diff --git "a/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_12_v1.json" "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_12_v1.json" new file mode 100644--- /dev/null +++ "b/data/data_annotator_data/new_v1/crowdsourcing_input_en_shard_12_v1.json" @@ -0,0 +1,662 @@ +[ + { + "index": 0, + "label": "low_health_literacy", + "original_doc": "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.", + "wiki_anchor": "Sarin's researches have helped describe two major liver diseases, Portal Biliopathy and Acute-on-Chronic Liver Failure. He has developed or significantly contributed to the development of several treatment protocols for liver diseases such as the band ligation to prevent variceal hemorrhage. He has worked on gastric varices, and their classification bears his name as Sarin's Classification of Gastric Varices. Seventeen major treatment protocols have been credited to him including five major Asian Pacific treatment guidelines in liver disease, and the model he proposed on \"endotoxemia induced portal hypertension and liver disease\" is reported to have been universally accepted. His work has assisted in the understanding of Chronic HBV Infection, liver cancer and the B and C variants of hepatitis. His studies on \"acute-on-chronic liver failure\" disease and its therapy using Granulocyte colony-stimulating factor (G-CSF), a glycoprotein, have been successful in clinical trials. He has also contributed in analyzing the mother-baby transmission of Hepatitis B and its pathogenesis.", + "doc_fkgl": 4.138157894736846, + "wiki_fkgl": 15.869377289377294, + "doc_tree_depth": 4.5, + "wiki_tree_depth": 8.285714285714286, + "fkgl_delta": -11.731219394640448 + }, + { + "index": 0, + "label": "intermediate_health_literacy", + "original_doc": "A 20\u2011year\u2011old woman had a 12\u2011year history of idiopathic nephrotic syndrome that initially presented with extensive cerebral venous thrombosis and pulmonary embolism. She was treated with anticoagulation and oral corticosteroids, then mycophenolate mofetil as a steroid\u2011sparing agent. A comprehensive thrombophilia work\u2011up was negative. She experienced multiple relapses controlled with steroids until 2017, then remained in remission; anticoagulation and MMF were discontinued. One year later, she developed sudden diffuse abdominal pain with postprandial vomiting and bilateral leg edema. Laboratory tests confirmed a relapse of nephrotic syndrome. Abdominal CT showed acute superior mesenteric artery thrombosis causing acute mesenteric ischemia. At surgery, there was extensive small\u2011bowel necrosis not compatible with survival. She died 48 hours later.", + "wiki_anchor": "Diagnosis\nIn 2018, of 12 patients in a study who fulfilled the then-current diagnostic criteria for CRION, eleven (92%) were positive for MOG-IgG, and the last patient was borderline. Diagnosis requires exclusion of other neurological, ophthalmological, and systemic conditions. Any cause of optic neuropathy should be ruled out, including demyelinating (MOG antibody disease, multiple sclerosis, and neuromyelitis optica) and systemic disease (diabetic, toxic, nutritional, and infectious causes). Corticosteroid responsive optic neuritis not associated with demyelinating disease should also be ruled out, including sarcoidosis, systemic lupus erythematosus, or other systemic autoimmune disease. Hereditary causes such as Leber's hereditary optic neuropathy are also part of the differential diagnosis.", + "doc_fkgl": 15.20401179941003, + "wiki_fkgl": 19.061018867924535, + "doc_tree_depth": 4.888888888888889, + "wiki_tree_depth": 8.6, + "fkgl_delta": -3.8570070685145055 + }, + { + "index": 0, + "label": "proficient_health_literacy", + "original_doc": "A 20\u2011year\u2011old woman had been followed since age eight for idiopathic nephrotic syndrome (NS) inaugurated by cerebral venous thrombosis extended to the right jugular vein with a massive pulmonary embolism, without sequelae and without personal or family thrombotic history. Kidney biopsy was deferred because there was no kidney failure, gross hematuria, hypertension, or extra\u2011renal signs suggestive of secondary NS at presentation. She was treated with an oral vitamin K antagonist and oral corticosteroids with good evolution. Subsequently, she had multiple steroid\u2011dependent relapses and was started on mycophenolate mofetil (MMF) as background therapy to spare corticosteroids and ensure normal growth. An exhaustive thrombophilia assessment was negative: homocysteine, fibrinogen, protein C, protein S, antithrombin III, factor V Leiden, JAK\u20112, cryoglobulins, anticardiolipin antibodies, lupus anticoagulant, and anti\u2011\u03b22\u2011glycoprotein I antibodies were all normal. Anticoagulation was stopped after nine years. Several relapses occurred but were controlled with oral corticosteroids. NS remission was documented from 2017; MMF was gradually discontinued in 2019, and she remained asymptomatic without relapse.\n\nOne year later, she presented to the emergency department with acute intense diffuse abdominal pain without irradiation, associated with postprandial vomiting and bilateral lower\u2011limb edema for six hours. Examination showed intense epigastric tenderness with normal vital signs (BP 120/70 mm Hg, HR 83 bpm, SpO2 100% on room air) and no fever or neurological impairment. Urinalysis detected proteinuria. Hemogasanalysis showed metabolic acidosis with respiratory compensation. Labs revealed hypoalbuminemia, hypercholesterolemia, prothrombin time 90%, elevated D\u2011dimer, LDH, and creatine phosphokinase, with inflammatory markers (CRP 37 mg/L) and leukocytosis (26.4 \u00d7 10^3/\u00b5L); renal and liver function were normal. Urgent abdominal ultrasound showed a low\u2011to\u2011moderate intra\u2011abdominal effusion. Contrast\u2011enhanced CT demonstrated acute thrombosis of the superior mesenteric artery with acute mesenteric ischemia. She underwent emergency laparotomy: intraoperative exploration confirmed mesenteric ischemia with extensive necrosis of almost the entire small bowel, rendering resection incompatible with life. She died 48 hours later.\n\nThis case illustrates catastrophic arterial thrombosis in the setting of NS despite a negative thrombophilia work\u2011up. NS is a hypercoagulable state with multifactorial mechanisms, including urinary loss of anticoagulant proteins (e.g., antithrombin III, protein S), increased fibrinogen, hemoconcentration, dyslipidemia, and systemic inflammation. While venous thromboembolism is more common in NS, superior mesenteric artery thrombosis is rare but often fatal, underscoring the need for high clinical suspicion and rapid imaging when severe acute abdominal pain occurs in patients with active or relapsing NS.", + "wiki_anchor": "Used specifically as antiandrogens (major)\n Cyproterone acetate (Androcur): A combined AR antagonist and progestogen/antigonadotropin. Also has weak glucocorticoid activity. Previously used widely in the treatment of prostate cancer, but since largely replaced by NSAAs. Also used for androgen-dependent indications in women and transgender women, precocious puberty in boys, and as a means of chemical castration for sexual deviation in men. Widely used in oral contraceptives as well (with ethinylestradiol under the brand names Diane and Diane-35). Not available in the United States. Uniquely among most SAAs, has a high risk of liver changes and hepatotoxicity. Also has a high incidence of psychiatric side effects such as depression, anxiety, and fatigue.\n Spironolactone (Aldactone): An antimineralocorticoid (aldosterone antagonist) with additional/coincidental antiandrogen activity. Specifically acts as an AR antagonist, weak antigonadotropin, and weak steroidogenesis inhibitor. Used for androgen-dependent indications in women and transgender women, particularly in the United States where cyproterone acetate is unavailable. Studied in the treatment of benign prostatic hyperplasia but was found to be ineffective. Contraindicated in prostate cancer due to weak androgenic activity and stimulation of tumor growth. Most commonly used as a diuretic and antihypertensive for cardiovascular disease. Commonly associated with gynecomastia (breast development) and menstrual disturbances.", + "doc_fkgl": 17.108284910965327, + "wiki_fkgl": 14.96289447236181, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.066666666666666, + "fkgl_delta": 2.145390438603517 + }, + { + "index": 1, + "label": "low_health_literacy", + "original_doc": "She is 34 years old and pregnant. She had a seizure and trouble speaking clearly. She was sent right away for a head MRI scan. The scan showed a pattern doctors call the \u201cMedusa head.\u201d This means the veins in her brain are arranged in an unusual way that she was born with. There is a small blood clot at the outer part of this vein pattern. The blood is also moving slowly closer to the main vein.", + "wiki_anchor": "Patient DF is a woman with visual apperceptive agnosia who has been studied extensively due to the implications of her behavior for the two streams theory of visual perception. Though her vision remains intact, she has trouble visually locating and identifying objects. Her agnosia is thought to be caused by a bilateral lesion to her lateral occipital cortex, an area thought by dual-stream proponents to be the ventral \"object recognition\" stream. Despite being unable to identify or recognize objects, DF can still use visual input to guide her action.", + "doc_fkgl": 3.5813553113553134, + "wiki_fkgl": 14.30098314606742, + "doc_tree_depth": 5.142857142857143, + "wiki_tree_depth": 8.5, + "fkgl_delta": -10.719627834712107 + }, + { + "index": 1, + "label": "intermediate_health_literacy", + "original_doc": "A 34-year-old woman who is 8 weeks pregnant had a first-time generalized seizure with temporary slurred speech. Because she is pregnant and this was her first seizure, doctors obtained an urgent brain MRI. The MRI showed the classic \u201cMedusa head\u201d sign, which indicates a developmental venous anomaly (DVA)\u2014a vein pattern you are born with. Imaging also suggested a partial clot along the peripheral portion of the draining system and slower blood flow closer to the main draining vein. These findings support the diagnosis: a developmental venous anomaly with peripheral partial thrombosis and proximal slow flow.", + "wiki_anchor": "Patient DF is a woman with visual apperceptive agnosia who has been studied extensively due to the implications of her behavior for the two streams theory of visual perception. Though her vision remains intact, she has trouble visually locating and identifying objects. Her agnosia is thought to be caused by a bilateral lesion to her lateral occipital cortex, an area thought by dual-stream proponents to be the ventral \"object recognition\" stream. Despite being unable to identify or recognize objects, DF can still use visual input to guide her action.", + "doc_fkgl": 11.942105263157895, + "wiki_fkgl": 14.30098314606742, + "doc_tree_depth": 6.4, + "wiki_tree_depth": 8.5, + "fkgl_delta": -2.3588778829095247 + }, + { + "index": 1, + "label": "proficient_health_literacy", + "original_doc": "A 34-year-old woman, 8 weeks pregnant and without other relevant history, presented with generalized convulsions and postictal dysarthria that resolved within two hours. On examination she was alert, oriented, and without focal language, motor, or sensory deficits; a right lateral tongue bite was noted. Laboratory tests and ECG were unremarkable. Given a first epileptic seizure in pregnancy, an urgent cranial MRI was performed. The protocol included 3D T1 pre- and post-contrast (axial, coronal, sagittal), axial FLAIR, axial T2, VEN BOLD and magnetic susceptibility sequences, as well as axial diffusion and ADC mapping. MRI demonstrated multiple venous cortico-medullary vascular structures converging centripetally to a large central draining vein that emptied via the inferior anastomotic vein into the left transverse sinus, forming the classic \u201cMedusa head\u201d sign. On T1 post-contrast, the drainage vein showed increased signal with central hyphocaptation, suggesting partial thrombosis versus slow flow. On T2 and FLAIR, the parenchyma surrounding the drainage vein was hyperintense, without diffusion restriction, compatible with edema. Overall, the findings are diagnostic of a developmental venous anomaly with signs of partial peripheral thrombosis and more proximal slow flow, causing perilesional edema. Management was initiated with clexane 60 mg every 12 hours and levetiracetam 500 mg every 12 hours, with symptomatic improvement and stability after one week. Contextually, DVAs are typically benign venous variants; however, pregnancy-associated hypercoagulability may predispose to thrombosis. Partial thrombosis and impaired outflow in a DVA can lead to venous congestion and edema, manifesting clinically with seizures.", + "wiki_anchor": "Signs and symptoms\nReview of past cases, patients often do not exhibit many symptoms or obtain a diagnosis until they are around 20 to 40 years old. If the patient does show symptoms, it is most likely due to pressure from growth of the tumor. Depending on which part the epidermoid is pressing against can result in varying symptoms.\n Headaches \u2013 often worse in the morning or by changing positions; can be constant and become more severe or more frequent; not your typical headache\n Vision problems like blurred vision, double vision, or loss of peripheral vision, including hemianopia [new reference]\n Loss of sensation or movement in the arms, legs, or face\n Dizziness or difficulty with balance and walking, unsteadiness, vertigo\n Speech difficulties\n Confusion in everyday matters or disorientation\n Seizures, especially in someone who hasn\u2019t had seizures before\n Hearing loss or buzzing or ringing in the ear\n Swallowing or speech difficulty\n Fatigue or sleepiness especially in children", + "doc_fkgl": 16.247417695473253, + "wiki_fkgl": 19.316048387096775, + "doc_tree_depth": 6.083333333333333, + "wiki_tree_depth": 9.25, + "fkgl_delta": -3.0686306916235218 + }, + { + "index": 2, + "label": "low_health_literacy", + "original_doc": "A 22-year-old woman had painful mouth sores. The sores made eating and drinking hard. The problem started after a fever. Small pimples showed up on her lips. She had been vaping for about one year. The checkup found no spots on the rest of her body. Her lips had crusts with a little blood. The corners of her mouth were raw and bled easily. Inside her mouth there were white sores with yellow edges. The sores were different shapes and sizes and were in several places. A test for the cold-sore virus was negative. The doctor said this was a mouth reaction called oral erythema multiforme. She was treated with salt-water compresses on the lips. She used a mouth rinse with an anti-swelling medicine (dexamethasone) mixed with a coating gel (hyaluronic acid). She put 2% miconazole cream on the sores at the mouth corners. She used petroleum jelly on her dry lips. She was told to stop vaping. Her mouth got better after one week of treatment.", + "wiki_anchor": "Contemporary Oral Medicine: A Comprehensive Approach to Clinical Practice (co-author) 2018\n Swine Flu Vaccination (in Arabic) 2010\n Problem Facing Dentists During their Practice (three volumes, in Arabic) 2009\n Part 1: Muscoskeletal Disorders\n Part 2: Infection Control\n Part 3: Dental Office environment effects \n Maintaining Oral hygiene of Cancer patient (in Arabic) 2009\n Swine Flu (in Arabic) 2009\n Oral Pathology for practicing dentists (series with several authors, in Arabic)\n Volume 1: Oral Mucosa Lesions\n Part 1: White lesions (April 2007)\n Part 2: Red Lesions (Augustus 2007)\n Part 3: Ulcerative lesions (Augustus 2007)\n Part 4: Lymphatic lesions (Augustus 2007)\n Part 5: Vesicolobullous lesions (September 2007)\n Part 6: Verrocous lesions (February 2008)\n Part 7: Pigmented lesions (March 2008)\n Odontogenic Cysts, Clinical Complication & Potential Neoplastic Transformation. Thesis submitted to obtain the title Doctor of Philosophy in Dental Science (PhD), University of Brussels 2005 (in English \u2013translated and published in Arabic 2009).\n Expression of cell proliferating-associated nuclear antigen Ki67 in jaws cyst, Master thesis submitted to obtain the degree of master in medical and pharmaceutical research at the University of Brussels, Brussels, Belgium. June 2002 (in English).", + "doc_fkgl": 4.63312375249501, + "wiki_fkgl": 25.07075966850829, + "doc_tree_depth": 5.277777777777778, + "wiki_tree_depth": 5.75, + "fkgl_delta": -20.43763591601328 + }, + { + "index": 2, + "label": "intermediate_health_literacy", + "original_doc": "A 22-year-old woman presented with a month of painful stomatitis that made eating and drinking difficult. The illness began with a fever and pimple-like lesions on the lips. She had been vaping regularly for about one year. Examination showed no skin lesions elsewhere. The lips had serosanguineous crusts and erosions at the labial commissures that tended to bleed. Intraorally, there were multiple irregular white ulcers with yellowish borders on several sites of the oral mucosa. Anti\u2013HSV-1 IgG was non-reactive. The diagnosis was oral erythema multiforme, likely related to vaping. Management included normal saline compresses to the lips, a dexamethasone mouth rinse mixed with hyaluronic acid, 2% miconazole cream applied to the lip corner, petroleum jelly for dry lips, and stopping vaping. Her oral condition improved within one week.", + "wiki_anchor": "Beyond these, many other recurrent infections have been observed, including recurrent fungal infections and recurrent viral infections (including molluscum contagiosum, herpes simplex, and herpes zoster), recurrent upper respiratory infection (including Streptococcus pneumoniae, Haemophilus influenzae, respiratory syncytial virus, and adenovirus), recurrent sinusitis, recurrent otitis media, mastoiditis, pneumonia, bronchitis with bronchiectasis, osteomyelitis, candidiasis, meningitis (caused by cryptococcus or H. influenzae), pericarditis, salmonella enteritis, and giardiasis. Other dermatologic problems include squamous-cell carcinoma/dysplasia (vulvar, anal, and facial). Immune problems are also common, including autoimmune hemolytic anemia, severe allergies (both food and environmental), asthma, and reactive airway disease. The nervous system may also be affected; observed conditions in DOCK8 deficient people include hemiplegia, ischemic stroke, subarachnoid hemorrhage, and facial paralysis. Vascular complications are common, including aortic aneurysm, cerebral aneurysm, vessel occlusion and underperfusion, and leukocytoclastic vasculitis.", + "doc_fkgl": 10.328562500000004, + "wiki_fkgl": 22.379961832061074, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 7.4, + "fkgl_delta": -12.05139933206107 + }, + { + "index": 2, + "label": "proficient_health_literacy", + "original_doc": "A 22-year-old woman presented to Oral Medicine with a 1-month history of painful oral ulcers causing difficulty eating and drinking. The episode began with fever followed by pimple-like lesions on the lips. She had used pod-type vapes for approximately one year, often trying different e-liquid flavors; she had never smoked conventional cigarettes. She reported no medication exposure prior to onset (no antibiotics, analgesics, anticonvulsants, NSAIDs, or antifungals), no drug or food allergies, and unhealthy eating habits. Extraorally, there were no lesions elsewhere on the body. The lips exhibited serosanguineous crusts with an erosive area at the right labial commissure that tended to bleed. Intraoral examination showed multiple painful white ulcers with yellowish edges, irregular and variable in size, on the labial and buccal mucosa, lateral and ventral tongue, and floor of mouth. Anti-HSV-1 IgG was non-reactive. Based on isolated oral mucosal involvement, absence of cutaneous lesions, and negative HSV serology, a diagnosis of vaping-related oral erythema multiforme, minor type, was established. Management comprised 0.9% NaCl\u2013moistened gauze compresses to the lips three times daily; a dexamethasone mouthrinse (1 mg in 10 mL hyaluronic acid) three times daily with a 30-minute post-rinse fasting period; 2% miconazole cream applied to the wound at the right labial commissure twice daily; and vaseline album (petrolatum) for dry lips. Adjunctive advice included brushing teeth and tongue twice daily (after breakfast and before bed), cessation of vaping, and avoidance of foods containing monosodium glutamate. At 1-week follow-up, the oral condition had improved. Ethical considerations: written informed consent was obtained; the case conformed to the Helsinki Declaration and had institutional approval. Context: Erythema multiforme is a mucocutaneous hypersensitivity reaction classically triggered by infections (e.g., HSV) or drugs; in this case, vaping exposure and frequent e-liquid flavor changes were considered plausible triggers in the absence of medication exposure and with non-reactive anti-HSV-1 serology.", + "wiki_anchor": "Contemporary Oral Medicine: A Comprehensive Approach to Clinical Practice (co-author) 2018\n Swine Flu Vaccination (in Arabic) 2010\n Problem Facing Dentists During their Practice (three volumes, in Arabic) 2009\n Part 1: Muscoskeletal Disorders\n Part 2: Infection Control\n Part 3: Dental Office environment effects \n Maintaining Oral hygiene of Cancer patient (in Arabic) 2009\n Swine Flu (in Arabic) 2009\n Oral Pathology for practicing dentists (series with several authors, in Arabic)\n Volume 1: Oral Mucosa Lesions\n Part 1: White lesions (April 2007)\n Part 2: Red Lesions (Augustus 2007)\n Part 3: Ulcerative lesions (Augustus 2007)\n Part 4: Lymphatic lesions (Augustus 2007)\n Part 5: Vesicolobullous lesions (September 2007)\n Part 6: Verrocous lesions (February 2008)\n Part 7: Pigmented lesions (March 2008)\n Odontogenic Cysts, Clinical Complication & Potential Neoplastic Transformation. Thesis submitted to obtain the title Doctor of Philosophy in Dental Science (PhD), University of Brussels 2005 (in English \u2013translated and published in Arabic 2009).\n Expression of cell proliferating-associated nuclear antigen Ki67 in jaws cyst, Master thesis submitted to obtain the degree of master in medical and pharmaceutical research at the University of Brussels, Brussels, Belgium. June 2002 (in English).", + "doc_fkgl": 14.527236842105264, + "wiki_fkgl": 25.07075966850829, + "doc_tree_depth": 7.214285714285714, + "wiki_tree_depth": 5.75, + "fkgl_delta": -10.543522826403027 + }, + { + "index": 3, + "label": "low_health_literacy", + "original_doc": "At 32 weeks of pregnancy, a routine scan found one small lump inside the baby\u2019s heart. It caused no symptoms. This was the only problem seen. Doctors watched it with clinic visits until 39 weeks plus 1 day. Then the baby was delivered by C-section (a surgery to deliver the baby). After birth, the child had checkups on day 1, day 7, day 30, month 7, and month 12. At each visit, the child\u2019s growth and behavior were healthy for age. The heart lump stayed the same size; it did not grow or shrink. By 1 year old, there were no signs of a related condition called tuberous sclerosis complex.", + "wiki_anchor": "Signs and symptoms\nAffected infants present within a few months after birth with failure to thrive and severe folate deficiency manifested as macrocytic anemia and developmental delays. There can be (i) pancytopenia, (ii) diarrhea and/or mucositis and/or (iii) immune deficiency due to T-cell dysfunction and hypoimmunoglobulinemia resulting in pneumonia usually due to Pneumocystis jirovecii. Recently, several infants with the immune deficiency syndrome were described. Untreated, or with inadequate treatment, there are progressive systemic and neurological signs with a spectrum of manifestations including seizures that are often intractable. Females with HFM are fertile and, if folate sufficient during pregnancy, have normal offspring. Subjects that carry one mutated PCFT allele are normal. The genomic and clinical features of HFM were recently reviewed.", + "doc_fkgl": 4.623939393939395, + "wiki_fkgl": 14.499047619047623, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 6.428571428571429, + "fkgl_delta": -9.875108225108228 + }, + { + "index": 3, + "label": "intermediate_health_literacy", + "original_doc": "This case describes an isolated, asymptomatic fetal cardiac rhabdomyoma first detected at 32 weeks\u2019 gestation. The pregnancy was monitored as an outpatient until 39 weeks plus one day, when delivery occurred by cesarean section. Postnatal follow-up at day 1, day 7, day 30, 7 months, and 12 months showed normal growth and neurodevelopment. The intracardiac mass remained stable in size across all visits. Up to one year of age, the child did not meet any clinical diagnostic criteria for tuberous sclerosis complex (TSC).", + "wiki_anchor": "Cancer\nAt the age of four months, he was diagnosed with rhabdomyosarcoma, a cancer of the connective tissue. He was treated at Children's Hospital Oakland, where they surgically removed the tumor. He underwent chemotherapy for the following two years. The cancer has not returned. In his youth he also attended Camp Okizu as a child, a camp for childhood cancer survivors, and volunteered with The American Cancer Society events to raise funding for cancer research and treatments.", + "doc_fkgl": 11.214120481927715, + "wiki_fkgl": 10.18483116883117, + "doc_tree_depth": 5.4, + "wiki_tree_depth": 5.4, + "fkgl_delta": 1.0292893130965446 + }, + { + "index": 3, + "label": "proficient_health_literacy", + "original_doc": "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 \u00d7 8.3 mm and 13.5 \u00d7 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 \u00d7 9.2 mm and 14.7 \u00d7 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.", + "wiki_anchor": "Signs and symptoms \nThoracic endometriosis is characterised by onset of the following clinical symptoms within 24 hours prior to and 72 hours after onset of menses.\n Catamenial pneumothorax: this is the most common clinical manifestation, present in 80% of cases. Catamenial pneumothorax is defined as a recurrent pneumothorax that occurs within the first 72 hours after menstruation. It may not necessarily occur with every menstrual cycle and in most cases is one-sided and on the right side. There are cases of catamenial pneumothorax on the left side, and on very rare occasions there may be a bilateral catamenial pneumothorax. Symptoms are the same as for other types of pneumothorax: chest pain, cough and breathlessness. Symptoms are usually mild but there may be severe presentations.\n Catamenial hemothorax: this is a rare manifestation of thoracic endometriosis, occurring in 14% of cases. In almost all cases, the right side is affected but has been one case of a bilateral catamenial hemothorax documented. The most common presenting symptoms are nonspecific and include cough, chest pain and shortness of breath. In some cases, signs may mimic pulmonary embolism. The quantity of blood loss varies, but severe anemia is possible. In almost all cases, chest X-ray shows the presence of pleural effusion without specific characteristics. A CT scan may show additional features such as nodular lesions of the pleura, multiloculated effusions, or bulky pleural masses.\n Cyclic haemoptysis: haemoptysis during menstruation is extremely rare, with about 30 case reports in medical literature. Currently, there have been no reports of massive haemoptysis or death. Cyclic haemoptysis is a sign of pulmonary parenchymal endometriosis; ectopic endometrial tissue in the lung responds to cyclical hormonal variation, bleeding along with the normal endometrium located in the uterus.\n Pulmonary nodules: nodules are common radiological features in patients with thoracic endometriosis; most cases are associated with catamenial haemoptysis.\nA woman with thoracic endometriosis may also have dysmenorrhoea and irregular menses.", + "doc_fkgl": 13.580182389937107, + "wiki_fkgl": 13.69791466046821, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 6.157894736842105, + "fkgl_delta": -0.11773227053110347 + }, + { + "index": 4, + "label": "low_health_literacy", + "original_doc": "This is about a 13-year-old boy. He has had small growths in his throat since he was two years old. The growths were in his voice box and windpipe. They narrowed his breathing tube, so he had trouble breathing. It was like trying to breathe through a pinched straw. A chest scan showed several small cysts in his lungs. Doctors removed the throat growths. They also placed a breathing tube through a small hole in his neck to help him breathe. He got one dose of a medicine called bevacizumab (400 mg) through a vein. He also had breathing therapy. He got better. The problem has not come back during follow-up.", + "wiki_anchor": "Signs and symptoms\nThe three most common symptoms of Opitz G/BBB syndrome (both type I & II) are hypertelorism (exceptionally wide-spaced eyes), laryngo-tracheo-esophalgeal defects (including clefts and holes in the palate, larynx, trachea and esophagus) and hypospadias (urinary openings in males not at the tip of the penis) (Meroni, Opitz G/BBB syndrome, 2012). Abnormalities in the larynx, trachea and esophagus can cause significant difficulty breathing and/or swallowing and can result in reoccurring pneumonia and life-threatening situations. Commonly, there may be a gap between the trachea and esophagus, referred to as a laryngeal cleft; which can allow food or fluid to enter the airway and make breathing and eating a difficult task.", + "doc_fkgl": 2.581463963963966, + "wiki_fkgl": 19.842727272727277, + "doc_tree_depth": 4.583333333333333, + "wiki_tree_depth": 7.333333333333333, + "fkgl_delta": -17.26126330876331 + }, + { + "index": 4, + "label": "intermediate_health_literacy", + "original_doc": "A 13-year-old boy with recurrent respiratory papillomatosis since age two presented with breathing difficulty, noisy breathing (stridor), and hoarseness. Airway evaluation showed multiple nodules narrowing the larynx and trachea. Chest CT revealed several pulmonary cysts. He underwent surgical removal of the papillomatosis lesions and a tracheostomy. He received a single 400 mg intravenous dose of bevacizumab and respiratory therapy. He recovered well, and there has been no recurrence on follow-up.", + "wiki_anchor": "Pathology \nThe majority of PB cases are associated with an underlying disease. Several systemic illnesses have been associated with plastic bronchitis:\n Cardiac: constrictive pericarditis, congenital heart disease\n Pulmonary: asthma, allergic bronchopulmonary aspergillosis, aspergillosis, bronchiectasis, cystic fibrosis, tuberculosis, pneumonia, and bronchocentric granulomatosis\n Disorders of lymphatic drainage: lymphangiectasia, lymphangiomatosis\n Miscellaneous: acute chest syndrome/sickle cell disease, amyloidosis, rheumatoid arthritis, membranous colitis, inhaled irritants, neoplastic (lymphoma)", + "doc_fkgl": 12.728571428571431, + "wiki_fkgl": 28.283870967741937, + "doc_tree_depth": 5.166666666666667, + "wiki_tree_depth": 8.0, + "fkgl_delta": -15.555299539170505 + }, + { + "index": 4, + "label": "proficient_health_literacy", + "original_doc": "A 13-year-old male from Cusco with recurrent respiratory papillomatosis (RRP) since age two (tracheostomy at age three) and a maternal history of genital papilloma presented after 16 days of predominantly nocturnal respiratory difficulty, inspiratory laryngeal stridor, and moderate dysphonia. He had previously received azithromycin and supplemental oxygen without improvement. On exam, there was mild subcostal retraction, decreased vesicular breath sounds over the left hemithorax, and scant wheezes predominating on the right; he required 4 L/min oxygen via binasal cannula. Laboratory studies showed WBC 8.03 \u00d7 10^3/\u03bcL, platelets 209 \u00d7 10^3/\u03bcL, hemoglobin 13.2 g/dL, and CRP 36.6 mg/L. Imaging included a chest study and head and neck tomography; chest tomography visualized several pulmonary cysts. Forty-eight hours after admission, he developed worsening stridor and respiratory distress, prompting emergent OR transfer for tracheostomy, microlaryngoscopy, and excision of papillomatous lesions. Intraoperative findings demonstrated extensive papillomatous disease with appendicular tumor-like lesions and ventricular bands involving the epiglottis, glottic surface, vocal cords, subglottis, and trachea to ring 5. Histopathology showed koilocytotic atypia consistent with HPV and mild focal dysplasia. Postoperatively, he was managed in the PICU with respiratory monitoring and was weaned off oxygen within 48 hours. He received a single intravenous dose of bevacizumab 400 mg and showed prompt clinical improvement. He completed a seven-day hospitalization with normalization of oxygen saturation and progressive oxygen weaning, then was transferred for ongoing care. He also received respiratory therapy. On telemonitoring at eight months, there was no evidence of recurrence or intercurrent events. Clinical context: RRP is typically HPV-related (often low-risk types) and can cause multifocal papillomas leading to airway stenosis; anti-VEGF therapy such as bevacizumab is used off-label to reduce angiogenesis and disease recurrence, and in this case was associated with a favorable short- to mid-term outcome.", + "wiki_anchor": "Signs and symptoms \nThoracic endometriosis is characterised by onset of the following clinical symptoms within 24 hours prior to and 72 hours after onset of menses.\n Catamenial pneumothorax: this is the most common clinical manifestation, present in 80% of cases. Catamenial pneumothorax is defined as a recurrent pneumothorax that occurs within the first 72 hours after menstruation. It may not necessarily occur with every menstrual cycle and in most cases is one-sided and on the right side. There are cases of catamenial pneumothorax on the left side, and on very rare occasions there may be a bilateral catamenial pneumothorax. Symptoms are the same as for other types of pneumothorax: chest pain, cough and breathlessness. Symptoms are usually mild but there may be severe presentations.\n Catamenial hemothorax: this is a rare manifestation of thoracic endometriosis, occurring in 14% of cases. In almost all cases, the right side is affected but has been one case of a bilateral catamenial hemothorax documented. The most common presenting symptoms are nonspecific and include cough, chest pain and shortness of breath. In some cases, signs may mimic pulmonary embolism. The quantity of blood loss varies, but severe anemia is possible. In almost all cases, chest X-ray shows the presence of pleural effusion without specific characteristics. A CT scan may show additional features such as nodular lesions of the pleura, multiloculated effusions, or bulky pleural masses.\n Cyclic haemoptysis: haemoptysis during menstruation is extremely rare, with about 30 case reports in medical literature. Currently, there have been no reports of massive haemoptysis or death. Cyclic haemoptysis is a sign of pulmonary parenchymal endometriosis; ectopic endometrial tissue in the lung responds to cyclical hormonal variation, bleeding along with the normal endometrium located in the uterus.\n Pulmonary nodules: nodules are common radiological features in patients with thoracic endometriosis; most cases are associated with catamenial haemoptysis.\nA woman with thoracic endometriosis may also have dysmenorrhoea and irregular menses.", + "doc_fkgl": 15.644583333333337, + "wiki_fkgl": 13.69791466046821, + "doc_tree_depth": 6.769230769230769, + "wiki_tree_depth": 6.157894736842105, + "fkgl_delta": 1.9466686728651261 + }, + { + "index": 5, + "label": "low_health_literacy", + "original_doc": "This 54-year-old man had long-term kidney disease. He took steroids and other medicines that weaken the body\u2019s defenses for a long time. He came to the lung department with fever, cough with mucus, and trouble breathing. A scan showed many cloudy spots in both lungs, like frosted glass. Blood tests showed a lot of inflammation. This suggested an infection from germs such as bacteria, a virus, or a fungus. A blood test was positive for RSV antibodies. Tests for other germs were not positive. His immune system was weak. His antibody level (IgG) was low. His infection-fighting T cells (CD4 and CD8) were also low. Doctors gave strong medicines for infection and support to help his breathing. His illness got worse quickly. He died from breathing failure.", + "wiki_anchor": "Disease association\nWU virus was originally discovered in respiratory secretions from a patient diagnosed with pneumonia of unknown origin. However, the overall rate of co-infection with other respiratory viruses is high, and it is not clear that WU virus itself causes disease. WU virus has not been detected in urine, although many polyomaviruses infect the kidneys and urinary tract and one human polyomavirus, BK virus, is associated with nephropathy in renal transplant patients. Some polyomaviruses are well known as carcinogenic, including the human polyomavirus Merkel cell polyomavirus, but WU virus has also not been associated with cancer. While no clear association with clinical symptoms has been identified, there is weak indication that WU and KI viruses may have pathogenic potential in immunocompromised patients.", + "doc_fkgl": 5.415573678290215, + "wiki_fkgl": 16.452780487804876, + "doc_tree_depth": 4.785714285714286, + "wiki_tree_depth": 6.6, + "fkgl_delta": -11.037206809514661 + }, + { + "index": 5, + "label": "intermediate_health_literacy", + "original_doc": "A 54-year-old man with chronic kidney disease on long-term corticosteroids and immunosuppressants was admitted to respiratory medicine with fever, cough with sputum, and shortness of breath. Chest CT showed multiple bilateral ground-glass opacities. Laboratory studies showed elevated inflammatory markers, indicating possible bacterial, viral, or fungal infection. RSV antibodies were positive, while tests for other pathogens were negative. He was immunocompromised from prolonged corticosteroid and immunosuppressant use, with low total IgG and reduced CD4 and CD8 T-lymphocyte counts. Despite intensive anti-infective therapy and escalating respiratory support, his condition deteriorated rapidly, and he died from respiratory failure.", + "wiki_anchor": "Granulomatous\u2013lymphocytic interstitial lung disease (GLILD) is a lung complication of common variable immunodeficiency disorders (CVID). It is seen in approximately 15% of patients with CVID. It has been defined histologically as the presence of (non-caseating) granuloma and lymphoproliferation in the lung. However, as GLILD is often associated with other auto-immune features such as splenomegaly, adenopathy and cytopenias, a definition based on abnormalities on lung imaging (CT scan) together with evidence of granulomatous inflammation elsewhere has also been employed.", + "doc_fkgl": 16.420789473684213, + "wiki_fkgl": 16.976538461538464, + "doc_tree_depth": 6.166666666666667, + "wiki_tree_depth": 8.0, + "fkgl_delta": -0.5557489878542512 + }, + { + "index": 5, + "label": "proficient_health_literacy", + "original_doc": "A 54-year-old male with membranous nephropathy II and nephrotic syndrome on long-term oral glucocorticoids and immunosuppressants (immunocompromised) presented to the Department of Respiratory Medicine with 5 days of fever, cough, expectoration, and progressive dyspnea. He had a 20 pack-year smoking history and no family history of hereditary disease. A chest x-ray one month prior was normal. On admission (August 8, 2016): BMI 24.5 kg/m2, T 39.0\u00b0C, tachypnea 35 breaths/min, severe hypoxemia (SaO2 86%). Auscultation revealed good bilateral air entry with scattered diffuse crackles and rhonchi. Chest CT demonstrated multiple bilateral ground-glass opacities. Initial labs showed a normal WBC count with elevated neutrophils and increased inflammatory markers (CRP, ESR) and elevated (1\u21923)-\u03b2-D-glucan. Serology was positive for RSV antibodies on hospital day 4; other pathogen testing was negative. He had laboratory evidence of immunosuppression with decreased total IgG and reduced CD4 and CD8 T-lymphocyte counts, consistent with chronic exposure to corticosteroids and immunosuppressants.\n\nManagement: Immediate respiratory monitoring and supplemental oxygen were initiated. Empiric anti-infective therapy included antibiotics (moxifloxacin for 4 days, then cefminoxine for 8 days) and antifungal therapy (voriconazole for 10 days). The glucocorticoid and immunosuppressant doses were largely unchanged. After 10 days, clinical status and oxygenation worsened with radiographic progression. He was transferred to the Emergency ICU for noninvasive mechanical ventilation, broad-spectrum antibiotics (i.v. meropenem, oral moxifloxacin, cotrimoxazole), antifungal therapy (micafungin), systemic corticosteroids (methylprednisolone 40 mg bid i.v.), and supportive care. Ganciclovir was added for possible viral coinfection (e.g., CMV). Five days later, chest x-ray showed further aggravation. Despite escalation to invasive ventilator-assisted ventilation, higher-dose methylprednisolone (80 mg bid), additional antibacterials (cefoperazone-sulbactam, tigecycline, cotrimoxazole), and continued micafungin, he developed rapid progression culminating in respiratory failure and death two days later.\n\nInterpretation: The presentation is consistent with severe viral pneumonia due to RSV in an immunocompromised host, with imaging showing multifocal ground-glass opacities and laboratory evidence of systemic inflammation. Elevated (1\u21923)-\u03b2-D-glucan prompted antifungal coverage, while broad-spectrum antibacterial and antiviral regimens addressed possible coinfections. Profound immunosuppression (low IgG, reduced CD4/CD8 T cells) likely contributed to rapid deterioration and refractory hypoxemic respiratory failure despite intensive anti-infective therapy and advanced respiratory support.", + "wiki_anchor": "Signs and symptoms\nLRBA deficiency presents as a syndrome of autoimmunity, lymphoproliferation, and humoral immune deficiency. Predominant clinical problems include idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia (AIHA), and an autoimmune enteropathy. Before the discovery of these gene mutations, patients were diagnosed with common variable immune deficiency (CVID), which is characterized by low antibody levels and recurrent infections. Infections mostly affect the respiratory tract, as many patients suffer from chronic lung disease, pneumonias, and bronchiectasis. Lymphocytic interstitial lung disease (ILD) is also observed, which complicates breathing and leads to impairment of lung function and mortality. Infections can also occur at other sites, such as the eyes, skin and gastrointestinal tract. Many patients suffer from chronic diarrhea and inflammatory bowel disease. Other clinical features can include hepatosplenomegaly, reoccurring warts, growth retardation, allergic dermatitis, and arthritis. Notably, LRBA deficiency has also been associated with type 1 diabetes mellitus. There is significant clinical phenotypic overlap with disease caused by CTLA4 haploinsufficiency. Since LRBA loss results in a loss of CTLA4 protein, the immune dysregulation syndrome of LRBA deficient patients can be attributed to the secondary loss of CTLA4. Because the predominant features of the disease include autoantibody-mediated disease (AIHA, ITP), Treg defects (resembling those found in CTLA4 haploinsufficient patients), autoimmune infiltration (of non-lymphoid organs, also resembling that found in CTLA4 haploinsufficient patients), and enteropathy, the disease has been termed LATAIE for LRBA deficiency with autoantibodies, Treg defects, autoimmune infiltration, and enteropathy.", + "doc_fkgl": 16.479367816091955, + "wiki_fkgl": 17.43071428571429, + "doc_tree_depth": 6.15, + "wiki_tree_depth": 6.75, + "fkgl_delta": -0.9513464696223366 + }, + { + "index": 6, + "label": "low_health_literacy", + "original_doc": "A 34-year-old woman had new lower back pain. She saw blood in her urine. She also had a big bruise under the skin on her right buttock. She had never had bleeding problems before. Because these bleeding signs were serious, she was sent to the emergency room. Doctors did blood-clotting tests. One test mixed her blood with normal blood to see how it clotted. Another test looked for a blocker against a clotting protein called factor eight. These tests confirmed the diagnosis.", + "wiki_anchor": "Symptoms and signs\nX-linked thrombocytopenia is typically diagnosed in infancy. The disease presents as a bleeding disorder with easy bruising, mucosal bleeding, such as nosebleeds, and mild to severe anemia. Anemia is a condition in which there is an insufficient number of red blood cells to carry adequate levels of oxygen to the body's tissues. X-linked thrombocytopenia is considered to be the milder phenotype of the WAS-related disorders. As age increases, the severity of symptoms tends to decrease. However, individuals with X-linked thrombocytopenia have an increased risk for life-threatening brain hemorrhages and spontaneous bleeding.", + "doc_fkgl": 4.512113821138211, + "wiki_fkgl": 12.739148936170213, + "doc_tree_depth": 4.444444444444445, + "wiki_tree_depth": 6.0, + "fkgl_delta": -8.227035115032002 + }, + { + "index": 6, + "label": "intermediate_health_literacy", + "original_doc": "A 34-year-old woman with no prior bleeding history developed lower back pain, passed a kidney stone, and then had three days of haematuria. She later developed painful thigh and right gluteal bruising after an intramuscular injection. Because the bleeding was extensive, she was transferred to the emergency department. Her coagulation work-up showed a markedly prolonged aPTT. A mixing study only partially corrected the aPTT, and factor VIII activity was very low with a measurable factor VIII inhibitor (8.64 BU/mL), confirming acquired haemophilia A, likely postpartum. She was treated with prednisone and cyclophosphamide, and received bypassing therapy (initially FEIBA, then switched to recombinant factor VIIa due to side effects). Her bleeding improved and she was discharged.", + "wiki_anchor": "Achievements\nTranexamic acid's value remained unappreciated for years, and it was not until 2009, that it was included on the WHO list of essential medicines to be used during cardiac surgery.\n \nIn 2010, a large randomised controlled trial in trauma patients showed its remarkable benefit if given within 3 hours of injury.\nAlso in 2010, the WOMAN (World Maternal Antifibrinolytic) trial began, a randomised, double-blind, placebo-controlled study of tranexamic acid in 20 060 women with post-partum haemorrhage. Enrollment was completed in 2016, and in April 2017, the results were published and showed that tranexamic acid reduced death in the 10,036 treated women versus the 9985 on placebo with no adverse effects.", + "doc_fkgl": 11.051032608695653, + "wiki_fkgl": 15.643310810810814, + "doc_tree_depth": 5.0, + "wiki_tree_depth": 6.75, + "fkgl_delta": -4.5922782021151605 + }, + { + "index": 6, + "label": "proficient_health_literacy", + "original_doc": "A 34-year-old female, 2 months post\u2013cesarean section (37 weeks) with persistent postoperative wound bleeding and no childhood/adolescent bleeding history, presented with a 4-week illness. The clinical course began with lower back pain attributed to bilateral renal lithiasis; after spontaneous passage of a stone she had 3 days of haematuria and was given tranexamic acid q12h. Three weeks later she developed progressive pain and induration of the left distal thigh. Following intramuscular diclofenac for persistent pain, she developed ecchymosis and ongoing bleeding in the gluteal area despite compression. An outside \u201cparticular Doppler ultrasound\u201d reportedly showed deep venous thrombosis (left lower limb), and she was started on enoxaparin 30 mg SC q24h plus morphine and hospitalized. The next day she developed epigastralgia, blurred vision, HR 117 bpm, BP 113/85 mmHg, and SpO2 93%; enoxaparin was discontinued. Hemoglobin fell from 10.4 g/dL (day prior to admission) to 6.4 g/dL, prompting 2 units of packed red cells. With a working diagnosis of vasculitis, methylprednisolone was started and she was referred for further evaluation.\n\nOn admission she had severe pallor, extensive ecchymosis of the left thigh and lateral knee, and a right thigh haematoma. Hemogram: Hb 9.8 g/dL, normocytic, normochromic. Chemistry notable for glucose 160 mg/dL; AST 52 U/L, ALT 86 U/L. Coagulation profile showed isolated prolongation of the activated partial thromboplastin time (aPTT) to 91.2 s; the remainder of hemogram, biochemistry, electrolytes, liver profile, and coagulation parameters were within reference limits. Soft-tissue ultrasound of the right gluteal region revealed a subcutaneous collection (TCSC) with oedema extending to the upper third of the thigh. Repeat Doppler ultrasound of the left lower limb showed normal flow without thrombosis in the common femoral, superficial, or deep venous systems. Blood and urine cultures were negative. ANA, C3, C4, and ferritin were within reference ranges.\n\nGiven suspected acquired haemophilia, a mixing test demonstrated partial correction of the aPTT. Factor VIII activity was <1.0 U/dL, and a factor VIII inhibitor was detected at 8.64 Bethesda units/mL, confirming acquired haemophilia A, likely postpartum in onset. Therapy included prednisone 50 mg PO at breakfast plus 10 mg at lunch, cyclophosphamide 50 mg (2 tablets) PO q24h, and FEIBA for haemostasis. After 5 days, FEIBA was discontinued due to chest tightness, dyspnoea, and nausea (suspected adverse drug reaction) and replaced with activated recombinant factor VII (rFVIIa; NovoSeven). Clinical evolution was favourable, with decreasing ecchymoses and no new symptoms, and she was discharged.\n\nContext: Postpartum acquired haemophilia A is mediated by autoantibodies to factor VIII and typically presents with isolated aPTT prolongation, low FVIII activity, and an inhibitor measured in Bethesda units. Partial correction on mixing supports an inhibitor pattern. First-line immunosuppression (e.g., prednisone with or without cyclophosphamide) and bypassing agents (FEIBA or rFVIIa) are standard to control bleeding while eradicating the inhibitor.", + "wiki_anchor": "Career\nIn January 1942, Okamoto started out as a research assistant at Tokyo Women's Medical University researching the cerebellum under a neurophysiologist who \"created many more opportunities for [women] than were otherwise available at the time.\" \nAfter World War II and the Second Sino-Japanese War respectively in 1945, she moved to Keio University in Shinanomachi in Tokyo. As resources were scarce, she and her husband Shosuke Okamoto changed to research on blood: \"If there was not enough we could simply use our own\". They hoped to find a treatment for post-partum haemorrhage, a potent drug to stop bleeding after childbirth. They began by studying epsilon-amino-caproic acid (EACA). They then studied a related chemical, 1-(aminomethyl)-cyclohexane-4-carboxylic acid (AMCHA), also known as tranexamic acid. The Okamotos found it was 27 times as powerful and thus a promising hemostatic agent and published their findings in the Keio Journal of Medicine in 1962.", + "doc_fkgl": 11.779287370862324, + "wiki_fkgl": 13.624633204633206, + "doc_tree_depth": 6.208333333333333, + "wiki_tree_depth": 7.571428571428571, + "fkgl_delta": -1.8453458337708817 + }, + { + "index": 7, + "label": "low_health_literacy", + "original_doc": "This is about a 2-day-old newborn boy. He was born at full term by C-section at a private hospital. He came to the children\u2019s hospital because the right side of his scrotum (the sack that holds the testicles) was swollen since birth. In the emergency room, he looked well. His skin was pink and warm. His blood flow looked good. On exam, the right testicle was big and tight. It was not sore when touched. The skin was red and looked rubbed. A light test did not shine through the right side. The light did shine through the left side. There were no signs of a hernia. An urgent ultrasound scan was done. The scan showed the right testicle was larger and looked uneven inside. No blood was flowing to it. The doctors took him quickly to surgery to look inside the scrotum. In surgery, the right testicle was dead because it had twisted, like a kinked hose that stops flow. There was a small amount of fluid. They removed the right testicle. They fixed the left testicle in place to help prevent twisting.", + "wiki_anchor": "Medical history\nTorres was found to have XY chromosomes, and neither a uterus nor the hypothesized tumor that might produce estrogen. She was referred to Dr.Robert Stoller, and was interviewed by him; Dr.Alexander Rosen, a psychologist; and Harold Garfinkel, a sociologist interested in the way sex works in society. Torres was taken to be an example of testicular feminization syndrome. She refused to meet or be classified with any other transgender people or homosexuals. She was recommended for surgery as an intersex patient, at a time when such surgery was regularly denied to transgender people. Surgery was done in 1959 by a team of doctors including Elmer Belt. Stoller presented his findings at the 1963 International Psychoanalytic Congress in Stockholm; Garfinkel included an extensive chapter on Agnes in his pioneering 1967 book on ethnomethodology. Post-operative infection and partial closure of her neovagina, weight loss that led to a reduction in breast size, and unpredictable mood changes led to problems with her boyfriend. In 1966 Torres confessed to Stoller that she had indeed taken external estrogens, causing Stoller to doubt his own theories. He retracted his earlier findings at the 1968 International Psychoanalytic Congress in Copenhagen.", + "doc_fkgl": 3.26104347826087, + "wiki_fkgl": 12.471602564102565, + "doc_tree_depth": 4.0, + "wiki_tree_depth": 6.9, + "fkgl_delta": -9.210559085841695 + }, + { + "index": 7, + "label": "intermediate_health_literacy", + "original_doc": "A full\u2011term male newborn, 2 days old and delivered by cesarean section, presented with a congenital right scrotal swelling. On arrival he appeared well perfused and stable. Examination showed the right testis was enlarged, tense, non\u2011tender, and visibly reddish with excoriated overlying skin. Transillumination was negative on the right and positive on the left; both hernia openings were normal. Doppler ultrasound showed the right testis was enlarged with a heterogeneous, darker appearance and no detectable blood flow; the left testis looked normal, with only a small amount of fluid. He was taken urgently to surgery. Intra\u2011operatively, the right testis was frankly nonviable due to intravaginal torsion, with minimal hydrocele. Surgeons removed the right testis (orchidectomy) and fixed the left testis in place (contralateral orchidopexy) to reduce the risk of future twisting.", + "wiki_anchor": "Rupture of the urethra is an uncommon result of penile injury, incorrect catheter insertion, straddle injury, or pelvic girdle fracture. The urethra, the muscular tube that allows for urination, may be damaged by trauma. When urethral rupture occurs, urine may extravasate (escape) into the surrounding tissues. The membranous urethra is most likely to be injured in pelvic fractures, allowing urine and blood to enter the deep perineal space and subperitoneal spaces via the genital hiatus. The spongy urethra is most likely to be injured with a catheter or in a straddle injury, allowing urine and blood to escape into the scrotum, the penis, and the superficial peritoneal space. Urethral rupture may be diagnosed with a cystourethrogram. Due to the tight adherence of the fascia lata, urine from a urethral rupture cannot spread into the thighs.", + "doc_fkgl": 11.784036259541985, + "wiki_fkgl": 12.209947089947093, + "doc_tree_depth": 5.375, + "wiki_tree_depth": 6.428571428571429, + "fkgl_delta": -0.42591083040510824 + }, + { + "index": 7, + "label": "proficient_health_literacy", + "original_doc": "A 2\u2011day\u2011old term male neonate, delivered by cesarean section at a private hospital, was referred for a congenital right scrotal swelling and presented to our children\u2019s 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\u2011tender, 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 \u00d7 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\u2011operatively 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.", + "wiki_anchor": "Acardiac twin\n Achondrogenesis\n Achondroplasia\n Adrenal hematoma\n Agenesis of the corpus callosum\n Amniotic band syndrome\n Anal atresia\n Anencephaly\n Angelman syndrome\n Aqueductal stenosis\n Arachnoid cyst\n Arthrogryposis\n Bilateral multicystic dysplastic kidneys\n Camptomelic dysplasia\n Cardiac rhabdomyoma\n Caudal regression syndrome\n Chorioangioma\n Cleft palate\n Club foot\n Coarctation of the aorta\n Conjoined twins\n Cystic hygroma\n Dandy\u2013Walker malformation\n Diaphragmatic hernia\n Diastrophic dysplasia\n Double outlet right ventricle\n Duodenal atresia\n Ebstein's anomaly\n Ectopia cordis\n Encephalocele\n Endocardial cushion defect\n Esophageal atresia\n Exstrophy of the bladder\n Fetal alcohol syndrome\n First arch syndrome\n Focal femoral hypoplasia\n Gastrointestinal atresia\n Gastroschisis\n Holoprosencephaly\n Hydranencephaly\n Hydronephrosis\n Hydrops fetalis\n Hypoplastic left heart syndrome\n Infantile polycystic kidney disease\n Iniencephaly\n Intracranial teratoma\n Intrauterine growth retardation\n Klippel\u2013Tr\u00e9naunay syndrome\n Limb body wall complex\n Macrosomia\n Meconium cyst\n Meconium ileus\n Microcephaly\n Multicystic dysplastic kidney\n Multiple pterygium syndrome\n Oligohydramnios\n Omphalocele\n Osteogenesis imperfecta\n Pentalogy of Cantrell\n Polydactyly\n Polyhydramnios\n Posterior urethral valves\n Renal agenesis\n Rh incompatibility\n Sacrococcygeal teratoma\n Spina bifida\n Spinal dysraphism\n Syndactyly\n Tetralogy of Fallot\n Thanatophoric dwarfism\n Transposition of the great vessels\n Triploidy\n Trisomy 13\n Trisomy 18\n Trisomy 21 (Down Syndrome)\n Turner syndrome (Monosomy X)\n Twin-to-twin transfusion syndrome\n Ureterocele\n VACTERL association\n Vein of Galen malformation\n Ventricular septal defect", + "doc_fkgl": 15.11899521531101, + "wiki_fkgl": 84.43615384615384, + "doc_tree_depth": 6.5, + "wiki_tree_depth": 13.0, + "fkgl_delta": -69.31715863084284 + }, + { + "index": 8, + "label": "low_health_literacy", + "original_doc": "A 4-year-old boy had blood in his pee and swelling for 5 days. He then had headaches, nausea, and vomiting. He came to the hospital with seizures and very high blood pressure. Blood tests showed a low level of a protein called C3 and signs of a recent strep infection. This meant his kidney filters were inflamed after strep. His brain was affected by the very high blood pressure. Doctors suspected a problem called PRES, which is brain swelling from high pressure. A brain MRI confirmed this. His immune system also attacked his red blood cells. This made his blood level drop very low, to 5 g/dL. He was treated with medicines to lower his blood pressure, steps to protect his brain, and steroid medicines. He left the hospital after 31 days. Six months later, he had no symptoms.", + "wiki_anchor": "Post-streptococcus glomerulonephritis is more often associated with group A strep skin infection than it is with strep pharyngitis, so in a patient with suspected post-strep glomerulonephritis with a negative ASO titer, one can then obtain anti-DNase-B titers which are more sensitive for group A strep and for its various strains. Anti-DNase B antibody titers also stay elevated for longer, which is useful since often ASO titers may rise, but then fall prior to the onset of the glomerulonephritis where the onset of disease is often greater than 2 weeks after the infection resolved. In this way anti-DNase B titers are very useful to clinicians and allow for evidence of the recent infection to be seen and levels of this antibody to be quantified.", + "doc_fkgl": 4.794388489208632, + "wiki_fkgl": 19.107317073170737, + "doc_tree_depth": 4.923076923076923, + "wiki_tree_depth": 9.666666666666666, + "fkgl_delta": -14.312928583962105 + }, + { + "index": 8, + "label": "intermediate_health_literacy", + "original_doc": "A 4-year-old boy presented after 5 days of visible blood in the urine and leg swelling, plus new headaches, nausea, and vomiting. He developed seizures with a hypertensive emergency. Labs showed low complement C3 and a high anti-streptolysin O (ASO) titer, consistent with acute post-streptococcal glomerulonephritis. He developed encephalopathy, and MRI confirmed posterior reversible encephalopathy syndrome (PRES) secondary to the hypertensive crisis. He also developed autoimmune hemolytic anemia, with hemoglobin falling to 5 g/dL. Treatment included antihypertensive therapy, neuroprotective measures, and corticosteroids. He was discharged after 31 days and remained asymptomatic at 6-month follow-up.", + "wiki_anchor": "In a patient with suspected post-streptococcal glomerulonephritis, anti-streptolysin-O titres (ASOTs) can be negative even after strep pharyngitis. Some studies suggest that up to 85% of patients with acute rheumatic fever from group A strep infection will be positive for ASO titers, leaving 15% of patients having been diagnosed with rheumatic fever negative for ASO titers. In addition and contrary to percentages seen in strep pharyngitis, strep skin infection induces ASO antibodies less often, which can be problematic for physicians searching for a cause of the glomerulonephritis and having a high suspicion that its etiology was strep.", + "doc_fkgl": 14.753525835866263, + "wiki_fkgl": 17.540000000000003, + "doc_tree_depth": 6.333333333333333, + "wiki_tree_depth": 9.333333333333334, + "fkgl_delta": -2.7864741641337396 + }, + { + "index": 8, + "label": "proficient_health_literacy", + "original_doc": "A 4-year-old male, two weeks post nasal impetigo treated with topical mupirocin and oral cefadroxil (dose/duration/adherence unknown), presented with 5 days of macroscopic glomerular haematuria and lower-extremity oedema, followed by 12 hours of headache, nausea, and vomiting, and arrived to the ED in convulsive status after 20 minutes of generalized tonic\u2013clonic seizures. On ED arrival he was afebrile, with non-evaluable BP, depressed consciousness, generalized hypertonia, and bilateral pretibial oedema. He was intubated and loaded with phenobarbital 10 mg/kg. In the ICU, BP was 134/94 mmHg (p95 for age 108/66; p95+12 120/78), consistent with hypertensive emergency. Initial labs: urinalysis with haematuria (>100 RBC/hpf), proteinuria 3+, leucocyturia 10\u201325/hpf; creatinine 0.3 mg/dL; anaemia Hct 21%, Hb 7 g/dL with normocytic, normochromic indices; leukocytosis 23,900/mm3; thrombocytosis 756,000/mm3; no elevation of acute-phase reactants; hypocomplementemia with C3 25 mg/dL (VN 80\u2013150) and normal C4. Throat rapid antigen for group A Streptococcus was positive and ASO positive. Non-contrast head CT was unremarkable. Renal ultrasound showed bilateral nephromegaly with increased cortical echogenicity and decreased corticomedullary differentiation. The working diagnosis was nephritic syndrome due to complicated GNAPE with hypertensive emergency and status epilepticus. He required mechanical ventilation and phenobarbital; EEG the next day was normal; CSF was normal. Cefotaxime was started for Streptococcus pyogenes eradication and furosemide for diuresis. By day 2 he developed AKI (creatinine 0.99 mg/dL), hypertension, and 24-hour proteinuria 36.6 mg/m2/h without oliguria. Antihypertensive therapy included amlodipine and IV labetalol with initial control. After extubation at 48 hours, he deteriorated neurologically within 24 hours (GCS 8) with BP > p95+12 despite labetalol infusion up to 3 mg/kg/h, amlodipine 10 mg/day, and furosemide, necessitating reintubation and sodium nitroprusside infusion up to 3 mcg/kg/min with a planned gradual BP reduction of 25% per day to mitigate secondary neurologic injury. Given acute neurologic deficits with severe HTN in GN, PRES was suspected and confirmed by brain MRI on day 5 showing increased subcortical T2/FLAIR signal in bilateral symmetric occipital regions without diffusion restriction, consistent with vasogenic edema. Ophthalmologic exam was normal; repeat EEG showed occasional generalized voltage depression. Enalapril was added. Over 10 days, BP normalized with slow pharmacologic weaning; follow-up MRI on day 12 showed radiologic regression, and he was successfully extubated after 5 days. During the ICU course, Hb fell to 5 g/dL with normocytic, normochromic indices and no thrombocytopenia; hemolytic anemia was diagnosed given a positive direct Coombs test and hemoglobinuria. He required two packed RBC transfusions. Methylprednisolone 1 mg/kg/day was given for 72 hours. Stool culture and urinary antigen for Streptococcus pneumoniae were negative. Serologies for EBV and Parvovirus B19, ENA profile, ANCA, anti-dsDNA, anti-\u03b22 glycoprotein I, anticardiolipin, and lupus anticoagulant were all negative; all cultures (blood, urine, endotracheal aspirate, pharyngeal) were negative. ANA was positive at 1:160. Clinical status improved with BP control, rising complement levels, and resolution of proteinuria and haematuria; the direct Coombs remained positive on hospital day 9. He was discharged on day 31 normotensive, non-anaemic, with preserved renal function, no proteinuria or haematuria, normalized C3, and asymptomatic neurologically. Discharge medications: prednisone, amlodipine, enalapril, and folic acid. He remained asymptomatic with no recurrence at 6 months. Overall, the case represents GNAPE with hypocomplementemia (low C3) and elevated ASO complicated by hypertensive emergency causing encephalopathy and secondary PRES, plus autoimmune hemolytic anemia with Hb nadir 5 g/dL, successfully managed with antihypertensives, neuroprotective measures, and corticosteroids, with full clinical and radiologic recovery.", + "wiki_anchor": "Prolonged EEG/Continuous video EEG/ Epilepsy Monitoring Unit monitoring \nOne of the first steps in management of drug resistant epilepsy is confirming the diagnosis by EEG. Typically patients are admitted to hospital for prolonged EEG monitoring. Typically patients are taken off their antiseizure medications so that the evolution of seizure symptoms and there relation with changes in electrical activity of brain can be determined; while minimizing adverse consequences of seizures as far as possible. Additional maneuvers to provoke seizures are also frequently performed, like sleep deprivation, photic stimulation, hyperventilation. This study can take 3\u201314 days. Length of study depends on factors like baseline seizure frequency, number and types of seizure medication patient is taking prior to study, institutional protocols etc. The goal is to record 3-4 typical seizures, though in some cases more or less seizures may need to be recorded. After this evaluation some patients may be determined to have non-epileptic causes of their symptoms, eg syncope, psychogenic nonepileptic seizures, cardiac arrhythmia etc. For patients who are confirmed to have epilepsy, this testing helps confirm the type of epilepsy- generalized vs focal. In case of focal epilepsy, this evaluation provides crucial information to determine the area of brain where seizures begin. Information from seizure symptoms and their evolution over the course of the seizure as well changes on EEG in relation to the symptoms is used to hypothesize the likely area of the brain responsible for seizure symptoms (symptomatic zone) and by extrapolation the area where seizure likely starts (seizure onset zone).", + "doc_fkgl": 14.958653673835126, + "wiki_fkgl": 15.86756132756133, + "doc_tree_depth": 5.866666666666666, + "wiki_tree_depth": 7.363636363636363, + "fkgl_delta": -0.9089076537262031 + }, + { + "index": 9, + "label": "low_health_literacy", + "original_doc": "This 69-year-old man had heart bypass surgery in the past. For 2 months, he got very short of breath with light activity. Tests\u2014a heart tracing, a blood test, and an X-ray movie with dye of the heart arteries\u2014showed heart failure from poor blood flow after a bypass vein to the right heart artery failed. Doctors first opened a totally blocked artery on the left side of his heart. Then they used tiny natural detours between heart arteries to reach the right heart artery from the far end and open it. His breathing was better when he left the hospital. Six months later, his shortness of breath had not come back.", + "wiki_anchor": "After being drafted into the United States Navy, Johnson discovered that he was susceptible to seasickness, so he joined the United States Public Health Service. Later, he joined cardiac surgeon Derward Lepley in Milwaukee to work on coronary artery bypass procedures. Johnson became known for a 1968 operation in which he bypassed a patient's right coronary artery using a vein taken from the patient's leg. The same year, Lepley and Johnson performed a heart transplant. The patient lived for nine years after the transplant; at the time, that patient's survival was the longest of any heart transplant patient.", + "doc_fkgl": 6.522207792207791, + "wiki_fkgl": 11.560122448979595, + "doc_tree_depth": 5.571428571428571, + "wiki_tree_depth": 6.8, + "fkgl_delta": -5.037914656771804 + }, + { + "index": 9, + "label": "intermediate_health_literacy", + "original_doc": "A 69-year-old man with prior coronary bypass surgery presented with two months of severe shortness of breath with mild activity (NYHA class III). He was diagnosed with heart failure due to ischemia after failure of a saphenous vein graft to the right coronary artery. This was supported by an abnormal ECG, elevated NT-proBNP, and a coronary angiogram; echocardiography also showed reduced pumping function. The team reopened a chronic total occlusion in the native right coronary artery using a retrograde approach through septal channels (septal surfing). To enable that route, they first re-opened the totally occluded left coronary artery. After the procedure, his dyspnea improved before discharge, and at 6 months he had no recurrence of shortness of breath.", + "wiki_anchor": "After being drafted into the United States Navy, Johnson discovered that he was susceptible to seasickness, so he joined the United States Public Health Service. Later, he joined cardiac surgeon Derward Lepley in Milwaukee to work on coronary artery bypass procedures. Johnson became known for a 1968 operation in which he bypassed a patient's right coronary artery using a vein taken from the patient's leg. The same year, Lepley and Johnson performed a heart transplant. The patient lived for nine years after the transplant; at the time, that patient's survival was the longest of any heart transplant patient.", + "doc_fkgl": 13.480000000000004, + "wiki_fkgl": 11.560122448979595, + "doc_tree_depth": 7.166666666666667, + "wiki_tree_depth": 6.8, + "fkgl_delta": 1.9198775510204094 + }, + { + "index": 9, + "label": "proficient_health_literacy", + "original_doc": "A 69-year-old male with prior CABG presented with 2 months of severe dyspnea on mild exertion (NYHA III). ECG showed ST depression in II, III, aVF, and V4\u20136; NT-proBNP was 2640 pg/mL. Echocardiography demonstrated LV systolic dysfunction with LVEF 30%. His history included an inferior STEMI in 2009 with severe 3-vessel disease (proximal LAD CTO, 90% mid/distal LCx stenoses, 95% mid RCA stenosis) treated with CABG (LIMA\u2013LAD; sequential SVG to OM1, OM2, and PL). Current angiography via 6 Fr left radial access showed patent LIMA\u2013LAD and SVG\u2013OM1/OM2, but complete occlusion of the sequential SVG to PL. The native LM was occluded at the ostium and the native RCA was occluded in the mid segment with bridging collaterals. The strategy was to treat the native RCA CTO. Dual arterial access was obtained with an additional 6 Fr right femoral sheath. The right and left coronaries were engaged with 6 Fr AL 0.75 (Launcher; Medtronic) and 6 Fr EBU 3.5 (Launcher; Medtronic) guide catheters, respectively. An antegrade approach from the left radial artery failed: neither a Fielder XTR nor a Gaia 3 with a Finecross microcatheter could enter the distal true lumen. A parallel wire technique with a Crusade microcatheter and two Gaia 3 wires also failed. The team then switched to a retrograde approach via septal channels from the LAD through the occluded left coronary system. A Gaia 3 crossed the occluded LM and LAD to reach the distal LAD true lumen. A Sion wire was exchanged via a Finecross into the distal LAD, followed by dilation of the LM and proximal LAD with a 2.0 \u00d7 15 mm balloon. Septal surfing technique (SST) was then used to identify a viable septal channel. A Sion wire, supported by a 150-cm Finecross, was advanced retrogradely through a distal septal branch into the distal RCA. A Gaia 3 traversed the RCA CTO retrogradely into the proximal RCA true lumen and was advanced into a Guidezilla guide extension catheter positioned in the antegrade guide. The Finecross was delivered to the antegrade guide and an RG3 wire was externalized. The CTO segment was predilated with a 2.0 \u00d7 15 mm balloon and stented with two overlapping DES (2.5 \u00d7 38 mm and 3.0 \u00d7 38 mm), achieving an excellent angiographic result with TIMI 3 flow in all distal branches. Dyspnea was relieved at discharge, and at 6-month follow-up there was no recurrence of dyspnea.", + "wiki_anchor": "Tarlochan Singh Kler is an Indian interventional cardiologist, medical administrator, writer, Chairman at Fortis Heart and Vascular Institute, (Fortis Memorial Research Institute,Gurugram and Fortis Flt. Lt. Rajan Dhall Hospital) and (former Director of Cardiac Sciences at Fortis Escorts Heart Institute). Born in Amargarh in the Indian state of Punjab, he graduated in medicine from Punjabi University in 1976, secured his MD in general medicine from Postgraduate Institute of Medical Education and Research (PGIMER) in 1980 and followed it up with the degree of DM in cardiology from the same institution in 1983. He succeeded Naresh Trehan as the executive director of Fortis Heart Institute and Research Centre before becoming its director. He has written several articles on interventional cardiology; Persistent left superior vena cava opening directly into right atrium and mistaken for coronary sinus during biventricular pacemaker implantation, Mammary coronary artery anastomosis without cardiopulmonary bypass through minithoracotomy: one year clinical experience, and Ventricular Fibrillation in the EP Lab. What is the Atrial Rhythm? are some of the notable ones. The Government of India awarded him the third highest civilian honour of the Padma Bhushan, in 2005, for his contributions to medicine.", + "doc_fkgl": 9.065632911392406, + "wiki_fkgl": 17.877270942408384, + "doc_tree_depth": 6.684210526315789, + "wiki_tree_depth": 6.375, + "fkgl_delta": -8.811638031015978 + }, + { + "index": 10, + "label": "low_health_literacy", + "original_doc": "A 51-year-old man came to us with sudden, painful vision loss in his left eye for three days. His right eye could see clearly (20/20). His left eye could only see hand movements. The back of his left eye showed swelling of the seeing nerve, a bulge in the layer under the retina, several patches of fluid under the retina, and wrinkles in the thin lining there. An MRI scan with contrast dye of the eyes and brain showed a small lump behind the eye where the eye nerve meets the white part of the eye. Tests for cancer and immune diseases were normal. The doctors diagnosed inflammation in the back part of the eye\u2019s white coat that forms a small lump (nodular posterior scleritis). They started high-dose steroid pills by mouth (prednisolone).", + "wiki_anchor": "Katscher had been operated upon twice for cancer of the right breast. Shortly after the second operation, she consulted, for blindness of the left eye, Dr. Wilhelm Goldzieher, of Budapest, who sent her to Dr. Adamkiewicz with a diagnosis of cancerous infiltration of the choroid and partial detachment of the retina. This diagnosis was confirmed by Dr. Sachs, assistant in the ophthalmological clinic of the University of Vienna. Sachs also followed up his ophthalmoscopic examinations during the treatment by cancroine, and certified to actual resorption of a cancerous process and restoration of vision to two thirds of normal. The conditions in the breast cicatrix were also improved.", + "doc_fkgl": 6.597509398496243, + "wiki_fkgl": 10.46924065420561, + "doc_tree_depth": 5.875, + "wiki_tree_depth": 8.6, + "fkgl_delta": -3.871731255709367 + }, + { + "index": 10, + "label": "intermediate_health_literacy", + "original_doc": "A 51-year-old man presented with 3 days of sudden, painful vision loss in the left eye. Visual acuity was 20/20 in the right eye and hand motion in the left eye. Left fundus findings included optic nerve head swelling, choroidal bulging, multiple areas of subretinal fluid, and RPE corrugations. Orbital/brain MRI with gadolinium showed a retrobulbar nodular mass enhancing at the junction of the optic nerve and sclera. Oncology and rheumatology evaluations were unremarkable. The clinical diagnosis was nodular posterior scleritis, and oral prednisolone was started.", + "wiki_anchor": "Signs and symptoms \n Long-term reduced eyesight\n Central or paracentral scotoma\nVision loss due to solar retinopathy is typically reversible, lasting for as short as one month to over one year. The fundus changes are variable and usually bilateral, mild cases often show no alteration and moderate to severe cases show a foveal yellow spot on the first days after exposure. After a few days it is replaced by a reddish dot often surrounded by pigment.", + "doc_fkgl": 11.54186046511628, + "wiki_fkgl": 13.669333333333334, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 6.666666666666667, + "fkgl_delta": -2.1274728682170547 + }, + { + "index": 10, + "label": "proficient_health_literacy", + "original_doc": "A 51-year-old male presented with acute, painful visual loss of the left eye (LE) for 3 days. Best-corrected distance visual acuity (BCDVA) was 20/20 OD and hand motion (HM) OS. Ocular motility and anterior segment were unremarkable OU. Fundus OS showed optic nerve head (ONH) swelling, choroidal bulging, multiple patches of subretinal fluid (SRF), and retinal pigment epithelial (RPE) corrugations; OD fundus was unremarkable.\n\nMultimodal imaging was obtained: OCT (OptoVue, Inc., Fremont, CA, USA; software version 2018.0.0.18) demonstrated mild RPE and choroidal bulging, RPE hyper-reflectivity with back shadowing, subretinal and intraretinal fluid, and mild retinal thickening. Indocyanine green angiography (ICGA) showed a geographic macular hypocyanescent area OS. Blue-autofluorescence (BAF) revealed a geographic macular area with speckled autofluorescence. B-scan ultrasonography showed optic nerve enlargement. Fluorescein angiography (FA) demonstrated vascular leakage at the ONH (hot disc) and a geographic patchy hypofluorescent area with speckled hyperfluorescent margins measuring approximately three disc diameters. Orbital and brain MRI with gadolinium revealed a retrobulbar nodular enhancing mass at the optic nerve\u2013sclera junction. Oncology consultation was unremarkable.\n\nGiven concern for malignancy and the enhancing orbital nodule, the patient underwent transconjunctival lateral orbitotomy one week after presentation. Intraoperatively, a pink localized scleral nodule with edematous Tenon was identified. With a clinical diagnosis of nodular posterior scleritis, sub-Tenon triamcinolone acetonide was administered. The patient declined admission and intravenous corticosteroids; oral prednisolone 50 mg/Kg was initiated. Rheumatologic and infectious work-up, including PPD (tuberculosis), chest X-ray, serum ACE (sarcoidosis), and C-ANCA (Wegener granulomatosis), was unremarkable.\n\nAt the one-week postoperative follow-up, BCDVA was 20/20 OD and counting fingers at 2 meters OS. SRF had resolved, and the macula was atrophic. Oral prednisolone was tapered over three months.", + "wiki_anchor": "Overview\nThe original article by Suchow and Alvarez describes the phenomenon occurring when participants observe a series of videos showing one hundred small dots arranged in a ring shape around a central fixation point that change either in color, brightness, size or shape. These rings would alternate between phases of motionlessness and movement in a rotational back and forward motion. Participants are instructed to focus on the fixation point and adjust the rate of the changing properties in the stationary phase to match that of the moving phase. The faster the rotational movement, the slower the dots appeared to change. It has been inferred by the authors of the original study, as well as by others that have replicated the effect, that although the task involves motion in space and motion on the retina, it is the movement of the image across the retina that is responsible for the silencing effect. In the same study, Suchow and Alvarez required participants to complete a fixation-tracking task in order to assess whether Conversely, the illusory effect can be eliminated by moving the eye to follow the movement of the image or monitoring its changing properties specifically.", + "doc_fkgl": 14.661870129870131, + "wiki_fkgl": 17.15298969072165, + "doc_tree_depth": 5.473684210526316, + "wiki_tree_depth": 10.5, + "fkgl_delta": -2.4911195608515193 + }, + { + "index": 11, + "label": "low_health_literacy", + "original_doc": "A 78-year-old man from the Amhara region of Ethiopia had a permanent heart pacemaker because of a complete heart block. He was scheduled for prostate surgery. Before surgery, the anesthesia and heart doctors advised switching his pacemaker to a steady, fixed beat to lower the chance of problems. He could not afford that change. He chose to go ahead with the operation. He signed consent for the plan. After surgery, he also gave permission to share his case. For anesthesia, he got a numbing injection in the lower back (a combined spinal\u2013epidural). The team used 2.5 ml of strong numbing medicine (0.5% bupivacaine) and a tiny dose of fentanyl (50 micrograms). Standard monitors were used, and his heart was watched closely. His vital signs stayed steady, with only small changes. His blood pressure stayed good with IV salt water. After surgery, he went to the recovery room. He got pain medicine after 4 hours and an extra dose through the epidural. Six hours after surgery, he moved to the ward in stable condition. The epidural pain control continued for 72 hours. He went home in stable condition about 88 hours after surgery.", + "wiki_anchor": "Legacy \nAfter introducing the endomyocardial biopsy (EMB) procedure at AIIMS in 1986, he deployed the technique in the evaluation and diagnosis of tropical heart muscle diseases, and his findings on the occurrence of inflammatory myocarditis in Takayasu's arteritis patients have been documented, the first instance the topic was published in medical literature. He also proposed therapeutical protocol for reversing the myocardial dysfunction using immunosuppressants. He established radiofrequency ablation facility in 1992 at AIIMS as a therapeutic procedure for remedying Cardiac arrhythmia and three years later, he introduced Implantable cardioverter-defibrillator implantation procedure in 1995, the first time the procedure was performed in South Asia. The effort earned him a mention in the 1997 edition of the Limca Book of Records. In 2000, he brought the Cardiac Resynchronization Therapy to India for the first time. The introduction of multisite pacing system for managing heart failure and pioneering efforts in electrophysiology and cardiac pacemakers are some of his other notable contributions. His work on Cardiac arrhythmia helped develop it as a specialty in India and he was associated with Heart transplant program at AIIMS. His work has been documented by way of several publications which include 240 articles and 270 abstracts, published in various peer-reviewed medical journals. He has also contributed 15 chapters to various medical texts.", + "doc_fkgl": 6.542719298245618, + "wiki_fkgl": 17.117912772585672, + "doc_tree_depth": 4.823529411764706, + "wiki_tree_depth": 7.555555555555555, + "fkgl_delta": -10.575193474340054 + }, + { + "index": 11, + "label": "intermediate_health_literacy", + "original_doc": "A 78-year-old man from the Amhara region, Ethiopia, with a permanent pacemaker placed for complete heart block was scheduled for retropubic prostatectomy. The anesthesia and cardiology teams recommended switching his dual-chamber, rate\u2011modulated pacemaker to an asynchronous mode perioperatively to reduce the risk of electromagnetic interference during surgery. He could not afford reprogramming and chose to proceed with the existing plan after informed consent; permission to publish the case was obtained after the operation. He received combined spinal\u2013epidural anesthesia at L3\u2013L4 using 0.5% isobaric bupivacaine 2.5 ml (12.5 mg) plus fentanyl 50 \u00b5g. Standard ASA monitoring was applied with special attention to cardiac stability. Intraoperatively, he remained stable with minimal changes in vital signs; blood pressure was supported with isotonic saline as needed. Postoperatively, he was monitored in the PACU, received analgesia at 4 hours with an epidural top\u2011up, and was transferred to the ward about 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in good condition.", + "wiki_anchor": "Facilities Available\n Accident & Emergency 24/7\n Department of General Surgery and Surgical Oncology (Providing a complete range of General Surgical and Cancer Surgery Services for all Solid Organ Cancers)\n Gastroenterology with services of endoscopy, Colonoscopy and ERCP procedures\n Liver Transplant\n Renal Transplantation and Renal Haemodialysis.\n Nutritional rehabilitation\n Neonatal and Pediatric intensive care unit\n Central Intensive Care Unit (ICU) with Central Oxygen and Suction System\n Coronary Care Unit (CCU) Facilities\n Cardiology\n Angiography, Angioplasty, Cardiac Bypass, Heart Valves Replacement and all sorts of Cardiac Operations and procedures\n Heart lung lab with services of echocardiography, EET and Holter monitoring\n Lungs function lab with services of bronchoscopy procedures\n Physiotherapy and Manual therapy on both indoor and outdoor basis\n Latest Physiotherapy Equipment, Rehabilitation Center and Orthopaedic Workshop\n Neuroangiography, Electromyography (EMG), Electroencephalography (EEG) and all kind of sophisticated Neurosurgical operations\n Operations of Plastic Surgery and cosmetology Lip Augmentation, Rhioplasty)\n Dental Surgery\n All kinds of Orthopedic Operations\n All kind of Eye and Otorhinolaryngology Operations\n Surgical Operations of all kind for neonates, children, young and old patients\n Anesthesia and Pain medicine\n Rheumatology Dept. The first dedicated indoor facility for patients suffering from auto-immune disease was inaugurated at Shaikh Zayed Hospital Lahore on Wednesday 14-Mar-2017.\n All kind of diagnostic investigations", + "doc_fkgl": 12.910294117647059, + "wiki_fkgl": 30.755, + "doc_tree_depth": 6.444444444444445, + "wiki_tree_depth": 10.25, + "fkgl_delta": -17.84470588235294 + }, + { + "index": 11, + "label": "proficient_health_literacy", + "original_doc": "A 78-year-old male from the Amhara region of Ethiopia with a 7-year history of a permanent pacemaker for complete heart block was scheduled for retropubic prostatectomy for BPH after prior TURP 3 months earlier. Comorbidities included long-standing hypertension (amlodipine 5 mg daily, enalapril 10 mg BID, atorvastatin 10 mg daily) and type 2 diabetes mellitus (metformin 500 mg BID; NPH insulin 20 IU AM/10 IU PM). Preoperative evaluation showed complete bundle branch block on ECG; electrophysiology assessment demonstrated LVH due to hypertensive heart disease with mild diastolic dysfunction and an EF of 62%. Abdominal ultrasound showed an 82-ml prostate; AP chest X-ray was normal with a left-sided pacemaker in situ; electrolytes and troponin were normal. He had a frailty score of 5.5, METs 3.4, and an RCRI class III, indicating an estimated 10.1% risk of major adverse cardiac events within 30 days and intermediate surgical risk. Multidisciplinary planning recommended reprogramming the dual-chamber, rate\u2011modulated pacemaker to an asynchronous mode to mitigate intraoperative electromagnetic interference risk. Due to financial and logistical constraints, reprogramming was not performed; risks were disclosed, and he consented to proceed. Preoperatively, usual medications were continued (with a lower morning NPH dose at two\u2011thirds); diazepam 5 mg PO was given at midnight for anxiolysis. On the day of surgery, random blood glucose was checked and managed with a sliding scale. Team communication emphasized CIED precautions (electrosurgery pad positioned away from the device; emergency drugs and defibrillator immediately available). Dexamethasone was given for PONV prophylaxis and paracetamol for preemptive analgesia. ASA standard monitoring was applied and baselines recorded. An L3\u2013L4 combined epidural\u2013spinal anesthetic was performed using 0.5% isobaric bupivacaine 12.5 mg (2.5 ml) plus fentanyl 50 \u00b5g, achieving a sensory level to T7. The procedure used a midline infraumbilical incision; monopolar cautery at low voltage (20 mA) with bipolar low\u2011voltage cautery for hemostasis. Intraoperative hemodynamics remained within 10% of baseline without cardiorespiratory events; blood pressure was maintained with isotonic saline. Postoperatively, he was transferred to PACU with vigilant monitoring; analgesia was administered at 4 hours with an epidural top\u2011up, and he was transferred to the ward approximately 6 hours after surgery in stable condition. Epidural analgesia was continued for 72 hours. He was discharged at the 88th postoperative hour in stable condition, with cardiology follow\u2011up advised. Informed consent was obtained, and permission for case report publication was granted after the operation.", + "wiki_anchor": "Antzelevitch C, Yan G-X Ackerman MJ, Borggrefe M, Corrado D; Guo J; Gussak I; Hasdemir C; Horie M; Huikuri H; Ma C; Morita H; Nam G-B; Sacher F; Shimizu W; Viskin S; Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), and the Latin American Society of Cardiac Pacing and Electrophysiology (Sociedad Latinoamericana de Estimulacifin Cardiaca y Electrofisiologia [SOLAECE]). Published in 3 journals worldwide: Heart Rhythm. 2016 Oct;13(10):e295-324. PMID 27423412; Europace. 2017 Apr 1;19(4):665-6942016. PMID 27411360; Journal of Arrhythmia 2016; J Arrhythm. 2016 Oct;32(5):315-339. PMID 27761155.\n Antzelevitch C. Brugada Syndrome. In: Encyclopedia of Cardiovascular Research and Medicine. Cardiac Electrophysiology, Arrhythmias and Sudden Death Section, Vasan Ramachandran and Douglas Sawyer, Editors-in-Chief and In: Elsevier Biomedical Sciences Reference Modules, 2017.\n Chen PS, Antzelevitch C. Mechanisms of cardiac arrhythmias and conduction disturbances. In: Hurst\u2019s The Heart 14th ed. Fuster V, O\u2019Rourke R, Walsh R, Poole-Wilson P, eds. McGraw Hill, New York, NY, Chapter 79, 2017.\n Antzelevitch C, Di Diego JM. Tpeak-Tend Interval as a Marker of Arrhythmic Risk. Invited Editorial. Heart Rhythm, S1547-5271(19)30017-7, 2019.\n J\u00e9r\u00f4me Clatot*, Nathalie Neyroud, Robert Cox, Charlotte Souil, Pascale Guicheney, and Charles Antzelevitch. Inter-regulation of Kv4.3 and Voltage-gated Sodium Channels Underlies Predisposition to Cardiac and Neuronal Channelopathies. Int J Mol Sci. 2020 Jul 17;21(14): E5057. PMID 32709127.\n Peter J. Schwartz, Michael J. Ackerman, Charles Antzelevitch, Connie R. Bezzina, Martin Borggrefe, Bettina F. Cuneo, Arthur A. M. Wilde. Inherited Cardiac Arrhythmias. Nature Reviews Disease Primers, Jul 16;6(1):58, 2020. PMID 32678103.\n Chen P-S, Antzelevitch C, Ho SY, Priori S. Electrophysiologic anatomy, mechanisms of arrhythmias and conduction disturbances, and genetics, 15th Edition of Hurst\u2019s The Heart, 2020.\n Di Diego JM*, Patocskai B*, Barajas-Martinez H*, Borb\u00e1th V; Ackerman MJ, Burashnikov A, Clatot J, Li G-R, Robinson VM, Hu D and Antzelevitch C. Acacetin Suppresses the Electrocardiographic and Arrhythmic Manifestations of the J Wave Syndromes. PLoS One. 2020 Nov 24;15(11):e0242747 .PMID 33232375.", + "doc_fkgl": 13.475840409207162, + "wiki_fkgl": 10.190359421921922, + "doc_tree_depth": 6.2631578947368425, + "wiki_tree_depth": 4.382352941176471, + "fkgl_delta": 3.28548098728524 + }, + { + "index": 12, + "label": "low_health_literacy", + "original_doc": "A 52-year-old woman had burning when she peed and had to pee very often for a long time. She tried many treatments for bladder infections, but the problem did not go away. Regular scans and lab tests looked normal. A camera test that looked inside her bladder showed the lining was red and irritated, with tiny bits floating in the urine. Later, the lab saw a live larva (a baby insect) in her urine under the microscope. That finding explained her symptoms. She was told to keep very clean. She was also told to drink plenty of water every day.", + "wiki_anchor": "Biology\nThe adults can sustain themselves by drinking water or consuming flower nectar and live for about 12 days. They spend most of their life perched on walls. They move rarely, and with weak flight. The larvae live in aquatic environments, feeding on organic decaying matter, and take about 18 days to turn into a pupa, which develops into an adult after 5 days. They often infest drains of bathrooms and, for this reason, they are also known as \"bath flies\" in the United States.", + "doc_fkgl": 6.041, + "wiki_fkgl": 8.531764705882352, + "doc_tree_depth": 5.125, + "wiki_tree_depth": 6.6, + "fkgl_delta": -2.490764705882352 + }, + { + "index": 12, + "label": "intermediate_health_literacy", + "original_doc": "A 52-year-old woman had ongoing dysuria and urinary frequency despite multiple treatments for presumed infections. Cystoscopy showed bladder redness and debris, while imaging and routine lab tests were unremarkable. Eventually, a live larva was identified in the urine, confirming the cause of her symptoms. Management focused on better personal hygiene and increased fluid intake.", + "wiki_anchor": "Selected works \n De conjugatae verae pelvis introitus mensuris et mensurationibus (dissertation), 1850.\n Klinische Studien \u00fcber die verschiedenen Formen von chronischen diffusen Nierenentz\u00fcndungen, 1870 \u2013 Clinical studies on the various forms of chronic diffuse kidney infections. \n Handbuch der Krankheiten des Harnapparates, 1875 \u2013 Handbook of diseases of the urinary system (considered to be his best work).", + "doc_fkgl": 12.18240740740741, + "wiki_fkgl": 15.122641509433969, + "doc_tree_depth": 5.5, + "wiki_tree_depth": 6.25, + "fkgl_delta": -2.940234102026558 + }, + { + "index": 12, + "label": "proficient_health_literacy", + "original_doc": "A 52-year-old woman presented with a three-year history of urinary frequency, dysuria, and dribbling, along with intermittent passage of red and black thread-like material in the urine. Episodes with these discharges were associated with headache, fever, and chills, and she reported intermittent periurethral and genital pruritus. She had been repeatedly treated for recurrent urinary tract infections without clinical improvement. She denied recent travel, camping, hiking, farming, swimming, or insect bites. Past surgical history included pilonidal sinus surgery (8 years prior) and hysterectomy (7 years prior). Two years before the current visit, she was hospitalized for evaluation. Examination revealed a well-appearing patient with normal vital signs. Laboratory testing, including complete blood count, urinalysis, and serum chemistries, was within normal limits. Abdominopelvic CT was unremarkable. Cystoscopy demonstrated erythema and hyperemia of the bladder mucosa, suspended intravesical debris, and dilatation of the left ureteral orifice. Schistosomiasis was suspected and she received praziquantel at appropriate dose and duration, without improvement. A second infectious diseases consultation raised suspicion for urinary myiasis, and ivermectin was prescribed, again without benefit. She underwent bladder irrigation with polyethylene glycol; no visible larvae were recovered from the washings, and she experienced self-limited hematuria for two days post-procedure. A subsequent random urinalysis was normal. However, a 24-hour urine collection demonstrated a live larva on light microscopy. The specimen was isolated and identified morphologically by an entomologist as Sarcophaga spp. Final management emphasized personal hygiene measures and liberal oral hydration.", + "wiki_anchor": "Types of vaginal trauma \nIntercourse-related lacerations can range from superficial tears to more severe lacerations, tears rarely extend into the rectal lumen and the peritoneal cavity. Recto-vaginal injuries are usually a result of assault with a foreign object, rape, or accidental gynecologic injury. Injuries of this severity that resulted from consensual sex are very rare. Posterior and right vaginal fornix lacerations have been known to occur during consensual vaginal intercourse. The location of these lacerations is usually based on a woman's reproductive anatomy. It is common for women to have a uterus that lies slightly to the right, this exposes the right fornix and makes it easier for some type of tearing or trauma to occur. Lacerations to the posterior peri-cervical vagina tend to occur in the missionary position, hips and legs hyperflexed. Other positions can also expose the posterior vaginal wall that usually protected by the cervix, this allows for posterior fornix tears. Tears in the upper area of the vagina are more often reported in consensual intercourse than forced intercourse. Complications from severe vaginal lacerations, such as from an assault, can include hemoperitoneum, pneumoperitoneum, and retroperitoneal hematoma with or without vaginal perforation. Tears along the long axis of the vagina or the posterior fourchette lacerations are more likely to occur from rape. Lacerations or tears of the hymen are common but are not indicative of consensual or non-consensual intercourse.", + "doc_fkgl": 14.957394957983198, + "wiki_fkgl": 14.189361471861474, + "doc_tree_depth": 5.411764705882353, + "wiki_tree_depth": 6.916666666666667, + "fkgl_delta": 0.7680334861217233 + }, + { + "index": 13, + "label": "low_health_literacy", + "original_doc": "A 36-year-old woman had a long-term bowel disease (ulcerative colitis). She came in with chest pain that kept getting worse. She also had shortness of breath, sweating, and felt sick to her stomach. For months she had felt very tired and had night sweats. Her heart test (EKG) showed signs of a heart attack in the lower part of the heart. Doctors did a dye X-ray to look at the heart arteries. It showed bad blockages in two heart pipes. They opened the most blocked pipe right away with a balloon and a tiny mesh tube (stent). While looking, the team worried the main body artery (aorta) was swollen. Blood tests showed mild inflammation. A special CT scan showed the aorta wall looked thick and scarred, with tight narrow spots in several arteries. This pointed to a rare illness that causes swollen big arteries, called Takayasu arteritis. She started strong anti-inflammatory and immune medicines (prednisone and methotrexate). Later she had heart bypass surgery to improve blood flow. She did well after treatment.", + "wiki_anchor": "Types of heart disease \nThere are number of conditions that involves the heart such as:\n Heart failure \u2013 damaged heart muscles, therefore, it becomes too weak to pump blood to the body (Newton & Joyce, 2012, p.\u00a074).\n Coronary heart disease \u2013 when plaques deposits in the coronary artery narrowing the artery reducing the flow of blood to the heart muscle (Newton & Joyce, 2012, p.\u00a075)\n Stroke \u2013 blocked blood vessel in the brain resulting in the brain tissues not receive oxygen (Newton & Joyce, 2012, p.\u00a076)\n Myocardial infarction (heart attack) \u2013 blockage in the arteries that completely blocks the blood flow to the heart (Newton & Joyce, 2012, p.\u00a076)\n Peripheral vascular disease \u2013 the flow of blood supply is slow or absent in veins and arteries in the limbs (Newton & Joyce, 2012, p.\u00a072)", + "doc_fkgl": 5.827348837209307, + "wiki_fkgl": 12.03479069767442, + "doc_tree_depth": 5.066666666666666, + "wiki_tree_depth": 10.5, + "fkgl_delta": -6.207441860465114 + }, + { + "index": 13, + "label": "intermediate_health_literacy", + "original_doc": "A 36-year-old woman with ulcerative colitis developed a week of worsening chest pressure with autonomic symptoms (such as sweating and nausea). Her electrocardiogram showed ST-segment elevation in the inferior leads, consistent with an inferior-wall heart attack. She also reported several months of fatigue and night sweats.\n\nUrgent coronary angiography found severe two-vessel coronary artery disease. The right coronary artery was the culprit lesion and was opened successfully with a stent. Because the interventional team suspected inflammation of the aorta (aortitis), additional workup was done. Inflammatory markers were mildly elevated, and CT angiography showed fibrotic thickening around the aorta with significant narrowing in multiple arteries, pointing to Takayasu arteritis.\n\nShe started treatment with prednisone and methotrexate. After stabilization, she underwent delayed coronary bypass surgery and did well.", + "wiki_anchor": "Inflammatory aortic aneurysm (IAA), also known as Inflammatory abdominal aortic aneurysm (IAAA), is a type of abdominal aortic aneurysm (AAA) where the walls of the aneurysm become thick and inflamed. Similar to AAA, IAA occurs in the abdominal region. IAA is closely associated and believed to be a response to and extensive peri-aneurysmal fibrosis, which is the formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process IAA accounts for 5-10% of aortic aneurysms. IAA occurs mainly in a population that is on average younger by 10 years than most AAA patients. Some common symptoms of IAA may include back pain, abdominal tenderness, fevers, weight loss or elevated Erythrocyte sedimentation rate (ESR) levels. Corticosteroids and other immunosuppressive drugs have been found to decrease symptoms and the degree of peri-aortic inflammation and fibrosis", + "doc_fkgl": 14.593809523809526, + "wiki_fkgl": 14.92269784172662, + "doc_tree_depth": 5.888888888888889, + "wiki_tree_depth": 8.166666666666666, + "fkgl_delta": -0.3288883179170945 + }, + { + "index": 13, + "label": "proficient_health_literacy", + "original_doc": "A 36-year-old female with ulcerative colitis (well controlled on sulfasalazine, ferrous fumarate, and intermittent prednisone for flares) presented with 1 week of progressive oppressive precordial pain associated with dyspnea and neurovegetative symptoms. On admission, the ECG was in sinus rhythm with ST-segment elevation in the inferior wall. She endorsed a 6-month history of general malaise, fatigue, and night sweats, and had experienced exertional precordial pain that progressed to occur at rest. Physical examination revealed no murmurs or peripheral pulse abnormalities.\n\nEmergency coronary angiography demonstrated severe 2-vessel coronary disease: a severe 90% ostial lesion in the left coronary trunk (left main) and a severe 99\u2013100% subocclusive ostial lesion in the right coronary artery (culprit vessel). Primary angioplasty of the right coronary artery was performed with successful placement of a drug-eluting stent. The hemodynamicist noted possible aortitis given arch involvement and vessel friability during balloon advancement and recommended an inflammatory/etiologic evaluation prior to definitive management of the left main lesion.\n\nLaboratory testing showed mild anemia (hemoglobin 11.6 g/dL), mild leukocytosis (13,800/mm3), elevated ESR 42 mm/h, CRP 4.9 mg/L (normal <1), and elevated high-sensitivity troponin. Autoimmunity panel: normal complement C3/C4, negative ANA, anti-DNA, and ENA profile; non-reactive VDRL. Cardiac MRI with contrast demonstrated acute non-transmural infarction of the left ventricular inferior wall and subendocardial ischemia in the anteroseptoapical region at rest, with mild aortic and mitral insufficiency and preserved biventricular systolic function.\n\nComputed tomographic angiography of the chest/abdomen/pelvis showed periaortic fibrotic wall thickening involving the aortic root, arch, and abdominal aorta, with severe left coronary trunk stenosis, mild left subclavian and left vertebral artery stenoses, and severe inferior mesenteric artery stenosis. The differential included IgG4-related disease versus Takayasu arteritis. Total IgG was 1,600 mg/dL (ref 700\u20131,600) with IgG1 1,024 mg/dL (elevated) and normal IgG2 456 mg/dL, IgG3 98.8 mg/dL, and IgG4 13.6 mg/dL, findings not supportive of IgG4-related aortitis. Takayasu arteritis was diagnosed clinically and by imaging.\n\nImmunosuppression was initiated with prednisone 60 mg daily and methotrexate 20 mg weekly (parenteral) with folic acid 1 mg daily. After 3 weeks of therapy, she underwent myocardial revascularization surgery using the left internal mammary artery graft to the descending anterior artery (LAD) and an aortocoronary bypass to the circumflex artery. Intraoperatively, the aortic root and ascending aorta appeared healthy. She was discharged home in good general condition and remains under ambulatory follow-up.\n\nContext: Takayasu arteritis is a large-vessel granulomatous vasculitis affecting the aorta and its major branches that can produce aorto-ostial coronary lesions (as in this case, involving the left main and right coronary ostia), leading to myocardial ischemia/infarction. The mildly elevated inflammatory indices, periaortic fibrotic thickening, and multifocal arterial stenoses on CTA are characteristic, and the lack of IgG4 elevation argues against IgG4-related aortitis. The staged approach\u2014urgent culprit-vessel PCI followed by immunosuppression and delayed CABG\u2014is consistent with management principles aiming to control vascular inflammation before definitive surgical revascularization.", + "wiki_anchor": "Antzelevitch C, Yan G-X Ackerman MJ, Borggrefe M, Corrado D; Guo J; Gussak I; Hasdemir C; Horie M; Huikuri H; Ma C; Morita H; Nam G-B; Sacher F; Shimizu W; Viskin S; Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), and the Latin American Society of Cardiac Pacing and Electrophysiology (Sociedad Latinoamericana de Estimulacifin Cardiaca y Electrofisiologia [SOLAECE]). Published in 3 journals worldwide: Heart Rhythm. 2016 Oct;13(10):e295-324. PMID 27423412; Europace. 2017 Apr 1;19(4):665-6942016. PMID 27411360; Journal of Arrhythmia 2016; J Arrhythm. 2016 Oct;32(5):315-339. PMID 27761155.\n Antzelevitch C. Brugada Syndrome. In: Encyclopedia of Cardiovascular Research and Medicine. Cardiac Electrophysiology, Arrhythmias and Sudden Death Section, Vasan Ramachandran and Douglas Sawyer, Editors-in-Chief and In: Elsevier Biomedical Sciences Reference Modules, 2017.\n Chen PS, Antzelevitch C. Mechanisms of cardiac arrhythmias and conduction disturbances. In: Hurst\u2019s The Heart 14th ed. Fuster V, O\u2019Rourke R, Walsh R, Poole-Wilson P, eds. McGraw Hill, New York, NY, Chapter 79, 2017.\n Antzelevitch C, Di Diego JM. Tpeak-Tend Interval as a Marker of Arrhythmic Risk. Invited Editorial. Heart Rhythm, S1547-5271(19)30017-7, 2019.\n J\u00e9r\u00f4me Clatot*, Nathalie Neyroud, Robert Cox, Charlotte Souil, Pascale Guicheney, and Charles Antzelevitch. Inter-regulation of Kv4.3 and Voltage-gated Sodium Channels Underlies Predisposition to Cardiac and Neuronal Channelopathies. Int J Mol Sci. 2020 Jul 17;21(14): E5057. PMID 32709127.\n Peter J. Schwartz, Michael J. Ackerman, Charles Antzelevitch, Connie R. Bezzina, Martin Borggrefe, Bettina F. Cuneo, Arthur A. M. Wilde. Inherited Cardiac Arrhythmias. Nature Reviews Disease Primers, Jul 16;6(1):58, 2020. PMID 32678103.\n Chen P-S, Antzelevitch C, Ho SY, Priori S. Electrophysiologic anatomy, mechanisms of arrhythmias and conduction disturbances, and genetics, 15th Edition of Hurst\u2019s The Heart, 2020.\n Di Diego JM*, Patocskai B*, Barajas-Martinez H*, Borb\u00e1th V; Ackerman MJ, Burashnikov A, Clatot J, Li G-R, Robinson VM, Hu D and Antzelevitch C. Acacetin Suppresses the Electrocardiographic and Arrhythmic Manifestations of the J Wave Syndromes. PLoS One. 2020 Nov 24;15(11):e0242747 .PMID 33232375.", + "doc_fkgl": 16.972754430379748, + "wiki_fkgl": 10.190359421921922, + "doc_tree_depth": 6.380952380952381, + "wiki_tree_depth": 4.382352941176471, + "fkgl_delta": 6.782395008457826 + }, + { + "index": 14, + "label": "low_health_literacy", + "original_doc": "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\u2019s symptoms and body anatomy. This patient did not receive any treatment.", + "wiki_anchor": "Bleeding can be life-threatening and can occur in 1 to 4%. Rarely, intercostal artery can be injured when biopsy needle is punctured through the back, due to variations in the course of the artery during its first 6 cm from the spine when emerged from the midline vessels such as costocervical trunk of subclavian artery and descending thoracic aorta. There is a higher chance of the artery deviated from its usual course of groove below the ribs (subcostal groove), for the ribs that are nearer to the head. Therefore, target lesions near the back of the lungs are usually avoided if possible, and the puncture should be as near to the superior margin of the ribs as possible during biopsy.", + "doc_fkgl": 5.730088652482269, + "wiki_fkgl": 14.596666666666668, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 9.0, + "fkgl_delta": -8.866578014184398 + }, + { + "index": 14, + "label": "intermediate_health_literacy", + "original_doc": "A 36-year-old woman had dysphagia due to a congenital right aortic arch with mirror-image branching.\nIn this rare pattern, the aorta runs to the right, wraps around the right main bronchus, and the head-and-arm arteries branch in the reverse order of normal.\nMost people have no symptoms unless the aorta or an associated bulge compresses the esophagus or trachea.\nSurgery is considered for major airway or esophageal compression, aneurysmal disease, thoracic aortic dissection, or a Kommerell diverticulum larger than 2 cm.\nThere is no standard operation; treatment is tailored to the person\u2019s anatomy and symptoms.\nIn this case, imaging showed external compression of the upper esophagus with a small Kommerell diverticulum (about 1.3 cm), so no intervention was performed and her symptoms improved.", + "wiki_anchor": "Signs and symptoms\nThe three most common symptoms of Opitz G/BBB syndrome (both type I & II) are hypertelorism (exceptionally wide-spaced eyes), laryngo-tracheo-esophalgeal defects (including clefts and holes in the palate, larynx, trachea and esophagus) and hypospadias (urinary openings in males not at the tip of the penis) (Meroni, Opitz G/BBB syndrome, 2012). Abnormalities in the larynx, trachea and esophagus can cause significant difficulty breathing and/or swallowing and can result in reoccurring pneumonia and life-threatening situations. Commonly, there may be a gap between the trachea and esophagus, referred to as a laryngeal cleft; which can allow food or fluid to enter the airway and make breathing and eating a difficult task.", + "doc_fkgl": 11.984808362369339, + "wiki_fkgl": 19.842727272727277, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 7.333333333333333, + "fkgl_delta": -7.857918910357938 + }, + { + "index": 14, + "label": "proficient_health_literacy", + "original_doc": "A 36-year-old female presented with dysphagia and longstanding cervical and upper thoracic pain; she also had a multinodular goiter with no other significant history. Esophagogastroduodenal transit after barium ingestion showed a posterior and lateral right impression on the proximal esophagus extending 3.5 cm craniocaudally, with an estimated maximal esophageal stenosis of 60%. Cervical and thoracic CT revealed a congenital anomaly of the aortic arch: a right aortic arch with mirror-image branching. The arch originated from the aortic root, coursed above the right stem bronchus, and gave rise to the three supra-aortic trunks as follows: (1) left brachiocephalic artery (giving rise to the left common carotid artery and the left subclavian artery), (2) right common carotid artery, and (3) right subclavian artery. The aortic arch then passed posterior to the esophagus and exhibited a small anterior saccule measuring 1.3 cm, consistent with a Kommerell diverticulum. This configuration formed a vascular ring around the tracheo-esophageal pair, bounded posterolaterally on the right by the aortic arch, posterolaterally on the left by the Kommerell diverticulum, laterally on the left by the arteriosum ligamentum (or arterial ligament), and anteriorly by the left brachiocephalic artery. Gastroscopy confirmed endoluminal impact of extrinsic compression. Given minimal clinical repercussions and absence of nutritional disorders, no surgical cure was performed. The evolution was favorable with patient-reported spontaneous amelioration of symptoms.\n\nContext: Right aortic arch with mirror-image branching is a rare anomaly of embryologic development. The vast majority of patients are asymptomatic unless mediastinal structures are compressed. Indications for surgery include major compression of the esophagus or trachea, aneurysmal disease, thoracic aortic dissection, or a Kommerell diverticulum larger than 2 cm. There is no standardized treatment; management is individualized according to clinical presentation and anatomic configuration.", + "wiki_anchor": "Description\nTokarahia differs from other eomysticetids in possessing elongate, dorsoventrally tapering zygomatic processes that are medially bowed, with a concave lateral margin, an elongate diamond-shaped posterior bullar facet lacking longitudinal striations, and a transverse crest on the dorsal surface of the periotic, between the posterodorsal angle and the posterior internal acoustic meatus. It is similar to Tohoraata raekohao in having numerous foramina in the supraorbital process of the frontal, an ovalshaped incisural flange closely appressed to the anteroventral part of the pars cochlearis, a prominent dorsal tubercle between the stylomastoid fossa and apertures for the cochlear and vestibular aqueducts, a triangular anterior process in medial view with a posteriorly placed anterodorsal angle, a concave anterodorsal margin between the anteroventral and anterodorsal angles, an internal acoustic meatus that is anteriorly transversely pinched, a posterodorsal angle that is more acute and approximately 90\u00b0 or smaller, and lacking a posterior bullar facet that is 'folded' into two facets by a hingeline, and additionally lacking longitudinal striations on the posterior bullar facet. However, it differs from Tohoraata in the structure of the earbone. The two species of Tokarahia are distinguished by the structure of the earbone as well as the degree of cranial telescoping.", + "doc_fkgl": 16.455087719298245, + "wiki_fkgl": 26.507, + "doc_tree_depth": 7.0, + "wiki_tree_depth": 10.5, + "fkgl_delta": -10.051912280701757 + }, + { + "index": 15, + "label": "low_health_literacy", + "original_doc": "This story is about a 62-year-old white North African woman. She was diagnosed in 2021 with a rare condition called Von Hippel\u2013Lindau disease. This condition caused growths in several parts of her body. She had a tumor in a bone near her left ear. She had a tumor in the left adrenal gland, which sits above the kidney. She had cancer in her left kidney. Her right kidney had many cysts. She also had growths in her pancreas. She received several treatments. She had radiation treatment. She had surgery to remove the left adrenal gland. She had surgery to remove the left kidney. She had major surgery on the pancreas and nearby small intestine. Later, ultrasound and MRI scans showed a lump with both fluid and solid parts near the left ovary and tube. Keyhole surgery looked inside the pelvis. It found cyst-type tumors in the thin support tissue next to both fallopian tubes. Doctors then removed the uterus and both ovaries and tubes. The lab checked the tissue. It showed tumors of the same type on both sides in the thin support tissue around the tubes and the uterus. These findings fit with Von Hippel\u2013Lindau disease.", + "wiki_anchor": "History\nKlein's line is named after the orthopaedic surgeon Armin Klein (1892\u20131954), Chief of Orthopaedic Services at the then newly opened Beth Israel Hospital of Boston for his observations presented to the American Academy of Orthopaedic Surgeons in 1951 and published in 1952. Klein and three colleagues at Massachusetts General Hospital had seen the crippling effects in later life for a person with slipped capital femoral epiphysis; they were convinced that early diagnosis in childhood and \"prophylactic procedures\" were needed to treat the condition. The diagnosis was up until then made by comparing the X-ray of the suspected epiphysis with the \"normal\" hip on the opposite side, which in Klein's series had left 11 of 38 children undiagnosed. In children with the condition they observed an abnormal alignment of the femoral head with the femoral neck on an X-ray taken from a frontal view of the hip joint and a side view taken with the child in the frog-leg position: \"The proximal part of the femoral neck at its juncture with the epiphysis was left bare superiorly and anteriorly over an area equivalent to the amount of slipping of the head as much as in the 'normal' hip.\"", + "doc_fkgl": 5.262667512690356, + "wiki_fkgl": 22.845303030303032, + "doc_tree_depth": 5.15, + "wiki_tree_depth": 11.75, + "fkgl_delta": -17.582635517612676 + }, + { + "index": 15, + "label": "intermediate_health_literacy", + "original_doc": "A 62-year-old white North African woman with Von Hippel\u2013Lindau (VHL) disease diagnosed in 2021 developed several VHL-related tumors: a left petrous bone tumor, a left pheochromocytoma, left renal cell carcinoma, a multicystic right kidney, and pancreatic masses. She was treated with radiotherapy to the petrous bone lesion, left adrenalectomy, left nephrectomy, and cephalic duodenopancreatectomy for the pancreatic tumors. During surveillance, ultrasound and MRI showed a solid\u2013cystic mass in the left adnexal (ovary/tube) region. Laparoscopy then identified cystic tumors in the mesosalpinx on both the right and left sides. She underwent hysterectomy with removal of both adnexa. Pathology confirmed bilateral clear-cell papillary cystadenomas of the mesosalpinx and broad ligament, a pattern consistent with VHL.", + "wiki_anchor": "Background \nWhiteley, who is from Northallerton, North Yorkshire, attended Hurworth House School and Polam Hall School. He competed in triathlons as a youth and was the British Triathlon regional champion for the 13\u201314 age group. In 2006 at the age of 14 he was diagnosed with osteosarcoma (a form of bone cancer) below his right knee, and was given only a 30% chance of survival by doctors. He had surgery to remove the tumour, during which his knee joint and part of his fibula were removed, and further surgery to replace the joint and insert titanium rods into his leg. He also had chemotherapy over an 11-month period. He learned to walk again after a year of physiotherapy.", + "doc_fkgl": 13.893053097345135, + "wiki_fkgl": 9.980000000000004, + "doc_tree_depth": 6.666666666666667, + "wiki_tree_depth": 6.333333333333333, + "fkgl_delta": 3.9130530973451307 + }, + { + "index": 15, + "label": "proficient_health_literacy", + "original_doc": "A 62-year-old Tunisian Arab postmenopausal woman with Von Hippel\u2013Lindau (VHL) disease (diagnosed 2021) had multisystem involvement. In 2021 she had a 6 cm left petrous bone endolymphatic sac tumor managed with radiotherapy; a 6 cm left pheochromocytoma treated with left adrenalectomy (pathology: pheochromocytoma); and a ruptured left renal mass treated with left nephrectomy (microscopy: multifocal clear-cell renal cell carcinoma, nuclear grade 2). In 2022 she underwent cephalic duodenopancreatectomy for a pancreatic mass; histology showed three serous cystadenomas and two well-differentiated neuroendocrine tumors. In January 2021, surveillance abdominal\u2013pelvic CT incidentally identified a 4 cm solid\u2013cystic left adnexal mass suspected to be malignant; this was confirmed on transvaginal ultrasound and pelvic MRI and classified O-RADS 5. Gynecologic exam was unremarkable. At laparotomy via a midline infraumbilical incision, a well-defined solid\u2013cystic mass was found in the left adnexa. There was no ascites, no peritoneal carcinomatosis, and the right adnexa appeared grossly normal without exocystic vegetations. Peritoneal cytology was obtained. Left adnexectomy was performed and the specimen sent for frozen section, which was inconclusive, raising the differential of a borderline tumor versus a VHL-associated tumor. Given her postmenopausal status, total hysterectomy with right adnexectomy was completed. Final histology demonstrated bilateral clear-cell papillary cystadenomas of the Fallopian tubes and broad ligament, measuring 0.5 cm on the right and 4 cm on the left. The tumors were composed of tightly packed papillae with fibrous cores lined by monolayered epithelium, consistent with VHL-associated mesosalpinx/broad ligament lesions. The postoperative course was uneventful; 1-month postoperative evaluation was normal. She has been followed every 4 months with normal pelvic ultrasound for 2 years, and was recently readmitted to neurosurgery for recurrence of a brain tumor.", + "wiki_anchor": "Laparoscopic surgery (gastroesophageal reflux disease, achalasia, oesophagus and stomach tumours, diverticular disease, inflammatory bowel disease \u2013 Crohn\u2019s disease and ulcerative colitis \u2013, colorectal cancer, colonic bowel polyposis, liver surgery, gall bladder and bile duct surgery, pancreas tumours, etc.) He has performed various new procedures: the first laparoscopic and thoracoscopy approach to oesophageal cancer, the first laparoscopic approach to live kidney donation, etc.\n NOTES (Natural Orifice Transluminal Endoscopic Surgery) and SILS (Single Incision Laparoscopic Surgery). He has performed transgastric cholecystectomy, anti-transoral oesophageal-gastric reflux techniques, transvaginal sigmoidectomy, transvaginal tubular gastroplasty, cholecystectomy and obesity surgery \u2013 sleeve gastrectomy, taking a SILS approach.\n Oncological Surgery (colon and rectal cancer, esophageal and stomach cancer, metastasis treatment \u2013 surgical resection, radiofrequency, etc. \u2013, pancreas cancer, liver tumours).\n Obesity Surgery and Development of Surgical Programme for Type-2 Diabetes and Metabolic Syndrome, as part of international working groups for the development of new techniques.\n Dr Lacy is also a pioneer in use of the Cecil Approach (simultaneous robotic transabdominal and transanal approach to removal of rectal cancer).\n He is a Founding Member of AIS (Advances in Surgery) Channel, a leading global educational platform providing training and networking for surgeons.", + "doc_fkgl": 15.117090909090908, + "wiki_fkgl": 19.305483870967745, + "doc_tree_depth": 6.071428571428571, + "wiki_tree_depth": 9.142857142857142, + "fkgl_delta": -4.188392961876836 + }, + { + "index": 16, + "label": "low_health_literacy", + "original_doc": "A 59-year-old man with type 1 diabetes came to the hospital with heart failure. A heart ultrasound showed big clumps of germs stuck to two heart valves, the mitral and the aortic valves. His blood test grew a germ called Staphylococcus warneri. This is a kind of staph that usually lives on the skin and is normally harmless. Doctors found he had an infection on his own heart valves (native valve endocarditis). He later had surgery to replace both the mitral and the aortic valves. Looking back, small lab changes and weight loss that began about four months earlier may have been early warning signs. He had not been on immune-weakening medicines and did not have any implanted medical devices.", + "wiki_anchor": "Awards and honors\n 1980 - Alpha Omega Alpha medical honor society\n 1981 - The Otto Saphir Award in Pathology\n 1982 - Valedictorian Address, University of Illinois School of Medicine\n 1982 - Merck Manual Award\n 1982 - The Dr. Charles Spencer Williamson Award in Medicine\n 2000-2001 - Department of Environmental Health Faculty Outreach Award\n 2004 - University of Washington School of Public Health and Community Medicine Outstanding Mentor Award\n 2007 - University of Washington School of Public Health and Community Outreach Award\n 2009 - Health Sciences/UW Medical Center Community Service Award\n 2013 - Convocation address, University of Washington Department of Environmental and Occupational Health Sciences\n 2015 - National Safety Council Stakeholder Collaboration Award", + "doc_fkgl": 7.468333333333334, + "wiki_fkgl": 30.041633663366344, + "doc_tree_depth": 6.125, + "wiki_tree_depth": 10.0, + "fkgl_delta": -22.57330033003301 + }, + { + "index": 16, + "label": "intermediate_health_literacy", + "original_doc": "A 59-year-old man with long-standing type 1 diabetes presented with acute heart failure. An echocardiogram showed large vegetations on the mitral and aortic valves. Blood cultures were positive for Staphylococcus warneri, a coagulase\u2011negative staphylococcus commonly found on the skin. He was diagnosed with native valve endocarditis. After medical stabilization, he ultimately underwent replacement of both the mitral and aortic valves. In retrospect, mild laboratory abnormalities and several months of weight loss beginning about four months earlier were likely early signs of endocarditis. He had no history of immunosuppressive therapy and no implanted medical devices.", + "wiki_anchor": "If the bacteria involved in the bacteraemia reach the cardiac tissue, infective (or bacterial) endocarditis can develop, with fatal outcomes. Infective endocarditis is an infection of the endothelium lining of the heart. Infective endocarditis is known to dentists as a post-operative infection and is very serious and life-threatening, especially to patients at high risk of developing the disease, due to a weakened heart. This may be through having congenital heart defect, rheumatic or acquired valvular heart disease and prosthetic heart valves or vessels. The most common bacteria associated with infective endocarditis are streptococcus sanguinis.", + "doc_fkgl": 12.996079027355623, + "wiki_fkgl": 14.714340425531919, + "doc_tree_depth": 5.714285714285714, + "wiki_tree_depth": 7.6, + "fkgl_delta": -1.7182613981762955 + }, + { + "index": 16, + "label": "proficient_health_literacy", + "original_doc": "A 59-year-old Japanese man with a 28-year history of type 1 diabetes on intensive multiple-dose insulin therapy (BMI 18.4 kg/m2, undetectable C\u2011peptide, HbA1c ~9.0%) and remote, asymptomatic chronic severe (grade III) aortic regurgitation (diagnosed 16 years earlier without subsequent follow\u2011up) presented with acute decompensated heart failure. He had never undergone surgery or prosthetic device implantation and had no history of immunosuppressive therapies.\n\nEight days after a routine visit, he developed dyspnea and fever >38\u2103. On arrival: BP 192/82 mmHg, HR 118/min, orthopnea, SpO2 80%. Exam: Levine 3/6 systolic murmur; no Osler nodes, Janeway lesions, or conjunctival petechiae. Labs: WBC 20,800/\u03bcL, CRP 6.06 mg/dL, CK\u2011MB 6.0 IU/L, troponin T negative. CXR showed pulmonary congestion with cardiomegaly (CTR 55%). ECG had ST elevation in V1\u2013V4, but emergent echocardiography showed no systolic dysfunction. He was diagnosed with acute heart failure due to valvular disease and treated with non\u2011invasive positive pressure ventilation and nitrates.\n\nTransthoracic echocardiography demonstrated severe aortic regurgitation and severe mitral regurgitation with a mobile mitral vegetation. Transesophageal echocardiography identified a 16.5\u00d76\u2011mm mobile vegetation on the anterior leaflet of the mitral valve and an 11.2\u00d75\u2011mm nonmobile vegetation on the noncoronary cusp of the aortic valve, raising strong suspicion for native valve endocarditis (NVE). Head CT and MRI showed no cerebral infarction or hemorrhage.\n\nRetrospective review revealed subtle abnormalities starting four months pre\u2011admission: mildly elevated WBC, albumin decreased to 3.0 g/dL the following month, and gradual hemoglobin decline over two months, with a 4\u2011kg weight loss. EGD and whole\u2011body CT were unrevealing. He partially regained weight and labs nearly normalized except for a CRP of 0.54 mg/dL. At the last pre\u2011admission visit (8 days prior), WBC was 9,300/\u03bcL, Hb 13.1 g/dL, Alb 3.0 g/dL, CRP 4.18 mg/dL, and diastolic BP had fallen; he remained afebrile and asymptomatic aside from weight loss.\n\nEmpiric antibiotics were initiated with ampicillin\u2013sulbactam 12 g/day plus gentamicin 120 mg/day. Three admission blood culture sets all grew Staphylococcus warneri, a coagulase\u2011negative staphylococcus (CoNS) and resident skin flora (MICs: ABPC/S \u22648 \u03bcg/mL; GM \u22641 \u03bcg/mL; CEZ \u22642 \u03bcg/mL), confirming S. warneri IE. Per Japanese Circulation Society guidance, emergency surgery is generally recommended for NYHA III\u2013IV heart failure or urgent surgery for NVE with mobile vegetation >10 mm and severe valve dysfunction. Because heart failure improved rapidly and appropriate antibiotics were started (reducing embolic risk), and given poorly controlled type 1 diabetes increasing operative risk, elective surgery was planned after stabilization of infection and glycemia. Antibiotics were narrowed to cefazolin 6 g/day; dental evaluation showed no periodontitis.\n\nAfter four weeks of antibiotics, surgery revealed a bicuspid aortic valve with intact aortic and mitral annuli and no abscess. Large vegetations were exenterated, and both valves were replaced with mechanical prostheses. The postoperative course was uneventful; he was discharged on postoperative day 22 without apparent embolism and has remained recurrence\u2011free for over two years. This case represents NVE due to the resident CoNS S. warneri in a patient without prosthetic material or immunosuppression, with prodromal laboratory abnormalities and weight loss evident up to four months before presentation.", + "wiki_anchor": "Antzelevitch C, Yan G-X Ackerman MJ, Borggrefe M, Corrado D; Guo J; Gussak I; Hasdemir C; Horie M; Huikuri H; Ma C; Morita H; Nam G-B; Sacher F; Shimizu W; Viskin S; Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), and the Latin American Society of Cardiac Pacing and Electrophysiology (Sociedad Latinoamericana de Estimulacifin Cardiaca y Electrofisiologia [SOLAECE]). Published in 3 journals worldwide: Heart Rhythm. 2016 Oct;13(10):e295-324. PMID 27423412; Europace. 2017 Apr 1;19(4):665-6942016. PMID 27411360; Journal of Arrhythmia 2016; J Arrhythm. 2016 Oct;32(5):315-339. PMID 27761155.\n Antzelevitch C. Brugada Syndrome. In: Encyclopedia of Cardiovascular Research and Medicine. Cardiac Electrophysiology, Arrhythmias and Sudden Death Section, Vasan Ramachandran and Douglas Sawyer, Editors-in-Chief and In: Elsevier Biomedical Sciences Reference Modules, 2017.\n Chen PS, Antzelevitch C. Mechanisms of cardiac arrhythmias and conduction disturbances. In: Hurst\u2019s The Heart 14th ed. Fuster V, O\u2019Rourke R, Walsh R, Poole-Wilson P, eds. McGraw Hill, New York, NY, Chapter 79, 2017.\n Antzelevitch C, Di Diego JM. Tpeak-Tend Interval as a Marker of Arrhythmic Risk. Invited Editorial. Heart Rhythm, S1547-5271(19)30017-7, 2019.\n J\u00e9r\u00f4me Clatot*, Nathalie Neyroud, Robert Cox, Charlotte Souil, Pascale Guicheney, and Charles Antzelevitch. Inter-regulation of Kv4.3 and Voltage-gated Sodium Channels Underlies Predisposition to Cardiac and Neuronal Channelopathies. Int J Mol Sci. 2020 Jul 17;21(14): E5057. PMID 32709127.\n Peter J. Schwartz, Michael J. Ackerman, Charles Antzelevitch, Connie R. Bezzina, Martin Borggrefe, Bettina F. Cuneo, Arthur A. M. Wilde. Inherited Cardiac Arrhythmias. Nature Reviews Disease Primers, Jul 16;6(1):58, 2020. PMID 32678103.\n Chen P-S, Antzelevitch C, Ho SY, Priori S. Electrophysiologic anatomy, mechanisms of arrhythmias and conduction disturbances, and genetics, 15th Edition of Hurst\u2019s The Heart, 2020.\n Di Diego JM*, Patocskai B*, Barajas-Martinez H*, Borb\u00e1th V; Ackerman MJ, Burashnikov A, Clatot J, Li G-R, Robinson VM, Hu D and Antzelevitch C. Acacetin Suppresses the Electrocardiographic and Arrhythmic Manifestations of the J Wave Syndromes. PLoS One. 2020 Nov 24;15(11):e0242747 .PMID 33232375.", + "doc_fkgl": 12.497337640821737, + "wiki_fkgl": 10.190359421921922, + "doc_tree_depth": 5.96, + "wiki_tree_depth": 4.382352941176471, + "fkgl_delta": 2.3069782188998147 + }, + { + "index": 17, + "label": "low_health_literacy", + "original_doc": "A 27-year-old woman had many cancers in her large intestine and rectum. She also had an inherited condition that causes many polyps.\n\nShe had robot-assisted surgery to remove the entire colon and rectum. The team also removed lymph nodes from the whole area. They used a surgical robot called Hugo RAS.\n\nThe robot work had three steps.\n\nStep 1: Her head was tilted down. The team removed the right side of the colon with its nearby tissue, up to the bend near the liver.\n\nStep 2: They removed the left side of the colon with its nearby tissue. They also removed the rectum with the tissue around it. They took deeper lymph nodes.\n\nStep 3: Her body was kept flat. The team tied off the main blood vessels along the main artery that feeds the intestines.\n\nAfter the robot part was finished, they took the removed bowel out through the anus. Through a small cut at the belly button, they made a pouch from the small intestine. They connected this pouch to the anus.\n\nThe surgery took about 10 and a half hours. Blood loss was very small. Recovery after surgery went smoothly.", + "wiki_anchor": "ESD is characterized by three steps: injecting fluid into the submucosa to elevate the lesion from the muscle layer, circumferential cutting of the surrounding mucosa of the lesion, and subsequent dissection of the connective tissue of the submucosa beneath the lesion. The major advantages of this technique in comparison with polypectomy or EMR are as follows. The resected size and shape can be controlled, en bloc resection is possible even in a large neoplasm, and neoplasms with submucosal fibrosis are also resectable. So this technique can be applied to the resection of complex neoplasms such as large neoplasms, ulcerative non-lifting neoplasms, and recurrent neoplasms. The disadvantages of this technique are the requirement of two or more assistants, it is time-consuming, there is a higher risk of bleeding and perforation than EMR. In Japan, ESD is now gaining acceptance as the standard endoscopic resection technique for stomach neoplasms in an early stage, especially for large or ulcerative neoplasms. Recently, the ESD technique is applied to esophageal or colorectal neoplasms in some institutions, although it is still controversial considering the technical difficulty, associated risks, and favorable outcomes by EMR.", + "doc_fkgl": 5.185050449959093, + "wiki_fkgl": 16.030710466004585, + "doc_tree_depth": 4.526315789473684, + "wiki_tree_depth": 8.428571428571429, + "fkgl_delta": -10.845660016045493 + }, + { + "index": 17, + "label": "intermediate_health_literacy", + "original_doc": "A 27-year-old woman with familial adenomatous polyposis and multiple colorectal cancers underwent robot-assisted total proctocolectomy with complete lymph node dissection using the Hugo RAS system. The robotic work was organized into three steps: 1) in Trendelenburg position, ascending colon complete mesocolic excision up to the hepatic flexure; 2) descending colon complete mesocolic excision and total mesorectal excision with D3 lymph node dissection; and 3) in a flat position, central vessel ligation along the superior mesenteric artery. After undocking, the specimen was removed transanally. An ileal pouch was created through a small umbilical incision and then connected to the anus (ileal pouch\u2013anal anastomosis). The operation lasted 632 minutes with minimal blood loss, and the postoperative course was uneventful.", + "wiki_anchor": "Research interests and contributions\nAlbo's research has focused on translational and health services research in surgical oncology. In the health services research area, he has published outcomes of minimally invasive surgery utilization patterns as well as barriers and facilitators for a widespread adoption of minimally invasive surgery in colorectal disease. He has also studied the impact of minimally invasive surgery on reducing the cost of care in colorectal surgery. His work has also dealt with on issues of health care disparities in surgical oncology, particularly as it affects minorities. In the translational research arena, his work has focused on the mechanisms of tumor invasion and metastases.", + "doc_fkgl": 16.9342905982906, + "wiki_fkgl": 16.389320754716984, + "doc_tree_depth": 5.8, + "wiki_tree_depth": 6.8, + "fkgl_delta": 0.5449698435736146 + }, + { + "index": 17, + "label": "proficient_health_literacy", + "original_doc": "A 27-year-old woman with multiple colorectal cancers on a background of familial adenomatous polyposis (FAP) underwent robot-assisted total proctocolectomy (TPC) with lymph node dissection of the entire colorectal region using the Hugo RAS system. Preoperative CT showed multiple nodal swellings along the inferior mesenteric artery (IMA) and middle colic artery without distant metastases. After multidisciplinary review, robot-assisted TPC was performed under approvals from the Evaluating Committee for Highly Difficult New Medical Technologies (H-0051) and the Kyoto University IRB.\n\nUnder general anesthesia in lithotomy with arms tucked, a 5-cm vertical umbilical incision was made and a wound protector placed. After pneumoperitoneum, 4 robotic and 2 assistant trocars were inserted. Instruments included a camera, monopolar curved shears (right hand), bipolar fenestrated forceps (left hand), and Cadiere/double-fenestrated forceps (reserve arm). Two table positions (Trendelenburg and flat) were used with specific docking tilts; arm cart angles were unchanged. The robotic procedure comprised three steps, followed by transanal specimen extraction, ileal pouch construction via a small umbilical laparotomy, and ileal pouch\u2013anal anastomosis (IPAA).\n\nStep 1: Ascending colon complete mesocolic excision (CME) from a caudal approach, completed through hepatic flexure mobilization.\n\nStep 2: Central vessel ligation (CVL) of the IMA, descending colon CME to completion of splenic flexure mobilization, and total mesorectal excision (TME) to full exposure of the intersphincteric space. This corresponds to a D3 lymph node dissection of the left colon/rectum.\n\nStep 3: After undocking and repositioning the patient flat, CVL along the superior mesenteric artery (SMA) was performed, ligating the ileocolic, right colic, and middle colic vessels; the inferior mesenteric vein (IMV) was ligated at its root (exposed in Step 2).\n\nTransanal and small laparotomy procedures: After transection of the terminal ileum, a transanal specimen extraction was performed with complete rectal mucosectomy from just below the dentate line due to multiple adenomas in the anal canal. An ileal pouch was constructed via the small umbilical incision, its reach to the anal canal confirmed, and a transanal hand-sewn IPAA was completed. No diverting ileostomy was created.\n\nAll three steps were completed without conversion. Following undocking after Step 3, laparoscopy confirmed hemostasis, specimen extraction, and anastomotic integrity. Total operative time was 632 minutes (Step 1: 36 min; Step 2: 160 min; Step 3: 188 min; positioning/docking/specimen extraction/anastomosis: 248 min). Estimated blood loss was 20 mL. Postoperatively, the course was uneventful: flatus and initiation of liquids on POD 1, advancement to a solid diet on POD 3, with a functional ileal pouch and satisfactory anal function.\n\nFinal pathology identified two sigmoid cancers (S1: Type 0-Ip, 55 \u00d7 50 mm, tub1, T1b, ly0, v0; S2: Type 0-Isp, 55 \u00d7 50 mm, tub1, Tis, ly0, v0) and one rectal cancer (R1: Type 0-Ip, 40 \u00d7 35 mm, tub1, Tis, ly0, v0). Lymph node status: 18/89 positive, all in sigmoid/rectosigmoid stations (#241, #242, #251), yielding UICC pT1bN2b stage.", + "wiki_anchor": "Laboratories \n Intravascular therapeutic Microbot Lab - Microrobot moving controlled through blood vessel for drug delivery and treatment of coronary artery disease such as CTO(chronic total occlusion) and thrombus. The lab achieved the world's first microrobot navigation through artery in a live pig.\n Bacteria-based Biomedical Microbot Lab - Development of the fundamental technology for intelligent theragnostic bacteria-based microrobot.(Using bacteria with the abilities such as active movement, fluorescence expression, recombination and replication)\n Telesurgical robot for brain surgery Lab - Development of an Articulated multi-DOF Manipulator for Minimal Invasive Surgery.(Master and Slave System with force reflection control & image guided surgical robot system)\n Robotic Couch for Heavy Ion Therapy Lab - Development of a Novel Robotic Couch System to adjust Patient's position to treat using Heavy Ion Therapy. (An articulated robotic arm to carry a human & respiration synchronization method)\n Surgeon-Robot Interaction for Bone-Fracture Reposition Robot Lab - Robotic Assistant Robot for Bone-Fracture Reposition Surgery, which replaces assistant surgeons who align the broken bone to reduce their exposure to X-ray and labor-intensive work. Surgeon-robot interaction method including an interactive mode and a remote mode will be developed and integrated into the robotic system.\n Cable Robotics Lab - The establishment of Fraunhofer-IPA, one of the Europe's largest robotics institutes, is expected to facilitate the technical improvement through the collaboration in intelligent robotics. The research topic is \u201cdevelopment of core and application technologies on high dynamic parallel cable robotics.\u201d", + "doc_fkgl": 14.549020678891925, + "wiki_fkgl": 20.04846607669617, + "doc_tree_depth": 6.681818181818182, + "wiki_tree_depth": 10.714285714285714, + "fkgl_delta": -5.499445397804244 + }, + { + "index": 18, + "label": "low_health_literacy", + "original_doc": "A 65-year-old man had a swollen right middle finger after a motorcycle crash 6 months earlier. The middle joint stayed bent, and the fingertip bent backward. He could not fully straighten the finger. An X-ray showed no broken bones. The problem was in the soft tissues and tendon on top of the finger. Before surgery, the middle joint could bend from 45 to 110 degrees but could not straighten. The doctors repaired the top tendon using a small strip from another tendon in the same finger. They put the middle joint in a straight splint for 2 weeks. After 2 weeks, he started gentle bending and straightening exercises for that joint. One month after surgery, the middle joint moved from 0 to 90 degrees. Two months after surgery, movement went back to normal. His hand function score (DASH) improved from 50 to 4.2.", + "wiki_anchor": "Posterior interosseus palsy is distinguished from radial nerve palsy by the preservation of elbow extension.\nSymptoms vary depending on the severity and location of the trauma; however, common symptoms include wrist drop (the inability to extend the wrist upward when the hand is palm down); numbness of the back of the hand and wrist, specifically over the first web space which is innervated by the radial nerve; and inability to voluntarily straighten the fingers or extend the thumb, which is performed by muscles of the extensor group, all of which are primarily innervated by the radial nerve. Loss of wrist extension is due to paralysis of the posterior compartment of forearm muscles; although the elbow extensors are also innervated by the radial nerve, their innervation is usually spared because the compression occurs below, distal, to the level of the axillary nerve, which innervates the long head of the triceps, and the upper branches of the radial nerve that innervate the remainder of the Triceps.", + "doc_fkgl": 5.560996503496504, + "wiki_fkgl": 26.092195121951224, + "doc_tree_depth": 4.916666666666667, + "wiki_tree_depth": 10.666666666666666, + "fkgl_delta": -20.53119861845472 + }, + { + "index": 18, + "label": "intermediate_health_literacy", + "original_doc": "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\u2013110 degrees. X\u2011rays 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\u201390 degrees, and by 2 months it returned to normal. Hand function, measured by the DASH score, improved markedly from 50 to 4.2.", + "wiki_anchor": "Posterior interosseus palsy is distinguished from radial nerve palsy by the preservation of elbow extension.\nSymptoms vary depending on the severity and location of the trauma; however, common symptoms include wrist drop (the inability to extend the wrist upward when the hand is palm down); numbness of the back of the hand and wrist, specifically over the first web space which is innervated by the radial nerve; and inability to voluntarily straighten the fingers or extend the thumb, which is performed by muscles of the extensor group, all of which are primarily innervated by the radial nerve. Loss of wrist extension is due to paralysis of the posterior compartment of forearm muscles; although the elbow extensors are also innervated by the radial nerve, their innervation is usually spared because the compression occurs below, distal, to the level of the axillary nerve, which innervates the long head of the triceps, and the upper branches of the radial nerve that innervate the remainder of the Triceps.", + "doc_fkgl": 9.454666666666668, + "wiki_fkgl": 26.092195121951224, + "doc_tree_depth": 5.454545454545454, + "wiki_tree_depth": 10.666666666666666, + "fkgl_delta": -16.637528455284556 + }, + { + "index": 18, + "label": "proficient_health_literacy", + "original_doc": "A 65-year-old male presented with six months of swelling and boutonniere deformity of the right digit III following a motorcycle accident on January 1, 2023. He initially self-managed with analgesics and did not seek care. He reported inability to fully extend the right middle finger. Examination demonstrated edema and a boutonniere posture (PIP flexion, DIP hyperextension). Active PIP ROM was 45\u2013110 degrees, with passive PIP ROM within normal limits. Radiographs of the right hand (AP/lateral) revealed no osseous pathology, supporting a soft-tissue etiology consistent with a central slip injury. \n\nSurgical technique: Central slip defect reconstruction was performed using the partial ulnar slip of the flexor digitorum superficialis (FDS) tendon. Under anesthesia and tourniquet control in the supine position, a midlateral incision was made on the ulnar aspect of the middle phalanx centered at the PIP joint with dorsal oblique extension, and a transverse incision was made over the MCP flexion crease proximal to the A1 pulley. The ulnar digital neurovascular bundle was identified and protected. Full-thickness dorsal flaps were elevated to expose the central slip and extensor mechanism to the PIPJ. Scar and pseudotendinous tissue were excised. The central slip was not amenable to primary repair; therefore, the ulnar slip of the FDS was selected for reconstruction. The ulnar neurovascular bundle was mobilized to visualize the periosteal insertion of the A3 pulley. The extensor tendon was mobilized and tenolyzed; the dorsal PIP capsule was incised with removal of interposed tissue. The A3 pulley periosteal insertion and the volar capsule of the PIP joint were incised longitudinally. A 2\u20130 non-absorbable monofilament suture was placed around the ulnar FDS slip at the PIP level. Through the proximal incision, the flexor sheath and A1 pulley were incised longitudinally to expose the FDS; the ulnar slip was isolated and transected, preserving the radial slip. The previously placed 2\u20130 suture facilitated delivery of the distally based ulnar FDS slip distally. A 2.8\u2011mm dorsal-to-volar bone tunnel was drilled at the base of the middle phalanx; an elevator protected the FDP, volar plate, and volar structures. With the PIP reduced in full extension, the FDS slip was passed through the tunnel and routed through the intact proximal segment of the central slip/extensor tendon. A tendon weaver completed a Pulvertaft weave under appropriate tension with the PIP in full extension and reduction, secured with 3\u20130 non-absorbable suture. The capsule and central slip reconstruction margins were approximated; adhesions were released and lateral bands mobilized. Tenodesis effect, posture, stability, and motion were assessed. Wounds were irrigated, the tourniquet deflated, hemostasis obtained, and capillary refill confirmed. Skin was closed with horizontal mattress sutures. A sterile dressing and a well-padded PIP extension splint were applied to allow early DIP and MCP motion.\n\nPostoperative course: First wound check at postoperative day 4; the patient received meloxicam 7.5 mg PO BID and doxycycline 100 mg PO BID for 3 days. A second wound visit occurred 3 days later. At 2 weeks, the back slab and external sutures were removed, and active and passive PIP ROM exercises were initiated. By 3 weeks, the wound had healed and PIP ROM was 0\u201390 degrees. At 1 month, PIP ROM improved to 0\u2013100 degrees, with continued functional gains. After 7 weeks of rehabilitation, he returned to work with PIP ROM 0\u2013110 degrees. Overall function improved substantially, with the DASH score decreasing from 50 to 4.2.\n\nInterpretation: Clinical and radiographic findings were concordant with a chronic central slip injury producing boutonniere deformity (PIP flexion, DIP hyperextension due to dorsal apparatus disruption and volar migration of lateral bands). Reconstruction using an ulnar FDS slip via bone tunnel and Pulvertaft weave restored PIP extension and yielded progressive ROM gains and marked functional recovery.", + "wiki_anchor": "Lateral epicondylitis is an overuse injury that frequently occurs in tennis. It is also known as tennis elbow. This injury categorizes as a tendon injury where it occurs in the forearm muscle called the extensor carpi radialis brevis (ECRB). The injury is regularly developed in recreational players. Experienced players are less likely to develop lateral epicondylitis than the inexperienced players due to poorer technique. \tTennis elbow or lateral epicondylalgia is a common injury that occurs in 40-50% of tennis players. It is more prominent at the lower levels of play and usually comes from any incorrect use of the wrist or grip on the forehand or one-handed backhand strokes Players at higher levels often have more relaxed grips and have a larger racquet extension out to the ball after they make contact, where professionals have less emphasis on the arm and more on the use of every part of the body in order exert the natural power behind the ball, lower level players don\u2019t always receive the training on how to use their whole body for a tennis stroke and are often reduced to using their arms in order to exert all of the power, therefore putting heavy strain on the arm. Holding the grip tightly will put more tension on the arm therefore when going for a swing the muscles will be absorbing all of the shock from the initial contact of the ball. Symptoms of tennis elbow includes slow pain, which occurs around the elbow. Simple tasks such as shaking hands or moving the wrist with force, like lifting weights or doing push ups, will worsen the pain Tennis Elbow has actually shown that inflammatory tendons are only part of the early stages or acute stages with a treatment of anti-inflammatory or steroids being appropriate uses for this symptom. Most players respond well to simple rest, but other means of treatment include physical therapy, strength training, and electrical stimulation. Some players will make alterations to their racquet, such as increasing their grip size which will ultimately prevent any unwanted movement of the wrist when extending out and finishing the tennis stroke.", + "doc_fkgl": 11.863529411764706, + "wiki_fkgl": 15.070035410764874, + "doc_tree_depth": 5.75, + "wiki_tree_depth": 8.25, + "fkgl_delta": -3.206505999000168 + }, + { + "index": 19, + "label": "low_health_literacy", + "original_doc": "A 23-year-old man came to the emergency room with a sudden, very bad headache. He also felt sick, threw up, and felt heavy pressure in his chest. His blood pressure was high and he was breathing fast. A quick heart test looked like a major heart attack. He was rushed for a procedure to check and open the heart arteries. The heart arteries looked normal. A head CT scan then showed bleeding in the space around his brain. A team of specialists cared for him, but he got worse quickly. He went into cardiac arrest and died.", + "wiki_anchor": "Autopsy\nOn May 22, an autopsy report revealed that Fontejon and Garcia died due to sudden heart attack, this according to Dr. Wilfredo Esquivel Tierra, Assistant Chief of the National Bureau of Investigation (NBI) Medico-Legal Division. According to the medico legal report of NBI, it was shown that Fontejon had two types of dangerous drugs in her body: MDMA methylene homolog and synthetic cathinones. The NBI refused to speculate how it got into her body. The last two autopsies conducted by Superintendent Bonnie Chua, head of the Crime Laboratory of the Southern Police District (SPD), revealed that Migawa and Miller died of heart failure and brain swelling.", + "doc_fkgl": 4.0628178694158095, + "wiki_fkgl": 12.716747663551406, + "doc_tree_depth": 4.777777777777778, + "wiki_tree_depth": 8.5, + "fkgl_delta": -8.653929794135596 + }, + { + "index": 19, + "label": "intermediate_health_literacy", + "original_doc": "A 23-year-old man came to the emergency department with a sudden severe headache, nausea, vomiting, and chest heaviness. His initial vital signs showed high blood pressure and a fast breathing rate. An emergency ECG showed a heart attack pattern (STEMI), so he was urgently sent for percutaneous coronary intervention; the angiogram revealed normal coronary arteries. Further evaluation with a brain CT identified a cisternal subarachnoid hemorrhage (bleeding around the brain). Despite coordinated care by multiple teams, his condition rapidly worsened, leading to cardiac arrest and death.", + "wiki_anchor": "Accident and subsequent football career\nHe was a passenger in a car crash in Liverpool which resulted in the death of two of his friends, and left him with critical injuries which included a bleed on his brain, three of the four main ligaments in his right knee being snapped, a broken neck and ankle. It resulted in the removal of a kidney and being in a coma for five days.", + "doc_fkgl": 13.757534883720933, + "wiki_fkgl": 15.040915492957748, + "doc_tree_depth": 6.0, + "wiki_tree_depth": 9.0, + "fkgl_delta": -1.283380609236815 + }, + { + "index": 19, + "label": "proficient_health_literacy", + "original_doc": "A 23-year-old male with a 23 pack-year smoking history, no alcohol use, and no illicit drug use presented with 2 hours of sudden severe frontal headache, nausea, vomiting, and chest heaviness. He was distressed but alert and oriented. Vitals: BP 178/103 mmHg, RR 26/min, T 38.9\u00b0C, HR 87/min, SpO2 94%. Exam: normal vesicular breath sounds; cardiovascular and abdominal exams inconclusive; neurological exam notable for neck stiffness, dilated but light-reactive pupils, normal plantar reflexes, and no focal deficits. ECG showed ST-segment elevation >2 mm in V2\u2013V5, consistent with STEMI; he received a 300 mg aspirin load and was urgently transferred for PCI. Troponin was elevated at 1.48 mg/dl (normal <0.16 mg/dl). Femoral-access coronary angiography demonstrated normal coronary arteries with TIMI 3 flow. Post-angiography ECG showed normal sinus rhythm with LVH; echocardiography revealed normal ventricular function without RWMA. Subsequent workup found lymphocytosis and mildly elevated CRP. Non-contrast CT brain demonstrated a cisternal subarachnoid haemorrhage with extension anterior to the right temporal lobe. Abdominal ultrasound was negative for polycystic kidney disease; cerebral CT angiography was planned to exclude aneurysm. Nimodipine 60 mg q4h was initiated with a BP target of 160/100 mmHg. On day 2, he acutely deteriorated with cardiac arrest; after CPR, GCS was 6, and he was intubated and mechanically ventilated in the ICU. Owing to instability, repeat CT brain and planned cerebral CTA were not performed. He received multidisciplinary ICU care with NG feeding, IV fluids, antibiotics, a proton pump inhibitor, and nimodipine. On day 8, he developed ventricular fibrillation and, despite CPR and more than five defibrillation attempts, could not be resuscitated and died.", + "wiki_anchor": "Antzelevitch C, Yan G-X Ackerman MJ, Borggrefe M, Corrado D; Guo J; Gussak I; Hasdemir C; Horie M; Huikuri H; Ma C; Morita H; Nam G-B; Sacher F; Shimizu W; Viskin S; Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge: Endorsed by the Asia Pacific Heart Rhythm Society (APHRS), the European Heart Rhythm Association (EHRA), the Heart Rhythm Society (HRS), and the Latin American Society of Cardiac Pacing and Electrophysiology (Sociedad Latinoamericana de Estimulacifin Cardiaca y Electrofisiologia [SOLAECE]). Published in 3 journals worldwide: Heart Rhythm. 2016 Oct;13(10):e295-324. PMID 27423412; Europace. 2017 Apr 1;19(4):665-6942016. PMID 27411360; Journal of Arrhythmia 2016; J Arrhythm. 2016 Oct;32(5):315-339. PMID 27761155.\n Antzelevitch C. Brugada Syndrome. In: Encyclopedia of Cardiovascular Research and Medicine. Cardiac Electrophysiology, Arrhythmias and Sudden Death Section, Vasan Ramachandran and Douglas Sawyer, Editors-in-Chief and In: Elsevier Biomedical Sciences Reference Modules, 2017.\n Chen PS, Antzelevitch C. Mechanisms of cardiac arrhythmias and conduction disturbances. In: Hurst\u2019s The Heart 14th ed. Fuster V, O\u2019Rourke R, Walsh R, Poole-Wilson P, eds. McGraw Hill, New York, NY, Chapter 79, 2017.\n Antzelevitch C, Di Diego JM. Tpeak-Tend Interval as a Marker of Arrhythmic Risk. Invited Editorial. Heart Rhythm, S1547-5271(19)30017-7, 2019.\n J\u00e9r\u00f4me Clatot*, Nathalie Neyroud, Robert Cox, Charlotte Souil, Pascale Guicheney, and Charles Antzelevitch. Inter-regulation of Kv4.3 and Voltage-gated Sodium Channels Underlies Predisposition to Cardiac and Neuronal Channelopathies. Int J Mol Sci. 2020 Jul 17;21(14): E5057. PMID 32709127.\n Peter J. Schwartz, Michael J. Ackerman, Charles Antzelevitch, Connie R. Bezzina, Martin Borggrefe, Bettina F. Cuneo, Arthur A. M. Wilde. Inherited Cardiac Arrhythmias. Nature Reviews Disease Primers, Jul 16;6(1):58, 2020. PMID 32678103.\n Chen P-S, Antzelevitch C, Ho SY, Priori S. Electrophysiologic anatomy, mechanisms of arrhythmias and conduction disturbances, and genetics, 15th Edition of Hurst\u2019s The Heart, 2020.\n Di Diego JM*, Patocskai B*, Barajas-Martinez H*, Borb\u00e1th V; Ackerman MJ, Burashnikov A, Clatot J, Li G-R, Robinson VM, Hu D and Antzelevitch C. Acacetin Suppresses the Electrocardiographic and Arrhythmic Manifestations of the J Wave Syndromes. PLoS One. 2020 Nov 24;15(11):e0242747 .PMID 33232375.", + "doc_fkgl": 12.237704402515725, + "wiki_fkgl": 10.190359421921922, + "doc_tree_depth": 5.529411764705882, + "wiki_tree_depth": 4.382352941176471, + "fkgl_delta": 2.0473449805938024 + } +] \ No newline at end of file