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code/support_check/model_finetune/gemma3-finetune.py

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+import ast
+import json
+import os
+from datetime import datetime
+
+import torch
+from datasets import Dataset
+from trl import SFTConfig, SFTTrainer
+from unsloth import FastModel
+from unsloth.chat_templates import (
+    get_chat_template,
+    standardize_data_formats,
+    train_on_responses_only,
+)
+
+model_name = "unsloth/gemma-3-4b-it"
+data_path = "/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json"
+test_size = 0.1
+seed = 3407
+
+
+def formatting_prompts_func(examples):
+    convos = examples["conversations"]
+    texts = [
+        tokenizer.apply_chat_template(
+            convo,
+            tokenize=False,
+            add_generation_prompt=False,
+        ).removeprefix("<bos>")
+        for convo in convos
+    ]
+    return {"text": texts}
+
+
+def parse_label_array(raw_text):
+    text = (raw_text or "").strip()
+    if not text:
+        return []
+
+    if "```" in text:
+        text = text.replace("```json", "").replace("```", "").strip()
+
+    start = text.find("[")
+    end = text.rfind("]")
+    if start != -1 and end != -1 and end > start:
+        text = text[start : end + 1]
+
+    parsed = None
+    for parser in (json.loads, ast.literal_eval):
+        try:
+            parsed = parser(text)
+            break
+        except Exception:
+            continue
+
+    if not isinstance(parsed, list):
+        return []
+
+    normalized = []
+    for item in parsed:
+        if not isinstance(item, str):
+            normalized.append("not_supported")
+            continue
+        label = item.strip().lower().replace("-", "_").replace(" ", "_")
+        if label not in {"supported", "not_supported"}:
+            label = "not_supported"
+        normalized.append(label)
+    return normalized
+
+
+def extract_conversation_pair(conversations):
+    user_prompt = ""
+    gold_response = ""
+    for message in conversations:
+        role = message.get("role") or message.get("from")
+        content = message.get("content", "")
+        if role == "user" and not user_prompt:
+            user_prompt = content
+        elif role == "assistant" and not gold_response:
+            gold_response = content
+    return user_prompt, gold_response
+
+
+def generate_prediction(user_prompt):
+    prompt = tokenizer.apply_chat_template(
+        [{"role": "user", "content": user_prompt}],
+        tokenize=False,
+        add_generation_prompt=True,
+    )
+    inputs = tokenizer(prompt, return_tensors="pt").to(model.device)
+    with torch.inference_mode():
+        outputs = model.generate(
+            **inputs,
+            max_new_tokens=128,
+            do_sample=False,
+            temperature=0.0,
+            use_cache=True,
+        )
+    generated_tokens = outputs[0][inputs["input_ids"].shape[1] :]
+    return tokenizer.decode(generated_tokens, skip_special_tokens=True).strip()
+
+
+# 1. Load Model and Tokenizer
+model, tokenizer = FastModel.from_pretrained(
+    model_name=model_name,
+    max_seq_length=2048,
+    load_in_4bit=True,
+)
+
+# 2. Add LoRA Adapters
+model = FastModel.get_peft_model(
+    model,
+    r=8,
+    target_modules=[
+        "q_proj",
+        "k_proj",
+        "v_proj",
+        "o_proj",
+        "gate_proj",
+        "up_proj",
+        "down_proj",
+    ],
+    lora_alpha=16,
+    lora_dropout=0,
+    bias="none",
+    random_state=seed,
+)
+
+# 3. Data Preparation
+tokenizer = get_chat_template(tokenizer, chat_template="gemma-3")
+with open(data_path, "r", encoding="utf-8") as f:
+    raw_data = json.load(f)
+
+raw_dataset = Dataset.from_list(raw_data)
+split_dataset = raw_dataset.train_test_split(test_size=test_size, seed=seed, shuffle=True)
+train_raw = split_dataset["train"]
+test_raw = split_dataset["test"]
+
+train_dataset = standardize_data_formats(train_raw)
+train_dataset = train_dataset.map(formatting_prompts_func, batched=True)
+
+# 4. Training Setup
+trainer = SFTTrainer(
+    model=model,
+    tokenizer=tokenizer,
+    train_dataset=train_dataset,
+    dataset_text_field="text",
+    max_seq_length=2048,
+    args=SFTConfig(
+        per_device_train_batch_size=2,
+        gradient_accumulation_steps=4,
+        warmup_steps=5,
+        max_steps=30,
+        learning_rate=2e-4,
+        fp16=not torch.cuda.is_bf16_supported(),
+        bf16=torch.cuda.is_bf16_supported(),
+        logging_steps=1,
+        optim="adamw_8bit",
+        weight_decay=0.01,
+        lr_scheduler_type="linear",
+        seed=seed,
+        output_dir="outputs",
+        report_to="none",
+    ),
+)
+
+# Masking to train on assistant responses only
+trainer = train_on_responses_only(
+    trainer,
+    instruction_part="<start_of_turn>user\n",
+    response_part="<start_of_turn>model\n",
+)
+
+# 5. Execute Training
+save_dir = f"/home/mshahidul/readctrl_model/support_checking_vllm/{model_name.split('/')[-1]}"
+os.makedirs(save_dir, exist_ok=True)
+trainer.train()
+
+# 6. Save in float16 Format
+model.save_pretrained_merged(save_dir, tokenizer, save_method="merged_16bit")
+tokenizer.save_pretrained(save_dir)
+
+# 7. Test-set Inference + Accuracy
+FastModel.for_inference(model)
+model.eval()
+
+model_info_dir = "/home/mshahidul/readctrl/code/support_check/model_info"
+os.makedirs(model_info_dir, exist_ok=True)
+
+timestamp = datetime.now().strftime("%Y%m%d_%H%M%S")
+model_tag = model_name.split("/")[-1].replace(".", "_")
+
+results = []
+exact_match_correct = 0
+label_correct = 0
+label_total = 0
+parsed_prediction_count = 0
+
+for idx, sample in enumerate(test_raw):
+    conversations = sample.get("conversations", [])
+    user_prompt, gold_text = extract_conversation_pair(conversations)
+    if not user_prompt:
+        continue
+
+    gold_labels = parse_label_array(gold_text)
+    pred_text = generate_prediction(user_prompt)
+    pred_labels = parse_label_array(pred_text)
+
+    if pred_labels:
+        parsed_prediction_count += 1
+
+    exact_match = bool(gold_labels) and pred_labels == gold_labels
+    if exact_match:
+        exact_match_correct += 1
+
+    sample_label_correct = 0
+    for pos, gold_label in enumerate(gold_labels):
+        if pos < len(pred_labels) and pred_labels[pos] == gold_label:
+            sample_label_correct += 1
+
+    label_correct += sample_label_correct
+    label_total += len(gold_labels)
+
+    results.append(
+        {
+            "sample_index": idx,
+            "gold_labels": gold_labels,
+            "predicted_labels": pred_labels,
+            "raw_prediction": pred_text,
+            "exact_match": exact_match,
+            "label_accuracy": (
+                sample_label_correct / len(gold_labels) if gold_labels else None
+            ),
+        }
+    )
+
+total_samples = len(results)
+exact_match_accuracy = exact_match_correct / total_samples if total_samples else 0.0
+label_accuracy = label_correct / label_total if label_total else 0.0
+
+accuracy_summary = {
+    "model_name": model_name,
+    "model_save_dir": save_dir,
+    "dataset_path": data_path,
+    "seed": seed,
+    "test_size": test_size,
+    "test_samples_evaluated": total_samples,
+    "parsed_prediction_count": parsed_prediction_count,
+    "exact_match_accuracy": exact_match_accuracy,
+    "label_accuracy": label_accuracy,
+    "exact_match_correct": exact_match_correct,
+    "label_correct": label_correct,
+    "label_total": label_total,
+    "timestamp": timestamp,
+}
+
+predictions_path = os.path.join(
+    model_info_dir,
+    f"{model_tag}_test_inference_{timestamp}.json",
+)
+accuracy_path = os.path.join(
+    model_info_dir,
+    f"{model_tag}_test_accuracy_{timestamp}.json",
+)
+
+with open(predictions_path, "w", encoding="utf-8") as f:
+    json.dump(results, f, ensure_ascii=False, indent=2)
+
+with open(accuracy_path, "w", encoding="utf-8") as f:
+    json.dump(accuracy_summary, f, ensure_ascii=False, indent=2)
+
+print(f"Saved test inference to: {predictions_path}")
+print(f"Saved test accuracy to: {accuracy_path}")
+print(f"Exact match accuracy: {exact_match_accuracy:.4f}")
+print(f"Label accuracy: {label_accuracy:.4f}")

code/support_check/model_finetune/llama31_8b_32_3b.py

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+import os
+os.environ["CUDA_DEVICE_ORDER"] = "PCI_BUS_ID"
+os.environ["CUDA_VISIBLE_DEVICES"] = "1"
+import json
+import ast
+from unsloth import FastLanguageModel
+import torch
+from trl import SFTConfig, SFTTrainer
+from datasets import Dataset
+from unsloth.chat_templates import get_chat_template, standardize_sharegpt
+
+# 1. Configuration
+max_seq_length = 2048
+dtype = None # Auto-detection
+load_in_4bit = True
+data_path = "/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json"
+# model_name = "unsloth/Llama-3.1-8B"
+model_name = "unsloth/Llama-3.2-3B-Instruct"
+# 2. Load Model & Tokenizer
+model, tokenizer = FastLanguageModel.from_pretrained(
+    model_name = model_name,
+    max_seq_length = max_seq_length,
+    dtype = dtype,
+    load_in_4bit = load_in_4bit,
+)
+
+# 3. Add LoRA Adapters
+model = FastLanguageModel.get_peft_model(
+    model,
+    r = 16,
+    target_modules = ["q_proj", "k_proj", "v_proj", "o_proj", "gate_proj", "up_proj", "down_proj"],
+    lora_alpha = 16,
+    lora_dropout = 0,
+    bias = "none",
+    use_gradient_checkpointing = "unsloth",
+    random_state = 3407,
+)
+
+# 4. Data Prep (Conversation Format)
+tokenizer = get_chat_template(tokenizer, chat_template="llama-3.1")
+
+def formatting_prompts_func(examples):
+    convos = examples["conversations"]
+    texts = [
+        tokenizer.apply_chat_template(
+            convo,
+            tokenize=False,
+            add_generation_prompt=False,
+        ).removeprefix("<bos>")
+        for convo in convos
+    ]
+    return { "text" : texts, }
+
+def parse_label_array(raw_text):
+    text = (raw_text or "").strip()
+    if not text:
+        return []
+
+    if "```" in text:
+        text = text.replace("```json", "").replace("```", "").strip()
+
+    start = text.find("[")
+    end = text.rfind("]")
+    if start != -1 and end != -1 and end > start:
+        text = text[start : end + 1]
+
+    parsed = None
+    for parser in (json.loads, ast.literal_eval):
+        try:
+            parsed = parser(text)
+            break
+        except Exception:
+            continue
+
+    if not isinstance(parsed, list):
+        return []
+
+    normalized = []
+    for item in parsed:
+        if not isinstance(item, str):
+            normalized.append("not_supported")
+            continue
+        label = item.strip().lower().replace("-", "_").replace(" ", "_")
+        if label not in {"supported", "not_supported"}:
+            label = "not_supported"
+        normalized.append(label)
+    return normalized
+
+def extract_conversation_pair(conversations):
+    user_prompt = ""
+    gold_response = ""
+    for message in conversations:
+        role = message.get("role") or message.get("from")
+        content = message.get("content", "")
+        if role == "user" and not user_prompt:
+            user_prompt = content
+        elif role == "assistant" and not gold_response:
+            gold_response = content
+    return user_prompt, gold_response
+
+def generate_prediction(user_prompt):
+    prompt = tokenizer.apply_chat_template(
+        [{"role": "user", "content": user_prompt}],
+        tokenize=False,
+        add_generation_prompt=True,
+    )
+    inputs = tokenizer([prompt], return_tensors="pt").to("cuda")
+    with torch.inference_mode():
+        outputs = model.generate(
+            **inputs,
+            max_new_tokens=128,
+            do_sample=False,
+            temperature=0.0,
+            use_cache=True,
+        )
+    generated_tokens = outputs[0][inputs["input_ids"].shape[1]:]
+    return tokenizer.decode(generated_tokens, skip_special_tokens=True).strip()
+
+with open(data_path, "r", encoding="utf-8") as f:
+    raw_data = json.load(f)
+
+dataset = Dataset.from_list(raw_data)
+dataset = standardize_sharegpt(dataset)
+dataset = dataset.train_test_split(test_size=0.1, seed=3407, shuffle=True)
+
+train_dataset = dataset["train"].map(formatting_prompts_func, batched=True)
+test_dataset = dataset["test"]
+
+# 5. Training
+trainer = SFTTrainer(
+    model = model,
+    tokenizer = tokenizer,
+    train_dataset = train_dataset,
+    dataset_text_field = "text",
+    max_seq_length = max_seq_length,
+    packing = False,
+    args = SFTConfig(
+        per_device_train_batch_size = 2,
+        gradient_accumulation_steps = 4,
+        warmup_steps = 5,
+        max_steps = 60, # Increase for full training
+        learning_rate = 2e-4,
+        fp16 = not torch.cuda.is_bf16_supported(),
+        bf16 = torch.cuda.is_bf16_supported(),
+        logging_steps = 1,
+        optim = "adamw_8bit",
+        weight_decay = 0.01,
+        lr_scheduler_type = "linear",
+        seed = 3407,
+        output_dir = "outputs",
+    ),
+)
+trainer.train()
+
+# 6. Test-set Inference + Accuracy
+FastLanguageModel.for_inference(model)
+model.eval()
+print("\n--- Testing Model on Test Set Samples ---")
+
+for i in range(3):
+    sample = test_dataset[i]
+    user_prompt, _ = extract_conversation_pair(sample["conversations"])
+    print(f"\nTest Sample {i+1} Prompt: {user_prompt}")
+    decoded_output = generate_prediction(user_prompt)
+    print(f"Model Response: {decoded_output}")
+
+exact_match_correct = 0
+label_correct = 0
+label_total = 0
+evaluated_samples = 0
+parsed_prediction_count = 0
+
+for sample in test_dataset:
+    conversations = sample.get("conversations", [])
+    user_prompt, gold_text = extract_conversation_pair(conversations)
+    if not user_prompt:
+        continue
+
+    gold_labels = parse_label_array(gold_text)
+    pred_text = generate_prediction(user_prompt)
+    pred_labels = parse_label_array(pred_text)
+
+    evaluated_samples += 1
+    if pred_labels:
+        parsed_prediction_count += 1
+
+    if gold_labels and pred_labels == gold_labels:
+        exact_match_correct += 1
+
+    for pos, gold_label in enumerate(gold_labels):
+        if pos < len(pred_labels) and pred_labels[pos] == gold_label:
+            label_correct += 1
+    label_total += len(gold_labels)
+
+exact_match_accuracy = exact_match_correct / evaluated_samples if evaluated_samples else 0.0
+label_accuracy = label_correct / label_total if label_total else 0.0
+
+print("\n--- Test Accuracy ---")
+print(f"Samples evaluated: {evaluated_samples}")
+print(f"Parsed predictions: {parsed_prediction_count}")
+print(f"Exact match accuracy: {exact_match_accuracy:.4f}")
+print(f"Label accuracy: {label_accuracy:.4f}")
+save_dir = f"/home/mshahidul/readctrl_model/support_checking_vllm/it_{model_name.split('/')[-1]}"
+# 7. Save in FP16 Format (Merged)
+# This creates a folder with the full model weights, not just adapters.
+model.save_pretrained_merged(save_dir, tokenizer, save_method = "merged_16bit")
+print(f"\nModel successfully saved in FP16 format to {save_dir}")

code/support_check/model_finetune/llama32_4B.py

@@ -0,0 +1,264 @@
+import ast
+import json
+import os
+from datetime import datetime
+
+import torch
+from datasets import Dataset
+from trl import SFTConfig, SFTTrainer
+from unsloth import FastLanguageModel
+
+model_name = "unsloth/Llama-3.2-3B-Instruct"
+data_path = "/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json"
+test_size = 0.1
+seed = 3407
+max_seq_length = 2048
+load_in_4bit = True
+
+
+def formatting_prompts_func(examples):
+    convos = examples["conversations"]
+    texts = [
+        tokenizer.apply_chat_template(
+            convo,
+            tokenize=False,
+            add_generation_prompt=False,
+        ).removeprefix("<|begin_of_text|>")
+        for convo in convos
+    ]
+    return {"text": texts}
+
+
+def parse_label_array(raw_text):
+    text = (raw_text or "").strip()
+    if not text:
+        return []
+
+    if "```" in text:
+        text = text.replace("```json", "").replace("```", "").strip()
+
+    start = text.find("[")
+    end = text.rfind("]")
+    if start != -1 and end != -1 and end > start:
+        text = text[start : end + 1]
+
+    parsed = None
+    for parser in (json.loads, ast.literal_eval):
+        try:
+            parsed = parser(text)
+            break
+        except Exception:
+            continue
+
+    if not isinstance(parsed, list):
+        return []
+
+    normalized = []
+    for item in parsed:
+        if not isinstance(item, str):
+            normalized.append("not_supported")
+            continue
+        label = item.strip().lower().replace("-", "_").replace(" ", "_")
+        if label not in {"supported", "not_supported"}:
+            label = "not_supported"
+        normalized.append(label)
+    return normalized
+
+
+def extract_conversation_pair(conversations):
+    user_prompt = ""
+    gold_response = ""
+    for message in conversations:
+        role = message.get("role") or message.get("from")
+        content = message.get("content", "")
+        if role == "user" and not user_prompt:
+            user_prompt = content
+        elif role == "assistant" and not gold_response:
+            gold_response = content
+    return user_prompt, gold_response
+
+
+def generate_prediction(user_prompt):
+    prompt = tokenizer.apply_chat_template(
+        [{"role": "user", "content": user_prompt}],
+        tokenize=False,
+        add_generation_prompt=True,
+    )
+    inputs = tokenizer(prompt, return_tensors="pt").to(model.device)
+    with torch.inference_mode():
+        outputs = model.generate(
+            **inputs,
+            max_new_tokens=128,
+            do_sample=False,
+            temperature=0.0,
+            use_cache=True,
+        )
+    generated_tokens = outputs[0][inputs["input_ids"].shape[1] :]
+    return tokenizer.decode(generated_tokens, skip_special_tokens=True).strip()
+
+
+# 1. Load model and tokenizer
+model, tokenizer = FastLanguageModel.from_pretrained(
+    model_name=model_name,
+    max_seq_length=max_seq_length,
+    dtype=None,
+    load_in_4bit=load_in_4bit,
+)
+
+# 2. Add LoRA adapters
+model = FastLanguageModel.get_peft_model(
+    model,
+    r=16,
+    target_modules=[
+        "q_proj",
+        "k_proj",
+        "v_proj",
+        "o_proj",
+        "gate_proj",
+        "up_proj",
+        "down_proj",
+    ],
+    lora_alpha=16,
+    lora_dropout=0,
+    bias="none",
+    use_gradient_checkpointing="unsloth",
+    random_state=seed,
+)
+
+# 3. Data preparation
+with open(data_path, "r", encoding="utf-8") as f:
+    raw_data = json.load(f)
+
+raw_dataset = Dataset.from_list(raw_data)
+split_dataset = raw_dataset.train_test_split(test_size=test_size, seed=seed, shuffle=True)
+train_raw = split_dataset["train"]
+test_raw = split_dataset["test"]
+train_dataset = train_raw.map(formatting_prompts_func, batched=True)
+
+# 4. Save directories for this run
+timestamp = datetime.now().strftime("%Y%m%d_%H%M%S")
+model_tag = model_name.split("/")[-1].replace(".", "_")
+model_save_dir = f"/home/mshahidul/readctrl_model/support_checking_vllm/{model_tag}"
+run_info_dir = os.path.join(
+    "/home/mshahidul/readctrl/code/support_check/model_info",
+    f"{model_tag}_{timestamp}",
+)
+os.makedirs(model_save_dir, exist_ok=True)
+os.makedirs(run_info_dir, exist_ok=True)
+
+# 5. Training setup
+trainer = SFTTrainer(
+    model=model,
+    tokenizer=tokenizer,
+    train_dataset=train_dataset,
+    dataset_text_field="text",
+    max_seq_length=max_seq_length,
+    args=SFTConfig(
+        per_device_train_batch_size=2,
+        gradient_accumulation_steps=4,
+        warmup_steps=5,
+        max_steps=30,
+        learning_rate=2e-4,
+        fp16=not torch.cuda.is_bf16_supported(),
+        bf16=torch.cuda.is_bf16_supported(),
+        logging_steps=1,
+        optim="adamw_8bit",
+        weight_decay=0.01,
+        lr_scheduler_type="linear",
+        seed=seed,
+        output_dir=os.path.join(run_info_dir, "trainer_outputs"),
+        report_to="none",
+    ),
+)
+
+# 6. Train
+trainer.train()
+
+# 7. Save merged model
+model.save_pretrained_merged(model_save_dir, tokenizer, save_method="merged_16bit")
+tokenizer.save_pretrained(model_save_dir)
+
+# 8. Test-set inference + accuracy
+FastLanguageModel.for_inference(model)
+model.eval()
+
+results = []
+exact_match_correct = 0
+label_correct = 0
+label_total = 0
+parsed_prediction_count = 0
+
+for idx, sample in enumerate(test_raw):
+    conversations = sample.get("conversations", [])
+    user_prompt, gold_text = extract_conversation_pair(conversations)
+    if not user_prompt:
+        continue
+
+    gold_labels = parse_label_array(gold_text)
+    pred_text = generate_prediction(user_prompt)
+    pred_labels = parse_label_array(pred_text)
+
+    if pred_labels:
+        parsed_prediction_count += 1
+
+    exact_match = bool(gold_labels) and pred_labels == gold_labels
+    if exact_match:
+        exact_match_correct += 1
+
+    sample_label_correct = 0
+    for pos, gold_label in enumerate(gold_labels):
+        if pos < len(pred_labels) and pred_labels[pos] == gold_label:
+            sample_label_correct += 1
+
+    label_correct += sample_label_correct
+    label_total += len(gold_labels)
+
+    results.append(
+        {
+            "sample_index": idx,
+            "gold_labels": gold_labels,
+            "predicted_labels": pred_labels,
+            "raw_prediction": pred_text,
+            "exact_match": exact_match,
+            "label_accuracy": (
+                sample_label_correct / len(gold_labels) if gold_labels else None
+            ),
+        }
+    )
+
+total_samples = len(results)
+exact_match_accuracy = exact_match_correct / total_samples if total_samples else 0.0
+label_accuracy = label_correct / label_total if label_total else 0.0
+
+accuracy_summary = {
+    "model_name": model_name,
+    "model_save_dir": model_save_dir,
+    "run_info_dir": run_info_dir,
+    "dataset_path": data_path,
+    "seed": seed,
+    "test_size": test_size,
+    "test_samples_evaluated": total_samples,
+    "parsed_prediction_count": parsed_prediction_count,
+    "exact_match_accuracy": exact_match_accuracy,
+    "label_accuracy": label_accuracy,
+    "exact_match_correct": exact_match_correct,
+    "label_correct": label_correct,
+    "label_total": label_total,
+    "timestamp": timestamp,
+}
+
+predictions_path = os.path.join(run_info_dir, "test_inference.json")
+accuracy_path = os.path.join(run_info_dir, "test_accuracy.json")
+
+with open(predictions_path, "w", encoding="utf-8") as f:
+    json.dump(results, f, ensure_ascii=False, indent=2)
+
+with open(accuracy_path, "w", encoding="utf-8") as f:
+    json.dump(accuracy_summary, f, ensure_ascii=False, indent=2)
+
+print(f"Saved merged model to: {model_save_dir}")
+print(f"Saved run info folder to: {run_info_dir}")
+print(f"Saved test inference to: {predictions_path}")
+print(f"Saved test accuracy to: {accuracy_path}")
+print(f"Exact match accuracy: {exact_match_accuracy:.4f}")
+print(f"Label accuracy: {label_accuracy:.4f}")

code/support_check/model_finetune/qwen3-finetune.py

@@ -0,0 +1,255 @@
+import ast
+import json
+import os
+import sys
+from datetime import datetime
+
+os.environ["CUDA_DEVICE_ORDER"] = "PCI_BUS_ID"
+os.environ["CUDA_VISIBLE_DEVICES"] = "0"
+from unsloth import FastLanguageModel
+import torch
+model_name = "unsloth/Qwen3-8B"
+model, tokenizer = FastLanguageModel.from_pretrained(
+    model_name = model_name, 
+    max_seq_length = 8192,   # Context length - can be longer, but uses more memory
+    load_in_4bit = False,     # 4bit uses much less memory
+    load_in_8bit = False,    # A bit more accurate, uses 2x memory
+    full_finetuning = False, # We have full finetuning now!
+    # token = "hf_...",      # use one if using gated models
+)
+model = FastLanguageModel.get_peft_model(
+    model,
+    r = 32,           # Choose any number > 0! Suggested 8, 16, 32, 64, 128
+    target_modules = ["q_proj", "k_proj", "v_proj", "o_proj",
+                      "gate_proj", "up_proj", "down_proj",],
+    lora_alpha = 32,  # Best to choose alpha = rank or rank*2
+    lora_dropout = 0, # Supports any, but = 0 is optimized
+    bias = "none",    # Supports any, but = "none" is optimized
+    # [NEW] "unsloth" uses 30% less VRAM, fits 2x larger batch sizes!
+    use_gradient_checkpointing = "unsloth", # True or "unsloth" for very long context
+    random_state = 3407,
+    use_rslora = False,   # We support rank stabilized LoRA
+    loftq_config = None,  # And LoftQ
+)
+
+with open(f"/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json") as f:
+    data = json.load(f)
+from datasets import Dataset
+dataset = Dataset.from_list(data)
+
+from unsloth.chat_templates import standardize_sharegpt
+dataset = standardize_sharegpt(dataset)
+
+def formatting_prompts_func(examples):
+   convos = examples["conversations"]
+   texts = [tokenizer.apply_chat_template(convo, tokenize = False, add_generation_prompt = False) for convo in convos]
+   return { "text" : texts, }
+
+
+def parse_label_array(raw_text):
+    text = (raw_text or "").strip()
+    if not text:
+        return []
+
+    if "```" in text:
+        text = text.replace("```json", "").replace("```", "").strip()
+
+    start = text.find("[")
+    end = text.rfind("]")
+    if start != -1 and end != -1 and end > start:
+        text = text[start : end + 1]
+
+    parsed = None
+    for parser in (json.loads, ast.literal_eval):
+        try:
+            parsed = parser(text)
+            break
+        except Exception:
+            continue
+
+    if not isinstance(parsed, list):
+        return []
+
+    normalized = []
+    for item in parsed:
+        if not isinstance(item, str):
+            normalized.append("not_supported")
+            continue
+        label = item.strip().lower().replace("-", "_").replace(" ", "_")
+        if label not in {"supported", "not_supported"}:
+            label = "not_supported"
+        normalized.append(label)
+    return normalized
+
+
+def extract_conversation_pair(conversations):
+    user_prompt = ""
+    gold_response = ""
+    for message in conversations:
+        role = message.get("role") or message.get("from")
+        content = message.get("content", "")
+        if role == "user" and not user_prompt:
+            user_prompt = content
+        elif role == "assistant" and not gold_response:
+            gold_response = content
+    return user_prompt, gold_response
+
+
+def generate_prediction(user_prompt):
+    prompt = tokenizer.apply_chat_template(
+        [{"role": "user", "content": user_prompt}],
+        tokenize=False,
+        add_generation_prompt=True,
+    )
+    inputs = tokenizer(prompt, return_tensors="pt").to(model.device)
+    with torch.inference_mode():
+        outputs = model.generate(
+            **inputs,
+            max_new_tokens=128,
+            do_sample=False,
+            temperature=0.0,
+            use_cache=True,
+        )
+    generated_tokens = outputs[0][inputs["input_ids"].shape[1] :]
+    return tokenizer.decode(generated_tokens, skip_special_tokens=True).strip()
+
+dataset = dataset.map(formatting_prompts_func, batched = True)
+
+split_dataset = dataset.train_test_split(test_size = 0.1, seed = 3407, shuffle = True)
+train_dataset = split_dataset["train"]
+eval_dataset = split_dataset["test"]
+
+from trl import SFTTrainer, SFTConfig
+trainer = SFTTrainer(
+    model = model,
+    tokenizer = tokenizer,
+    train_dataset = train_dataset,
+    eval_dataset = eval_dataset,
+    args = SFTConfig(
+        dataset_text_field = "text",
+        per_device_train_batch_size = 8,
+        gradient_accumulation_steps = 2, # Use GA to mimic batch size!
+        warmup_steps = 5,
+        num_train_epochs = 3, # Set this for 1 full training run.
+        # max_steps = 30,
+        learning_rate = 2e-4, # Reduce to 2e-5 for long training runs
+        logging_steps = 1,
+        per_device_eval_batch_size = 8,
+        bf16 = True,
+        tf32 = True,
+        optim = "adamw_8bit",
+        weight_decay = 0.01,
+        lr_scheduler_type = "linear",
+        seed = 3407,
+        report_to = "none", # Use this for WandB etc
+    ),
+)
+trainer_stats = trainer.train()
+
+save_dir = f"/home/mshahidul/readctrl_model/support_checking_vllm/{model_name.split('/')[-1]}"
+os.makedirs(save_dir, exist_ok=True)
+# Export merged model weights in FP16 format.
+model.save_pretrained_merged(
+    save_dir,
+    tokenizer,
+    save_method = "merged_16bit",
+)
+tokenizer.save_pretrained(save_dir)
+
+FastLanguageModel.for_inference(model)
+model.eval()
+
+model_info_dir = "/home/mshahidul/readctrl/code/support_check/model_info"
+os.makedirs(model_info_dir, exist_ok=True)
+
+timestamp = datetime.now().strftime("%Y%m%d_%H%M%S")
+model_tag = model_name.split("/")[-1].replace(".", "_")
+
+results = []
+exact_match_correct = 0
+label_correct = 0
+label_total = 0
+parsed_prediction_count = 0
+
+for idx, sample in enumerate(eval_dataset):
+    conversations = sample.get("conversations", [])
+    user_prompt, gold_text = extract_conversation_pair(conversations)
+    if not user_prompt:
+        continue
+
+    gold_labels = parse_label_array(gold_text)
+    pred_text = generate_prediction(user_prompt)
+    pred_labels = parse_label_array(pred_text)
+
+    if pred_labels:
+        parsed_prediction_count += 1
+
+    exact_match = bool(gold_labels) and pred_labels == gold_labels
+    if exact_match:
+        exact_match_correct += 1
+
+    sample_label_correct = 0
+    for pos, gold_label in enumerate(gold_labels):
+        if pos < len(pred_labels) and pred_labels[pos] == gold_label:
+            sample_label_correct += 1
+
+    label_correct += sample_label_correct
+    label_total += len(gold_labels)
+
+    results.append(
+        {
+            "sample_index": idx,
+            "gold_labels": gold_labels,
+            "predicted_labels": pred_labels,
+            "raw_prediction": pred_text,
+            "exact_match": exact_match,
+            "label_accuracy": (
+                sample_label_correct / len(gold_labels) if gold_labels else None
+            ),
+        }
+    )
+
+total_samples = len(results)
+exact_match_accuracy = exact_match_correct / total_samples if total_samples else 0.0
+label_accuracy = label_correct / label_total if label_total else 0.0
+
+accuracy_summary = {
+    "model_name": model_name,
+    "model_save_dir": save_dir,
+    "dataset_path": "/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json",
+    "seed": 3407,
+    "test_size": 0.1,
+    "test_samples_evaluated": total_samples,
+    "parsed_prediction_count": parsed_prediction_count,
+    "exact_match_accuracy": exact_match_accuracy,
+    "label_accuracy": label_accuracy,
+    "exact_match_correct": exact_match_correct,
+    "label_correct": label_correct,
+    "label_total": label_total,
+    "timestamp": timestamp,
+}
+
+predictions_path = os.path.join(
+    model_info_dir,
+    f"{model_tag}_test_inference_{timestamp}.json",
+)
+accuracy_path = os.path.join(
+    model_info_dir,
+    f"{model_tag}_test_accuracy_{timestamp}.json",
+)
+
+with open(predictions_path, "w", encoding="utf-8") as f:
+    json.dump(results, f, ensure_ascii=False, indent=2)
+
+with open(accuracy_path, "w", encoding="utf-8") as f:
+    json.dump(accuracy_summary, f, ensure_ascii=False, indent=2)
+
+print(f"Saved test inference to: {predictions_path}")
+print(f"Saved test accuracy to: {accuracy_path}")
+print(f"Exact match accuracy: {exact_match_accuracy:.4f}")
+print(f"Label accuracy: {label_accuracy:.4f}")
+
+# model.push_to_hub(f"Translation_Evaluator_Qwen3_14B_v1", )
+# tokenizer.push_to_hub(f"Translation_Evaluator_Qwen3_14B_v1")
+# print(f"Model pushed to Hugging Face Hub")
+

code/support_check/model_info/Qwen3-4B_test_accuracy_20260214_225926.json

@@ -0,0 +1,15 @@
+{
+  "model_name": "unsloth/Qwen3-4B",
+  "model_save_dir": "/home/mshahidul/readctrl_model/support_checking_vllm/Qwen3-4B",
+  "dataset_path": "/home/mshahidul/readctrl/data/finetuning_data/dataset_for_sft_support_check_list.json",
+  "seed": 3407,
+  "test_size": 0.1,
+  "test_samples_evaluated": 30,
+  "parsed_prediction_count": 30,
+  "exact_match_accuracy": 1.0,
+  "label_accuracy": 1.0,
+  "exact_match_correct": 30,
+  "label_correct": 240,
+  "label_total": 240,
+  "timestamp": "20260214_225926"
+}

code/support_check/model_info/Qwen3-4B_test_inference_20260214_225926.json

@@ -0,0 +1,782 @@
+[
+  {
+    "sample_index": 0,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 1,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 2,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 3,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 4,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 5,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 6,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 7,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 8,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 9,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 10,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 11,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 12,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 13,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "raw_prediction": "<think>\n\n</think>\n\n[\"supported\", \"supported\", \"supported\", \"supported\", \"not_supported\", \"not_supported\", \"not_supported\", \"not_supported\"]",
+    "exact_match": true,
+    "label_accuracy": 1.0
+  },
+  {
+    "sample_index": 14,
+    "gold_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
+    "predicted_labels": [
+      "supported",
+      "supported",
+      "supported",
+      "supported",
+      "not_supported",
+      "not_supported",
+      "not_supported",
+      "not_supported"
+    ],
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code/support_check/model_info/Qwen3-8B_test_accuracy_20260214_230512.json

@@ -0,0 +1,15 @@
+{
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+  "timestamp": "20260214_230512"
+}

code/support_check/model_info/Qwen3-8B_test_inference_20260214_230512.json

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code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_(fulltxt+gen_sum)/accuracy.json

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+}

code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_(fulltxt+gen_sum)/cost.json

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code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_(fulltxt+gen_sum)/model.json

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+{
+  "classifier.predict": {
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+    "train": [],
+    "demos": [
+      {
+        "augmented": true,
+        "full_text": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+        "generated_text": "A 57-year-old patient had asthma and nose allergies. She kept having stomach pain. Her blood showed very high levels of allergy-fighting white cells. A certain immune protein (IgG4) was also high. The doctors checked for blood cancers and other causes and did not find them. They gently took tiny samples from the lining of her large intestine. The samples showed too many of those allergy cells sitting in the tissue. This meant she had eosinophilic colitis, which is swelling of the colon from a build-up of allergy cells. She took a steroid medicine to calm the swelling. Then she stayed on montelukast to keep the problem quiet. Her pain went away and did not come back for three months.",
+        "reasoning": "The generated text uses plain, everyday vocabulary (“nose allergies,” “stomach pain,” “allergy-fighting white cells,” “tiny samples,” “lining of her large intestine”) and short, simple sentences. It omits nearly all numerical values, test names, and imaging details from the source, and it avoids specialized jargon; where a term appears (e.g., “IgG4,” “eosinophilic colitis”), it is briefly explained (“swelling of the colon from a build-up of allergy cells”). Compared with the highly technical full text (extensive labs, imaging, histology thresholds, differentials), this rewrite is substantially simplified and geared to lay understanding.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "full_text": "A 56-year-old Italian female patient with β-thalassemia major presented to the radiology department to undergo MRI to quantify myocardial, hepatic, and pancreatic iron deposition. The clinical history of the patient included a transfusion-dependent β-thalassemia condition (genotype HBB:c.118C > T/ HBB:c.93-21G > A), diagnosed at the age of 7 years, despite the fact that the first transfusion was carried out at 2 years. As a consequence of β-thalassemia, the patient underwent splenectomy and cholecystectomy.\n\nAt the moment of MRI, she had a negative HCV-RNA (Hepatitis C virus-Ribonucleic acid) test, no osteoporosis or other endocrine, cardiac, or hepatic complications, and good iron levels. The patient’s therapy included iron chelation with deferasirox, vitamin D, and luspatercept, an erythropoiesis modulator started 2 years before the MRI examination (good response, with an increase of about 35% of transfusion interval duration). Transfusion therapy included two units of concentrated and filtered red blood cells every 25 days with pre-transfusion hemoglobin values of 10–10.5 g/dl.\n\nOn MRI, a solid mass with lobulated and regular contours was incidentally identified within the prevascular compartment of the mediastinum.\n\nThe lesion was mildly hyperintense on T2-weighted images (T2-wi) and isointense on T1-wi. The mediastinal mass in question was discernible in a prior MRI examination conducted for the same purpose in 2020 before starting luspatercept therapy, albeit with a marginal enlargement.\n\nThere were no other apparent abnormalities observed in the remaining mediastinal compartments. No pleural or pericardial effusions were present.\n\nThe neurological examination was unremarkable, and in the preceding months, the patient exhibited no symptoms of mediastinal syndrome associated with compression of the adjacent neurovascular structures. Moreover, she did not exhibit any fever or experience any weight loss.\n\nFor further evaluation, the patient underwent 18F-deoxyglucose (18FDG) positron emission tomography (PET)-computed tomography (CT) and chest CT with contrast media. On PET-CT, the mediastinal mass showed only mild FDG uptake (SUVmax = 4.3); no other sites of abnormal radiotracer uptake were reported in the neck, chest, abdomen, and skeleton. On CT images, the lesion presented regular margins, solid density, and mild contrast enhancement. The adjacent structures did not exhibit any signs of invasion, and lymphadenopathies or extra-thoracic disease were not present. Such radiological features, the indolent behaviour over time, the absence of systemic symptoms, and the lack of avid FDG uptake on PET-CT scan made the diagnosis of thymoma probable.\n\nHowever, on lung window visualization, multiple rounded areas of parenchymal lucency, consistent with thin-walled cysts distributed symmetrically throughout both lungs, with normal intervening parenchyma, were evident.\n\nNo nodules or other interstitial abnormalities were associated with the cysts. No pneumothorax was detected. Coherently with thalassemic bone disease, the ribs appeared widened, and the spine displayed mild platyspondyly. The remaining portion of the chest and visible upper abdomen were unremarkable. The radiological findings were consistent with cystic lung disease, most likely LAM.\n\nThe patient was then referred to the pulmonary clinic for further evaluation. She was a never-smoker and did not report any respiratory symptoms. In particular, she denied a history of chronic cough, recurrent respiratory infections, or pneumothorax. No cutaneous lesions, notably facial fibrofolliculomas, were evident. On chest examination, the lung fields were clear. Peripheral capillary oxygen saturation was normal (98%), with a heart rate of 75 beats per minute. Pulmonary function tests revealed a substantial reduction in diffusing capacity of the lungs for carbon monoxide (DLCO; 42% of the predicted value), partly imputable to the condition of anemia, with a carbon monoxide transfer coefficient (KCO) of 73% of the predicted value. After discussion in a multidisciplinary tumor board setting, including a pulmonologist, the patient underwent left thoracoscopic thymectomy and concomitant lingual segment wedge resection. The histopathological report revealed a morphological finding and immunohistochemical pattern referable to type B2 thymoma with focal infiltration of the capsule. Extracapsular extension was not evident. However, the lesion was present at the resection margin (stage IIa according to Masaoka–Koga; stage 1a according to the tumor, node, metastasis [TNM] classification).\n\nRegarding the lung parenchyma, histopathologic analysis described lung parenchyma with cysts of variable size lined by spindle cells in myoid habit with immunohistochemical reactivity for actin, estrogen, progesterone receptors, and HMB45 (focal positivity). Modest chronic interstitial inflammation, vascular congestion, and recent blood extravasation were evident. These morphological findings were compatible with pulmonary LAM.\n\nA final histological diagnosis of thymoma and pulmonary LAM was made. For the neoplastic condition, the patient was a candidate for adjuvant radiation therapy due to the microscopically incomplete resection (R1). For LAM with concomitant β-thalassemia, treatment with sirolimus was recommended.",
+        "generated_text": "A 56-year-old Italian woman with transfusion-dependent beta-thalassemia major (with prior splenectomy and cholecystectomy) underwent MRI to measure iron in the heart, liver, and pancreas. At the time of imaging, she had no significant endocrine, cardiac, or hepatic complications and was taking deferasirox, vitamin D, and luspatercept. The MRI incidentally revealed a lobulated mass in the prevascular mediastinum. PET showed only mild FDG uptake, and chest CT identified multiple thin-walled cysts throughout both lungs, a pattern consistent with lymphangioleiomyomatosis (LAM). After multidisciplinary review, she had thoracoscopic thymectomy and a lung wedge resection. Pathology confirmed type B2 thymoma and pulmonary LAM. Based on these findings, adjuvant radiation therapy was recommended for the thymoma, and sirolimus was advised for LAM.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "full_text": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis, on salmeterol/fluticasone, was hospitalized for recurrent abdominal pain that began two months earlier. The pain was intermittent and dull, accompanied by nausea, anorexia, malaise, and a weight loss of 5 kg. There was no fever, blood / mucus in the stool, or respiratory symptoms (rhinorrhea, wheezing, coughing). She had no history of alcohol/tobacco use or traditional herbal medicines. Six weeks before admission, she was diagnosed with an intestinal infection in a local clinic after a complete blood count (CBC) revealed leukocytosis and significant eosinophilia (25.61 G/L, 77.8% eosinophils). She received antibiotics and mebendazole without relief of symptoms. At presentation, the patient was alerted and oriented with stable vitals (BP 110/70 mmHg, T 37°C, HR 88 bpm, RR 18 bpm). She had a BMI of 16.6 kg/m² and sarcopenia, but no skin rash, lymphadenopathy, or edema. The abdominal exam showed tenderness in the epigastric and umbilical regions without guarding. CBC revealed leukocytosis and significant eosinophilia (20.8 G/L, with a total white blood cell count of 26.8 G/L, comprising 77.8% eosinophils). Peripheral blood film examination showed normal eosinophils. Bone marrow aspiration reveals 48% eosinophils without blasts, atypical cells. Fluorescence in situ hybridization (FISH) for CHIC2 deletion as a surrogate marker for FIP1L1-PDGFRA showed no rearrangements of the PDGFRA gene. Autoimmune and vasculitis screenings (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Elevated serum IgG (2760 mg/dL; normal range, 700–1600 mg/dL) and IgG4 (1260 mg/dL; normal range, 3.9–86.4 mg/dL), slightly elevated IgE (137.5 IU/mL; normal range, <100 IU/mL) and high RF (144.4 IU/mL; normal range, <20 IU/mL) were observed. Other parameters were normal, including aminotransferase, blood urea nitrogen, serum creatinine, complement C3, complement C4, vitamin B12, serum cortisol, and NT-proBNP. ECG and echocardiogram were normal. Chest CT scans showed mild fibrosis and bronchiectasis. Sputum AFB smears and bronchoscopy were negative. The cytology of the bronchoalveolar lavage fluid showed 35% neutrophils, no eosinophils. Spirometry indicated severe obstruction with bronchodilator response. The fractional exhaled nitric oxide (FeNO) level was 15 ppb. Stool samples were tested positive for leukocytes, with no signs of ova or parasites. Serology tests were positive for toxocariasis (positive IgG of Toxocara canis at 54.2 NovaTec-Units) but negative for Strongyloides stercoralis, Fasciola sp., Toxoplasma gondii, Trichinella spiralis, Ancylostoma sp., Angiostrongylus cantonensis, Ascaris lumbricoides, Clonorchis sinensis, Paragonimus sp., Gnathostoma sp., Entamoeba histolytica, cysticercosis, filariasis, and HIV. An abdominal contrast-enhanced computed tomography scan revealed gallbladder stones without acute cholecystitis and showed no gastrointestinal tract abnormalities. The upper gastrointestinal endoscopy showed unremarkable results with a normal appearance. Colonoscopy showed mucosal inflammation in the sigmoid, left, transverse, and right colon with systemic biopsy. A five-day course of albendazole (400 mg twice daily) for suspected toxocariasis was ineffective. Colonic biopsies revealed significant eosinophilic infiltration (>85 eosinophils/High-power field (HPF) in the left colon, >100 eosinophils/HPF in the transverse and right colon). Given the patient’s nonresponse to toxocariasis treatment and the significant eosinophilic infiltration observed in the colon mucosa biopsy, a diagnosis of eosinophilic colitis was confirmed. The patient was treated with oral methylprednisolone (16 mg) and montelukast (5 mg). Symptoms resolved in two weeks and eosinophil counts normalized (0.3 G/L). The corticosteroid was reduced and discontinued, and the patient was maintained on montelukast for three months without symptom recurrence.",
+        "generated_text": "A 57-year-old woman with a 14-year history of asthma and allergic rhinitis on salmeterol/fluticasone presented with two months of intermittent, dull abdominal pain, nausea, anorexia, malaise, and 5-kg weight loss. She was afebrile, hemodynamically stable, underweight (BMI 16.6 kg/m²) with sarcopenia, and had epigastric/umbilical tenderness without guarding. CBC showed leukocytosis with marked eosinophilia (WBC 26.8 G/L with 20.8 G/L eosinophils; 77.8%). Peripheral smear showed morphologically normal eosinophils. Bone marrow aspiration revealed 48% eosinophils without blasts or atypia. FISH for CHIC2 deletion (surrogate for FIP1L1-PDGFRA) was negative. Autoimmune/vasculitis screens (ANA, anti-dsDNA, p-ANCA, c-ANCA) were negative. Serum immunoglobulins demonstrated elevated IgG (2760 mg/dL) and IgG4 (1260 mg/dL), mildly elevated IgE (137.5 IU/mL), and high RF (144.4 IU/mL). Liver enzymes, BUN/creatinine, C3/C4, vitamin B12, cortisol, and NT-proBNP were within normal limits. ECG/echocardiogram were normal. Chest CT showed mild fibrosis and bronchiectasis. Bronchoscopy and AFB smears were negative; BAL cytology had 35% neutrophils and no eosinophils. Spirometry demonstrated severe obstruction with bronchodilator responsiveness; FeNO was 15 ppb. Stool leukocytes were present, but ova/parasite exams were negative. Serology was positive for Toxocara canis IgG (54.2 NovaTec-Units) and negative for other helminths and HIV. Empiric albendazole (400 mg twice daily for 5 days) was ineffective. Abdominal contrast-enhanced CT showed cholelithiasis without cholecystitis and no GI structural abnormality. Upper GI endoscopy was unremarkable. Colonoscopy demonstrated mucosal inflammation in the sigmoid, left, transverse, and right colon. Systematic colonic biopsies showed dense eosinophilic infiltration (>85 eosinophils/HPF in the left colon; >100 eosinophils/HPF in the transverse and right colon). Given the exclusion of hematologic neoplasms and secondary causes (including lack of response to anti-parasitic therapy and negative work-up for vasculitis/autoimmune disease), the findings were diagnostic of eosinophilic colitis. She was treated with oral methylprednisolone 16 mg and montelukast 5 mg. Symptoms resolved within two weeks with normalization of eosinophils to 0.3 G/L. Corticosteroids were tapered and discontinued, and montelukast was continued for three months with no symptom recurrence. This case illustrates eosinophilic colitis in an atopic patient with marked peripheral and tissue eosinophilia, elevated IgG4, negative myeloid neoplasm markers, and steroid-responsiveness, consistent with primary eosinophilic gastrointestinal disease after exclusion of secondary etiologies.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "A 56-year-old female patient presented with complaints of dyspnea that required oxygen supplementation. Her medical history dates back to July 2013 when she was hospitalized in the chest ward for dyspnea and cough with yellow sputum. She was subsequently diagnosed with Sjogren’s syndrome complicated with interstitial lung disease (ILD) and PAH (Table I). Her chest X-ray at that time showed vascular markings with interstitial thickening, costophrenic (CP) angle blunting and cardiomegaly. An echocardiogram revealed a pulmonary arterial (PA) systolic pressure of 99 mmHg, enlargement of the right atrium and ventricle, D-shaped left ventricle (LV), and severe tricuspid regurgitation. Chest CNYCT showed no filling defects, excluding pulmonary embolism; it also displayed an enlarged pulmonary trunk, right atrium (RA), and right ventricle (RV), further evidencing pulmonary hypertension. Symptoms of dry mouth, dry eyes, and cracked tongue mucosa, with a Schirmer’s test showing <5 cm, oculus uterque (OU). A positive minor salivary gland biopsy, nuclear medicine scan showing impaired salivary gland function, and a positive anti-Ro test, confirmed Sjogren’s syndrome. She started on Revatio (Sildenafil) 20 mg three times a day (TID) for pulmonary hypertension control, adding Tracleer (Bosentan) in 2016 due to disease progression. A right heart catheterization (RHC) revealed a mean pulmonary arterial pressure (PAP) of 39 mmHg, pulmonary vascular resistance (PVR) nearly 15 Woods, and a wedge pressure of 4, indicating pre-capillary type, group I, CTD-related PAH in 2017. The right heart catheterization (RHC) report allowed for insurance coverage of Opsumit (Macitentan) 10 mg once a day (QD), replacing Tracleer (Bosentan) in 2017. From 2017 to 2020, she was hospitalized multiple times for steroid treatments to manage her underlying Sjogren’s syndrome.\n\nPulmonary hypertension treatment is risk-based, and until 2017, the patient was considered low to intermediate risk, controlled with two medications (Sildenafil + Macitentan). Her condition remained stable until October 2020, when she experienced worsened dyspnea accompanied by cough and expectoration of white sputum, suggestive of infection. On November 10, 2020, the patient experienced severe dyspnea, cold sweats, and cyanosis, with SpO2 dropping to 70%, necessitating 100% O2 via face tent. Blood gas and lab tests revealed a lactate level of 5.2 mmol/l and brain natriuretic peptide (BNP) over 10,000 pg/ml, strongly suggesting cardiogenic shock. She was prepped for intensive care unit (ICU) admission, intubated, and initiated on four pulmonary hypertension medications. Her condition stabilized and showed improvement, preventing further deterioration. On November 12, 2020, evaluation for heart-lung transplantation began. Her condition continued to improve with off vasopressors on November 13, 2020, and extubating on November 14, 2020, and transferred to a general ward on November 21, 2020, with O2 tapered to nasal cannula 2l/min. A follow-up RHC continued to show elevated pulmonary artery pressure, likely attributed to chronic hypertension leading to right heart strain and eventual failure. After intensive care unit (ICU) treatment, she was referred to National Taiwan University Hospital for evaluation for heart-lung transplant.\n\nReviewing the records since the onset of her illness, it was evident that pulmonary artery pressure had steadily increased, and the distance covered in the 6-minute walk test was progressively shortened. Currently, the patient is classified as high risk. She continues regular hospitalizations for control. Despite the relatively stable condition, her chief complaint during the admission is still dyspnea. The physical examination revealed mild rhonchi ILD and a pansystolic murmur indicative of severe valvular heart disease, with no other significant findings. Ventavis (Iloprost) 10 mcg/ml 2 ml was added in 2020. Molecular hydrogen therapy (1 capsule/day) was initiated in May 2023. Hydrogen capsules (PURE HYDROGEN) were purchased from HoHo Biotech Co., Ltd. (Taipei, Taiwan, ROC). Each capsule contained 170 mg of hydrogen-rich coral calcium containing 1.7×1,021 molecules of hydrogen, which is equivalent to 24 cups of water with 1,200 ppb of hydrogen or 0.6 mM of hydrogen per 200 ml of water. Adjuvant therapy with hydrogen capsules resulted in increased CD127 + Treg, decreased anti-Ro antibody, decreased B cell subsets, and stabilization of clinical symptoms and signs was observed following the addition of hydrogen therapy in this patient. No adverse reactions or events were observed following the administration of hydrogen capsules. Flow cytometry and serological examination were employed for whole-blood analysis to assess changes in immune cells and autoantibody before and after hydrogen therapy. For subsequent whole-blood analysis via flow cytometry, blood samples were prepared using standard fluorescent dye preparation methods and fluorescent antibody reagent kits with dried reagents (Beckman Coulter, Brea, CA, USA). The methods, steps, immunophenotypic analysis, and cell gating were conducted following previously described procedures. Our analysis of immunophenotypic markers before and after hydrogen therapy revealed increased CD127 + Treg and decreased B cell subsets after treatment. Moreover, this study adheres to the CARE reporting guidelines (2013 CARE Checklist).",
+        "generated_text": "This report is about a 56-year-old woman with Sjogren’s syndrome. It caused lung scarring and high blood pressure in the lungs. Doctors found this in 2013. She took medicines for lung pressure and for her immune disease: sildenafil, bosentan, macitentan, iloprost, and steroids. Even with treatment, she got worse. In 2020, she had very hard breathing and went into heart-related shock. In May 2023, her care team added daily hydrogen capsules to help. After starting the hydrogen capsules, tests showed more immune cells that calm the body (CD127+ Tregs). A Sjogren’s antibody called anti-Ro went down. Some B cells, another kind of immune cell, also went down. Her symptoms became stable. She had no side effects.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "full_text": "A 71-year-old patient with a history of untreated vitiligo presented with visual loss in the right eye 6 months prior to admission accompanied by bilateral hearing loss with a predominance in the right ear. Chronic headaches and intermittent fever were also reported, although the patient denied a history of drug use or prior infections. He was evaluated by our department due to the presence of significant and unintentional weight loss, generalized weakness and thickening of the skin. On initial ophthalmologic examination, visual acuity in the right eye (RO) was reduced to light perception and color discrimination, and visual acuity in the left eye (LO) was 20/200 with afferent pupillary defect in both eyes with hyperemic margins of the eyelid. On examination of the RO, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, aqueous anterior chamber (AAC) without cellularity, normal iris and lens with nuclear opacities. On examination of the left eye, it was found to have a hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral, nummular, subepithelial infiltrates, AAC, aqueous without cellularity, normal iris and lens with nuclear opacities. On examination of the right fundus, a round, pale ++ papilla was found with a 50% excavation, slightly blunt nasal border, with a raised and thinned vascular pattern, with macular area and scattered pigment. On the left fundus, a vitreous haze 2+ was found with edematous papilla, blurred borders, hyperemic, peripapillary, streaked hemorrhages, and an unevaluable excavation with a thinned vascular pattern and macular area with scattered pigment, with right optic atrophy and left anterior optic neuritis.\n\nDue to ocular involvement, weight loss and neurological symptoms, additional testing was performed to rule out causes such as tuberculosis, herpes, ANCA and non-ANCA vasculitis, and sarcoidosis. As for the management of the neurological condition, a lumbar puncture was performed and an opening pressure within normal limits and a proteinocracy of 54 mg/dL was found. Due to distal symmetric polyneuropathy, nerve conduction velocities (NCV) were performed, which showed a pattern of polyradiculoneuropathy with moderate to severe axonal degeneration, involving all 4 extremities with a predominance of the lower extremities; the contrasted magnetic resonance imaging (MRI) of the skull and orbit did not show enhancement of the optic nerve or brain tumors; however, it did show sinusitis and meningeal enhancement. Within the management, sarcoidosis was ruled out, with angiotensin converting enzyme (ACE) within normal parameters, as well as a whole body gamma scan, without enhancement or boosting. After all the study and clinical evaluation of the patient, a second ophthalmological assessment was performed in which persistence and progression of the ocular condition was found, with optic atrophy in the right eye and anterior optic neuritis in the left eye. Because of this, high dose pulse steroid treatment was initiated, followed by a gradual reduction of the dose and the patient was referred for follow-up in the Outpatient Department. A clinical and functional improvement was observed, mainly at the neurological and ophthalmological level.\n",
+        "generated_text": "A 71-year-old man had vitiligo for many years. He lost vision in his right eye about six months before he came to the hospital. He also had hearing loss in both ears, worse on the right. While in the hospital, he had ongoing headaches. He had fevers. He lost a lot of weight without trying. The eye exam showed the right eye could only sense light. The white part of the right eye looked very red. The left eye could see at 20/200, which is very blurry. The back of the right eye had small specks of color. The back of the left eye showed a swollen nerve. The nerve of the right eye looked damaged.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "full_text": "46-year-old Haitian male, residing in Chile for one year. In Haiti he was a livestock farmer. He presented a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, which increased in size progressively. Initially asymptomatic, three months prior to the consultation he developed pruritus, pain, superficial ulceration and yellowish discharge. On physical examination, the patient was found to be of phototype V, with 1 x 1 cm, 2 x 2 cm and 3 x 2 cm warty plaques on the anterior aspect of the right leg. A dermatoscopy revealed a hyperkeratotic mass with ulcerated center, with reddish-black dots and congested hemorrhagic vessels. The general laboratory was normal; VDRL, HIV and PPD were non-reactive. Tissue samples were taken by a punch biopsy, including epidermis, dermis and subcutaneous tissue, and stained with Gram, routine bacteriological culture and anaerobic culture, which were negative. Bacilloscopy and Koch culture of the same tissue were also negative. The histopathological study was performed with hematoxylin and eosin stain, and showed a pseudoepitheliomatous epidermis with irregular hyperplasia, a dermis with abundant mixed inflammatory infiltrate with suppurative foci and giant cells of the foreign body type, some of which contained round cells with a thick brown wall, compatible with muriform cells; these cells were more evident when evaluated with PAS stain. Fungal culture was performed on Sabouraud dextrose agar at 25°C, which showed, after 15 days of incubation, the growth of black or dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous, hyphae, and short chains of acropetal conidia, suggestive of Fonsecaea spp. Itraconazole was administered at 100 mg every 12 h for six months, in association with physical measures, which consisted of cryotherapy (liquid nitrogen) application to hypertrophic areas every six to eight weeks. Due to local complications, such as erosion or ulceration of the lesions, frequent healing was performed with application of mupirocin ointment topically for signs of bacterial superinfection.\n\nThe patient had a favorable evolution, with regression of the lesions and no evidence of relapses to date, remaining with a mild local hypopigmentation, expected in areas of treatment with cryotherapy.\n",
+        "generated_text": "A 46-year-old Haitian male, residing in Chile for one year, presented with a one-and-a-half-year history of a lesion that began as a papule on the anterior aspect of the right leg, with progressive enlargement. Initially asymptomatic, pruritus, pain, superficial ulceration, and yellowish discharge developed three months prior to consultation. On examination (phototype V), there were warty plaques measuring 1 × 1 cm, 2 × 2 cm, and 3 × 2 cm on the anterior right leg. Dermatoscopy revealed a hyperkeratotic mass with an ulcerated center, reddish-black dots, and congested hemorrhagic vessels. General laboratories were normal; VDRL, HIV, and PPD were non-reactive. Punch biopsy including epidermis, dermis, and subcutis was performed; Gram stain, routine bacteriological culture, and anaerobic culture were negative. Bacilloscopy and Koch culture were also negative. Histopathology (hematoxylin and eosin) showed pseudoepitheliomatous epidermal hyperplasia with irregular hyperplasia; the dermis contained abundant mixed inflammatory infiltrate with suppurative foci and foreign body-type giant cells, some containing round, thick-walled brown cells compatible with muriform (sclerotic) cells; these were more evident with PAS stain. Fungal culture on Sabouraud dextrose agar at 25°C demonstrated, after 15 days, growth of black/dematiaceous, elevated, well-defined, velvety colonies. Direct microscopic examination with 20% KOH showed long, branched, sometimes tortuous hyphae and short chains of acropetal conidia, suggestive of Fonsecaea spp. The diagnosis was chromoblastomycosis. Treatment included itraconazole 100 mg every 12 hours for six months, combined with physical measures consisting of cryotherapy (liquid nitrogen) applied to hypertrophic areas every 6–8 weeks. Due to local complications (erosion/ulceration), frequent wound care was provided, with topical mupirocin for signs of bacterial superinfection. The patient had a favorable evolution, with regression of lesions and no evidence of relapse to date, remaining with mild local hypopigmentation expected after cryotherapy. Contextual note: Chromoblastomycosis is a chronic cutaneous and subcutaneous mycosis caused by dematiaceous fungi (classically Fonsecaea, Cladophialophora, and Phialophora), with muriform cells being pathognomonic; combined antifungal therapy and cryotherapy are standard strategies, with itraconazole commonly dosed at 200 mg/day as used here.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "A 39-year-old woman with a diagnosis of peripartum cardiomyopathy who received a heart transplant in October 2014. She received induction with Basiliximab and methylprednisolone. She also received maintenance treatment with tacrolimus XL prolonged release 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection during the first year post-transplant, and was controlled with methylprednisolone pulse therapy with good results. There was no history of renal disease and her renal function was stable with creatinine of 0.88 mg/dL and a glomerular filtration rate (GFR) of 102 mL/min/1.73m2 during the first year post-transplant. Follow-up was done exclusively by the heart transplant group and routine polyomavirus viral load BK or urinary cytology was not performed. In 2016, she presented a creatinine serum elevation of up to 1.9 mg/dL, with a GFR of 32.6 mL/min/1.73m2. At that time, the minimum tacrolimus level was 7.2 ng/mL and everolimus, 5.2 ng/mL. Anticalcineurin toxicity was suspected; therefore, tacrolimus was reduced to 4 mg daily and creatinine returned to near baseline (creatinine 1.25 mg/dL, GFR 54.1 mL/min/1.73m2); no renal biopsy was performed. In March 2017, creatinine increased to 2.69 mg/dL, with a GFR of 21.4 mL/min/1.73m2, for which she was hospitalized. The patient stated that she did not have any symptoms. During physical examination, she was in good general condition, heart rate of 80 beats per minute, blood pressure of 130/90 mmHg, respiratory rate of 15 per minute, afebrile. Further studies were performed: renal tract ultrasound showed normal renal size but increased echogenicity; urinalysis and urine cultures were negative, without haematuria, pyuria or casts; echocardiogram with adequate cardiac function; HIV, syphilis, hepatitis B and C serologic tests were negative; minimum tacrolimus level of 5.2 ng/mL, and everolimus of 5.98 ng/mL. Control was initiated with intravenous hydration, and tacrolimus XL dose was reduced to 2 mg daily, but there was no improvement in renal function; a renal biopsy was planned.\n\nRenal biopsy revealed active chronic interstitial nephritis associated with advanced poliomyelitis virus nephritis. BK virus PCR was performed and was positive at 33,800 copies/mL in blood (log 4.5). Tacrolimus was discontinued; creatinine levels stabilized between 2.2 and 2.4 mg/dL, with no further elevation in post-discharge controls. Her viral load began to decline to undetectable levels. The patient did not have episodes of cardiac rejection in 3 years of follow-up; the last creatinine measurement was 2.5 mg/dL, corresponding to a GFR of 23.4 mL/min/1.73m2.\n",
+        "generated_text": "A 39-year-old woman with peripartum cardiomyopathy underwent orthotopic heart transplantation in October 2014. Induction was basiliximab plus methylprednisolone. Maintenance immunosuppression included tacrolimus XL 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection in the first post-transplant year, managed with methylprednisolone pulse therapy. Baseline renal function during year one was normal (creatinine 0.88 mg/dL; eGFR 102 mL/min/1.73m2). Follow-up was by the heart transplant team; routine BK polyomavirus screening (plasma PCR or urine cytology) was not performed.\n\nIn 2016, creatinine rose to 1.9 mg/dL (eGFR 32.6), with tacrolimus trough 7.2 ng/mL and everolimus 5.2 ng/mL. Calcineurin inhibitor toxicity was suspected; tacrolimus was reduced to 4 mg daily, and creatinine improved to 1.25 mg/dL (eGFR 54.1); no biopsy was obtained. In March 2017, creatinine increased to 2.69 mg/dL (eGFR 21.4) without symptoms. Vitals and exam were unremarkable; renal ultrasound showed normal size with increased echogenicity; urinalysis/culture were negative (no hematuria, pyuria, or casts); echocardiogram showed adequate cardiac function; HIV, syphilis, HBV, and HCV serologies were negative. Tacrolimus and everolimus troughs were 5.2 ng/mL and 5.98 ng/mL, respectively. Despite IV hydration and reducing tacrolimus XL to 2 mg daily, renal function did not improve, prompting biopsy.\n\nRenal biopsy demonstrated active chronic interstitial (tubulointerstitial) nephritis associated with advanced polyomavirus nephritis. Plasma BK virus PCR was positive at 33,800 copies/mL (log 4.5). Tacrolimus was discontinued; creatinine stabilized between 2.2 and 2.4 mg/dL with declining BK viremia to undetectable. Over three years, there were no further cardiac rejection episodes. At two years of follow-up from diagnosis of BKVN, renal function was stable with creatinine 2.5 mg/dL (eGFR 23.4 mL/min/1.73m2).\n\nContext: BK polyomavirus nephropathy, while classically described in kidney transplant recipients, can occur in non-renal solid organ transplant recipients under potent immunosuppression. Management centers on reduction of immunosuppression; maintaining an mTOR inhibitor (everolimus) while withdrawing the calcineurin inhibitor can aid viral clearance, at the potential cost of rejection risk, which was not observed here. Plasma BK viral load (log 4.5) plus biopsy-proven late-stage BKVN established the diagnosis and guided therapy.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "27-year-old woman with a history of uncontrolled asthma, mild SARS-CoV-2 infection. In March 2021, she consulted a doctor for pain in the left hemicara and trismus. She reported having completed 48 hours before the antibiotic treatment with phenoxymethyl penicillin 1,000,000 IU daily orally for five days for a peritonsillar abscess. She was hemodynamically stable at the physical examination, without the need for supplemental oxygen, and without relevant findings in respiratory symptoms. The head and neck examination showed a soft, painful, cervical adenopathy, palpable and painful, predominantly homolateral and trismus. Complementary studies were performed. The admission laboratory reported leukocytosis, platelopenia, increased acute phase reactants and the rest of the parameters within normal values. An angiotomy of the craniofacial mass was performed, where a large thrombus was found in the internal and external carotid arteries. Studies were completed with a chest tomography and arterial Doppler ultrasound of neck vessels with no relevant findings. Early intravenous antibiotic treatment was initiated with ceftriaxone 1 g every 12 hours, clindamycin 300 mg every 6 hours and anticoagulation with enoxaparin adjusted to body weight and renal function, 60 mg subcutaneously every 12 hours. The patient evolved 72 hours after initiating the directed treatment with a fever of 38.5 °C and increased leukocytosis, so new complementary studies were performed, including a Doppler ultrasound of the heart without finding cardiac vegetations and a chest tomography where bilateral pulmonary septic emboli were found. With the admission hemocultures negative, a new admission of 3 units, culture of pharyngeal exudate and rotation of ceftriaxone to piperacillin tazobactam 4.5 g every 6 hours intravenous was decided. The patient evolved favorably, without rescue of germs in cultures. After 14 days of initiating the new therapeutic scheme, and with a control chest tomography without pulmonary lesions, it was decided to continue antibiotic treatment with oral clindamycin 300 mg every 6 hours, anticoagulation with acenocumarol adjusted to body weight and hospital discharge.\n",
+        "generated_text": "A 27-year-old woman got face swelling and a tight jaw two days after finishing penicillin for a tooth infection. A blood clot is like a plug that blocks a pipe. A scan of her neck found a big clot in a neck vein. A scan of her chest showed the infection had sent clots to her lungs. Doctors gave strong antibiotics through a vein right away. They also gave blood thinners to treat the clot.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "full_text": "This is a 32-year-old patient, a baker, from Bamako, who was admitted to the Infectious and Tropical Diseases department of the CHU du Point G (Bamako, Mali) on 27 April 2023 for chronic productive cough, otalgia and a chronic right-sided purulent otorrhea.\n\nThe symptomatology would be of progressive installation in 1 month, initially treated in a medical center with artésunate, paracetamol and unspecified antibiotics for confirmed malaria and acute otitis media, without success. He is immunosuppressed by a HIV1 infection, diagnosed and put on a tritherapy antiretroviral (TARV) Tenofovir/Lamivudine/Dolutégravir 7 months ago, not observed due to denial of his illness.\n\nThe general physical examination found a fever (38.2 °C), altered general condition, otalgia, purulent right foul-smelling otorrhea, a right basal pulmonary condensation syndrome, a normal neurological examination, without the involvement of the cranial nerves, mainly the facial nerve VII and the VIII cochleovestibular nerve.\n\nIn the ENT examination, the otoscopy of the right ear showed an inflammatory external auditory canal with purulent secretions and the presence of a single tympanic perforation in the anterior-inferior quadrant. The left ear is normal. The Rinne and Weber test is in favor of a right conductive hearing loss.\n\nImmuno-virological evaluation shows a CD4 count of 118 cells/pl and a viral load of 12,370 copies/ml at the time of diagnosis of HIV infection, compared to a viral load of 9,460 copies/ml and a CD4 lymphocyte count of 193 cells/pl at the 6th month of antiretroviral treatment. At the time of diagnosis of tuberculosis at the 7th month, the immuno-virological evaluation shows a CD4 count of 89 cells/pl and a viral load of 10,230 copies/ml.\n\nThe Ziehl Neelsen bacilloscopy was positive with a cross in the gastric washings on admission and 19 days later in the right ear swab because of the persistent otorrhea. The Xpert-MTB/GeneXpert test did not detect rifampicin-resistant Mycobacterium tuberculosis.\n\nThe frontal chest radiograph shows a more accentuated bronchovascular network at the base of the right lung.\n\nThe diagnosis of tuberculosis of the middle ear concomitant to a pulmonary localization in the field of immunosuppression by HIV1 is therefore retained.\n\nThe patient is put on oral first-line anti-tuberculosis for 6 months, a fixed dose of a quadra-therapy in the intensive phase of isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months (2RHZE), followed by a bi-therapy in the maintenance phase of isoniazid and rifampicin for 4 months (4RH) at a dose of 3 tablets/day in the morning on an empty stomach, associated with vitamin B6 (1 tablet/day). He benefits from two sessions of therapeutic reinforcement with anti-retroviral drugs. The ART is restarted on 4 May 2023 with his consent, given the good tolerance of the anti-tuberculosis drugs, with the combination of tenofovir/lamivudine/dolutegravir at a dose of 1 tablet/day associated with dolutegravir 50 mg as a supplement (1 tablet/day) according to the protocol for the management of HIV/AIDS. A chemoprophylaxis with cotrimoxazole 960 mg (1 tablet/day) is undertaken as well as a cleaning of the external auditory canal by aspiration and the instillation of ciprofloxacin ear drops (2 drops 3 times a day) for 14 days.\n\nThe evolution is favorable after 14 days of treatment, marked by a pyrexia, a good general state, the amendment of the cough and otorrhea with the negativation of the bacilloscopy in the gastric tube liquid and the swab of the pus of the right ear. At the end of the maintenance anti-tuberculosis treatment, the clinical healing is complete with a normal ENT and neurological examination. The bacilloscopy associated with the Xpert-MTB/GeneXpert test at the end of the 2nd month of the intensive phase, during the 5th month and at the end of the 6th month of the maintenance phase were negative. The HIV viral load performed after 3 months of ART is 329 copies/ml.\n",
+        "generated_text": "You developed a month of productive cough, ear pain, and a long-lasting pus discharge from the right ear. Tests showed tuberculosis bacteria: the direct smear for acid-fast bacilli (AFB) was positive in a gastric aspirate (stomach fluid) and in a swab of the pus from the right ear. This supported TB affecting the middle ear, with likely lung involvement.\nYou were treated with standard anti-tuberculosis therapy for 6 months, along with supportive care. The treatment cleared the infection, and you made a complete recovery.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "full_text": "The patient was a 4-month-old male from central Mexico with two healthy male siblings. His mother was hypothyroid during the first trimester of pregnancy and took drugs. The infant was born with normal weight and size, was breast-fed, and received the BCG vaccine with no scarring. The mother of the patient was a prisoner in a jail cell with the infant in a crowded cell with two others.At 4 months, the patient was medically evaluated for a painful tumor in the left axilla. A chest X-ray showed suggestive images of rib fractures; the mother was suspected of child abuse, and the infant was admitted to a pediatric hospital. The infant was weighed (4,190 g) and measured (58 cm) below the third percentile, oxygen saturation of 70%, fever, cough, increased volume in the left axilla, and pain, redness, and warmth. The blood count showed: hemoglobin of 8.8 g/dL (11.0-12.6), 29.3 × 109 leukocytes/L (6.0-17.5), 18.4 × 109 neutrophils/L (1.0-8.5), 7.0 × 109 lymphocytes/L (4.0-13.5), 3.5 × 109 monocytes/L, 459 × 109 platelets/L (150-350), and C-reactive protein of 16 mg/L (< 3.0). The first thoracoabdominal tomography showed an abscess in the left axilla, lytic lesions in ribs 3-6, left apical pneumonia, pulmonary nodules in both lungs, and enlarged cervical and mediastinal lymph nodes. The biopsy of the left axilla abscess reported myositis and suppurative panniculitis. Only the culture for bacteria from the bronchoalveolar liquid was negative, and the PCR for the Mycobacterium tuberculosis complex was negative. After 41 days of hospitalization and receiving two antimicrobial regimens of ceftriaxone-clindamycin and cefepime-vancomycin, the patient was discharged.\n\nTwo months later, at eight months of age, he was readmitted to hospital with a fever, irritability and a suppurating abscess in the left scapula. The blood count showed haemoglobin of 10.8 g/dl (10.5-12), 21.2 × 109 leukocytes/L (6-17), 12.2 × 109 neutrophils/L (1.5-8.5), 7.5 × 109 lymphocytes/L (4-10.5), 1.2 × 109 monocytes/L (600), and 583 × 109 platelets/L (150-350); the serum test for HIV was negative. A left apical consolidation, bronchiectasis, lytic lesions in ribs 2-7 and dorsal vertebrae 2-7, and a multilocular fluid collection were observed on a chest scan; ultrasound showed a fistula associated with the scapular abscess. The patient received piperacillin-tazobactam, which was later replaced with voriconazole after Aspergillus fumigatus was detected in the secretion sample culture. Given the recurrence and severity of the infection, an innate immunity defect was suspected. The dihydrorhodamine test showed no production of reactive oxygen species and the gp91phox expression in neutrophils was absent, establishing a diagnosis of X-linked chronic granulomatous disease. The pathogenic variant detected by next-generation sequencing was c.80_83del/Y (p.Val27Glyfs*33) in CYBB. The mother was a carrier of the variant (c.80_83del/WT). The two older male siblings, who were apparently healthy, could not be genetically tested. The patient was discharged after 65 days of hospitalisation and 28 days of voriconazole treatment. Daily antibiotic prophylaxis with trimethoprim-sulfamethoxazole and antifungal prophylaxis with fluconazole twice a week were initiated. Two months later, at one year of age, the infant was readmitted due to multifocal pneumonia, for which mechanical respiratory assistance was required. The galactomannan antigen was detected in the serum and A. fumigatus was detected in the culture of the lavage fluid, so treatment with voriconazole was initiated again. The patient suffered a multiple organ failure and died one month after admission.\n",
+        "generated_text": "A baby boy was 4 months old. He lived with his mother in a prison cell. A painful lump grew in his left armpit. A chest X-ray looked like some ribs were broken. Doctors worried he might have been hurt. The pictures also showed a pocket of pus in his armpit, damage to his ribs, a lung infection, and small spots in his lungs. He got strong antibiotics. He went home. When he was 8 months old, he got a fever. The pus spread toward his left shoulder. New chest pictures looked worse. Tests found a mold called Aspergillus fumigatus in the pus. The doctors said he had a serious mold infection. He took a strong antifungal medicine called voriconazole for 28 days. A special blood test showed his germ-fighting cells did not work well. He had a rare immune problem called chronic granulomatous disease. It was caused by a change in a gene called CYBB. His mother carried this gene change. When he was 12 months old, the mold infection came back. The treatments did not work. He died.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "full_text": "A 19-year-old woman presented to the emergency department of our institution for acute onset of palpitations. An electrocardiogram (ECG) showed ventricular tachycardia, with right branch bundle block associated to left posterior hemiblock, and T waves inversion in the inferior and precordial leads. Blood test showed elevated troponin (27 ng/L, normal values <14 ng/L) and NT-pro BNP (aminoterminal pro B-Type Natriuretic Peptide) levels (2225 pg/mL, normal values <130 pg/mL). Hence, she was admitted to the coronary care unit.\n\nAbout 5 years before, she had already presented to the emergency department with cardiogenic shock due to fascicular ventricular tachycardia; she was subsequently hospitalized and underwent cardiac magnetic resonance (CMR) and a transoesophageal electrophysiological study, both with inconclusive results. She was discharged with a diagnosis of tachycardiomiopathy, with the prescription of a standard medical therapy (angiotensin-converting enzyme inhibitors, mineralocorticoid receptor antagonist, and beta blockers), and a follow-up was planned. Her subsequent clinical history was uneventful.\n\nDuring the present hospitalization, no further episodes of hyperkinetic arrhythmias were detected. Basal 12-lead ECG. Echocardiography showed diffuse hypokinesia of both the left and the right ventricles, and CMR was once again inconclusive. Then, the patient was advised to undergo cardiac computed tomography angiography (CCTA) to evaluate the anatomy of the coronary tree, under the suspicion of an undiagnosed congenital cardiac anomaly. CCTA was performed with a GE Lightspeed unit (GE HealthCare, Chicago, United States), with retrospective gating, at 100 kVp and 696 mAs, with a gantry rotation time of 0.35 s, and 0.625 mm slice thickness, with intravenous injection of 70 mL of Iomeron 400 mgI/mL (Bracco Imaging, Milan, Italy).\n\nDifferential diagnosis\nCardiogenic shock, namely a shock caused by inadequate blood flow, may be caused by different pathologies such as myocardial infarction, arrhythmias, or other cardiomyopathies. Undiagnosed congenital heart disease is a non-negligible cause of cardiogenic shock in otherwise healthy adult patients. Once myocardial infarction is ruled out by a 12-lead ECG, and an underlying cardiomyopathy has been excluded by an inconclusive CMR examination, CCTA is the technique of choice for the differential diagnosis among diverse causes of cardiogenic shock.\n\nInvestigations/imaging findings\nThe CCTA examination showed regular origin of the left main coronary artery, the left anterior descending artery, which presented a wide ramus intermedium, 2 diagonal branches, and the left circumflex artery, which appeared thin and non-dominant. Among all these vessels, there was no evidence of obstructive coronary artery disease. However, the ostium and the proximal portion of the right coronary artery (RCA) were absent, whereas its mid and distal portions were supplied by a wide collateral branch originating from the distal left anterior descending artery, which then surrounded the lateral wall of the right ventricle, ran through the distal part of the atrioventricular groove, finally giving rise to thin posterior interventricular and posterolateral arteries. Furthermore, a thin branch going from the mid left anterior descending artery to the sinoatrial node was observed.\n\nTreatment, outcome, and follow-up\nIn view of the CCTA findings, the patient underwent an echo-stress test, which confirmed the presence of inducible myocardial ischaemia in the inferior wall, in line with the positioning of the arrhythmic focus. After being transferred to a specialized centre for the diagnosis and treatment of congenital heart disease, the patient underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia originating by the posteromedial papillary muscle. Then, she was discharged with medical therapy (Acetylsalicylic acid and Verapamil). At her 6-month follow-up, she has always been asymptomatic, with no further signs of arrhythmias.",
+        "generated_text": "A 19-year-old woman presented with acute palpitations. The initial ECG demonstrated ventricular tachycardia with right bundle branch block morphology associated with left posterior hemiblock, and T-wave inversion in the inferior and precordial leads. Biomarkers were elevated (troponin 27 ng/L, normal <14 ng/L; NT-proBNP 2225 pg/mL, normal <130 pg/mL). She was admitted to the coronary care unit. Five years earlier, she had presented with cardiogenic shock due to fascicular ventricular tachycardia; CMR and a transoesophageal electrophysiological study at that time were inconclusive. She was discharged with a diagnosis of tachycardiomyopathy on ACE inhibitors, a mineralocorticoid receptor antagonist, and beta blockers, with an uneventful interval thereafter.\n\nDuring the current hospitalization, there were no further hyperkinetic arrhythmias. Basal 12-lead ECG was obtained. Echocardiography showed diffuse hypokinesia of both ventricles. CMR was again inconclusive, and an undiagnosed congenital cardiac anomaly was suspected. Cardiac computed tomography angiography (CCTA) was performed (GE Lightspeed, retrospective gating, 100 kVp, 696 mAs, gantry rotation 0.35 s, 0.625 mm slice thickness; 70 mL Iomeron 400 mgI/mL IV). The left main and left anterior descending (with a wide ramus intermedius and two diagonal branches) and a thin, non-dominant left circumflex showed no obstructive coronary artery disease. The right coronary artery ostium and proximal segment were absent (ostial atresia); the mid and distal RCA were supplied by a large collateral from the distal LAD that coursed around the lateral right ventricular wall, traversed the distal atrioventricular groove, and gave rise to thin posterior interventricular and posterolateral branches. A thin branch from the mid LAD to the sinoatrial node was also observed.\n\nIn the differential for cardiogenic shock in otherwise healthy adults, once acute myocardial infarction is ruled out on 12-lead ECG and cardiomyopathy is not demonstrated on CMR, CCTA is the modality of choice to evaluate for congenital coronary anomalies and other causes. In this case, an echo-stress test confirmed inducible ischemia in the inferior wall, concordant with the arrhythmic focus location. The patient was transferred to a specialist congenital heart disease center, where she underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia arising from the posteromedial papillary muscle. She was discharged on acetylsalicylic acid and verapamil. At 6-month follow-up she remained asymptomatic, without recurrent arrhythmias.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "A 29-year-old woman, Para 1, with abnormal vaginal bleeding of one-month duration presented to the gynecology outpatient department of a level 2 hospital. She was HIV positive, commenced on antiretroviral treatment following diagnosis, but had defaulted the antiretroviral treatment for one month when she became ill with vaginal bleeding, resulting in virological and immunological failures (viral load 37400 copies/mL and CD4 count 26 cells/μL). Of note, it was unclear when the patient first started showing HIV symptoms. However, she was diagnosed with HIV about a year prior to presentation. Physical examination revealed a large mass on the cervix measuring 8 × 8 cm extending to the parametrium and to the pelvic side walls bilaterally. There was bleeding on contact and foul-smelling vaginal discharge. Ultrasonography detected a bulky cervix and bilateral hydronephrosis. The patient was clinically diagnosed with cervical malignancy stage 3B. She was recommenced on antiretroviral therapy with a treatment change from TLD (Tenofovir-Lamivudine-Dolutegravir combination) to a preferable renal friendly regimen (Lamivudine-Abacavir-Dolutegravir combination). A punch biopsy of the cervix was performed, and the histopathological report revealed the diagnosis of an extra-nodal BL. The immunohistochemical and in situ hybridization confirmed the diagnosis, with CD20, CD75a, CD10, PAX5 and Bcl-6 positive. In addition, the CD44 and c-Myc were positive, with the EBER-ISH demonstrating focal positivity. The Ki67 demonstrated a proliferation index of almost 100% and PAX5 moderately positive BCL6. She had white cell count of 2.67 x109/L, haemoglobin of 5.7g/dl and platelet count of 71 × 109/L. Results of other investigations were serum creatinine 187 mmol/L, urea 11.1 mmol/l, albumin 21 g/l, aspartate transaminase 41 U/l and alkaline phosphatase 100 U/l.\n\nFollowing histological confirmation of the diagnosis and review at an oncology multidisciplinary meeting, she spent 43 days waiting to start treatment at oncology unit. The delay was due to long waiting list. This delay exceeded the 48 hours waiting period during which oncological treatment for BL should commence following diagnosis. The treatment plan was chemo-radiation therapy, and the patient gave written informed consent for the case to be published. However, she demised in the gynaecological ward on the 43rd day while waiting to start the treatment. During the 43 days, further imaging could not be performed due to poor functionality of the available CT and MRI machines. In addition to antiretroviral therapy, the patient received other supportive care such as blood transfusion and analgesia. Again, the number of days between the diagnosis of the BL and her death was 43 days. Histopathological postmortem was not performed as the diagnoses (BL and retroviral disease) were known. We reckon that the main primary cause of death is challenging to assign because of the multiple principal diagnoses. Because BL has rapid progression and high mortality rate in persons living with HIV particularly with high viral load, the attending physician certifying the death assigned BL as the most likely cause of death. However, the secondary cause of death was multiple organ failure (renal and haematological inclusive).",
+        "generated_text": "A 29-year-old woman (Para 1) with HIV presented with one month of abnormal vaginal bleeding. She had defaulted antiretroviral therapy before this illness and on presentation had a very low CD4 count (26 cells/µL) and a high viral load. Examination and ultrasound found an 8 × 8 cm cervical mass with pelvic side wall involvement and bilateral hydronephrosis, and she was clinically staged as FIGO 3B. A cervical punch biopsy confirmed an extranodal Burkitt lymphoma (BL); immunohistochemistry showed B‑cell markers and a very high tumor proliferation rate, with focal Epstein–Barr virus (EBV) positivity. Blood tests showed severe anemia (hemoglobin 5.7 g/dL), low platelets (71 ×10^9/L), low white cell count (2.67 ×10^9/L), and impaired kidney function. The oncology multidisciplinary team recommended chemoradiation, and she was restarted on antiretroviral therapy with a renal‑friendly regimen and given supportive care (blood transfusion, pain relief). There was a long delay to start oncologic treatment because of a waiting list and limited imaging availability; she died in the ward 43 days after diagnosis without receiving the planned chemoradiation. The treating physician attributed the most likely primary cause of death to rapidly progressive BL, with multiple organ failure (including kidney and blood‑related failure) as contributing causes.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "full_text": "February 2020, a 36-year-old with no significant past medical history presented with 5 years history of left sided penoscrotal mass. He has no lower urinary tract symptoms. No History of trauma or infections and he denied any history of weight loss, anorexia or fever. On examination, there is a smooth surface, tender cystic lesion around 20 mm ∗ 20 mm attached to the left side of the bulbar urethra at the penoscrotal junction, it was deep without any skin tethering and not related to the left spermatic cord and it was partially mobile.\n\nDoppler ultrasonography showed a well-defined hypoechoic mass measuring 2.7 ∗ 3.1 ∗ 2.0 cm with significantly increased vascularity at the left of penoscrotal junction. Pelvis Magnetic resonance imaging revealed a mass in the left inferolateral side of the base of the penis with a clear fat plane, which is isointense to the testes in the T2 weighted imaging, T1 weighted imaging and Diffusion-weighted imaging and it was connected to the vas deferens, no lymphadenopathy was noted. Alpha fetoprotein and beta-human chronic gonadotrophin levels were all in the normal range. Given the results of workup and the pain experienced by the patient, a decision was made to proceed with surgical removal of the mass for both diagnostic and therapeutic purposes. During surgery, a mass was seen in the left posterolateral of the scrotum and it was resected completely and sent for histopathology.\n\nHistopathology of the mass showed cellular spindle cell tumour arranged into interlacing fascicle, the cells have spindle to oval vesicular nuclei with evenly dispersed chromatin and inconspicuous nucleoli. The tumour showed high mitotic activity reaching up to 3/High-power field. Immunohistochemistry analysis was consistent with synovial sarcoma, revealing a positive TLE-1, CD99, B-cell lymphoma 2 (BLC2), Focal cytokeratin and focal epithelial membrane antigen (EMA). The material was sent for Fluorescence in situ hybridization (FISH) and reported a rearrangement of the SS18 gene at 18q11.2 which has been observed in synovial sarcomas. The mass margins were difficult to be assessed by histopathology as the sample had fragmented margins.\n\nThe patient presented to the clinic after 2 weeks and given the histopathology report, a re-resection with wider margin was discussed with the patient and he agreed. Positron emission tomography – Computed tomography (PET/CT) was done for Head and Neck, Chest, Abdomen, Pelvis and musculoskeletal structures. Only a 29 ∗ 27 mm thyroid nodule in the lower pole of the left thyroid lobe with moderate hypermetabolism at standardized uptake values (SUVs) of 4.9. Thyroid US showed a solid isoechoic well-defined nodule in the lower pole of the left thyroid lobe with no echogenic foci, Thyroid Imaging Reporting and Data System (TIRADS) was TR3.\n\nA second resection was made 3 weeks from the first one. The whole specimen was resected from both cords bilaterally which was deepened until reaching the corpus spongiosum which was shaved superiorly up to the urethra. The specimen was sent for histopathology. The resected mass was 6.0 ∗ 6.0 ∗ 3.0 cm in size, and it was negative for any pathology. The patient then went into active surveillance and after 16 months of active surveillance he was found to have metastatic lesions in the sixth liver segment and L1 vertebral body. Oncology team started chemotherapy regimen of Ifosfamide and Doxorubicin for 6 cycles with no improvement in the liver lesion. Surgical resection was made for the Fifth and Sixth liver sections with cholecystectomy. Patient then developed a new lung lesion and was started on Pazopanib and Stereotactic Body Radiation Therapy SBRT. The patient then underwent surveillance for 6 months then developed new liver and lung lesions then chemotherapy regimen of Gemcitabine and Docetaxel combination for 3 cycles and progressed then he was started 2 cycles of Dacarbazine and progressed then 2 cycles of Pembrolizumab and progressed. The patient then was shifted to palliative care, and he stopped following up.",
+        "generated_text": "A 36-year-old man presented with a 5-year history of a tender left penoscrotal mass attached to the left side of the bulbar urethra at the penoscrotal junction; on exam it was a deep, smooth, tender, partially mobile cystic lesion (~20 × 20 mm) without skin tethering and not involving the spermatic cord. Doppler ultrasound showed a well-defined hypoechoic mass (2.7 × 3.1 × 2.0 cm) with marked vascularity. Pelvic MRI demonstrated a mass at the left inferolateral base of the penis with a clear fat plane, isointense to the testes on T1, T2, and diffusion-weighted sequences, connected to the vas deferens, without lymphadenopathy. Serum AFP and β-hCG were normal. The mass was excised for diagnosis and symptom control. Pathology revealed a cellular spindle cell tumor arranged in interlacing fascicles with spindle-to-oval vesicular nuclei, evenly dispersed chromatin, and inconspicuous nucleoli; mitotic activity reached up to 3/HPF. Immunohistochemistry was positive for TLE-1, CD99, and BCL2 with focal cytokeratin and focal EMA, supporting synovial sarcoma. FISH demonstrated SS18 gene rearrangement at 18q11.2, confirming the diagnosis. Margins were difficult to assess due to specimen fragmentation. Two weeks later, a wider re-resection was performed; the specimen (6.0 × 6.0 × 3.0 cm), resected deeply to the corpus spongiosum with shaving up to the urethra, showed no residual tumor. Staging PET/CT was notable only for an incidental left thyroid nodule (29 × 27 mm, SUV 4.9; TR3 on ultrasound). After 16 months of surveillance, metastatic disease developed in liver segment VI and the L1 vertebral body. Systemic ifosfamide/doxorubicin (6 cycles) produced no response in the liver lesion. He subsequently underwent hepatic resection of segments V and VI with cholecystectomy. New pulmonary lesions later emerged; therapy included pazopanib and stereotactic body radiation therapy, followed by gemcitabine/docetaxel (3 cycles), dacarbazine (2 cycles), and pembrolizumab (2 cycles), with continued progression. He was transitioned to palliative care and was lost to follow-up. Overall, this case represents a primary penoscrotal synovial sarcoma with SS18 rearrangement and an aggressive, treatment-refractory course despite two surgical resections and multiple systemic regimens.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "A 29-year-old gravida V par IV (all alive, 3 spontaneous vaginal deliveries, and the last child was delivered by cesarean section for the indication of a failed induction 4 years prior to the current pregnancy) came for ANC follow-up at a gestational age of 32 weeks from her LNMP.\n\nAfter taking a medical history, it was discovered that all four of her children are healthy, doing well in school, and have no known history of genetic or seizure disorders. She was investigated with the Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBSag), and urine analysis, all of which were negative. All cell lines in the CBC were normal, her blood group is A, and Rh is positive, according to the Complete Blood Count (CBC), blood group, and RH. Obstetric ultrasound was also performed showing normal anatomical scan of the all body parts of the fetus except the heart. Detailed fetal echocardiography evaluation was done with findings of: both atria have comparable size and normal situs. Both atrioventricular and semilunar valves are normally positioned with normal opening and closure. Both ventricles are comparable in size and contractility; in both 2D and color flow, the left ventricle forms the apex of the heart without any ventricular septal defect. But on the papillary muscles of the left ventricle there were two circumscribed, round, echogenic mass measuring 18.2 mm by 8.3mm and 13.5mm by 8.3 mm. Upon evaluation of the outflow tract, both the LVOT (left ventricular outflow tract) and RVOT (right ventricular outflow tract) have normal anatomy and function using 2D and CF ultrasound evaluation. According to the fetal echo finding, a diagnosis of cardiac rhabdomyoma was made. Since there is a high chance of tuberous sclerosis in cardiac rhabdomyoma, detailed neurosonography and other system exams were done to look for other signs of tuberous sclerosis. Despite searching for the other features of tuberous sclerosis, no other sign of it was found other than the tumor. She had regular ANC follow-up from 32 weeks of gestation up to 39 weeks without any complications.\n\nAt gestational age of 39 weeks plus 1 day, she underwent a cesarean section for the indication of full-term pregnancy plus a request for a repeat cesarean section, with the outcome of a 3200-gram female with an APGAR score of 10 and 10 at the 1st and 5th minutes. Both the mother and the neonate had a smooth post-operative period and were discharged on the third day.\n\nAfter delivery, the neonate was evaluated on the 1st, 7th, and 30th days for any regression or increment of the mass, emergence of skin lesions, or seizure. All physical examination results were normal, and the mass size was similar to the antepartal evaluation.\n\nAt her 7th month, the child was evaluated again, and upon history inquiries, the infant was doing great developmentally for her age group. The infant was examined for neurodevelopmental delay, and the child was growing appropriately for her age. An echocardiography study by a pediatric cardiologist revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles, each measuring 21.8 mm by 9.2 mm and 14.7 mm by 8.5 mm and creating no left ventricular inflow obstruction.\n\nA history from the family was obtained, and a physical examination with anthropometric measurements was performed to assess her developmental condition during her first-year evaluation. The child was developing normally, as other children her age were. Except for the heart, all of the systems examined were unremarkable. An echocardiography study has revealed well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and creating no left ventricular inflow obstruction.",
+        "generated_text": "A 29-year-old gravida V para IV (3 spontaneous vaginal deliveries, prior cesarean for failed induction 4 years earlier) presented for ANC at 32 weeks by LNMP. Maternal labs: VDRL, HBsAg, and urinalysis negative; CBC within normal limits; blood group A Rh-positive. Obstetric ultrasound revealed normal fetal anatomy except the heart. Fetal echocardiography showed normal situs; atria of comparable size; normally positioned atrioventricular and semilunar valves with normal motion; ventricles comparable in size and contractility; left ventricle forming the apex; no ventricular septal defect. Two circumscribed, round, echogenic masses were noted on the left ventricular papillary muscles, measuring 18.2 × 8.3 mm and 13.5 × 8.3 mm. LVOT and RVOT anatomy and function were normal on 2D and color flow. Impression: cardiac rhabdomyoma. Given the association with tuberous sclerosis complex (TSC), detailed neurosonography and systemic evaluation were performed and were unremarkable. She continued routine ANC without complications to 39 weeks. At 39 weeks + 1 day, a cesarean section (repeat on request at term) delivered a 3200 g female, Apgar 10 and 10 at 1 and 5 minutes. Postoperative courses for mother and neonate were uneventful; discharge occurred on postoperative day 3. The neonate was evaluated on days 1, 7, and 30: physical examinations were normal; no seizure activity or new cutaneous lesions; mass dimensions were similar to the antenatal findings. At 7 months, development was age-appropriate; pediatric echocardiography showed well-circumscribed hyperechoic masses on both left ventricular papillary muscles measuring 21.8 × 9.2 mm and 14.7 × 8.5 mm, without left ventricular inflow obstruction. At 12 months, anthropometric and neurobehavioral development remained normal. Echocardiography again demonstrated well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and no left ventricular inflow obstruction. Up to one year of age, apart from the persistent intracardiac rhabdomyomas, the child met none of the clinical diagnostic criteria for TSC. Notably, while cardiac rhabdomyomas often regress spontaneously in infancy, these lesions were stable through 12 months.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "full_text": "27-year-old male patient with a history of fibrous dysplasia in the right proximal femur, which was managed prophylactically to reduce the risk of fracture 20 years ago by curettage (intralesional resection), application of bone graft and fixation with osteosynthesis material, which was removed one year after the fixation. Two weeks before admission to hospital, the patient experienced pain after a fall with low energy mechanism characterised by axial load and rotational component of the right hip, which resulted in pain intensity 8/10 on the visual analogue scale (VAS) at the level of the inguinal fold and right thigh, which incapacitated him for walking. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient was discharged clinically and haemodynamically stable, without the need for transfusion of blood products. During his follow-up in the postoperative period (612 weeks), the patient continued with partial support until day 20, in which he began with full support even accompanied by a walker. Radiological control was performed at four weeks, observing all prosthetic components adequately. The patient is currently carrying out daily activities with slight limitation due to claudicatio intermittens caused by the incision in the middle gluteus. However, he was able to participate in low-impact sports activities, such as walking and expressed great satisfaction with the functional outcome of the procedure.\n",
+        "generated_text": "A 27-year-old man presented to the emergency department with a fracture at the base of the neck of the right femur after a low-energy fall that involved axial loading and a twisting motion of the right hip. He had a known history of fibrous dysplasia in the right proximal femur and, 20 years earlier, underwent curettage, bone grafting, and prophylactic fixation; the hardware was removed one year later, and biopsy at that time confirmed fibrous dysplasia. Given the pattern and pathologic nature of the current fracture, the team proceeded with a definitive treatment: wide resection of the proximal femur and a total hip replacement using a modular prosthesis, along with cerclage to secure the construct. An excisional biopsy performed during surgery confirmed the same fibrous dysplasia that had been treated in childhood. He recovered well: imaging at four weeks showed the components in good position, and he progressed from partial weight-bearing to full weight-bearing with a walker around day 20. He returned to daily activities with a mild, intermittent limp related to the gluteus medius incision and was able to do low-impact activities such as walking, reporting high satisfaction with the outcome.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "full_text": "A 12-year-old boy was brought to our department exhibiting sudden onset symptoms of headache and polyuria-polydipsia syndrome, which began one week prior to his initial visit. The child had no significant medical history. During the first clinical evaluation, he measured 146.5 cm in height (M) and weighed 30 kg (-1.4 SD). There were no observed signs of adrenal insufficiency or hypothyroidism. He was at the onset of puberty, with gonad sizes measuring 3.2 cm on each side and a penis length of 6.2 cm (M). Notably, the patient experienced polyuria-polydipsia syndrome, with fluid excretion reaching up to 113ml/kg/day, nocturnal enuresis, and an excessive liquid intake of 3.8 liters/m². Ophthalmologic examination yielded expected results, with no visual impairments detected and normal optical coherence tomography (OCT) findings.\n\nThe biological assessment revealed DI, with a serum sodium level of 140 mEq/l and plasma osmolality of 287 mosm/kg, while the urine osmolality was significantly low at 179 mosm/kg. Furthermore, his serum levels of insulin-like growth factor-1 (IGF1), prolactin (PRL), free T4, cortisol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were all within the normal range.\n\nMRI scans with and without contrast highlighted apoplexy in an RCC, showing a spontaneous hyperintensity on T1 and T2 sequences measuring 15x6x11 mm. The anterior pituitary gland displayed homogeneous contrast uptake. However, we observed a loss of the typical hyperintensity of the posterior pituitary gland, with no radiological indications of a craniopharyngioma. Therefore, during the initial hormonal evaluation, the only hormone deficiency identified in our case was DI, which showed significant improvement under vasopressin treatment. The case was reviewed in a multidisciplinary meeting, including an endocrinologist, neurosurgeon, and radiologist. Given the absence of clinical or biological signs other than DI and the stability of the RCC apoplexy over nine months of MRI monitoring—with measurements of 12 × 11 × 10 mm—a conservative management approach with regular follow-ups was chosen.\n\nThe child was monitored for three years, during which he displayed normal puberty development and maintained a stable hormonal profile (Table 1). Visual evaluations revealed no abnormalities. However, a decrease in growth velocity was noted, dropping from -0.8 SD to -1.1 SD. This necessitated an investigation for acquired growth hormone (GH) deficiency. At the age of 14 years and nine months, the child was readmitted to undergo two GH stimulation tests: A propranolol-glucagon test and an Insulin Tolerance Test, which indicated a partial GH deficiency with peaks of 19.3 µUI/ml and 10.0 µUI/ml, respectively. After receiving GH treatment, the patient experienced a notable increase in growth velocity, improving from -1.1 SD to 0.2 SD over one year.\n\nSubsequently, MRI monitoring showed a stable appearance of the RCC apoplexy after two years (11 × 12 × 11 mm), with a slight decrease in size observed at the three-year follow-up, measuring 7 × 10 × 6 mm. It is important to note that the radiological follow-up was consistently conducted at the same MRI center, with the same radiologist interpreting both recent and previous MRI findings during multidisciplinary meetings that included an endocrinologist and a neurosurgeon.",
+        "generated_text": "A 12-year-old boy was admitted with sudden headaches and a week-long history of excessive urination and thirst. Tests showed central diabetes insipidus (low urine concentration with normal blood sodium and plasma osmolality), and MRI identified apoplexy (bleeding or sudden change) in a Rathke cleft cyst measuring about 15 × 6 × 11 mm; the normal bright signal of the posterior pituitary was lost but the anterior pituitary enhanced normally. He had no visual problems and routine pituitary hormone tests were otherwise normal. Because he was early in puberty, had no compressive symptoms, and basic endocrine tests were normal, a multidisciplinary team chose conservative management: clinical, hormonal and MRI follow-up, and treatment of the diabetes insipidus with vasopressin. Over three years the cyst remained stable then decreased in size (about 12 × 11 × 10 mm at nine months, 11 × 12 × 11 mm at two years, and 7 × 10 × 6 mm at three years), puberty progressed normally, and vision stayed normal. During follow-up his growth slowed, and stimulation tests at age 14 years 9 months showed a partial growth hormone deficiency; after starting growth hormone therapy his growth rate improved markedly. Overall, conservative follow-up was effective: the Rathke cleft cyst apoplexy stabilized and shrank, diabetes insipidus was controlled, and the only long-term endocrine issue was a treatable partial GH deficiency.",
+        "literacy_label": "intermediate_health_literacy"
+      }
+    ],
+    "signature": {
+      "instructions": "Analyze the linguistic complexity, use of medical jargon, and sentence \nstructure of 'generated_text' relative to 'full_text' to determine \nthe health literacy level.",
+      "fields": [
+        {
+          "prefix": "Full Text:",
+          "description": "Original clinical or medical source text containing jargon and technical details."
+        },
+        {
+          "prefix": "Generated Text:",
+          "description": "A version of the source text rewritten for a specific audience."
+        },
+        {
+          "prefix": "Reasoning: Let's think step by step in order to",
+          "description": "${reasoning}"
+        },
+        {
+          "prefix": "Literacy Label:",
+          "description": "Classification: low_health_literacy (simple words, no jargon), intermediate_health_literacy (moderate technicality), or proficient_health_literacy (highly technical/original level)."
+        }
+      ]
+    },
+    "lm": null
+  },
+  "metadata": {
+    "dependency_versions": {
+      "python": "3.11",
+      "dspy": "3.1.3",
+      "cloudpickle": "3.1"
+    }
+  }
+}

code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_v1/accuracy.json

@@ -0,0 +1,4 @@
+{
+  "accuracy_score": 78.57,
+  "num_results": 84
+}

code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_v1/cost.json

@@ -0,0 +1,14 @@
+{
+  "gpt-5": {
+    "prompt_tokens": 136508,
+    "completion_tokens": 13761,
+    "cached_tokens": 0,
+    "cost_usd": 0.308245
+  },
+  "gpt-5-mini": {
+    "prompt_tokens": 9267568,
+    "completion_tokens": 737445,
+    "cached_tokens": 0,
+    "cost_usd": 3.7917820000000004
+  }
+}

code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_v1/full_dataset_accuracy.json

@@ -0,0 +1,23 @@
+{
+  "model_path": "/home/mshahidul/readctrl/code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_v1/model.json",
+  "dataset_path": "/home/mshahidul/readctrl/code/text_classifier/verified_combined_0-80.json",
+  "num_examples": 221,
+  "num_correct": 182,
+  "lenient_accuracy": 0.8235294117647058,
+  "exact_accuracy": 0.8235294117647058,
+  "per_label_accuracy": {
+    "intermediate_health_literacy": 0.6438356164383562,
+    "low_health_literacy": 0.8571428571428571,
+    "proficient_health_literacy": 0.971830985915493
+  },
+  "target_clean_size": 200,
+  "removed_count": 21,
+  "clean_dataset_size": 200,
+  "removed_dataset_size": 21,
+  "removed_misclassified_count": 16,
+  "removed_per_label": {
+    "low_health_literacy": 7,
+    "proficient_health_literacy": 7,
+    "intermediate_health_literacy": 7
+  }
+}

code/text_classifier/dspy_model/student-gpt5-mini_teacher-gpt5_v1/model.json

@@ -0,0 +1,99 @@
+{
+  "classifier.predict": {
+    "traces": [],
+    "train": [],
+    "demos": [
+      {
+        "augmented": true,
+        "generated_text": "A 19-year-old woman presented with acute palpitations. The initial ECG demonstrated ventricular tachycardia with right bundle branch block morphology associated with left posterior hemiblock, and T-wave inversion in the inferior and precordial leads. Biomarkers were elevated (troponin 27 ng/L, normal <14 ng/L; NT-proBNP 2225 pg/mL, normal <130 pg/mL). She was admitted to the coronary care unit. Five years earlier, she had presented with cardiogenic shock due to fascicular ventricular tachycardia; CMR and a transoesophageal electrophysiological study at that time were inconclusive. She was discharged with a diagnosis of tachycardiomyopathy on ACE inhibitors, a mineralocorticoid receptor antagonist, and beta blockers, with an uneventful interval thereafter.\n\nDuring the current hospitalization, there were no further hyperkinetic arrhythmias. Basal 12-lead ECG was obtained. Echocardiography showed diffuse hypokinesia of both ventricles. CMR was again inconclusive, and an undiagnosed congenital cardiac anomaly was suspected. Cardiac computed tomography angiography (CCTA) was performed (GE Lightspeed, retrospective gating, 100 kVp, 696 mAs, gantry rotation 0.35 s, 0.625 mm slice thickness; 70 mL Iomeron 400 mgI/mL IV). The left main and left anterior descending (with a wide ramus intermedius and two diagonal branches) and a thin, non-dominant left circumflex showed no obstructive coronary artery disease. The right coronary artery ostium and proximal segment were absent (ostial atresia); the mid and distal RCA were supplied by a large collateral from the distal LAD that coursed around the lateral right ventricular wall, traversed the distal atrioventricular groove, and gave rise to thin posterior interventricular and posterolateral branches. A thin branch from the mid LAD to the sinoatrial node was also observed.\n\nIn the differential for cardiogenic shock in otherwise healthy adults, once acute myocardial infarction is ruled out on 12-lead ECG and cardiomyopathy is not demonstrated on CMR, CCTA is the modality of choice to evaluate for congenital coronary anomalies and other causes. In this case, an echo-stress test confirmed inducible ischemia in the inferior wall, concordant with the arrhythmic focus location. The patient was transferred to a specialist congenital heart disease center, where she underwent transcatheter radiofrequency ablation of sustained ventricular tachycardia arising from the posteromedial papillary muscle. She was discharged on acetylsalicylic acid and verapamil. At 6-month follow-up she remained asymptomatic, without recurrent arrhythmias.",
+        "reasoning": "The text is dense with specialized cardiology terminology and acronyms (e.g., ventricular tachycardia, right bundle branch block, left posterior hemiblock, NT-proBNP, CMR, CCTA, ostial atresia, collateral circulation, inducible ischemia, transcatheter radiofrequency ablation). It includes detailed imaging parameters and precise coronary anatomy, lab values, and device/protocol specifics without lay explanations. Sentences are complex and multi-clause, reflecting advanced clinical reasoning and differential diagnosis. This level of jargon, detail, and structure targets readers with professional medical knowledge.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 45-year-old man was hospitalized with COVID-19 pneumonia and had no prior neurologic history. On hospital day 16, he suddenly developed reduced consciousness, his eyes deviated to the right, and he had jerking movements on the left side of his face and chest, followed by a generalized tonic–clonic seizure. After the seizure, he was left with persistent weakness on the left side (left hemiparesis). Brain CT was normal, and a spinal tap showed slightly elevated protein but no increase in white blood cells. Importantly, the cerebrospinal fluid tested positive for SARS-CoV-2 by RT-PCR, making viral involvement of the brain (encephalitis) likely and bacterial meningitis unlikely. An EEG did not show clear abnormalities, and later MRI was also unremarkable. He improved gradually, his condition stabilized, and his overall outcome was favorable.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 25-year-old man went to the mouth clinic because he had painful canker sores on his lips. The outside of his lips had crusty scabs that hurt and bled easily. Inside his mouth, the inner parts of his upper and lower lips had red, sore, uneven patches. A blood test for the cold sore virus (HSV-1) was positive. The doctor said he had a condition called HAEM. His treatment included a steroid mouth paste (triamcinolone acetonide 0.1% in orabase), acyclovir pills, multivitamins, and salt-water (0.9% NaCl). He was also told to keep his mouth clean, avoid spicy and sour foods, and stop licking his lips.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 20-year-old Arabic male martial artist had 5 weeks of left hamstring pain after a sports injury and did not improve with medications or physiotherapy. Hamstring syndrome was ruled out, and he stopped all sports during recovery. Intervention: a modified slump mobilization (a seated nerve-gliding technique) was performed with four repetitions on 3 consecutive days, along with postural retraining. Outcomes: Pain on the numeric pain rating scale improved from 5/10 at rest and 7/10 with activity to 2/10 at rest and 4/10 with activity by day 3. The Knee Society Score also improved: pain from 22 to 61 and function from 30 to 80. At 2 months, he reported complete symptom resolution and returned to sports without limitation.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 65-year-old man developed persistent swelling and a boutonniere deformity of the right middle finger after a motorcycle fall six months earlier. He could not fully extend the finger. On exam, the finger showed edema with flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal (DIP) joint. Active PIP range of motion (ROM) was 45–110 degrees. X‑rays of the right hand (AP/oblique) showed no bone injury, indicating a soft-tissue problem consistent with a central slip injury. The patient underwent reconstruction of the central slip using a partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. A PIP extension splint was used for 2 weeks. Active and passive PIP ROM exercises began after 2 weeks. One month after surgery, PIP ROM improved to 0–90 degrees, and by 2 months it returned to normal. Hand function, measured by the DASH score, improved markedly from 50 to 4.2.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 67-year-old patient with no medical history presented with a 6‑month course of dysphagia and dysphonia and deterioration of general condition (15 kg weight loss over 6 months). On examination: GCS 15/15, afebrile, BP 12/07 cmHg, SpO2 100%, HR 80/min, normal conjunctivae, and a large mass in the cavum; no hepatosplenomegaly or peripheral adenopathy; otherwise unremarkable exam. Cervico-thoraco-abdomino-pelvic CT identified a 70 × 40 mm nasopharyngeal mass extending to 60 mm. Laboratory studies were normal (WBC, renal and hepatic function, LDH) with negative HIV, HCV, and HBV serologies. Nasopharyngeal biopsy with histology and immunohistochemistry in two independent readings supported a grade 1–2 follicular B‑cell NHL: CD20+, CD19+, CD79a+, CD10+. Bone marrow biopsy and the pre‑therapeutic work‑up were normal. The patient received 4 cures of R‑CHOP‑21 (rituximab 375 mg/m2 IV, cyclophosphamide 750 mg/m2 IV, oncovin 2 mg IV, prednisolone 100 mg PO, doxorubicin 50 mg/m2 IV) without response, followed by 3 cures of R‑DHAOX (rituximab 375 mg/m2 IV D1, high‑dose aracytine 2 g/m2 × 2 IV D2, dexamethasone 40 mg D1–D4, oxaliplatine 100 mg/m2 D1) with no clinical response. Due to persistence and increase of the nasopharyngeal mass, a tracheotomy was performed. Repeat biopsy of the mass objectified disappearance of lymphoid B infiltration with presence of AL‑type kappa amyloid deposits. Immune electrophoresis of plasma proteins revealed immunoglobulin M kappa; serum free light chains were not dosed due to resource limitations. Myelogram and a second bone marrow biopsy were normal. PET (TEP) showed a hypermetabolic nasopharyngeal process without other anomalies. Cardiac evaluation (ECG, natriuretic peptides, troponin, echocore) and renal assessment were unremarkable. The patient is currently under a bortezomib, prednisone, and bendamustine protocol, with good clinical evolution after the first treatment. This trajectory suggests an IgM‑associated localized AL amyloid process emerging in the site of the prior follicular lymphoma, despite systemic evaluations (including marrow and organ assessments) remaining normal.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 2‑day‑old term male neonate, delivered by cesarean section at a private hospital, was referred for a congenital right scrotal swelling and presented to our children’s hospital one day later. On ED arrival he was well hydrated, pink on room air with good perfusion. Physical exam: right hemiscrotum with an enlarged, tense, non‑tender, visibly reddish testis and overlying skin excoriation; transillumination negative on the right and positive contralaterally; both hernial orifices normal. Laboratory studies were obtained, and urgent inguinoscrotal Doppler ultrasonography demonstrated an enlarged right testis measuring 15.6 × 9.4 mm with heterogeneous hypoechoic echotexture, prominent rete testis, and absent intratesticular color Doppler flow. The left testis was normal in size, shape, and echotexture; there was minimal hydrocele. The patient underwent urgent scrotal exploration. Intra‑operatively there was frank necrosis of the right testis secondary to intravaginal testicular torsion, with minimal hydrocele. A right orchidectomy and contralateral orchidopexy were performed. Contextually, perinatal testicular torsion often presents at or shortly after birth and Doppler evidence of absent flow with heterogeneous hypoechoic parenchyma correlates with nonviability; salvage rates are low when presentation is delayed. Contralateral orchidopexy is commonly performed to mitigate future torsion risk.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "At 16 months, a boy had a stiff heart muscle and was put on the heart transplant list. At 20 months, he needed an external heart pump (Berlin Heart) to help both sides of his heart. At 23 months, he had a stroke on the left side of his brain. Doctors treated the clot from inside an artery, like snaking a drain. The treatment worked well. One month later, he got a new heart, and the surgery went well.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "An 18-year-old man came to the emergency room with new chest pain, fever, and trouble breathing when he lay down. A blood test showed strain on his heart. His heart tracing had changes that can happen when the heart is irritated. His chest X-ray made the heart look bigger than normal. An ultrasound showed the heart muscle was very thick on both sides. It also showed fluid around the heart. Blood tests pointed to a common virus called Coxsackie, which can inflame the sac around the heart. Doctors treated him, but he got worse with shortness of breath and very low blood pressure. A new heart ultrasound showed the fluid was starting to squeeze his heart, like a tight jacket. Doctors drained the fluid, but his heart stopped, and he needed a heart-lung machine to stay alive. A small piece of heart tissue did not show infection. A small skin lump on his right arm was tested. It showed a rare blood cancer linked to the Epstein–Barr virus. He started cancer medicines. His heart pumping got better. The fluid around his heart went away. The thick heart muscle slowly went back toward normal.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_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.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 65-year-old man presented with cough, shortness of breath, and weight loss. Chest CT showed a poorly defined nodule in the right lung. A trans-thoracic biopsy confirmed a pulmonary lymphoepithelioma-like carcinoma: large polygonal tumor cells arranged in sheets with abundant lymphocytes and plasma cells. Immunohistochemistry supported this diagnosis (cytokeratin 5/6 and p63 positive; Napsin A and TTF-1 negative). PD-L1 expression was very high (about 100%), and the tumor cells were positive for Epstein–Barr virus by EBER in situ hybridization. To confirm the lung as the primary site, a nasopharyngeal exam was negative. Additional testing from the case showed no EGFR, KRAS, ALK, or ROS1 alterations. Imaging later showed a right perihilar lesion with nodal disease. He received platinum-based chemotherapy (gemcitabine/cisplatin) with durvalumab; cisplatin was later changed to carboplatin because of side effects. Despite treatment, the disease progressed, and he died 9 months after diagnosis.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 19‑month‑old boy was admitted following a fall from a feeding highchair, landing on his gluteal region and striking the occiput. He had three episodes of vomiting, marked irritability, RR >60/min, HR >150/min, and SpO2 <80%. On exam, he was hydrated and conscious but irritable, with subcostal retractions and decreased breath sounds at the left base. Bag‑mask ventilation with supplemental oxygen and pulse oximetry monitoring were initiated; paradoxically, SpO2 fell below 70% with ongoing ventilation. Lung ultrasound demonstrated absent A‑lines and consolidation, visualizing the lung as solid parenchyma. Given the poor clinical condition, orotracheal intubation with a cuffed endotracheal tube was performed. Post‑stabilization chest CT revealed complete atelectasis of the left lung with interruption of the main left bronchus at 12 cm from the bronchial bifurcation. In the context of maternal history of an intensive coughing episode in the preceding days that resolved spontaneously within 24 h, foreign body aspiration was suspected. Rigid bronchoscopy identified and removed a 2‑cm almond lodged in the left main bronchus. The patient improved progressively, was extubated at 24 h, transferred from intensive care to the general pediatrics ward, and achieved full recovery of respiratory function. Based on the clinical course, the team hypothesized that severe respiratory compromise likely preceded the event, causing altered consciousness and subsequent head trauma.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "This report is about a woman with abnormal blood vessel connections in her left leg that she was born with. Her left leg stayed swollen for a long time. She then started having signs of heart trouble. At age 67, doctors confirmed the leg problem was complex and present since birth. The team used a special tube made for the big belly artery, plus a blocking procedure, to slow the bad blood flow in her leg. This was done to help her sudden heart failure caused by the leg problem. The report explains what worked well and what did not.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "This report describes the first known case of heatstroke occurring together with SARS‑CoV‑2 infection in a 52‑year‑old man. He had a recent cold and a positive self-test for COVID‑19, then returned to work and lost consciousness after five hours outdoors in 35°C heat. On arrival at the hospital his core temperature was 40°C and he was comatose with breathing problems and gastrointestinal bleeding; clinicians diagnosed heatstroke. He was admitted to the ICU, placed on a ventilator, given IV fluids, antibiotics, blood‑pressure support, and continuous renal replacement therapy when his kidneys failed. Laboratory tests showed severe infection, low platelets and a severe clotting disorder (disseminated intravascular coagulation), plus liver, kidney and heart injury. Sputum and airway cultures later grew several pathogens (including Stenotrophomonas, Candida, MRSA, Acinetobacter and Aspergillus), and he was treated with broad antibiotics, antifungals, plasma and blood products, and anticoagulation as needed. After these treatments his fever subsided and he regained consciousness by about day 13 and was briefly taken off the ventilator. Several days later he suddenly worsened with respiratory failure, high fever and a return to coma; brain imaging showed an ischemic stroke and a hemorrhagic infarct. Despite further intensive care, he developed a large cerebral hemorrhage with brain herniation; surgery was not performed and his condition progressed to multiple organ dysfunction syndrome (MODS). The combination of multi‑pathogen pulmonary infection and an intractable coagulopathy ultimately led to MODS and death on day 29.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 35-year-old man developed heart failure due to Carney syndrome, which caused a cardiac myxoma and dilated cardiomyopathy. Three years earlier, he presented with sudden chest tightness and shortness of breath. Echocardiography suggested a myxoma, and the diagnosis of Carney syndrome with cardiac myxoma was confirmed by physical examination and genetic screening. He improved with symptomatic treatment and was discharged; surgery was not performed at that time. His symptoms later worsened, and he returned with severe (New York Heart Association class IV) heart failure. Echocardiography then showed dilated cardiomyopathy accompanied by a cardiac myxoma. He ultimately underwent heart transplantation, which successfully treated his heart failure.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "This newborn had a very serious genetic condition called neonatal Marfan syndrome. It badly affected his heart. His fingers and toes were very long like spider legs. Some fingers and toes were stuck in a bent position. His elbows and knees could not fully straighten. His face looked old for a baby. His eyes were deep set and tilted downward. His ears were soft and not well formed. His mouth sagged. His head was short and wide. The clear lenses in his eyes were out of place. A DNA test found a new change in the fibrillin-1 gene in a spot linked to the newborn form of this condition. Doctors tried medicines to lower the heart’s workload, kept him deeply sedated to reduce strain, and gave water pills to help him pee and move extra fluid. Even with this care, the heart valve leaks and high pressure in the lungs got worse, and the heart grew weaker. Surgery would have been needed to help him live longer. Because the disease was getting worse very fast, the family chose comfort care. A few months after birth, his heart failure worsened and he died.",
+        "literacy_label": "low_health_literacy"
+      }
+    ],
+    "signature": {
+      "instructions": "Analyze the linguistic complexity, use of medical jargon, and sentence \nstructure of 'generated_text' to determine the health literacy level.",
+      "fields": [
+        {
+          "prefix": "Generated Text:",
+          "description": "A version of the source text rewritten for a specific audience."
+        },
+        {
+          "prefix": "Reasoning: Let's think step by step in order to",
+          "description": "${reasoning}"
+        },
+        {
+          "prefix": "Literacy Label:",
+          "description": "Classification: low_health_literacy (simple words, no jargon), intermediate_health_literacy (moderate technicality), or proficient_health_literacy (highly technical/original level)."
+        }
+      ]
+    },
+    "lm": null
+  },
+  "metadata": {
+    "dependency_versions": {
+      "python": "3.11",
+      "dspy": "3.1.3",
+      "cloudpickle": "3.1"
+    }
+  }
+}

code/text_classifier/dspy_model/vllm-Qwen2.5-7B-Instruct_teacher-gpt5_v1/accuracy.json

@@ -0,0 +1,4 @@
+{
+  "accuracy_score": 59.52,
+  "num_results": 84
+}

code/text_classifier/dspy_model/vllm-Qwen2.5-7B-Instruct_teacher-gpt5_v1/cost.json

@@ -0,0 +1,8 @@
+{
+  "gpt-5": {
+    "prompt_tokens": 122958,
+    "completion_tokens": 12233,
+    "cached_tokens": 0,
+    "cost_usd": 0.2760275
+  }
+}

code/text_classifier/dspy_model/vllm-gemma-3-12b-it_teacher-gpt5_v1/accuracy.json

@@ -0,0 +1,4 @@
+{
+  "accuracy_score": 79.76,
+  "num_results": 84
+}

code/text_classifier/dspy_model/vllm-gemma-3-12b-it_teacher-gpt5_v1/cost.json

@@ -0,0 +1,8 @@
+{
+  "gpt-5": {
+    "prompt_tokens": 122958,
+    "completion_tokens": 12114,
+    "cached_tokens": 0,
+    "cost_usd": 0.27483749999999996
+  }
+}

code/text_classifier/dspy_model/vllm-gemma-3-12b-it_teacher-gpt5_v1/model.json

@@ -0,0 +1,99 @@
+{
+  "classifier.predict": {
+    "traces": [],
+    "train": [],
+    "demos": [
+      {
+        "augmented": true,
+        "generated_text": "A 19-year-old male with no significant history presented with an 8-month painful left scrotal mass unresponsive to antibiotics for presumed pyogenic infection, along with intermittent low-grade fever, night sweats, anorexia, and weight loss. Exam showed a large, painful, slightly warm left bursa and two firm, painful subcutaneous formations on the anterior thoracic wall (3–4 cm). CRP was 90 mg/dl; CBC, creatinine, glucose, and liver function tests were normal. Chest radiograph demonstrated bilateral reticulonodular infiltrates. Scrotal ultrasound suggested an epididymal tumor, and a left orchidectomy was performed. Histopathology revealed granulomatous epithelioid necrosis of the epididymis, consistent with active epididymal tuberculosis involving the body and tail and sparing the head and testis. The tuberculin skin test was positive. AFB studies of sputum and urine on 3 consecutive days were negative on direct smear and culture. HIV, HBV, HCV serologies and Wright's were negative. Thoraco-abdomino-pelvic CT identified miliary tuberculosis, coelo-mesenteric necrotic adenopathies, two thoracic parietal collections within the external oblique muscles (33 × 10 mm right, 45 × 10 mm left), and focal osteolysis of D11 and L5 suggestive of early spondylodiscitis; spinal MRI confirmed spondylodiscitis at D7, D11, L4, and L5. The diagnosis was disseminated tuberculosis with epididymal, pulmonary, parietal, ganglionary, and osteo-articular involvement. Treatment consisted of isoniazid, rifampicin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid plus rifampicin. At month 4 of therapy he developed generalized tonic-clonic seizures; brain MRI showed multiple supra- and infratentorial nodular lesions compatible with tuberculomas. An anticonvulsant was added and anti-tuberculous therapy was continued. Evolution was favorable with early weight gain and disappearance of thoracic parietal formations, adenopathies, and miliary lesions on CT; there was no recurrence of seizures. Because the tuberculomas regressed slowly, therapy was prolonged; he was ultimately declared cured without sequelae at the end of the 234th month of treatment (as reported) with 2-year follow-up. Context: Epididymal tuberculosis can mimic neoplasm and may occur with negative AFB studies; CNS tuberculomas emerging during therapy are a recognized phenomenon, typically managed by continuing anti-tuberculous treatment with seizure control.",
+        "reasoning": "The text uses dense medical jargon and numerous abbreviations (e.g., AFB, CT, MRI, CRP, CNS), detailed pathology/imaging terms (granulomatous epithelioid necrosis, miliary tuberculosis, spondylodiscitis, tuberculomas), and specific drug regimens. Sentences are long and multi‑clause, with parenthetical measurements and technical qualifiers. It assumes familiarity with diagnostic workflows and disease mechanisms without lay explanations. This is written in a professional case‑report style suited to clinicians.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "Who: A 27-year-old woman, 16 weeks pregnant. She has a blood problem called beta thalassemia major. She gets a blood transfusion every month. She stopped her iron-removing medicine because she is pregnant.\n\nMain mouth problems: Her gums are swollen, red, soft, and bleed easily. She has bad breath. Her lips are very dry and peeling. There are deep spaces like pockets around her teeth that trap germs and cause pain all around her mouth. She had never seen a dentist before. Her blood test showed anemia and signs of an infection.\n\nWhat the dentists called it: Swollen gums and long-term gum disease linked to pregnancy and her blood problem.\n\nCare plan: Rinse the mouth with 3% hydrogen peroxide. Use a chlorine dioxide spray mouthwash. Take antibiotics. Get a professional teeth cleaning to remove hard buildup. Follow simple daily mouth-care steps at home. Keep getting monthly blood transfusions. Do not take the iron-removing medicine during pregnancy.\n\nResult: After three months of care by a dental and medical team, her mouth got much better.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 70-year-old man had a bad leak in his main heart valve. Doctors placed a new valve through a small opening near the tip of his heart. Four weeks later, his heart got worse again. Doctors added a heart pump to help move blood. About a year later, a heart scan showed the valve was leaking badly through the middle. The team put a second valve inside the first one, like stacking one cup inside another. They turned the heart pump down to its lowest setting during the procedure. They also made his heart beat fast at 140 beats per minute to keep the new valve steady. The result was excellent. One year later, he felt well and the valve leak was no longer a problem.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 16-year-old girl has a sunken, gray patch on her left thigh. A special scan that looks at blood vessels showed a blood vessel problem in the skin and in the layer just under the skin.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 56-year-old female with CTD-PAH secondary to Sjogren’s syndrome (diagnosed 2013) complicated by ILD initially presented with dyspnea. Early studies showed interstitial changes and cardiomegaly on chest X-ray; echocardiography demonstrated PASP 99 mmHg, RA/RV enlargement, D-shaped LV, and severe TR. Chest CNYCT showed no filling defects to suggest PE, with enlarged pulmonary trunk, RA, and RV, consistent with PH. Sjogren’s was confirmed by sicca symptoms with Schirmer’s <5 cm OU, positive minor salivary gland biopsy, impaired salivary gland function on nuclear medicine scan, and positive anti-Ro. She began Revatio (sildenafil) 20 mg TID in 2013; Tracleer (bosentan) was added in 2016. Right heart catheterization in 2017 showed mPAP 39 mmHg, PVR nearly 15 Woods, and wedge 4 mmHg, indicating pre-capillary, group I CTD-PAH; Opsumit (macitentan) 10 mg QD replaced bosentan. From 2017 to 2020 she required repeated steroid hospitalizations for Sjogren’s control. Her risk status was low-to-intermediate on dual therapy until October–November 2020, when she developed worsened dyspnea and signs of infection, then severe decompensation on November 10 with SpO2 70% requiring 100% O2 via face tent, lactate 5.2 mmol/L, and BNP >10,000 pg/mL, consistent with cardiogenic shock. She was intubated in the ICU, started on four PH agents, stabilized, and improved; heart–lung transplant evaluation began November 12, vasopressors were discontinued November 13, she was extubated November 14, and transferred to the ward November 21 on nasal cannula 2 L/min. Follow-up RHC showed persistently elevated PA pressures attributed to chronic PH with right heart strain. She was reclassified as high risk; Ventavis (iloprost) 10 mcg/ml 2 ml was added in 2020. In May 2023, molecular hydrogen was initiated as adjuvant therapy: 1 capsule/day (PURE HYDROGEN; HoHo Biotech, Taipei, Taiwan), each containing 170 mg of hydrogen-rich coral calcium with 1.7×1,021 molecules of hydrogen, equivalent to 24 cups of water at 1,200 ppb H2 or 0.6 mM H2 per 200 ml water. Flow cytometry and serology (standard fluorescent dye preparation; dried reagent kits, Beckman Coulter; immunophenotyping and gating per prior methods) before and after hydrogen therapy demonstrated increased CD127+ Treg populations and decreased B cell subsets; anti-Ro antibody levels declined. Clinically, signs and symptoms stabilized following the addition of hydrogen therapy, and no adverse reactions occurred. The case adheres to CARE reporting guidelines (2013 CARE Checklist).",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 42-year-old woman with primary cough headache (PCH) could not tolerate oral preventive medicines because of side effects. She developed more than ten short, severe headache attacks a day after a bout of bronchitis; each attack lasted about 30 minutes, was triggered by coughing, straining or lifting, and reached 9/10 on a pain scale. Neurological exam and brain and neck imaging were normal, and she declined a lumbar puncture. Because she could not keep taking indomethacin and could not use other oral options, we offered an ultrasound-guided proximal greater occipital nerve block (PGONB) using bupivacaine. After a single, unilateral block the pain fell from 9/10 to 2/10 within 20 minutes. The block was repeated once weekly for a month; at two months both the number of attacks and their intensity had declined (about two attacks per month at 4/10), and by six months she reported no attacks. No adverse effects from the nerve blocks were observed, suggesting ultrasound-guided GON blockade can be an effective option when oral drugs are not tolerated.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 14-year-old with suspected lymphoblastic non-Hodgkin lymphoma on protocolized induction (PINDA 0516) received L-asp E. coli 10,000 IU/m2 plus a glucocorticoid (prednisone). After seven doses of L-asp (cumulative ~90,000 IU) he developed clinical decline with vomiting, abdominal pain, and mild dehydration. Pancreatitis was suspected but excluded (amylase/lipase normal; liver tests normal). Laboratory assessment showed hyponatraemia (reported as 126 mOsm/kg) with urinary osmolality 510 mOsm/kg and concurrent hypertriglyceridaemia, prompting the diagnosis of pseudohyponatraemia secondary to hypertriglyceridaemia associated with L-asp plus corticosteroids. He was managed by Gastroenterology and Endocrinology with a diet low in refined sugars and rich in fiber, fibrates (ciprofibrato/ciprofibrate 100 mg PO daily), and omega-3 fatty acids (4 g PO daily), targeting triglycerides ≤300 mg/dL. Two weeks later triglycerides were 79 mg/dL; ciprofibrato and omega-3 were discontinued with advice for prophylactic use during subsequent corticosteroid/L-asp exposure. The patient ultimately completed 12 total doses of L-asp (cumulative 184,000 IU) for induction; L-asp and prednisone were not discontinued due to the end of indication per protocol. Causality assessment for the adverse drug reaction (ADR) using the modified Karch and Lasagna algorithm (WHO) was Definitive for the association of L-asp plus prednisone. No complications occurred, and the hypertriglyceridaemia resolved within 14 days. Mechanistically, L-asparaginase can reduce lipoprotein lipase activity and increase VLDL, while corticosteroids augment hepatic VLDL production; marked lipaemia then produces pseudohyponatraemia via indirect ion-selective electrode dilutional error, with normalization as triglycerides fall.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 56-year-old Italian woman has a serious inherited blood problem that needs regular transfusions. She had an MRI to check iron in her heart, liver, and pancreas. At that time, her heart, liver, and hormone health were okay. She was taking an iron-removing medicine, vitamin D, and a medicine that helps her body make red blood cells. The MRI also spotted a lump in the middle of her chest, in front of the heart, where the thymus sits. A PET scan showed the lump was only a little active. A chest CT showed many thin-walled air pockets like bubbles in both lungs. This pattern fits a rare lung disease called LAM. A team of doctors reviewed her case. She had keyhole surgery to remove the thymus lump and a small wedge of lung. Lab tests showed the chest lump was a thymus tumor called thymoma. The lung tissue showed LAM. After surgery, her doctors advised radiation to the chest area and a medicine called sirolimus for LAM.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 39-year-old woman with peripartum cardiomyopathy underwent orthotopic heart transplantation in October 2014. Induction was basiliximab plus methylprednisolone. Maintenance immunosuppression included tacrolimus XL 7 mg daily, everolimus 1 mg twice daily, and prednisolone 5 mg/day. She had two episodes of acute rejection in the first post-transplant year, managed with methylprednisolone pulse therapy. Baseline renal function during year one was normal (creatinine 0.88 mg/dL; eGFR 102 mL/min/1.73m2). Follow-up was by the heart transplant team; routine BK polyomavirus screening (plasma PCR or urine cytology) was not performed.\n\nIn 2016, creatinine rose to 1.9 mg/dL (eGFR 32.6), with tacrolimus trough 7.2 ng/mL and everolimus 5.2 ng/mL. Calcineurin inhibitor toxicity was suspected; tacrolimus was reduced to 4 mg daily, and creatinine improved to 1.25 mg/dL (eGFR 54.1); no biopsy was obtained. In March 2017, creatinine increased to 2.69 mg/dL (eGFR 21.4) without symptoms. Vitals and exam were unremarkable; renal ultrasound showed normal size with increased echogenicity; urinalysis/culture were negative (no hematuria, pyuria, or casts); echocardiogram showed adequate cardiac function; HIV, syphilis, HBV, and HCV serologies were negative. Tacrolimus and everolimus troughs were 5.2 ng/mL and 5.98 ng/mL, respectively. Despite IV hydration and reducing tacrolimus XL to 2 mg daily, renal function did not improve, prompting biopsy.\n\nRenal biopsy demonstrated active chronic interstitial (tubulointerstitial) nephritis associated with advanced polyomavirus nephritis. Plasma BK virus PCR was positive at 33,800 copies/mL (log 4.5). Tacrolimus was discontinued; creatinine stabilized between 2.2 and 2.4 mg/dL with declining BK viremia to undetectable. Over three years, there were no further cardiac rejection episodes. At two years of follow-up from diagnosis of BKVN, renal function was stable with creatinine 2.5 mg/dL (eGFR 23.4 mL/min/1.73m2).\n\nContext: BK polyomavirus nephropathy, while classically described in kidney transplant recipients, can occur in non-renal solid organ transplant recipients under potent immunosuppression. Management centers on reduction of immunosuppression; maintaining an mTOR inhibitor (everolimus) while withdrawing the calcineurin inhibitor can aid viral clearance, at the potential cost of rejection risk, which was not observed here. Plasma BK viral load (log 4.5) plus biopsy-proven late-stage BKVN established the diagnosis and guided therapy.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "This is about a 20-year-old woman. She had a kidney problem since age eight that made protein leak into her urine. The problem first showed up when a big blood clot blocked veins in her brain, and a clot also went to her lungs. She took blood thinners and steroid pills. Later she took a medicine that calms the immune system to help her use fewer steroids. Tests showed no inherited blood-clotting problem. She had several flare-ups of the kidney problem. Steroid pills controlled them until 2017. After that she had no relapses. Her doctors stopped the blood thinner and the immune-calming medicine. One year later she had sudden, very bad belly pain all over. She threw up after eating. Both legs were swollen. Tests showed the kidney problem was back. A special X-ray picture (CT scan) showed a new clot in the main artery that feeds the small intestine. It was like a plug in a pipe that stops water. Blood could not reach the intestines. In surgery, most of her small intestine was dead. Taking out that much bowel would not allow life. She died 48 hours later.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "We retrospectively reviewed medical records from a pediatric neurology consultation at a third‑level hospital (2015–2020) for patients with congenital myotonia. Inclusion criteria comprised a clinical diagnosis (myotonia, warm‑up phenomenon, characteristic electromyographic pattern and/or family history) and/or a molecular diagnosis (CLCN1 mutation). For each patient we abstracted demographics (age, sex), disease course (age of onset, symptoms and signs, time to diagnosis, clinical evolution), family history, and treatment response, along with complementary testing and genotypes. Five cases with a clinical diagnosis of congenital myotonia were identified: three with Becker’s disease (recessive phenotype) and two with Thomsen’s disease (dominant phenotype). Incidence relative to births was estimated at 1:15,000 for Becker phenotypes and 1:21,000 for Thomsen phenotypes. Most patients were female; the single male was the only child with onset before age six. Initial presentation included myotonia in the lower limbs in four of five patients and in the upper limbs in all but one. Age at onset ranged from 22 months to 12 years (median 6 years). Genetic diagnosis was pursued approximately two years after onset; one family declined testing. All patients reported worsening with cold; the warming phenomenon was noted only in those with the Becker phenotype. Patients with recessive congenital myotonia showed some progression. Family history included: patients 2 and 3 were sisters with unaffected parents; the mother of patient 1 had mild, cold‑provoked, doubtful clinical signs; the patient who declined genetic testing had a maternal‑line history of myotonia. Serum creatine kinase was not elevated in any case. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age (not repeated). Initial therapy most often used was oxcarbazepine in the recessive form, with generally good response; in case 2 it lost efficacy and mexiletine was initiated. Case 4 trialed several drugs without success due to loss of efficacy or adverse effects. Case 5 declined treatment given mild symptoms. Patient 1 harbored a previously undescribed, likely pathogenic variant, CLCN1: c.824T>C, maternally inherited. Cases 1–3 (Becker phenotype) carried composite heterozygosity mutations; cases 4–5 had the Thomsen phenotype, and case 5 declined genetic testing.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 78-year-old woman enrolled in a community pharmacy personalised dosage system (PDS/SPD) presented at medication pickup reporting several months of asthenia, weakness, dizziness, and confusion, limiting her usual ambulation. There were no new medicines in the SPD register. On-site vitals with an Omron Complete device showed SBP 96 mmHg, DBP 52 mmHg, HR 69 bpm, raising concern for symptomatic hypotension possibly related to her regimen. Her active medications and doses were: doxazosin 2 mg q24h (0-0-1) for hypertension; losartan 100 mg q24h (1-0-0) for hypertension; manidipine 20 mg q24h (0-1-0) for hypertension; simvastatin 40 mg q24h (0-0-1) for hypercholesterolemia; acetylsalicylic acid 100 mg q24h (1-0-0) for secondary prophylaxis; omeprazole 20 mg q24h (1-0-0) for ulcer prevention; pregabalin 100 mg q12h (1-0-1) for neuralgia; torasemide 10 mg q24h (1-0-0) for edema; dulaglutide 1.5 mg weekly; insulin glargine 74 IU q24h (1-0-0); insulin lispro 20 IU q24h (0-1-0) for diabetes; brimonidine 1 drop q12h (1-0-1) for ocular hypertension.\n\nRenal function by CKD-EPI yielded eGFR 30 ml/min/1.73 m2. Dose appropriateness was assessed against product information and a consensus guideline for drug use in renal impairment from the University of Barcelona Faculty of Pharmacy practical pharmacy group (ATC-organised, with overdose symptom summaries and risk stratification by eGFR). Based on eGFR 30 ml/min/1.73 m2, antihypertensive agents losartan and manidipine required dose adjustment; pregabalin also warranted renal dosing, and torasemide was recognised as potentially contributing to low BP. The team prioritised adjusting antihypertensives first and proposed deferring changes to pregabalin until after reassessing response.\n\nIntervention: A report to the primary care physician recommended reducing losartan to 50–75% of standard dose for eGFR 30–59 ml/min/1.73 m2 and adjusting manidipine for eGFR 15–30 ml/min/1.73 m2. The PCP implemented losartan 50 mg q24h and manidipine 10 mg q24h. The PCP also substituted pregabalin 100 mg q12h with gabapentin 300 mg q12h.\n\nFollow-up over two months showed improved BP values and resolution of the initial symptoms. Gabapentin 300 mg q12h was verified as appropriate for eGFR ~30 ml/min/1.73 m2 (recommended total daily dose 300–900 mg for eGFR 30–60). Overall, the case suggests symptomatic hypotension related to cumulative antihypertensive effect in the setting of stage 3b CKD by eGFR, with clinical improvement after renal dose adjustment of losartan and manidipine and subsequent regimen optimisation.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 71-year-old patient with untreated, long-standing vitiligo presented with a 6-month history of right-eye visual loss and bilateral hearing loss, right-predominant. During admission he endorsed chronic headaches, intermittent fever, significant unintentional weight loss, generalized asthenia, and skin thickening. Initial ophthalmologic assessment: RO visual acuity reduced to light perception with impaired color discrimination; LO visual acuity 20/200. There was an afferent pupillary defect in both eyes and hyperemic eyelid margins. Anterior segment (both eyes): hyperemic bulbar conjunctiva, ciliary injection, cornea with peripheral nummular subepithelial infiltrates, aqueous anterior chamber without cellularity, normal iris, and lenses with nuclear opacities. Fundus, RO: pale (++) optic disc with approximately 50% excavation, slightly blunted nasal margin, attenuated/“raised and thinned” vasculature, macular area with scattered pigment. Fundus, LO: 2+ vitreous haze; edematous, hyperemic optic disc with blurred margins; peripapillary streaked hemorrhages; excavation not assessable; thinned vasculature; macular area with scattered pigment. Impression at that time documented right optic atrophy and left anterior optic neuritis. Workup for ocular–neurologic disease included evaluation to exclude tuberculosis, herpes, ANCA and non-ANCA vasculitides, and sarcoidosis. Lumbar puncture: opening pressure within normal limits; CSF protein 54 mg/dL. Nerve conduction velocities showed a polyradiculoneuropathy with moderate–severe axonal degeneration involving all four extremities, greater in the lower limbs. Contrast-enhanced MRI of the brain and orbits showed no optic nerve enhancement and no intracranial masses, but did reveal sinusitis and meningeal enhancement. Sarcoidosis was further disfavored by a normal ACE level and a whole-body gamma scan without hypermetabolic foci. On repeat ophthalmologic evaluation, there was progression with persistent right optic atrophy and left anterior optic neuritis. High-dose pulse corticosteroids were initiated, followed by a taper. The patient experienced clinical and functional improvement, particularly in neurologic and ophthalmologic parameters.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "This story is about a 49-year-old woman who had lupus for many years. Over time, her kidneys and her heart got weaker. She needed dialysis to do the work of her kidneys for 4 years until she could get a kidney transplant. Her heart pump was very weak before surgery. To help her heart get through the operation, doctors gave her a heart-helping medicine called levosimendan. The time after surgery had some ups and downs. But she got through it. At about one month after surgery, her heart started to work better, and her new kidney worked normally. At about five months, her heart kept improving, and her kidney function stayed normal.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 27-year-old man presented to the emergency department with a fracture at the base of the neck of the right femur after a low-energy fall that involved axial loading and a twisting motion of the right hip. He had a known history of fibrous dysplasia in the right proximal femur and, 20 years earlier, underwent curettage, bone grafting, and prophylactic fixation; the hardware was removed one year later, and biopsy at that time confirmed fibrous dysplasia. Given the pattern and pathologic nature of the current fracture, the team proceeded with a definitive treatment: wide resection of the proximal femur and a total hip replacement using a modular prosthesis, along with cerclage to secure the construct. An excisional biopsy performed during surgery confirmed the same fibrous dysplasia that had been treated in childhood. He recovered well: imaging at four weeks showed the components in good position, and he progressed from partial weight-bearing to full weight-bearing with a walker around day 20. He returned to daily activities with a mild, intermittent limp related to the gluteus medius incision and was able to do low-impact activities such as walking, reporting high satisfaction with the outcome.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 19-year-old man was admitted with an 8-month history of a painful left scrotal mass. He underwent an orchidectomy, and pathology favored epididymal tuberculosis. Imaging then revealed additional TB sites: lymph nodes, lungs, the chest wall (parietal), and the bones and joints (osteoarticular). Standard anti-tuberculosis therapy was started. In the fourth month of treatment he developed generalized seizures, and brain MRI showed tuberculomas. Treatment was continued along with an anticonvulsant, leading to good clinical and radiologic improvement.",
+        "literacy_label": "intermediate_health_literacy"
+      }
+    ],
+    "signature": {
+      "instructions": "Analyze the linguistic complexity, use of medical jargon, and sentence\nstructure of 'generated_text' to determine the health literacy level.",
+      "fields": [
+        {
+          "prefix": "Generated Text:",
+          "description": "A version of the source text rewritten for a specific audience."
+        },
+        {
+          "prefix": "Reasoning: Let's think step by step in order to",
+          "description": "${reasoning}"
+        },
+        {
+          "prefix": "Literacy Label:",
+          "description": "Classification: low_health_literacy (simple words, no jargon), intermediate_health_literacy (moderate technicality), or proficient_health_literacy (highly technical/original level)."
+        }
+      ]
+    },
+    "lm": null
+  },
+  "metadata": {
+    "dependency_versions": {
+      "python": "3.11",
+      "dspy": "3.1.3",
+      "cloudpickle": "3.1"
+    }
+  }
+}

code/text_classifier/dspy_model/vllm-gpt-oss-20b_teacher-gpt5_v1/accuracy.json

@@ -0,0 +1,4 @@
+{
+  "accuracy_score": 78.57,
+  "num_results": 84
+}

code/text_classifier/dspy_model/vllm-phi-4_teacher-gpt5_v1/accuracy.json

@@ -0,0 +1,4 @@
+{
+  "accuracy_score": 73.81,
+  "num_results": 84
+}

code/text_classifier/dspy_model/vllm-phi-4_teacher-gpt5_v1/cost.json

@@ -0,0 +1,8 @@
+{
+  "gpt-5": {
+    "prompt_tokens": 136508,
+    "completion_tokens": 14810,
+    "cached_tokens": 0,
+    "cost_usd": 0.318735
+  }
+}

code/text_classifier/dspy_model/vllm-phi-4_teacher-gpt5_v1/model.json

@@ -0,0 +1,103 @@
+{
+  "classifier.predict": {
+    "traces": [],
+    "train": [],
+    "demos": [
+      {
+        "augmented": true,
+        "generated_text": "A 2-year-old female with a 1-year history of painless, progressive left proptosis and no systemic disease or family history presented with light perception only in the left eye. Examination showed proptosis with inward and upward globe displacement; restricted extraocular movements in downward and outward gaze; a palpable, irregular, well-defined soft mass in the inferior orbit; left lower lid ectropion; a 4 mm mydriatic, nonreactive pupil; and otherwise unremarkable anterior segment (fundus view limited by age). Hertel exophthalmometry: OD 10.5 mm, OS 18 mm. MRI demonstrated a well-circumscribed mass, hypointense on T1WI and hyperintense on T2WI; contrast-enhanced imaging demonstrated no significant improvement. The lesion was excised via a transconjunctival approach through the inferior fornix with canthotomy and cantholysis. Intraoperatively, a grayish-white cystic mass with a distinct boundary was identified; posterior dissection revealed tight adhesion to the optic nerve. Due to lesion size and limited exposure, volume reduction was performed with aspiration of approximately 12.5 mL of fluid, followed by complete excision. Histopathology showed a fibrous capsule lined by squamous and glandular epithelium with visible brain tissue and cartilage-like matrix, consistent with orbital teratoma; immunohistochemical examination corroborated the diagnosis. One month postoperatively, the patient developed enophthalmos, conjunctival hyperemia, and keratitis, attributed to prior orbital cavity enlargement by the mass leading to postoperative volume deficit; corneal nonapposition to the lids created a gap and corneal inflammation. After guardian consent, a second operation implanted allogeneic sclera to augment orbital volume, alleviate fossa pitting, and normalize keratitis. At 1-year follow-up, there was no recurrence of the teratoma. Residual findings included minor enophthalmos and outer canthus abnormality; visual acuity remained at preoperative levels. Hertel measurements were OD 10.5 mm and OS 8 mm; the remaining anterior segment examination was unremarkable.",
+        "reasoning": "The text uses dense medical jargon (e.g., proptosis, ectropion, Hertel exophthalmometry, T1WI/T2WI, transconjunctival approach, canthotomy/cantholysis, enophthalmos, conjunctival hyperemia, keratitis, orbital teratoma, immunohistochemistry). It includes detailed surgical techniques, imaging findings, histopathology descriptors, and quantitative measurements. Sentences are long and complex with multiple clauses, parentheses, and semicolons. This level of technicality and structure targets clinicians, not lay readers.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "augmented": true,
+        "generated_text": "A 28-year-old man had two red patches with small blisters and shallow sores on the inner part of his right arm and forearm for 2 days. The spots burned and itched. He had been on vacation on the coast of Ecuador when this started. The doctor took a small piece of skin to test. The diagnosis was a type of skin irritation called Paederus dermatitis. He was treated with allergy pills, a steroid cream, and cold packs. After 8 days, the rash went away. It left dark marks on the skin.",
+        "reasoning": "The text uses simple, everyday vocabulary and short sentences. Medical jargon is minimal; the only technical term (“Paederus dermatitis”) is framed as “a type of skin irritation,” and treatments (“allergy pills,” “steroid cream,” “cold packs”) are common terms. There are no complex statistics, acronyms, or dense syntax. Overall, it is easily understandable by a lay audience.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "augmented": true,
+        "generated_text": "A 4-year-old boy with metastatic neuroblastoma received intensive treatment, including chemotherapy, an autologous stem cell transplant, and then an allogeneic cord blood transplant. About a month after he developed upper respiratory symptoms and tested positive for RSV, he presented on day 194 post–cord blood transplant with worsening breathing problems and was ultimately diagnosed with pulmonary veno-occlusive disease (PVOD), a rare form of pulmonary hypertension caused by blockage of small lung veins. Lung biopsy not only confirmed PVOD-related changes but also showed lung injury patterns consistent with a recent viral infection. Taken together, the timing of his RSV infection and the biopsy findings suggest RSV may have contributed to the onset of PVOD.",
+        "reasoning": "The text uses several specialized medical terms and procedures (metastatic neuroblastoma, autologous/allogeneic transplants, pulmonary veno-occlusive disease, pulmonary hypertension, lung biopsy, RSV) and includes abbreviations. Some jargon is briefly explained (e.g., PVOD as blockage of small lung veins), and sentences are clear and moderately complex. Overall, it’s more technical than plain language but not as dense or detailed as a professional medical report.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 28-year-old male with no significant past medical history presented with a 48-hour history of two erythematous plaques with central vesicles and superficial ulceration on the flexor surface of the right arm and forearm, equidistant from the antecubital crease, associated with burning and pruritus. He denied systemic symptoms and had not self-medicated. He reported being on vacation in coastal Ecuador at the time of onset. Incisional biopsy demonstrated epidermal acanthosis, parakeratosis, and spongiosis, neutrophils within the stratum corneum, and perivascular lymphocytic infiltrates in the superficial, mid, and deep dermis. Integrating the clinical morphology, tropical travel history, and histopathology, the diagnosis of Paederus dermatitis was made. Management included antihistamines, topical corticosteroids, and cold compresses. By day 8, the eruption resolved, with residual post-inflammatory hyperpigmentation. Paederus dermatitis is an irritant contact dermatitis due to exposure to Paederus species toxin (pederin), typically producing burning, vesiculation, and superficial erosions; the histologic pattern here (spongiotic dermatitis with mixed inflammatory infiltrates) is consistent with this mechanism.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 28-year-old man presented to dermatology with a 48-hour history of two red patches with central blisters and shallow ulcers on the inner (flexor) side of his right arm and forearm. He described burning and itching at the sites, had no other systemic symptoms, and had not self‑medicated. He reported being on vacation in the coastal region of Ecuador when the lesions appeared. A skin biopsy showed changes consistent with an acute inflammatory reaction, and, together with the clinical picture and recent travel, the diagnosis of Paederus dermatitis (skin injury caused by contact with certain rove beetles) was made. He was treated with oral antihistamines, topical corticosteroids and cold compresses. After 8 days the lesions resolved, leaving post‑inflammatory hyperpigmentation.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 20-year-old Arabic male martial artist had 5 weeks of left hamstring pain after a sports injury and did not improve with medications or physiotherapy. Hamstring syndrome was ruled out, and he stopped all sports during recovery. Intervention: a modified slump mobilization (a seated nerve-gliding technique) was performed with four repetitions on 3 consecutive days, along with postural retraining. Outcomes: Pain on the numeric pain rating scale improved from 5/10 at rest and 7/10 with activity to 2/10 at rest and 4/10 with activity by day 3. The Knee Society Score also improved: pain from 22 to 61 and function from 30 to 80. At 2 months, he reported complete symptom resolution and returned to sports without limitation.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "A 5-year-old presented to the pediatric ED 13 hours after ingesting chlorpyrifos with abnormal jerks, severe dyspnea, tachypnea (RR 48/min with intermittent sighs), diaphoresis, salivation, polyuria, vomiting, and subsequent aspiration of a charcoal–palm oil mixture. On arrival: T 38.3°C, GCS 3/15, pinpoint pupils, generalized hypotonia, SpO2 88% with widespread crackles, HR 180/min, BP 120/80 mmHg, random blood glucose 14 mg/dl. Serum lactate and cholinesterase levels were unavailable. The working diagnoses were severe organophosphate poisoning (cholinergic crisis with type I paralysis), aspiration pneumonitis, respiratory failure, and impending shock. Because ICU care was unaffordable, NIV via bubble CPAP was initiated, improving SpO2 to 99–100%. Hypoglycemia was corrected with a dextrose bolus; 20 ml/kg normal saline was given for tachycardia. The patient received IV dexamethasone, mannitol, and atropine 0.02 mg/kg (discontinued after the first dose due to rapid tachycardia), plus empiric IV antibiotics for aspiration pneumonitis; pralidoxime was unavailable. Within 3 hours, a 500 mL fresh whole blood exchange transfusion (FWB-EBT) was performed, after which GCS improved to 9/15. Blood glucose fluctuated between 41–259 mg/dl during the first 15 hours and subsequently normalized. By hospital day 2, the patient developed thready pulses and hypotension; an additional NS bolus was administered and dopamine was started at 5 mcg/kg/min via a peripheral vein. Mannitol was discontinued. A second 500 mL FWB-EBT was performed. Over the first 30 hours, consciousness and respiratory distress improved, though rhonchi developed and were treated with nebulized salbutamol and budesonide; the patient was transitioned to oxygen via nasal prongs with SpO2 ~97%. A day-2 chest radiograph showed bilateral infiltrates consistent with pneumonia. Full consciousness returned by hour 39. Antioxidants (IV vitamins C and B; oral vitamin E and zinc) were started, and diet was advanced over 48 hours. The patient responded rapidly overall, did not develop intermediate syndrome, and was discharged on hospital day 10; follow-up was lost. Exchange transfusion was utilized as a detoxification strategy in the absence of oximes and may have contributed to clinical stabilization by reducing circulating toxin and replenishing cholinesterase activity, alongside atropinization, ventilatory support, fluids, and inotropic therapy.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "A 4-year-old boy had a cancer called neuroblastoma that had spread. He got strong chemotherapy and then had his own stem cells put back. Later, he received a cord blood transplant from a donor. About a month before his lung problem, he had cold-like symptoms and tested positive for RSV. On day 194 after the cord blood transplant, he developed a rare problem where the small veins in the lungs get blocked (PVOD). A lung biopsy showed damage that looked like it came from a virus, along with the PVOD changes. This suggests the RSV infection may have helped trigger the lung problem.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A young man from Morocco had strong liver pain for about a month. He also had mild signs that can come with TB infection. Scans of his belly showed small spots in his liver. Doctors used a small camera surgery to take a tiny piece from one of the spots. The test on that piece proved the spots were TB in the liver. He started TB medicines. He felt better, and his blood tests got better too.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 29-year-old gravida V para IV (3 spontaneous vaginal deliveries, prior cesarean for failed induction 4 years earlier) presented for ANC at 32 weeks by LNMP. Maternal labs: VDRL, HBsAg, and urinalysis negative; CBC within normal limits; blood group A Rh-positive. Obstetric ultrasound revealed normal fetal anatomy except the heart. Fetal echocardiography showed normal situs; atria of comparable size; normally positioned atrioventricular and semilunar valves with normal motion; ventricles comparable in size and contractility; left ventricle forming the apex; no ventricular septal defect. Two circumscribed, round, echogenic masses were noted on the left ventricular papillary muscles, measuring 18.2 × 8.3 mm and 13.5 × 8.3 mm. LVOT and RVOT anatomy and function were normal on 2D and color flow. Impression: cardiac rhabdomyoma. Given the association with tuberous sclerosis complex (TSC), detailed neurosonography and systemic evaluation were performed and were unremarkable. She continued routine ANC without complications to 39 weeks. At 39 weeks + 1 day, a cesarean section (repeat on request at term) delivered a 3200 g female, Apgar 10 and 10 at 1 and 5 minutes. Postoperative courses for mother and neonate were uneventful; discharge occurred on postoperative day 3. The neonate was evaluated on days 1, 7, and 30: physical examinations were normal; no seizure activity or new cutaneous lesions; mass dimensions were similar to the antenatal findings. At 7 months, development was age-appropriate; pediatric echocardiography showed well-circumscribed hyperechoic masses on both left ventricular papillary muscles measuring 21.8 × 9.2 mm and 14.7 × 8.5 mm, without left ventricular inflow obstruction. At 12 months, anthropometric and neurobehavioral development remained normal. Echocardiography again demonstrated well-circumscribed hyperechoic masses on both left ventricular papillary muscles with no size increment and no left ventricular inflow obstruction. Up to one year of age, apart from the persistent intracardiac rhabdomyomas, the child met none of the clinical diagnostic criteria for TSC. Notably, while cardiac rhabdomyomas often regress spontaneously in infancy, these lesions were stable through 12 months.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "She was 29 years old and had one child. She had HIV and a very weak immune system (CD4 count of 26). She had abnormal vaginal bleeding for one month. A tissue test from her cervix showed a blood cancer called Burkitt lymphoma in the cervix, outside the lymph nodes. Doctors also said the cervical cancer was stage 3B because it reached the pelvic wall and caused the kidneys to swell from blocked urine. A team of cancer doctors said she needed chemotherapy and radiation together. There was a long waiting list for this treatment. The start of care was delayed. She died 43 days after the diagnosis. She did not get the planned treatment.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 27-year-old woman with uncontrolled asthma and recent mild SARS-CoV-2 infection presented in March 2021 with left hemifacial pain and trismus 48 hours after completing phenoxymethylpenicillin 1,000,000 IU orally once daily for five days for a peritonsillar/oropharyngeal infection. She was hemodynamically stable, without oxygen requirement. Examination showed tender ipsilateral cervical lymphadenopathy and trismus. Admission labs demonstrated leukocytosis, thrombocytopenia, and elevated acute phase reactants; other parameters were within normal limits. Head and neck CT angiography identified a large thrombus within the internal jugular vein. Initial Doppler assessment of neck vessels did not add further actionable findings. Chest CT demonstrated bilateral septic pulmonary emboli. Management included immediate intravenous broad-spectrum antibiotics (ceftriaxone 1 g every 12 hours plus clindamycin 300 mg every 6 hours initially) and therapeutic anticoagulation with enoxaparin 60 mg subcutaneously every 12 hours, dose-adjusted to body weight and renal function. At 72 hours, she developed fever to 38.5 °C with rising leukocytosis; transthoracic echocardiography showed no valvular vegetations. Blood cultures remained negative and a pharyngeal exudate culture was obtained. Antibiotics were escalated to piperacillin–tazobactam 4.5 g IV every 6 hours, with subsequent clinical improvement and no organisms isolated. After 14 days of the revised regimen, follow-up chest CT showed resolution of pulmonary lesions. She was transitioned to oral clindamycin 300 mg every 6 hours and oral anticoagulation with acenocoumarol (dose-adjusted to body weight) and discharged. The presentation and imaging were consistent with internal jugular vein thrombosis complicated by septic pulmonary emboli.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "This story is about a 4‑month‑old baby girl from an Indigenous community in rural Panama. The nearest clinic was three hours away by canoe. She was not getting enough protein and calories. She suddenly had bad diarrhea. She got very dehydrated, like a plant without water. A probiotic medicine called Enterogermina was given at the start. She was moved to a large hospital. She arrived breathing hard. She was in shock, which means her blood was not carrying enough to her organs. A blood test found a hard‑to‑treat germ called MRSA. A stool test found a germ called C. difficile that can cause diarrhea. Later blood tests from her arm and from a central line found Bacillus clausii. Doctors tried many antibiotics, but the germs did not respond. Her organs began to fail. She died 12 days after she got to the hospital.",
+        "literacy_label": "low_health_literacy"
+      },
+      {
+        "generated_text": "A 35-year-old man developed heart failure due to Carney syndrome, which caused a cardiac myxoma and dilated cardiomyopathy. Three years earlier, he presented with sudden chest tightness and shortness of breath. Echocardiography suggested a myxoma, and the diagnosis of Carney syndrome with cardiac myxoma was confirmed by physical examination and genetic screening. He improved with symptomatic treatment and was discharged; surgery was not performed at that time. His symptoms later worsened, and he returned with severe (New York Heart Association class IV) heart failure. Echocardiography then showed dilated cardiomyopathy accompanied by a cardiac myxoma. He ultimately underwent heart transplantation, which successfully treated his heart failure.",
+        "literacy_label": "intermediate_health_literacy"
+      },
+      {
+        "generated_text": "We retrospectively reviewed medical records from a pediatric neurology consultation at a third‑level hospital (2015–2020) for patients with congenital myotonia. Inclusion criteria comprised a clinical diagnosis (myotonia, warm‑up phenomenon, characteristic electromyographic pattern and/or family history) and/or a molecular diagnosis (CLCN1 mutation). For each patient we abstracted demographics (age, sex), disease course (age of onset, symptoms and signs, time to diagnosis, clinical evolution), family history, and treatment response, along with complementary testing and genotypes. Five cases with a clinical diagnosis of congenital myotonia were identified: three with Becker’s disease (recessive phenotype) and two with Thomsen’s disease (dominant phenotype). Incidence relative to births was estimated at 1:15,000 for Becker phenotypes and 1:21,000 for Thomsen phenotypes. Most patients were female; the single male was the only child with onset before age six. Initial presentation included myotonia in the lower limbs in four of five patients and in the upper limbs in all but one. Age at onset ranged from 22 months to 12 years (median 6 years). Genetic diagnosis was pursued approximately two years after onset; one family declined testing. All patients reported worsening with cold; the warming phenomenon was noted only in those with the Becker phenotype. Patients with recessive congenital myotonia showed some progression. Family history included: patients 2 and 3 were sisters with unaffected parents; the mother of patient 1 had mild, cold‑provoked, doubtful clinical signs; the patient who declined genetic testing had a maternal‑line history of myotonia. Serum creatine kinase was not elevated in any case. The electromyogram was abnormal in all patients except the first one at 2.8/12 years of age (not repeated). Initial therapy most often used was oxcarbazepine in the recessive form, with generally good response; in case 2 it lost efficacy and mexiletine was initiated. Case 4 trialed several drugs without success due to loss of efficacy or adverse effects. Case 5 declined treatment given mild symptoms. Patient 1 harbored a previously undescribed, likely pathogenic variant, CLCN1: c.824T>C, maternally inherited. Cases 1–3 (Becker phenotype) carried composite heterozygosity mutations; cases 4–5 had the Thomsen phenotype, and case 5 declined genetic testing.",
+        "literacy_label": "proficient_health_literacy"
+      },
+      {
+        "generated_text": "Technique (TFD/PDT): The patient receives intravenous photosensitizer (Photogen, 1.5 mg/kg) 24 h pre‑procedure; peak absorption is 630 nm. Under general anesthesia, standard duodenoscopy (Olympus TJF‑180) is performed. After identification of the greater duodenal papilla and retrograde cannulation, a digital cholangioscope (SpyGlass DS, Boston Scientific) is introduced into the common bile duct. Cholangioscopy is used to identify the neoplastic stenosis. Under direct visualization, the illumination catheter (Medlight S.A., RD10‑323) is advanced through the cholangioscope. The catheter is a three‑way cannula: port 1 carries a 1‑cm cylindrical light diffuser with two black radiopaque markers denoting its limits; port 2 accommodates a 0.025‑inch guidewire; port 3 is an injection portal. Following cholangioscopic positioning, illumination is delivered at 90 J/cm² with power of 70 mW/cm², with 1‑cm stepwise repositioning to cover the entire stenosed segment. Completion cholangioscopy assesses immediate outcome and adverse events. Post‑procedure care: patients are fasted for 24 h; if no adverse events occur, oral intake is resumed. Discharge includes strict photoprotection instructions (avoidance of light exposure and use of sunglasses), especially during the first week after TFD. Results/Case: An 82‑year‑old man presented with a 2‑month history of obstructive jaundice and weight loss. EUS showed severe dilation of the common bile duct with choledocholithiasis; ERCP confirmed these findings but stone extraction was unsuccessful due to disproportionate ductal dilation, so a plastic biliary stent was placed. Cholestasis recurred 45 days later; two additional ERCPs failed to clear stones. During the third ERCP, a long irregular CHD stenosis was noted, prompting repeat EUS. Repeat EUS revealed a well‑circumscribed hypoechoic solid mass (1.8 × 2 cm) compressing the common hepatic duct, with apparent involvement of the common hepatic artery. Ultrasound‑guided needle biopsy confirmed moderately differentiated cholangiocarcinoma (Bismuth I). After staging, the lesion was deemed unresectable and the patient was referred for palliative therapy. Following multidisciplinary discussion, adjunctive PDT was performed to treat recurrent biliary obstruction. The procedure lasted 150 minutes without complications. A 10 Fr plastic stent was placed for biliary drainage (SEMS unavailable at that time). No photosensitivity occurred in the subsequent week. Early recurrence of cholestasis with cholangitis ensued; ERCP demonstrated stent occlusion by debris and biliary sludge secondary to tumor necrosis. A biliary scan and re‑drainage resolved the acute episode. He then remained asymptomatic for three months—the longest interval since symptom onset. At subsequent recurrence, a self‑expanding metal stent was placed. He continued systemic therapy and later required a duodenal stent for palliation of dysphagia. He died from complications of pulmonary metastases two years after symptom onset and 15 months after the TFD session. Mechanistic context: PDT activates the photosensitizer at 630 nm to generate reactive oxygen species, inducing localized tumor cytotoxicity and microvascular damage, which can debulk malignant biliary strictures and improve ductal patency.",
+        "literacy_label": "proficient_health_literacy"
+      }
+    ],
+    "signature": {
+      "instructions": "Analyze the linguistic complexity, use of medical jargon, and sentence\nstructure of 'generated_text' to determine the health literacy level.",
+      "fields": [
+        {
+          "prefix": "Generated Text:",
+          "description": "A version of the source text rewritten for a specific audience."
+        },
+        {
+          "prefix": "Reasoning: Let's think step by step in order to",
+          "description": "${reasoning}"
+        },
+        {
+          "prefix": "Literacy Label:",
+          "description": "Classification: low_health_literacy (simple words, no jargon), intermediate_health_literacy (moderate technicality), or proficient_health_literacy (highly technical/original level)."
+        }
+      ]
+    },
+    "lm": null
+  },
+  "metadata": {
+    "dependency_versions": {
+      "python": "3.11",
+      "dspy": "3.1.3",
+      "cloudpickle": "3.1"
+    }
+  }
+}

data/annotators_validate_data/120_2026-01-06_03-52-52/annotation_results.json

@@ -0,0 +1,218 @@
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+        "queue_position": 0,
+        "doc_id": 10,
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+        "doc_rating": 2,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:55:33"
+    },
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+        "doc_id": 19,
+        "health_literacy_label": "low_health_literacy",
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+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:55:37"
+    },
+    {
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+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 2,
+        "wiki_rating": 2,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:55:49"
+    },
+    {
+        "queue_position": 3,
+        "doc_id": 13,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 2,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:56:00"
+    },
+    {
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+        "timestamp": "2026-01-06 03:56:16"
+    },
+    {
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+        "timestamp": "2026-01-06 03:56:24"
+    },
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+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:56:39"
+    },
+    {
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+        "timestamp": "2026-01-06 03:56:46"
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+    },
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+        "timestamp": "2026-01-06 03:57:25"
+    },
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+        "timestamp": "2026-01-06 03:57:29"
+    },
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+    },
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+        "timestamp": "2026-01-06 03:58:10"
+    },
+    {
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+        "doc_rating": 3,
+        "wiki_rating": 3,
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+        "timestamp": "2026-01-06 03:58:17"
+    },
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+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:58:34"
+    },
+    {
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+        "doc_id": 15,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:58:37"
+    },
+    {
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+        "doc_id": 2,
+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-06 03:58:40"
+    }
+]

data/annotators_validate_data/120_2026-01-06_03-52-52/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 13,
+        "question_text": "I hereby give permission to the ________ to get such proof.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "toast",
+        "is_correct": true
+    },
+    {
+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/2207062_2026-01-04_01-49-23/annotation_results.json

@@ -0,0 +1,173 @@
+[
+    {
+        "queue_position": 0,
+        "doc_id": 18,
+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 5,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:49:49"
+    },
+    {
+        "queue_position": 1,
+        "doc_id": 17,
+        "health_literacy_label": "proficient_health_literacy",
+        "doc_rating": 4,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:49:57"
+    },
+    {
+        "queue_position": 2,
+        "doc_id": 19,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:00"
+    },
+    {
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+        "doc_id": 18,
+        "health_literacy_label": "proficient_health_literacy",
+        "doc_rating": 5,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:05"
+    },
+    {
+        "queue_position": 4,
+        "doc_id": 19,
+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:07"
+    },
+    {
+        "queue_position": 5,
+        "doc_id": 6,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:09"
+    },
+    {
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+        "doc_id": 13,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:11"
+    },
+    {
+        "queue_position": 7,
+        "doc_id": 9,
+        "health_literacy_label": "proficient_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:14"
+    },
+    {
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+        "doc_id": 18,
+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": true,
+        "timestamp": "2026-01-04 01:50:16"
+    },
+    {
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+        "doc_id": 17,
+        "health_literacy_label": "proficient_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": true,
+        "timestamp": "2026-01-04 01:50:17"
+    },
+    {
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+        "doc_id": 19,
+        "health_literacy_label": "intermediate_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": true,
+        "timestamp": "2026-01-04 01:50:18"
+    },
+    {
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+        "doc_id": 18,
+        "health_literacy_label": "proficient_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": true,
+        "timestamp": "2026-01-04 01:50:19"
+    },
+    {
+        "queue_position": 12,
+        "doc_id": 11,
+        "health_literacy_label": "low_health_literacy",
+        "doc_rating": 3,
+        "wiki_rating": 3,
+        "is_duplicate": false,
+        "timestamp": "2026-01-04 01:50:20"
+    },
+    {
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+        "timestamp": "2026-01-04 01:50:22"
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+    {
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+        "timestamp": "2026-01-04 01:50:23"
+    },
+    {
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+        "timestamp": "2026-01-04 01:50:24"
+    }
+]

data/annotators_validate_data/2207062_2026-01-04_01-49-23/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 19,
+        "question_text": "If you ________ AFDC for any family member, you will have to sign a different application form.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 11,
+        "question_text": "I agree to give correct information to ________ if I can receive Medicaid.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 13,
+        "question_text": "I hereby give permission to the ________ to get such proof.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Faija_2026-01-03_09-14-38/annotation_results.json

@@ -0,0 +1,218 @@
+[
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+    },
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+    },
+    {
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+    {
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+    }
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data/annotators_validate_data/Faija_2026-01-03_09-14-38/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 12,
+        "question_text": "I ________ to provide the county information to prove statements given in this application.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 13,
+        "question_text": "I hereby give permission to the ________ to get such proof.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "little",
+        "is_correct": true
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 19,
+        "question_text": "If you ________ AFDC for any family member, you will have to sign a different application form.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Farhatun Shama_2026-01-03_00-10-06/annotation_results.json

@@ -0,0 +1,218 @@
+[
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+    },
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+        "timestamp": "2026-01-03 00:12:33"
+    },
+    {
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+        "timestamp": "2026-01-03 00:13:09"
+    },
+    {
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+        "health_literacy_label": "intermediate_health_literacy",
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+    },
+    {
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+        "timestamp": "2026-01-03 00:15:24"
+    },
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+        "timestamp": "2026-01-03 00:15:53"
+    },
+    {
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+        "timestamp": "2026-01-03 00:16:33"
+    },
+    {
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+        "timestamp": "2026-01-03 00:34:16"
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+        "timestamp": "2026-01-03 00:46:22"
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+        "is_duplicate": false,
+        "timestamp": "2026-01-03 00:46:57"
+    },
+    {
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+        "health_literacy_label": "proficient_health_literacy",
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+        "wiki_rating": 5,
+        "is_duplicate": false,
+        "timestamp": "2026-01-03 00:47:31"
+    },
+    {
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+        "health_literacy_label": "proficient_health_literacy",
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+        "timestamp": "2026-01-03 00:48:12"
+    }
+]

data/annotators_validate_data/Farhatun Shama_2026-01-03_00-10-06/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "little",
+        "is_correct": true
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 12,
+        "question_text": "I ________ to provide the county information to prove statements given in this application.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/KuetUser123_2026-01-04_06-02-30/annotation_results.json

@@ -0,0 +1,119 @@
+[
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+        "timestamp": "2026-01-04 07:29:18"
+    },
+    {
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+        "timestamp": "2026-01-04 07:33:06"
+    },
+    {
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data/annotators_validate_data/KuetUser123_2026-01-04_06-02-30/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 20,
+        "question_text": "We will use the ________ on this form to determine your eligibility.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 14,
+        "question_text": "I ________ that for Medicaid I must report any changes in my circumstances...",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 2,
+        "question_text": "You must have an ________ stomach when you come for it.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 11,
+        "question_text": "I agree to give correct information to ________ if I can receive Medicaid.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 13,
+        "question_text": "I hereby give permission to the ________ to get such proof.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/KuetUser123_2026-01-04_07-44-01/annotation_results.json

@@ -0,0 +1,218 @@
+[
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+    },
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+    },
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+    },
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+    },
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data/annotators_validate_data/KuetUser123_2026-01-04_07-44-01/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 14,
+        "question_text": "I ________ that for Medicaid I must report any changes in my circumstances...",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
+        "user_answer": "questions,",
+        "is_correct": true
+    }
+]

data/annotators_validate_data/Labib_2026-01-03_10-06-08/annotation_results.json

@@ -0,0 +1,218 @@
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data/annotators_validate_data/Labib_2026-01-03_10-06-08/literacy_results.json

@@ -0,0 +1,62 @@
+[
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+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 19,
+        "question_text": "If you ________ AFDC for any family member, you will have to sign a different application form.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 20,
+        "question_text": "We will use the ________ on this form to determine your eligibility.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": null,
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 12,
+        "question_text": "I ________ to provide the county information to prove statements given in this application.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Lamisa_2026-01-02_22-06-28/annotation_results.json

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data/annotators_validate_data/Lamisa_2026-01-02_22-06-28/literacy_results.json

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+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
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+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
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+    },
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+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
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+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "midnight,",
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+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "that",
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+    },
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+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "eat",
+        "is_correct": true
+    },
+    {
+        "question_id": 2,
+        "question_text": "You must have an ________ stomach when you come for it.",
+        "user_answer": "empty",
+        "is_correct": true
+    },
+    {
+        "question_id": 19,
+        "question_text": "If you ________ AFDC for any family member, you will have to sign a different application form.",
+        "user_answer": "want",
+        "is_correct": true
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "drink",
+        "is_correct": true
+    }
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data/annotators_validate_data/Mahi_2026-01-06_18-12-03/annotation_results.json

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data/annotators_validate_data/Mahi_2026-01-06_18-12-03/literacy_results.json

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+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "stomach",
+        "is_correct": false
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+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
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+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "toast",
+        "is_correct": false
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+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "midnight,",
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+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
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+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "breakfast.",
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+    },
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+        "question_text": "You must have an ________ stomach when you come for it.",
+        "user_answer": "drink",
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+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
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data/annotators_validate_data/Plaban Das_2026-01-03_19-10-40/annotation_results.json

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data/annotators_validate_data/Plaban Das_2026-01-03_19-10-40/literacy_results.json

@@ -0,0 +1,62 @@
+[
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+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 2,
+        "question_text": "You must have an ________ stomach when you come for it.",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 12,
+        "question_text": "I ________ to provide the county information to prove statements given in this application.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 5,
+        "question_text": "...fruit, ________, and jelly, with coffee and tea.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 7,
+        "question_text": "...you must not ________ until after you have had the X-ray.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 20,
+        "question_text": "We will use the ________ on this form to determine your eligibility.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Resam Zaha_2026-01-04_05-50-37/annotation_results.json

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data/annotators_validate_data/Resam Zaha_2026-01-04_05-50-37/literacy_results.json

@@ -0,0 +1,62 @@
+[
+    {
+        "question_id": 19,
+        "question_text": "If you ________ AFDC for any family member, you will have to sign a different application form.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 9,
+        "question_text": "Do not ________ even water.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 13,
+        "question_text": "I hereby give permission to the ________ to get such proof.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 12,
+        "question_text": "I ________ to provide the county information to prove statements given in this application.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 11,
+        "question_text": "I agree to give correct information to ________ if I can receive Medicaid.",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 16,
+        "question_text": "I understand ________ in this case, I have the right to a fair hearing.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 15,
+        "question_text": "...within ________ days of becoming aware of the change.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Shakhor Mistry_2026-01-06_03-02-40/annotation_results.json

@@ -0,0 +1,110 @@
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+    },
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+    },
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+    },
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+    },
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+    },
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+    }
+]

data/annotators_validate_data/Shakhor Mistry_2026-01-06_03-02-40/literacy_results.json

@@ -0,0 +1,62 @@
+[
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+        "question_id": 3,
+        "question_text": "The X-ray will ________ from 1 to 3 hours to do.",
+        "user_answer": "stomach",
+        "is_correct": false
+    },
+    {
+        "question_id": 17,
+        "question_text": "I have the ________ to a fair hearing if I DO NOT like the decision made on my case.",
+        "user_answer": "empty",
+        "is_correct": false
+    },
+    {
+        "question_id": 2,
+        "question_text": "You must have an ________ stomach when you come for it.",
+        "user_answer": "take",
+        "is_correct": false
+    },
+    {
+        "question_id": 6,
+        "question_text": "After ________, you must not eat anything...",
+        "user_answer": "little",
+        "is_correct": false
+    },
+    {
+        "question_id": 10,
+        "question_text": "If you have any ________, call the X-ray Department.",
+        "user_answer": "toast",
+        "is_correct": false
+    },
+    {
+        "question_id": 8,
+        "question_text": "THE DAY OF THE X-RAY: Do not eat ________.",
+        "user_answer": "midnight,",
+        "is_correct": false
+    },
+    {
+        "question_id": 4,
+        "question_text": "THE DAY BEFORE THE X-RAY: For supper have only a ________ snack of fruit...",
+        "user_answer": "eat",
+        "is_correct": false
+    },
+    {
+        "question_id": 18,
+        "question_text": "I can ________ a hearing by writing or calling the county where I applied.",
+        "user_answer": "breakfast.",
+        "is_correct": false
+    },
+    {
+        "question_id": 1,
+        "question_text": "Your doctor has sent you to have a ________ X-ray.",
+        "user_answer": "drink",
+        "is_correct": false
+    },
+    {
+        "question_id": 11,
+        "question_text": "I agree to give correct information to ________ if I can receive Medicaid.",
+        "user_answer": "questions,",
+        "is_correct": false
+    }
+]

data/annotators_validate_data/Shakhor Mistry_2026-01-06_03-10-24/annotation_results.json

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+    },
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