| You are an expert in health communication. Your task is to judge the health literacy level of a target text based on its original medical source. |
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| Classify the text into one of three categories: |
| 1. low_health_literacy: Uses common words (everyday language), very short sentences, and eliminates all medical jargon. |
| 2. intermediate_health_literacy: Uses some medical terms with explanation, standard sentence length, requires basic health knowledge. |
| 3. proficient_health_literacy: Uses high-level medical jargon, technical language, and academic or professional structures. |
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| ### Few-Shot Examples: |
| Target Text: "A 78-year-old man from the Amhara region of Ethiopia had a permanent heart pacemaker because of a complete heart block. He was scheduled for prostate surgery. Before surgery, the anesthesia and heart doctors advised switching his pacemaker to a steady, fixed beat to lower the chance of problems. He could not afford that change. He chose to go ahead with the operation. He signed consent for the plan. After surgery, he also gave permission to share his case. For anesthesia, he got a numbing injection in the lower back (a combined spinal–epidural). The team used 2.5 ml of strong numbing medicine (0.5% bupivacaine) and a tiny dose of fentanyl (50 micrograms). Standard monitors were used, and his heart was watched closely. His vital signs stayed steady, with only small changes. His blood pressure stayed good with IV salt water. After surgery, he went to the recovery room. He got pain medicine after 4 hours and an extra dose through the epidural. Six hours after surgery, he moved to the ward in stable condition. The epidural pain control continued for 72 hours. He went home in stable condition about 88 hours after surgery." |
| Reasoning: The Target Text replaces jargon with plain words (e.g., “heart pacemaker,” “numbing injection in the lower back,” “IV salt water”), drops acronyms and risk scores (RCRI, MET, ASA, ECG/lab details), and often swaps precise metrics for simple descriptors (“tiny dose,” “small changes”). It uses short, direct sentences in a clear sequence, reducing clause complexity and cognitive load—hallmarks of low health literacy adaptation. |
| Label: low_health_literacy |
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| Target Text: "A 36-year-old woman had trouble swallowing. Tests found she was born with an unusual shape of the main body artery in her chest. The artery curves to the right in a mirror-image pattern. It wraps around a main branch of the airway. The side branches of the artery come off in the reverse order from normal. Most people with this have no symptoms. Problems happen only if the artery squeezes the space in the middle of the chest. This can press on the food pipe or the windpipe. Surgery may be needed if there is strong pressure on these tubes, a bulge or a tear in the chest artery, or a pouch on the artery bigger than 2 cm. There is no one-size-fits-all treatment. Care is tailored to the person’s symptoms and body anatomy. This patient did not receive any treatment." |
| Reasoning: The Target Text replaces technical terms with plain words (e.g., “dysphagia” → “trouble swallowing,” “congenital anomaly of the aortic arch” → “unusual shape of the main body artery”), removes detailed anatomy (e.g., Kommerell diverticulum, brachiocephalic/subclavian arteries), and omits precise measurements and percentages. It uses short, simple sentences and everyday terms (“squeezes,” “food pipe,” “windpipe”), avoiding dense jargon and complex clause structures, which fits low health literacy. |
| Label: low_health_literacy |
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| Target Text: "A 69-year-old man with prior coronary bypass surgery presented with two months of severe shortness of breath with mild activity (NYHA class III). He was diagnosed with heart failure due to ischemia after failure of a saphenous vein graft to the right coronary artery. This was supported by an abnormal ECG, elevated NT-proBNP, and a coronary angiogram; echocardiography also showed reduced pumping function. The team reopened a chronic total occlusion in the native right coronary artery using a retrograde approach through septal channels (septal surfing). To enable that route, they first re-opened the totally occluded left coronary artery. After the procedure, his dyspnea improved before discharge, and at 6 months he had no recurrence of shortness of breath." |
| Reasoning: The Target Text replaces heavy jargon and brand/device lists with simpler, common terms and shorter sentences (e.g., “shortness of breath” instead of “dyspnea,” summarizes the procedure without wire/catheter names), but still includes some specialized concepts/acronyms like NYHA class III, NT‑proBNP, “chronic total occlusion,” and “retrograde approach.” This balance of simplification with retained medical terminology fits an intermediate health literacy level. |
| Label: intermediate_health_literacy |
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| Target Text: "A 36-year-old woman with ulcerative colitis developed a week of worsening chest pressure with autonomic symptoms (such as sweating and nausea). Her electrocardiogram showed ST-segment elevation in the inferior leads, consistent with an inferior-wall heart attack. She also reported several months of fatigue and night sweats. |
| Reasoning: The Target Text simplifies and condenses the original by removing most numbers, acronyms, and detailed lab/imaging values, using shorter sentences and plain explanations (e.g., “autonomic symptoms” with examples, summarizing tests as “inflammatory markers were mildly elevated”). It still retains some essential medical terms (angiography, stent, bypass, Takayasu arteritis) with context, making it understandable to readers with moderate health knowledge—appropriate for intermediate health literacy. |
| Label: intermediate_health_literacy |
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| Target Text: "A 78-year-old male from the Amhara region of Ethiopia with a 7-year history of a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy for BPH after prior TURP 3 months earlier. Comorbidities included long-standing hypertension (amlodipine 5 mg daily, enalapril 10 mg BID, atorvastatin 10 mg daily) and type 2 diabetes mellitus (metformin 500 mg BID; NPH insulin 20 IU AM/10 IU PM). Preoperative evaluation showed complete bundle branch block on ECG; electrophysiology assessment demonstrated LVH due to hypertensive heart disease with mild diastolic dysfunction and an EF of 62%. Abdominal ultrasound showed an 82-ml prostate; AP chest X-ray was normal with a left-sided pacemaker in situ; electrolytes and troponin were normal. He had a frailty score of 5.5, METs 3.4, and an RCRI class III, indicating an estimated 10.1% risk of major adverse cardiac events within 30 days and intermediate surgical risk. Multidisciplinary planning recommended reprogramming the dual-chamber, rate‑modulated pacemaker to an asynchronous mode to mitigate intraoperative electromagnetic interference risk. Due to financial and logistical constraints, reprogramming was not performed; risks were disclosed, and he consented to proceed. Preoperatively, usual medications were continued (with a lower morning NPH dose at two‑thirds); diazepam 5 mg PO was given at midnight for anxiolysis. On the day of surgery, random blood glucose was checked and managed with a sliding scale. Team communication emphasized CIED precautions (electrosurgery pad positioned away from the device; emergency drugs and defibrillator immediately available). Dexamethasone was given for PONV prophylaxis and paracetamol for preemptive analgesia. ASA standard monitoring was applied and baselines recorded. An L3–L4 combined epidural–spinal anesthetic was performed using 0.5% isobaric bupivacaine 12.5 mg (2.5 ml) plus fentanyl 50 µg, achieving a sensory level to T7. The procedure used a midline infraumbilical incision; monopolar cautery at low voltage (20 mA) with bipolar low‑voltage cautery for hemostasis. Intraoperative hemodynamics remained within 10% of baseline without cardiorespiratory events; blood pressure was maintained with isotonic saline. Postoperatively, he was transferred to PACU with vigilant monitoring; analgesia was administered at 4 hours with an epidural top‑up, and he was transferred to the ward approximately 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in stable condition, with cardiology follow‑up advised. Informed consent was obtained, and permission for case report publication was granted after the operation." |
| Reasoning: The Target Text uses dense clinical jargon and numerous unexplained abbreviations (e.g., RCRI, METs, LVH, EF, CIED, PONV, ASA), and reports precise dosages and device settings, assuming the reader understands perioperative and cardiology concepts. Its compact, multi-clause sentences and chronological, data-heavy structure reflect professional communication suited to readers with proficient health literacy rather than lay audiences. |
| Label: proficient_health_literacy |
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| Target Text: "A 54-year-old male with membranous nephropathy II and nephrotic syndrome on long-term oral glucocorticoids and immunosuppressants (immunocompromised) presented to the Department of Respiratory Medicine with 5 days of fever, cough, expectoration, and progressive dyspnea. He had a 20 pack-year smoking history and no family history of hereditary disease. A chest x-ray one month prior was normal. On admission (August 8, 2016): BMI 24.5 kg/m2, T 39.0°C, tachypnea 35 breaths/min, severe hypoxemia (SaO2 86%). Auscultation revealed good bilateral air entry with scattered diffuse crackles and rhonchi. Chest CT demonstrated multiple bilateral ground-glass opacities. Initial labs showed a normal WBC count with elevated neutrophils and increased inflammatory markers (CRP, ESR) and elevated (1→3)-β-D-glucan. Serology was positive for RSV antibodies on hospital day 4; other pathogen testing was negative. He had laboratory evidence of immunosuppression with decreased total IgG and reduced CD4 and CD8 T-lymphocyte counts, consistent with chronic exposure to corticosteroids and immunosuppressants. |
| Reasoning: The Target Text retains and accurately uses dense medical jargon and abbreviations (e.g., ground-glass opacities, CRP/ESR, SaO2, bid, i.v., RSV serology, immunocompromised), and assumes familiarity with therapeutic classes and diagnostics without lay explanations—hallmarks of proficient health literacy. It also employs a concise, structured format (chronology, “Management” and “Interpretation” sections) with multi-clause sentences and parenthetical clarifications that synthesize data and infer pathophysiology, suitable for readers comfortable with complex clinical prose. |
| Label: proficient_health_literacy |
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| ### Now judge this text: |
| Target Text: "{input_text}" |
| Reasoning: |
