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The National Cancer Institute has long been a leader in terminology related services and has provided the cancer community with structured terminology through the NCI enterprise vocabulary services for several years. There are now a much wider range of terminology use cases to meet the needs from bedside to bench and back and the semantic infrastructure version 2 the Semantic Infrastructure 2.0 is being designed to meet all of these use cases. The use cases require thinking beyond the capabilities of the existing metadata repository as demonstrated in caDSR and to support semantic representations of concepts as they are used in clinical information exchange using the HL7 structure document's. It is also recognized that there are needs to bind concepts to information models in the abstract as domain values for use in models such as the BRIDG domain analysis model or the life sciences DAM.

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The user is building the specifications for a new application to manage follow-up of chemotherapy patients to track the signs and symptoms associated with a clinical trial of these chemotherapy agents. She has been given a set of CTCAE terms to capture the signs and symptoms but the set of symptoms are symptom list is so large that it does not fit well into a single drop-down menu. She would like to subset these concepts into related organ systems affected. She would like to have a unique identifier for each of these sets so that she can reuse them in future studies. She has already investigated the available resources and did not find a collection of codes that met her requirements.

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