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-- phpMyAdmin SQL Dump
-- version 2.11.1
-- http://www.phpmyadmin.net
--
-- Host: localhost
-- Generation Time: Oct 29, 2009 at 03:16 PM
-- Server version: 5.0.45
-- PHP Version: 5.2.4
SET SQL_MODE="NO_AUTO_VALUE_ON_ZERO";
SET AUTOCOMMIT=0;
START TRANSACTION;
--
-- Database: `questionbox`
--
-- --------------------------------------------------------
--
-- Table structure for table `qbanswer`
--
DROP TABLE IF EXISTS `qbanswer`;
CREATE TABLE `qbanswer` (
`AnswerID` bigint(20) NOT NULL,
`Source` varchar(200) default NULL,
`Details` text NOT NULL,
`Link_to_answer` varchar(100) default NULL,
`CategoryID` int(11) default NULL,
`Datecreated` timestamp NOT NULL default CURRENT_TIMESTAMP on update CURRENT_TIMESTAMP,
`Dateupdated` timestamp NOT NULL default '0000-00-00 00:00:00',
`Active` tinyint(4) NOT NULL default '1',
PRIMARY KEY (`AnswerID`),
FULLTEXT KEY `Details` (`Details`)
) ENGINE=MyISAM DEFAULT CHARSET=latin1;
--
-- Dumping data for table `qbanswer`
--
INSERT INTO `qbanswer` (`AnswerID`, `Source`, `Details`, `Link_to_answer`, `CategoryID`, `Datecreated`, `Dateupdated`, `Active`) VALUES
(1, '', 'Some time in August ', '', 7, '2009-10-21 19:43:17', '2009-10-16 19:37:40', 1),
(2, '', 'Some time in August ', '', 0, '2009-10-21 19:43:17', '2009-10-16 19:43:02', 1),
(3, '', 'Some time timing August', '', 7, '2009-10-21 19:43:17', '2009-10-16 19:44:59', 1),
(4, '', 'Some time in August ', '', 0, '2009-10-21 19:43:17', '2009-10-16 19:49:55', 1),
(5, '', 'Some time in August Timing Timing changed from the ticket screen We found the answer', '', 7, '2009-10-28 09:55:01', '2009-10-28 12:55:01', 1),
(6, '', 'Some time in August ', '', 0, '2009-10-21 19:43:17', '2009-10-16 19:54:40', 1),
(7, '', 'Some time in August ', '', 0, '2009-10-21 19:43:17', '2009-10-19 15:16:16', 1),
(8, 'http://www.un.org/events/tenstories/07/printable/uganda.shtml', '<html>\n <head>\n \n </head>\n <body>\n <html lang="en" xml="#DEFAULT" xmlns="http://www.w3.org/1999/xhtml">\n <body>\n <div id="skiplink">\n <div id="content" class="column">\n <p class="bold">\n While increased violence in other African countries grabbed the \n world’s attention, there has been a quiet but steady progress \n over the past two years towards ending one of the continent’s \n longest and most notorious armed conflicts – the war in northern \n Uganda.\n </p>\n <h3>\n The Story\n </h3>\n <p>\n Two decades after the Lord’s Resistance Army (LRA) launched its \n war in northern Uganda, persistent peacemaking efforts are \n finally bearing fruit. The conflict appears on the verge of \n resolution, as a result of internationally mediated talks \n between the Ugandan Government and the LRA which have \n accelerated at the beginning of 2008.  A final peace agreement \n is now slated to be signed in the first week of April.\n </p>\n <p>\n Current peace efforts, known as the “Juba” process after the \n town in Southern Sudan which has hosted the negotiations, are \n being facilitated on the UN side by Joaquim Chissano, the former \n President of Mozambique and Special Envoy of the UN \n Secretary-General for the peace process in northern Uganda. \n Working closely with the chief mediator in the talks, Mr. Riek \n Machar, the Vice-President of the Government of Southern Sudan, \n Mr. Chissano has helped at critical times to reinforce the peace \n process, particularly through his discussions with the LRA \n leadership in the bush and with key international and regional \n actors assisting the effort.  \n </p>\n <p>\n The first major step forward came in August 2006 when the two \n sides signed a cessation of hostilities agreement which has \n since been converted into a formal ceasefire.  The accord, \n effectively stopping the fighting while negotiations continued, \n brought relief to a suffering civilian population and gave space \n for the political efforts to flourish.  This was followed in \n mid-2007 by the signing of agreements setting out the broad \n contours of a final settlement based on comprehensive solutions \n to the conflict – including measures to address the economic, \n political and social difficulties in northern Uganda, as well as \n a set of principles on human rights, accountability and \n reconciliation. As a further confidence-building measure, LRA \n representatives were welcomed on an official visit to Uganda \n towards the end of 2007.  \n </p>\n <p>\n A series of more detailed agreements signed in quick succession \n early in 2008 has brought the two sides close to a final \n settlement.  These include accords on a legal framework for \n justice and reconciliation, the disarmament, demobilization and \n reintegration of former combatants and the recovery of \n war-affected areas of northern Uganda.  Close attention is being \n paid in particular to the issue of accountability for human \n rights abuses, for which the International Criminal Court has \n issued arrest warrants against senior LRA leaders. The United \n Nations has made clear its position against impunity, and has \n called for credible implementation of the commitment by the \n Government to establish a special court within Uganda to try \n those persons accused of the most serious crimes. \n </p>\n <p>\n Following the signing of a final peace settlement, the United \n Nations is preparing to play a continued role along with others \n in the international community in assisting the parties in \n northern Uganda as they take on the difficult and long-term \n process of implementing the agreements.  \n </p>\n <h3>\n The Context\n </h3>\n <ul type="disc">\n <li>\n The Lord’s Resistance Army has been fighting the Government of \n Uganda since the mid-1980s. In all, the conflict is estimated \n to have killed tens of thousands and forced nearly 2 million \n Ugandans to flee their homes, while also spilling over into \n Southern Sudan and the Democratic Republic of the Congo.\n </li>\n <li>\n Human rights abuses were widespread.  The LRA became notorious \n for abducting children and then using them as soldiers or \n porters, while subjecting some to torture and allocating many \n girls to senior officers in a form of institutional rape. \n Ugandan Government forces are also implicated in abuses in \n their counterinsurgency efforts.\n </li>\n <li>\n In addition to establishing a national judicial process for \n serious crimes, the two parties have agreed to other measures \n aimed at fostering reconciliation.  These include the \n establishment of a truth-commission-style body to examine the \n history of the conflict and programs of reparations for \n victims of the violence.\n </li>\n <li>\n The UN Children’s Fund (UNICEF) has urged all sides to ensure \n the immediate and safe return home of roughly 1,500 women and \n children still associated with the LRA.\n </li>\n <li>\n An estimated one million people have returned home since the \n 2006 ceasefire, but some 850,000 people continue to live in \n camps for internally displaced persons, according to the \n United Nations High Commissioner for Refugees.\n </li>\n </ul>\n <p>\n <strong>FOR FURTHER INFORMATION:</strong>\n </p>\n <p>\n <strong>Department of Political Affairs (DPA)</strong><br>Jared \n Kotler, Press and Public Affairs, Tel: + 1917-367-5264<br>Send \n an email<br>http://www.un.org/events/tenstories/07/contactus.asp?address=16<br><br><strong>Office \n for the Coordination of Humanitarian Affairs (OCHA)</strong><br>Stephanie \n Bunker, Spokesperson and Public Information Officer<br>Tel: + \n 1917-367-5126Send an email<br>Send an email<br>http://www.un.org/events/tenstories/07/contactus.asp?address=2\n </p>\n <p>\n <strong>USEFUL WEB LINKS:</strong><br><strong>Office for the \n Coordination of Humanitarian Affairs (OCHA), ReliefWeb<br>http://www.reliefweb.int/rw/dbc.nsf/doc104?OpenForm&rc=1&cc=uga</strong><br><a href="http://www.reliefweb.int/rw/dbc.nsf/doc104?OpenForm&rc=1&cc=uga">\n</a><br><strong>United Nations High Commissioner for Refugees (UNHCR)<br>http://www.unhcr.org/country/uga.html</strong><br><a href="http://www.unhcr.org/country/uga.html">\n</a><br><strong>United Nations Children’s Fund (UNICEF)</strong><br>http://www.unicef.org/infobycountry/uganda.html<br><a href="http://www.unicef.org/infobycountry/uganda.html">\n</a><br><strong>United Nations Office of the High Commissioner for Human \n Rights (OHCHR)</strong><br>http://www.ohchr.org/EN/countries/AfricaRegion/Pages/UGIndex.aspx<br><br><strong>International \n Criminal Court (ICC)</strong><br>http://www.icc-cpi.int/cases/UGD.html<br><a href="http://www.icc-cpi.int/cases/UGD.htmlCC">\n</a><br><strong>UN News Service</strong><br>http://www.un.org/news<br><br>\n </p>\n </div>\n </div>\n </body>\n </html>\n </body>\n</html>\n', 'http://www.un.org/events/tenstories/07/printable/uganda.shtml', 7, '2009-10-27 16:09:39', '2009-10-27 19:08:45', 1);
INSERT INTO `qbanswer` (`AnswerID`, `Source`, `Details`, `Link_to_answer`, `CategoryID`, `Datecreated`, `Dateupdated`, `Active`) VALUES
(9, 'http://en.wikipedia.org/wiki/Malaria_vaccine', '<html xml="#DEFAULT" xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en">\n <head>\n <title>Malaria vaccine - Wikipedia, the free encyclopedia</title>\n <meta content="text/html; charset=utf-8" http-equiv="Content-Type">\n <meta content="text/css" http-equiv="Content-Style-Type">\n <meta content="MediaWiki 1.16alpha-wmf" name="generator">\n <link type="application/x-wiki" href="/w/index.php?title=Malaria_vaccine&action=edit" rel="alternate" title="Edit this page">\n <link href="/w/index.php?title=Malaria_vaccine&action=edit" rel="edit" title="Edit this page">\n <link href="http://en.wikipedia.org/apple-touch-icon.png" rel="apple-touch-icon">\n <link href="/favicon.ico" rel="shortcut icon">\n <link type="application/opensearchdescription+xml" href="/w/opensearch_desc.php" rel="search" title="Wikipedia (en)">\n <link href="http://creativecommons.org/licenses/by-sa/3.0/" rel="copyright">\n <link type="application/rss+xml" href="/w/index.php?title=Special:RecentChanges&feed=rss" rel="alternate" title="Wikipedia RSS Feed">\n <link type="application/atom+xml" href="/w/index.php?title=Special:RecentChanges&feed=atom" rel="alternate" title="Wikipedia Atom Feed">\n <link type="text/css" href="/skins-1.5/common/shared.css?243z2" rel="stylesheet" media="screen">\n <link type="text/css" href="/skins-1.5/common/commonPrint.css?243z2" rel="stylesheet" media="print">\n <link type="text/css" href="/skins-1.5/monobook/main.css?243z2" rel="stylesheet" media="screen">\n <link type="text/css" href="/skins-1.5/chick/main.css?243z2" rel="stylesheet" media="handheld">\n <!--[if lt IE 5.5000]><link rel="stylesheet" href="/skins-1.5/monobook/IE50Fixes.css?243z2" type="text/css" media="screen" /><![endif]-->\n <!--[if IE 5.5000]><link rel="stylesheet" href="/skins-1.5/monobook/IE55Fixes.css?243z2" type="text/css" media="screen" /><![endif]-->\n <!--[if IE 6]><link rel="stylesheet" href="/skins-1.5/monobook/IE60Fixes.css?243z2" type="text/css" media="screen" /><![endif]-->\n <!--[if IE 7]><link rel="stylesheet" href="/skins-1.5/monobook/IE70Fixes.css?243z2" type="text/css" media="screen" /><![endif]-->\n <link type="text/css" href="/w/index.php?title=MediaWiki:Common.css&usemsgcache=yes&ctype=text%2Fcss&smaxage=2678400&action=raw&maxage=2678400" rel="stylesheet" media="all">\n <link type="text/css" href="/w/index.php?title=MediaWiki:Print.css&usemsgcache=yes&ctype=text%2Fcss&smaxage=2678400&action=raw&maxage=2678400" rel="stylesheet" media="print">\n <link type="text/css" href="/w/index.php?title=MediaWiki:Handheld.css&usemsgcache=yes&ctype=text%2Fcss&smaxage=2678400&action=raw&maxage=2678400" rel="stylesheet" media="handheld">\n <link type="text/css" href="/w/index.php?title=MediaWiki:Monobook.css&usemsgcache=yes&ctype=text%2Fcss&smaxage=2678400&action=raw&maxage=2678400" rel="stylesheet" media="all">\n <link type="text/css" href="/w/index.php?title=-&action=raw&maxage=2678400&gen=css" rel="stylesheet" media="all">\n <script type="text/javascript">\n <!--var skin="monobook",\nstylepath="/skins-1.5",\nwgArticlePath="/wiki/$1",\nwgScriptPath="/w",\nwgScriptExtension=".php",\nwgScript="/w/index.php",\nwgVariantArticlePath=false,\nwgActionPaths={},\nwgServer="http://en.wikipedia.org",\nwgCanonicalNamespace="",\nwgCanonicalSpecialPageName=false,\nwgNamespaceNumber=0,\nwgPageName="Malaria_vaccine",\nwgTitle="Malaria vaccine",\nwgAction="view",\nwgArticleId=10280304,\nwgIsArticle=true,\nwgUserName=null,\nwgUserGroups=null,\nwgUserLanguage="en",\nwgContentLanguage="en",\nwgBreakFrames=false,\nwgCurRevisionId=321290250,\nwgVersion="1.16alpha-wmf",\nwgEnableAPI=true,\nwgEnableWriteAPI=true,\nwgSeparatorTransformTable=["", ""],\nwgDigitTransformTable=["", ""],\nwgMainPageTitle="Main Page",\nwgFormattedNamespaces={"-2": "Media", "-1": "Special", "0": "", "1": "Talk", "2": "User", "3": "User talk", "4": "Wikipedia", "5": "Wikipedia talk", "6": "File", "7": "File talk", "8": "MediaWiki", "9": "MediaWiki talk", "10": "Template", "11": "Template talk", "12": "Help", "13": "Help talk", "14": "Category", "15": "Category talk", "100": "Portal", "101": "Portal talk"},\nwgNamespaceIds={"media": -2, "special": -1, "": 0, "talk": 1, "user": 2, "user_talk": 3, "wikipedia": 4, "wikipedia_talk": 5, "file": 6, "file_talk": 7, "mediawiki": 8, "mediawiki_talk": 9, "template": 10, "template_talk": 11, "help": 12, "help_talk": 13, "category": 14, "category_talk": 15, "portal": 100, "portal_talk": 101, "wp": 4, "wt": 5, "image": 6, "image_talk": 7},\nwgMWSuggestTemplate="http://en.wikipedia.org/w/api.php?action=opensearch\\x26search={searchTerms}\\x26namespace={namespaces}\\x26suggest",\nwgDBname="enwiki",\nwgSearchNamespaces=[0],\nwgMWSuggestMessages=["with suggestions", "no suggestions"],\nwgRestrictionEdit=[],\nwgRestrictionMove=[],\nwgNotice="",\nwgNoticeLocal="";-->\n </script>\n <script type="text/javascript" src="/skins-1.5/common/wikibits.js?urid=243z2_1254880607">\n <!---->\n </script>\n <script type="text/javascript" src="/skins-1.5/common/ajax.js?urid=243z2">\n <!---->\n </script>\n <script type="text/javascript" src="/skins-1.5/common/mwsuggest.js?urid=243z2">\n <!---->\n </script>\n <script type="text/javascript" src="http://upload.wikimedia.org/centralnotice/wikipedia/en/centralnotice.js?243z2">\n <!---->\n </script>\n <!--[if lt IE 7]><script type="text/javascript" src="/skins-1.5/common/IEFixes.js?243z2"></script>\n <meta http-equiv="imagetoolbar" content="no" /><![endif]-->\n <script type="text/javascript" src="/w/index.php?title=-&action=raw&gen=js&useskin=monobook&urid=243z2_319406805">\n <!---->\n </script>\n \n </head>\n <body class="mediawiki ltr ns-0 ns-subject page-Malaria_vaccine skin-monobook">\n <div id="globalWrapper">\n <div id="column-content">\n <div id="content">\n <div id="siteNotice">\n <h1 id="firstHeading" class="firstHeading">\n Malaria vaccine\n </h1>\n <div id="bodyContent">\n <h3 id="siteSub">\n From Wikipedia, the free encyclopedia\n </h3>\n <table class="metadata plainlinks ambox ambox-content">\n <tr>\n <td class="mbox-image">\n <div>\n <ul>\n <li>\n <br>\n \n </li>\n </ul>\n </div>\n </td>\n </tr>\n </table>\n <table class="metadata plainlinks ambox ambox-style">\n <tr>\n <td class="mbox-image">\n <div style="width: 52px">\n <a class="image" href="/wiki/File:Text_document_with_red_question_mark.svg"><img width="40" height="40" src="http://upload.wikimedia.org/wikipedia/commons/thumb/a/a4/Text_document_with_red_question_mark.svg/40px-Text_document_with_red_question_mark.svg.png" alt="Text document with red question mark.svg">\n </a>\n </div>\n </td>\n <td class="mbox-text">\n This article includes a <a title="Wikipedia:Citing sources" href="/wiki/Wikipedia:Citing_sources">list \n of references</a>, related reading or <a title="Wikipedia:External links" href="/wiki/Wikipedia:External_links">external \n links</a>, but <b>its sources remain unclear because it \n lacks <a title="Wikipedia:Citing sources" href="/wiki/Wikipedia:Citing_sources#Inline_citations">inline \n citations</a>.</b> Please <a title="Wikipedia:WikiProject Fact and Reference Check" href="/wiki/Wikipedia:WikiProject_Fact_and_Reference_Check">improve</a> \n this article by introducing more precise citations <a title="Wikipedia:When to cite" href="/wiki/Wikipedia:When_to_cite">where \n appropriate</a>. <small><i>(July 2008)</i></small>\n </td>\n </tr>\n </table>\n <p>\n <b>Malaria vaccines</b> are an area of intensive research, \n however, no effective vaccine has yet been introduced into \n clinical practice.\n </p>\n <p>\n The global burden of P. falciparum malaria increased through \n the 1990s due to the development of drug-resistant parasites \n and insecticide-resistant mosquitoes; this is illustrated by \n re-emergence of the disease in areas that had been previously \n malaria free. The first decade of the 21st century has seen \n reductions in morbidity and mortality in many settings. Though \n the reasons are not entirely clear, improving socioeconomic \n indices, deployment of artemisinin-combination drugs and \n insecticide-treated bednets are all likely to have \n contributed. There has been a major scaling-up in distribution \n of malaria control measures particularly since the advent of \n the Global Fund for AIDS, Tuberculosis and Malaria. It is \n unclear what the future will hold for disease burden trends. \n If political will and funding is maintained, the disease \n burden could drop further; if as in the past funding lapses or \n clinically significant resistance develops to the main \n antimalarial drugs and insecticides used then the disease \n burden may rise again. Early evidence of resistance to \n artemisinins, the most important class of antimalarials, is \n now confirmed having manifested as delayed parasite clearance \n times in the western region of Cambodia on the border with \n Thailand. This is also the region where resistance to earlier \n antimalarial drugs emerged and then subsequently spread \n throughout much of the world in the case of chloroquine. The \n Bill and Melinda Gates Foundation has launched a call for the \n aim of the malaria community to shift from sustained control \n to eradication. It is agreed that eradication is not possible \n with current tools and that research and development of new \n drugs, diagnostics, insecticides and a cost-effective \n deployable vaccine will be needed to facilitate eradication. \n There has been a great increase in funding for such research \n in the 21st century.\n </p>\n <p>\n Vaccines are often the most cost-effective tools for public \n health. They have historically contributed to a reduction in \n the spread and burden of infectious diseases and have played \n the major part in previous elimination campaigns for smallpox \n and the ongoing polio and measles initiatives. Yet no \n effective vaccine for malaria has so far been developed. \n Despite this, researchers remain hopeful. Optimism is \n justified for several reasons. The first of these being that \n individuals who are exposed to the parasite in endemic \n countries develop acquired immunity against disease and death. \n Such immunity does not however prevent malaria infection such \n that immune individuals often harbour asymptomatic parasites \n in their blood. . Additionally, research shows that if <a class="mw-redirect" title="Immunoglobulin" href="/wiki/Immunoglobulin">immunoglobulin</a> \n is taken from immune adults, purified and then given to \n individuals that have no protective immunity, some protection \n can be gained.<sup style="white-space: nowrap" class="noprint Template-Fact" title="This claim needs references to reliable sources from December 2008">[<a title="Wikipedia:Citation needed" href="/wiki/Wikipedia:Citation_needed"><i>citation \n needed</i></a>]</sup> In addition to this clinical and animal \n studies have shown that experimental vaccination has some \n degree of success when using attenuated <a class="new" title="Sporozites (page does not exist)" href="/w/index.php?title=Sporozites&action=edit&redlink=1">sporozites</a> \n and using the RTS,S/AS01 malaria vaccine candidate.<sup style="white-space: nowrap" class="noprint Template-Fact" title="This claim needs references to reliable sources from December 2008">[<a title="Wikipedia:Citation needed" href="/wiki/Wikipedia:Citation_needed"><i>citation \n needed</i></a>]</sup>\n </p>\n <h2>\n <span class="editsection">[<a title="Edit section: Considerations for vaccine development" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=1">edit</a>]</span> \n <span class="mw-headline" id="Considerations_for_vaccine_development">Considerations \n for vaccine development</span>\n </h2>\n <p>\n The task of developing a vaccine that is of potentially \n preventative benefit for malaria is a complex process. There \n are a number of considerations to be made concerning what \n strategy a potential vaccine should adopt.\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: The diversity of the parasite" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=2">edit</a>]</span> \n <span class="mw-headline" id="The_diversity_of_the_parasite">The \n diversity of the parasite</span>\n </h3>\n <p>\n <i>P. falciparum</i> has demonstrated the capability, through \n the development for multiple drug-resistance parasites, of \n evolutionary change. The <a title="Plasmodium" href="/wiki/Plasmodium">plasmodium \n species</a> has a very high rate of replication, much higher \n than that actually needed to ensure transmission in the \n parasite’s life cycle. This enables pharmaceutical treatments \n that are effective in reducing the reproduction rate but not \n halting it to exert a high selection pressure, thus favoring \n the development of resistance. The process of evolutionary \n change is one of the key considerations necessary when \n considering potential vaccine candidates. The development of \n resistance could cause a significant reduction in efficacy of \n any potential vaccine thus rendering useless a carefully \n developed and effective treatment.\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Choosing to address the symptom or the source" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=3">edit</a>]</span> \n <span class="mw-headline" id="Choosing_to_address_the_symptom_or_the_source">Choosing \n to address the symptom or the source</span>\n </h3>\n <p>\n There are two main types of immune response than could be \n elicited by the parasite. These are Anti-parasitic Immunity \n and Anti-toxic Immunity.\n </p>\n <ul>\n <li>\n "Anti-Parasitic Immunity" addresses the source; it consists \n of an antibody response (<a title="Humoral immunity" href="/wiki/Humoral_immunity">humoral \n immunity</a>) and a cell-mediated immune response. Ideally a \n vaccine would enable the development of anti-plasmodial <a class="mw-redirect" title="Antibodies" href="/wiki/Antibodies">antibodies</a> \n in addition to generating an elevated cell-mediated \n response. Potential antibodies against which a vaccine could \n be targeted will be discussed in greater depth later. \n Antibodies are part of the specific immune response. They \n exert their effect by activating the complement cascade, \n stimulating <a class="mw-redirect" title="Phagocytic cells" href="/wiki/Phagocytic_cells">phagocytic \n cells</a> into <a title="Endocytosis" href="/wiki/Endocytosis">endocytosis</a> \n through adhesion to an external surface of the antigenic \n substances, thus ‘marking’ it as offensive. Humoral or \n Cell-Mediated Immunity consists of many interlinking \n mechanisms that essentially aim to prevent infection \n entering the body (through external barriers or hostile \n internal environments) then killing any micro-organisms or \n foreign particles that succeed in penetration. The \n cell-mediated component consists of many white blood cells \n that target foreign bodies by a variety of different \n mechanisms, these include: <a class="mw-redirect" title="Monocytes" href="/wiki/Monocytes">monocytes</a>, \n <a class="mw-redirect" title="Neutrophils" href="/wiki/Neutrophils">neutrophils</a>, \n <a class="mw-redirect" title="Macrophages" href="/wiki/Macrophages">macrophages</a>, \n <a class="mw-redirect" title="Lymphocytes" href="/wiki/Lymphocytes">lymphocytes</a>, \n <a class="mw-redirect" title="Basophils" href="/wiki/Basophils">basophils</a>, \n <a class="mw-redirect" title="Mast cells" href="/wiki/Mast_cells">mast \n cells</a>, <a class="mw-redirect" title="Natural killer cells" href="/wiki/Natural_killer_cells">natural \n killer cells</a>, <a class="mw-redirect" title="Eosinophils" href="/wiki/Eosinophils">eosinophils</a> \n etc… In the case of Malaria both systems would be targeted \n to attempt to increase the potential response generated thus \n ensuring the maximum chance of preventing disease.\n </li>\n </ul>\n <ul>\n <li>\n "Anti-toxic Immunity" addresses the symptoms; it refers to \n the suppression of the immune response associated with the \n production of factors that either induce symptoms or reduce \n the effect that any toxic by-products (of micro-organism \n presence) have on the development of disease. For example it \n has been shown that <a class="new" title="Tumor Necrosis Factor-a (page does not exist)" href="/w/index.php?title=Tumor_Necrosis_Factor-a&action=edit&redlink=1">Tumor \n Necrosis Factor-a</a> has a central role in generating the \n symptoms experienced in severe <i>P.falciparum</i> malaria. \n Thus a therapeutic vaccine could target the production of \n TNF-a, preventing the respiratory distress and cerebral \n symptoms experienced. This approach has serious limitations \n as it would have no effect on reducing the parasitic load; \n rather it only reduces the associated pathology. As a \n result, there are substantial difficulties in evaluating \n efficacy in human trials.\n </li>\n </ul>\n <p>\n Taking this information into consideration an ideal vaccine \n candidate would attempt to generate a more substantial \n cell-mediated and antibody response on parasite presentation. \n This would have the benefit of increasing the rate of parasite \n clearance, thus reducing the experienced symptoms and \n providing a level of consistent future immunity against the \n parasite.\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Potential Targets of a Vaccine" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=4">edit</a>]</span> \n <span class="mw-headline" id="Potential_Targets_of_a_Vaccine">Potential \n Targets of a Vaccine</span>\n </h3>\n <p>\n By their very nature, parasites are more complex organisms \n than bacteria and viruses, with more complicated structures \n and life-cycles. This presents problems in vaccine development \n but also increases the number of potential targets that a \n vaccine could be directed towards. These have been summarised \n into the life-cycle stage and the antibodies that could \n potentially elicit an immune response.\n </p>\n <p>\n The life cycle of the malaria parasite is particularly \n complex, presenting initial developmental problems. It should \n be noted that despite the huge number of vaccines available at \n the current time, there are none that target parasitic \n infections. Despite this, the distinct developmental stages \n involved in the life cycle present numerous opportunities for \n targeting antigens, thus potentially eliciting an immune \n response. Theoretically, each developmental stage could have a \n vaccine developed specifically to target the parasite. The \n initial stage in the life cycle, following inoculation is \n relatively short "pre-erythrocytic" or "hepatic" phase. A \n vaccine at this stage must have the ability to protect against \n sporozoites invading and possibly inhibiting the development \n of parasites in the hepatocytes (through inducing <a class="mw-redirect" title="Cytotoxic" href="/wiki/Cytotoxic">cytotoxic</a> \n <a class="mw-redirect" title="T-lymphocytes" href="/wiki/T-lymphocytes">T-lymphocytes</a> \n that can destroy the infected <a class="mw-redirect" title="Liver cells" href="/wiki/Liver_cells">liver \n cells</a>). However, if any sporozoites evaded the immune \n system they would then have the potential to be symptomatic \n and cause the clinical disease.\n </p>\n <p>\n The second phase of the life cycle is the "erythrocytic" or \n blood phase. A vaccine here could prevent <a title="Merozoite" href="/wiki/Merozoite">merozoite</a> \n multiplication or the invasion or <a class="mw-redirect" title="Red blood cells" href="/wiki/Red_blood_cells">red \n blood cells</a>. This approach is complicated by the lack of <a class="new" title="MHC molecule (page does not exist)" href="/w/index.php?title=MHC_molecule&action=edit&redlink=1">MHC \n molecule</a> expression on the surface of erythrocytes. \n Instead malarial antigens are expressed and it is this towards \n which the antibodies could potentially be directed. Another \n approach would be to attempt to block the process of \n erythrocyte adherence to blood vessel walls. It is thought \n that this process is accountable for much of the clinical \n syndrome associated with malarial infection. Therefore a \n vaccine given to during this stage would be therapeutic and \n hence administered during clinical episodes to prevent further \n deterioration. The last phase of the life cycle that has the \n potential to be targeted by a vaccine is the "sexual stage". \n This would not give any protective benefits to the individual \n inoculated but would prevent further transmission of the \n parasite by preventing the <a class="mw-redirect" title="Gametocytes" href="/wiki/Gametocytes">gametocytes</a> \n from producing multiple sporozoites in the gut wall of the \n mosquito. It therefore would be used as part of a policy \n directed at eliminating the parasite from areas of low \n prevalence or to prevent the development and spread of \n vaccine-resistant parasites. This type of \n transmission-blocking vaccine is potentially very important. \n The evolution of resistance in the malaria parasite occurs \n very quickly therefore potentially making any vaccine \n developed redundant within a few generations. This approach to \n the prevention of spread is therefore essential. Any vaccine \n produced would ideally have the ability to be of therapeutic \n value as well as preventing further transmission and is likely \n to consist of a combination of antigens from different phases \n of the parasite’s development.\n </p>\n <h4>\n <span class="editsection">[<a title="Edit section: Sporozoite" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=5">edit</a>]</span> \n <span class="mw-headline" id="Sporozoite">Sporozoite</span>\n </h4>\n <ul>\n <li>\n Abs that block hepatocyte invasion\n </li>\n <li>\n Abs that kill the sporozoite via complement fixation or \n opsonization\n </li>\n </ul>\n <h4>\n <span class="editsection">[<a title="Edit section: Infected hepatocyte" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=6">edit</a>]</span> \n <span class="mw-headline" id="Infected_hepatocyte">Infected \n hepatocyte</span>\n </h4>\n <ul>\n <li>\n CTL mediated lysis\n </li>\n <li>\n CD4+ help for the activation and differentiation of CTL\n </li>\n <li>\n Localized cytokine release by T cells or APCs\n </li>\n <li>\n ADCC or C'' mediated lysis\n </li>\n </ul>\n <h4>\n <span class="editsection">[<a title="Edit section: Asexual erythrocytic" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=7">edit</a>]</span> \n <span class="mw-headline" id="Asexual_erythrocytic">Asexual \n erythrocytic</span>\n </h4>\n <ul>\n <li>\n Localized cytokine release that directly kills infected \n erythrocyte or intracellular parasite\n </li>\n <li>\n Abs that agglutinate the merozoites before schizont rupture\n </li>\n <li>\n Abs that block merozoite invasion of RBCs\n </li>\n <li>\n Abs that kill iRBC via opsonization or phagocytotic \n mechanisms\n </li>\n <li>\n Abs engulfed with the merozoite at time of invasion which \n kill intraerythrocytic parasite\n </li>\n <li>\n Abs which agglutinate iRBCs and prevent cytoadherence by \n blocking receptor-ligand interactions (CD-36 is such a \n receptor)\n </li>\n <li>\n Abs which neutralize harmful soluble parasite toxins\n </li>\n </ul>\n <h4>\n <span class="editsection">[<a title="Edit section: Sexual erythrocytic" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=8">edit</a>]</span> \n <span class="mw-headline" id="Sexual_erythrocytic">Sexual \n erythrocytic</span>\n </h4>\n <ul>\n <li>\n Cytokines which kill gametocytes within the iRBC\n </li>\n <li>\n Abs that kill gametocytes within iRBC via C''\n </li>\n <li>\n Abs that interfere with fertilization\n </li>\n <li>\n Abs that inhibit transformation of the zygote into the \n ookinete\n </li>\n <li>\n Abs that block the egress of the ookinete from the mosquito \n midgut (Doolan and Hoffman)\n </li>\n </ul>\n <p>\n When selecting the most suitable vaccine target the following \n considerations are made:\n </p>\n <p>\n a) How accessible is the antigen to the immune system?\n </p>\n <p>\n b) How susceptible is the antigen to evolutionary change?\n </p>\n <p>\n c) How critical is the antigen to parasitic biological \n functions?\n </p>\n <p>\n d) How likely is a protective response in animal models?\n </p>\n <p>\n e) Does the antigen contain epitopes that are recognisable by \n HLA allele superfamilies?\n </p>\n <p>\n f) How compatible is the antigen with other potential antigens?\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Mix of Antigenic Components" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=9">edit</a>]</span> \n <span class="mw-headline" id="Mix_of_Antigenic_Components">Mix \n of Antigenic Components</span>\n </h3>\n <p>\n Increasing the potential immunity generated against the \n plasmodia can be achieved by attempting to target multiple \n phases in the life-cycle. This is additionally beneficial in \n reducing the possibility of resistant parasites developing. \n The use of multiple parasite antigens can therefore have a \n synergistic or additive effect.\n </p>\n <p>\n One of the most successful vaccine candidates currently in \n clinical trials consist of recombinant antigenic proteins to \n the circumsporozoite protein.<span><a href="#cite_note-pmid19633296-0"><sup class="reference" id="cite_ref-pmid19633296_0-0">[</sup></a></span><a href="#cite_note-pmid19633296-0"><sup class="reference" id="cite_ref-pmid19633296_0-0">1<span>]</span></sup></a> \n (This is discussed in more detail below.).\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Vaccine delivery system." href="/w/index.php?title=Malaria_vaccine&action=edit§ion=10">edit</a>]</span> \n <span class="mw-headline" id="Vaccine_delivery_system.">Vaccine \n delivery system.</span>\n </h3>\n <p>\n The selection of an appropriate system is fundamental in all \n vaccine development but especially so in the case of malaria. \n A vaccine targeting several antigens may require delivery to \n different areas and by different means in order to elicit an \n effective response. Some <a class="mw-redirect" title="Adjuvants" href="/wiki/Adjuvants">adjuvants</a> \n can direct the vaccine to the specifically targeted cell type \n e.g. the use of <a title="Hepatitis B virus" href="/wiki/Hepatitis_B_virus">Hepatitis \n B virus</a> in the <a class="new" title="RTS,S vaccine (page does not exist)" href="/w/index.php?title=RTS,S_vaccine&action=edit&redlink=1">RTS,S \n vaccine</a> to target infected hepatocytes, but in other \n cases, particularly when using combined antigenic vaccines \n this approach is very complex. Some methods that have been \n attempted include the use of two vaccines, for example, one \n directed at generating a blood response and the other a \n liver-stage response. These two vaccines could then be \n injected into two different sites thus enabling the use of a \n more specific and potentially efficacious delivery system.\n </p>\n <p>\n To increase, accelerate or modify the development of an immune \n response to a vaccine candidate it is often necessary to \n combine the antigenic substance to be delivered with an \n adjuvant or specialised delivery system. These terms are often \n used interchangeably in relation to vaccine development; \n however in most cases a distinction can be made. An adjuvant \n is typically thought of as a substance used in combination \n with the antigen to produce as more substantial and robust \n immune response than that elicited to the antigen alone. This \n is achieved through three mechanisms: by effecting the antigen \n delivery and presentation, by inducing the production of \n immunomodulatory cytokines and by effecting the <a class="mw-redirect" title="Antigen presenting cells" href="/wiki/Antigen_presenting_cells">antigen \n presenting cells</a> (APC). They can consist of many different \n materials from cell microparticles to other particulated \n delivery systems e.g. <a class="mw-redirect" title="Liposomes" href="/wiki/Liposomes">liposomes</a>. \n Whereas delivery systems are substances designed purely to \n deliver antigens into the target cells. Adjuvants are crucial \n in effecting the specificity and isotype of the necessary \n antibodies. They are thought to be able to potentiate the link \n between the innate and adaptive immune responses. Due to the \n diverse nature of substances that can potentially have this \n effect on the immune system it is difficult to classify \n adjuvants into specific groups. In most circumstances they \n consist of easily identifiable components of micro-organisms \n that are recognised by the innate immune system cells. The \n role of delivery systems is primarily to direct the chosen \n adjuvant and antigen into target cells to attempt to increase \n the efficacy of the vaccine further therefore acting \n synergistically with the adjuvant. There is increasing concern \n that the use of very potent adjuvants could precipitate \n autoimmune responses, making it imperative that the vaccine is \n focused on the target cells only. Specific delivery systems \n can reduce this risk by limiting the potential toxicity and \n systemic distribution of newly developed adjuvants. Studies \n into the efficacy of malaria vaccines developed to date have \n illustrated that the presence of an adjuvant is key in \n determining any protection gained against malaria. A large \n number of natural and synthetic adjuvants have been identified \n throughout the history of vaccine development. Options \n identified thus far for use combined with a malaria vaccine \n include mycobacterial cell walls, liposomes, monophosphoryl \n lipid A and squalene.\n </p>\n <h2>\n <span class="editsection">[<a title="Edit section: Vaccines developed thus far" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=11">edit</a>]</span> \n <span class="mw-headline" id="Vaccines_developed_thus_far">Vaccines \n developed thus far</span>\n </h2>\n <p>\n The epidemiology of Malaria varies enormously across the \n globe, and has led to the belief that it may be necessary to \n adopt very different vaccine development strategies to target \n the different populations. A Type 1 vaccine is suggested for \n those exposed mostly to P.falciparum malaria in sub-Saharan \n Africa, with the primary objective to reduce the number of \n severe malaria cases and deaths in infants and children \n exposed to high transmission rates. The Type 2 vaccine could \n be thought of as a ‘travellers’ vaccine’, aiming to prevent \n all cases of clinical symptoms in individuals with no previous \n exposure. This is another major public health problem, with \n malaria presenting as one of the most substantial threats to \n travellers’ health. Problems with the current available \n pharmaceutical therapies include costs, availability, adverse \n effects and contraindications, inconvenience and compliance \n many of which would be reduced or eliminated entirely if an \n effective (greater than 85-90%) vaccine was developed.\n </p>\n <p>\n There are many antigens present throughout the parasite life \n cycle that potentially could act as targets for the vaccine. \n More than 30 of these are currently being researched by teams \n all over the world in the hope of identifying a combination \n that can elicit immunity in the inoculated individual. Some of \n the approaches involve surface expression of the antigen, \n inhibitory effects of specific antibodies on the life cycle \n and the protective effects through immunization or passive \n transfer of antibodies between an immune and a non-immune \n host. The majority of research into malarial vaccines has \n focused on the <i>Plasmodium falciparum</i> strain due to the \n high mortality caused by the parasite and the ease of a \n carrying out in vitro/in vivo studies. The earliest vaccines \n attempted to use the parasitic <a class="new" title="Circumsporozoite (page does not exist)" href="/w/index.php?title=Circumsporozoite&action=edit&redlink=1">circumsporozoite</a> \n (CS) protein. This is the most dominant surface antigen of the \n initial pre-erythrocytic phase. However, problems were \n encountered due to low efficacy, <a class="new" title="Reactogenicity (page does not exist)" href="/w/index.php?title=Reactogenicity&action=edit&redlink=1">reactogenicity</a> \n and low <a title="Immunogenicity" href="/wiki/Immunogenicity">immunogenicity</a>.\n </p>\n <p>\n The first vaccine developed that has undergone field trials, \n is the <a class="new" title="SPf66 (page does not exist)" href="/w/index.php?title=SPf66&action=edit&redlink=1">SPf66</a>, \n developed by <a title="Manuel Elkin Patarroyo" href="/wiki/Manuel_Elkin_Patarroyo">Manuel \n Elkin Patarroyo</a> in 1987. It presents a combination of \n antigens from the sporozoite (using CS repeats) and merozoite \n parasites. During phase I trials a 75% efficacy rate was \n demonstrated and the vaccine appeared to be well tolerated by \n subjects and immunogenic. The phase IIb and III trials were \n less promising, with the efficacy falling to between 38.8% and \n 60.2%. A trial was carried out in <a title="Tanzania" href="/wiki/Tanzania">Tanzania</a> \n in 1993 demonstrating the efficacy to be 31% after a year of \n follow up, however the most recent (though controversial) \n study was carried out in Gambia. It did not show any effect \n despite the relatively long trial periods and the number of \n studies carried out. It is still not known how the SPf66 \n vaccine confers immunity; it therefore remains an unlikely \n solution to malaria. The CSP was the next vaccine developed \n that initially appeared promising enough to undergo trials. It \n is also based on the circumsporoziote protein, but \n additionally has the recombinant \n (Asn-Ala-Pro15Asn-Val-Asp-Pro)2-Leu-Arg(<a class="new" title="R32LR (page does not exist)" href="/w/index.php?title=R32LR&action=edit&redlink=1">R32LR</a>) \n protein covalently bound to a purified <a title="Pseudomonas aeruginosa" href="/wiki/Pseudomonas_aeruginosa"><i>Pseudomonas \n aeruginosa</i></a> toxin (A9). However at an early stage a \n complete lack of protective immunity was demonstrated in those \n inoculated. The study group used in <a title="Kenya" href="/wiki/Kenya">Kenya</a> \n had an 82% incidence of <a class="new" title="Parasitaemia (page does not exist)" href="/w/index.php?title=Parasitaemia&action=edit&redlink=1">parasitaemia</a> \n whilst the control group only had an 89% incidence. The \n vaccine intended to cause an increased T-lymphocyte response \n in those exposed, this was also not observed.\n </p>\n <p>\n The <a class="new" title="NYVAC-Pf7 (page does not exist)" href="/w/index.php?title=NYVAC-Pf7&action=edit&redlink=1">NYVAC-Pf7</a> \n multistage vaccine attempted to use different technology, \n incorporating seven <i>P.falciparum</i> antigenic genes. These \n came from a variety of stages during the life cycle. CSP and \n sporozoite surface protein 2 (called <a class="new" title="PfSSP2 (page does not exist)" href="/w/index.php?title=PfSSP2&action=edit&redlink=1">PfSSP2</a>) \n were derived from the sporozoite phase. The liver stage \n antigen 1 (LSA1), three from the erythrocytic stage (merozoite \n surface protein 1, serine repeat antigen and AMA-1) and one \n sexual stage antigen (the 25-kDa Pfs25) were included. This \n was first investigated using <a class="mw-redirect" title="Rhesus monkeys" href="/wiki/Rhesus_monkeys">Rhesus \n monkeys</a> and produced encouraging results: 4 out of the 7 \n antigens produced specific antibody responses (CSP, PfSSP2, <a title="Merozoite surface protein" href="/wiki/Merozoite_surface_protein">MSP1</a> \n and PFs25). Later trials in humans, despite demonstrating \n cellular immune responses in over 90% of the subjects had very \n poor antibody responses. Despite this following administration \n of the vaccine some candidates had complete protection when \n challenged with <i>P.falciparum</i>. This result has warranted \n ongoing trials.\n </p>\n <p>\n In 1995 a field trial involving [NANP]19-5.1 proved to be very \n successful. Out of 194 children vaccinated none developed \n symptomatic malaria in the 12 week follow up period and only 8 \n failed to have higher levels of antibody present. The vaccine \n consists of the <a class="new" title="Schizont export protein (page does not exist)" href="/w/index.php?title=Schizont_export_protein&action=edit&redlink=1">schizont \n export protein</a> (5.1) and 19 repeats of the sporozoite \n surface protein [NANP]. Limitations of the technology exist as \n it contains only 20% <a title="Peptide" href="/wiki/Peptide">peptide</a> \n and has low levels of immunogenicity. It also does not contain \n any immunodominant T-cell <a class="mw-redirect" title="Epitopes" href="/wiki/Epitopes">epitopes</a>.\n </p>\n <p>\n RTS,S is the most recently developed <a title="Recombinant" href="/wiki/Recombinant">recombinant</a> \n vaccine. It consists of the <i>P. falciparum</i> \n cirumsporozoite protein from the pre-erythrocytic stage. The \n CSP antigen causes the production of antibodies capable of \n preventing the invasion of hepatocytes and additionally \n elicits a cellular response enabling the destruction of \n infected hepatocytes. The CSP vaccine presented problems in \n trials due to its poor immunogenicity. The RTS,S attempted to \n avoid these by fusing the protein with a surface antigen from \n Hepatitis B, hence creating a more potent and immunogenic \n vaccine. When tested in trials an emulsion of oil in water and \n the added adjuvants of monophosphoryl A and QS21 (SBAS2), the \n vaccine gave 7 out of 8 volunteers challenged with <i>P. \n falciparum</i> protective immunity.\n </p>\n <h2>\n <span class="editsection">[<a title="Edit section: Vaccine development strategies for the future" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=12">edit</a>]</span> \n <span class="mw-headline" id="Vaccine_development_strategies_for_the_future">Vaccine \n development strategies for the future</span>\n </h2>\n <p>\n The development of a vaccine of therapeutic and protective \n benefit against the malaria parasite requires a novel approach \n as to date there are no vaccines available that effectively \n target a parasitic infection. The focus so far has been \n predominately on the use of sub-unit vaccines. The use of \n live, inactivated or attenuated whole parasites is not \n feasible and therefore antigenic particles, or subunits, from \n the parasite are isolated and tested for immunogenicity i.e. \n the ability to elicit an immune response. The majority of \n subunits tested have been discussed above and are frequently \n combined with adjuvants and specialised delivery systems to \n increase the very variable level of immune response. The most \n recent advances in the field of sub-unit vaccine development \n include the use of <a class="new" title="DNA vaccines (page does not exist)" href="/w/index.php?title=DNA_vaccines&action=edit&redlink=1">DNA \n vaccines</a>. This approach involves removing sections of DNA \n from the parasitic genome and inserting the sequences into a \n vector, examples including plasmid genomes, attenuated DNA \n viral genomes, liposomes or <a class="new" title="Proteoliposes (page does not exist)" href="/w/index.php?title=Proteoliposes&action=edit&redlink=1">proteoliposes</a>, \n and other carrier complex molecules. When inoculated the \n plasmid or attenuated virus is endocytosed into a host cell, \n the DNA sequence is then incorporated into the host DNA and \n replicated by protein synthesis. The proteins then produced \n are expressed on the cell surface membrane of the ‘infected’ \n cell. These bind to the <a class="new" title="HLA molecules (page does not exist)" href="/w/index.php?title=HLA_molecules&action=edit&redlink=1">HLA \n molecules</a>, priming T cells and therefore creating a \n population of memory T cells specific to the inoculated DNA \n sub-unit. This technique has been shown to produce a high rate \n of T cell response but poor level of antibody production. The \n efficacy of DNA vaccines can be assessed using an <a class="new" title="ELISPOT assay (page does not exist)" href="/w/index.php?title=ELISPOT_assay&action=edit&redlink=1">ELISPOT \n assay</a>. The development of this method of testing for \n immune responses is extremely beneficial when examining the \n potential efficacy of a vaccine candidate and is hoped to \n enable critical analysis of the mechanisms that provide \n ‘partial’ protection, thus facilitating a greater \n understanding of vaccine technology. This approach of \n potentially allowing the modification of vaccine candidates to \n improve development techniques and further scientific \n understanding is known as ‘iterative development’. The \n advantage of DNA vaccines over classical attenuated vaccines \n are numerous and include being able to mimic MHC class 1 CD8+ \n T cell specific responses that potentially could reduce some \n of the safety concerns associated with vaccine therapy and \n additionally provide a substantial reduction in production \n cost and due to the nature of DNA vaccines, increased ease of \n storage.\n </p>\n <p>\n The most successful candidate developed to date is the RTS,S \n recombinant vaccine. The <a class="new" title="RTS,S/AS02A (page does not exist)" href="/w/index.php?title=RTS,S/AS02A&action=edit&redlink=1">RTS,S/AS02A</a>, \n one of the key vaccines produced using this technique, has \n been used in field trials in The Gambia. Three repeat doses \n were administered in the 6 months leading up to the period of \n highest malaria transmission. The vaccine efficacy was \n reported at approximately 71% (with 95% confidence intervals \n spanning from 46 to 85%) during the first 2 months of \n follow-up, but falling to 0% in the last 6 weeks in 250 male \n volunteers. Explanations for this are likely to be complex. On \n further analysis it was noticed that the majority of control \n subjects had become infected towards the end of the follow up \n period thus only the remaining (and therefore potentially more \n immune) subjects were included in the comparison against \n inoculated individuals, therefore as the efficacy of the \n vaccine decreased it was being tested against an increasingly \n immune cohort of controls, potentially explaining the massive \n decrease in protective immunity seen. Another reason to \n explain this is that an increase in the rate of malaria \n transmission during the final follow-up period occurred; this \n is particularly plausible and would coincide additionally with \n the suspected decrease in protection given by the last vaccine \n booster.\n </p>\n <h2>\n <span class="editsection">[<a title="Edit section: References" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=13">edit</a>]</span> \n <span class="mw-headline" id="References">References</span>\n </h2>\n <ol class="references">\n <li id="cite_note-pmid19633296-0">\n <a href="#cite_ref-pmid19633296_0-0"><b>^</b></a> <span class="citation">Plassmeyer \n ML, Reiter K, Shimp RL, <i>et al.</i> (July 2009). "<a class="external text" rel="nofollow" href="http://www.jbc.org/cgi/pmidlookup?view=long&pmid=19633296">The \n structure of the Plasmodium falciparum circumsporozoite \n protein, a leading malaria vaccine candidate</a>". <i>J. \n Biol. Chem.</i>. <a title="Digital object identifier" href="/wiki/Digital_object_identifier">doi</a>:</span><span class="neverexpand"><a class="external text" rel="nofollow" href="http://dx.doi.org/10.1074%2Fjbc.M109.013706">10.1074/jbc.M109.013706</a></span><span class="citation">. \n <a class="external mw-magiclink-pmid" href="http://www.ncbi.nlm.nih.gov/pubmed/19633296">PMID \n 19633296</a></span><span class="printonly">. <a class="external free" rel="nofollow" href="http://www.jbc.org/cgi/pmidlookup?view=long&pmid=19633296">http://www.jbc.org/cgi/pmidlookup?view=long&pmid=19633296</a></span><span class="citation">.</span><span style="display: none"> </span>\n </li>\n </ol>\n <ul>\n <li>\n <span class="citation book">Good, Michael F.; Levine, Myron \n A.; James B. Kaper; Rappuoli, Rino; Liu, Margaret A. (2004). <i>New \n generation vaccines</i>. New York, N.Y: Marcel Dekker. <a class="internal mw-magiclink-isbn" href="/wiki/Special:BookSources/0824740718">ISBN \n 0-8247-4071-8</a>.</span><span style="display: none"> </span>\n\n <ul>\n <li>\n Malaria: A Complex Disease that May Require a Complex \n Vaccine. Hoffman et al. in New Generation Vaccines 2004. \n 3rd edition.\n </li>\n <li>\n Overview of Vaccine Strategies for Malaria. Good, M and \n Kemp D in New Generation Vaccines 2004. 3rd edition.\n </li>\n <li>\n Malaria Transmission-Blocking Vaccines. Saul A in New \n Generation Vaccines 2004. 3rd edition.\n </li>\n <li>\n Adjuvanted RTS,S and Other Protein- Based \n Pre-Erythrocytic Stage Malaria Vaccines. Heppner et al. \n in New Generation Vaccines 2004. 3rd edition.\n </li>\n <li>\n Plasmodium falciparum Asexual Vaccine Candidates: \n Current Status. Good et al. in New Generation Vaccines \n 2004. 3rd edition\n </li>\n </ul>\n </li>\n </ul>\n <ul>\n <li>\n <span class="citation">Moorthy VS, Good MF, Hill AV (January \n 2004). "Malaria vaccine developments". <i>Lancet</i> \n <b>363</b> (9403): 150–6. <a title="Digital object identifier" href="/wiki/Digital_object_identifier">doi</a>:</span><span class="neverexpand"><a class="external text" rel="nofollow" href="http://dx.doi.org/10.1016%2FS0140-6736%2803%2915267-1">10.1016/S0140-6736(03)15267-1</a></span><span class="citation">. \n <a class="external mw-magiclink-pmid" href="http://www.ncbi.nlm.nih.gov/pubmed/14726170">PMID \n 14726170</a>.</span><span style="display: none"> </span>\n </li>\n </ul>\n <ul>\n <li>\n The Jordan Report\n </li>\n </ul>\n <ul>\n <li>\n <span class="citation">Gurunathan S, Klinman DM, Seder RA \n (2000). "DNA vaccines: immunology, application, and \n optimization*". <i>Annu. Rev. Immunol.</i> <b>18</b>: \n 927–74. <a title="Digital object identifier" href="/wiki/Digital_object_identifier">doi</a>:</span><span class="neverexpand"><a class="external text" rel="nofollow" href="http://dx.doi.org/10.1146%2Fannurev.immunol.18.1.927">10.1146/annurev.immunol.18.1.927</a></span><span class="citation">. \n <a class="external mw-magiclink-pmid" href="http://www.ncbi.nlm.nih.gov/pubmed/10837079">PMID \n 10837079</a>.</span><span style="display: none"> </span>\n </li>\n </ul>\n <ul>\n <li>\n <span class="citation book">Delves, Peter J.; Roitt, Ivan \n Maurice (2001). <i>Roitt''s essential immunology</i>. Oxford: \n Blackwell Science. <a class="internal mw-magiclink-isbn" href="/wiki/Special:BookSources/0632059028">ISBN \n 0-632-05902-8</a>.</span><span style="display: none"> </span>\n </li>\n </ul>\n <ul>\n <li>\n <span class="citation">Waters A (February 2006). "<a class="external text" rel="nofollow" href="http://linkinghub.elsevier.com/retrieve/pii/S0092-8674(06)00186-3">Malaria: \n new vaccines for old?</a>". <i>Cell</i> <b>124</b> (4): \n 689–93. <a title="Digital object identifier" href="/wiki/Digital_object_identifier">doi</a>:</span><span class="neverexpand"><a class="external text" rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cell.2006.02.011">10.1016/j.cell.2006.02.011</a></span><span class="citation">. \n <a class="external mw-magiclink-pmid" href="http://www.ncbi.nlm.nih.gov/pubmed/16497579">PMID \n 16497579</a></span><span class="printonly">. <a class="external free" rel="nofollow" href="http://linkinghub.elsevier.com/retrieve/pii/S0092-8674(06)00186-3">http://linkinghub.elsevier.com/retrieve/pii/S0092-8674(06)00186-3</a></span><span class="citation">.</span><span style="display: none"> </span>\n </li>\n </ul>\n <h2>\n <span class="editsection">[<a title="Edit section: External links" href="/w/index.php?title=Malaria_vaccine&action=edit§ion=14">edit</a></span>\n </h2>\n </div>\n </div>\n </div>\n </div>\n </div>\n </body>\n</html>\n', 'http://en.wikipedia.org/wiki/Malaria_vaccine', 7, '2009-10-27 19:34:53', '2009-10-27 19:34:53', 1);
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", "ogg-download": "Download file", "ogg-desc-link": "About this file", "ogg-dismiss": "Close", "ogg-player-soundthumb": "No player", "ogg-no-xiphqt": "You do not appear to have the XiphQT component for QuickTime.\\nQuickTime cannot play Ogg files without this component.\\nPlease \\x3ca href=\\"http://www.mediawiki.org/wiki/Extension:OggHandler/Client_download\\"\\x3edownload XiphQT\\x3c/a\\x3e or choose another player."};\nwgOggPlayer.cortadoUrl = "http://upload.wikimedia.org/jars/cortado.jar";\nwgOggPlayer.extPathUrl = "/w/extensions/OggHandler";-->\n </script>\n \n </head>\n <body class="mediawiki ltr ns-0 ns-subject page-AIDS skin-monobook">\n <div id="globalWrapper">\n <div id="column-content">\n <div id="content">\n <div id="siteNotice">\n <div id="bodyContent">\n <table align="left" style="line-height: 1.5em" cellspacing="5" class="infobox">\n <tr>\n <th align="center" colspan="2" class="">\n Acquired immunodeficiency syndrome (AIDS)\n </th>\n </tr>\n </table>\n <p>\n <b>Acquired immune deficiency syndrome</b> or <b>acquired \n immunodeficiency syndrome</b> (<b>AIDS</b>) is a disease of \n the human <a title="Immune system" href="/wiki/Immune_system">immune \n system</a> caused by the <a title="HIV" href="/wiki/HIV">human \n immunodeficiency virus</a> (HIV).<span><sup id="cite_ref-pmid11396444_0-0" class="reference"><a href="#cite_note-pmid11396444-0">[</a></sup></span><sup id="cite_ref-pmid11396444_0-0" class="reference"><a href="#cite_note-pmid11396444-0">1<span>]</span></a></sup><span><sup id="cite_ref-1" class="reference"><a href="#cite_note-1">[</a></sup></span><sup id="cite_ref-1" class="reference"><a href="#cite_note-1">2<span>]</span></a></sup><span><sup id="cite_ref-2" class="reference"><a href="#cite_note-2">[</a></sup></span><sup id="cite_ref-2" class="reference"><a href="#cite_note-2">3<span>]</span></a></sup>\n </p>\n <p>\n This condition progressively reduces the effectiveness of the \n immune system and leaves individuals susceptible to <a title="Opportunistic infection" href="/wiki/Opportunistic_infection">opportunistic \n infections</a> and <a title="Tumor" href="/wiki/Tumor">tumors</a>. \n HIV is <a title="Transmission (medicine)" href="/wiki/Transmission_(medicine)">transmitted</a> \n through direct contact of a <a title="Mucous membrane" href="/wiki/Mucous_membrane">mucous \n membrane</a> or the bloodstream with a <a title="Bodily fluid" href="/wiki/Bodily_fluid">bodily \n fluid</a> containing HIV, such as <a title="Blood" href="/wiki/Blood">blood</a>, \n <a title="Semen" href="/wiki/Semen">semen</a>, <a title="Vaginal fluid" class="mw-redirect" href="/wiki/Vaginal_fluid">vaginal \n fluid</a>, <a title="Preseminal fluid" class="mw-redirect" href="/wiki/Preseminal_fluid">preseminal \n fluid</a>, and <a title="Breast milk" href="/wiki/Breast_milk">breast \n milk</a>.<span><sup id="cite_ref-CDCtransmission_3-0" class="reference"><a href="#cite_note-CDCtransmission-3">[</a></sup></span><sup id="cite_ref-CDCtransmission_3-0" class="reference"><a href="#cite_note-CDCtransmission-3">4<span>]</span></a></sup><span><sup id="cite_ref-sfaf_4-0" class="reference"><a href="#cite_note-sfaf-4">[</a></sup></span><sup id="cite_ref-sfaf_4-0" class="reference"><a href="#cite_note-sfaf-4">5<span>]</span></a></sup>\n </p>\n <p>\n This transmission can involve <a title="Anal sex" href="/wiki/Anal_sex">anal</a>, \n <a title="Vaginal sex" class="mw-redirect" href="/wiki/Vaginal_sex">vaginal</a> \n or <a title="Oral sex" href="/wiki/Oral_sex">oral</a> <a title="Sexual intercourse" href="/wiki/Sexual_intercourse">sex</a>, \n <a title="Blood transfusion" href="/wiki/Blood_transfusion">blood \n transfusion</a>, contaminated <a title="Hypodermic needle" href="/wiki/Hypodermic_needle">hypodermic \n needles</a>, exchange between mother and baby during <a title="Pregnancy" href="/wiki/Pregnancy">pregnancy</a>, \n <a title="Childbirth" href="/wiki/Childbirth">childbirth</a>, <a title="Breastfeeding" href="/wiki/Breastfeeding">breastfeeding</a> \n or other exposure to one of the above bodily fluids.\n </p>\n <p>\n AIDS is now a <a title="Pandemic" href="/wiki/Pandemic">pandemic</a>.<span><sup id="cite_ref-Kallings_5-0" class="reference"><a href="#cite_note-Kallings-5">[</a></sup></span><sup id="cite_ref-Kallings_5-0" class="reference"><a href="#cite_note-Kallings-5">6<span>]</span></a></sup> \n In 2007, it was estimated that 33.2 million people lived with \n the disease worldwide, and that AIDS killed an estimated \n 2.1 million people, including 330,000 children.<span><sup id="cite_ref-UNAIDS2007_6-0" class="reference"><a href="#cite_note-UNAIDS2007-6">[</a></sup></span><sup id="cite_ref-UNAIDS2007_6-0" class="reference"><a href="#cite_note-UNAIDS2007-6">7<span>]</span></a></sup> \n Over three-quarters of these deaths occurred in <a title="Sub-Saharan Africa" href="/wiki/Sub-Saharan_Africa">sub-Saharan \n Africa</a>,<span><sup id="cite_ref-UNAIDS2007_6-1" class="reference"><a href="#cite_note-UNAIDS2007-6">[</a></sup></span><sup id="cite_ref-UNAIDS2007_6-1" class="reference"><a href="#cite_note-UNAIDS2007-6">7<span>]</span></a></sup> \n retarding <a title="Economic growth" href="/wiki/Economic_growth">economic \n growth</a> and destroying <a title="Human capital" href="/wiki/Human_capital">human \n capital</a>.<span><sup id="cite_ref-Bell-et-al-2003_7-0" class="reference"><a href="#cite_note-Bell-et-al-2003-7">[</a></sup></span><sup id="cite_ref-Bell-et-al-2003_7-0" class="reference"><a href="#cite_note-Bell-et-al-2003-7">8<span>]</span></a></sup>\n </p>\n <p>\n <a title="Molecular phylogenetics" href="/wiki/Molecular_phylogenetics">Genetic \n research</a> indicates that HIV originated in west-central \n Africa during the late nineteenth or early twentieth century.<span><sup id="cite_ref-Gao_8-0" class="reference"><a href="#cite_note-Gao-8">[</a></sup></span><sup id="cite_ref-Gao_8-0" class="reference"><a href="#cite_note-Gao-8">9<span>]</span></a></sup><span><sup id="cite_ref-Worobey_9-0" class="reference"><a href="#cite_note-Worobey-9">[</a></sup></span><sup id="cite_ref-Worobey_9-0" class="reference"><a href="#cite_note-Worobey-9">10<span>]</span></a></sup> \n AIDS was first recognized by the U.S. <a title="Centers for Disease Control and Prevention" href="/wiki/Centers_for_Disease_Control_and_Prevention">Centers \n for Disease Control and Prevention</a> in 1981 and its cause, \n HIV, identified in the early 1980s.<span><sup id="cite_ref-10" class="reference"><a href="#cite_note-10">[</a></sup></span><sup id="cite_ref-10" class="reference"><a href="#cite_note-10">11<span>]</span></a></sup>\n </p>\n <p>\n Although treatments for AIDS and HIV can slow the course of \n the disease, there is currently no <a title="HIV vaccine" href="/wiki/HIV_vaccine">vaccine</a> \n or cure. <a title="Antiretroviral drug" href="/wiki/Antiretroviral_drug">Antiretroviral</a> \n treatment reduces both the <a title="Mortality rate" href="/wiki/Mortality_rate">mortality</a> \n and the morbidity of HIV infection, but these drugs are \n expensive and routine access to antiretroviral <a title="Medication" class="mw-redirect" href="/wiki/Medication">medication</a> \n is not available in all countries.<span><sup id="cite_ref-Palella_11-0" class="reference"><a href="#cite_note-Palella-11">[</a></sup></span><sup id="cite_ref-Palella_11-0" class="reference"><a href="#cite_note-Palella-11">12<span>]</span></a></sup> \n Due to the difficulty in treating HIV infection, preventing \n infection is a key aim in controlling the AIDS pandemic, with \n health organizations promoting <a title="Safe sex" href="/wiki/Safe_sex">safe \n sex</a> and <a title="Needle-exchange programme" href="/wiki/Needle-exchange_programme">needle-exchange \n programmes</a> in attempts to slow the spread of the virus.\n </p>\n <div class="thumb tright">\n <div style="width: 452px" class="thumbinner">\n <div class="thumbcaption">\n <font size="90%"><span style="margin-right: 0px; padding-bottom: 1px; margin-top: 0px; margin-bottom: 0px; margin-left: 0px; display: block"> \n RNA copies per mL of plasma</span></font>\n </div>\n </div>\n </div>\n <p>\n The symptoms of AIDS are primarily the result of conditions \n that do not normally develop in individuals with healthy <a title="Immune system" href="/wiki/Immune_system">immune \n systems</a>. Most of these conditions are infections caused by <a title="Bacteria" href="/wiki/Bacteria">bacteria</a>, \n <a title="Virus" href="/wiki/Virus">viruses</a>, <a title="Fungus" href="/wiki/Fungus">fungi</a> \n and <a title="Parasite" class="mw-redirect" href="/wiki/Parasite">parasites</a> \n that are normally controlled by the elements of the immune \n system that HIV damages.\n </p>\n <p>\n <a title="Opportunistic infection" href="/wiki/Opportunistic_infection">Opportunistic \n infections</a> are common in people with AIDS.<span><sup id="cite_ref-Holmes_12-0" class="reference"><a href="#cite_note-Holmes-12">[</a></sup></span><sup id="cite_ref-Holmes_12-0" class="reference"><a href="#cite_note-Holmes-12">13<span>]</span></a></sup> \n HIV affects nearly every <a title="Organ system" class="mw-redirect" href="/wiki/Organ_system">organ \n system</a>.\n </p>\n <p>\n People with AIDS also have an increased risk of developing \n various cancers such as <a title="Kaposi''s sarcoma" href="/wiki/Kaposi%27s_sarcoma">Kaposi''s \n sarcoma</a>, <a title="Cervical cancer" href="/wiki/Cervical_cancer">cervical \n cancer</a> and cancers of the immune system known as <a title="Lymphoma" href="/wiki/Lymphoma">lymphomas</a>. \n Additionally, people with AIDS often have systemic symptoms of \n infection like <a title="Fever" href="/wiki/Fever">fevers</a>, <a title="Sleep hyperhidrosis" href="/wiki/Sleep_hyperhidrosis">sweats</a> \n (particularly at night), swollen glands, chills, weakness, and <a title="Weight loss" href="/wiki/Weight_loss">weight \n loss</a>.<span><sup id="cite_ref-Guss_13-0" class="reference"><a href="#cite_note-Guss-13">[</a></sup></span><sup id="cite_ref-Guss_13-0" class="reference"><a href="#cite_note-Guss-13">14<span>]</span></a></sup><span><sup id="cite_ref-Guss2_14-0" class="reference"><a href="#cite_note-Guss2-14">[</a></sup></span><sup id="cite_ref-Guss2_14-0" class="reference"><a href="#cite_note-Guss2-14">15<span>]</span></a></sup> \n The specific opportunistic infections that AIDS patients \n develop depend in part on the prevalence of these infections \n in the geographic area in which the patient lives.\n </p>\n <div class="thumb tleft">\n <div style="width: 262px" class="thumbinner">\n \n\n <div class="thumbcaption">\n \n </div>\n </div>\n </div>\n <p>\n <a title="Pneumocystis pneumonia (PCP)" class="mw-redirect" href="/wiki/Pneumocystis_pneumonia_(PCP)">Pneumocystis \n pneumonia</a> (originally known as <i>Pneumocystis carinii</i> \n pneumonia, and still abbreviated as PCP, which now stands for <b>P</b>neumo<b>c</b>ystis \n <b>p</b>neumonia) is relatively rare in healthy, <a title="Immunocompetent" class="mw-redirect" href="/wiki/Immunocompetent">immunocompetent</a> \n people, but common among HIV-infected individuals. It is \n caused by <i><a title="Pneumocystis pneumonia (PCP)" class="mw-redirect" href="/wiki/Pneumocystis_pneumonia_(PCP)">Pneumocystis \n jirovecii</a></i>.\n </p>\n <p>\n Before the advent of effective diagnosis, treatment and \n routine <a title="Prophylaxis" class="mw-redirect" href="/wiki/Prophylaxis">prophylaxis</a> \n in Western countries, it was a common immediate cause of \n death. In developing countries, it is still one of the first \n indications of AIDS in untested individuals, although it does \n not generally occur unless the CD4 count is less than 200 \n cells per µL of blood.<span><sup id="cite_ref-Feldman_15-0" class="reference"><a href="#cite_note-Feldman-15">[</a></sup></span><sup id="cite_ref-Feldman_15-0" class="reference"><a href="#cite_note-Feldman-15">16<span>]</span></a></sup>\n </p>\n <p>\n <a title="Tuberculosis" href="/wiki/Tuberculosis">Tuberculosis</a> \n (TB) is unique among infections associated with HIV because it \n is transmissible to immunocompetent people via the respiratory \n route, is easily treatable once identified, may occur in \n early-stage HIV disease, and is preventable with drug therapy. \n However, <a title="Multidrug resistance" class="mw-redirect" href="/wiki/Multidrug_resistance">multidrug \n resistance</a> is a potentially serious problem.\n </p>\n <p>\n Even though its incidence has declined because of the use of \n directly observed therapy and other improved practices in \n Western countries, this is not the case in developing \n countries where HIV is most prevalent. In early-stage HIV \n infection (CD4 count >300 cells per µL), TB typically presents \n as a pulmonary disease. In advanced HIV infection, TB often \n presents atypically with extrapulmonary (systemic) disease a \n common feature. Symptoms are usually constitutional and are \n not localized to one particular site, often affecting <a title="Bone marrow" href="/wiki/Bone_marrow">bone \n marrow</a>, <a title="Bone" href="/wiki/Bone">bone</a>, \n urinary and <a title="Gastrointestinal tract" class="mw-redirect" href="/wiki/Gastrointestinal_tract">gastrointestinal \n tracts</a>, <a title="Liver" href="/wiki/Liver">liver</a>, \n regional <a title="Lymph node" href="/wiki/Lymph_node">lymph \n nodes</a>, and the <a title="Central nervous system" href="/wiki/Central_nervous_system">central \n nervous system</a>.<span><sup id="cite_ref-Decker_16-0" class="reference"><a href="#cite_note-Decker-16">[</a></sup></span><sup id="cite_ref-Decker_16-0" class="reference"><a href="#cite_note-Decker-16">17<span>]</span></a></sup>\n </p>\n <h3>\n <span id="Gastrointestinal_infections" class="mw-headline">Gastrointestinal \n infections</span>\n </h3>\n <p>\n <a title="Esophagitis" href="/wiki/Esophagitis">Esophagitis</a> \n is an inflammation of the lining of the lower end of the <a title="Esophagus" href="/wiki/Esophagus">esophagus</a> \n (gullet or swallowing tube leading to the <a title="Stomach" href="/wiki/Stomach">stomach</a>). \n In HIV infected individuals, this is normally due to fungal (<a title="Candidiasis" href="/wiki/Candidiasis">candidiasis</a>) \n or viral (<a title="Herpes simplex virus" href="/wiki/Herpes_simplex_virus">herpes \n simplex-1</a> or <a title="Cytomegalovirus" href="/wiki/Cytomegalovirus">cytomegalovirus</a>) \n infections. In rare cases, it could be due to <a title="Mycobacteria" class="mw-redirect" href="/wiki/Mycobacteria">mycobacteria</a>.<span><sup id="cite_ref-Zaidi_17-0" class="reference"><a href="#cite_note-Zaidi-17">[</a></sup></span><sup id="cite_ref-Zaidi_17-0" class="reference"><a href="#cite_note-Zaidi-17">18<span>]</span></a></sup>\n </p>\n <p>\n Unexplained chronic <a title="Diarrhea" href="/wiki/Diarrhea">diarrhea</a> \n in HIV infection is due to many possible causes, including \n common bacterial (<i><a title="Salmonella" href="/wiki/Salmonella">Salmonella</a></i>, \n <i><a title="Shigella" href="/wiki/Shigella">Shigella</a></i>, <i><a title="Listeria" href="/wiki/Listeria">Listeria</a></i> \n or <i><a title="Campylobacter" href="/wiki/Campylobacter">Campylobacter</a></i>) \n and parasitic infections; and uncommon opportunistic \n infections such as <a title="Cryptosporidiosis" href="/wiki/Cryptosporidiosis">cryptosporidiosis</a>, \n <a title="Microsporidiosis" href="/wiki/Microsporidiosis">microsporidiosis</a>, \n <i><a title="Mycobacterium avium" class="mw-redirect" href="/wiki/Mycobacterium_avium">Mycobacterium \n avium</a></i> complex (MAC) and viruses,<span><sup id="cite_ref-pmid11444032_18-0" class="reference"><a href="#cite_note-pmid11444032-18">[</a></sup></span><sup id="cite_ref-pmid11444032_18-0" class="reference"><a href="#cite_note-pmid11444032-18">19<span>]</span></a></sup> \n <a title="Astrovirus" href="/wiki/Astrovirus">astrovirus</a>, <a title="Adenovirus" class="mw-redirect" href="/wiki/Adenovirus">adenovirus</a>, \n <a title="Rotavirus" href="/wiki/Rotavirus">rotavirus</a> and <a title="Cytomegalovirus" href="/wiki/Cytomegalovirus">cytomegalovirus</a>, \n (the latter as a course of <a title="Colitis" href="/wiki/Colitis">colitis</a>).\n </p>\n <p>\n In some cases, diarrhea may be a side effect of several drugs \n used to treat HIV, or it may simply accompany HIV infection, \n particularly during primary HIV infection. It may also be a \n side effect of <a title="Antibiotic" href="/wiki/Antibiotic">antibiotics</a> \n used to treat bacterial causes of diarrhea (common for <i><a title="Clostridium difficile" href="/wiki/Clostridium_difficile">Clostridium \n difficile</a></i>). In the later stages of HIV infection, \n diarrhea is thought to be a reflection of changes in the way \n the <a title="Intestinal tract" class="mw-redirect" href="/wiki/Intestinal_tract">intestinal \n tract</a> absorbs nutrients, and may be an important component \n of HIV-related <a title="Wasting" href="/wiki/Wasting">wasting</a>.<span><sup id="cite_ref-Guerrant_19-0" class="reference"><a href="#cite_note-Guerrant-19">[</a></sup></span><sup id="cite_ref-Guerrant_19-0" class="reference"><a href="#cite_note-Guerrant-19">20<span>]</span></a></sup>\n </p>\n <h3>\n <span id="Neurological_and_psychiatric_involvement" class="mw-headline">Neurological \n and psychiatric involvement</span>\n </h3>\n <p>\n HIV infection may lead to a variety of neuropsychiatric <a title="Sequela" href="/wiki/Sequela">sequelae</a>, \n either by infection of the now susceptible nervous system by \n organisms, or as a direct consequence of the illness itself.\n </p>\n <p>\n <a title="Toxoplasmosis" href="/wiki/Toxoplasmosis">Toxoplasmosis</a> \n is a disease caused by the single-celled <a title="Parasite" class="mw-redirect" href="/wiki/Parasite">parasite</a> \n called <i>Toxoplasma gondii</i>; it usually infects the brain, \n causing toxoplasma <a title="Encephalitis" href="/wiki/Encephalitis">encephalitis</a>, \n but it can also infect and cause disease in the <a title="Eye" href="/wiki/Eye">eyes</a> \n and lungs.<span><sup id="cite_ref-Luft_20-0" class="reference"><a href="#cite_note-Luft-20">[</a></sup></span><sup id="cite_ref-Luft_20-0" class="reference"><a href="#cite_note-Luft-20">21<span>]</span></a></sup> \n Cryptococcal meningitis is an infection of the <a title="Meninges" href="/wiki/Meninges">meninx</a> \n (the membrane covering the brain and <a title="Spinal cord" href="/wiki/Spinal_cord">spinal \n cord</a>) by the fungus <i><a title="Cryptococcus neoformans" href="/wiki/Cryptococcus_neoformans">Cryptococcus \n neoformans</a></i>. It can cause fevers, <a title="Headache" href="/wiki/Headache">headache</a>, \n <a title="Fatigue (medical)" href="/wiki/Fatigue_(medical)">fatigue</a>, \n <a title="Nausea" href="/wiki/Nausea">nausea</a>, and <a title="Vomiting" href="/wiki/Vomiting">vomiting</a>. \n Patients may also develop <a title="Seizure" href="/wiki/Seizure">seizures</a> \n and confusion; left untreated, it can be lethal.\n </p>\n <p>\n <a title="Progressive multifocal leukoencephalopathy" href="/wiki/Progressive_multifocal_leukoencephalopathy">Progressive \n multifocal leukoencephalopathy</a> (PML) is a <a title="Demyelinating disease" href="/wiki/Demyelinating_disease">demyelinating \n disease</a>, in which the gradual destruction of the <a title="Myelin" href="/wiki/Myelin">myelin</a> \n sheath covering the <a title="Axon" href="/wiki/Axon">axons</a> \n of nerve cells impairs the transmission of nerve impulses. It \n is caused by a virus called <a title="JC virus" href="/wiki/JC_virus">JC \n virus</a> which occurs in 70% of the population in <a title="Virus latency" href="/wiki/Virus_latency">latent</a> \n form, causing disease only when the immune system has been \n severely weakened, as is the case for AIDS patients. It \n progresses rapidly, usually causing death within months of \n diagnosis.<span><sup id="cite_ref-Sadler_21-0" class="reference"><a href="#cite_note-Sadler-21">[</a></sup></span><sup id="cite_ref-Sadler_21-0" class="reference"><a href="#cite_note-Sadler-21">22<span>]</span></a></sup>\n </p>\n <p>\n <a title="AIDS dementia complex" href="/wiki/AIDS_dementia_complex">AIDS \n dementia complex</a> (ADC) is a metabolic <a title="Encephalopathy" href="/wiki/Encephalopathy">encephalopathy</a> \n induced by HIV infection and fueled by immune activation of \n HIV infected brain <a title="Macrophage" href="/wiki/Macrophage">macrophages</a> \n and <a title="Microglia" href="/wiki/Microglia">microglia</a>. \n These cells are productively infected by HIV and secrete <a title="Neurotoxin" href="/wiki/Neurotoxin">neurotoxins</a> \n of both host and viral origin.<span><sup id="cite_ref-Gray_22-0" class="reference"><a href="#cite_note-Gray-22">[</a></sup></span><sup id="cite_ref-Gray_22-0" class="reference"><a href="#cite_note-Gray-22">23<span>]</span></a></sup> \n Specific neurological impairments are manifested by cognitive, \n behavioral, and motor abnormalities that occur after years of \n HIV infection and are associated with low CD4<sup>+</sup> T \n cell levels and high plasma viral loads.\n </p>\n <p>\n Prevalence is 10–20% in Western countries<span><sup id="cite_ref-Grant_23-0" class="reference"><a href="#cite_note-Grant-23">[</a></sup></span><sup id="cite_ref-Grant_23-0" class="reference"><a href="#cite_note-Grant-23">24<span>]</span></a></sup> \n but only 1–2% of HIV infections in India.<span><sup id="cite_ref-Satischandra_24-0" class="reference"><a href="#cite_note-Satischandra-24">[</a></sup></span><sup id="cite_ref-Satischandra_24-0" class="reference"><a href="#cite_note-Satischandra-24">25<span>]</span></a></sup><span><sup id="cite_ref-Wadia_25-0" class="reference"><a href="#cite_note-Wadia-25">[</a></sup></span><sup id="cite_ref-Wadia_25-0" class="reference"><a href="#cite_note-Wadia-25">26<span>]</span></a></sup> \n This difference is possibly due to the HIV subtype in India. \n AIDS related mania is sometimes seen in patients with advanced \n HIV illness; it presents with more irritability and cognitive \n impairment and less euphoria than a <a title="Manic episode" class="mw-redirect" href="/wiki/Manic_episode">manic \n episode</a> associated with true <a title="Bipolar disorder" href="/wiki/Bipolar_disorder">bipolar \n disorder</a>. Unlike the latter condition, it may have a more \n chronic course. This syndrome is less often seen with the \n advent of multi-drug therapy.\n </p>\n <h3>\n <span id="Tumors_and_malignancies" class="mw-headline">Tumors \n and malignancies</span>\n </h3>\n <div class="thumb tright">\n <div style="width: 152px" class="thumbinner">\n \n\n <div class="thumbcaption">\n <div class="magnify">\n \n </div>\n <a title="Kaposi''s sarcoma" href="/wiki/Kaposi%27s_sarcoma">Kaposi''s \n sarcoma</a>\n </div>\n </div>\n </div>\n <p>\n Patients with HIV infection have substantially increased \n incidence of several <a title="Cancer" href="/wiki/Cancer">cancers</a>. \n This is primarily due to co-infection with an <a title="Oncogene" href="/wiki/Oncogene">oncogenic</a> \n <a title="DNA virus" href="/wiki/DNA_virus">DNA virus</a>, \n especially <a title="Epstein-Barr virus" href="/wiki/Epstein-Barr_virus">Epstein-Barr \n virus</a> (EBV), <a title="Kaposi''s sarcoma-associated herpesvirus" href="/wiki/Kaposi%27s_sarcoma-associated_herpesvirus">Kaposi''s \n sarcoma-associated herpesvirus</a> (KSHV) (also known as human \n herpesvirus-8 [HHV-8]), and human <a title="Papillomavirus" class="mw-redirect" href="/wiki/Papillomavirus">papillomavirus</a> \n (HPV).<span><sup id="cite_ref-Boshoff_26-0" class="reference"><a href="#cite_note-Boshoff-26">[</a></sup></span><sup id="cite_ref-Boshoff_26-0" class="reference"><a href="#cite_note-Boshoff-26">27<span>]</span></a></sup><span><sup id="cite_ref-Yarchoan_27-0" class="reference"><a href="#cite_note-Yarchoan-27">[</a></sup></span><sup id="cite_ref-Yarchoan_27-0" class="reference"><a href="#cite_note-Yarchoan-27">28<span>]</span></a></sup>\n </p>\n <p>\n Kaposi''s sarcoma (KS) is the most common tumor in HIV-infected \n patients. The appearance of this tumor in young homosexual men \n in 1981 was one of the first signals of the AIDS epidemic. \n Caused by a <a title="Gammaherpesvirinae" href="/wiki/Gammaherpesvirinae">gammaherpes</a> \n virus called <a title="Kaposi''s sarcoma-associated herpes virus" class="mw-redirect" href="/wiki/Kaposi%27s_sarcoma-associated_herpes_virus">Kaposi''s \n sarcoma-associated herpes virus</a> (KSHV), it often appears \n as purplish <a title="Nodule (medicine)" href="/wiki/Nodule_(medicine)">nodules</a> \n on the skin, but can affect other organs, especially the <a title="Mouth" href="/wiki/Mouth">mouth</a>, \n gastrointestinal tract, and lungs. High-grade <a title="B cell" href="/wiki/B_cell">B \n cell</a> <a title="Lymphoma" href="/wiki/Lymphoma">lymphomas</a> \n such as <a title="Burkitt''s lymphoma" href="/wiki/Burkitt%27s_lymphoma">Burkitt''s \n lymphoma</a>, Burkitt''s-like lymphoma, diffuse large B-cell \n lymphoma (DLBCL), and <a title="Primary central nervous system lymphoma" href="/wiki/Primary_central_nervous_system_lymphoma">primary \n central nervous system lymphoma</a> present more often in \n HIV-infected patients. These particular cancers often \n foreshadow a poor prognosis. <a title="Epstein-Barr virus" href="/wiki/Epstein-Barr_virus">Epstein-Barr \n virus</a> (EBV) or KSHV cause many of these lymphomas. In \n HIV-infected patients, lymphoma often arises in extranodal \n sites such as the gastrointestinal tract. <span><sup id="cite_ref-28" class="reference"><a href="#cite_note-28">[</a></sup></span><sup id="cite_ref-28" class="reference"><a href="#cite_note-28">29<span>]</span></a></sup> \n When they occur in an HIV-infected patient, KS and aggressive \n B cell lymphomas confer a diagnosis of AIDS.\n </p>\n <p>\n Invasive <a title="Cervical cancer" href="/wiki/Cervical_cancer">cervical \n cancer</a> in HIV-infected women is also considered \n AIDS-defining. It is caused by <a title="Human papillomavirus" href="/wiki/Human_papillomavirus">human \n papillomavirus</a> (HPV).<span><sup id="cite_ref-29" class="reference"><a href="#cite_note-29">[</a></sup></span><sup id="cite_ref-29" class="reference"><a href="#cite_note-29">30<span>]</span></a></sup>\n </p>\n <p>\n In addition to the AIDS-defining tumors listed above, \n HIV-infected patients are at increased risk of certain other \n tumors, notably <a title="Hodgkin''s disease" class="mw-redirect" href="/wiki/Hodgkin%27s_disease">Hodgkin''s \n disease</a>, <a title="Anal cancer" href="/wiki/Anal_cancer">anal</a> \n and <a title="Rectal carcinoma" class="mw-redirect" href="/wiki/Rectal_carcinoma">rectal \n carcinomas</a>, <a title="Hepatocellular carcinoma" href="/wiki/Hepatocellular_carcinoma">hepatocellular \n carcinomas</a>, <a title="Head and neck cancer" href="/wiki/Head_and_neck_cancer">head \n and neck cancers</a>, and <a title="Lung cancer" href="/wiki/Lung_cancer">lung \n cancer</a>. Some of these are causes by viruses, such as \n Hodgkin''s disease (EBV), anal/rectal cancers (HPV), head and \n neck cancers (HPV), and hepatocellular carcinoma (hepatitis B \n or C). Other contributing factors include exposure to \n carcinogens (cigarette smoke for lung cancer), or living for \n years with subtle immune defects.\n </p>\n <p>\n Interestingly, the incidence of many common tumors, such as <a title="Breast cancer" href="/wiki/Breast_cancer">breast \n cancer</a> or <a title="Colon cancer" class="mw-redirect" href="/wiki/Colon_cancer">colon \n cancer</a>, does not increase in HIV-infected patients. In \n areas where <a title="HAART" class="mw-redirect" href="/wiki/HAART">HAART</a> \n is extensively used to treat AIDS, the incidence of many \n AIDS-related malignancies has decreased, but at the same time \n malignant cancers overall have become the most common cause of \n death of HIV-infected patients.<span><sup id="cite_ref-Bonnet_30-0" class="reference"><a href="#cite_note-Bonnet-30">[</a></sup></span><sup id="cite_ref-Bonnet_30-0" class="reference"><a href="#cite_note-Bonnet-30">31<span>]</span></a></sup> \n In recent years, an increasing proportion of these deaths have \n been from non-AIDS-defining cancers.\n </p>\n <h3>\n <span id="Other_infections" class="mw-headline">Other \n infections</span>\n </h3>\n <p>\n AIDS patients often develop opportunistic infections that \n present with non-specific symptoms, especially <a title="Low-grade fever" class="mw-redirect" href="/wiki/Low-grade_fever">low-grade \n fevers</a> and weight loss. These include opportunistic \n infection with <i><a title="Mycobacterium avium" class="mw-redirect" href="/wiki/Mycobacterium_avium">Mycobacterium \n avium</a>-intracellulare</i> and <a title="Cytomegalovirus" href="/wiki/Cytomegalovirus">cytomegalovirus</a> \n (CMV). CMV can cause colitis, as described above, and <a title="Cytomegalovirus retinitis" href="/wiki/Cytomegalovirus_retinitis">CMV \n retinitis</a> can cause <a title="Blindness" href="/wiki/Blindness">blindness</a>.\n </p>\n <p>\n <a title="Penicilliosis" href="/wiki/Penicilliosis">Penicilliosis</a> \n due to <i><a title="Penicillium marneffei" href="/wiki/Penicillium_marneffei">Penicillium \n marneffei</a></i> is now the third most common opportunistic \n infection (after extrapulmonary tuberculosis and <a title="Cryptococcosis" href="/wiki/Cryptococcosis">cryptococcosis</a>) \n in HIV-positive individuals within the endemic area of <a title="Southeast Asia" href="/wiki/Southeast_Asia">Southeast \n Asia</a>.<span><sup id="cite_ref-Skoulidis_31-0" class="reference"><a href="#cite_note-Skoulidis-31">[</a></sup></span><sup id="cite_ref-Skoulidis_31-0" class="reference"><a href="#cite_note-Skoulidis-31">32<span>]</span></a></sup>\n </p>\n <p>\n An infection that often goes unrecognized in AIDS patients is <a title="Parvovirus B19" href="/wiki/Parvovirus_B19">Parvovirus \n B19</a>. Its main consequence is anemia, which is difficult to \n distinguish from the effects of antiretroviral drugs used to \n treat AIDS itself.<span><sup id="cite_ref-32" class="reference"><a href="#cite_note-32">[</a></sup></span><sup id="cite_ref-32" class="reference"><a href="#cite_note-32">33<span>]</span></a></sup>\n </p>\n <h2>\n <span id="Cause" class="mw-headline">Cause</span>\n </h2>\n <div class="rellink boilerplate seealso">\n For more details on this topic, see <a title="HIV" href="/wiki/HIV">HIV</a>.\n </div>\n <div class="thumb tright">\n <div style="width: 302px" class="thumbinner">\n \n\n <div class="thumbcaption">\n <div class="magnify">\n <a title="Enlarge" class="internal" href="/wiki/File:HIV-budding-Color.jpg"><img alt="" src="/skins-1.5/common/images/magnify-clip.png" width="15" height="11">\n </a>\n </div>\n <a title="Scanning electron microscope" href="/wiki/Scanning_electron_microscope">Scanning \n electron micrograph</a> of HIV-1, colored green, budding \n from a cultured <a title="Lymphocyte" href="/wiki/Lymphocyte">lymphocyte</a>.\n </div>\n </div>\n </div>\n <p>\n AIDS is the most severe acceleration of <a title="Infection" href="/wiki/Infection">infection</a> \n with HIV. HIV is a <a title="Retrovirus" href="/wiki/Retrovirus">retrovirus</a> \n that primarily infects vital organs of the human <a title="Immune system" href="/wiki/Immune_system">immune \n system</a> such as <a title="T helper cell" href="/wiki/T_helper_cell">CD4<sup>+</sup> \n T cells</a> (a subset of <a title="T cell" href="/wiki/T_cell">T \n cells</a>), <a title="Macrophage" href="/wiki/Macrophage">macrophages</a> \n and <a title="Dendritic cell" href="/wiki/Dendritic_cell">dendritic \n cells</a>. It directly and indirectly destroys CD4<sup>+</sup> \n T cells.<sup id="cite_ref-Alimonti_33-0" class="reference"><span><a href="#cite_note-Alimonti-33">[</a></span><a href="#cite_note-Alimonti-33">34<span>]</span></a></sup>\n </p>\n <p>\n Once HIV has killed so many CD4<sup>+</sup> T cells that there \n are fewer than 200 of these cells per <a title="Microliter" class="mw-redirect" href="/wiki/Microliter">microliter</a> \n (µL) of <a title="Blood" href="/wiki/Blood">blood</a>, <a title="Cellular immunity" class="mw-redirect" href="/wiki/Cellular_immunity">cellular \n immunity</a> is lost. <a title="Acute (medicine)" href="/wiki/Acute_(medicine)">Acute</a> \n HIV infection progresses over time to clinical latent HIV \n infection and then to early <a title="Symptomatic" class="mw-redirect" href="/wiki/Symptomatic">symptomatic</a> \n HIV infection and later to AIDS, which is identified either on \n the basis of the amount of CD4<sup>+</sup> T cells remaining \n in the blood, and/or the presence of certain infections, as \n noted above.<sup id="cite_ref-Differential_diagnosis_34-0" class="reference"><span><a href="#cite_note-Differential_diagnosis-34">[</a></span><a href="#cite_note-Differential_diagnosis-34">35<span>]</span></a></sup>\n </p>\n <p>\n In the absence of <a title="Antiretroviral drug" href="/wiki/Antiretroviral_drug">antiretroviral \n therapy</a>, the <a title="Median" href="/wiki/Median">median</a> \n <a title="HIV Disease Progression Rates" class="mw-redirect" href="/wiki/HIV_Disease_Progression_Rates">time \n of progression from HIV infection to AIDS</a> is nine to ten \n years, and the median survival time after developing AIDS is \n only 9.2 months.<sup id="cite_ref-Morgan2_35-0" class="reference"><span><a href="#cite_note-Morgan2-35">[</a></span><a href="#cite_note-Morgan2-35">36<span>]</span></a></sup> \n However, the rate of clinical disease progression varies \n widely between individuals, from two weeks up to 20 years.\n </p>\n <p>\n Many factors affect the rate of progression. These include \n factors that influence the body''s ability to defend against \n HIV such as the infected person''s general immune function.<sup id="cite_ref-Clerici_36-0" class="reference"><span><a href="#cite_note-Clerici-36">[</a></span><a href="#cite_note-Clerici-36">37<span>]</span></a></sup><span><sup id="cite_ref-Morgan_37-0" class="reference"><a href="#cite_note-Morgan-37">[</a></sup></span><sup id="cite_ref-Morgan_37-0" class="reference"><a href="#cite_note-Morgan-37">38<span>]</span></a></sup> \n Older people have weaker immune systems, and therefore have a \n greater risk of rapid disease progression than younger people.\n </p>\n <p>\n Poor access to <a title="Health care" href="/wiki/Health_care">health \n care</a> and the existence of coexisting infections such as <a title="Tuberculosis" href="/wiki/Tuberculosis">tuberculosis</a> \n also may predispose people to faster disease progression.<sup id="cite_ref-Morgan2_35-1" class="reference"><span><a href="#cite_note-Morgan2-35">[</a></span><a href="#cite_note-Morgan2-35">36<span>]</span></a></sup><span><sup id="cite_ref-Gendelman_38-0" class="reference"><a href="#cite_note-Gendelman-38">[</a></sup></span><sup id="cite_ref-Gendelman_38-0" class="reference"><a href="#cite_note-Gendelman-38">39<span>]</span></a></sup><span><sup id="cite_ref-Bentwich_39-0" class="reference"><a href="#cite_note-Bentwich-39">[</a></sup></span><sup id="cite_ref-Bentwich_39-0" class="reference"><a href="#cite_note-Bentwich-39">40<span>]</span></a></sup> \n The infected person''s <a title="Genetics" href="/wiki/Genetics">genetic \n inheritance</a> plays an important role and some people are <a title="Resistance (biology)" class="mw-redirect" href="/wiki/Resistance_(biology)">resistant</a> \n to certain strains of HIV. An example of this is people with \n the <a title="Homozygous" class="mw-redirect" href="/wiki/Homozygous">homozygous</a> \n <a title="CCR5-?32" class="mw-redirect" href="/wiki/CCR5-%CE%9432">CCR5-Δ32</a> \n variation are resistant to infection with certain <a title="Strain (biology)" href="/wiki/Strain_(biology)">strains</a> \n of HIV.<sup id="cite_ref-Tang_40-0" class="reference"><span><a href="#cite_note-Tang-40">[</a></span><a href="#cite_note-Tang-40">41<span>]</span></a></sup> \n HIV is genetically variable and exists as different strains, \n which cause different rates of clinical disease progression.<sup id="cite_ref-Quinones_41-0" class="reference"><span><a href="#cite_note-Quinones-41">[</a></span><a href="#cite_note-Quinones-41">42<span>]</span></a></sup><span><sup id="cite_ref-Campbell_42-0" class="reference"><a href="#cite_note-Campbell-42">[</a></sup></span><sup id="cite_ref-Campbell_42-0" class="reference"><a href="#cite_note-Campbell-42">43<span>]</span></a></sup><span><sup id="cite_ref-Kaleebu_43-0" class="reference"><a href="#cite_note-Kaleebu-43">[</a></sup></span><sup id="cite_ref-Kaleebu_43-0" class="reference"><a href="#cite_note-Kaleebu-43">44<span>]</span></a></sup>\n </p>\n <h3>\n <span id="Sexual_transmission" class="mw-headline">Sexual \n transmission</span>\n </h3>\n <p>\n Sexual transmission occurs with the contact between sexual \n secretions of one person with the rectal, genital or oral <a title="Mucous membrane" href="/wiki/Mucous_membrane">mucous \n membranes</a> of another. Unprotected receptive sexual acts \n are riskier than unprotected insertive sexual acts, and the \n risk for transmitting HIV through unprotected anal intercourse \n is greater than the risk from vaginal intercourse or oral sex.\n </p>\n <p>\n However, oral sex is not entirely safe, as HIV can be \n transmitted through both insertive and receptive oral sex.<sup id="cite_ref-Rothenberg_44-0" class="reference"><span><a href="#cite_note-Rothenberg-44">[</a></span><a href="#cite_note-Rothenberg-44">45<span>]</span></a></sup><span><sup id="cite_ref-Vincenzi_45-0" class="reference"><a href="#cite_note-Vincenzi-45">[</a></sup></span><sup id="cite_ref-Vincenzi_45-0" class="reference"><a href="#cite_note-Vincenzi-45">46<span>]</span></a></sup> \n <a title="Sexual assault" href="/wiki/Sexual_assault">Sexual \n assault</a> greatly increases the risk of HIV transmission as \n condoms are rarely employed and physical trauma to the vagina \n or rectum occurs frequently, facilitating the transmission of \n HIV.<sup id="cite_ref-46" class="reference"><span><a href="#cite_note-46">[</a></span><a href="#cite_note-46">47<span>]</span></a></sup>\n </p>\n <p>\n Other <a title="Sexually transmitted infection" class="mw-redirect" href="/wiki/Sexually_transmitted_infection">sexually \n transmitted infections</a> (STI) increase the risk of HIV \n transmission and infection, because they cause the disruption \n of the normal <a title="Epithelial" class="mw-redirect" href="/wiki/Epithelial">epithelial</a> \n barrier by <a title="Genital ulcer" href="/wiki/Genital_ulcer">genital \n ulceration</a> and/or microulceration; and by accumulation of \n pools of HIV-susceptible or HIV-infected cells (<a title="Lymphocyte" href="/wiki/Lymphocyte">lymphocytes</a> \n and <a title="Macrophage" href="/wiki/Macrophage">macrophages</a>) \n in semen and vaginal secretions. Epidemiological studies from \n sub-Saharan Africa, <a title="Europe" href="/wiki/Europe">Europe</a> \n and <a title="North America" href="/wiki/North_America">North \n America</a> suggest that genital ulcers, such as those caused \n by <a title="Syphilis" href="/wiki/Syphilis">syphilis</a> \n and/or <a title="Chancroid" href="/wiki/Chancroid">chancroid</a>, \n increase the risk of becoming infected with HIV by about \n fourfold. There is also a significant although lesser increase \n in risk from STIs such as <a title="Gonorrhea" href="/wiki/Gonorrhea">gonorrhea</a>, \n <a title="Chlamydia infection" href="/wiki/Chlamydia_infection">chlamydia</a> \n and <a title="Trichomoniasis" href="/wiki/Trichomoniasis">trichomoniasis</a>, \n which all cause local accumulations of lymphocytes and \n macrophages.<sup id="cite_ref-Laga_47-0" class="reference"><span><a href="#cite_note-Laga-47">[</a></span><a href="#cite_note-Laga-47">48<span>]</span></a></sup>\n </p>\n <p>\n Transmission of HIV depends on the infectiousness of the <a title="Index case" href="/wiki/Index_case">index \n case</a> and the susceptibility of the uninfected partner. \n Infectivity seems to vary during the course of illness and is \n not constant between individuals. An undetectable plasma <a title="Viral load" href="/wiki/Viral_load">viral \n load</a> does not necessarily indicate a low viral load in the \n seminal liquid or genital secretions.\n </p>\n <p>\n However, each 10-fold increase in the level of HIV in the \n blood is associated with an 81% increased rate of HIV \n transmission.<sup id="cite_ref-Laga_47-1" class="reference"><span><a href="#cite_note-Laga-47">[</a></span><a href="#cite_note-Laga-47">48<span>]</span></a></sup><span><sup id="cite_ref-Tovanabutra_48-0" class="reference"><a href="#cite_note-Tovanabutra-48">[</a></sup></span><sup id="cite_ref-Tovanabutra_48-0" class="reference"><a href="#cite_note-Tovanabutra-48">49<span>]</span></a></sup> \n Women are more susceptible to HIV-1 infection due to hormonal \n changes, vaginal microbial ecology and physiology, and a \n higher prevalence of sexually transmitted diseases.<sup id="cite_ref-Sagar_49-0" class="reference"><span><a href="#cite_note-Sagar-49">[</a></span><a href="#cite_note-Sagar-49">50<span>]</span></a></sup><span><sup id="cite_ref-Lavreys_50-0" class="reference"><a href="#cite_note-Lavreys-50">[</a></sup></span><sup id="cite_ref-Lavreys_50-0" class="reference"><a href="#cite_note-Lavreys-50">51<span>]</span></a></sup>\n </p>\n <p>\n People who have been infected with one strain of HIV can still \n be infected later on in their lives by other, more <a title="Virulent" class="mw-redirect" href="/wiki/Virulent">virulent</a> \n strains.\n </p>\n <p>\n Infection is unlikely in a single encounter. High rates of \n infection have been linked to a pattern of overlapping \n long-term sexual relationships. This allows the virus to \n quickly spread to multiple partners who in turn infect their \n partners. A pattern of serial monogamy or occasional casual \n encounters is associated with lower rates of infection.<sup id="cite_ref-51" class="reference"><span><a href="#cite_note-51">[</a></span><a href="#cite_note-51">52<span>]</span></a></sup>\n </p>\n <p>\n HIV spreads readily through heterosexual sex in Africa, but \n less so elsewhere. One possibility being researched is that <a title="Schistosomiasis" href="/wiki/Schistosomiasis">schistosomiasis</a>, \n which affects up to 50 per cent of women in parts of Africa, \n damages the lining of the vagina.<sup id="cite_ref-52" class="reference"><span><a href="#cite_note-52">[</a></span><a href="#cite_note-52">53<span>]</span></a></sup><span><sup id="cite_ref-53" class="reference"><a href="#cite_note-53">[</a></sup></span><sup id="cite_ref-53" class="reference"><a href="#cite_note-53">54<span>]</span></a></sup>\n </p>\n </div>\n </div>\n </div>\n </div>\n </div>\n </body>\n</html>\n', 'http://en.wikipedia.org/wiki/AIDS', 7, '2009-10-28 12:53:59', '2009-10-28 12:53:59', 1);
INSERT INTO `qbanswer` (`AnswerID`, `Source`, `Details`, `Link_to_answer`, `CategoryID`, `Datecreated`, `Dateupdated`, `Active`) VALUES
(11, 'http://www.newvision.co.ug/D/8/12/688235', '<html xmlns="http://www.w3.org/1999/xhtml">\n <head>\n \n </head>\n <body>\n <table class="bodyTable">\n <tr>\n <td class="middleColumn">\n <table border="0" width="480" cellpadding="4" cellspacing="0">\n <tr>\n <td colspan="2">\n <table align="center">\n <tr>\n <td>\n <p class="captionCenter">\n Rugasira takes Museveni around the factory during the \n opening on Friday\n </p>\n </td>\n </tr>\n </table>\n <p>\n <b>By David Mugabe</b><br><br>THE first factory that \n processes coffee to its final product in Africa for export \n to Europe was officially opened by President Yoweri Museveni \n yesterday.<br><br>The Good African Coffee factory at \n Bugoloobi is the first coffee roasting and packaging factory \n in the whole of Africa to export coffee to supermarkets in \n the UK.<br><br>The $1m factory is located on Fifth Street in \n Kampala�s industrial area. It has a capacity of producing \n three million kilogrammes annually.<br><br>The project fits \n into the Government�s value addition strategy and is a bold \n move to penetrate western markets with processed African \n products.<br><br>By having the whole chain of value addition \n done in Uganda, the company saves 45% of the entire costs of \n transporting green coffee beans to Dublin, Ireland, and \n having it roasted and packaged there.<br><br>Museveni called \n it part of the liberation process of Africa. �The total \n global coffee business is $144b. Out of this, all the coffee \n growing countries, including Brazil and Columbia, get only \n $15b. The rest goes to importing countries,� he noted.<br><br>�This \n is, therefore, a small step in the process of liberating \n ourselves from working for others.�<br><br>Green \n coffee beans fetch an estimated $1 per kilo but when roasted \n and processed, they fetch $15.<br><br>Museveni thanked the \n proprietor, Andrew Rugasira, and promised government \n assistance to investors who are honest, serious and engage \n in value addition.<br><br>�If some in the private sector are \n reliable, we will come in and help, if you do well and do \n not let us down like some people have,� said Museveni.<br><br>�Today \n we celebrate a landmark, not just for Good African Coffee \n but for Africa as a continent. We are proud to be the first \n African company in an African country to be retaining the \n value addition at source,� Rugasira stated while opening the \n factory.<br><br>The company will make four types of single \n origin roast and ground coffee and one premium dried instant \n coffee.<br><br>Rugasira narrated how the project started in \n 2003 as a social enterprise in Kasese, Western Uganda, to \n link coffee growers directly to the market and bring the \n benefits of the global coffee value chain closer to the \n farmers.<br><br>Today, Rugasira says, 14,000 out-growers \n have been accredited to supply Arabica coffee to the factory \n at prices 30% to 40% above the prevailing market price.<br><br>The \n company will export coffee directly to global supermarket \n chain stores Tesco�s, Sainsbury and Waitrose in the United \n Kingdom, and Shoprite Checkers of South Africa.<br><br>According \n to Rugasira, over $2.5m has been invested in developing \n farmers� infrastructure in Kasese and brand development \n programmes in the UK and South Africa. The money came from \n loans and shareholders� capital. Setting up the factory \n alone has cost $1m, with the roasting machinery bought from \n China.<br><br>The Government invested $995,500 into the \n company as part of a private-public partnership in 2008. \n This investment is expected to be paid back with interest by \n 2013.<br><br>Rugasira, however, complained about the \n difficulties for Ugandan investors to access long term \n financing, which he blamed on lack of faith in the younger \n generation of entrepreneurs.<br>�Here, you cannot have long \n term capital. And if it is available, it is very expensive,� \n he noted.<br><br>According to Rugasira, 50% of the company�s \n tax profits will be invested back into sustainable \n programmes, defined by the communities as critical to their \n economic empowerment and social wellbeing.<br><br>Simon \n Kaheru, the company�s spokesperson, said priority now was to \n maintain the quality of the coffee beans among a selected \n but growing network of farmers. So far, the company has only \n sourced coffee from farmers in Kasese, where it maintains \n stringent quality controls.<br><br>�We have had farmers in \n neighbouring Bushenyi and Rukungiri districts expressing an \n interest in joining the network and adopting our agronomic \n practices and the wet processing technology,� said Kaheru. \n �We also source quality coffee from Kenya and Tanzania which \n we shall be roasting and packing in Uganda.�<br><br>The \n coffee sector employs some 1 million Ugandans. Last year, \n Uganda fetched $388m by exporting 3.2million bags.<br><br>According \n to the Minister of Agriculture, Hope Mwesigye, coffee export \n is expected to decline this year to $340m due to a \n contracted global economy and reduced global demand.\n </p>\n </td>\n </tr>\n </table>\n </td>\n </tr>\n </table>\n </body>\n</html>\n', 'http://www.newvision.co.ug/D/8/12/688235', 7, '2009-10-28 16:46:05', '2009-10-28 16:46:05', 1),
(12, '', 'International Day for the Eradication of Poverty\nFrom Wikipedia, the free encyclopedia\nJump to: navigation, search\n United Nations portal \nThe International Day for the Eradication of Poverty is celebrated every year on October 17 throughout the world. It was officially recognised by the United Nations in 1992, but the first commemoration of the event took place in Paris, France, in 1987 when 100,000 people gathered on the Human Rights and Liberties Plaza at the Trocadéro to honour victims of poverty, hunger, violence and fear. This call was made by Joseph Wresinski (1917-1988) founder of the prestigious International Movement ATD Fourth World.\n\nThe text engraved in the stone reads as follows :\n\n"Wherever men and women are condemned to live in extreme poverty, human rights are violated. To come together to ensure that these rights be respected is our solemn duty". Joseph Wresinski (1917-1988) founder of ATD Fourth World\n\n[edit] Testimonies\nOne of the main aims of the day is to make the voice of the poor heard. To this end, commemorations often include testimonies from people living in poverty, describing their own experiences or those of people they know.\n\n[edit] See also\nPoverty \nInternational Year of the Child \n[edit] External links\n"International Day for the Eradication of Poverty", Dag Hammarskjöld Library[1] \n"Social Perspective on Development Branch", United Nations Department of economic and social affairs[2] \n"October 17, World Day to Overcome Extreme Poverty", oct17.org[3] \n"International Movement ATD Fourth World"[4] \n"UN Day for Eradication of Poverty - Oct 17", Caritas New Zealand[5] \n', '', 8, '2009-10-28 17:10:14', '2009-10-28 17:10:14', 1),
(13, 'http://en.wikipedia.org/wiki/Barack_Obama', 'Barack Hussein Obama II (/b??r??k hu??se?n o??b??m?/ ( listen); born August 4, 1961) is the 44th and current president of the United States. He is the first African American to hold the office, as well as the first president born in Hawaii. Obama previously served as the junior United States Senator from Illinois from January 2005 until he resigned after his election to the presidency in November 2008.\n\nObama is a graduate of Columbia University and Harvard Law School, where he was the president of the Harvard Law Review. He was a community organizer in Chicago before earning his law degree. He worked as a civil rights attorney in Chicago and taught constitutional law at the University of Chicago Law School from 1992 to 2004.\n\nObama served three terms in the Illinois Senate from 1997 to 2004. Following an unsuccessful bid for a seat in the U.S. House of Representatives in 2000, Obama ran for United States Senate in 2004. During the campaign, several events brought him to national attention, such as his victory in the March 2004 Democratic primary election for the United States Senator from Illinois as well as his prime-time televised keynote address at the Democratic National Convention in July 2004. He won election to the U.S. Senate in November 2004.\n\nHe began his run for the presidency in February 2007. After a close campaign in the 2008 Democratic Party presidential primaries against Hillary Clinton, he won his party''s nomination. In the 2008 general election, he defeated Republican nominee John McCain and was inaugurated as president on January 20, 2009. On October 9, 2009, Obama was awarded the 2009 Nobel Peace Prize.\n', 'http://en.wikipedia.org/wiki/Barack_Obama', 11, '2009-10-28 17:25:46', '2009-10-28 17:25:46', 1),
(14, 'http://en.wikipedia.org/wiki/Microfinance', 'Microfinance is the provision of financial services to low-income clients, including consumers and the self-employed, who traditionally lack access to banking and related services.\n\nMore broadly, it is a movement whose object is a world in which as many poor and near-poor households as possible have permanent access to an appropriate range of high quality financial services, including not just credit but also savings, insurance, and fund transfers.[1] Those who promote microfinance generally believe that such access will help poor people out of poverty.\nThe challenge\nTraditionally, banks have not provided financial services to clients with little or no cash income. Banks must incur substantial costs to manage a client account, regardless of how small the sums of money involved. For example, the total revenue from delivering one hundred loans worth $1,000 each will not differ greatly from the revenue that results from delivering one loan of $100,000. But the fixed cost of processing loansof any sizeis considerable: assessment of potential borrowers, their repayment prospects and security; administration of outstanding loans, collecting from delinquent borrowers and so on. There is a break-even point in providing loans or deposits below which banks lose money on each transaction they make. Poor people usually fall below it.\n\nIn addition, most poor people have few assets that can be secured by a bank as collateral. As documented extensively by Hernando de Soto and others, even if they happen to own land in the developing world, they may not have effective title to it.[2] This means that the bank will have little recourse against defaulting borrowers.\n\nSeen from a broader perspective, it has long been accepted that the development of a healthy national financial system is an important goal and catalyst for the broader goal of national economic development (see for example Alexander Gerschenkron, Paul Rosenstein-Rodan, Joseph Schumpeter, Anne Krueger etc.). However, the efforts of national planners and experts to develop financial services for their nations'' majorities have often failed since World War II, for reasons summarized well by Adams, Graham & Von Pischke in their classic analysis ''Undermining Rural Development with Cheap Credit''.[3]\n\nBecause of these difficulties, when poor people borrow they often rely on relatives or a local moneylender, whose interest rates can be very high. An analysis of 28 studies of informal moneylending rates in fourteen countries in Asia, Latin America and Africa concluded that 76% of moneylender rates exceed 10% per month, including 22% that exceed 100% per month. Moneylenders usually charge higher rates to poorer borrowers than to less poor ones.[4] While moneylenders are often demonized and accused of usury, their services are convenient and fast, and they can be very flexible when borrowers run into problems. Hopes of quickly putting them out of business have proven unrealistic, even in places where microfinance institutions are very active.[citation needed]\n\nOver the past centuries practical visionaries from the Franciscan monks who founded the community-oriented pawnshops of the fifteenth century, to the founders of the European credit union movement in the nineteenth century (such as Friedrich Wilhelm Raiffeisen) and the founders of the microcredit movement in the 1970s (such as Muhammad Yunus) have tested practices and built institutions designed to bring the kinds of livelihood opportunities and risk management tools that financial services provide to the doorsteps of poor people.[5] While the success of Grameen Bank (which now serves over seven million poor Bangladeshi women) has inspired the world, it has proved difficult to replicate this success in practice. In nations with lower population densities, meeting the operating costs of a retail branch by serving nearby customers has proven considerably more challenging.\n\nAlthough much progress has been made, the problem has not been solved yet, and the overwhelming majority of people who earn less than $1 a day, especially in the rural areas, continue to have no practical access to formal sector finance. Microfinance has been growing rapidly with $25B currently at work in microfinance loans.[6] It is estimated that the industry needs $250 billion to get capital to all the poor people who need it.[6] The industry has been growing rapidly and there have been concerns that the rate of capital flowing into microfinance is a potential risk unless managed well.[7]\n\n[edit] Boundaries and principles\nTheoretically, microfinance may encompass any efforts to increase access to, or improve the quality of, financial services poor people currently use or could benefit from using. For example, poor people borrow from informal moneylenders and save with informal collectors. They receive loans and grants from charities. They buy insurance from state-owned companies. They receive funds transfers through remittance networks (like Hawala).\n\nThere are not many bright lines that can sharply distinguish microfinance from similar activities. Claims could be made that a government that orders state banks to open deposit accounts for poor consumers, or a moneylender that engages in usury, or a charity that runs a heifer pool are engaged in microfinance. Furthermore, correcting the problem of access is best done by expanding the number of financial institutions available to them, as well as the capacity of those institutions. In recent years there has been increasing emphasis on expanding the diversity of those institutions as well, since different institutions serve different needs.\n\nSome principles that summarize a century and a half of development practice were encapsulated in 2004 by Consultative Group to Assist the Poor (CGAP) and endorsed by the Group of Eight leaders at the G8 Summit on June 10, 2004:[5]\n\nPoor people need not just loans but also savings, insurance and money transfer services. \nMicrofinance must be useful to poor households: helping them raise income, build up assets and/or cushion themselves against external shocks. \nMicrofinance can pay for itself.[8] Subsidies from donors and government are scarce and uncertain, and so to reach large numbers of poor people, microfinance must pay for itself. \nMicrofinance means building permanent local institutions. \nMicrofinance also means integrating the financial needs of poor people into a countrys mainstream financial system. \nThe job of government is to enable financial services, not to provide them.[9] \nDonor funds should complement private capital, not compete with it.[9] \nThe key bottleneck is the shortage of strong institutions and managers.[9] Donors should focus on capacity building. \nInterest rate ceilings hurt poor people by preventing microfinance institutions from covering their costs, which chokes off the supply of credit. \nMicrofinance institutions should measure and disclose their performance both financially and socially. \nMicrofinance can also be distinguished from charity. It is better to provide grants to families who are destitute, or so poor they are unlikely to be able to generate the cash flow required to repay a loan. This situation can occur for example, in a war zone or after a natural disaster.\n\n[edit] Debates at the boundaries\nThere are several key debates at the boundaries of microfinance.\n\nPractitioners and donors from the charitable side of microfinance frequently argue for restricting microcredit to loans for productive purposessuch as to start or expand a microenterprise. Those from the private-sector side respond that because money is fungible, such a restriction is impossible to enforce, and that in any case it should not be up to rich people to determine how poor people use their money.\n\nPerhaps influenced by traditional Western views about usury, the role of the traditional moneylender has been subject to much criticism, especially in the early stages of modern microfinance. As more poor people gained access to loans from microcredit institutions however, it became apparent that the services of moneylenders continued to be valued. Borrowers were prepared to pay very high interest rates for services like quick loan disbursement, confidentiality and flexible repayment schedules. They did not always see lower interest rates as adequate compensation for the costs of attending meetings, attending training courses to qualify for disbursements or making monthly collateral contributions. They also found it distasteful to be forced to pretend they were borrowing to start a business, when they were often borrowing for other reasons (such as paying for school fees, dealing with health costs or securing the family food supply).[10] The more recent focus on inclusive financial systems (see section below) affords moneylenders more legitimacy, arguing in favour of regulation and efforts to increase competition between them to expand the options available to poor people.\n\nModern microfinance emerged in the 1970s with a strong orientation towards private-sector solutions. This resulted from evidence that state-owned agricultural development banks in developing countries had been a monumental failure, actually undermining the development goals they were intended to serve (see the compilation edited by Adams, Graham & Von Pischke).[3] Nevertheless public officials in many countries hold a different view, and continue to intervene in microfinance markets.\n\nThere has been a long-standing debate over the sharpness of the trade-off between ''outreach'' (the ability of a microfinance institution to reach poorer and more remote people) and its ''sustainability'' (its ability to cover its operating costsand possibly also its costs of serving new clientsfrom its operating revenues).[11] Although it is generally agreed that microfinance practitioners should seek to balance these goals to some extent, there are a wide variety of strategies, ranging from the minimalist profit-orientation of BancoSol in Bolivia to the highly integrated not-for-profit orientation of BRAC in Bangladesh. This is true not only for individual institutions, but also for governments engaged in developing national microfinance systems.\n\nMicrofinance experts generally agree that women should be the primary focus of service delivery. Evidence shows that they are less likely to default on their loans than men. Industry data from 2006 for 704 MFIs reaching 52 million borrowers includes MFIs using the solidarity lending methodology (99.3% female clients) and MFIs using individual lending (51% female clients). The delinquency rate for solidarity lending was 0.9% after 30 days (individual lending3.1%), while 0.3% of loans were written off (individual lending0.9%).[12] Because operating margins become tighter the smaller the loans delivered, many MFIs consider the risk of lending to men to be too high. This focus on women is questioned sometimes, however. A recent study of microenterpreneurs from Sri Lanka published by the World Bank found that the return on capital for male-owned businesses (half of the sample) averaged 11%, whereas the return for women-owned businesses was 0% or slightly negative.[13]\n\nMicrofinancial services are needed everywhere, including the developed world. However, in developed economies intense competition within the financial sector, combined with a diverse mix of different types of financial institutions with different missions, ensures that most people have access to some financial services. Efforts to transfer microfinance innovations such as solidarity lending from developing countries to developed ones have met with little success.[14]\n\n[edit] Financial needs of poor people\n \nFinancial needs and financial services.In developing economies and particularly in the rural areas, many activities that would be classified in the developed world as financial are not monetized: that is, money is not used to carry them out. Almost by definition, poor people have very little money. But circumstances often arise in their lives in which they need money or the things money can buy.\n\nIn Stuart Rutherfords recent book The Poor and Their Money, he cites several types of needs:[15]\n\nLifecycle Needs: such as weddings, funerals, childbirth, education, homebuilding, widowhood, old age. \nPersonal Emergencies: such as sickness, injury, unemployment, theft, harassment or death. \nDisasters: such as fires, floods, cyclones and man-made events like war or bulldozing of dwellings. \nInvestment Opportunities: expanding a business, buying land or equipment, improving housing, securing a job (which often requires paying a large bribe), etc. \nPoor people find creative and often collaborative ways to meet these needs, primarily through creating and exchanging different forms of non-cash value. Common substitutes for cash vary from country to country but typically include livestock, grains, jewellery and precious metals.\n\nAs Marguerite Robinson describes in The Microfinance Revolution, the 1980s demonstrated that microfinance could provide large-scale outreach profitably, and in the 1990s, microfinance began to develop as an industry (2001, p. 54). In the 2000s, the microfinance industrys objective is to satisfy the unmet demand on a much larger scale, and to play a role in reducing poverty. While much progress has been made in developing a viable, commercial microfinance sector in the last few decades, several issues remain that need to be addressed before the industry will be able to satisfy massive worldwide demand. The obstacles or challenges to building a sound commercial microfinance industry include:\n\n Inappropriate donor subsidies\n\n Poor regulation and supervision of deposit-taking MFIs\n\n Few MFIs that meet the needs for savings, remittances or insurance\n\n Limited management capacity in MFIs\n\n Institutional inefficiencies\n\n Need for more dissemination and adoption of rural, agricultural microfinance methodologies\n\n[edit] Ways in which poor people manage their money\n \nSaving upRutherford argues that the basic problem poor people as money managers face is to gather a usefully large amount of money. Building a new home may involve saving and protecting diverse building materials for years until enough are available to proceed with construction. Childrens schooling may be funded by buying chickens and raising them for sale as needed for expenses, uniforms, bribes, etc. Because all the value is accumulated before it is needed, this money management strategy is referred to as saving up.\n\nOften people dont have enough money when they face a need, so they borrow. A poor family might borrow from relatives to buy land, from a moneylender to buy rice, or from a microfinance institution to buy a sewing machine. Since these loans must be repaid by saving after the cost is incurred, Rutherford calls this saving down. Rutherford''s point is that microcredit is addressing only half the problem, and arguably the less important half: poor people borrow to help them save and accumulate assets. Microcredit institutions should fund their loans through savings accounts that help poor people manage their myriad risks.\n\n \nSaving downMost needs are met through mix of saving and credit. A benchmark impact assessment of Grameen Bank and two other large microfinance institutions in Bangladesh found that for every $1 they were lending to clients to finance rural non-farm micro-enterprise, about $2.50 came from other sources, mostly their clients savings.[16] This parallels the experience in the West, in which family businesses are funded mostly from savings, especially during start-up.\n\nRecent studies have also shown that informal methods of saving are very unsafe. For example a study by Wright and Mutesasira in Uganda concluded that those with no option but to save in the informal sector are almost bound to lose some money probably around one quarter of what they save there.[17]\n\nThe work of Rutherford, Wright and others has caused practitioners to reconsider a key aspect of the microcredit paradigm: that poor people get out of poverty by borrowing, building microenterprises and increasing their income. The new paradigm places more attention on the efforts of poor people to reduce their many vulnerabilities by keeping more of what they earn and building up their assets. While they need loans, they may find it as useful to borrow for consumption as for microenterprise. A safe, flexible place to save money and withdraw it when needed is also essential for managing household and family risk.\n\n[edit] Current scale of microfinance operations\nNo systematic effort to map the distribution of microfinance has yet been undertaken. A useful recent benchmark was established by an analysis of alternative financial institutions in the developing world in 2004.[18] The authors counted approximately 665 million client accounts at over 3,000 institutions that are serving people who are poorer than those served by the commercial banks. Of these accounts, 120 million were with institutions normally understood to practice microfinance. Reflecting the diverse historical roots of the movement, however, they also included postal savings banks (318 million accounts), state agricultural and development banks (172 million accounts), financial cooperatives and credit unions (35 million accounts) and specialized rural banks (19 million accounts).\n\nRegionally the highest concentration of these accounts was in India (188 million accounts representing 18% of the total national population). The lowest concentrations were in Latin American and the Caribbean (14 million accounts representing 3% of the total population) and Africa (27 million accounts representing 4% of the total population). Considering that most bank clients in the developed world need several active accounts to keep their affairs in order, these figures indicate that the task the microfinance movement has set for itself is still very far from finished.\n\nBy type of service savings accounts in alternative finance institutions outnumber loans by about four to one. This is a worldwide pattern that does not vary much by region.[19]\n\nAn important source of detailed data on selected microfinance institutions is the MicroBanking Bulletin. At the end of 2006 it was tracking 704 MFIs that were serving 52 million borrowers ($23.3 billion in outstanding loans) and 56 million savers ($15.4 billion in deposits). Of these clients, 70% were in Asia, 20% in Latin America and the balance in the rest of the world.[20]\n\nAs yet there are no studies that indicate the scale or distribution of informal microfinance organizations like ROSCAs and informal associations that help people manage costs like weddings, funerals and sickness. Numerous case studies have been published however, indicating that these organizations, which are generally designed and managed by poor people themselves with little outside help, operate in most countries in the developing world.[21]\n\n[edit] "Inclusive financial systems"\nThe microcredit era that began in the 1970s has lost its momentum, to be replaced by a financial systems approach. While microcredit achieved a great deal, especially in urban and near-urban areas and with entrepreneurial families, its progress in delivering financial services in less densely populated rural areas has been slow.\n\nThe new financial systems approach pragmatically acknowledges the richness of centuries of microfinance history and the immense diversity of institutions serving poor people in developing world today. It is also rooted in an increasing awareness of diversity of the financial service needs of the worlds poorest people, and the diverse settings in which they live and work.\n\nBrigit Helms in her book ''Access for All: Building Inclusive Financial Systems'', distinguishes between four general categories of microfinance providers, and argues for a pro-active strategy of engagement with all of them to help them achieve the goals of the microfinance movement.[22]\n\nInformal financial service providers \nThese include moneylenders, pawnbrokers, savings collectors, money-guards, ROSCAs, ASCAs and input supply shops. Because they know each other well and live in the same community, they understand each others financial circumstances and can offer very flexible, convenient and fast services. These services can also be costly and the choice of financial products limited and very short-term. Informal services that involve savings are also risky; many people lose their money. \nMember-owned organizations \nThese include self-help groups, credit unions, and a variety of hybrid organizations like financial service associations and CVECAs. Like their informal cousins, they are generally small and local, which means they have access to good knowledge about each others financial circumstances and can offer convenience and flexibility. Since they are managed by poor people, their costs of operation are low. However, these providers may have little financial skill and can run into trouble when the economy turns down or their operations become too complex. Unless they are effectively regulated and supervised, they can be captured by one or two influential leaders, and the members can lose their money. \nNGOs \nThe Microcredit Summit Campaign counted 3,316 of these MFIs and NGOs lending to about 133 million clients by the end of 2006.[23] Led by Grameen Bank and BRAC in Bangladesh, Prodem in Bolivia, and FINCA International, headquartered in Washington, DC, these NGOs have spread around the developing world in the past three decades; others, like the Gamelan Council, address larger regions. They have proven very innovative, pioneering banking techniques like solidarity lending, village banking and mobile banking that have overcome barriers to serving poor populations. However, with boards that dont necessarily represent either their capital or their customers, their governance structures can be fragile, and they can become overly dependent on external donors. \nFormal financial institutions \nIn addition to commercial banks, these include state banks, agricultural development banks, savings banks, rural banks and non-bank financial institutions. ', 'http://en.wikipedia.org/wiki/Microfinance', 9, '2009-10-28 17:35:39', '2009-10-28 17:35:39', 1);
INSERT INTO `qbanswer` (`AnswerID`, `Source`, `Details`, `Link_to_answer`, `CategoryID`, `Datecreated`, `Dateupdated`, `Active`) VALUES
(15, 'http://en.wikipedia.org/wiki/Isaac_Hayes', '<html xml="#DEFAULT" xmlns="http://www.w3.org/1999/xhtml" dir="ltr" lang="en">\n <head>\n \n </head>\n <body class="mediawiki ltr ns-0 ns-subject page-Isaac_Hayes skin-monobook">\n <div id="globalWrapper">\n <div id="column-content">\n <div id="content">\n <div id="siteNotice">\n <div id="bodyContent">\n <div class="thumb tright">\n <div style="width: 152px" class="thumbinner">\n <div class="thumbcaption">\n Isaac Hayes was the voice of <a title="Chef (South Park)" href="/wiki/Chef_(South_Park)">Chef</a> \n on <i>South Park</i>.\n </div>\n </div>\n </div>\n <p>\n During the late 1990s, Hayes gained new popularity as the \n voice of <a title="Chef (South Park)" href="/wiki/Chef_(South_Park)">Chef</a> \n on the <a title="Comedy Central" href="/wiki/Comedy_Central">Comedy \n Central</a> animated television series <i><a title="South Park" href="/wiki/South_Park">South \n Park</a></i>. Chef was a soul-singing cafeteria worker at the <i>South \n Park</i> kids'' school. A song from the series performed by \n Chef, "<a title="Chocolate Salty Balls" href="/wiki/Chocolate_Salty_Balls">Chocolate \n Salty Balls</a> (P.S. I Love You)", received international \n radio airplay in 1999. It reached number-one on the <a title="UK singles chart" class="mw-redirect" href="/wiki/UK_singles_chart">UK \n singles chart</a> and also on the <a title="Irish singles chart" class="mw-redirect" href="/wiki/Irish_singles_chart">Irish \n singles chart</a>. The track also appeared on the album <a title="Chef Aid: The South Park Album" href="/wiki/Chef_Aid:_The_South_Park_Album"><i>Chef \n Aid: The South Park Album</i></a> in 1998.\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Scientology episode" href="/w/index.php?title=Isaac_Hayes&action=edit§ion=11">edit</a>]</span> \n <span class="mw-headline" id="Scientology_episode">Scientology \n episode</span>\n </h3>\n <p>\n In the <i>South Park</i> episode "<a title="Trapped in the Closet (South Park)" href="/wiki/Trapped_in_the_Closet_(South_Park)">Trapped \n in the Closet</a>", a satire of <a title="Scientology" href="/wiki/Scientology">Scientology</a> \n which aired on November 16, 2005, Hayes did not appear in his \n role as Chef. While appearing on the <a title="Opie and Anthony" href="/wiki/Opie_and_Anthony"><i>Opie \n and Anthony</i></a> radio show about a month after the episode \n aired, Hayes was asked, "What did you think about when Matt \n and Trey did that episode on Scientology?" He replied, "One \n thing about Matt and Trey, they <a title="Lampoon" href="/wiki/Lampoon">lampoon</a> \n everybody, and if you take that serious, I''ll sell you the \n Brooklyn bridge for two dollars. That''s what they do."\n </p>\n <p>\n In an interview for <a title="The A.V. Club" href="/wiki/The_A.V._Club"><i>The \n A.V. Club</i></a> on January 4, 2006, Hayes was again asked \n about the episode. Hayes said that he told the creators, <a title="Matt Stone" href="/wiki/Matt_Stone">Matt \n Stone</a> and <a title="Trey Parker" href="/wiki/Trey_Parker">Trey \n Parker</a>, "Guys, you have it all wrong. We''re not like that. \n I know that’s your thing, but get your information correct, \n because somebody might believe that shit, you know?" He then \n told them to take a couple of Scientology courses to \n understand what they do. In the interview, Hayes defended <i>South \n Park''s</i> style of controversial humor, noting that he was \n not pleased with the show''s treatment of Scientology, but \n conceding that he "understands what Matt and Trey are doing."<sup class="reference" id="cite_ref-22"><span><a href="#cite_note-22">[</a></span><a href="#cite_note-22">23<span>]</span></a></sup>\n </p>\n <h3>\n <span class="editsection">[<a title="Edit section: Departure from South Park" href="/w/index.php?title=Isaac_Hayes&action=edit§ion=12">edit</a>]</span> \n <span class="mw-headline" id="Departure_from_South_Park">Departure \n from <i>South Park</i></span>\n </h3>\n <table style="border: 1px solid #aaa; background-color: #f9f9f9" class="metadata plainlinks mbox-small">\n <tr>\n <td class="mbox-image">\n <a href="http://en.wikinews.org/wiki/Special:Search/Isaac_Hayes" title="Search Wikinews"><img alt="Search Wikinews" width="40" height="23" src="http://upload.wikimedia.org/wikipedia/commons/thumb/2/24/Wikinews-logo.svg/40px-Wikinews-logo.svg.png">\n </a>\n </td>\n <td class="mbox-text">\n <a href="/wiki/Wikinews" title="Wikinews">Wikinews</a> has \n related news: <b><a href="http://en.wikinews.org/wiki/Isaac_Hayes_quits_South_Park_over_Scientology_episode" title="wikinews:Isaac Hayes quits South Park over Scientology episode" class="extiw"><i>Isaac \n Hayes quits South Park over Scientology episode</i></a></b>\n </td>\n </tr>\n </table>\n <p>\n On March 13, 2006, a statement was issued in Hayes'' name, \n indicating that he was asking to be released from his contract \n with Comedy Central, citing recent episodes which satirized \n religious beliefs as being intolerant. "There is a place in \n this world for satire, but there is a time when satire ends \n and intolerance and bigotry towards religious beliefs of \n others begins," he was quoted in a press statement. The \n statement, however, did not directly mention Scientology. A \n response from Stone said that Hayes'' complaints stemmed from \n the show''s criticism of Scientology and that he "has no \n problem – and he''s cashed plenty of checks – with our show \n making fun of Christians, Muslims, Mormons or Jews."<a href="#cite_note-23"><span><sup id="cite_ref-23" class="reference">[</sup></span><sup id="cite_ref-23" class="reference">24<span>]</span></sup></a><span><a href="#cite_note-24"><sup id="cite_ref-24" class="reference">[</sup></a></span><a href="#cite_note-24"><sup id="cite_ref-24" class="reference">25<span>]</span></sup></a> \n Stone adds, "[We] never heard a peep out of Isaac in any way \n until we did Scientology. He wants a different standard for \n religions other than his own, and to me, that is where \n intolerance and bigotry begin." Stone and Parker agreed to \n release Hayes from his contract by his request.\n </p>\n <p>\n On March 20, 2006, Roger Friedman of <a href="/wiki/Fox_News" title="Fox News" class="mw-redirect">Fox \n News</a> reported having been told that the March 13 statement \n was made in Hayes'' name, but not by Hayes himself. He wrote: \n "Isaac Hayes did not quit <i>South Park</i>. My sources \n say that someone quit it for him. ... Friends in Memphis tell \n me that Hayes did not issue any statements on his own about \n South Park. They are mystified."<a href="#cite_note-Friedman-March2006-15"><span><sup id="cite_ref-Friedman-March2006_15-1" class="reference">[</sup></span><sup id="cite_ref-Friedman-March2006_15-1" class="reference">16<span>]</span></sup></a> \n In 2007, the <i>New York Post</i> reported that Hayes felt \n Stone and Parker "didn’t pay [him] enough" and "weren’t that \n nice."<a href="#cite_note-25"><span><sup id="cite_ref-25" class="reference">[</sup></span><sup id="cite_ref-25" class="reference">26<span>]</span></sup></a>\n </p>\n <p>\n The <i>South Park</i> season 10 premiere (aired March 22, \n 2006) featured "<a href="/wiki/The_Return_of_Chef" title="The Return of Chef">The \n Return of Chef</a>," a thinly veiled telling of the affair \n from Parker and Stone''s point of view. Using sound clips from \n past episodes, it depicts Chef as having been <a href="/wiki/Brainwashing" title="Brainwashing" class="mw-redirect">brainwashed</a> \n and urges viewers (via Kyle talking to the town) to "remember \n Chef as the jolly old guy who always broke into song" and not \n to blame Chef for his defection, but rather, as Kyle stated, \n "be mad at that fruity little club for scrambling his brains."\n </p>\n <h3>\n <span class="editsection">[<a href="/w/index.php?title=Isaac_Hayes&action=edit§ion=13" title="Edit section: After South Park">edit</a>]</span> \n <span class="mw-headline" id="After_South_Park">After <i>South \n Park</i></span>\n </h3>\n <p>\n Hayes’ income was sharply reduced as a result of leaving <i>South \n Park</i>.<a href="#cite_note-Friedman-August2008-26"><span><sup id="cite_ref-Friedman-August2008_26-0" class="reference">[</sup></span><sup id="cite_ref-Friedman-August2008_26-0" class="reference">27<span>]</span></sup></a> \n There followed announcements that he would be touring and \n performing. A reporter present at a January 2007 show in New \n York City, who had known Hayes fairly well, reported that \n "Isaac was plunked down at a keyboard, where he pretended to \n front his band. He spoke-sang, and his words were halting. He \n was not the Isaac Hayes of the past."<a href="#cite_note-Friedman-August2008-26"><span><sup id="cite_ref-Friedman-August2008_26-1" class="reference">[</sup></span><sup id="cite_ref-Friedman-August2008_26-1" class="reference">27<span>]</span></sup></a>\n </p>\n <p>\n In April 2008, while a guest on <a href="/wiki/The_Adam_Carolla_Show" title="The Adam Carolla Show"><i>The \n Adam Carolla Show</i></a>, Hayes stumbled in his responses to \n questions – possibly as a result of health issues. A caller \n questioned whether Hayes was under the influence of a \n substance, and Carolla and co-host <a href="/wiki/Teresa_Strasser" title="Teresa Strasser">Teresa \n Strasser</a> asked Hayes if he had ever used <a href="/wiki/Marijuana" title="Marijuana" class="mw-redirect">marijuana</a>. \n After some confusion on what was being asked, Hayes replied \n that he had only ever tried it once. During the interview the \n radio hosts made light of Hayes'' awkward answers, and replayed \n Hayes comments as sound drops – often simulating conversation \n with his co-hosts. Hayes stated during this interview that he \n was no longer on good terms with <a href="/wiki/Trey_Parker" title="Trey Parker">Trey \n Parker</a> and <a href="/wiki/Matt_Stone" title="Matt Stone">Matt \n Stone</a>.<a href="#cite_note-27"><span><sup id="cite_ref-27" class="reference">[</sup></span><sup id="cite_ref-27" class="reference">28<span>]</span></sup></a> \n Two months after his death, the <i>South Park</i> episode "<a href="/wiki/The_China_Probrem" title="The China Probrem">The \n China Probrem</a>" was dedicated to him.\n </p>\n <p>\n During the spring of 2008, Hayes shot scenes for a comedy \n about soul musicians inspired by the history of Stax Records \n entitled <a href="/wiki/Soul_Men_(film)" title="Soul Men (film)" class="mw-redirect"><i>Soul \n Men</i></a>, in which he appears as himself in a supporting \n role. His voice can be heard in the film in a voice-over role \n as <a href="/wiki/Samuel_L._Jackson" title="Samuel L. Jackson">Samuel \n L. Jackson</a>, <a href="/wiki/Bernie_Mac" title="Bernie Mac">Bernie \n Mac</a>, and <a href="/wiki/Sharon_Leal" title="Sharon Leal">Sharon \n Leal</a>''s characters are traveling through Memphis, \n Tennessee. His first actual appearance in the film is when he \n is shown in the audience clapping his hands as The Real Deal \n does a rendition of Hayes'' 1971 hit song "Do Your Thing." His \n next appearance consists of him entering The Real Deal''s \n dressing room to wish them luck on their performance and \n shaking hands with Louis Hinds (played by Jackson) and Floyd \n Henderson (played by Mac). During this scene, Hayes also helps \n Hinds reunite with his long-lost daughter Cleo (played by \n Leal). His final appearance in the film consists of him \n introducing The Real Deal to the audience. <a href="#cite_note-Friedman-August2008-26"><span><sup id="cite_ref-Friedman-August2008_26-2" class="reference">[</sup></span><sup id="cite_ref-Friedman-August2008_26-2" class="reference">27<span>]</span></sup></a> \n The film was released in November 7, 2008. At the premiere, \n Hayes'' son Darius was briefly interviewed. <a href="/wiki/Soul_Men_(film)" title="Soul Men (film)" class="mw-redirect"><i>Soul \n Men</i></a> would also be Mac''s final film, as he died the day \n before Hayes. The film was heavily edited to soften its tone \n as a tribute to the late stars.\n </p>\n <h2>\n <span class="editsection">[<a href="/w/index.php?title=Isaac_Hayes&action=edit§ion=14" title="Edit section: Charitable work">edit</a>]</span> \n <span class="mw-headline" id="Charitable_work">Charitable work</span>\n </h2>\n <p>\n The Isaac Hayes Foundation was founded in 1999 by Hayes.<a href="#cite_note-28"><span><sup id="cite_ref-28" class="reference">[</sup></span><sup id="cite_ref-28" class="reference">29<span>]</span></sup></a>\n </p>\n <p>\n In February 2006, Hayes appeared in a <a href="/wiki/Youth_for_Human_Rights_International" title="Youth for Human Rights International">Youth \n for Human Rights International</a> music video called \n "United". YHRI is a human rights group founded by the Church \n of Scientology.\n </p>\n <p>\n Hayes was also involved in other human rights related groups \n such as the <a href="/wiki/One_Campaign" title="One Campaign" class="mw-redirect">One \n Campaign</a>.\n </p>\n <h2>\n <span class="editsection">[<a href="/w/index.php?title=Isaac_Hayes&action=edit§ion=15" title="Edit section: Family">edit</a>]</span> \n <span class="mw-headline" id="Family">Family</span>\n </h2>\n <p>\n Hayes fathered 12 children, and had 14 grandchildren and three \n great-grandchildren.<a href="#cite_note-29"><span><sup id="cite_ref-29" class="reference">[</sup></span><sup id="cite_ref-29" class="reference">30<span>]</span></sup></a> \n His fourth wife Adjowa<a href="#cite_note-30"><span><sup id="cite_ref-30" class="reference">[</sup></span><sup id="cite_ref-30" class="reference">31<span>]</span></sup></a> \n gave birth to a son named Nana Kwadjo Hayes on April 10, 2006.<a href="#cite_note-31"><span><sup id="cite_ref-31" class="reference">[</sup></span><sup id="cite_ref-31" class="reference">32<span>]</span></sup></a> \n One son is his namesake, <a href="/wiki/Isaac_Hayes_III" title="Isaac Hayes III">Isaac \n Hayes III</a>, known as rap producer Ike Dirty.\n </p>\n <p>\n Hayes'' first marriage, in 1960, ended in divorce.<a href="#cite_note-32"><span><sup id="cite_ref-32" class="reference">[</sup></span><sup id="cite_ref-32" class="reference">33<span>]</span></sup></a>\n </p>\n <p>\n He married bank teller<sup title="This claim needs references to reliable sources from September 2009" style="white-space: nowrap" class="noprint Template-Fact">[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><i>citation \n needed</i></a>]</sup> Mignon Harley on April 18, 1973 and they \n divorced in 1986; they had two children.<a href="#cite_note-33"><span><sup id="cite_ref-33" class="reference">[</sup></span><sup id="cite_ref-33" class="reference">34<span>]</span></sup></a> \n For her wedding gift, Hayes gave her a matching convertible \n Jaguar.<sup title="This claim needs references to reliable sources from September 2009" style="white-space: nowrap" class="noprint Template-Fact">[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><i>citation \n needed</i></a>]</sup> The couple resided in a mansion with \n maid service. Hayes and his wife were forced into bankruptcy, \n owing over $6 million. Over the years, Isaac Hayes was able to \n recover financially.<a href="#cite_note-34"><span><sup id="cite_ref-34" class="reference">[</sup></span><sup id="cite_ref-34" class="reference">35<span>]</span></sup></a>\n </p>\n <p>\n Hayes'' eldest daughter is named Veronica,<a href="#cite_note-35"><span><sup id="cite_ref-35" class="reference">[</sup></span><sup id="cite_ref-35" class="reference">36<span>]</span></sup></a> \n and he also has a daughter named Heather Hayes.<a href="#cite_note-36"><span><sup id="cite_ref-36" class="reference">[</sup></span><sup id="cite_ref-36" class="reference">37<span>]</span></sup></a>\n </p>\n <h2>\n <span class="editsection">[<a href="/w/index.php?title=Isaac_Hayes&action=edit§ion=16" title="Edit section: Awards and nominations">edit</a>]</span> \n <span class="mw-headline" id="Awards_and_nominations">Awards \n and nominations</span>\n </h2>\n <table style="margin-right: 0; background-position: null; background-attachment: scroll; margin-left: 0; background-repeat: repeat; background-image: null; margin-bottom: 0; border: 1px #aaa solid; background-color: #f9f9f9; margin-top: 0" cellpadding="4" cellspacing="0" border="2">\n <tr bgcolor="#B0C4DE" align="center">\n <th style="background-color: #BCBCBC">\n Year\n </th>\n <th style="background-color: #BCBCBC">\n Awa\n </th>\n </tr>\n </table>\n </div>\n </div>\n </div>\n </div>\n </div>\n </body>\n</html>\n', 'http://en.wikipedia.org/wiki/Isaac_Hayes', 7, '2009-10-28 18:08:30', '2009-10-28 18:08:30', 1);
-- --------------------------------------------------------
--
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(7, '', 'Heroscope', '2009-10-19 15:16:15', '2009-10-19 15:16:15', 1),
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-- --------------------------------------------------------
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-- --------------------------------------------------------
--
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-- --------------------------------------------------------
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-- --------------------------------------------------------
--
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PRIMARY KEY (`TicketID`)
) ENGINE=MyISAM DEFAULT CHARSET=latin1;
--
-- Dumping data for table `qbticket`
--
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-- --------------------------------------------------------
--
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) ENGINE=MyISAM DEFAULT CHARSET=latin1;
--
-- Dumping data for table `qbticketnote`
--
-- --------------------------------------------------------
--
-- Table structure for table `qbuser`
--
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--
-- Dumping data for table `qbuser`
--
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-- --------------------------------------------------------
--
-- Table structure for table `qbusertype`
--
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--
-- Dumping data for table `qbusertype`
--
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(2, 'Admin', 1),
(3, 'Expert', 1),
(4, 'Caller', 1);
COMMIT;