romikgosai/squad_modified_2 huggingface dataset:
In January 2015, a customer named Ricardo Brown received a bill from Comcast with his name changed to "Asshole Brown". Brown's wife, Lisa, believed a Comcast employee changed the name in response to the Browns' request to cancel their cable service, an incident in which she was refused a cancellation unless she paid a $60 fee and instead was routed to a retention specialist. Comcast refused to correct the name on their bill after bringing it to the attention of numerous customer service outlets for the company by explaining that Ricardo is the legal name of the customer, so the Browns turned to consumer advocate Christopher Elliott. Elliott posted the facts of the incident, along with a copy of the bill, on his blog. Shortly thereafter, Elliott contacted Comcast and Comcast offered the Browns an apology, a $60 refund, and a promise to track down and fire the responsible employee. The Browns instead requested a full refund for their negative experience and Comcast agreed to refund the family the last two years of service and provide the next two years of service at no charge. Comcast released a statement explaining: "We have spoken with our customer and apologized for this completely unacceptable and inappropriate name change. We have zero tolerance for this type of disrespectful behavior and are conducting a thorough investigation to determine what happened. We are working with our customer to make this right and will take appropriate steps to prevent this from happening again."

Q1: What name was listed on Comcast customer Ricardo Brown's invoice in January, 2015?
A1: "Asshole Brown"
Q2: What consumer advocate took over the Brown's case?
A2: Christopher Elliott
Q3: What was the amount of disputed money that Comcast eventually returned to the Browns?
A3: $60
Q4: Comcast eventually refunded how much service time to the Browns?
A4: two years
Q5: Comcast also told the Browns they would do what to correct the situation with the name change?
A5: promise to track down and fire the responsible employee
Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those infected. The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss. The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.

Q1: What bacterium causes tuberculosis infection?
A1: Mycobacterium tuberculosis
Q2: What primary body part is affected by tuberculosis?
A2: lungs
Q3: Roughly, what percentage of latent tuberculosis infections result in active tuberculosis?
A3: 10%
Q4: Along with cough, weight loss, and night sweats, what's the fourth classic symptom of the disease?
A4: fever
Q5: What name has been used to refer to tuberculosis because of associated weight loss?
A5: consumption
One-third of the world's population is thought to be infected with TB. New infections occur in about 1% of the population each year. In 2014, there were 9.6 million cases of active TB which resulted in 1.5 million deaths. More than 95% of deaths occurred in developing countries. The number of new cases each year has decreased since 2000. About 80% of people in many Asian and African countries test positive while 5–10% of people in the United States population tests positive by the tuberculin test. Tuberculosis has been present in humans since ancient times.

Q1: How much of the entire population of the planet is estimated to be carrying tuberculosis?
A1: One-third
Q2: How many cases of tuberculosis were active over the course of 2014?
A2: 9.6 million
Q3: In 2014, how many people died from TB?
A3: 1.5 million
Q4: Does the majority of fatalities from TB occur in developing countries or industrialized nations?
A4: developing countries
Q5: Has TB infection increased or decreased worldwide since the start of the 21st century?
A5: decreased
If a tuberculosis infection does become active, it most commonly involves the lungs (in about 90% of cases). Symptoms may include chest pain and a prolonged cough producing sputum. About 25% of people may not have any symptoms (i.e. they remain "asymptomatic"). Occasionally, people may cough up blood in small amounts, and in very rare cases, the infection may erode into the pulmonary artery or a Rasmussen's aneurysm, resulting in massive bleeding. Tuberculosis may become a chronic illness and cause extensive scarring in the upper lobes of the lungs. The upper lung lobes are more frequently affected by tuberculosis than the lower ones. The reason for this difference is not clear. It may be due either to better air flow, or to poor lymph drainage within the upper lungs.

Q1: Which lobes of the lungs are more often affected by TB?
A1: upper lung lobes
Q2: What symptom will result if TB infection causes a Rasmussen's aneurysm?
A2: massive bleeding
Q3: What percentage of tuberculosis infections don't ever manifest in symptoms of the disease?
A3: 25%
Q4: If TB becomes chronic, what lasting effect might it have on the lung's upper lobes?
A4: scarring
Q5: Approximately what percentage of active TB cases affect the lungs?
A5: 90%
In 15–20% of active cases, the infection spreads outside the lungs, causing other kinds of TB. These are collectively denoted as "extrapulmonary tuberculosis". Extrapulmonary TB occurs more commonly in immunosuppressed persons and young children. In those with HIV, this occurs in more than 50% of cases. Notable extrapulmonary infection sites include the pleura (in tuberculous pleurisy), the central nervous system (in tuberculous meningitis), the lymphatic system (in scrofula of the neck), the genitourinary system (in urogenital tuberculosis), and the bones and joints (in Pott disease of the spine), among others. When it spreads to the bones, it is also known as "osseous tuberculosis", a form of osteomyelitis. Sometimes, bursting of a tubercular abscess through skin results in tuberculous ulcer. An ulcer originating from nearby infected lymph nodes is painless, slowly enlarging and has an appearance of "wash leather". A potentially more serious, widespread form of TB is called "disseminated tuberculosis", also known as miliary tuberculosis. Miliary TB makes up about 10% of extrapulmonary cases.

Q1: What's the medical term for TB when it spreads from the lungs to other parts of the body?
A1: extrapulmonary tuberculosis
Q2: At least what percentage of HIV-positive patients who contract TB will experience extrapulmonary infection?
A2: 50%
Q3: What's the other name for "disseminated tuberculosis"?
A3: miliary tuberculosis
Q4: Along with people with diminished immune function, like HIV patients, what group of people is more likely to develop extrapulmonary TB?
A4: young children
Q5: If TB infection spreads to the central nervous system, what is it called?
A5: tuberculous meningitis
The main cause of TB is Mycobacterium tuberculosis, a small, aerobic, nonmotile bacillus. The high lipid content of this pathogen accounts for many of its unique clinical characteristics. It divides every 16 to 20 hours, which is an extremely slow rate compared with other bacteria, which usually divide in less than an hour. Mycobacteria have an outer membrane lipid bilayer. If a Gram stain is performed, MTB either stains very weakly "Gram-positive" or does not retain dye as a result of the high lipid and mycolic acid content of its cell wall. MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in the laboratory.

Q1: The uniqueness of Mycobacterium tuberculosis is due to its high level of what type of molecule?
A1: lipid
Q2: Is the division rate of the TB bacterium fast or slow relative to other bacteria?
A2: slow
Q3: In nature, what "helper" does the MTB bacterium require to grow?
A3: a host organism
Q4: How long is the period between division of MTB cells?
A4: 16 to 20 hours
Q5: How much time does it take most bacteria to divide?
A5: less than an hour
Using histological stains on expectorated samples from phlegm (also called "sputum"), scientists can identify MTB under a microscope. Since MTB retains certain stains even after being treated with acidic solution, it is classified as an acid-fast bacillus. The most common acid-fast staining techniques are the Ziehl–Neelsen stain and the Kinyoun stain, which dye acid-fast bacilli a bright red that stands out against a blue background. Auramine-rhodamine staining and fluorescence microscopy are also used.

Q1: What's another word for "sputum"?
A1: phlegm
Q2: One of the two standard acid-fast staining techniques is the Kinyoun stain; what's the other?
A2: Ziehl–Neelsen stain
Q3: What color will acid-fast bacilli become when stained?
A3: bright red
Q4: What's the term for bacillus that can be exposed to acidic solutions without losing their stains?
A4: acid-fast
Q5: If a scientist didn't want to use an acid-fast staining technique, what type of microscopy could they use instead?
A5: fluorescence
The M. tuberculosis complex (MTBC) includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canetti, and M. microti. M. africanum is not widespread, but it is a significant cause of tuberculosis in parts of Africa. M. bovis was once a common cause of tuberculosis, but the introduction of pasteurized milk has almost completely eliminated this as a public health problem in developed countries. M. canetti is rare and seems to be limited to the Horn of Africa, although a few cases have been seen in African emigrants. M. microti is also rare and is seen almost only in immunodeficient people, although its prevalence may be significantly underestimated.

Q1: Which mycobacterium that causes TB can often be found in unpasteurized milk?
A1: M. bovis
Q2: Which one of the tuberculosis mycobacteria is associated with the Horn of Africa?
A2: M. canetti
Q3: Which of the four TB-causing bacteria do scientists think might be more common than we know?
A3: M. microti
Q4: What bacterium has the name of the country it affects most in its name?
A4: M. africanum
People with prolonged, frequent, or close contact with people with TB are at particularly high risk of becoming infected, with an estimated 22% infection rate. A person with active but untreated tuberculosis may infect 10–15 (or more) other people per year. Transmission should occur from only people with active TB – those with latent infection are not thought to be contagious. The probability of transmission from one person to another depends upon several factors, including the number of infectious droplets expelled by the carrier, the effectiveness of ventilation, the duration of exposure, the virulence of the M. tuberculosis strain, the level of immunity in the uninfected person, and others. The cascade of person-to-person spread can be circumvented by segregating those with active ("overt") TB and putting them on anti-TB drug regimens. After about two weeks of effective treatment, subjects with nonresistant active infections generally do not remain contagious to others. If someone does become infected, it typically takes three to four weeks before the newly infected person becomes infectious enough to transmit the disease to others.

Q1: If you're around someone with active TB, what's the chance you'll contract it expressed as a percentage?
A1: 22%
Q2: Left untreated, about how many people could contract tuberculosis from an active TB patient in a year?
A2: 10–15
Q3: About how long will a TB patient receiving effective treatment stay contagious?
A3: two weeks
Q4: If you contracted tuberculosis today, what's the estimated gestation period before you could spread the infection to others?
A4: three to four weeks
Q5: What term is interchangeable with "active" when talking about tuberculosis infection?
A5: overt
TB infection begins when the mycobacteria reach the pulmonary alveoli, where they invade and replicate within endosomes of alveolar macrophages. Macrophages identify the bacterium as foreign and attempt to eliminate it by phagocytosis. During this process, the bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. The phagosome then combines with a lysosome to create a phagolysosome. In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium. However, M. tuberculosis has a thick, waxy mycolic acid capsule that protects it from these toxic substances. M. tuberculosis is able to reproduce inside the macrophage and will eventually kill the immune cell.

Q1: What specific part of the lungs marks the start of tuberculosis infection?
A1: pulmonary alveoli
Q2: What's the process by which macrophages try to get rid of the TB bacterium?
A2: phagocytosis
Q3: What do you get when you combine a lysosome and a phagosome?
A3: a phagolysosome
Q4: What does the M. tuberculosis bacterium have that protects it from being affected by toxins?
A4: mycolic acid capsule
Q5: What vesicle is the temporary holding room for the M. tuberculosis bacterium during phagocytosis?
A5: phagosome
The primary site of infection in the lungs, known as the "Ghon focus", is generally located in either the upper part of the lower lobe, or the lower part of the upper lobe. Tuberculosis of the lungs may also occur via infection from the blood stream. This is known as a Simon focus and is typically found in the top of the lung. This hematogenous transmission can also spread infection to more distant sites, such as peripheral lymph nodes, the kidneys, the brain, and the bones. All parts of the body can be affected by the disease, though for unknown reasons it rarely affects the heart, skeletal muscles, pancreas, or thyroid.

Q1: What two-word phrase is used for the main part of the lungs infected by TB?
A1: Ghon focus
Q2: If the lungs are infected by TB via bloodstream, what's the type of focus?
A2: Simon focus
Q3: In what general area of the lungs is SImon focus usually located?
A3: the top
Q4: What is the term that describes a blood-borne infection, like TB when it travels through the blood to the kidneys or brain?
A4: hematogenous
Q5: Four areas of the body are usually safe from TB infection, including skeletal muscles, heart, and thyroid; what's the fourth?
A5: pancreas
Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, T lymphocytes, B lymphocytes, and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages. When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. However, more recent evidence suggests that the bacteria use the granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis.

Q1: What specific type of disease is TB?
A1: granulomatous inflammatory
Q2: What type of cells gather around infected macrophages in a person infected with TB?
A2: lymphocytes
Q3: What type of cell forms when macrophages clump together trying to kill off the TB infection?
A3: multinucleated
Q4: What natural defensive response is hindered by cells in granulomas that can't send antigen to lymphocytes?
A4: immune response
Q5: What's the technical term for abnormal cell death?
A5: necrosis
In many people, the infection waxes and wanes. Tissue destruction and necrosis are often balanced by healing and fibrosis. Affected tissue is replaced by scarring and cavities filled with caseous necrotic material. During active disease, some of these cavities are joined to the air passages bronchi and this material can be coughed up. It contains living bacteria, so can spread the infection. Treatment with appropriate antibiotics kills bacteria and allows healing to take place. Upon cure, affected areas are eventually replaced by scar tissue.

Q1: What process replaces tissue damaged by TB?
A1: scarring
Q2: What material can sometimes be expelled by coughing if the cavities it's stored in connect to bronchi?
A2: caseous necrotic material
Q3: What type of bacteria-attacking medicine will treat tuberculosis?
A3: antibiotics
Q4: Are the bacteria in caseous necrotic material living or dead?
A4: living
Diagnosing active tuberculosis based only on signs and symptoms is difficult, as is diagnosing the disease in those who are immunosuppressed. A diagnosis of TB should, however, be considered in those with signs of lung disease or constitutional symptoms lasting longer than two weeks. A chest X-ray and multiple sputum cultures for acid-fast bacilli are typically part of the initial evaluation. Interferon-γ release assays and tuberculin skin tests are of little use in the developing world. IGRA have similar limitations in those with HIV.

Q1: Is active TB difficult or easy to diagnose by patients' symptoms alone?
A1: difficult
Q2: If a patient has some symptoms associated with TB, after what time period should tuberculosis be diagnostically considered?
A2: two weeks
Q3: What part of the body would be X-rayed to check for TB?
A3: chest
Q4: What sign of TB infection would a lab be looking for in a sputum culture?
A4: acid-fast bacilli
Q5: Along with interferon-y release essays, what other tests aren't useful in TB diagnosis in developing countries?
A5: tuberculin skin tests
The Mantoux tuberculin skin test is often used to screen people at high risk for TB. Those who have been previously immunized may have a false-positive test result. The test may be falsely negative in those with sarcoidosis, Hodgkin's lymphoma, malnutrition, and most notably, active tuberculosis. Interferon gamma release assays (IGRAs), on a blood sample, are recommended in those who are positive to the Mantoux test. These are not affected by immunization or most environmental mycobacteria, so they generate fewer false-positive results. However, they are affected by M. szulgai, M. marinum, and M. kansasii. IGRAs may increase sensitivity when used in addition to the skin test, but may be less sensitive than the skin test when used alone.

Q1: What result might someone who has received a TB vaccination get from the Mantoux test?
A1: false-positive
Q2: What liquid would you need from a patient to perform IGRAs?
A2: blood
Q3: In combination with skin tests, are IGRAs associated with an increase or decrease in sensitivity?
A3: increase
Q4: Which test has fewer false positives: IGRAs or the Mantoux skin test?
A4: IGRAs
Q5: What does "IGRAs" stand for?
A5: Interferon gamma release assays
It is the most widely used vaccine worldwide, with more than 90% of all children being vaccinated. The immunity it induces decreases after about ten years. As tuberculosis is uncommon in most of Canada, the United Kingdom, and the United States, BCG is administered only to those people at high risk. Part of the reasoning against the use of the vaccine is that it makes the tuberculin skin test falsely positive, reducing the test's use in screening. A number of new vaccines are currently in development.

Q1: For about how long does full immunity from the TB vaccine last?
A1: ten years
Q2: What percentage of kids in the whole world get the BCG vaccine?
A2: 90%
Q3: Is TB common or uncommon in the United States?
A3: uncommon
Q4: In addition to the U.S. and Canada, what European country sees very few tuberculosis infections?
A4: the United Kingdom
Q5: What segment of the population gets the TB vaccine in countries like Canada with a very low incidence of infection?
A5: high risk
The World Health Organization declared TB a "global health emergency" in 1993, and in 2006, the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between its launch and 2015. A number of targets they have set are not likely to be achieved by 2015, mostly due to the increase in HIV-associated tuberculosis and the emergence of multiple drug-resistant tuberculosis. A tuberculosis classification system developed by the American Thoracic Society is used primarily in public health programs.

Q1: What group heads up the Global Plan to Stop Tuberculosis?
A1: Stop TB Partnership
Q2: In what year did the WHO say tuberculosis was a "global health emergency"?
A2: 1993
Q3: How many lives did the Stop TB Partnership vow to save in the nine years between its start and 2015?
A3: 14 million
Q4: Drug-resistant TB is one of the barriers to success of the Stop TB Partnership's initiative; what's the other other?
A4: HIV-associated tuberculosis
Q5: What organization created a system to classify various types of TB?
A5: American Thoracic Society
Treatment of TB uses antibiotics to kill the bacteria. Effective TB treatment is difficult, due to the unusual structure and chemical composition of the mycobacterial cell wall, which hinders the entry of drugs and makes many antibiotics ineffective. The two antibiotics most commonly used are isoniazid and rifampicin, and treatments can be prolonged, taking several months. Latent TB treatment usually employs a single antibiotic, while active TB disease is best treated with combinations of several antibiotics to reduce the risk of the bacteria developing antibiotic resistance. People with latent infections are also treated to prevent them from progressing to active TB disease later in life. Directly observed therapy, i.e., having a health care provider watch the person take their medications, is recommended by the WHO in an effort to reduce the number of people not appropriately taking antibiotics. The evidence to support this practice over people simply taking their medications independently is poor. Methods to remind people of the importance of treatment do, however, appear effective.

Q1: What part of the mycobacterial cell makes tuberculosis more difficult to treat?
A1: wall
Q2: Isoniazid is one of the two most popular drugs for TB treatment; what's the other one?
A2: rifampicin
Q3: What complication does the use of combinations of antibiotics for active TB prevent?
A3: antibiotic resistance
Q4: What's the three-word name for the method where a health care worker watches their patient take their medication?
A4: Directly observed therapy
Q5: What organization recommends directly observed therapy to make sure people take their antibiotics correctly?
A5: WHO