In this task, you are given a passage which has a question and the context. You have to generate an answer to the question based on the information present in the context.

Example Input: Context: Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran.', 'This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation.', "TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers' about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers' and employees' commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively.\Question: Does why TQM work in Iranian healthcare organisations?
Example Output: Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence.

Example Input: Context: Our previous work demonstrated altered messenger RNA expression of integrin -5 and -8, using an in silico analysis of publically available data from patients with biliary atresia (BA); however, we were unable to demonstrate statistically significant differences in protein expression because of sample size. In the present study, we repeated the analysis of liver fibrosis and protein expression of the integrins in a larger cohort of patients with BA and compared them with patients undergoing liver biopsy for other diagnoses, with the hypothesis that 1 of the integrins would be differentially expressed.', 'Liver specimens were obtained at 2 collaborating institutions. Samples from infants with BA (n = 23) were compared with samples from those who underwent liver biopsy for neonatal hepatitis (n = 9). All of the specimens were analyzed by 2 pathologists (C.R. and R.A.), who were blinded to the diagnoses. Standard Ishak scoring was performed to evaluate fibrosis and inflammation, and immunohistochemical (IHC) positivity was graded from 0 to 4. Comparisons between the IHC positivity and Ishak scoring for the BA and control groups were performed using the Student t test with P < 0.01 considered significant because of the multiple comparisons. Interobserver variability was assessed by intraclass correlation (ICC).', 'Pooled analysis from specimens from patients with BA showed significantly more fibrosis than controls based on Ishak scores (3.21 1.82 vs 1.17 1.00, P < 0.005). IHC evaluation showed increased integrin 8 protein expression when compared with controls (2.67 0.81 vs 1.72 0.62, P < 0.005); however, there were no significant differences in integrin 5 (1.93 0.84 vs 1.50 0.90, P = 0.23) or integrin 6 (0.85 1.20 vs 0.94 0.85, P = 0.82) expression. These data were confirmed on individual analysis. Interobserver agreement was fair for integrin 5 (ICC 0.52), good for integrin 6 (ICC 0.72), and excellent for integrin 8 (ICC 0.79) and fibrosis (ICC 0.89).\Question: Is integrin -8 , but not -5 or -6 , protein expression increased in livers of children with biliary atresia?
Example Output: Our data show that integrin 8, but not integrin 5 or integrin 6, protein expression is increased in liver specimens of patients with BA. These data support the mounting evidence that transforming growth factor- (TGF-) activation is responsible for the fibrosis found in BA. Anti-integrin 8 or more global integrin blocking strategies may be therapeutic options in BA, but further work is clearly needed.

Example Input: Context: The present prospective study examines the levels of maternal plasma folate, vitamin B12 and homocysteine in normotensive control (NC) women and women with preeclampsia (PE) from early pregnancy till delivery.', 'The present study includes 126 NC and 62 PE women. Maternal blood was collected at 3 time points during pregnancy (T1 = 16th-20th weeks, T2 = 26th-30th weeks and T3 = at delivery). Levels of folate, vitamin B12 and homocysteine were estimated by the chemiluminescent microparticle immunoassay technology.', 'Maternal plasma folate levels were similar between NC and PE women at all the time points across gestation. Maternal plasma vitamin B12 levels were significantly higher in PE (p < 0.05) as compared with NC at T2. Maternal plasma homocysteine levels were higher in PE as compared with NC at all the time points, i.e. T1, T2 (p < 0.05 for both) and T3 (p < 0.01).\Question: Do increased homocysteine levels exist in women with preeclampsia from early pregnancy?
Example Output:
Our results indicate that higher homocysteine levels exist in women with PE from early pregnancy and continue till delivery.