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      "solution_preview": "{\n  \"low_health_literacy\": \"A woman from Nigeria had a long fever and swelling in her neck. She went to the doctor many times, but her symptoms didn't go away. The doctor thought she might have malari..."
    },
    {
      "instance_id": 61,
      "target_level": "intermediate_health_literacy",
      "reward": -1.2,
      "prediction": "low_health_literacy",
      "prediction_tokens": 444,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 26-year-old Nigerian woman went to the hospital with a recurring fever that lasted a month and swelling in her neck that started two weeks prior to her visit. De..."
    },
    {
      "instance_id": 62,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 772,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 25-year-old Nigerian woman presented with a month-long history of recurring low-grade fever, chills, and rigor, which were temporarily relieved by paracetamol and ..."
    },
    {
      "instance_id": 63,
      "target_level": "low_health_literacy",
      "reward": -0.8181818181818182,
      "prediction": "low_health_literacy",
      "prediction_tokens": 525,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 42-year-old man had a fever, sore throat, and runny nose for 5 days. He then got a sudden, severe headache on one side of his head and felt dizzy. He also had trouble see..."
    },
    {
      "instance_id": 64,
      "target_level": "intermediate_health_literacy",
      "reward": -0.8333333333333334,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 473,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 42-year-old man developed severe symptoms, including fever, sore throat, and a runny nose, which were followed by a sudden and severe headache, vertigo, and conf..."
    },
    {
      "instance_id": 65,
      "target_level": "proficient_health_literacy",
      "reward": -0.42857142857142855,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 537,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 42-year-old man presented with fever, sore throat, and runny nose for 5 days, followed by sudden onset of occipital headache, vertigo, transient confusion, diplopi..."
    },
    {
      "instance_id": 66,
      "target_level": "low_health_literacy",
      "reward": -0.42857142857142855,
      "prediction": "low_health_literacy",
      "prediction_tokens": 450,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 42-year-old woman had a serious problem with her spine after a surgery. She had numbness, tingling, and pain in both arms. Doctors thought she had a different condition, ..."
    },
    {
      "instance_id": 67,
      "target_level": "intermediate_health_literacy",
      "reward": -0.3,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 582,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 42-year-old woman developed severe numbness, tingling, and pain in both arms after a surgery to remove a parathyroid gland. She had a history of a spinal cord in..."
    },
    {
      "instance_id": 68,
      "target_level": "proficient_health_literacy",
      "reward": -0.35714285714285715,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 798,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 42-year-old woman with a history of spinal cord injury (SCI) developed symptoms of numbness, tingling, and pain in both arms after undergoing parathyroidectomy. He..."
    },
    {
      "instance_id": 69,
      "target_level": "low_health_literacy",
      "reward": -0.8571428571428571,
      "prediction": "low_health_literacy",
      "prediction_tokens": 464,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 5-month-old baby was very sick with a rare form of a disease called Kawasaki Disease (KD). He had a fever for 4 days, diarrhea, and a rash. His heart and blood tests show..."
    },
    {
      "instance_id": 70,
      "target_level": "intermediate_health_literacy",
      "reward": -0.3333333333333333,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 541,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 5-month-old boy was admitted to the hospital with a high fever, diarrhea, and cough. He had been treated for a ear infection, but his symptoms persisted. After s..."
    },
    {
      "instance_id": 71,
      "target_level": "proficient_health_literacy",
      "reward": -0.2,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 731,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 5-month-old boy was admitted to the Emergency Room with fever, diarrhea, cough, and irritability. He had been treated with antibiotics for a middle ear infection, ..."
    },
    {
      "instance_id": 72,
      "target_level": "low_health_literacy",
      "reward": -0.2857142857142857,
      "prediction": "low_health_literacy",
      "prediction_tokens": 451,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 68-year-old woman had severe belly pain, nausea, and vomiting. She had surgery 4 years ago to remove a tumor from her pituitary gland. During a new surgery to fix a bowel..."
    },
    {
      "instance_id": 73,
      "target_level": "intermediate_health_literacy",
      "reward": -0.2222222222222222,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 530,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 68-year-old woman was rushed to the emergency room with severe abdominal pain, nausea, and vomiting. Four years earlier, she had undergone surgery to remove a pi..."
    },
    {
      "instance_id": 74,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 68-year-old African American female presented with intestinal obstruction four years after a transphenoidal pituitary resection for pituitary adenoma. During surgi..."
    },
    {
      "instance_id": 75,
      "target_level": "low_health_literacy",
      "reward": -0.75,
      "prediction": "low_health_literacy",
      "prediction_tokens": 463,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 56-year-old man was found unconscious in his home with open doors and windows. He had a history of drinking too much alcohol. When he arrived at the hospital, he had a ve..."
    },
    {
      "instance_id": 76,
      "target_level": "intermediate_health_literacy",
      "reward": -0.6666666666666666,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 474,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 56-year-old man was found unconscious and hypothermic in his home. He had a history of excessive drinking and was taken to the hospital, where he developed a lif..."
    },
    {
      "instance_id": 77,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 56-year-old man with a history of excessive alcohol consumption was found unconscious and hypothermic in his home. He was admitted to Ume\u00e5 University Hospital and ..."
    },
    {
      "instance_id": 78,
      "target_level": "low_health_literacy",
      "reward": -0.8571428571428571,
      "prediction": "low_health_literacy",
      "prediction_tokens": 439,
      "solution_preview": "{\n  \"low_health_literacy\": \"A man, 31 years old, had severe belly pain. He was very overweight and had serious health problems, including kidney failure and diabetes. He had a hole in his colon that n..."
    },
    {
      "instance_id": 79,
      "target_level": "intermediate_health_literacy",
      "reward": -1.6666666666666665,
      "prediction": "low_health_literacy",
      "prediction_tokens": 476,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 31-year-old man with severe obesity and uncontrolled diabetes was rushed to the hospital with severe abdominal pain. He had also developed kidney failure. After ..."
    },
    {
      "instance_id": 80,
      "target_level": "proficient_health_literacy",
      "reward": -0.2,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 618,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 31-year-old man with morbid obesity (BMI 50 kg/m2) and uncontrolled diabetes presented with acute abdominal pain due to perforated diverticulitis. He also had acut..."
    },
    {
      "instance_id": 81,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "low_health_literacy",
      "prediction_tokens": 382,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 57-year-old man had a long-term illness called Crohn's disease. He was taking medicine to stop his body from fighting itself, but it wasn't working. Doctors did more test..."
    },
    {
      "instance_id": 82,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 504,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 57-year-old man with a history of Crohn's disease was not responding to treatment. He had been losing weight, feeling weak, and experiencing abdominal pain for o..."
    },
    {
      "instance_id": 83,
      "target_level": "proficient_health_literacy",
      "reward": -0.36363636363636365,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 674,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 57-year-old male patient with a history of Beta-thalassemia was initially diagnosed with Crohn's disease and treated with immunosuppressive therapy. However, due t..."
    },
    {
      "instance_id": 84,
      "target_level": "low_health_literacy",
      "reward": 0.5,
      "prediction": "low_health_literacy",
      "prediction_tokens": 497,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 35-year-old man went to the emergency room after falling on his outstretched hand. He hurt both shoulders and had trouble moving them. He had fallen before, but this was ..."
    },
    {
      "instance_id": 85,
      "target_level": "intermediate_health_literacy",
      "reward": 0.8888888888888888,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 545,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 35-year-old man went to the emergency department after falling on his outstretched hand while tripping on a stone. He had severe pain and difficulty moving both ..."
    },
    {
      "instance_id": 86,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 686,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 35-year-old male patient presented to the emergency department with a history of falling onto an outstretched hand after tripping on a stone. He experienced pain a..."
    },
    {
      "instance_id": 87,
      "target_level": "low_health_literacy",
      "reward": -0.7142857142857143,
      "prediction": "low_health_literacy",
      "prediction_tokens": 443,
      "solution_preview": "{\n  \"low_health_literacy\": \"A man, 61 years old, had a tumor in his intestine. It started as a small growth near an old surgery site from 20 years ago. The tumor grew and spread to other parts of his ..."
    },
    {
      "instance_id": 88,
      "target_level": "intermediate_health_literacy",
      "reward": -0.3,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 589,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 61-year-old man was admitted to the hospital with constipation and a palpable mass in his abdomen. He had a history of surgery for appendicitis 20 years ago and ..."
    },
    {
      "instance_id": 89,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 61-year-old man was admitted for constipation and a palpable mass in the periumbilical area. His medical history included a surgery for acute perforative appendici..."
    },
    {
      "instance_id": 90,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "low_health_literacy",
      "prediction_tokens": 451,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 59-year-old woman with no heart problems had chest pain, trouble breathing, and a fever. She was treated for pneumonia, but her symptoms didn't go away. An ECG showed sig..."
    },
    {
      "instance_id": 91,
      "target_level": "intermediate_health_literacy",
      "reward": -1.2857142857142856,
      "prediction": "low_health_literacy",
      "prediction_tokens": 455,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 59-year-old woman with no history of heart problems came to the hospital with chest pain, difficulty breathing, and a fever. She was diagnosed with pneumonia and..."
    },
    {
      "instance_id": 92,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 533,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 59-year-old woman with a history of heavy smoking and hypertension presented with chest pain, dyspnea, and fever. Initially, she was diagnosed with acute community..."
    },
    {
      "instance_id": 93,
      "target_level": "low_health_literacy",
      "reward": -0.8888888888888888,
      "prediction": "low_health_literacy",
      "prediction_tokens": 465,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 77-year-old woman had severe hip pain due to wear and tear. She had a previous knee injury that caused her knee to fuse together. This made it hard for her to walk and ca..."
    },
    {
      "instance_id": 94,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5555555555555556,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 526,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 77-year-old woman had severe hip pain due to degenerative hip disease. She also had a previous knee fusion in the same leg, which made it difficult to move. To m..."
    },
    {
      "instance_id": 95,
      "target_level": "proficient_health_literacy",
      "reward": 0.75,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 665,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 77-year-old woman with degenerative hip disease and a previous knee arthrodesis due to a childhood traffic accident presented with progressive left groin pain. She..."
    },
    {
      "instance_id": 96,
      "target_level": "low_health_literacy",
      "reward": -0.7777777777777778,
      "prediction": "low_health_literacy",
      "prediction_tokens": 480,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 48-year-old woman was very sick with a brain infection and a severe kidney infection. She had a high fever and was in a coma. Doctors gave her strong medicine to fight th..."
    },
    {
      "instance_id": 97,
      "target_level": "intermediate_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 48-year-old woman was rushed to the intensive care unit (ICU) with a severe infection in her kidneys and brain. She had developed septic shock, a life-threatenin..."
    },
    {
      "instance_id": 98,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 48-year-old Caucasian woman was admitted to the intensive care unit (ICU) with suspected pyelonephritis, sepsis, and altered mental state. She underwent a computer..."
    },
    {
      "instance_id": 99,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "### Low Health Literacy Version\n\n{\n  \"low_health_literacy\": \"A woman who traveled to Colombia got sick after returning to the USA. She had been bitten by mosquitoes and had a fever, back pain, and a r..."
    },
    {
      "instance_id": 100,
      "target_level": "intermediate_health_literacy",
      "reward": -0.7142857142857143,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 511,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A woman who recently returned from a trip to Colombia developed symptoms that suggested she might have contracted Zika, Chikungunya, or Dengue. Tests confirmed she..."
    },
    {
      "instance_id": 101,
      "target_level": "proficient_health_literacy",
      "reward": -0.4444444444444444,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 664,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 40-year-old woman, who had recently traveled to Colombia with her husband, presented to the outpatient infectious diseases clinic with symptoms consistent with Zik..."
    },
    {
      "instance_id": 102,
      "target_level": "low_health_literacy",
      "reward": -0.6666666666666666,
      "prediction": "low_health_literacy",
      "prediction_tokens": 528,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 59-year-old Malay woman had a fever and swelling in her left cheek. She had a history of a condition that affects her skin and glands. She was not taking any medicine to ..."
    },
    {
      "instance_id": 103,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5555555555555556,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 544,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 59-year-old Malay woman had a fever and swelling in her left parotid gland. She had a history of a condition called systemic sclerosis and Sj\u00f6gren's syndrome, wh..."
    },
    {
      "instance_id": 104,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 59-year-old Malay woman with a history of systemic sclerosis and secondary Sj\u00f6gren's syndrome presented with fever and left parotid gland swelling. Clinical examin..."
    },
    {
      "instance_id": 105,
      "target_level": "low_health_literacy",
      "reward": -1.8571428571428572,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 464,
      "solution_preview": "{\n  \"low_health_literacy\": \"This patient had a condition called TED (Thyroid Eye Disease) that made his eyes bulge out. He also had a low immune system and was at risk for infections. Before starting ..."
    },
    {
      "instance_id": 106,
      "target_level": "intermediate_health_literacy",
      "reward": -0.7142857142857143,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 535,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 67-year-old man with a history of several health issues, including high blood pressure, high cholesterol, and hepatitis B, was diagnosed with thyroid eye disease..."
    },
    {
      "instance_id": 107,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 67-year-old male with a history of hypertension, hyperlipidemia, chronic hepatitis B, and chronic obstructive pulmonary disease (COPD) was referred to our clinic f..."
    },
    {
      "instance_id": 108,
      "target_level": "low_health_literacy",
      "reward": -0.875,
      "prediction": "low_health_literacy",
      "prediction_tokens": 448,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 6-month-old baby girl had heart surgery. She needed a machine to help her breathe for a long time. After 52 days, the breathing tube was removed, but she needed it put ba..."
    },
    {
      "instance_id": 109,
      "target_level": "intermediate_health_literacy",
      "reward": -1.4,
      "prediction": "low_health_literacy",
      "prediction_tokens": 546,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 6-month-old baby girl underwent heart surgery to fix a condition called tetralogy of Fallot. After the operation, she needed help breathing and was put on a mach..."
    },
    {
      "instance_id": 110,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 6-month-old female infant underwent cardiac surgery for tetralogy of Fallot, pulmonary artery atresia, and major aortopulmonary collateral artery. Post-operatively..."
    },
    {
      "instance_id": 111,
      "target_level": "low_health_literacy",
      "reward": -0.75,
      "prediction": "low_health_literacy",
      "prediction_tokens": 366,
      "solution_preview": "{\n  \"low_health_literacy\": \"A healthy young woman got a serious infection from a tongue piercing. The infection spread to her liver and caused it to fail. She died from the infection. The infection wa..."
    },
    {
      "instance_id": 112,
      "target_level": "intermediate_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A previously healthy 19-year-old woman contracted herpes simplex virus (HSV) through a tongue piercing. The virus caused a severe liver infection, known as fulmina..."
    },
    {
      "instance_id": 113,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 699,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 19-year-old immunocompetent woman presented with nonspecific symptoms of fatigue, fever, and abdominal pain. Her past medical history was unremarkable, and she did..."
    },
    {
      "instance_id": 114,
      "target_level": "low_health_literacy",
      "reward": -0.8,
      "prediction": "low_health_literacy",
      "prediction_tokens": 424,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 46-year-old man had trouble breathing and bleeding from his nose for 4 months. Doctors did tests and found a big tumor in his nose and sinuses. They removed the tumor in ..."
    },
    {
      "instance_id": 115,
      "target_level": "intermediate_health_literacy",
      "reward": -0.4,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 466,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 46-year-old man had been experiencing nasal bleeding and nasal obstruction for four months. Imaging tests showed a large tumor in his left nasal cavity that had ..."
    },
    {
      "instance_id": 116,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 649,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 46-year-old male patient presented with nasal bleeding and nasal obstruction for 4 months. Imaging studies revealed a large heterogeneous mass in the left superior..."
    },
    {
      "instance_id": 117,
      "target_level": "low_health_literacy",
      "reward": -0.42857142857142855,
      "prediction": "low_health_literacy",
      "prediction_tokens": 437,
      "solution_preview": "{\n  \"low_health_literacy\": \"An 83-year-old woman had pain and swelling in her left thumb for 1 week. She went to her doctor, who thought it might be a minor infection. But after trying antibiotics and..."
    },
    {
      "instance_id": 118,
      "target_level": "intermediate_health_literacy",
      "reward": -1.5,
      "prediction": "low_health_literacy",
      "prediction_tokens": 450,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"An 83-year-old woman visited her doctor with pain and swelling in her left thumb. At first, the doctor thought it might be a minor infection, so she prescribed ant..."
    },
    {
      "instance_id": 119,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"An 83-year-old woman presented to her primary care provider with pain and swelling of her left thumb distal phalanx for 1 week. Initial imaging was normal, and she w..."
    },
    {
      "instance_id": 120,
      "target_level": "low_health_literacy",
      "reward": -0.7777777777777778,
      "prediction": "low_health_literacy",
      "prediction_tokens": 478,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 66-year-old man with diabetes had severe vision loss due to fluid buildup in his eyes. He tried several treatments, but they didn't work. He then received a new treatment..."
    },
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      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 40-year-old woman, pregnant with twins, was referred to our hospital at 28 weeks due to pre-eclampsia and a suspected molar pregnancy. She presented with headache,..."
    },
    {
      "instance_id": 243,
      "target_level": "low_health_literacy",
      "reward": -1.375,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 474,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 21-year-old woman was admitted to the hospital with a large liver tumor. The tumor was found one month ago during a check-up. It was not causing any pain or discomfort. S..."
    },
    {
      "instance_id": 244,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 475,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 21-year-old woman was admitted to the hospital with a large liver tumor. The tumor was found a month earlier during a routine check-up. Initial tests showed that..."
    },
    {
      "instance_id": 245,
      "target_level": "proficient_health_literacy",
      "reward": -0.5454545454545454,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 660,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 21-year-old woman was admitted to our department for a giant hepatic tumor measuring 22 cm \u00d7 20 cm \u00d7 10 cm that completely replaced the left hepatic lobe. Laborato..."
    },
    {
      "instance_id": 246,
      "target_level": "low_health_literacy",
      "reward": -0.375,
      "prediction": "low_health_literacy",
      "prediction_tokens": 475,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 79-year-old man had a rare heart infection called endocarditis. He had a pre-existing heart condition and was not taking any medications. He went to the hospital with sym..."
    },
    {
      "instance_id": 247,
      "target_level": "intermediate_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A Rare Case of Heart Infection: A 79-Year-Old Man's Story\n\nA 79-year-old man was admitted to the hospital with symptoms of heart failure, including shortness of br..."
    },
    {
      "instance_id": 248,
      "target_level": "proficient_health_literacy",
      "reward": -0.2857142857142857,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 531,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 79-year-old man with a history of degenerative valvular heart disease presented with heart failure symptoms, including shortness of breath and leg swelling. Despit..."
    },
    {
      "instance_id": 249,
      "target_level": "low_health_literacy",
      "reward": -0.7142857142857143,
      "prediction": "low_health_literacy",
      "prediction_tokens": 480,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 7-year-old girl had strange behaviors after a special treatment to help her body make new blood cells. She had been diagnosed with a condition that affects her bone marro..."
    },
    {
      "instance_id": 250,
      "target_level": "intermediate_health_literacy",
      "reward": -0.36363636363636365,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 634,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 7-year-old girl was admitted to the hospital due to unusual behaviors that had been occurring for several months. These behaviors included episodes of eye rollin..."
    },
    {
      "instance_id": 251,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "proficient_health_literacy\n\n[[ ## completed",
      "prediction_tokens": 799,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 7-year-old girl was admitted to Wuhan Children's Hospital due to noticeable behavioral changes over the past months. These changes included episodes of eye rolling..."
    },
    {
      "instance_id": 252,
      "target_level": "low_health_literacy",
      "reward": -0.8,
      "prediction": "low_health_literacy",
      "prediction_tokens": 432,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 25-year-old woman with a serious liver disease got an infection in her arm from a vein used for medicine. She had been in the hospital for a long time and was very sick. ..."
    },
    {
      "instance_id": 253,
      "target_level": "intermediate_health_literacy",
      "reward": -0.14285714285714285,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 522,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 25-year-old woman with a rare liver condition was admitted to the hospital with symptoms of fatigue, jaundice, and swelling in her lower limbs. She had a history..."
    },
    {
      "instance_id": 254,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 679,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 25-year-old woman with liver cirrhosis due to autoimmune hepatitis presented with fatigue, jaundice, and swelling in her lower limbs. She had been taking prednisol..."
    },
    {
      "instance_id": 255,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "low_health_literacy",
      "prediction_tokens": 437,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 51-year-old woman had a condition called Fabry disease. She had fluid around her heart and her heart was getting bigger. She was taking medicine to help, but it wasn't wo..."
    },
    {
      "instance_id": 256,
      "target_level": "intermediate_health_literacy",
      "reward": -0.7142857142857143,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 557,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 51-year-old woman with a history of a genetic disorder called Fabry disease (FD) was admitted to the hospital due to a buildup of fluid in the sac surrounding he..."
    },
    {
      "instance_id": 257,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 683,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 51-year-old Japanese woman with a history of Fabry disease (FD) presented with pericardial effusion. Despite regular administration of agalsidase alfa every 2 week..."
    },
    {
      "instance_id": 258,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "### Low Health Literacy Version\n\n{\n  \"low_health_literacy\": \"A 72-year-old man had a big surgery to remove his voice box. He uses a special device to help him talk. For 17 years, this device worked pe..."
    },
    {
      "instance_id": 259,
      "target_level": "intermediate_health_literacy",
      "reward": 0.625,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 531,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 72-year-old man who had his larynx removed and a voice prosthesis implanted 17 years ago came to our voice clinic with trouble swallowing and leakage around the ..."
    },
    {
      "instance_id": 260,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 563,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 72-year-old patient with a total laryngectomy and tracheoesophageal voice prosthesis (VP) presented to our voice clinic with complaints of difficulty swallowing an..."
    },
    {
      "instance_id": 261,
      "target_level": "low_health_literacy",
      "reward": -1.6,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 425,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 24-year-old man with rheumatoid arthritis has been losing his vision in both eyes for four years. His eyes have thinning and bulging in the outer edges, with blood vessel..."
    },
    {
      "instance_id": 262,
      "target_level": "intermediate_health_literacy",
      "reward": -0.25,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 526,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 24-year-old man with a history of rheumatoid arthritis has been experiencing vision problems in both eyes for four years. His symptoms started with eye irritatio..."
    },
    {
      "instance_id": 263,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 24-year-old man with a history of rheumatoid arthritis presented with progressive vision loss over four years. His symptoms began with bilateral ocular irritation,..."
    },
    {
      "instance_id": 264,
      "target_level": "low_health_literacy",
      "reward": -1.625,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 460,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 67-year-old man had severe pain in his chest and trouble breathing. He also had pain and weakness in his right shoulder and arm. Doctors used special tests to find the ca..."
    },
    {
      "instance_id": 265,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5714285714285714,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 494,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 67-year-old man had severe pain in his right side and difficulty breathing. He also had pain and weakness in his right shoulder and arm. Tests showed that he had..."
    },
    {
      "instance_id": 266,
      "target_level": "proficient_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 67-year-old male patient presented with severe pain in the right side of his chest and shortness of breath, along with pain and weakness in his right shoulder and ..."
    },
    {
      "instance_id": 267,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "low_health_literacy",
      "prediction_tokens": 398,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 65-year-old woman had a problem with her pituitary gland that was causing her to lose her vision. She had surgery to remove the problem, and a special material called chi..."
    },
    {
      "instance_id": 268,
      "target_level": "intermediate_health_literacy",
      "reward": -0.42857142857142855,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 494,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 65-year-old woman experienced progressive vision loss in both eyes, which worsened over 10 months. She also had a sudden loss of consciousness, prompting her hos..."
    },
    {
      "instance_id": 269,
      "target_level": "proficient_health_literacy",
      "reward": -0.2222222222222222,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 624,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 65-year-old woman presented with progressive bilateral visual loss in her temporal fields, which had occurred over 10 months. Two weeks prior to admission, she exp..."
    },
    {
      "instance_id": 270,
      "target_level": "low_health_literacy",
      "reward": -0.6,
      "prediction": "low_health_literacy",
      "prediction_tokens": 391,
      "solution_preview": "{\n  \"low_health_literacy\": \"A man from Bangladesh had diabetes and was feeling very sick. He had a fever, cough, and trouble breathing. He also had a hard time thinking clearly. Doctors did tests and ..."
    },
    {
      "instance_id": 271,
      "target_level": "intermediate_health_literacy",
      "reward": -1.4444444444444444,
      "prediction": "low_health_literacy",
      "prediction_tokens": 514,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 48-year-old Bangladeshi man was rushed to the emergency room with difficulty breathing and confusion. He had been experiencing fever, cough, and sputum productio..."
    },
    {
      "instance_id": 272,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 656,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 48-year-old Bangladeshi man with diabetes mellitus presented to the emergency room with symptoms of fever, cough, shortness of breath, and altered mental status. H..."
    },
    {
      "instance_id": 273,
      "target_level": "low_health_literacy",
      "reward": -0.625,
      "prediction": "low_health_literacy",
      "prediction_tokens": 470,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 68-year-old man had a serious blockage in the main artery on one side of his neck. He had a similar problem on the other side 5 months ago. Doctors put a stent in the blo..."
    },
    {
      "instance_id": 274,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5555555555555556,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 537,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 68-year-old man had a serious blockage in one of the main arteries in his brain. He had a history of a stroke and was taking medication to prevent another one. D..."
    },
    {
      "instance_id": 275,
      "target_level": "proficient_health_literacy",
      "reward": -0.26666666666666666,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 837,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 68-year-old male with severe right internal carotid artery stenosis and left internal carotid artery occlusion underwent right stenosis stent implantation. Post-pr..."
    },
    {
      "instance_id": 276,
      "target_level": "low_health_literacy",
      "reward": 0.75,
      "prediction": "low_health_literacy",
      "prediction_tokens": 455,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 31-year-old woman from Sudan came to Canada with her 5 kids in 2017. She's a refugee and was diagnosed with HIV and bad teeth. She's very stressed because she's afraid of..."
    },
    {
      "instance_id": 277,
      "target_level": "intermediate_health_literacy",
      "reward": -0.125,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 501,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 31-year-old woman from Sudan arrived in Canada as a refugee with her five children in 2017. She was diagnosed with HIV and severe tooth decay during her initial ..."
    },
    {
      "instance_id": 278,
      "target_level": "proficient_health_literacy",
      "reward": -1.1428571428571428,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 557,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 31-year-old Sudanese woman, who fled to Canada with her five children in 2017, was diagnosed with HIV and severe dental caries during her initial medical evaluatio..."
    },
    {
      "instance_id": 279,
      "target_level": "low_health_literacy",
      "reward": -0.2857142857142857,
      "prediction": "low_health_literacy",
      "prediction_tokens": 444,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 72-year-old man had severe pain in his penis. He had been on dialysis for 4 years because of kidney damage from diabetes. Doctors found black and yellow dead tissue on hi..."
    },
    {
      "instance_id": 280,
      "target_level": "intermediate_health_literacy",
      "reward": -0.2857142857142857,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 481,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 72-year-old man was referred to the hospital for severe pain in his penis. He had been undergoing dialysis for four years due to diabetes-related kidney damage. ..."
    },
    {
      "instance_id": 281,
      "target_level": "proficient_health_literacy",
      "reward": -0.1111111111111111,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 606,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 72-year-old male patient with a 4-year history of dialysis therapy for diabetic nephropathy presented with penile pain. He had a complex medical history, including..."
    },
    {
      "instance_id": 282,
      "target_level": "low_health_literacy",
      "reward": -1.0,
      "prediction": "",
      "prediction_tokens": 0,
      "solution_preview": "### Low Health Literacy Version\n\n{\n  \"low_health_literacy\": \"A 76-year-old man went to the emergency room because he was feeling weak and confused. He had been getting weaker over a few months and was..."
    },
    {
      "instance_id": 283,
      "target_level": "intermediate_health_literacy",
      "reward": -1.5714285714285714,
      "prediction": "low_health_literacy",
      "prediction_tokens": 510,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 76-year-old man with diabetes and high blood pressure came to the emergency room feeling weak and confused. He had been getting weaker over a few months and had ..."
    },
    {
      "instance_id": 284,
      "target_level": "proficient_health_literacy",
      "reward": -0.3333333333333333,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 521,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 76-year-old male with a history of hypertension, diabetes, and a previous ischemic stroke presented to the emergency department with progressive weakness and encep..."
    },
    {
      "instance_id": 285,
      "target_level": "low_health_literacy",
      "reward": -0.6666666666666666,
      "prediction": "low_health_literacy",
      "prediction_tokens": 405,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 71-year-old man had a sudden stroke. He had trouble speaking, was weak on one side of his body, and had trouble controlling his bladder. Doctors found a small tumor in hi..."
    },
    {
      "instance_id": 286,
      "target_level": "intermediate_health_literacy",
      "reward": -0.14285714285714285,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 484,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 71-year-old man suddenly experienced symptoms of a stroke, including loss of bladder control, weakness in his right leg, and trouble speaking. He also had facial..."
    },
    {
      "instance_id": 287,
      "target_level": "proficient_health_literacy",
      "reward": 0.0,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 624,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 71-year-old man presented with sudden symptoms of stroke, including urinary incontinence, weakness in his right lower limb, and trouble speaking. Physical examinat..."
    },
    {
      "instance_id": 288,
      "target_level": "low_health_literacy",
      "reward": 0.25,
      "prediction": "low_health_literacy",
      "prediction_tokens": 437,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 60-year-old man with a long-term bowel problem called Crohn's disease had parts of his intestine removed. This left him with a short bowel, making it hard for his body to..."
    },
    {
      "instance_id": 289,
      "target_level": "intermediate_health_literacy",
      "reward": -1.5,
      "prediction": "low_health_literacy",
      "prediction_tokens": 415,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 60-year-old man with Crohn's disease had a serious complication called short bowel syndrome after multiple surgeries to remove parts of his intestine. He was dri..."
    },
    {
      "instance_id": 290,
      "target_level": "proficient_health_literacy",
      "reward": -0.14285714285714285,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 596,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 60-year-old male patient with Crohn's disease, who had undergone multiple intestinal resections, presented to the emergency department with symptoms of headache, n..."
    },
    {
      "instance_id": 291,
      "target_level": "low_health_literacy",
      "reward": -1.8571428571428572,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 463,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 53-year-old woman with stage IVB endometrial cancer had a tumor in her colon and rectum. After four rounds of chemotherapy, her cancer spread to other parts of her body. ..."
    },
    {
      "instance_id": 292,
      "target_level": "intermediate_health_literacy",
      "reward": -0.5,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 538,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 53-year-old woman with stage IVB endometrial cancer had a tumor in her colon and rectum. After four cycles of chemotherapy, her cancer had spread to other parts ..."
    },
    {
      "instance_id": 293,
      "target_level": "proficient_health_literacy",
      "reward": -0.2727272727272727,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 674,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 53-year-old woman with stage IVB endometrial cancer and rectal metastases underwent four cycles of paclitaxel-carboplatin therapy. Following treatment, she experie..."
    },
    {
      "instance_id": 294,
      "target_level": "low_health_literacy",
      "reward": -0.2222222222222222,
      "prediction": "low_health_literacy",
      "prediction_tokens": 484,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 57-year-old woman had trouble speaking, walking, and moving her body. She had weakness, stiffness, and cramping in her legs. She also had trouble with balance and falling..."
    },
    {
      "instance_id": 295,
      "target_level": "intermediate_health_literacy",
      "reward": -0.1111111111111111,
      "prediction": "intermediate_health_literacy",
      "prediction_tokens": 510,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 57-year-old woman experienced weakness, difficulty walking, and speech problems over a year. She initially had trouble with her left side, but the symptoms sprea..."
    },
    {
      "instance_id": 296,
      "target_level": "proficient_health_literacy",
      "reward": -0.1111111111111111,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 794,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 57-year-old right-handed female presented to a neurology clinic with weakness, hypophonia, and difficulty walking. Her symptoms began approximately one year prior,..."
    },
    {
      "instance_id": 297,
      "target_level": "low_health_literacy",
      "reward": -0.8,
      "prediction": "low_health_literacy",
      "prediction_tokens": 414,
      "solution_preview": "{\n  \"low_health_literacy\": \"A 58-year-old woman with a history of Sj\u00f6gren's syndrome took an herbal supplement before bed. The next day, she felt her heart racing, was sweating a lot, and had a bad fe..."
    },
    {
      "instance_id": 298,
      "target_level": "intermediate_health_literacy",
      "reward": -1.3333333333333333,
      "prediction": "low_health_literacy",
      "prediction_tokens": 456,
      "solution_preview": "{\n  \"intermediate_health_literacy\": \"A 58-year-old woman with a history of Sj\u00f6gren's syndrome was experiencing symptoms like excessive sweating, feeling unwell, nausea, and a rapid heartbeat. She had ..."
    },
    {
      "instance_id": 299,
      "target_level": "proficient_health_literacy",
      "reward": -0.16666666666666666,
      "prediction": "proficient_health_literacy",
      "prediction_tokens": 534,
      "solution_preview": "{\n  \"proficient_health_literacy\": \"A 58-year-old Caucasian female with a history of Sj\u00f6gren's syndrome and subacute cutaneous lupus erythematosus presented to our primary care office with symptoms of ..."
    }
  ]
}