomach acid production, and is
commonly used in the treatment of peptic ulcer disease and
gastroesophageal reflux disease. It was patented in 1980 and
approved for medical use in 1988. It was developed by Eli Lilly.
Brand names include Tazac and Axid. [from Wikipedia]")
(termFormat EnglishLanguage Nizatidine "Nizatidine")

(instance PepticUlcers DiseaseOrSyndrome)
(documentation PepticUlcers EnglishLanguage "The presence of
&%Ulcers in the &%Stomach.")
(diseaseMedicine Nizatidine PepticUlcers Ingesting)
(termFormat EnglishLanguage PepticUlcers "peptic ulcers")
(termFormat EnglishLanguage PepticUlcers "stomach ulcers")

(=>
  (attribute ?H PepticUlcers)
  (exists (?S ?U)
    (and
      (instance ?S Stomach)
      (instance ?U Ulcer)
      (part ?S ?H)
      (located ?U ?S))))

(subclass Tazac Nizatidine)
(termFormat EnglishLanguage Tazac "Tazac")

(subclass Axid Nizatidine)
(termFormat EnglishLanguage Axid "Axid")

(instance Bulimia PsychologicalDysfunction)
(documentation Bulimia EnglishLanguage "Bulimia nervosa, also known as
simply bulimia, is an eating disorder characterized by binge eating
followed by purging; and excessive concern with body shape and
weight. The aim of this activity is to expel the body of
calories eaten from the binging phase of the process. Binge eating
refers to eating a large amount of food in a short amount of time.
Purging refers to the attempts to get rid of the food consumed.
This may be done by vomiting or taking laxatives. Other efforts to
lose weight may include the use of diuretics, stimulants, water
fasting, or excessive exercise. Most people with bulimia are at
a normal weight. The forcing of vomiting may result in thickened
skin on the knuckles, breakdown of the teeth and effects on metabolic
rate and caloric intake which cause thyroid dysfunction.
Bulimia is frequently associated with other mental disorders such as
&%Depression, &%Anxiety, bipolar disorder and problems with drugs or
&%Alcohol. There is also a higher risk of &%Suicide and self-harm.
Clinical studies show a relationship between bulimia and vulnerable
narcissism as caused by childhood 'parental invalidation' leading to a
later need for social validation. [from Wikipedia]")
(termFormat EnglishLanguage Bulimia "bulimia")
(termFormat EnglishLanguage Bulimia "bulimia nervosa")

(=>
  (attribute ?H Bulimia)
  (exists (?E ?P)
    (and
      (instance ?E Eating)
      (or
        (instance ?P Vomiting)
        (instance ?P Defecating))
      (agent ?P ?H)
      (wants ?H ?P)
      (earlier
        (WhenFn ?E)
        (WhenFn ?P)))))

(instance Anorexia PsychologicalDysfunction)

(documentation Anorexia EnglishLanguage "Anorexia nervosa, often
referred to simply as anorexia, is an eating disorder
characterized by low weight, food restriction, body image disturbance,
fear of gaining weight, and an overpowering desire to be thin.
The symptom of hunger is frequently present and the pathological control
of this instinct is a source of satisfaction for the patients. [from
Wikipedia]")

(termFormat EnglishLanguage Anorexia "anorexia")
(termFormat EnglishLanguage Anorexia "anorexia nervosa")

(=>
  (attribute ?H Anorexia)
  (exists (?E)
    (and
      (instance ?E Eating)
      (agent ?E ?H)
      (needs ?H ?E)
      (not
        (wants ?H ?E)))))

(subclass Pyelonephritis (InflammationFn Kidney))
(documentation Pyelonephritis EnglishLanguage "Pyelonephritis is
&%Inflammation of the &%Kidney, typically due to a bacterial infection.
Symptoms most often include fever and flank tenderness. Other
symptoms may include nausea, burning with urination, and frequent
urination. Complications may include pus around the kidney, sepsis,
or kidney failure. It is typically due to a bacterial infection,
most commonly Escherichia coli. Risk factors include sexual
intercourse, prior urinary tract infections, diabetes, structural
problems of the urinary tract, and spermicide use. The mechanism
of infection is usually spread up the urinary tract. Less often
infection occurs through the bloodstream. Diagnosis is typically
based on symptoms and supported by urinalysis. If there is no
improvement with treatment, medical imaging may be recommended.[from
Wikipedia]")
(termFormat EnglishLanguage Pyelonephritis "pyelonephritis")
(termFormat EnglishLanguage Pyelonephritis "urosepsis")

(=>
  (attribute ?H Pyelonephritis)
  (modalAttribute
    (exists (?B ?K)
      (and
        (instance ?B Bacterium)
        (instance ?K Kidney)
        (part ?K ?H)
        (located ?B ?K)))
    Likely))

(subclass Ondansetron Medicine)
(documentation Ondansetron EnglishLanguage "Ondansetron, sold under the
brand name Zofran among others, is a medication used to prevent &%Nausea
and &%Vomiting caused by cancer chemotherapy, radiation therapy, or
surgery. It is also effective for treating gastroenteritis.
It is ineffective for treating vomiting caused by motion sickness.
It can be given by &%Mouth or by injection into a &%Muscle or into a &%Vein.
Common side effects include &%Diarrhea, constipation, &%Headache,
sleepiness, and itchiness. [from Wikipedia]")
(termFormat EnglishLanguage Ondansetron "ondansetron")
(diseaseMedicine Ondansetron Nausea Injecting)
(diseaseMedicine Ondansetron Nausea Ingesting)
(diseaseMedicine Ondansetron Vomiting Injecting)
(diseaseMedicine Ondansetron Vomiting Ingesting)
(sideEffect Ondansetron Diarrhea)
(sideEffect Ondansetron Headache)

(subclass Zofran Ondansetron)
(termFormat EnglishLanguage Zofran "Zofran")

(subclass RectalTenesmus DiseaseOrSyndrome)

(documentation RectalTenesmus EnglishLanguage "Rectal tenesmus is a
feeling of incomplete defecation. It is the sensation of inability or
difficulty to empty the bowel at defecation, even if the bowel
contents have already been evacuated. Tenesmus indicates the feeling
of a residue, and is not always correlated with the actual presence of
residual fecal matter in the rectum. It is frequently painful and may
be accompanied by involuntary straining and other gastrointestinal
symptoms. Tenesmus has both a nociceptive and a neuropathic
component.[from Wikipedia]")
(termFormat EnglishLanguage RectalTenesmus "tenesmus")
(termFormat EnglishLanguage RectalTenesmus "rectal tenesmus")

(=>
  (holdsDuring ?T
    (attribute ?H RectalTenesmus))
  (holdsDuring ?T
    (and
      (desires ?H
        (exists (?D)
          (and
            (instance ?D Defecation)
            (agent ?D ?H))))
      (not
        (needs ?H
          (exists (?D)
            (and
              (instance ?D Defecation)
              (agent ?D ?H))))))))

(subclass StripMall ShoppingMall)
(documentation StripMall EnglishLanguage "A shopping mall where
shops border a parking lot and there is no enclosed space for
transiting between shops.")

(=>
  (and
    (instance ?SM StripMall)
    (instance ?RS1 RetailStore)
    (part ?RS1 ?SM)
    (instance ?RS2 RetailStore)
    (part ?RS2 ?SM)
    (not
      (equal ?RS1 ?RS2)))
  (not
    (exists (?H)
      (and
        (instance ?H Hallway)
        (connects ?RS1 ?H ?RS2)))))

(=>
  (and
    (instance ?SM StripMall)
    (instance ?RS1 RetailStore)
    (part ?RS1 ?SM))
  (exists (?PL)
    (and
      (instance ?PL ParkingLot)
      (orientation ?RS1 ?PL Adjacent))))

(subclass DermatographicUrticaria Urticaria)
(documentation DermatographicUrticaria EnglishLanguage "Dermatographic
urticaria is a skin disorder and one of the most common types of
urticaria, affecting 2–5% of the population. The condition manifests
as an allergic-like reaction, causing a warm red wheal to appear on
the skin. As it is often the result of scratches, involving contact
with other materials, it can be confused with an allergic reaction,
when in fact it is the act of being scratched that causes a wheal to
appear. These wheals are a subset of urticaria (hives), and appear
within minutes, in some cases accompanied by itching. The first
outbreak of urticaria can lead to other reactions on body parts not
directly stimulated, scraped, or scratched. In a normal case, the
swelling will decrease without treatment within 15–30 minutes, but, in
extreme cases, itchy red welts may last anywhere from a few hours to
days.[from Wikipedia]")
(termFormat EnglishLanguage DermatographicUrticaria "dermatographic urticaria")
(termFormat EnglishLanguage DermatographicUrticaria "dermatographia")

(instance BrainDead DiseaseOrSyndrome)

(documentation BrainDead EnglishLanguage "Brain death is the complete
loss of &%Brain function, including involuntary activity necessary to
sustain life. It differs from persistent vegetative state,
in which the person is &%Living and some autonomic functions remain.
It is also distinct from an ordinary coma, whether induced medically
or caused by injury and/or illness, even if it is very deep, as long
as some brain and bodily activity and function remain; and it is also
not the same as the condition locked-in syndrome. A differential
diagnosis can medically distinguish these differing conditions.[from
Wikipedia]")
(termFormat EnglishLanguage BrainDead "brain dead")
(equal BrainDead (DeadOrMissingBodyPartFn Brain))

(instance Walmart RetailStore)
(headquartersOfOrganization Walmart Arkansas)

(documentation Walmart EnglishLanguage "Walmart Inc. is an American
multinational retail corporation that operates a chain of hypermarkets
(also called supercenters), discount department stores, and grocery
stores from the United States, headquartered in Bentonville, &%Arkansas.
The company was founded by Sam Walton in nearby Rogers, Arkansas in
1962. Walmart is the world's largest company by revenue, with
US$548.743 billion, according to the Fortune Global 500 list in 2020.
It is also the largest private employer in the world with 2.2 million
employees. [from Wikipedia]")
(termFormat EnglishLanguage Walmart "Walmart")

(instance Coma DiseaseOrSyndrome)
(subAttribute Coma Unconscious)
(documentation Coma EnglishLanguage "A coma is a deep state of
prolonged unconsciousness in which a person cannot be awakened, fails
to respond normally to painful stimuli, light, or sound, lacks a
normal wake-sleep cycle and does not initiate voluntary actions.[1]
Coma patients exhibit a complete absence of wakefulness and are unable
to consciously feel, speak or move. Comas can be derived by natural
causes, or can be medically induced. [from Wikipedia]")
(termFormat EnglishLanguage Coma "coma")

(=>
  (holdsDuring ?T
    (attribute ?H Coma))
  (not
    (exists (?IP)
      (and
        (instance ?IP IntentionalProcess)
        (agent ?IP ?H)
        (during ?T
          (WhenFn ?IP))))))

(instance AllergicRhinitis AllergicReaction)
(subAttribute AllergicRhinitis (InflammationFn Nose))

(documentation AllergicRhinitis EnglishLanguage "Allergic rhinitis, also
known as hay fever, is a type of inflammation in the nose that occurs
when the immune system overreacts to allergens in the air. Signs
and symptoms include a runny or stuffy nose, sneezing, red, itchy, and
watery eyes, and swelling around the eyes. The fluid from the nose
is usually clear. Symptom onset is often within minutes following
allergen exposure, and can affect sleep and the ability to work or
study. Some people may develop symptoms only during specific
times of the year, often as a result of pollen exposure. Many people
with allergic rhinitis also have asthma, allergic conjunctivitis, or
atopic dermatitis.[from Wikipedia]")

(termFormat EnglishLanguage AllergicRhinitis "allergic rhinitis")
(termFormat EnglishLanguage AllergicRhinitis "hay fever")

(subclass Levocetirizine Antihistamine)
(documentation Levocetirizine EnglishLanguage "Levocetirizine, sold
under the brand name Xyzal among others, is a third generation
antihistamine used for the treatment of allergic rhinitis (hay fever)
and long term hives of unclear cause. It is less sedating than
older antihistamines. It is taken by mouth. Common side effects
include sleepiness, dry mouth, cough, vomiting, and diarrhea.[from
Wikipedia]")
(sideEffect Levocetirizine Vomiting)
(sideEffect Levocetirizine Diarrhea)
(diseaseMedicine Hives Levocetirizine Ingesting)
(diseaseMedicine AllergicRhinitis Levocetirizine Ingesting)

(subclass Xyzal Levocetirizine)
(termFormat EnglishLanguage Xyzal "Xyzal")

(subclass Sarilumab MonoclonalAntibody)

(documentation Sarilumab EnglishLanguage "Sarilumab, sold under the
brand name Kevzara, is a human monoclonal antibody medication against
the interleukin-6 receptor. Regeneron Pharmaceuticals and Sanofi
developed the drug for the treatment of rheumatoid arthritis (RA), for
which it received US FDA approval on 22 May 2017 and European
Medicines Agency approval on 23 June 2017.[from Wikipedia]")
(termFormat EnglishLanguage Sarilumab "sarilumab")
(diseaseMedicine RheumatoidArthritis Sarilumab Injecting)

(subclass Kevzara Sarilumab)
(termFormat EnglishLanguage Kevzara "Kevzara")

(subclass FaecalibacteriumPrausnitzii Bacterium)

(documentation FaecalibacteriumPrausnitzii EnglishLanguage "Faecalibacterium
prausnitzii is gram-positive, mesophilic, rod-shaped, anaerobic and is one of
the most abundant and important commensal bacteria of the human gut microbiota.
It is non-spore forming and non-motile. These bacteria produce butyrate and
other short-chain fatty acids through the fermentation of dietary fiber.[from
Wikipedia]")

(termFormat EnglishLanguage FaecalibacteriumPrausnitzii "faecalibacterium prausnitzii")

(=>
  (instance ?F FaecalibacteriumPrausnitzii)
  (modalAttribute
    (exists (?H ?G)
      (and
        (instance ?H Human)
        (instance ?G GastroIntestinalTract)
        (part ?G ?H)
        (located ?F ?G)))
    Likely))

(subclass CrossFit FitnessExercise)
(documentation CrossFit EnglishLanguage "A form of exercise with a trademarked
name and affiliated gyms that implement a program of workouts that include
weightlifting, aerobic exercise and plyometrics with an emphasis on intense
interval training.")
(termFormat EnglishLanguage CrossFit "CrossFit")

(instance Reinfection DiseaseOrSyndrome)
(documentation Reinfection EnglishLanguage "Getting an &%InfectiousDisease
two or more times.")
(termFormat EnglishLanguage Reinfection "reinfection")

(=>
  (holdsDuring ?T
    (attribute ?H Reinfection))
  (and
    (holdsDuring ?T
      (and
        (instance ?D InfectiousDisease)
        (attribute ?H ?D)))
    (holdsDuring ?TEARLY
      (attribute ?H ?D))
    (earlier ?TEARLY ?T)))

(instance Hypersalivation DiseaseOrSyndrome)
(documentation Hypersalivation EnglishLanguage "Generation of too
much saliva, which can result in &%Spitting or &%Drooling or
&%Nausea from swallowing,")
(termFormat EnglishLanguage Hypersalivation "hypersalivation")

(=>
  (holdsDuring ?T
    (attribute ?H Hypersalivation))
  (modalAttribute
    (exists (?S)
      (and
        (experiencer ?S ?H)
        (during
          (WhenFn ?S)
          ?T)
        (or
          (instance ?S Spitting)
          (instance ?S Drooling)
          (instance ?S Nausea))))
    Likely))

(subclass GramStaining Coloring)
(subclass GramStaining Investigating)

(documentation GramStaining EnglishLanguage "Gram stain or Gram
staining, also called Gram's method, is a method of staining used to
distinguish and classify bacterial species (&%Bacterium) into two
large groups: &%GramPositive bacteria and &%GramNegative bacteria.
Gram staining differentiates bacteria by the chemical and physical
properties of their cell walls. Gram-positive cells have a thick layer
of peptidoglycan in the cell wall that retains the primary stain,
crystal violet. Gram-negative cells have a thinner peptidoglycan layer
that allows the crystal violet to wash out on addition of &%Ethanol.
They are stained pink or red by the counterstain commonly safranin or
fuchsine. Lugol's iodine solution is always added after addition of
crystal violet to strengthen the bonds of the stain with the cell
membrane. [from Wikipedia]")

(termFormat EnglishLanguage GramStaining "Gram staining")
(termFormat EnglishLanguage GramStaining "Gram stain")

(=>
  (instance ?G GramStaining)
  (exists (?B)
    (and
      (instance ?B Bacterium)
      (patient ?G ?B))))

(=>
  (and
    (instance ?G GramStaining)
    (agent ?G ?H)
    (patient ?G ?B))
  (hasPurpose ?G
    (knows ?H
      (exists (?S)
        (and
          (instance ?S GramStainAttribute)
          (attribute ?B ?S))))))

(subclass GramStainAttribute RelationalAttribute)
(termFormat EnglishLanguage GramStainAttribute "Gram stain")

(instance GramPositive GramStainAttribute)

(documentation GramPositive EnglishLanguage "In bacteriology,
gram-positive bacteria are bacteria that give a positive result in
&%GramStaining, which is traditionally used to quickly classify
bacteria (&%Bacterium) into two broad categories according to their
type of cell wall. Gram-positive bacteria take up the crystal violet
stain used in the test, and then appear to be purple-coloured when
seen through an optical microscope. This is because the thick
peptidoglycan layer in the bacterial &%Cell wall retains the stain after
it is washed away from the rest of the sample, in the decolorization
stage of the test. [from Wikipedia]")
(termFormat EnglishLanguage GramPositive "Gram-positive")

(instance GramNegative GramStainAttribute)

(documentation GramNegative EnglishLanguage "Gram-negative bacteria
are bacteria (&%Bacterium) that do not retain the crystal violet stain
used in the &%GramStaining method of bacterial differentiation. They
are characterized by their cell envelopes, which are composed of a
thin peptidoglycan cell wall sandwiched between an inner cytoplasmic
&%CellMembrane and a bacterial outer membrane. Gram-negative bacteria
are found in virtually all environments on Earth that support life.
The gram-negative bacteria include the model organism Escherichia
coli, as well as many pathogenic bacteria, such as Pseudomonas
aeruginosa, Chlamydia trachomatis, and &%YersiniaPestis. They are an
important medical challenge, as their outer membrane protects them
from many &%Antibiotics (including &%Penicillin), &%Detergents that
would normally damage the inner cell membrane, and lysozyme, an
antimicrobial &%Enzyme produced by animals that forms part of the
innate immune system. Additionally, the outer leaflet of this membrane
comprises a complex lipopolysaccharide (LPS) whose lipid A component
can cause a toxic reaction when bacteria are lysed by immune cells.
This toxic reaction lead to low blood pressure, respiratory failure,
reduced oxygen delivery, and lactic acidosis—a life-threatening
condition known as septic shock. Several classes of antibiotics have
been designed to target gram-negative bacteria, including
aminopenicillins, ureidopenicillins, cephalosporins,
beta-lactam-betalactamase inhibitor combinations (e.g.
piperacillin-tazobactam), Folate antagonists, quinolones, and
carbapenems. Many of these antibiotics also cover &%GamPositive
organisms. The drugs that specifically target gram negative organisms
include aminoglycosides, monobactams (aztreonam) and ciprofloxacin.
[from Wikipedia]")

(termFormat EnglishLanguage GramNegative "Gram-negative")

(instance GramVariable GramStainAttribute)
(termFormat EnglishLanguage GramVariable "Gram-variable")

(instance GramIndeterminate GramStainAttribute)
(termFormat EnglishLanguage GramIndeterminate "Gram-indeterminate")

(subclass Aminopenicillin Penicillin)

(documentation Aminopenicillin EnglishLanguage "The aminopenicillins
are a group of &%Antibiotics in the &%Penicillin family that are
structural analogs of ampicillin (which is the 2-amino derivative of
benzylpenicillin, hence the name). Like other penicillins and
beta-lactam antibiotics, they contain a beta-lactam ring that is
crucial to its antibacterial activity. Aminopenicillins feature a
positively charged amino group that enhances their uptake through
bacterial porin channels. This does not, however, prevent resistance
conferred by bacterial beta-lactamases. Members of this family
include ampicillin, amoxicillin and bacampicillin.[from Wikipedia]")

(termFormat EnglishLanguage Aminopenicillin "aminopenicillin")

(instance Ampicillin Aminopenicillin)
(termFormat EnglishLanguage Ampicillin "ampicillin")

(instance Amoxicillin Aminopenicillin)
(termFormat EnglishLanguage Amoxicillin "amoxicillin")

(instance Bacampicillin Aminopenicillin)
(termFormat EnglishLanguage Bacampicillin "bacampicillin")

(subclass EscherichiaColi Bacterium)

(documentation EscherichiaColi EnglishLanguage "Escherichia coli
is a &%GramNegative, facultative anaerobic, rod-shaped,
coliform &%Bacterium of the genus Escherichia that is commonly found in
the lower &%Intestine of warm-blooded organisms (endotherms). Most
E. coli strains are harmless, but some serotypes (EPEC, ETEC etc.) can
cause serious food poisoning in their hosts, and are occasionally
responsible for food contamination incidents that prompt product
recalls. The harmless strains are part of the normal microbiota
of the gut, and can benefit their hosts by producing vitamin K2,
(which helps blood to clot) and preventing colonisation of the
intestine with pathogenic bacteria, having a mutualistic
relationship. E. coli is expelled into the environment within
&%Feces. The bacterium grows massively in fresh fecal matter
under aerobic conditions for 3 days, but its numbers decline slowly
afterwards.[from Wikipedia]")

(termFormat EnglishLanguage EscherichiaColi "Escherichia coli")
(termFormat EnglishLanguage EscherichiaColi "E. coli")

(=>
  (instance ?E EscherichiaColi)
  (attribute ?E GramNegative))

(=>
  (instance ?E EscherichiaColi)
  (cellShape ?E Cylinder))

(=>
  (and
    (instance ?I Intestine)
    (instance ?A Animal)
    (part ?I ?A))
  (modalAttribute
    (exists (?E)
      (and
        (instance ?E EscherichiaColi)
        (contains ?I ?E)))
    Likely))

(subclass Sepsis AutoImmuneDisorder)

(documentation Sepsis EnglishLanguage "Sepsis is a life-threatening
condition that arises when the body's response to infection causes
injury to its own &%Tissues and &%Organs. This initial stage is
followed by suppression of the immune system. Common signs and
symptoms include &%Fever, increased &%heartRate, increased breathing
rate, and confusion. There may also be symptoms related to a specific
infection, such as a &%Cough with &%Pneumonia, or painful &%Urination
with a &%Kidney infection. The very young, old, and people with a
weakened immune system may have no symptoms of a specific infection,
and the body temperature may be low or normal instead of having a
fever. Severe sepsis causes poor organ function or blood flow. The
presence of low blood pressure (&%systoligBloodPressure and/or
&%diastolicBloodPressure), high blood lactate, or low &%Urine output may
suggest poor blood flow. Septic shock is low blood pressure due to
sepsis that does not improve after fluid replacement. Sepsis is
caused by many &%Organisms including a &%Bacterium, &%Virus or
&%Fungus.[from Wikipedia]")

(termFormat EnglishLanguage Sepsis "septicemia")
(termFormat EnglishLanguage Sepsis "sepsis")
(termFormat EnglishLanguage Sepsis "blood poisoning")
(termFormat EnglishLanguage Sepsis "septic shock")

(=>
  (and
    (instance ?S Sepsis)
    (experiencer ?S ?H))
  (exists (?I)
    (and
      (instance ?I Infecting)
      (experiencer ?I ?H)
      (causes ?I ?S))))

(subclass Upadacitinib Medicine)

(documentation Upadacitinib EnglishLanguage "Upadacitinib, sold under
the brand name &%Rinvoq, is a Janus kinase (JAK) inhibitor medication
for the treatment of moderately to severely active
&%RheumatoidArthritis in adults where methotrexate (a drug used to
treat active arthritis) did not work well or could not be tolerated.
It was developed by the biotech company &%AbbVie. Common side effects
include upper respiratory tract infections (common cold, sinus
infections), &%Nausea, &%Cough, and &%Fever.[from Wikipedia]")
(diseaseMedicine Upadacitinib RheumatoidArthritis Ingesting)
(sideEffect Upadacitinib Nausea)
(sideEffect Upadacitinib Fever)
(termFormat EnglishLanguage Upadacitinib "upadacitinib")

(subclass Rinvoq Upadacitinib)
(termFormat EnglishLanguage Rinvoq "Rinvoq")
(manufacturer Rinvoq AbbVie)

(instance Aetna HealthInsuranceCompany)
(termFormat EnglishLanguage Aetna "Aetna")
(subOrganization Aetna CVS)
(headquartersOfOrganization Aetna Connecticut)

(instance UnitedHealth HealthInsuranceCompany)
(termFormat EnglishLanguage UnitedHealth "United Health")

(instance KaiserFoundation HealthInsuranceCompany)
(termFormat EnglishLanguage KaiserFoundation "Kaiser Foundation")

(instance AnthemInc HealthInsuranceCompany)
(termFormat EnglishLanguage AnthemInc "Anthem Inc")

(instance CenteneCorporation HealthInsuranceCompany)
(termFormat EnglishLanguage CenteneCorporation "Centene Corporation")

(instance Humana HealthInsuranceCompany)
(termFormat EnglishLanguage Humana "Humana")

(instance CVS HealthInsuranceCompany)
(termFormat EnglishLanguage CVS "CVS")

(instance HealthCareServiceCorporation HealthInsuranceCompany)
(termFormat EnglishLanguage HealthCareServiceCorporation "Health Care Service Corporation")

(instance CIGNA HealthInsuranceCompany)
(termFormat EnglishLanguage CIGNA "CIGNA")

(instance MolinaHealthcare HealthInsuranceCompany)
(termFormat EnglishLanguage MolinaHealthcare "Molina Healthcare")

(instance IndependenceHealthGroup HealthInsuranceCompany)
(termFormat EnglishLanguage IndependenceHealthGroup "Independence Health Group")

(instance BlueCrossBlueShield Organization)

(documentation BlueCrossBlueShield EnglishLanguage "Blue Cross Blue
Shield Association (BCBSA) is a federation of 35 separate United
States health insurance companies that provide health insurance in the
United States to more than 106 million people. It is incorporated as
a 501(c)(4) public welfare organization. [from Wikipedia]")
(termFormat EnglishLanguage BlueCrossBlueShield "Blue Cross Blue Shield")

(instance Othena WebSite)
(termFormat EnglishLanguage Othena "Othena")
(documentation BlueCrossBlueShield EnglishLanguage "Othena.com is Orange
County’s Public Health Service digital platform.")

(subclass Hydroxychloroquine AntiParasitic)
(documentation Hydroxychloroquine EnglishLanguage
"Hydroxychloroquine, sold under the brand name Plaquenil among others,
is a medication used to prevent and treat malaria in areas where
malaria remains sensitive to chloroquine. Other uses include treatment
of rheumatoid arthritis, lupus, and porphyria cutanea tarda. It is
taken by mouth, often in the form of hydroxychloroquine sulfate.
Common side effects may include vomiting, headache, changes in vision,
and muscle weakness. [from Wikipedia]")
(termFormat EnglishLanguage Hydroxychloroquine "hydroxychloroquine")
(diseaseMedicine Malaria Hydroxychloroquine Ingesting)
(diseaseMedicine RheumatoidArthritis Hydroxychloroquine Ingesting)
(diseaseMedicine Lupus Hydroxychloroquine Ingesting)
(sideEffect Hydroxychloroquine Vomiting)
(sideEffect Hydroxychloroquine Headache)

(subclass Plaquenil Hydroxychloroquine)
(termFormat EnglishLanguage Plaquenil "Plaquenil")

(subclass Chlorpheniramine Antihistamine)

(documentation Chlorphenamine EnglishLanguage "Chlorphenamine (CP,
CPM), also known as chlorpheniramine, is an &%Antihistamine used to
treat the symptoms of allergic conditions such as &%AllergicRhinitis
(hay fever). It is taken by mouth. Common side effects include
sleepiness, restlessness, and weakness.[from Wikipedia]")

(termFormat EnglishLanguage Chlorphenamine "chlorphenamine")
(termFormat EnglishLanguage Chlorphenamine "chlorpheniramine")
(diseaseMedicine AllergicRhinitis Chlorpheniramine Ingesting)

(subclass Phlegm Mucus)
(documentation Phlegm EnglishLanguage "&%Mucus produced by the &%Lungs,
which may later be expelled as &%Sputum.")

(instance LowBodyTemperature BiologicalAttribute)
(documentation LowBodyTemperature EnglishLanguage "A body temperature
below 97 &%FahrenheitDegrees.")
(termFormat EnglishLanguage LowBodyTemperature "low body temperature")

(=>
  (holdsDuring ?T
    (attribute ?H LowBodyTemperature))
  (holdsDuring ?T
    (and
      (measure ?H
        (MeasureFn ?N FahrenheitDegree))
      (lessThan ?N 97))))

(subclass HumanBack BodyPart)
(documentation HumanBack EnglishLanguage "The back of the &%Torso of a
&%Human.")
(termFormat EnglishLanguage HumanBack "back")

(=>
  (instance ?B HumanBack)
  (exists (?P ?T)
    (and
      (instance ?P Human)
      (instance ?T Torso)
      (part ?T ?P)
      (equal ?B (BackFn ?T)))))

(subclass MucusMembrane CellMembrane)
(secretesSubstance MucusMembrane Mucus)

(documentation MucusMembrane EnglishLanguage "A mucous membrane or
mucosa is a membrane that lines various &%BodyCavities and covers the
surface of internal &%Organs. It consists of one or more layers of
epithelial cells overlying a layer of loose connective &%Tissue. It is
mostly of endodermal origin and is continuous with the skin at body
openings such as the &%Eyes, &%Ears, inside the &Nose, inside the
&%Mouth, &%Lip, &%Vagina, the urethral opening and the &%Anus. Some
mucous membranes secrete mucus, a thick protective fluid. The function
of the membrane is to stop pathogens and dirt from entering the body
and to prevent bodily &%Tissues from becoming dehydrated.[from
Wikipedia]")
(termFormat EnglishLanguage MucusMembrane "mucus membrane")
(termFormat EnglishLanguage MucusMembrane "mucosa")

(subclass Sinusitis DiseaseOrSyndrome)

(documentation Sinusitis EnglishLanguage "Sinusitis is inflammation of
the mucous membranes that line the sinuses (&%NavalCavity) resulting
in symptoms that may include thick nasal &%Mucus, a plugged &%Nose,
and facial &%Pain. Other signs and symptoms may include &%Fever,
&%Headaches, a poor sense of smell, sore throat, and &%Coughing. It is
defined as acute sinusitis if it lasts less than 4 weeks, and as
chronic sinusitis if it lasts for more than 12 weeks. Sinusitis can be
caused by infection, allergies, air pollution, or structural problems
in the nose. Most cases are caused by a viral infection. Recurrent
episodes are more likely in persons with &%Asthma, cystic fibrosis,
and poor immune function. Pain killers such as naproxen, nasal
&%Steroids, and nasal irrigation may be used to help with symptoms. If
symptoms do not improve in 7–10 days or get worse, then an antibiotic
may be used or changed. In those in whom &%Antibiotics are used,
either amoxicillin or &%Amoxicillin/clavulanate is recommended.[from
Wikipedia]")
(termFormat EnglishLanguage Sinusitis "sinusitis")
(termFormat EnglishLanguage Sinusitis "sinus infection")

(=>
  (holdsDuring ?T
    (attribute ?H Sinusitis))
  (exists (?NC ?NCH ?I)
    (and
      (instance ?NC NasalCavity)
      (equal ?NCH (HoleHostFn ?NC))
      (part ?NCH ?H)
      (instance ?I Inflammation)
      (during (WhenFn ?I) ?T)
      (patient ?I ?NCH))))

(instance HeartDisease DiseaseOrSyndrome)

(documentation HeartDisease EnglishLanguage "Cardiovascular disease
(CVD) is a class of diseases that involve the heart or blood
vessels. CVD includes coronary artery diseases (CAD) such as angina
and myocardial infarction (commonly known as a &%HeartAttack). Other
CVDs include stroke, heart failure, hypertensive heart disease,
rheumatic heart disease, cardiomyopathy, abnormal heart rhythms,
congenital heart disease, valvular heart disease, carditis, aortic
aneurysms, peripheral artery disease, thromboembolic disease, and
venous thrombosis.[from Wikipedia]")
(termFormat EnglishLanguage HeartDisease "heart disease")
(termFormat EnglishLanguage HeartDisease "cardiovascular disease")

(=>
  (attribute ?H HeartDisease)
  (or
    (attribute ?H (ImpairedBodyPartFn Heart))
    (attribute ?H (ImpairedBodyPartFn BloodVessel))))

(instance OxygenatedBlood SaturationAttribute)
(documentation OxygenatedBlood EnglishLanguage "The concentrations of &%Oxygen is 20%
and that of &%CarbonDioxide is 4% in oxygenated blood. from doi: 10.1183/20734735.001415")
(termFormat EnglishLanguage OxygenatedBlood "oxygenated blood")

(=>
  (and
    (instance ?B Blood)
    (attribute ?B OxygenatedBlood)
    (concentration
      (MeasureFn ?N Milliliter) Oxygen
      (MeasureFn 100 Milliliter) ?B))
  (approximateValue ?N 20))

(=>
  (and
    (instance ?B Blood)
    (attribute ?B OxygenatedBlood)
    (concentration
      (MeasureFn ?N Milliliter) CarbonDioxide
      (MeasureFn 100 Milliliter) ?B))
  (approximateValue ?N 5))

(instance DeoxygenatedBlood Blood)
(documentation DeoxygenatedBlood EnglishLanguage "The concentrations of &%Oxygen is 14%
and that of &%CarbonDioxide is 4% in deoxygenated blood. from doi: 10.1183/20734735.001415")
(termFormat EnglishLanguage DeoxygenatedBlood "deoxygenated blood")

(=>
  (and
    (instance ?B Blood)
    (attribute ?B DeoxygenatedBlood)
    (concentration
      (MeasureFn ?N Milliliter) Oxygen
      (MeasureFn 100 Milliliter) ?B))
  (approximateValue ?N 14))

(=>
  (and
    (instance ?B Blood)
    (attribute ?B DeoxygenatedBlood)
    (concentration
      (MeasureFn ?N Milliliter) CarbonDioxide
      (MeasureFn 100 Milliliter) ?B))
  (approximateValue ?N 4))

(instance Shock DiseaseOrSyndrome)
(documentation Shock EnglishLanguage "Shock is the state of insufficient &%Blood flow to the &%Tissues of the
body as a result of problems with the circulatory system. Initial symptoms of shock may include weakness,
fast &%heartRate, fast breathing, &%Perspiring, &%Anxiety, and an increase to being &%Thirsty. This may be
followed by confusion, being &%Unconsciousness, or cardiac arrest, as complications worsen.
Shock is divided into four main types based on the underlying cause: low volume, cardiogenic, obstructive,
and distributive shock. Low volume shock, also known as hypovolemic shock, may be from &%Bleeding, &%Diarrhea,
or &%Vomiting. Cardiogenic shock may be due to a heart attack or cardiac contusion. Obstructive shock may be
due to cardiac tamponade or a tension &%Pneumothorax. Distributive shock may be due to &%Sepsis, &%Anaphylaxis,
injury to the upper &%SpinalCord, or certain overdoses.[from Wikipedia]")
(termFormat EnglishLanguage Shock "shock")

(=>
  (attribute ?H Shock)
  (exists (?T)
    (and
      (instance ?T Tissue)
      (part ?T ?H)
      (not
        (exists (?OB)
          (and
            (attribute ?OB OxygenatedBlood)
            (part ?OB ?T)))))))

(subAttribute LowVolumeShock Shock)
(termFormat EnglishLanguage LowVolumeShock "low volume shock")
(subAttribute CardiogenicShock Shock)
(termFormat EnglishLanguage CardiogenicShock "cardiogenic shock")
(subAttribute ObstructiveShock Shock)
(termFormat EnglishLanguage ObstructiveShock "obstructive shock")
(subAttribute DistributiveShock Shock)
(termFormat EnglishLanguage DistributiveShock "distributive shock")

(instance diseaseTreatment BinaryPredicate)
(domain diseaseTreatment 1 DiseaseOrSyndrome)
(domainSubclass diseaseTreatment 2 TherapeuticProcess)
(documentation diseaseTreatment EnglishLanguage "A reasonable treatment for the given &%DiseaseOrSyndrome
is the given &%TherapeuticProcess.")
(format EnglishLanguage diseaseTreatment "%2 is a &%treatment for %1")

(=>
  (and
    (attribute ?H ?D)
    (diseaseTreatment ?D ?P)
    (instance ?TP TherpeuticProcess)
    (agent ?TP ?DOC)
    (patient ?TP ?H)
    (attribute ?DOC MedicalDoctor))
  (modalAttribute
    (instance ?TP ?P)
    Possibility))

(subclass RingersLactate Mixture)
(documentation RingersLactate EnglishLanguage "Ringer's lactate solution (RL), also known as sodium lactate
solution, Lactated Ringer’s, and Hartmann's solution, is a mixture of sodium chloride,
potassium chloride, and calcium chloride in water. It is used for replacing fluids and electrolytes in
those who have low blood volume or low blood pressure. It may also be used to treat metabolic acidosis
and to wash the &%Eye following a chemical burn. It is given by intravenous infusion or applied to the
affected area.[from Wikipedia].")

(termFormat EnglishLanguage RingersLactate "Ringer's lactate solution")
(termFormat EnglishLanguage RingersLactate "RL")
(termFormat EnglishLanguage RingersLactate "sodium lactate solution")
(termFormat EnglishLanguage RingersLactate "Lactated Ringer’s")
(termFormat EnglishLanguage RingersLactate "Hartmann's solution")

(=>
  (and
    (instance ?B Blood)
    (instance ?SL RingersLactate)
    (tonicity ?SL ?B (MeasureFn ?N Pascal)))
  (approximateValue ?N 0.0))

(instance mixturePartType BinaryPredicate)
(domainSubclass mixturePartType 1 Substance)
(domainSubclass mixturePartType 2 Mixture)
(documentation mixturePartType EnglishLanguage "The relation states that the given class of &%Substance is
part of the given class of &%Mixture.")
(format EnglishLanguage mixturePartType "%1 is a part of the &%mixture %2")

(subclass CalciumChloride ChemicalSalt)
(molecularRatio Chlorine 2 CalciumChloride)
(molecularRatio Calcium 1 CalciumChloride)

(molecularRatio Chlorine 1 SodiumChloride)
(molecularRatio Sodium 1 SodiumChloride)

(subclass PotassiumChloride ChemicalSalt)
(molecularRatio Chlorine 1 PotassiumChloride)
(molecularRatio Potassium 1 PotassiumChloride)

(subclass SodiumLactate ChemicalSalt)
(molecularRatio Sodium 1 SodiumLactate)
(molecularRatio Carbon 3 SodiumLactate)
(molecularRatio Hydrogen 5 SodiumLactate)
(molecularRatio Oxygen 3 SodiumLactate)

(mixturePartType SodiumChloride RingersLactate)
(mixturePartType CalciumChloride RingersLactate)
(mixturePartType PotassiumChloride RingersLactate)
(mixturePartType SodiumLactate RingersLactate)
(mixturePartType Water SodiumLactate)

; CardiacArrest

(instance bloodVolume BinaryPredicate)
(domain bloodVolume 1 Human)
(domain bloodVolume 2 VolumeMeasure)
(documentation bloodVolume EnglishLanguage "The &%Quantity of &%Blood present in a &%Human. A
&%Liter of blood weights 2.33 pounds (according to https://www.aqua-calc.com/calculate/volume-to-weight)
or 1060 kg/m3 (Wikipedia) and 7 percent of a &%HumanAdult's weight.")
(format EnglishLanguage bloodVolume "%1 &%has %2 of blood")

(=>
  (bloodVolume ?H ?V)
  (and
    (exists (?B)
      (and
        (instance ?B Blood)
        (contains ?H ?B)
        (instance ?H Human)
        (measure ?B ?V)))
    (not
      (exists (?B2)
         (and
           (instance ?B2 Blood)
           (contains ?H ?B2)
           (not
             (piece ?B2 ?B)))))))


(=>
  (and
    (instance ?H HumanAdult)
    (measure ?H
      (MeasureFn ?N Pounds)))
  (and
    (bloodVolume ?H (MeasureFn ?N2 Liter))
    (equal ?N2
      (DivisionFn
        (MultiplicationFn ?N 0.07) 2.33))))

(instance typicalBloodVolume BinaryPredicate)
(domainSubclass typicalBloodVolume 1 Mammal)
(domain typicalBloodVolume 2 VolumeMeasure)
(documentation typicalBloodVolume EnglishLanguage "The typical, approximate volume of &%Blood for
the given class of &%Mammal.")
(format EnglishLanguage typicalBloodVolume "the typical &%volume of blood of a %1 is %2")

(=>
  (and
    (typicalBloodVolume ?M
      (MeasureFn ?N ?U))
    (instance ?MI ?M)
    (holdsDuring ?T
      (and
        (not
          (attribute ?H DiseaseOrSyndrome))
        (bloodVolume ?H
          (MeasureFn ?N2 ?U)))))
  (approximateValue ?N2 ?N))

(instance CatastrophicBloodLoss DiseaseOrSyndrome)
(documentation CatastrophicBloodLoss EnglishLanguage "Loss of 50% or more of the blood volume of a &%Human.")
(termFormat EnglishLanguage CatastrophicBloodLoss "catastrophic blood loss")

(=>
  (and
    (typicalBloodVolume ?M
      (MeasureFn ?N ?U))
    (holdsDuring ?T
      (bloodVolume ?H
        (MeasureFn ?N2 ?U)))
    (instance ?H ?M)
    (lessThan
      (MultiplicationFn ?N2 2.0)
      ?N))
  (holdsDuring ?T
    (attribute ?H CatastrophicBloodLoss)))

(instance SevereBloodLoss DiseaseOrSyndrome)
(documentation SevereBloodLoss EnglishLanguage "Loss of 20-50% of the blood volume of a &%Human.")
(termFormat EnglishLanguage SevereBloodLoss "severe blood loss")

(=>
  (and
    (typicalBloodVolume ?M
      (MeasureFn ?N ?U))
    (holdsDuring ?T
      (bloodVolume ?H
        (MeasureFn ?N2 ?U)))
    (instance ?H ?M)
    (greaterThan
      (MultiplicationFn ?N2 2.0)
      ?N)
    (lessThan ?N2
      (MultiplicationFn 0.8 ?N)))
  (holdsDuring ?T
    (attribute ?H SevereBloodLoss)))

(subclass Transfusion IVTherapy)
(documentation Transfusion EnglishLanguage "Giving &%Blood to an &%Animal, typically as a
&%TherapeuticProcess in response to significant prior loss of &%Blood caused by &%Injuring
or &%Surgery.")
(termFormat EnglishLanguage Transfusion "transfusion")

(=>
  (instance ?T Transfusion)
  (exists (?B)
    (and
      (instance ?B Blood)
      (objectTransferred ?T ?B))))

(=>
  (and
    (instance ?T TimePeriod)
    (duration ?T
      (MeasureFn ?N MinuteDuration))
    (greaterThan ?N 5.0)
    (instance ?H Human)
    (not
      (exists (?B)
        (and
          (instance ?B Breathing)
          (during (WhenFn ?B) ?T)
          (patient ?B ?H)))))
  (modalAttribute
    (exists (?D)
      (and
        (instance ?D Death)
        (experiencer ?D ?H)
        (meetsTemporally ?T
          (WhenFn ?D))))
    Likely))

(subclass PressureBandage Bandage)
(documentation PressureBandage EnglishLanguage "A tight-fitting or tightly-wrapped bandage for
reducing swelling or blood loss from a wound by applying pressure to the injury.[from Wiktionary]")
(termFormat EnglishLanguage PressureBandage "pressure bandage")

(=>
  (instance ?PB PressureBandage)
  (hasPurpose ?PB
    (exists (?C)
      (and
        (instance ?C Compressing)
        (instrument ?C ?PB)))))

(subAttribute BurnInjury Injury)
(documentation BurnInjury EnglishLanguage "An &%Injury resulting from &%Combustion.")
(termFormat EnglishLanguage BurnInjury "burn injury")

(=>
  (holdsDuring ?T
    (attribute ?H BurnInjury))
  (exists (?C)
    (and
      (instance ?C Combustion)
      (located ?C ?H)
      (meetsTemporally (WhenFn ?C) ?T))))

(subclass DecompressionNeedle Needle)
(documentation DecompressionNeedle EnglishLanguage "A &%Needle intended for use in &%Thoracentesis.")
(termFormat EnglishLanguage DecompressionNeedle "decompression needle")

(=>
  (instance ?DN DecompressionNeedle)
  (hasPurpose ?DN
    (exists (?T)
      (and
        (instance ?T Thoracentesis)
        (instrument ?T ?DN)))))

(subclass FleetMarineForce MilitaryOrganization)
(documentation FleetMarineForce EnglishLanguage "The &%UnitedStates Fleet Marine Forces (FMF)
are combined general- and special-purpose forces within the United States Department of the &%Navy-BranchOfService that
perform offensive amphibious or expeditionary warfare and defensive maritime employment. The Fleet
Marine Forces provide the National Command Authority (NCA) with a responsive force that can conduct
operations in any spectrum of conflict around the globe.[from Wikipedia]")
(termFormat EnglishLanguage FleetMarineForce "fleet marine force")

(=>
  (instance ?FMF FleetMarineForce)
  (exists (?M)
    (and
      (instance ?M MarinesBranchOfService)
      (subOrganization ?FMF ?M))))

(subclass IED Bomb)
(documentation IED EnglishLanguage "An improvised explosive device (IED) is a &%Bomb constructed and
deployed in ways other than in conventional military action. It may be constructed of conventional
military explosives, such as an artillery shell, attached to a detonating mechanism. IEDs are
commonly used as roadside bombs, or homemade bombs.[from Wikipedia]")
(termFormat EnglishLanguage IED "IED")
(termFormat EnglishLanguage IED "improvised explosive device")

(=>
  (instance ?IED IED)
  (not
    (exists (?M)
      (and
        (instance ?M Manufacture)
        (result ?M ?IED)))))

(subclass HemostaticGauze Bandage)
(documentation HemostaticGauze EnglishLanguage "A &%Bandage that contains &%Medicine designed to
stimulate &%Clotting.")
(termFormat EnglishLanguage HemostaticGauze "hemostatic gauze")

(=>
  (instance ?HG HemostaticGauze)
  (hasPurpose ?HG
    (exists (?HG)
      (and
        (instance ?C Clotting)
        (instrument ?C ?HG)))))

(subclass TriageTag Label)
(documentation TriageTag EnglishLanguage "A triage tag is a tool first responders and medical
personnel use during a mass casualty incident. With the aid of the triage tags, the first-arriving
personnel are able to effectively and efficiently distribute the limited resources and provide the
necessary immediate care for the victims until more help arrives.
Simple triage and rapid treatment (START) is a strategy that the first responders and medical
personnel employ to evaluate the severity of injury of each victim as quickly as possible and tag
the victims in about 30–60 seconds. The triage tags are placed near the head and are used to better
separate the victims so that when more help arrives, the patients are easily recognizable for the
extra help to ascertain the most dire cases.[from Wikipedia]")
(termFormat EnglishLanguage TriageTag "triage tag")
(externalImage TriageTag "https://upload.wikimedia.org/wikipedia/commons/thumb/9/97/Deconference-2002-triage-tag.jpg/320px-Deconference-2002-triage-tag.jpg")

(=>
  (instance ?TT TriageTag)
  (hasPurpose ?TT
    (exists (?C)
      (and
        (instance ?C Classifying)
        (instrument ?C ?TT)))))

(instance BoneFracture DiseaseOrSyndrome)
(documentation BoneFracture EnglishLanguage "An &%Attribute of having a &%Bone that is damaged.  This
includes cracks that do not completely separate a bone, as well as complete breaks into separate
pieces and trauma such as an &%OpenFracture.")
(termFormat EnglishLanguage BoneFracture "bone fracture")

(=>
  (holdsDuring ?T
    (attribute ?H BoneFracture))
  (exists (?S ?B)
    (and
      (instance ?S Separating)
      (patient ?S ?B)
      (instance ?B Bone)
      (part ?B ?H)
      (meetsTemporally (WhenFn ?S) ?T))))

(subAttribute OpenFracture BoneFracture)
(documentation BoneFracture EnglishLanguage "A &%BoneFracture where a portion of &%Bone breaks the
&%Skin.")
(termFormat EnglishLanguage OpenFracture "open fracture")

(=>
  (holdsDuring ?T
    (attribute ?H OpenFracture))
  (exists (?S ?B)
    (and
      (instance ?S Skin)
      (part ?S ?H)
      (instance ?B Bone)
      (part ?B ?H)
      (holdsDuring ?T
        (traverses ?B ?S)))))

(subclass IVBolusTherapy IVTherapy)
(documentation IVBolusTherapy EnglishLanguage "Administering IV fluids through an open line, rather
than a drip, which entails that the contents empty in a few minutes.  This is used in emergency
settings to administer &%Fluid or &%Medicine quickly.")
(termFormat EnglishLanguage IVBolusTherapy "IV bolus therapy")

(=>
  (instance ?IV IVBolusTherapy)
  (and
    (duration
      (WhenFn ?IV)
      (MeasureFn ?N MinuteDuration))
    (lessThan ?N 5.0)))

(subclass Morphine BiologicallyActiveSubstance)
(subclass Morphine Medicine)
(documentation Morphine EnglishLanguage "Morphine is a strong opiate that is found naturally in
&%Opium, a dark brown resin produced by drying the latex of opium poppies (Papaver somniferum).
It is mainly used as a &%Pain medication, and is also commonly used recreationally, or to make
other illicit opioids. There are numerous methods used to administer morphine: oral; sublingual;
via inhalation; injection into a &%Muscle, injection under the &%Skin, or injection into the
&%SpinalCord area; transdermal; or via rectal suppository. It acts directly on the central nervous
system (CNS) to induce analgesia and alter perception and emotional response to pain. Physical
and psychological dependence and tolerance may develop with repeated administration. It can
be taken for both acute pain and chronic pain and is frequently used for pain from &%HeartAttack,
kidney stones, and during labor. Its maximum effect is reached after about 20
minutes when administered intravenously and 60 minutes when administered by &%Mouth, while the
duration of its effect is 3–7 hours.[from Wikipedia]")
(termFormat EnglishLanguage Morphine "morphine")

(=>
  (instance ?O Opium)
  (exists (?M)
    (and
      (instance ?M Morphine)
      (material ?M ?O))))

(subclass Fentanyl BiologicallyActiveSubstance)
(subclass Morphine Medicine)
(subclass Morphine Narcotic)
(documentation Fentanyl EnglishLanguage "Fentanyl is a highly potent
synthetic piperidine opioid drug primarily used as an analgesic. Because fentanyl is 50 to 100
times more potent than &%Morphine, its primary clinical utility is in &%Pain management for &%Cancer
patients and those recovering from painful surgical operations. Fentanyl is also used as a
sedative. Depending on the method of delivery, fentanyl can be very fast acting and
ingesting a relatively small quantity can cause overdose. Fentanyl works by activating
mu-opioid receptors. [from Wikipedia]")
(termFormat EnglishLanguage Fentanyl "fentanyl")
(termFormat EnglishLanguage Fentanyl "fentanil")
(termFormat EnglishLanguage Fentanyl "fentanyl citrate")
(termFormat EnglishLanguage Fentanyl "Sublimaze")

(subclass Laceration Hole)
(documentation Laceration EnglishLanguage "A cut or separation in the &%Skin that results
in a &%Hole.")

(=>
  (instance ?L Laceration)
  (exists (?S)
    (and
      (instance ?S Skin)
      (equal ?S (HoleHostFn ?L)))))

(=>
  (and
    (instance ?L Laceration)
    (instance ?S Skin)
    (equal ?S (HoleHostFn ?L))
    (part ?S ?H))
  (exists (?P)
    (and
      (instance ?P Poking)
      (result ?P ?L))))

(instance BodyAreaFn UnaryFunction)
(documentation BodyAreaFn EnglishLanguage "A &%Function that denotes the area
near a given organ or structure of the body such as 'bicep area' or 'stomach area'.")

(domainSubclass BodyAreaFn 1 BodyPart)
(rangeSubclass BodyAreaFn BodyPart)

(=>
  (and
    (instance ?A (BodyAreaFn ?OC))
    (instance ?H Animal)
    (part ?A ?H))
  (exists (?O)
    (and
      (instance ?O ?OC)
      (orientation ?A ?O Near)
      (part ?O ?H))))

(subclass Amputating Removing)
(documentation Amputating EnglishLanguage "Amputation is the removal of a limb by trauma,
medical illness, or surgery. As a surgical measure, it is used to control pain or a disease
process in the affected limb, such as malignancy or gangrene. In some cases, it is carried
out on individuals as a preventive surgery for such problems. [from Wikipedia] Note that
to distinguish this from a minor loss of part of a limb this must include loss of some &%Bone.")
(termFormat EnglishLanguage Amputating "amputating")
(termFormat EnglishLanguage Amputating "amputation")

(=>
  (and
    (instance ?A Amputating)
    (patient ?A ?H)
    (instance ?L Limb))
  (exists (?P ?B)
    (and
      (part ?P ?L)
      (part ?B ?P)
      (instance ?B Bone)
      (holdsDuring
        (ImmediatePastFn
          (WhenFn ?A))
        (part ?P ?H))
      (holdsDuring
        (ImmediatePastFn
          (WhenFn ?A))
        (not
          (part ?P ?H))))))

(subclass ShrapnelExplosion Explosion)
(documentation ShrapnelExplosion EnglishLanguage "An &%Explosion that causes the &%Motion of &%Shrapnel.")
(termFormat EnglishLanguage ShrapnelExplosion "shrapnel explosion")

(=>
  (instance ?SE ShrapnelExplosion)
  (exists (?M ?T)
    (and
      (instance ?M Metal)
      (instance ?T Translocation)
      (causes ?SE ?T)
      (objectTransferred ?T ?M))))

(=>
  (instance ?SE ShrapnelExplosion)
  (hasPurpose ?SE
    (exists (?P)
      (and
        (or
          (instance ?P Injuring)
          (instance ?P Killing))
        (causes ?SE ?P)))))

(subclass Asphyxiation Death)
(documentation Asphyxiation EnglishLanguage "A kind of &%Death caused by an inability to perform &%Beathing.")
(termFormat EnglishLanguage Asphyxiation "asphyxiation")

(=>
  (and
    (instance ?A Asphyxiation)
    (experiencer ?A ?M))
  (holdsDuring (WhenFn ?A)
    (not
      (exists (?B)
        (and
          (instance ?B Breathing)
          (experiencer ?B ?A))))))

(subclass Bleedout Bleeding)
(subclass Bleedout Death)
(documentation Bleedout EnglishLanguage "A kind of &%Death caused by &%Bleeding.")
(termFormat EnglishLanguage Bleedout "bleedout")

(instance MeasuringProcessFn UnaryFunction)
(domainSubclass MeasuringProcessFn 1 Process)
(rangeSubclass MeasuringProcessFn Measuring)
(documentation MeasuringProcessFn EnglishLanguage "Measuring a particular kind of &%Process.")
(termFormat EnglishLanguage MeasuringProcessFn "measuring a process")
(format EnglishLanguage MeasuringProcessFn "measuring a %1")

(=>
  (instance ?M (MeasuringProcessFn ?PC))
  (exists (?P)
    (and
      (instance ?P ?PC)
      (patient ?M ?P))))

(subclass MedicalPerson Profession)
(documentation MedicalPerson EnglishLanguage "An attribute of a person who has a profession involving
healing other, such as a nurse, doctor, EMT or medic.")
(termFormat EnglishLanguage MedicalPerson "medical person")
(=>
  (and
    (instance ?A MedicalPerson)
    (attribute ?C ?A))
  (hasPurpose ?C
    (exists (?TP)
      (and
        (instance ?TP TherapeuticProcess)
        (agent ?TP ?C)))))

(instance Corpsman MedicalPerson)
(instance Medic MedicalPerson)

(subclass EpiPen TherapeuticDevice)
(documentation EpiPen EnglishLanguage "An epinephrine autoinjector (or &%Adrenaline autoinjector,
also known by the trademark EpiPen) is a &%MedicalDevice for &%Injecting a measured dose or doses
of epinephrine (adrenaline) by means of autoinjector technology. It is most often used for the
treatment of &%Anaphylaxis. [from Wikipedia]")
(termFormat EnglishLanguage EpiPen "EpiPen")
(termFormat EnglishLanguage EpiPen "epinephrine autoinjector")
(termFormat EnglishLanguage EpiPen "adrenaline autoinjector")
(medicine Adrenaline Analphylaxis)

(=>
  (instance ?EP EpiPen)
  (exists (?N ?A)
    (and
      (instance ?N Needle)
      (part ?N ?EP)
      (instance ?A Adrenaline)
      (part ?A ?EP))))

(=>
  (instance ?EP EpiPen)
  (hasPurpose ?EP
    (exists (?I)
      (and
        (instance ?I Injecting)
        (instrument ?I ?EP)))))

(=>
  (instance ?EP EpiPen)
  (hasPurpose ?EP
    (exists (?I ?H ?A)
      (and
        (instance ?I Injecting)
        (instrument ?I ?EP)
        (destination ?I ?H)
        (experiencer ?A ?H)
        (instance ?A Anaphylaxis)
        (during
          (WhenFn ?I)
          (WhenFn ?A))))))

(subclass Analgesic Medicine)
(documentation Analgesic EnglishLanguage "An analgesic drug, also called simply an analgesic,
pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from
pain (that is, analgesia or pain management). Analgesics are conceptually distinct from
anesthetics, which temporarily reduce, and in some instances eliminate, sensation, although
analgesia and anesthesia are neurophysiologically overlapping and thus various drugs have
both analgesic and anesthetic effects. Various analgesics, such as many NSAIDs, are available
over the counter in most countries, whereas various others are prescription drugs owing to the
substantial risks and high chances of overdose, misuse, and addiction in the absence of medical
supervision. [from Wikipedia]")
(termFormat EnglishLanguage Analgesic "analgesic")
(termFormat EnglishLanguage Analgesic "analgesic drug")
(termFormat EnglishLanguage Analgesic "pain reliever")
(termFormat EnglishLanguage Analgesic "painkiller")

(pathologyTreatment Pain Analgesic Ingesting)
(subclass NSAID Analgesic)
(subclass Opium Analgesic)
(subclass Morphine Analgesic)

(subclass AVPUStatus RelationalAttribute)
(documentation AVPUStatus EnglishLanguage "The AVPU scale (an acronym from 'alert, verbal,
pain, unresponsive') is a system by which a health care professional can measure and record a
patient's level of consciousness. It is mostly used in emergency medicine protocols, and
within first aid. It is a simplification of the Glasgow Coma Scale, which assesses a patient
response in three measures: eyes, voice and motor skills. The AVPU scale should be assessed
using these three identifiable traits, looking for the best response of each [from Wikipedia]")
(termFormat EnglishLanguage AVPUStatus "AVPU status")

(instance AVPUAlertStatus AVPUStatus)
(documentation AVPUAlertStatus EnglishLanguage "The patient is fully awake (although not
necessarily oriented). This patient will have spontaneously open eyes, will respond to
voice (although may be confused) and will have bodily motor function. [from Wikipedia]")
(termFormat EnglishLanguage AVPUAlertStatus "AVPU alert status")

(=>
  (holdsDuring ?T
    (attribute ?H AVPUAlertStatus))
  (holdsDuring ?T
    (capability ?H agent Communication)))

(=>
  (holdsDuring ?T
    (attribute ?H AVPUAlertStatus))
  (holdsDuring ?T
    (attribute ?H Conscious)))

(instance AVPUVerbalStatus AVPUStatus)
(documentation AVPUVerbalStatus EnglishLanguage "The patient makes some kind of response
when you talk to them, which could be in any of the three component measures of eyes,
voice or motor – e.g. patient's eyes open on being asked 'Are you OK?'. The response
could be as little as a grunt, moan, or slight move of a limb when prompted by the voice
of the rescuer. [from Wikipedia]")
(termFormat EnglishLanguage AVPUVerbalStatus "AVPU verbal status")

(=>
  (and
    (holdsDuring ?T
      (attribute ?H AVPUVerbalStatus))
    (instance ?S Speaking)
    (destination ?S ?H)
    (during (WhenFn ?S) ?T))
  (exists (?IA)
    (and
      (instance ?IA IntentionalProcess)
      (agent ?IA ?H)
      (during (WhenFn ?IA) ?T)
      (causes ?S ?IA))))

(instance AVPUPainStatus AVPUStatus)
(documentation AVPUPainStatus EnglishLanguage "The patient makes a response on any of the
three component measures on the application of &%Pain stimulus, such as a central pain
stimulus like a sternal rub or a peripheral stimulus such as squeezing the &%Fingers. A
patient with some level of consciousness (a fully conscious patient would not require a
pain stimulus) may respond by using their voice, moving their &%Eyes, or moving part of
their body (including abnormal posturing).[from Wikipedia]")
(termFormat EnglishLanguage AVPUPainStatus "AVPU pain status")

(=>
  (and
    (holdsDuring ?T
      (attribute ?H AVPUPainStatus))
    (instance ?P Pain)
    (during (WhenFn ?P) ?T)
    (experiencer ?P ?H))
  (exists (?BM)
    (and
      (instance ?BM BodyMotion)
      (experiencer ?BM ?H)
      (during (WhenFn ?BM) ?T)
      (causes ?P ?BM))))

(instance AVPUUnresponsiveStatus AVPUStatus)
(documentation AVPUUnresponsiveStatus EnglishLanguage "Sometimes seen noted as
'unconscious', this outcome is recorded if the patient does not show any &%Eye, voice or
motor response to voice or &%Pain. [from Wikipedia]")
(termFormat EnglishLanguage AVPUUnresponsiveStatus "AVPU unresponsive status")
(termFormat EnglishLanguage AVPUUnresponsiveStatus "AVPU unconscious status")

(=>
  (holdsDuring ?T
    (attribute ?H AVPUUnresponsiveStatus))
  (holdsDuring ?T
    (attribute ?H Unconscious)))

(subclass CheckingVitals DiagnosticProcess)
(documentation CheckingVitals EnglishLanguage "There are four primary vital signs
that are standard in most medical settings: (1) Body temperature (2) Heart rate or
Pulse (3) Respiratory rate (4) Blood pressure. The equipment needed is a thermometer,
a sphygmomanometer, and a watch. Although a pulse can be taken by hand, a stethoscope
may be required for a clinician to take a patient's apical pulse.[from Wikipedia]")
(termFormat EnglishLanguage CheckingVitals "checking vitals")

(=>
  (and
    (instance ?C CheckingVitals)
    (agent ?C ?A)
    (patient ?C ?P)
    (instance ?H Heart)
    (part ?H ?P)
    (instance ?L Lung)
    (part ?L ?P)
    (holdsDuring (WhenFn ?C)
      (and
        (systolicBloodPressure ?P ?SYS)
        (diastolicBloodPressure ?P ?DIA)
        (measure ?P (MeasureFn ?T FahrenheitDegree))))
    (heartRate ?H (WhenFn ?C) ?I)
    (breathingRate ?L (WhenFn ?C) ?R))
  (knows ?A
    (and
      (holdsDuring (WhenFn ?C)
        (and
          (systolicBloodPressure ?P ?SYS)
          (diastolicBloodPressure ?P ?DIA)
          (measure ?P (MeasureFn ?T FahrenheitDegree))))
      (heartRate ?H (WhenFn ?C) ?I)
      (breathingRate ?L (WhenFn ?C) ?R))))

(subclass MoveToEvac Transportation)
(=>
  (and
    (instance ?M MoveToEvac)
    (objectTransferred ?M ?P))
  (hasPurpose ?M
    (exists (?E)
      (and
        (instance ?E Evacuation)
        (objectTransferred ?E ?P)
        (earlier
          (WhenFn ?M)
          (WhenFn ?E))))))

(relatedInternalConcept pathologicSymptom diseaseSymptom)