romikgosai/squad_modified_2 huggingface dataset:
Primary resistance occurs when a person becomes infected with a resistant strain of TB. A person with fully susceptible MTB may develop secondary (acquired) resistance during therapy because of inadequate treatment, not taking the prescribed regimen appropriately (lack of compliance), or using low-quality medication. Drug-resistant TB is a serious public health issue in many developing countries, as its treatment is longer and requires more expensive drugs. MDR-TB is defined as resistance to the two most effective first-line TB drugs: rifampicin and isoniazid. Extensively drug-resistant TB is also resistant to three or more of the six classes of second-line drugs. Totally drug-resistant TB is resistant to all currently used drugs. It was first observed in 2003 in Italy, but not widely reported until 2012, and has also been found in Iran and India. Bedaquiline is tentatively supported for use in multiple drug-resistant TB.

Q1: If a person has TB that's resistant to rifampicin and isoniazid, which type of the disease do they have?
A1: MDR-TB
Q2: What's the minimum number of second-line medication classes your TB would have to resist to make it count as "extensively drug-resistant"?
A2: three
Q3: In what country was the first case of totally drug-resistant tuberculosis?
A3: Italy
Q4: What's the only antibiotic that might be effective against totally drug-resistant TB?
A4: Bedaquiline
Q5: Cases of totally drug-resistant TB have been found in what country in addition to Italy and India?
A5: Iran
The risk of reactivation increases with immunosuppression, such as that caused by infection with HIV. In people coinfected with M. tuberculosis and HIV, the risk of reactivation increases to 10% per year. Studies using DNA fingerprinting of M. tuberculosis strains have shown reinfection contributes more substantially to recurrent TB than previously thought, with estimates that it might account for more than 50% of reactivated cases in areas where TB is common. The chance of death from a case of tuberculosis is about 4% as of 2008, down from 8% in 1995.

Q1: As immunosuppression goes up in tuberculosis cases, what risk rises with it?
A1: reactivation
Q2: What disease has a similar relationship as TB does between reactivation and immunosuppression?
A2: HIV
Q3: If you'd been diagnosed with tuberculosis in 1995, how great a chance would you have faced of dying from it?
A3: 8%
Q4: In what year did the risk of dying from TB reach half what it was in 1995?
A4: 2008
Q5: New studies have found that half of reactivation cases of tuberculosis might actually be due to what other "re-" word?
A5: reinfection
Roughly one-third of the world's population has been infected with M. tuberculosis, with new infections occurring in about 1% of the population each year. However, most infections with M. tuberculosis do not cause TB disease, and 90–95% of infections remain asymptomatic. In 2012, an estimated 8.6 million chronic cases were active. In 2010, 8.8 million new cases of TB were diagnosed, and 1.20–1.45 million deaths occurred, most of these occurring in developing countries. Of these 1.45 million deaths, about 0.35 million occur in those also infected with HIV.

Q1: At any given time, about how much of all the people in the world has M. tuberculosis?
A1: one-third
Q2: Approximately how many active TB cases were there in 2012?
A2: 8.6 million
Q3: How many patients were diagnosed with tuberculosis in 2010?
A3: 8.8 million
Q4: About how many people died in 2010 carrying both HIV and TB?
A4: 0.35 million
Q5: What percentage of the world's total population gets infected with tuberculosis every year?
A5: 1%
Tuberculosis is the second-most common cause of death from infectious disease (after those due to HIV/AIDS). The total number of tuberculosis cases has been decreasing since 2005, while new cases have decreased since 2002. China has achieved particularly dramatic progress, with about an 80% reduction in its TB mortality rate between 1990 and 2010. The number of new cases has declined by 17% between 2004–2014. Tuberculosis is more common in developing countries; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5–10% of the US population test positive. Hopes of totally controlling the disease have been dramatically dampened because of a number of factors, including the difficulty of developing an effective vaccine, the expensive and time-consuming diagnostic process, the necessity of many months of treatment, the increase in HIV-associated tuberculosis, and the emergence of drug-resistant cases in the 1980s.

Q1: What infectious disease causes more deaths than tuberculosis?
A1: HIV/AIDS
Q2: When did new cases of TB infection start going down?
A2: 2002
Q3: What country has had the most success reducing the TB mortality rate?
A3: China
Q4: In what decade did some strains of drug-resistant TB start showing up?
A4: 1980s
Q5: How much did China reduce its rate of death from TB in the 20 years leading up to 2010?
A5: 80%
In 2007, the country with the highest estimated incidence rate of TB was Swaziland, with 1,200 cases per 100,000 people. India had the largest total incidence, with an estimated 2.0 million new cases. In developed countries, tuberculosis is less common and is found mainly in urban areas. Rates per 100,000 people in different areas of the world were: globally 178, Africa 332, the Americas 36, Eastern Mediterranean 173, Europe 63, Southeast Asia 278, and Western Pacific 139 in 2010. In Canada and Australia, tuberculosis is many times more common among the aboriginal peoples, especially in remote areas. In the United States Native Americans have a fivefold greater mortality from TB, and racial and ethnic minorities accounted for 84% of all reported TB cases.

Q1: Out of every 100,000 people in Swaziland in 2007, how many were infected with tuberculosis?
A1: 1,200
Q2: What country had a record-setting 2 million new cases of TB in 2007?
A2: India
Q3: What people in Australia and Canada have a much higher risk of TB infection than other residents?
A3: aboriginal
Q4: What indigenous people in the U.S. are five times more likely to die from TB?
A4: Native Americans
Q5: What percentage of TB cases in America are diagnosed in minority groups?
A5: 84%
Tuberculosis has been present in humans since antiquity. The earliest unambiguous detection of M. tuberculosis involves evidence of the disease in the remains of bison in Wyoming dated to around 17,000 years ago. However, whether tuberculosis originated in bovines, then was transferred to humans, or whether it diverged from a common ancestor, is currently unclear. A comparison of the genes of M. tuberculosis complex (MTBC) in humans to MTBC in animals suggests humans did not acquire MTBC from animals during animal domestication, as was previously believed. Both strains of the tuberculosis bacteria share a common ancestor, which could have infected humans as early as the Neolithic Revolution.

Q1: What animal was found with 17,000-year-old damage from tuberculosis?
A1: bison
Q2: What does MTBC stand for?
A2: M. tuberculosis complex
Q3: During what time period do some scientist believe the first human could have contracted TB from an ancestor they shared with animals?
A3: Neolithic Revolution
Q4: In which U.S. state was the oldest definitive evidence of TB found?
A4: Wyoming
The bacillus causing tuberculosis, M. tuberculosis, was identified and described on 24 March 1882 by Robert Koch. He received the Nobel Prize in physiology or medicine in 1905 for this discovery. Koch did not believe the bovine (cattle) and human tuberculosis diseases were similar, which delayed the recognition of infected milk as a source of infection. Later, the risk of transmission from this source was dramatically reduced by the invention of the pasteurization process. Koch announced a glycerine extract of the tubercle bacilli as a "remedy" for tuberculosis in 1890, calling it "tuberculin". While it was not effective, it was later successfully adapted as a screening test for the presence of pre-symptomatic tuberculosis. The World Tuberculosis Day was established on 24 March for this reason.

Q1: Who discovered M. tuberculosis?
A1: Robert Koch
Q2: What year was Koch awarded a Nobel Prize?
A2: 1905
Q3: Koch's conviction that human and bovine strains of TB were unrelated meant more people were exposed by drinking what?
A3: milk
Q4: What did Koch call the ineffective treatment for TB he came up with in 1890?
A4: tuberculin
Q5: What event is celebrated on March 24th to recognize the test for latent TB?
A5: World Tuberculosis Day
Tuberculosis caused the most widespread public concern in the 19th and early 20th centuries as an endemic disease of the urban poor. In 1815, one in four deaths in England was due to "consumption". By 1918, one in six deaths in France was still caused by TB. After TB was determined to be contagious, in the 1880s, it was put on a notifiable disease list in Britain; campaigns were started to stop people from spitting in public places, and the infected poor were "encouraged" to enter sanatoria that resembled prisons (the sanatoria for the middle and upper classes offered excellent care and constant medical attention). Whatever the (purported) benefits of the "fresh air" and labor in the sanatoria, even under the best conditions, 50% of those who entered died within five years (circa 1916).

Q1: What was tuberculosis called in 19th-century England?
A1: consumption
Q2: How many deaths out of every six in France during 1918 were attributed to tuberculosis?
A2: one
Q3: In what decade was TB's communicability finally realized?
A3: 1880s
Q4: What did Britain try to get people to stop doing to reduce the spread of TB in public?
A4: spitting
Q5: What were the "treatment" facilities for poor people with TB in the early 1900s called?
A5: sanatoria
In Europe, rates of tuberculosis began to rise in the early 1600s to a peak level in the 1800s, when it caused nearly 25% of all deaths. By the 1950s, mortality had decreased nearly 90%. Improvements in public health began significantly reducing rates of tuberculosis even before the arrival of streptomycin and other antibiotics, although the disease remained a significant threat to public health such that when the Medical Research Council was formed in Britain in 1913, its initial focus was tuberculosis research.

Q1: When did the incidence of TB in Europe reach its highest point?
A1: 1800s
Q2: When tuberculosis was at its worst in Europe, what percentage of deaths was TB-related?
A2: 25%
Q3: What British health organization made tuberculosis its top priority at its start?
A3: Medical Research Council
Q4: What year was the Medical Research Council created?
A4: 1913
Q5: About how much had the death rate from TB been reduced in Europe by the midpoint of the 20th century?
A5: 90%
Slow progress has led to frustration, expressed by executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria – Mark Dybul: "we have the tools to end TB as a pandemic and public health threat on the planet, but we are not doing it." Several international organizations are pushing for more transparency in treatment, and more countries are implementing mandatory reporting of cases to the government, although adherence is often sketchy. Commercial treatment-providers may at times overprescribe second-line drugs as well as supplementary treatment, promoting demands for further regulations. The government of Brazil provides universal TB-care, which reduces this problem. Conversely, falling rates of TB-infection may not relate to the number of programs directed at reducing infection rates, but may be tied to increased level of education, income and health of the population. Costs of the disease, as calculated by the World Bank in 2009 may exceed 150 billion USD per year in "high burden" countries. Lack of progress eradicating the disease may also be due to lack of patient follow-up – as among the 250M rural migrants in China.

Q1: What member of leadership at the Global Fund to Fight AIDS, Tuberculosis and Malaria called TB a "pandemic"?
A1: Mark Dybul
Q2: What country covers treatment for tuberculosis for its citizens?
A2: Brazil
Q3: What organization said some countries might be spending as much as $150 billion each year on TB?
A3: World Bank
Q4: What population segment in China struggles to get follow-up care for TB infection?
A4: rural migrants
Q5: What do some people think we need more of to prevent for-profit providers of TB treatment from over-prescribing?
A5: regulations
One way to decrease stigma may be through the promotion of "TB clubs", where those infected may share experiences and offer support, or through counseling. Some studies have shown TB education programs to be effective in decreasing stigma, and may thus be effective in increasing treatment adherence. Despite this, studies on relationship between reduced stigma and mortality are lacking as of 2010, and similar efforts to decrease stigma surrounding AIDS have been minimally effective. Some have claimed the stigma to be worse than the disease, and healthcare providers may unintentionally reinforce stigma, as those with TB are often perceived as difficult or otherwise undesirable. A greater understanding of the social and cultural dimensions of tuberculosis may also help with stigma reduction.

Q1: What groups might help tuberculosis patients share with and support each other?
A1: TB clubs
Q2: Education about TB seems to decrease the stigma of the disease and lead to what other positive effect?
A2: increasing treatment adherence
Q3: What do some people say is even worse than the effects of tuberculosis itself?
A3: the stigma
Q4: What group of people can add to the TB stigma by treating patients as troublesome or unwanted?
A4: healthcare providers
Q5: As recently as what year were there no studies on how TB mortality is connected to stigma?
A5: 2010
The BCG vaccine has limitations, and research to develop new TB vaccines is ongoing. A number of potential candidates are currently in phase I and II clinical trials. Two main approaches are being used to attempt to improve the efficacy of available vaccines. One approach involves adding a subunit vaccine to BCG, while the other strategy is attempting to create new and better live vaccines. MVA85A, an example of a subunit vaccine, currently in trials in South Africa, is based on a genetically modified vaccinia virus. Vaccines are hoped to play a significant role in treatment of both latent and active disease.

Q1: What vaccine are researchers trying to improve on?
A1: BCG
Q2: What phase of clinical trials have some new vaccine options reached?
A2: I and II
Q3: What does one option propose adding to the existing BCG vaccine?
A3: subunit vaccine
Q4: What's the name of the subunit vaccine being studied in South Africa?
A4: MVA85A
Q5: What genetically modified virus was used to develop MVA85A?
A5: vaccinia
To encourage further discovery, researchers and policymakers are promoting new economic models of vaccine development, including prizes, tax incentives, and advance market commitments. A number of groups, including the Stop TB Partnership, the South African Tuberculosis Vaccine Initiative, and the Aeras Global TB Vaccine Foundation, are involved with research. Among these, the Aeras Global TB Vaccine Foundation received a gift of more than $280 million (US) from the Bill and Melinda Gates Foundation to develop and license an improved vaccine against tuberculosis for use in high burden countries.

Q1: What organization did the Bill and Melinda Gates Foundation donate $280 million to?
A1: Aeras Global TB Vaccine Foundation
Q2: Policymakers believe tax incentives, market commitments, and what third incentive will speed up vaccine development?
A2: prizes
Q3: What group with the initials SATVI is researching TB vaccines?
A3: South African Tuberculosis Vaccine Initiative
Q4: What nonprofit tuberculosis research foundation has a verb in its name?
A4: Stop TB Partnership
A number of medications are being studied for multi drug resistant tuberculosis including: bedaquiline and delamanid. Bedaquiline received U.S. Food and Drug Administration (FDA) approval in late 2012. The safety and effectiveness of these new agents are still uncertain, because they are based on the results of a relatively small studies. However, existing data suggest that patients taking bedaquiline in addition to standard TB therapy are five times more likely to die than those without the new drug, which has resulted in medical journal articles raising health policy questions about why the FDA approved the drug and whether financial ties to the company making bedaquiline influenced physicians' support for its use

Q1: What drug in the running to treat multi drug resistant TB has already gotten FDA approval?
A1: Bedaquiline
Q2: What year did the U.S. Food and Drug Administration approve bedaquiline?
A2: 2012
Q3: Despite FDA approval, how much more likely to die are patients who take bedaquiline in addition to the standard TB regimen?
A3: five times
Q4: Opposition to the use of bedaquiline think what providers were influenced by a connection with the drug company?
A4: physicians
Q5: What type of publication has put out articles questioning bedaquiline's safety?
A5: medical journal
Affirmative action in the United States tends to focus on issues such as education and employment, specifically granting special consideration to racial minorities, Native Americans, and women who have been historically excluded groups in America. Reports have shown that minorities and women have faced discrimination in schools and businesses for many years and this discrimination produced unfair advantages for whites and males in education and employment. The impetus toward affirmative action is redressing the disadvantages associated with past and present discrimination. Further impetus is a desire to ensure public institutions, such as universities, hospitals, and police forces, are more representative of the populations they serve.

Q1: Outside of employment, what is the other main issue that affirmative action focuses on?
A1: education
Q2: Affirmative action attempts to ask institutions to grant extra consideration to what group of people outside of Native Americans and women?
A2: racial minorities
Q3: Studies showed that discrimination in both business sectors and education resulted in advantages for what group of people?
A3: whites and males
Q4: Affirmative action does not only attempt to remove disadvantages, but also to ensure what about the number of people in a field?
A4: are more representative of the populations they serve
Affirmative action is a subject of controversy. Some policies adopted as affirmative action, such as racial quotas or gender quotas for collegiate admission, have been criticized as a form of reverse discrimination, and such implementation of affirmative action has been ruled unconstitutional by the majority opinion of Gratz v. Bollinger. Affirmative action as a practice was upheld by the Supreme Court's decision in Grutter v. Bollinger in 2003. Affirmative action policies were developed in order to correct decades of discrimination stemming from the Reconstruction Era by granting disadvantaged minorities opportunities. Many believe that the diversity of current American society suggests that affirmative action policies succeeded and are no longer required. Opponents of affirmative action argue that these policies are outdated and lead to reverse discrimination which entails favoring one group over another based upon racial preference rather than achievement.

Q1: What is another example aside from racial quotes of affirmative action for collegiate admissions?
A1: gender quotas
Q2: Having quotas regarding admissions or employment has been criticized and said to be what kind of discrimination?
A2: reverse
Q3: What case determined that some implementation of affirmative action was unconstitutional?
A3: Gratz v. Bollinger
Q4: In which time period did discrimination policies originate from?
A4: Reconstruction Era
Q5: What do critics of affirmative action believe should be the main factor in hiring?
A5: achievement
Ideas for affirmative action came as early as the Reconstruction Era (1865-1877) in which a former slave population lacked the skills and resources for sustainable living. In 1865, General William Tecumseh Sherman proposed to divide the land and goods from Georgia and grant it to families of color which became the "Forty acres and a mule" policy. The proposal was never widely adopted due to strong political opposition. Nearly a century later (1950s-1960s), policies to assist classes of individuals reemerged during the Civil Rights Movement. The civil rights guarantees came through the interpretation of the Equal Protection Clause of the 14th Amendment. The decisions came to be known as affirmative action in which mandatory, as well as voluntary programs, affirmed the civil rights of people of color. Furthermore, these affirmative action programs protected people of color from the present effects stemming from past discrimination. In 1961, President John F. Kennedy became the first to utilize the term "affirmative action" in Executive Order 10925 to ensure that government contractors "take affirmative action to ensure that applicants are employed, and employees are treated during employment, without regard to their race, creed, color, or national origin." This executive order realized the government's intent to create equal opportunities for all qualified people. This executive order was eventually amended and superseded by Lyndon B. Johnson's Executive Order 11246 which prevented discrimination based on race, color, religion, and national origin by organizations which received federal contracts and subcontracts. In 1967, the order was amended to include sex as well. The Reagan administration was opposed to the affirmative action requirements of Executive Order 11246, but these contemplated changes[which?] faced bi-partisan opposition in Congress.

Q1: When did the Reconstruction Era end?
A1: 1877
Q2: Who proposed that land be divided and split up among families of color?
A2: General William Tecumseh Sherman
Q3: What was the policy of dividing land among families of color referred to as?
A3: Forty acres and a mule
Q4: Which part of the constitution was the basis for policies that were developed during the Civil Rights Movement?
A4: Equal Protection Clause of the 14th Amendment
Q5: Who was the first person to utilize the term "affirmative action"?
A5: President John F. Kennedy
The first appearance of the term 'affirmative action' was in the National Labor Relations Act, better known as the Wagner Act, of 1935.:15 Proposed and championed by U.S. Senator Robert F. Wagner of New York, the Wagner Act was in line with President Roosevelt's goal of providing economic security to workers and other low-income groups. During this time period it was not uncommon for employers to blacklist or fire employees associated with unions. The Wagner Act allowed workers to unionize without fear of being discriminated against, and empowered a National Labor Relations Board to review potential cases of worker discrimination. In the event of discrimination, employees were to be restored to an appropriate status in the company through 'affirmative action'. While the Wagner Act protected workers and unions it did not protect minorities, who, exempting the Congress of Industrial Organizations, were often barred from union ranks.:11 This original coining of the term therefore has little to do with affirmative action policy as it is seen today, but helped set the stage for all policy meant to compensate or address an individual's unjust treatment.[citation needed]

Q1: In which document did the term "affirmative action" first appear?
A1: National Labor Relations Act
Q2: Who was the author of the National Labor Relations Act?
A2: Senator Robert F. Wagner
Q3: Who did employers routinely blacklist of fire?
A3: employees associated with unions
Q4: Who was able to review complaints about possible worker discrimination?
A4: National Labor Relations Board
Q5: Which group of people did the Wagner Act fail to protect?
A5: minorities