Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
unicystic ameloblastoma ( ua ) was first described by robinson and martinez in 1977 as a special type of ameloblastoma .
ua usually appears very similar to a non - neoplastic odontogenic cyst and is frequently clinically misdiagnosed as dentigerous cyst and odontogenic keratocyst hence , histological confirmation is mandatory from the management point of view .
this report highlights the importance of clinical and radiographic features in the diagnosis and management of ua in a 5-year - old boy .
a 5-year - old boy presented to our unit center for dental education and research , all india institute of medical sciences , new delhi , india with a painless hard swelling in the lower chin region of 3 months duration .
swelling was found to be approximately 2 cm  2 cm in size , overlying skin was normal in color and texture with no evidence of sinus / fistula .
swelling was non - tender , non - pulsatile , bony hard , non - fluctuant , non - compressible on palpation with expansion of both , buccal as well as lingual cortical plates and aspiration from the swelling yielded cystic color fluid .
panoramic radiographic revealed that unilocular well - defined radiolucent lesion extending from lower deciduous first mandibular molar to right lower canine with evidence of roots resorption [ figure 1 ] .
pre - operative panoramic radiograph showing radiolucent lesion in the right side of the mandible and resorption of the roots of the teeth on the basis of lingual cortical bone expansion , presence of cystic fluid on aspiration and evident of root resorption of the teeth in the panorex , we made the provisional diagnosis of ua .
enucleation of the cyst with extraction of the involved teeth followed by application of carnoy 's solution for 3 min over the cavity was planned under general anesthesia ( ga ) .
histopathology report of the specimen revealed that type 1 ua as per the histological criteria defined by ackerman et al .
( a ) discrete epithelial lines in a connective tissue stroma ( h and e , 10 ) , ( b ) discrete follicles with a similarity to the stellate reticulum of enamel with a varying quantity of connective tissue stroma.(h and e , 40 ) patient has been on regular follow - up since 2 years , patient is doing well with no signs of recurrence [ figure 3 ] . post - operative panoramic radiograph showing bone regeneration in the affected area and movement of tooth buds into the regenerated bone at 2 years follow - up period
ameloblastoma is rare before the age of 10 years . according to statistical analysis of 1036 cases of ameloblastoma collected from the literature by small and waldron
the ua is considered a variant of the solid or multicystic ameloblastoma , accounting for 6% to 15% of all intra osseous ameloblastomas .
presence of lingual cortical plate expansion , cystic fluid on aspiration and presence of root resorption of teeth in panoramic radiograph helped us in making the preoperative diagnosis of ua over the dentigerous cyst without incisional biopsy ( which requires ga in the child ) .
histopathological features of the tumor showed type 1 ( tumor confined to the luminal surface of the cyst ) ua as per the histological criteria defined by ackerman et al .
treatment modality of ua is being divided into following types - enucleation alone yielded the highest recurrence rate among all treatments ( 30.5% ) .
a more conservative approach is enucleation with application of carnoy 's solution and the extraction of closely related adjacent teeth has resulted in a recurrence rate of 16% .
the success of the application of carnoy 's solution after enucleation was thought to be due to both its penetration and fixation action .
the usual practice is to apply the solution with cotton applicators or ribbon gauze for 3 - 5 min , rinse the bony cavity .
the recurrence rate could even lower than reported , if the closely related teeth with tumor are extracted .
because in an attempt to preserve the tooth without damage , tumor remnants may be left around the tooth apex or root and these may lead to recurrence we carried out the same procedure in the case i.e. enucleation followed by application of carnoy 's solution for 3 min , extraction of all involved teeth and close follow - up .
second surgery ( i.e. incisional biopsy followed by definitive treatment ) under ga in the child was not required due to proper preoperative planning of the case . at 2 years

Answer:
unicystic ameloblastoma rarely seen in first decade of life .
 this tumour usually appears very similar to a non - neoplastic odontogenic cyst and is frequently clinically misdiagnosed as dentigerous cyst .
 the distinction from dentigerous cyst is important as unicystic ameloblastoma ( ua ) unlike dentigerous cyst needs different treatment approach and long term follow - up due to its chances of recurrence .
 this report highlights the importance of clinical examination in the diagnosis and management of ua in a 5 year old boy .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
cryptorchidism , defined as the absence of at least one testis in the scrotum , is a frequent condition in the pediatric population .
it affects up to 9% of full - term newborns and up to 1.5% of 1-year - old boys .
the most common location for an undescended testicle is just outside the external ring ( suprascrotal ) , followed by the inguinal canal followed by the abdomen .
cryptorchidism occurs more commonly among patients with congenital disorders of testosterone secretion or action , secondary hypogonadism , testosterone biosynthetic defects , or insensitivity syndromes , abdominal wall defects , neural tube defects , cerebral palsy , and various genetic syndromes ( e.g. , trisomy 18 , trisomy 13 , noonan syndrome , prader - willi syndrome , and laurence - moon - biedl syndrome ) .
rathke cleft cysts ( rccs ) are benign , epithelium - lined sellar and suprasellar cysts believed to originate from remnants of the rathke pouch lying between the pars anterior and the pars intermedia of the pituitary gland .
they are usually asymptomatic and are discovered incidentally , when radiographic or necropsy findings are reviewed .
symptomatic rccs are uncommon , but cysts can enlarge and cause symptoms secondary to compression of the pituitary gland , pituitary stalk , optic chiasm , or hypothalamus .
atypical presentations for rcc include abscess formation within the cyst , aseptic meningitis or entirely suprasellar rcc .
distinction among these remains a difficult preoperative problem , because the symptoms , signs , and biochemical and radiographic features of these lesions can mimic each other .
here , we report a rare case of entirely suprasellar rathke 's cleft cyst ( rcc ) in a 4.5-year old child causing hypopituitarism , who presented to us with bilateral cryptorchidism .
although till date , a few cases of symptomatic rccs have been reported in world literature , the condition continues to remain largely unknown to practicing clinicians .
the current report intends to draw attention towards hypopituitarism as one of the etiology of cryptorchidism . to the best of our knowledge ,
this is the first case of entirely suprasellar rcc presenting in a child with cryptorchidism to be reported from world literature .
a 4.5-year - old boy presented to the pediatric surgery department with bilateral undescended testes for which surgery was planned . upon evaluation for short stature at the department of endocrinology , he was found to be born to nonconsanguineous parents , at full term by normal vaginal delivery ; there was no history of prolonged labor or birth asphyxia and his birth weight was 2.5 kg .
mother noticed bilateral undescended testes at the time of delivery , but was reassured by the doctor that testes would descend subsequently .
there was no history of seizures or prolonged jaundice in the neonatal period , but his motor and mental milestones were delayed .
he remained shorter than his peers and his sister who is 2 years younger is taller than him .
there was no history of chronic systemic disease , hypothyroidism , or features suggestive of raised intracranial pressure . on examination ,
his height is 84 cm ( <3 percentile ) , upper to lower segment ratio is 0.9 [ figure 1 ] , standard deviation score was 4 , weight was 13 kg , and head circumference was 51 cm .
he had frontal bossing , doll - like facies , central obesity , micropenis with stretched penile length of 2 cm , and both gonads were palpable in suprascrotal area with a poorly developed empty scrotal sac .
investigations revealed a hemoglobin of 13.6 g% ( 11 - 15 ) , total lymphocyte count of 5,600/mm ( 4 - 11,000 ) , erythrocyte sedimentation rate of 15 ( 5 - 20 ) , random blood sugar of 94 mg% ( 90 - 130 ) , creatinine 0.8 mg / dl ( 0.6 - 1.5 ) , free thyroxine ( t4)-0.9 ng / ml ( 0.93 - 1.7 ) , thyroid stimulating hormone ( tsh)-7.27 miu / ml ( 0.3 - 5.5 ) , bone age-1 year , basal cortisol-13.76 g / dl ( 8 - 20 ) , follicle stimulating hormone ( fsh)-0.63 miu / dl ( 1.5 - 10.2 ) , luteinizing hormone ( lh)-0.1 miu / dl ( 1.9 - 12 ) , testosterone basal 0.025 ng / ml ( 3 - 6.5 ) , stimulated testosterone with human chorionic gonadotropin ( hcg ) was 0.68 ng / ml ( suggestive of normally functioning testes ) , and insulin - like growth factor 1 ( igf-1 ) was undetectable .
radiological evaluation revealed bilateral suprascrotal testes in ultrasound abdomen , a 3.8  3.6 cm suprasellar cystic lesion with compressed pituitary gland in magnetic resonance imaging ( mri ) brain [ figures 2 and 3 ] , which was hypointense on t1 and hyperintense on t2 images suggestive of cystic craniopharyngioma or rathke 's cyst .
child did not cooperate for an accurate visual field examination , but grossly he had some degree of visual impairment in left eye .
urine output and fluid input both were approximately 1 l. magnetic resonance imaging ( mri ) sagittal section is showing suprasellar rathke 's cleft cyst ( rcc ) with normal compressed pituitary mri coronal section is showing suprasellar rcc child was subsequently treated with levothyroxine replacement in view of secondary hypothyroidism .
after 4 weeks ( with the normalization of t4 levels ) , he underwent right frontotemporal orbitozygomatic craniotomy , marsupialization of suprasellar cyst along with biopsy .
biopsy revealed a single - cell layered , cuboidal epithelium , suggesting a rathke 's cleft cyst .
so the final diagnosis was rathke 's cleft cyst with hypopituitarism . at 6 and 12
weeks after surgery , child was reevaluated for pituitary function , which revealed persistent secondary hypothyroidism and low igf-1 levels suggestive of growth hormone deficiency .
levothyroxine was reinstituted followed by initiation of growth hormone replacement along with 5 week hcg therapy ( intramuscular ( i m ) 1,000 iu twice a week ) .
rccs are usually located in an intrasellar or combined intra- and suprasellar location , between the pars anterior and the pars intermedia of the pituitary gland ; they are assumed to be benign remnants of the craniopharyngeal duct , which is part of rathke 's pouch .
the pars tuberalis of the pituitary gland which lies above the diaphragma sellae , is also derived from rathke 's pouch , and is the site of origin of entirely suprasellar rccs .
majority of the rcc are asymptomatic . if the normal involution of rathke 's pouch fails to occur , the resulting rcc may increase in size by accumulation of cyst fluid and compress the surrounding structures with ensuing headache , visual problems , and hypopituitarism .
entirely suprasellar symptomatic rccs with normal sella turcica are exceptionally rare and very few case reports are available in world literature .
further , rcc presenting at such a young age with hypopituitarism has not been reported till date .
testicular descent occurs in two phases , comprising of transabdominal and inguinoscrotal descent , which occur approximately during the first and last thirds of gestation , respectively .
key anatomical events to release the testis from its urogenital ridge location and to guide the free gonad into the scrotum are the degeneration of the craniosuspensory ligament and a thickening of the gubernaculum .
androgens play a role in both these processes , particularly with respect to enabling the testis to traverse the inguinal canal in the final phase of descent .
the thickening of the gubernaculum , a process crucial for anchoring the testis to the inguinal region is controlled by insulin - like 3 peptide ( insl3 ) and its g protein coupled receptor ( great ) . in turn , this insl3 is controlled by hcg and lh .
even though surgical management is the cornerstone of treatment for cryptorchidism , medical treatment can be effective in the above mentioned endocrine disorders and it is prudent to give a trial before resorting to orchiopexy .
available agents are gonadotropin releasing hormone ( gnrh ) or hcg injections that produce a significant rise in local testosterone levels ; thereby facilitating testicular descent .
commonly used agent is hcg and there are many protocols for the use of hcg .
one such protocol is the administration of 1,000 - 2,500 iu two times per week intramuscularly for 4 - 5 weeks .
whatever protocol is used , the likelihood of success is greatest in the most distal true undescended testicles .
complete success was defined as full descent of the testicle into the scrotum and needs assessment between 8 weeks and 6 months after the completion of treatment .
these studies have reported temporary virilizing side effects , including increased penile length , erections , and testicular enlargement associated with hormonal treatment .
rcc causing a pressure effect on pituitary with subsequent inhibitory effect on the release of fsh , lh , growth hormone ( gh ) , and tsh led to the hypogonadism ( perhaps , the rcc was causing this pressure effect from the intrauterine period itself and hence resulted in cryptorchidism ) along with hyposomatotropism and hypothyroidism .
we also propose that because of its chronic compressive effect with consequent ischemic and pressure necrosis , all cell lineages were affected irreversibly as evidenced by no recovery of pituitary function in the post - surgical reevaluation .
after hcg therapy , gonads descended into the scrotum and the patient is on long - term follow - up with replacement of levothyroxine and growth hormone .
in conclusion , rccs are usually intrasellar or combined intra- and suprasellar , can rarely occur in an entirely suprasellar location with intact diaphragm and intact sella turcica , but a presentation as in our case , with features of hypopituitarism at such a young age , is distinctly uncommon . in the evaluation of cryptorchidism
one should explore the possibility of central causes in the etiology , as this may respond to medical therapy , thereby obviating the need for unnecessary surgical intervention .

Answer: rathke 's cleft cyst ( rcc ) are benign , epithelium - lined sellar and suprasellar cysts believed to originate from remnants of the rathke pouch . here , we report a rare case of entirely suprasellar rcc in a 4.5-year - old child causing hypopituitarism , who presented to us with bilateral cryptorchidism . subsequently we discuss the distinct rarity of entirely suprasellar rcc presenting in this fashion and the relevant literature is also discussed .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
ceftriaxone sodium is a long acting , broad - spectrum cephalosporin antibiotic for parenteral use .
it exerts in vitro activity against a wide range of gram - negative and gram - positive microorganisms .
it is highly stable to most beta - lactamases , both penicillinases and cephalosporinases , of gram - positive and gram - negative bacteria .
a thorough literature survey has revealed that hplc method for ceftriaxone sodium with combination of other drugs and individually in dosage forms [ 215 ] , microbial bioassay methods [ 16 , 17 ] , and spectrophotometric methods in dosage forms [ 1822 ] have been reported for analysis of ceftriaxone sodium .
costlier and volatile solvents were used as mobile phase solvent system and the time of analysis was more in some reported methods .
some spectrophotometric methods are recently described in the literature for analysis of drugs in raw material and finished products such as ceftazidime [ 2325 ] , cefuroxime , and cefazolin .
these spectrophotometric methods involve the use of no toxic organic solvents , which do not contribute to the generation of this kind of waste by the chemicals or industries . in this context
therefore , the trend is that the industries look for ways to reduce the impacts of their activities on the environment .
so , the principle objective of this study was , therefore , to develop a simple , selective , precise , less time consuming , and economical method with a wide linear range and good sensitivity for assay of ceftriaxone sodium in the powder for injection dosage forms .
the parent drug stability guidelines issued by the international conference of harmonization ( ich )   require that analytical test procedure should indicate stability .
therefore , the present study was extended to establish the inherent stability of ceftriaxone sodium under different stress conditions such as , alkaline , acidic , oxidative , and photolytic conditions .
thus , this method can be utilized to compare the results for the content analysis of stability samples , since the purpose of stability studies is to monitor possible changes to a product or a material over a time at different storage conditions .
spectrophotometric analysis was carried out on a systronics 2201 , uv - visible double - beam spectrophotometer with matched 1  cm path - length quartz cells .
absorption spectra were recorded on a medium scan speed , setting slit width to be 1  nm .
ceftriaxone sodium was obtained as a gift sample from orchid chemicals and pharmaceutical ltd . ,
the other chemicals like sodium hydroxide , hydrochloric acid , and hydrogen peroxide used were of merck - ar grade and double distilled water was used throughout the experiment .
a stock solution was prepared by dissolving 100  mg of ceftriaxone sodium pure drug in 100  ml of distilled water to get standard stock solution ( 1  mg / ml ) . to a set of 10  ml volumetric flasks , aliquot volumes containing the drug were quantitatively transferred from standard stock solution and made up to the mark with distilled water to obtain final concentrations of 550  g / ml of ceftriaxone sodium .
the absorbance was measured at 241  nm and calibration graph was constructed by plotting the absorbance versus the concentration of the drug .
the validity of the method was tested regarding linearity , specificity , accuracy , and precision according to ich q2b recommendations .
accuracy and precision of the method were evaluated with the help of percent recovery , standard deviation ( sd ) , and percent relative standard deviation ( rsd ) by using standard addition method .
three levels of standard drug ( 10% , 20% , and 30% ) were spiked individually with the 100  mg equivalent of powder for injection dosage form ceftriaxone sodium and analysed in six replicates during the same day ( intraday precision ) and six consecutive days ( interday precision ) .
a linear correlation was found between absorbance at   max and various concentrations of ceftriaxone sodium .
the linearity graph obeyed beer 's law in the range from 5 to 50  g / ml and it was described by regression equation ( y = mx + c ) and correlation coefficient ( r ) which were displayed on the graph .
molar absorptivity , sandell 's sensitivity , standard error on slope , confidence limit of slope ( 95% ) , standard error on intercept , confidence limit of intercept ( 95% ) , lod , and loq were calculated . for the determination of lod and loq ,
the method is based on residual standard deviation of regression line and slope . to determine lod and loq ,
the specific calibration curve was studied using the sample containing analyte in the range of detection limit and quantitation limit .
robustness was studied by evaluating the influence of small but deliberate variations in the experimental condition like storing the similar concentration ( 20  g / ml ) of drug solution at two different temperatures ( 20c and 30c ) for 1  h and performing the stability of the sample solution at various time intervals ( after 1  h and after 6  h ) on the analytical performance .
a 2  ml aliquot of standard stock solution of ceftriaxone sodium ( 1  mg / ml ) was taken in four replicates in a volumetric flask ( 100  ml ) and mixed with 10  ml of 0.1  n hcl ( acid hydrolysis ) or 0.1  n naoh ( alkaline hydrolysis ) or 5% h2o2 ( oxidative degradation ) and set aside for 1  h at room temperature .
a solution of drug ( 20  g / ml ) was prepared as per the procedure under construction of the calibration graph and was exposed to uv radiation of wavelength 254  nm and of 1.4 flux intensity for 24  h in a uv chamber . for thermal degradation solid drug
was kept in an oven at 100c for 24  h. after cooling to room temperature , 20  g / ml concentrated drug solution was prepared as per above said method .
finally , absorbance of all the solutions resulted from acid and alkaline hydrolysis , and oxidative degradation , photolytic degradation , and thermal degradation were measured at 241  nm against respective solvent as blank in each case .
for the estimation ceftriaxone sodium from injection ( by procuring three brands from market ) , a portion of powder equivalent to 100  g of the drug from each brand was accurately weighed and transferred into 100  ml volumetric flask .
the drug was dissolved by adding 70  ml of distilled water and sonicated for 15  min .
aliquot containing suitable concentration ( 20  g / ml ) of ceftriaxone sodium was analyzed as described under construction of the calibration graph .
the nominal content of the drug in injection for each brand was determined using the corresponding regression equation and results of % rsd of drug content were statistically compared with reported method .
aqueous solution of ceftriaxone sodium showed absorbance maximum (   max ) at 241  nm ( figure 2 ) , and at this wavelength distilled water did not show any significant absorbance .
least square regression equation of ceftriaxone sodium in aqueous medium has shown that the r value very close to 1 indicated high degree of correlation between two variables , such as absorbance and concentration ( figure 3 ) .
beer 's law was obeyed over the range of 550  g / ml ; high values of molar absorptivity and low values of sandell 's sensitivity and lod revealed that proposed methods are highly sensitive .
lod and loq values for the drug were found and all the parameters of calibraration curve were displayed in table 1 . to check accuracy and precision ,
assays were carried out for six times within a day ( intraday precision ) and in six consecutive days ( interday precision ) by adding three different levels of analyte to the formulation .
% rsd values were 0.5 ( intraday ) and 1.18 ( interday ) indicating high precision of developed method .
accuracy of the method was ascertained as mean % recovery between measured actual concentration and taken concentration for ceftriaxone sodium .
the values of % recovery , very close to 100% , demonstrate high accuracy of the proposed method ( table 2 ) .
robustness studies assumed that the small variations in any of the variables did not significantly affect the results ( table 3 ) .
ceftriaxone sodium sterile formulations were analysed by proposed method and by reported method , which involved the analysis of analyte with 0.1  m sodium hydroxide and absorbance measured at 258.8  nm .
results were compared by student 's t - test and variance - ratio f - test . calculated t - values and f - values did not exceed tabulated values of 2.776 ( t ) and 6.39 ( f ) at 95% confidence level and for four degrees of freedom ( table 4 ) which indicates close similarity between proposed and reported method .
ceftriaxone sodium was subjected to various stress conditions like acid , alkaline , hydrogen peroxide induced degradation , and thermal and photolytic condition .
analysis was performed by measuring absorbance of ceftriaxone sodium after subjecting it to stressed conditions at   max of pure drug .
percentage degradation was calculated by the formula : % degradation = ( expected concentrationactual concentration)/expected concentration  100 , and percentage recovery also was calculated for each case ( table 5 ) .
results revealed no change in absorbance of drug solution at alkaline hydrolysis , so its percentage recovery is very close to 100% which indicates the drug stability .
but there was significant change in absorbance after acid and hydrogen peroxide treatment , confirming that ceftriaxone sodium is susceptible to acid hydrolysis ( % degradation of 11.0% ) and oxidation ( % degradation of 7.95% ) .
analyte undergoes significant degradation under acid hydrolysis and oxidation , whereas it is stable under alkaline treatment .
proposed method was validated for linearity , accuracy , precision , and robustness and method was applied to various formulations and results were statistically compared with reference method which showed that there were no significant changes in the result .
so , method can be utilized for determination of purity of drug available from various sources without any tedious procedure and also used in analysis of stability study samples .

Answer:
a simple , selective , and stability indicating spectroscopic method has been selected and validated for the assay of ceftriaxone sodium in the powder for injection dosage forms .
 proposed method is based on the measurement of absorbance of ceftriaxone sodium in aqueous medium at 241  nm .
 the method obeys beer 's law in the range of 550  g / ml with correlation coefficient of 0.9983 .
 apparent molar absorptivity and sandell 's sensitivity were found to be 2.046  103 l  mol1  cm1 and 0.02732  g / cm2/0.001 absorbance units .
 this study indicated that ceftriaxone sodium was degraded in acid medium and also underwent oxidative degradation .
 percent relative standard deviation associated with all the validation parameters was less than 2 , showing compliance with acceptance criteria of q2 ( r1 ) , international conference on harmonization ( 2005 ) guidelines .
 then the proposed method was successfully applied to the determination of ceftriaxone sodium in sterile preparation and results were comparable with reported methods .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
ultrasound - guided fine - needle aspiration ( fna ) has become the gold standard for differentiating benign and malignant thyroid nodules due to the suboptimal accuracy using gray scale features alone . besides for mild associated pain ,
development of postprocedural hematoma has been reported from 1.9% to 6.4% , with seven reported cases of life - threatening hematomas relating to airway obstruction . the true rate of complications following thyroid nodule fna is likely much higher though as most go undocumented and unpublished .
although fna plays an essential role in thyroid nodule evaluation , the potential for a nondiagnostic ( nd ) specimen can lead to repeat procedures , increasing patient morbidity , cost , chance for complication , and delay in diagnosis .
recently , thyroid nodule fna pathological reporting has been standardized based on the bethesda system for reporting thyroid cytopathology adopted by the american society for clinical pathology ( ascp ) . based on their criteria ,
an adequate specimen needs to contain at least six groups of follicular cells with each group composed of at least 10 cells each .
an nd specimen can be secondary to obscuring blood , overlying thick smears , air drying of alcohol - fixed smears , or inadequate number of follicular cells . according to the ascp
, nd specimens occur in 2%20% of cases but ideally should be limited to no more than 10% of all thyroid nodule fnas .
recently , the use of ultrasound strain elastography ( use ) has emerged as a promising diagnostic tool in differentiating benign and malignant thyroid . a novel approach aimed at decreasing the rate of nd nodule fna maybe to use elastography as a map , targeting biopsy needles to areas of lower strain ( i.e. , stiffer ) .
several papers have been published illustrating increased detection of prostate cancer using use - targeted interventions through a transrectal approach .
our study was performed to evaluate the role of use - targeted fna in decreasing the rates of nd aspirates .
we performed a review of all thyroid nodule fna performed over a 3-year period comparing fna results when an elastogram was available before fna or not .
our hypothesis is that the presence of an elastogram before fna would decrease the rate of nd specimens .
the study was health insurance portability and accountability compliant , and informed consent was waived .
between january 2011 and january 2014 , a total of 225 patients underwent ultrasound - guided thyroid nodule fna . among them were 171 females and 54 males with ages ranging from 27 to 90 .
the demographical data recorded included patients ' age and gender as well as which thyroid lobe contained the nodule biopsied [ table 1 ] .
gray scale nodule characteristics that were recorded included the presence of microcalcifications , vascularity , solid components , and nodule size [ table 1 ] .
the decision to perform use was based strictly on suspicious gray scale characteristics , and guidelines set forth by the society of radiologists in ultrasound .
patient demographics and nodule characteristics during this period , use for thyroid nodules was performed in cases where the available technician was comfortable and experienced with the elastography software .
when elastography was performed , the applied transducer pressure was standardized by a real - time analysis utilizing a scale that was displayed at the right upper corner of the elastogram image [ figure 1 ] .
the nodule strain elastogram was displayed using a 256-color mapping scale [ figure 2 ] .
the degree of strain was assigned a given color shade utilizing a range from red ( greatest strain , soft ) to green ( intermediate strain ) to blue ( least strain , hardest component ) .
real - time applied transducer pressure analyzed by numeric scale displayed at the right upper corner of the elastogram image ( red box ) .
nodule strain elastogram is displayed by a 256-color mapping scale with red representing the softest components and blue representing the hardest components .
we separated patients into two groups , based if an elastogram was available for the radiologist to review before fna or not .
all fna were completed by one of two fellowship - trained radiologists with specialty in ultrasound - guided procedures .
a 21-gauge needle was used in every case , and aspiration was aided by a 5-cc syringe .
all pathological analyses were performed by one of three board - certified cytopathologists . in all cases ,
the final pathological diagnosis was reviewed through the institution 's electronic medical record for every case .
the chi - square test was used to determine statistically significant variances in the demographic parameters .
there was no significant difference between the two groups in demographics ( including gender , age , and which thyroid gland contained the nodule ) as well as nodule characteristics .
regarding the specimen adequacy , the total percentage of nd aspirates was 12.2% , slightly higher than the 10% supported by the ascp . in analyzing the two groups , when an elastogram was available before fna , the nd rate was 10% ( 14/140 ) which was in concordance with the ascp recommendations
. however , the group without an elastogram available had an nd rate of 16% ( 13/81 ) .
however , this difference was not found to be statistically significant , p = 0.205 .
thyroid nodules continue to pose a diagnostic dilemma secondary to poor sensitivity and specificity using gray scale features alone .
although considered the gold standard for nodule evaluation , fna carries its own risks including patient pain , cost , and possible complications ( although rare ) . the need for repeat fna secondary to nd results can cause further patient harm as well as delay time to treatment and increase patient anxiety . to help increase the rate of adequate specimen recovery , the use of ultrasound to guide fna has become the standard of care . with the assistance of ultrasound - guided fna ,
the rates of nd specimen aspirates still range up to 20% . in a recent meta - analysis ,
even the addition of rapid onsite evaluation by a cytopathologist has shown considerable variability in helping to reduce nd rates .
ex vivo studies have found that malignant thyroid lesions have a stiffer architecture compared to benign thyroid stroma .
first described in 1991 by ophir , tissue stiffness could be measured by applying an external axial stimulus and viewing the associated compressibility .
the continued research in elastography has focused on its ability to distinguish benign and malignant lesions by  virtual palpation .
 several studies have been performed to evaluate the role of elastography in targeting interventions .
most papers have focused on ultrasound - guided transrectal biopsies of the prostate gland . using elastograms ,
small studies have been able to show enhanced detection rates as well as decreasing the number of core specimens required for diagnosis . to date
, there has been only one study performed evaluating strain elastography - guided fna of thyroid nodules . in 2013 ,
yildrim et al . , prospectively analyzed the rates of nd aspirates between specimens obtained from regions of higher strain and lower strain from 96 patients .
the authors found a significant improvement in specimen adequacy when aspirates were obtained from regions that demonstrate a stiff elastogram as described previously .
our study was aimed at replicating yildrim 's results in a larger patient sample and hoping to show an improved rate of nd aspirates . in our retrospective review , although there was a decreased rate of nd specimens in the group that use was performed ( 16% vs. 10% ) , this was not found to be statistically significant .
first of all , we performed a retrospective review , which by its very nature allows for confounding bias .
furthermore , although an elastogram was available for the radiologist before fna in the elastography group , we were unable to prove that stiffer regions were actually targeted and aspirated during the procedure .
furthermore , it is possible that stiffer regions of nodules were sampled in the group without elastograms even though elastography was not performed . finally , as our study was a retrospective review , the pathologist performing the specimen analysis was not controlled for , leading to possible variability .
another possibility exists to explain why the presence of an elastogram prior the fna did not significantly reduce the rate of nd results .
our study was predicated on the idea that stiffer regions within nodules would likely decrease nd aspirates as these regions may represent more cellular areas
. however , the development of a stiff consistency in many cancers is secondary to a desmoplastic transformation that takes place .
this process is composed of activated fibroblasts ( also known as myofibroblasts ) , tumor vessels , inflammatory cells , and extracellular matrix components . activated carcinoma induced fibroblasts , along with other extracellular matrix proteins , comprise a dominant proportion of several carcinomas , including more than 90% of overall tumor mass in pancreatic cancers .
it has even been shown that the complex relationship between these components may promote tumor cell growth .
it is possible that the stiffer regions within thyroid nodules are more a product of fibroblastic growth than increased cellular density .
we were unable to demonstrate a significant difference in thyroid nodule aspirate adequacy between patients who had an elastogram present before fna compared with those without one .
these results may be secondary to lack of power , poor study design versus fibroblastic growth as described above .
we hope our study raises awareness of the exciting prospect of use - targeted biopsy and springs future studies confirming its potential .

Answer:
objectives : since 2009 , the rate of nondiagnostic ( nd ) thyroid nodule fine - needle aspiration ( fna ) has ranged from 2% to 20%
 . a nd result can cause further patient morbidity secondary to repeated procedures and delay in diagnosis .
 the use of real - time strain elastography ( rte ) in determining nodule malignant risk has gained considerable focus recently .
 a less studied area where rte may prove beneficial is its role in targeting areas for fna .
 our hypothesis is that fna performed in concurrence with rte will show a decreased rate of nd results leading to fewer repeated fna.materials and methods : the institutional review board approval was obtained .
 a retrospective review of all thyroid nodule fna from january 1 , 2011 , to january 1 , 2014 , was performed with review of nodule size , presence of microcalcifications , vascularity , solid components , patient age , and gender .
 cases were separated based if rte was done before fna or not .
 pathology reports were reviewed to assess for specimen adequacy .
 statistical comparison was performed using sas analysis software.results:a total of 221 specimens were reviewed , with rte performed on 140 cases ( 63.4% ) .
 both groups were similar in demographics and previously described nodule characteristics .
 the nd rate when rte was not performed was 16% ( 13/68 ) compared to 10% when rte was performed ( 14/126 ) .
 the difference was not found to be statistically significant , p = 0.205.conclusions:the presence of an elastogram failed to demonstrate a significant decrease in nd fna rates although these results may be secondary to study design .
 further evaluation with prospective trials using larger sample size may ultimately detect increased accuracy of rte - targeted fna .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
castleman 's disease ( cd ) is a rare lymphoproliferative disorder caused by faulty immune regulation resulting in excessive b - lymphocyte and plasma - cell proliferation in lymphatic tissue .
marked interfollicular vascular proliferation leads to mass formation , which can encase bronchi and sometimes cause mural erosion leading to life - threatening hemoptysis .
vascular supply to these lesions have been reported to arise from the bronchial , internal mammary , and intercostal arteries .
we report a case of hilar intrathoracic cd with atypical radiological features where the left inferior phrenic artery and bronchial circulation provided codominant blood supply .
a 24-year - old female with a 5-month history of wheeze and nonproductive cough underwent chest x - ray , which showed a well - defined mass in the left hilar region [ figure 1a  d ] . a contrast - enhanced computed tomography ( ct ) scan of the chest revealed a heterogeneously enhancing 7  5 cm mass containing flecks of calcification at the left hilum . 18 fluorodeoxyglucose positron emission tomography ( 18-fdg pet )
scan demonstrated an inhomogeneous hypermetabolic lesion with no evidence of metastatic uptake . a ct - guided percutaneous core biopsy revealed chronic inflammatory tissue with no evidence of malignancy .
due to worsening cough and wheeze , the patient underwent a thoracotomy and surgical resection . during the operation there was massive blood loss of 2000 ml .
histopathology confirmed the mass to have marked lymphoid infiltrate with irregular b cell follicles and hyaline vascular - like change consistent with cd .
chest x - ray of a 24-year - old female ( a ) showing well - defined left hilar mass .
contrast - enhanced ct scan ( b and c ) shows heterogeneously enhancing mass with coarse calcifications within this hilar mass .
18-fdg pet / ct scan ( d ) shows hypermetabolic uptake within the lesion two months after the thoracotomy , the patient presented to the emergency department with a 1-day history of massive hemoptysis ( > 200 ml ) .
a ct pulmonary angiogram for clinically suspected pulmonary embolism showed no pulmonary embolism , however , multiplanar reformats showed low attenuation soft tissue in the surgical resection bed at the left hilum receiving blood supply through hypertrophied left bronchial and left inferior phrenic arteries [ figure 2a  f ] .
the patient had an embolization through a right common femoral artery approach and the common ( conjoined ) origin of the right broncho - superior intercostal trunk and left bronchial arteries were catheterized with a 5 fr ( cordis , usa ) left amplatz coronary i catheter ( cordis , usa ) .
the sharply angulated left bronchial artery could not be superselectively catheterized with a range of microcatheters .
the main trunk was embolized with 300500 micron polyvinyl alcohol ( pva ) particles ( cook , usa ) .
the medial division of the inferior phrenic artery was seen to supply the mass via its pericardial branch .
this was super - selectively catheterized with the same 5 fr catheter and a renegade microcatheter ( boston scientific , usa ) and embolized with the same pva particles .
no spinal , esophageal , or coronary supply was demonstrated from the bronchial and left inferior phrenic arteries .
there were no procedure - related complications and the patient had an uneventful recovery with no further hemoptysis during the 3 years follow - up period .
contrast - enhanced ct with mip images ( a and c ) showing blood supply to the lesion with bronchial artery and left inferior phrenic artery ( arrows ) .
catheter angiogram demonstrates bronchial artery ( arrow in b ) and left inferior phrenic artery ( arrow in d ) and subsequent embolization with pva ( e and f )
cd may be localized or multicentric and primarily involves the mediastinum , neck , and mesentery .
there are three known histological variates namely ( a ) hyaline - vascular , ( b ) plasma - cell , and ( c ) mixed variant .
classic features on a ct scan is a solitary , intensely , and homogeneously enhancing mass with no local invasion .
the standard treatment of the localized form is surgical resection , however , where there is encasement or invasion of the adjacent structures , preoperative embolization has been advocated . recently ,
embolization alone without surgical resection has been shown to terminate hemoptysis and alleviate shortness of breath due to airway compression in patients with unresectable disease . in our patient ,
preoperative embolization , which may have reduced the large volume intraoperative blood loss , was not considered .
it was only when the patient presented with hemoptysis after surgical resection that the vascular supply was identified and an emergency referral to interventional radiology was made .
previous reports have identified bronchial , internal mammary , and intercostal arteries as feeding vessels to cd .
inferior phrenic supply to cd has not been reported before to the best of our knowledge .
when basal lung segments are suspected as the source of hemoptysis , inferior phrenic supply should always be considered .
inferior phrenic supply to hilar masses is much rarer , but when it occurs , the supply is usually via the pericardial branch of its medial division .
the left inferior phrenic medial branch may supply the esophagus , and it is important to exclude any esophageal supply before particulate embolization .
careful review of multiplanar reformats of the ct scan aided procedure planning and the consent process by identifying the hypertrophied arterial feeders .
cd should be considered in the differential diagnosis for all benign intrathoracic masses . where a mass shows avid enhancement , whether homogeneous or heterogeneous , a ct angiogram ,

Answer:
castleman 's disease ( cd ) is a rare lympho - proliferative disorder due to faulty immune regulation resulting in proliferation of lymphatic tissue .
 the vascular supply to these lesions have been reported to arise from the bronchial , internal mammary and the intercostal arteries .
 we report a case of hemoptysis secondary to intrathoracic cd with vascular supply arising from the left inferior phrenic artery which was successfully embolised with polyvinyl alcohol ( pva ) particles .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
attention - deficit / hyperactivity disorder ( adhd ) is a behavioral disorder usually diagnosed during childhood .
it is characterized by developmentally inappropriate symptoms of inattention , hyperactivity and impulsivity and significant impairment in multiple domains of functioning .
diagnostic and statistical manual of mental disorders ( dsm - iv ) diagnostic criteria define three adhd subtypes based on the presence of inattention and hyperactivity / impulsivity symptoms : predominantly inattentive type , predominantly hyperactive / impulsive type , and combined type . a recent us national epidemiological study of 8- to 15-year - old school children found an 8.7% prevalence of adhd , with the predominantly inattentive type most prevalent ( 4.4% ) among the adhd subtypes ( combined type , 2.2% ; predominantly hyperactive - impulsive type , 2.0% ) .
the behavioral manifestations of adhd inattentive type differ from those associated with combined and hyperactive / impulsive type .
children with combined and hyperactive / impulsive type exhibit problems with behavioral inhibition , including interrupting , blurting out , getting out of their seat at inappropriate times , and playing loudly .
in contrast , the primary difficulties of children with inattentive type are non - disruptive in nature and are related to planning and organizing actions .
children with inattentive type often forget to complete or lose assignments , procrastinate , complete work carelessly , have difficulty planning for the completion of long - term projects and studying for tests , and have problems keeping materials organized [ 7 - 9 ] .
three treatments qualify as  well - established interventions for children with adhd : psychopharmacological therapy , behavioral parent training , and behavioral classroom management .
psychopharmacological therapy ( e.g. stimulant medication ) is the most utilized intervention modality for treating patients with adhd and produces marked improvements in sustained attention , impulse control and noisy and disruptive behaviors .
while psychopharmacology ameliorates some of the core symptoms of adhd inattentive type , there is minimal evidence to suggest that medication promotes improvements in the ability to effectively plan and organize materials and/or actions . as such
, stimulant medication is only minimally effective in improving important areas of functioning such as long - term academic achievement .
similarly , evidence - based behavioral treatments , such as parent training and classroom management , primarily target impulsive and disruptive behaviors and do not focus on the problematic behaviors associated with inattentive type .
in the past 2 years , several advances have been made in the treatment of behaviors exhibited by children with adhd inattentive type .
interventions have been evaluated that target planning , materials organization , time - management , and homework management skills .
these interventions typically focus on behavior in the school setting as demands for these skills are greatest at school and can lead to significant academic impairment .
children are taught systems for organizing school materials and managing / planning homework responsibilities . checklists with operationalized definitions of behavior are used to monitor skills implementation . similar to existing evidence - based interventions for adhd , these interventions incorporate behavioral therapeutic techniques , such as rehearsal , prompting , shaping and contingency management , to teach and promote skills use and their generalization .
for example , point systems or token economies are often utilized to monitor and reward adherence .
interventions have been evaluated that target multiple aspects of organization and planning , including : classroom preparation , organization of bookbag , binder , and locker , and planning and tracking homework assignments and long - term projects .
these interventions are associated with short - term gains on process measures of materials organization , homework management , planning and procrastination .
some of these improvements appear to be sustainable for children with adhd as assessed at 8-week   and 3-month follow - ups . at this point , it is unclear if gains on process measures ( e.g. materials organization or homework management checklists ) are ultimately associated with improvement in functional outcomes such as school performance .
only a subset of studies completed to date included both process measures and measures of functional impairment .
documented improvements in organizational skills , parent ratings of homework problems , and grade point average . however , the gains in grade point average were relatively small .
pfiffner et al .   documented improvements in organizational skills and a clinician completed clinical global impression , and these gains were maintained at a 3- to 5-month follow - up .
abikoff and gallagher   showed improvements in both organizational skills and parent - rated homework problems , but it is unknown if improvements in homework problems resulted in overall academic improvements .
hence , alternative explanations for observed patient improvements are possible ( e.g. hawthorne effects ) .
in addition , generalization across settings was not formally assessed in most of the studies .
it would be important to determine if skills generalize across classrooms or from school to home .
the behavioral difficulties of patients with adhd inattentive type may be markedly different from those of children with combined or hyperactive / impulsive type and the targets of treatment will need to be tailored accordingly . while behavioral interventions targeting organization , planning and time - management can not be classified as
a central challenge will be figuring out how to disseminate these interventions into clinical practice .
the interventions evaluated to date have varied in where the intervention is delivered ( e.g. school , home , or clinic ) , and dissemination models will need to account for these factors . providing intervention directly in the setting where the skills are most relevant / problematic ( e.g. school ) should allow clinicians to achieve higher levels of skills generalization . to promote dissemination , intervention protocols should be developed that do not require a high degree of clinical specialization to implement and that can be implemented directly in the setting of interest .

Answer:
the behavioral difficulties of children with attention - deficit / hyperactivity disorder ( adhd ) inattentive type differ from those of children with adhd combined or hyperactive / impulsive type .
 existing evidence - based interventions primarily target the disruptive and impulsive behaviors exhibited by children with adhd combined and hyperactive / impulsive type .
 a number of recent advances have been made in the non - pharmacological treatment of behavioral difficulties associated with adhd inattentive type .
 additional research using randomized controlled research designs and long - term follow - up evaluation is necessary before these interventions may be considered established evidence - based interventions for patients with adhd inattentive type .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
renal transplantation rates are low among patients highly sensitized to human leukocyte antigen ( hla ) because of the high rate of antibody - mediated rejection and subsequent graft loss .
it was recently reported , however , that preoperative desensitization using an anti - cd 20 antibody ( rituximab ) and intravenous immunoglobulin improved transplantation rates in patients highly sensitized to hla . in contrast , the significance of a positive lymphocytotoxic crossmatch in living donor liver transplantation ( ldlt ) is controversial .
successful ldlt using a liver graft in which the lymphocytotoxic crossmatch was highly positive is reported .
the recipient was a 41-year - old woman with end - stage liver disease due to alcoholic liver cirrhosis ( model for end - stage liver disease score 21 ) . at the age of 20 , she was gravida one , para one .
she was considered a candidate for liver transplantation because of repeated episodes of encephalopathy . because of the severe shortage of cadaveric donor grafts in japan , we planned an ldlt , and her husband was willing to donate his partial liver .
the abo blood type was identical , but the t lymphocytotoxic crossmatch titer was over 10,000 and the b lymphocytotoxic crossmatch titer was 128 ( complement method with the dilution technique according to the standard national institutes of health technique ) .
in addition , an examination of anti - hla antibodies using fluorescent microspheres revealed that the recipient had donor specific antibodies ( b51 and b52 ) .
after obtaining written informed consent from the patient and donor and the approval of the intra - institutional committee , we proceeded to the preoperative preparations .
for preoperative desensitization , the patient was first infused with rituximab 2  weeks before the scheduled surgery ( due to a catheter - associated infection , however , the operation was postponed and ldlt was performed 21  days after initiation of the rituximab therapy ) . as the antibody to hepatitis b core antigen was positive , entecavir ( 0.5  mg / day ) was administered for 3  weeks preoperatively to prevent a possible hepatitis b virus breakthrough .
on postoperative days 1 and 4 , 20  mg of anti - cd25 antibody ( basiliximab ) was administered in addition to the routine methylprednisolone and tacrolimus , as we were anxious about hyperacute rejection . besides , mycophenolate mofetil ( mmf ; 2,000  mg / day ) was started on postoperative day 7 .
the postoperative course was uneventful except for an episode of mild acute cellular rejection ( banff score 3 ) on postoperative day 27 , which responded promptly to steroid recycle therapy .
the liver biopsy specimen obtained at the time of the acute rejection showed mild infiltration of lymphocytes in the portal area and around the bile ducts .
one year after the ldlt , the lymphocytotoxic crossmatch remained negative and the patient has been well with good graft function.fig .
acr acute cellular rejection , alt alanine aminotransferase , mmf mycophenolate mofetil , mp methylprednisolone , pe plasma exchange , tb total bilirubin , pod postoperative day the clinical profile of the present patient .
acr acute cellular rejection , alt alanine aminotransferase , mmf mycophenolate mofetil , mp methylprednisolone , pe plasma exchange , tb total bilirubin , pod postoperative day
the impact of a lymphocytotoxic crossmatch - positive liver graft on acute cellular rejection and graft survival remains controversial , both in deceased donor liver transplantation [ 3 , 4 ] and in ldlt [ 57 ] .
some institutions have reported significantly unfavorable outcomes in ldlt recipients with a positive lymphocytotoxic crossmatch [ 6 , 7 ] .
in contrast , our previous results   showed that if the titer is low ( no more than 32 ) , a positive lymphocytotoxic crossmatch does not adversely affect the graft or survival in patients without desensitization .
although the significance of a quantitative assessment of the lymphocytotoxic crossmatch has not been reported , the high titer in our present patient led to the need for perioperative desensitization to prevent early graft loss due to antibody - mediated rejection . after considering the results in the present patient ,
we have settled the indication criteria for preoperative desensitization therapy at the titer of 1,000 ( t lymphocyte crossmatch ) . in this patient ,
therefore , we applied preoperative desensitization using rituximab and plasmapheresis to reduce the high titer of preformed antibodies and b lymphocytes . as a result ,
the lymphocytotoxic crossmatch was negative after the 3rd plasmapheresis , and negativity was sustained thereafter .
preoperative desensitization using rituximab was introduced in abo - incompatible ldlt in 2003 and has dramatically improved the outcomes of abo - incompatible ldlt .
the appropriate dosage of rituximab is still controversial , but many previous studies have reported the administration of 375  mg / m of rituximab 13  weeks before the transplant . following these successful cases , we planned the administration of 375  mg / m ( 500  mg / body ) of rituximab 2  weeks before the operation [ 8 , 9 ] .
splenectomy is also considered to be effective to reduce antibody production , as the spleen is the site of antibody production .
after the operation , the suppression of t - cell function to prevent the initiation of t - cell - mediated antibody production was regarded as indispensable .
we have routinely used tacrolimus and steroid as an immunosuppressive regimen , and in this particular patient , we added basiliximab ( postoperative days [ pods ] 1 and 4 ) and mmf .
mild acute cellular rejection occurred about 3  weeks after the ldlt , but response to the steroid recycle therapy was prompt , and the lymphocytotoxic crossmatch was negative during this episode . in summary , we report a successful ldlt using a lymphocytotoxic crossmatch highly positive graft .
perioperative desensitization using plasmapheresis and rituximab may provide significant benefits for reducing anti - hla antibodies .

Answer:
we describe a successful living donor liver transplantation ( ldlt ) using a lymphocytotoxic crossmatch highly positive graft . a 41-year - old woman with alcoholic liver cirrhosis was referred as a potential candidate for ldlt , and her husband was willing to donate his partial liver .
 as the t - lymphocytotoxic crossmatch titer was over 10,000 , the patient was first infused with rituximab for preoperative desensitization , and then five rounds of plasmapheresis were performed . after the third plasmapheresis , the lymphocytotoxic crossmatch test was negative .
 a left liver graft including the caudate lobe was implanted , and anti - cd25 antibody ( basiliximab ) was administered on postoperative days 1 and 4 .
 the postoperative course was uneventful except for an episode of mild acute cellular rejection on postoperative day 27 .
 although the impact of a lymphocytotoxic crossmatch - positive liver graft on acute cellular rejection and graft survival in ldlt remains controversial , perioperative desensitization may provide benefits when using a highly sensitized liver graft .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
in this issue of critical care , laporta and coworkers   review a multidisciplinary working group 's analysis of a case study on the causes of and solutions for staff turnover in an intensive care unit ( icu ) setting .
this issue is of profound significance to health care leaders in western countries because the workforce is shrinking as a result of impending baby boomer retirements and , as the population ages , the demand for intensive care services will grow considerably .
these demographic factors are further compounded by the fact that the complexity of care provided in the icu demands professionals who are highly trained and skilled . in this environment
, turnover can be costly to the organization because of the significant expenses associated with recruiting and training workers .
there are many well documented reasons for staff turnover in the intensive care setting that are highlighted by laporta and coworkers   as core reasons .
these core reasons include job dissatisfaction due to inflexible scheduling practises , insufficient opportunity for professional development , as well as a lack of collaborative decision making around clinical and practice issues .
the authors discuss that data on icu turnover comes from nursing literature and that this research may be applicable to other health care professionals .
however , it is important not to assume that reasons for turnover are the same among different groups of health care providers and that staff turnover is something to be avoided at all costs .
for example , misra - hebert and coworkers   state that one contributor to physician turnover is conflict between the physician 's and organization 's philosophy and goals .
physician turnover in this case may be beneficial both to the physician and organization if the two parties can not reconcile their differences and the conflict impacts on the ability of both parties to move forward .
there are other important reasons for turnover that should be considered by icu leaders , and these include burnout and generational diversity .
burnout is a prevalent phenomenon in icus , and the nursing literature suggests that issues such as moral distress when engaging in futile care contributes to burnout . in the medical literature causes of physician burnout include volume of work , increased expectations of the public , lack of sleep and the possibility of being sued .
the consequence of burnout is that there is a negative impact on quality of care and staff morale , which can ultimately cause turnover .
for example , gunderson   indicates that physicians who are dissatisfied may engage in inappropriate prescribing patterns .
neuhauser , furthermore , discusses how environments with rigid systems and attitudes among the leadership will decrease staff morale because staff desire flexible policies and autonomy in decision - making .
the generational diversity found in the icu environment can also be a source of turnover of staff .
it is well documented that generation x ( born in 19651980 ) and the millennial generation ( born in 19802000 ) have a strong desire for more balanced work life than veterans ( born in 19251945 ) and baby boomers ( born in 19461964 ) .
research conducted by lorin and coworkers   on internal medicine residents of the millenial generation showed that although 41% considered a fellowship in critical care , only 3.4% chose this training because of lack of leisure time and stress levels among faculty and fellows .
clearly , it is important for leaders to be attuned to these generational differences when developing recruitment and retention plans and redesigning the workplace environment .
the review from laporta and coworkers   also highlights the importance of icu leadership working with frontline staff to create a vision and strategy that addresses the core reasons for turnover .
it is essential that this vision be aligned with the vision , mission and values , and strategic plan of the health care organization .
furthermore , the team should assess whether their hospital is highly reputable , has high patient satisfaction , and sufficient resources and equipment to provide care .
all of these components are signs of a positive work environment , and leadership can build on these attributes to recruit and retain staff . the other key factor in this process is the use of a team work approach
. team work training in the areas of conflict resolution , learning styles and giving feedback will help the staff to work together to create and achieve an inspiring vision .
although the financial and human resource investments required to engage in this process are considerable , there is substantial evidence in the literature that highly functioning , satisfied teams lead to more efficient patient care and better outcomes .
staff turnover is a critical issue that icu leaders need to understand and address in their unit settings .
attention to this issue with a systematic , evidence - based approach that focuses on team work and collaboration will not only improve retention but will also make the icu a highly competitive and desirable place to work .

Answer:
this commentary discusses laporta and coworkers analysis of a case study on the causes of and solutions for staff turnover in an intensive care setting .
 staff turnover is a significant issue for health care leaders due to the shrinking workforce in western countries and an increased demand for intensive care services as the population ages .
 the commentary considers reasons for turnover such as burnout and generational diversity , and highlights the importance of a team work approach to address the issue of turnover .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
shallots ( wild garlic / osghordion ) with the scientific name of allium hertifolium , is one of the most famous plants from the alliaceae family . for a long time , shallots have been used as a source of food and medicine in iran .
the active ingredients of the plant could be referred to agapentagenin , allicin , omega-3 , omega-6 , and minerals such as potassium , sodium , magnesium , iron , copper , zinc , and manganese .
this study was conducted to compare shallots in the traditional and modern medicine in order to make a better use of this precious plant .
to collect appropriate data , resources and articles in trustworthy databases ( e.g. cochrane library , pubmed , google scholar ) and traditional literature ( e.g. makhzan - ul - adwiah , canon , zakhireh - ye khwarazmshahi ) were studied .
subsequently , the findings were reviewed , classified , and reported in a tabular format .
shallots are rich in fatty acids and minerals with many pharmacological effects such as its effect on the respiratory and nervous system and blood dilution , as reflected in the modern medicine
. however , certain effects as mentioned in traditional medicine ( e.g. anti - warts , anti - lipoma , anti - kidney stone , and its diuretic effects ) are not covered in research studies of the modern medicine .
depending on its natural habitats , shallots have different pharmacological effects for which many usages are mentioned in traditional medicine .
some of these effects have been investigated in modern medicine ; however , further evaluation of its safety and dosages for clinical use is necessary .
furthermore , some cases have not been studied in modern medicine , which could be the basis for future research .

Answer:
background : shallots ( wild garlic / osghordion ) with the scientific name of allium hertifolium , is one of the most famous plants from the alliaceae family . for a long time , shallots have been used as a source of food and medicine in iran .
 the active ingredients of the plant could be referred to agapentagenin , allicin , omega-3 , omega-6 , and minerals such as potassium , sodium , magnesium , iron , copper , zinc , and manganese .
 this study was conducted to compare shallots in the traditional and modern medicine in order to make a better use of this precious plant.methods:to collect appropriate data , resources and articles in trustworthy databases ( e.g. cochrane library , pubmed , google scholar ) and traditional literature ( e.g. makhzan - ul - adwiah , canon , zakhireh - ye khwarazmshahi ) were studied .
 subsequently , the findings were reviewed , classified , and reported in a tabular format.results:shallots are rich in fatty acids and minerals with many pharmacological effects such as its effect on the respiratory and nervous system and blood dilution , as reflected in the modern medicine .
 however , certain effects as mentioned in traditional medicine ( e.g. anti - warts , anti - lipoma , anti - kidney stone , and its diuretic effects ) are not covered in research studies of the modern medicine.conclusion:depending on its natural habitats , shallots have different pharmacological effects for which many usages are mentioned in traditional medicine .
 some of these effects have been investigated in modern medicine ; however , further evaluation of its safety and dosages for clinical use is necessary .
 furthermore , some cases have not been studied in modern medicine , which could be the basis for future research .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
my experience in state government has been that after natural or manmade point - source disasters , a governor reflexively turns to the office of emergency management , the department of public safety ( or homeland security ) , or the national guard for advice and counsel .
the staffs of these agencies , however , have neither the expertise necessary to guide the response to an epidemic nor an established , ongoing communications and surveillance system with hospitals , laboratories , and medical providers .
it is essential , therefore , to establish a formal process that allows public health and medical experts to assist elected officials in analyzing and interpreting information about the outbreak and in coordinating the public health response to the outbreak .
guidance for fiscal year 2002 supplemental funds for public health preparedness and response for bioterrorism issued by the centers for disease control and prevention ( cdc ) requires that a state establish an advisory committee that includes representatives from health departments , first responders , hospitals , and voluntary organizations such as the red cross ( 11 ) . in colorado
this advisory committee includes not only the nine groups listed in the cdc announcement but also the presidents of the state board of health , state medical society , and state hospital association ; the state veterinarian ; a wildlife disease specialist ; a medical examiner ; a specialist in posttraumatic stress management ; a pharmacist member of the board of pharmacy ; the attorney general ; the chief public information officer for the state health department ; and , as an ex - officio member , the chief of the colorado national guard ( 3 ) .
these persons were named to the committee because they possess useful expertise or connections to the community .
the statute authorizing the formation of the committee provided legal immunity to members for their advice ( 4 ) , and the members pledged that they would attend the committee meetings during a bioterrorist attack rather than report to their regular jobs . by meeting regularly
the committee members learn about each other s skills , experience , and roles and develop a working relationship that , by itself , can be extremely valuable during a crisis .
one notable absence in the composition of the advisory committee is representation from federal agencies , such as cdc , the federal emergency management agency , the environmental protection agency , and the federal bureau of investigation . although these agencies can not , as a practical matter , attend meetings in every state and large municipality , during a crisis they will have an integral role , and disputes are more likely if the leaders are meeting for the first time in a highly stressful situation .
for example , local - state - federal disagreements occurred in the management of the pneumonic plague epidemic in los angeles in 1924 , the last instance of person - to - person transmission of plague in the united states , as well as during the anthrax outbreak in 2001 ( 12,13 ) .
some existing state regulations , which in normal times are intended to ensure quality medical care , could hinder community efforts during a bioterrorist attack .
for example , consideration should be given to modifying , for a limited period through executive orders , the regulations that control the prescription and dispensing of medicine , licensing of physicians and nurses , and transfer of patients between hospitals .
providing antibiotics or vaccinations in mass clinics and obtaining the services of retired or out - of - state physicians and nurses may be necessary .
in colorado , executive orders that address these concerns have been drafted by the governor s technical advisory committee .
the orders would permit a ) health - care providers other than pharmacists and physicians , such as nurses and emergency management technicians , to dispense medications , b ) medicines to be distributed without an identified patient s name on the packet or bottle , c ) practice of medicine and nursing by professionals who are not currently licensed in colorado , provided the practice is restricted to caring for epidemic - associated illnesses and the persons are working under the supervision of a licensed practitioner ( who is given legal immunity for the supervisee s work ) , and d ) persons seeking medical care at one facility to be redirected to another facility without initial assessment or stabilization attempt if the initial hospital is unable to care for any more persons or if a specific facility ( established or temporary ) has been directed to receive epidemic patients , e.g. , those with smallpox .
these draft orders must still be tailored to the actual emergency and signed by the governor , but the background legal work can be completed ahead of time . two additional features of the colorado bioterrorism statute exist ; these features were designed to encourage volunteers and remove legal barriers to cooperation among institutions and agencies .
first , the statutory definition of  civil defense worker  was modified to include a  physician , health care provider , public health worker , or emergency medical service provider who is ordered by the governor  to provide specific medical or public health services during and related to an emergency epidemic and who complies with this order without pay or other consideration  ( 7 ) . with this amendment
, civil defense workers may receive compensation for injury , including illness caused by bioterrorism , which is suffered as a result of civil defense service .
second , the statute provides that  persons and entities [ including hospitals ] that in good faith comply completely with board of health rules regarding the emergency epidemic and executive orders  shall be immune from civil or criminal liability for any action taken to comply with the executive order or rule  and that the state shall provide  compensation for property  if the property was commandeered or otherwise used in coping with an emergency epidemic   ( 4 ) .
to ensure that a sufficient number of health - care providers , laboratory technicians , public health epidemiologists , and administrative support workers show up for work during a bioterrorist attack , appropriate personal protection ( e.g. , respiratory protection , vaccination , or chemoprophylaxis ) for the worker and , probably , for household members of the worker are essential . when performing nonstandard work , the worker may also need legal protection , as discussed above .
plans for a bioterrorist attack should include these factors and be written by the employer who knows how the agency operates and is staffed because people work for an agency , hospital , or institution , not a region .
nonetheless , coordination of resources should develop mutual aid agreements with neighboring jurisdictions and integrate single institution or agency plans into community , regional , or statewide plans .
in the 2000 colorado bioterrorism statute , the state board of health was given the new authority to promulgate rules requiring each state and local health department , general or critical access hospital , and managed - care organization to write a plan for responding to bioterrorism ( 7 ) .
while hospitals and health departments may have previously written plans for managing mass casualties resulting from aircraft , bus , or train crashes or natural disasters , such plans need to be modified to include consideration of the special circumstances of bioterrorism ( e.g. , chemoprophylaxis and personal protective equipment for workers , infection control , and handling of laboratory specimens ) .
because pandemic influenza may pose challenges to the medical and public health systems similar to those of bioterrorism , a single plan for both types of epidemics should be drafted .
during  typical  outbreaks of communicable diseases , clear and timely communication by the state health department with multiple local health departments and hospitals can be a challenge . in a bioterrorist attack
, the communications challenge will likely be greater because many more persons and agencies will be involved .
the telephone system may not have sufficient capacity for the increased demand or it may be damaged and disorganized , as happened during the response to the attacks on the world trade centers in new york city in september 2001 ( 14 ) .
furthermore , a large , sometimes overwhelming , number of inquiries made by members of the public to the public health agency usually occur during public health crises , and therefore , administrative plans for a bioterrorist event should include consideration of this workload .
rather than relying on hospital personnel , public health agencies may find it advantageous to station their own personnel with mobile telephone or radio communications equipment in individual hospitals to assure that public health agencies get the information they need as rapidly as possible .
accomplishing this may require an executive order of the governor that commandeers two - way radios .
in colorado , board of health regulations require the state and local health departments to include assignment of employees to hospitals in the agency s emergency plan ( 8) .
disease reporting requires specification of what to report in what manner and timeframe to which parties .
a first legal step in this process is to require immediate reporting of any suspected or confirmed illness , syndrome , or outbreak caused by any potential bioterrorist agent .
for example , colorado regulations were modified in 1999 so that cases of plague , which had been required to be reported within 24 hours of diagnosis by telephone , fax , or through a web - based system , were to be reported immediately only by telephone to an on - call person if the physician or hospital suspected the case was related to a bioterrorist event ( 9 ) .
disease surveillance systems are critical not only for the initial detection of an outbreak but also for monitoring the extent and spread of the outbreak and for determining when it is over .
managing a large outbreak would require gathering information from contact tracing and source - of - exposure investigations as well as information about the availability of critical medicine , medical equipment , and the handling of corpses .
these information needs are much different than those needed for early detection of an attack .
therefore , legal authority for surveillance should be modified as necessary to ensure collection of all information that could be needed by the public health agency to fulfill its duties throughout the epidemic .
this legal authority may include requirements for groups that do not commonly report information , such as pharmacists , to provide it .
administrative public health orders restricting personal behavior of persons with certain diseases , such as tuberculosis , are relatively common in this country ( 15 ) . such orders are usually hand - delivered to a specific person(s ) , and the restrictions are removed after a specified period , such as after one incubation period or when an ill person is no longer infectious .
another type of public health order might involve work restriction , e.g. , health - care providers who can not demonstrate evidence of immunity to a vaccine - preventable disease are not permitted to work during an outbreak of such disease .
few , if any states , however , have experience issuing and enforcing large - scale quarantine orders that last more than 12 days . orders restricting large numbers of contacts of cases of plague to home were issued in florence , italy , in 1630 and described in the 1999 book , galileo s daughter ( 16 ) .
the enforcement of orders restricting the movement of residents of an entire town in which there was an outbreak of viral hemorrhagic fever was depicted in the 1996 movie , outbreak .
the images of severe disease and enforced quarantine are similar in the book and movie and are plausible and disturbing to lay audiences .
a more recent , well - documented example of a large - scale movement restriction was the british epidemic of foot - and - mouth disease of 2001 , which affected many farms and businesses and led to the quarantine and slaughter of 4 million sheep , cattle , and pigs for disease control purposes ( 17 ) .
in all three examples , a decentralized quarantine was imposed . in general , the advantage of a decentralized strategy ( e.g. , persons are restricted to home ) is that it may reduce the risk for transmission of disease because fewer persons congregate .
alternatively , the centralized strategy ( e.g. , restricted persons are taken to a sports arena , auditorium , theater , school , or hospital ) is seemingly easier for the government to care for restricted persons and to enforce the order but could allow contagious and noncontagious persons to come into contact with each other .
another example of large - scale quarantine occurred in los angeles in 1924 during the last epidemic of pneumonic plague in this country ( 12 ) .
three days after the first 15 cases in this outbreak became known to public health officials , eight city blocks that housed approximately 2,500 mexicans were placed in quarantine .
public health nurses were sent to the area to make house - to - house inspections to identify new cases , and all patients with suspected cases in the area were examined by physicians at the patient s home and then sent to the county hospital .
all persons who lived at addresses where cases had occurred were quarantined in the county general hospital , and a spanish - speaking priest and social workers were placed in the area to reassure and calm the residents .
the quarantine actions taken in this outbreak were a combination of centralized and decentralized strategies .
as has been discussed by barbera et al . ( 18 ) , numerous concerns regarding large - scale quarantine exist .
all states currently have in place varying degrees of legal authority enabling isolation , quarantine , or travel restrictions if needed to maintain the welfare and safety of the public .
drafting restrictive orders in advance is less helpful than with the other types of orders discussed above because restrictive orders require more tailoring to the specific circumstances and parameters of an outbreak .
factors such as duration and location of restriction are dependent on what the bioterrorist agent is , how it is transmitted , how widely the agent has been disseminated , whether exposed persons can be personally identified , and what resources are available to care for restricted persons .
not drafting such orders in advance , however , means that they may be written during the turmoil of multiple agencies trying to control an outbreak .
authorities should never hesitate to revise the orders on the basis of on updated information . at the end of the operation topoff exercise , for instance , when the governor had issued a travel restriction order for all of metropolitan denver and cdc
had quarantined the entire state of colorado , such orders created many unforeseen problems , including how to enforce the orders , maintain essential community services , and distribute foods and prescription medicines .
accurate and substantive information given to the public by credible public health and medical experts can do much to allay the fears of the public and encourage their cooperation and participation in constructive , organized community response efforts ( 19,20 ) .
i have discussed a number of ideas about legal and administrative preparations for a bioterrorist attack , but more work can be done , including development of strategies addressing issues related to mental health , disposal of corpses , performing forensic autopsies , signing death certificates , and managing potential animal vectors of disease .
i have not discussed the sharing of medical and epidemiologic information between public health agencies and law enforcement agencies , such as the federal bureau of investigation . under normal circumstances , public health officials typically argue that release of disease surveillance information to the criminal justice system will discourage persons with reportable conditions from disclosing to public health officials where they have been and with whom they have had contact . however , a bioterrorist attack is not a routine event , and i recommend that state and local public health agencies review the laws and regulations governing the confidentiality of disease surveillance records and develop a legal and administrative protocol for sharing pertinent and relevant information with law enforcement agencies during a bioterrorist attack ( 21 ) . finally , i have not discussed the protection of civil liberties and due process for persons affected by executive orders of the governor and public health officials .
this is an important and difficult issue , especially when well persons are quarantined solely on the basis of their having visited , worked , or resided in a particular location at a particular time , as opposed to having had face - to - face contact with a known contagious person .
public health officials and attorneys general should review existing safeguards for the protection of civil liberties and determine whether modifications need to be made for the special circumstances created by a bioterrorist attack .

Answer:
this article proposes and discusses legal and administrative preparations for a bioterrorist attack . to perform the duties expected of public health agencies during a disease outbreak caused by bioterrorism
 , an agency must have a sufficient number of employees and providers at work and a good communications system between staff in the central offices of the public health agency and those in outlying or neighboring agencies and hospitals .
 the article proposes strategies for achieving these objectives as well as for removing legal barriers that discourage agencies , institutions , and persons from working together for the overall good of the community .
 issues related to disease surveillance and special considerations regarding public health restrictive orders are discussed .


Question:
You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
indian population representing one - sixth of the world population has been the global melting pot of human diversity .
it has all the world s major linguistic groups and the populations have been shaped by different waves of migrations and admixture ( 1 ,  2 ) .
further , stringent mating patterns have led to the existence of several endogamous populations , which makes it an important resource for mapping genes ( 3 ) .
the indian genome variation consortium ( igvc ) project , an initiative of the council for scientific and industrial research ( csir)was set up to develop a database of genomic variations in indian population for predictive marker discovery in complex diseases such as diabetes , asthma , neuropsychiatric , infectious and cardiovascular disorders , response to drugs , etc .
the phase i of the project was conducted to determine the extent of genetic differentiation in india . toward this genotype data of 405 snps from 75 genes and 4.2
mb contiguous chromosome 22 regions were studied in 55 contrasting populations ( 4 , 5 ) .
these populations were identified from 4 major linguistic groups namely , austro - asiatic ( aa ) , tibeto - burman ( tb ) , indo - european ( ie ) and dravidian(dr ) spanning 6 geographical regions of habitat ( n , north ; ne , north - east ; w , west ; e , east ; s , south ; c , central ) and different ethnic groups ( lp , large population , caste ; ip , isolated population , tribes ; sp , special population , religious groups ) .
five genetically distinct clusters were identified and a set of 24 populations that represent these clusters were selected for the phase ii of the project . in the phase ii , 3824 snps from 834 candidate gene as well as 50  000 ( affy 50  k array ) genome wide neutral markers
this initiative lays the foundation for the integration of global genotype - to - phenotype data ( 6 ) with indian population data and development of a federated database .
to address the need for an online comprehensive resource that enables users to visualize igvc data with integrated information about snps from different resources we have developed igvbrowser as shown in figure 1 .

distribution of markers in 2.41  mb region in human chromosome 1 from igvc data is displayed along with annotation data from different resources .
distribution of markers in 2.41  mb region in human chromosome 1 from igvc data is displayed along with annotation data from different resources .
the database includes ( i ) final validated dataset from 1871 samples in phase i comprising of 405 autosomal snps spanning over 75 genes including 90 snps from 5.2  mb region of chromosome 22 from 55 diverse endogamous indian populations ( 3 ) ; ( ii ) phase ii dataset for 3824 snps spanning from 834 genes in 545 samples from 24 igvdb populations and ( iii ) 50  000 ( affy 50k xbai array ) neutral markers in 26 populations .
the phase ii populations are a subset of the populations genotyped in the phase i. web - based tool snpper ( http://snpper.chip.org/ ) was used to classify the 4229 markers in phase i and phase ii according to their location in genic regions ( figure 2 ) .
similarly , david ( http://david.abcc.ncifcrf.gov/ ) was used to classify the genes containing these markers according to gene  disease association class ( figure 3 ) and their mapping in various kegg pathways ( figure 4 ) .
we report that a large fraction of genes are implicated in cardiovascular , metabolic , cancer and immune system - related diseases .
thus , the igvc data provide a basal level variation data in indian population to study genetic diseases and pharmacology .

more than 50% of the snps belong to intronic regions and 15% are in coding exons .

figure 3.bar graph shows the functional annotation of candidate genes in igvc according to gene  disease association .

figure 4.bar graph shows the mapping of candidate genes in significant pathways ( after bonferroni correction ) of kegg pathway database .
more than 50% of the snps belong to intronic regions and 15% are in coding exons .
bar graph shows the mapping of candidate genes in significant pathways ( after bonferroni correction ) of kegg pathway database .
igvbrowser also included hapmap snp genotype data from phases i + ii and iii of the hapmap project ( http://hapmap.ncbi.nlm.nih.gov/downloads/gbrowse/2009-02_phaseii+iii/gff/ ) based on ncbi b36 assembly , dbsnp b126 from 4 populations : yoruba from ibadan , nigeria ( yri ) ; japanese in tokyo , japan ( jpt ) ; han chinese in beijing , china ( chb ) ; and ceph ( utah residents with ancestry from northern and western europe ) ( ceu ) .
additional annotation information including cytogenetic positions , link to pathway annotations in the reactome knowledgebase and mrna sequences were retrieved from hapmap in generic feature finding ( gff ) format .
annotation data in tab - delimited format for non - coding rna genes and pseudogenes , omim - associated genes , mirbase and snornabase , simple repeats , database of genomic variants were downloaded from ucsc genome annotation database ( http://hgdownload.cse.ucsc.edu/goldenpath/hg18/database ) based on build hg18 . the browser implements one of the widely used platform - independent genome annotation viewer generic genome browser ( gbrowse v1.69 ) , developed by stein et al .
( 7 ) as a part of the generic model organism system database project ( http://www.gmod.org ) .
gbrowse is a combination of database and interactive webpage for displaying genomic information along with providing data interoperability across systems running the same software .
integrated annotation data from primary sources like ncbi , ucsc and hapmap have been linked with variation data from different ethnic populations in india .
compiled data processed into gff format and complete human genome sequence as plain text files were loaded into mysql relational database management system using a script of gbrowse .
a user can query chromosomal region of interest , reference snp i d , hgnc symbols , pathway name or any other unique feature recognized by database as a query .
it allows researchers to upload their own data in gff format and view it along with data available in igvbrowser .
in addition , the resource is facilitated with sequence analysis servers maintained by ncbi and ucsc .
online data analysis plugins allows text dumps of visible features using a number of standard formats and also facilitates the download of sequence corresponding to selected region .
the browser implements one of the widely used platform - independent genome annotation viewer generic genome browser ( gbrowse v1.69 ) , developed by stein et al .
( 7 ) as a part of the generic model organism system database project ( http://www.gmod.org ) .
gbrowse is a combination of database and interactive webpage for displaying genomic information along with providing data interoperability across systems running the same software .
integrated annotation data from primary sources like ncbi , ucsc and hapmap have been linked with variation data from different ethnic populations in india .
compiled data processed into gff format and complete human genome sequence as plain text files were loaded into mysql relational database management system using a script of gbrowse .
a user can query chromosomal region of interest , reference snp i d , hgnc symbols , pathway name or any other unique feature recognized by database as a query .
it allows researchers to upload their own data in gff format and view it along with data available in igvbrowser
in addition , the resource is facilitated with sequence analysis servers maintained by ncbi and ucsc .
online data analysis plugins allows text dumps of visible features using a number of standard formats and also facilitates the download of sequence corresponding to selected region .
indian genome variation data would be enormously useful for the dissection of common complex diseases and in pharmacogenomics studies .
frequency profiles of markers on disease or drug - related genes that have been generated through the igvc are being used to identify at - risk chromosomes , founders , ld - based mapping , tracing history of diseases in pharmacogenetics as well as reference populations for mapping relatedness ( 3,4,5,819 ) .
the interactive web browser , igvbrowser , has been created as a central repository for the current and future dataset on indian populations and is being made accessible in the public domain .
a possible integration of igvbrowser with hgvbaseg2p ( 20 ) can enable researchers for cross study comparison among different populations of the world for disease  gene association study .
indian genome variation project was funded by the council for scientific and industrial research programme cmm0016 and sip0006 .
funding for igvbrowser and open access charge is provided by european community 's seventh framework programme ( fp7/2007 - 2013 ) under grant agreement number 200754the gen2phen project .

Answer:
the indian genome variation consortium ( igvc ) project , an initiative of the council for scientific and industrial research , has been the first large - scale comprehensive study of the indian population .
 one of the major aims of the project is to study and catalog the variations in nearly thousand candidate genes related to diseases and drug response for predictive marker discovery , founder identification and also to address questions related to ethnic diversity , migrations , extent and relatedness with other world population .
 the phase i of the project aimed at providing a set of reference populations that would represent the entire genetic spectrum of india in terms of language , ethnicity and geography and phase ii in providing variation data on candidate genes and genome wide neutral markers on these reference set of populations .
 we report here development of the igvbrowser that provides allele and genotype frequency data generated in the igvc project .
 the database harbors 4229 snps from more than 900 candidate genes in contrasting indian populations .
 analysis shows that most of the markers are from genic regions .
 further , a large fraction of genes are implicated in cardiovascular , metabolic , cancer and immune system - related diseases .
 thus , the igvc data provide a basal level variation data in indian population to study genetic diseases and pharmacology .
 additionally , it also houses data on 50  000 ( affy 50  k array ) genome wide neutral markers in these reference populations .
 in igvbrowser one can analyze and compare genomic variations in indian population with those reported in hapmap along with annotation information from various primary data sources.database url : http://igvbrowser.igib.res.in