{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.", "extra_info": {"index": 136, "original_id": "multiclinsum_test_2394_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung. Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe. However, intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe, further showing that the bronchi of the posterior segment of the right lung opened into the bronchus intermedius. The procedure was completed uneventfully. Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius.", "extra_info": {"index": 141, "original_id": "multiclinsum_test_2891_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We report and analyse a case of a 34-year-old female who presented with ataxia. Magnetic Resonance Imaging (MRI) of the brain revealed demyelinating lesions in the white matter. Genetic testing identified the c.4044C > G and c.1186-2A > G variants in the POLR3A gene. The patient was diagnosed with hypomyelinating leukodystrophy type 7 and received neurotrophic and symptomatic supportive therapy. However, after 1 month of follow-up, there was no improvement in her symptoms.", "extra_info": {"index": 134, "original_id": "multiclinsum_test_1579_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 56-year-old female, with previous history of intestinal pneumonitis, mild pulmonary hypertension and gastroesophageal reflux secondary to systemic scleroderma, is considered for lung transplant. Initially, due to persistent gastroesophageal reflux, a transplant was not a viable. This was corrected with an open gastrectomy with roux-en-Y anastomosis. Follow-up one week later revealed normal anatomy, adequate esophageal-jejunal anastomosis, and adequate contrast medium transit via esophagogram. Additionally, there was no evidence of contrast medium reflux indicating a resolved gastroesophageal reflux disease. This led to the patient becoming a candidate for lung transplant.", "extra_info": {"index": 138, "original_id": "multiclinsum_test_2494_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "This case report presents the case of a 77 year old female patient with degenerative hip disease in the presence of an ipsilateral arthrodesis of the knee. The patient was operated using the DAA. No complications were found and the patient had an excellent follow-up with a forgotten joint score of 93.75 at 1 year. The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy. Using pre-operative templating on X-rays, intraoperative fluoroscopy and the posterior femoral neck the hip biomechanics could be restored.", "extra_info": {"index": 140, "original_id": "multiclinsum_test_2302_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A Chinese family with ATS was recruited for the current study. Clinical characteristics (including findings from renal biopsy) of ATS patients were collected from medical records, and potential causative genes were explored by whole-exome sequencing. A heterozygous substitution in intron 22 of COL4A3 (NM_000091 c.2657-1G>A) was found in the patients, which was further confirmed by quantitative polymerase chain reaction.", "extra_info": {"index": 132, "original_id": "multiclinsum_test_1061_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "Here case report, a 24-year-old patient from an endemic region of Somalia presented with fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months. Initially, the patient received symptomatic treatment and a blood transfusion but showed no improvement. Physical examination revealed fever, pallor, and hepatosplenomegaly. Laboratory tests showed pancytopenia and positive rapid diagnostic test for plasmodium parasite antigen. Despite three days of anti-malarial treatment, the symptoms persisted, and hepatosplenomegaly worsened. Further investigations, including infectious disease tests, were conducted, ruling out HIV, viral hepatitis, Brucella, and Leishmania antibodies. Peripheral blood smear showed pancytopenia and bone marrow aspiration revealed no evidence of infection or malignancy. A tru-cut biopsy of the spleen was performed, confirming the diagnosis of visceral leishmaniasis. The patient received a combination therapy of sodium stibogluconate and paromomycin, leading to significant improvement. After completing treatment, the patient was discharged with normal spleen biopsy results.", "extra_info": {"index": 146, "original_id": "multiclinsum_test_292_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful.", "extra_info": {"index": 144, "original_id": "multiclinsum_test_2467_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male. His medical history was prostate hypertrophy. Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD. There was heavy corneal stromal opacity with intraocular fluid leakage. The patient underwent transplantation of a donor scleral graft to the burn site. Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration. An intraocular lens was eventually fixed in the ciliary sulcus 7 months later. His visual acuity remains at 2/20 OD.", "extra_info": {"index": 150, "original_id": "multiclinsum_test_1564_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 60-year-old white female with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes (POEMS) syndrome and newly diagnosed HTN was referred because of an elevated creatinine level. She denied being an active smoker but reported long-term exposure to cigarette smoke due to living with a heavy smoking family and working as a bartender. Further investigations revealed microscopic hematuria and nephritic range proteinuria. Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity, with negative staining for amyloid, fibrillary glomerulonephritis, and immunoglobulins, leading to a diagnosis of ING.", "extra_info": {"index": 147, "original_id": "multiclinsum_test_3054_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve.", "extra_info": {"index": 137, "original_id": "multiclinsum_test_2648_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "We present a documented case of a 4 years and 8-month-old Syrian Arabic girl with a distinctive course of signs and symptoms of rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation syndrome accompanied by mature ganglioneuroma in her chest, a homogenous mild enlargement of her pituitary gland, generalized cortical brain atrophy, and seizures. Three months after her first marked symptoms were noted she had a sudden progression of severe respiratory distress that ended with her death.", "extra_info": {"index": 139, "original_id": "multiclinsum_test_2845_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "We report the imaging appearance of dermatofibrosarcoma protuberans on the breast of a 41-year-old Chinese man who initially presented with a palpable lump. A mammogram showed two lesions, one with well circumscribed and the other with an ill defined border, in his right breast. Conventional magnetic resonance imaging was performed and showed the well defined larger lesion with mild central hypointensity while the smaller lesion had an irregular border. Both lesions were well characterized on the fat-suppressed sequences.", "extra_info": {"index": 135, "original_id": "multiclinsum_test_1990_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 48-year-old female underwent video-assisted thoracoscopic surgery (VATS) combined with left lower lobectomy. The distal end of the left branch of the tracheal tube was lodged by surgical sutures. In this case, the respiratory physician burned the sutures using an argon electrode, after discussion with the thoracic surgery experts.", "extra_info": {"index": 24, "original_id": "multiclinsum_test_1206_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A previously healthy 51-year-old female with history of hypothyroidism presented with acute onset chest pain for 1 day. Patient's electrocardiogram was normal, however, she had elevated troponins and given her typical chest pain, she was diagnosed with acute coronary syndrome (ACS). The patient had been on levothyroxine and was found to have a subnormal thyroid-stimulating hormone level suggesting hyperthyroidism. Echocardiogram was normal. Coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva and no evidence of atherosclerosis. A coronary computed tomography angiogram was done confirming this finding and showed a slit-like deformity of the coronary ostium with at least 50% luminal stenosis. The patient was referred to a cardiothoracic surgeon for potential coronary artery bypass graft.", "extra_info": {"index": 133, "original_id": "multiclinsum_test_2590_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "In this case, we present a young, otherwise healthy patient that was diagnosed with a primary leiomyosarcoma of the small finger. After her diagnosis, she underwent extensive oncologic workup, and subsequently underwent successful ray amputation with an excellent outcome. She remains disease free.", "extra_info": {"index": 143, "original_id": "multiclinsum_test_2201_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "We report a case of a 33-year-old man, presenting with a five-month history of bilateral lower extremity pain, as well as paresthesia, and mild weakness in one lateral lower extremity. A lumbar laminectomy of L3 to L5 and en bloc resection of the tumor was performed. Postoperative histopathology and immunohistochemical analysis of the tumor were consistent with that of a carcinoid tumor. There were no clinical or radiological signs of tumor recurrence or metastasis at the patient's two year postoperative follow-up.", "extra_info": {"index": 142, "original_id": "multiclinsum_test_2169_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 65-year-old woman with persistent atrial fibrillation was referred for LAAc. Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus; the LAA shape was tortuous and difficult to assess. A first LAAc procedure was unsuccessful given the unsuitable sheath position. Therefore, a soft three-dimensional (3D) model printing was performed by laser sintering and revealed excessive sheath kinking with an inferior approach, but successful deployment would be feasible using a superior approach. Successful trans-jugular implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved during the subsequent procedure. At 3-month follow-up, and after cessation of oral anticoagulation, the patient's symptoms improved. Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis.", "extra_info": {"index": 145, "original_id": "multiclinsum_test_2065_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued.", "extra_info": {"index": 22, "original_id": "multiclinsum_test_295_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye and inquired about refractive surgery. The patient denied any previous history of ocular inflammation, trauma, surgery, or use of topical or systemic medications. Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular which showed confluent pigment deposits stellate in shape over the pupillary axis, whereas left eye examination was completely within normal limits. Ophthalmic examination of the posterior segment was normal in both eyes. Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made.", "extra_info": {"index": 149, "original_id": "multiclinsum_test_2126_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago. He had poor cognition and his clinical examination findings were as follows: Mini-Mental Status Examination score, 14; and handgrip strength (right/left, kg), 32.3/31.3. DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit, and a partial injury of the anterior part of the fornix.", "extra_info": {"index": 148, "original_id": "multiclinsum_test_1723_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 21-year-old female patient with abdominal pain, irregular menstruation, hyperestrogenemia, and an ovarian mass was included. Brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, and transsphenoidal surgery relieved her clinical symptoms. Before transsphenoidal surgery, plasma CA125, estradiol levels were elevated, while prolactin, luteinizing hormone, follicle-stimulating hormone, PROG, cortisol, FT4, thyroid-stimulating hormone, parathyroid hormone, and GH levels were maintained at normal levels. After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma. During follow-up, pelvic ultrasound confirmed normal-sized ovaries in the patient, the menstrual cycle returned to regular, and her hormones were maintained within a normal range. There was no evidence of tumor recurrence after two years of follow-up.", "extra_info": {"index": 151, "original_id": "multiclinsum_test_318_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 58-year-old woman presented with palpitations and diarrhea. Atrial fibrillation with spontaneous conversion to sinus rhythm was noted, along with a left ventricular mass identified on echocardiogram and confirmed via computed tomography as dystrophic calcification. Management included rehydration, antiarrhythmic therapy, and anticoagulation. The calcification, linked to previous myocardial infarctions, was considered an incidental finding, with no significant systolic dysfunction.", "extra_info": {"index": 153, "original_id": "multiclinsum_test_3200_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of a 23-year-old patient with Burkitt's lymphoma and graft-versus-host disease admitted with intracerebral hemorrhage and sequential development of 12 anterior circulation aneurysms from disseminated Scedosporium infection. Despite aggressive surgical and antimicrobial treatment, the patient died 6 months later from multiorgan failure. The notable feature of this case is the rapid angioinvasiveness of the infection with new aneurysm formation within days of clear angiographic imaging despite the apparent lack of skull base osteomyelitis.", "extra_info": {"index": 152, "original_id": "multiclinsum_test_2127_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 75-year-old man presented with fever and right chest pain. He was suspected of a giant primary diaphragmatic tumor of extrahepatic origin by imaging studies. The preoperative differential diagnosis included benign masses such as myxoid sarcoma and schwannoma, and we planned a diaphragmatic resection. Intraoperatively, however, dissection of the tumor from the liver was not possible, requiring an extended right posterior segmentectomy with combined resection of the diaphragm. The patient had a good postoperative course and 1\u00a0year has passed since the surgery with no recurrence. The pathology showed that the mass was located just below the hepatic capsule/parenchymal region and was adherent to the diaphragm, but there was no continuity. The morphology suggested a low-grade mesenchymal tumor such as a solitary fibrous tumor and perivascular epithelioid cell tumor, but immunostaining was negative, making the diagnosis difficult. Although some areas of high proliferative activity were observed, finally, the diagnosis of primary spindle cell tumor of the liver with smooth muscle differentiation was made based on the positive results of muscle markers such as \u03b1SMA, desmin, and h-caldesmon.", "extra_info": {"index": 25, "original_id": "multiclinsum_test_447_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a 34-year-old patient with a cutaneous immunodeficiency characterized by recurrent crusted scabies infestation, diffuse tinea, and recurrent staphylococcal cellulitis, who we suspected had an undiagnosed syndrome. The patient also suffered from mental retardation, renal failure, and premature senescence. A cytogenetic fluorescence in situ hybridization analysis revealed a 9.34 Mb duplication within the short (p) arm of chromosome 1, precisely from 1p36.11 to 1p36.21, with an adjacent 193 kb copy gain entirely within 1p36.11. In addition, chromosome 4 had a 906 kb gain in 4p16.1 and chromosome 9 had a 81 kb copy gain in 9p24.3. Over 100 genes localized within these duplicated regions. Gene expression array revealed 82 genes whose expression changed >1.5-fold compared to a healthy age-matched skin control, but among them only the lipolytic enzyme arylacetamide deacetylase-like 3 was found within the duplicated 1p36 region of chromosome 1.", "extra_info": {"index": 33, "original_id": "multiclinsum_test_1677_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 52-year-old woman with primary Sj\u00f6gren's syndrome developed membranous glomerulonephritis and Epstein-Barr virus-positive diffuse large B-cell lymphoma (DLBCL). She was diagnosed with Sj\u00f6gren's syndrome based on the dry eyes, dry mouth, positive anti-nuclear antibody test, anti-Ro (SS-A) antibody, salivary gland biopsy, and salivary scintigraphy. Moreover, renal biopsy confirmed the diagnosis of membranous glomerulonephritis. Three months later, her small bowel was perforated with pneumoperitoneum, and the biopsy revealed Epstein-Barr virus-positive DLBCL.", "extra_info": {"index": 28, "original_id": "multiclinsum_test_2438_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe the case of a 65-year-old man, who was referred from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computed tomography of the abdomen with intravenous contrast was performed, which was interpreted as Meckel's diverticulitis complicated, being corroborated during the surgical act and confirmed by pathological anatomy.\n", "extra_info": {"index": 30, "original_id": "multiclinsum_test_3197_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report a case of a giant loose peritoneal body measuring 7 \u00d7 5 cm found incidentally in a 64-year-old Indian man who presented with acute intestinal obstruction. We present the current hypothesis and our opinion on the genesis of such large bodies and discuss the problems in diagnosis.", "extra_info": {"index": 36, "original_id": "multiclinsum_test_2469_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We reported a patient with acute lymphoblastic leukemia suffered from pulmonary TB infection after HSCT. During anti-TB treatment, the patient had a poor response to linezolid-containing regimen, and developed side effects such as gingival bleeding and thrombocytopenia, so the administration was switched to contezolid. After 15 days of continuous treatment, the patient's platelet increased to 58\u00d7109/L, and he was discharged in stable condition. During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable, and no hematological adverse reactions and no symptoms of peripheral neuropathy were observed. Moreover, repeat imaging showed that the bilateral lung lesions were significantly reduced, indicating a good outcome for the patient.", "extra_info": {"index": 40, "original_id": "multiclinsum_test_353_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 51 year-old Caucasian right handed housewife lady (weight 61 kg, height 159 cm) presented with a headache of acute onset which proved to be caused by acute subarachnoid hemorrhage. Cerebral computed tomographic angiography revealed multiple aneurysms. The patient underwent a right pterional craniotomy to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms. The post-operative course was uneventful.", "extra_info": {"index": 34, "original_id": "multiclinsum_test_2076_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A HIV-negative 56-year-old male was hospitalized for chest disease with main symptoms of chest tightness, chest pain, fatigue, anorexia, and weight loss. Heart rate 109 times/min, the computed tomography (CT) scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura, right pleural encapsulated effusion, and limited, incomplete expansion of the middle and lower lobes of the right lung, enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups, and multiple slightly low-density nodules in the liver, bone destruction in the 2nd thoracic vertebra, raising the possibility of multiple liver metastases of right lung cancer and malignant pleural fluid. The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally. After comprehensive analysis, the patient was diagnosed with atypical systemic HDTB. After three months of conventional anti-TB treatment, the patient refused our hospital follow-up, and his symptoms improved significantly during the telephone follow-up.", "extra_info": {"index": 38, "original_id": "multiclinsum_test_867_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 21-year-old Japanese patient, suffering from a traumatic hallux deficit with only a portion of the basal phalanx intact, underwent rehabilitation treatment. The thenar area exhibited instability, leading to impaired balance and walking difficulties. Biomechanical assessment revealed the need for a rehabilitation strategy for the foot, as well as the knee, hip, and trunk. A rehabilitation protocol was designed to enhance medial foot loading during walking and standing, including balance and trunk strength training. After a 12-week rehabilitation period, the patient's gait showed significant improvement. Specifically, the load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%, while the pre-swing phase decreased from 14.6% to 11.6%. The vertical component of the ground reaction force rose from 599.8 to 647.5\u00a0N. The enhanced stability from balance training and increased muscle strength contributed to the patient's improved walking and balance.", "extra_info": {"index": 42, "original_id": "multiclinsum_test_1445_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe the case of a 43-year-old Asian female who has mild vision impairment due to tractional retinal detachment secondary to diabetic retinopathy and how mental health screening and quality of life screening during low vision rehabilitation can improve in the management of this patient.", "extra_info": {"index": 26, "original_id": "multiclinsum_test_2493_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present the case of a 25 y.o. patient with COVID-19 respiratory failure requiring ECMO support for 16-days in which a 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein. Attempts to remove the cannula at the bedside failed due to immobility of the cannula. Ultrasound of the right neck was unremarkable, so he was taken to the hybrid OR where both TEE and fluoroscopy were unrevealing. An upper sternotomy was performed, and the superior vena cava and proximal jugular vein were dissected revealing a 2\u00a0cm segment of the distal SVC and proximal jugular vein that was densely sclerosed and adherent to the cannula. The vessel was opened across the adherent area at the level of the innominate vein and the cannula was then able to be withdrawn. The patient suffered no ill effects and had an unremarkable recovery to discharge.", "extra_info": {"index": 29, "original_id": "multiclinsum_test_2039_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report a case of 29 year old male with total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with transseptal portal technique to ensure the tibial tunnel is placed in appropriate position.", "extra_info": {"index": 23, "original_id": "multiclinsum_test_2913_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma. An 82-year old lady suffered from recurrent attacks of hypoglycemia and presented with an abdominal mass, 2 years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma. An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out. Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail, in the peripancreatic tissue and in the surrounding soft tissue consistent with metastatic Merkel cell carcinoma in addition to an insulinoma of the pancreatic body.", "extra_info": {"index": 32, "original_id": "multiclinsum_test_1055_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study.", "extra_info": {"index": 27, "original_id": "multiclinsum_test_445_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 20-year-old man presented with periumbilical pain. Physical exam showed a warm, erythematous infra-umbilical mass that was tender to palpation. CT revealed an infected urachal cyst. The patient underwent urachal abscess incision and drainage with cyst excision. The patient returned home on postoperative day two. Two-week outpatient follow-up confirmed an uncomplicated recovery.", "extra_info": {"index": 39, "original_id": "multiclinsum_test_1897_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 33-year-old woman was referred to our department with unstable angina. At the age of 6, she had undergone coronary artery bypass grafting of the second diagonal branch using the left internal thoracic artery and the obtuse marginal branch using saphenous vein grafting for left main coronary atresia. Although a coronary angiogram showed a patent left internal thoracic artery graft to the second diagonal branch and a patent saphenous vein graft to the obtuse marginal branch, the left anterior descending artery was not being perfused by the grafts because of a disruption of blood flow to the left anterior descending artery from the left internal thoracic artery. Therefore, we performed a redo coronary artery bypass grafting using the in situ right internal thoracic artery to the first diagonal branch, which was to be connected to the left anterior descending artery, resulting in amelioration of the ischemia of the left anterior wall. The patient was discharged 10\u00a0days after the operation and has been in good health for over 3\u00a0years without recurrence of chest symptoms.", "extra_info": {"index": 31, "original_id": "multiclinsum_test_2205_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 90-year-old female with atrial fibrillation on therapeutic apixaban and status-post TAVR presented with COVID-19 infection and was found to have severe bioprosthetic valvular regurgitation with features suggestive of valve thrombosis. She underwent valve-in-valve TAVR with resolution of valvular dysfunction.", "extra_info": {"index": 35, "original_id": "multiclinsum_test_303_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In August 2012, a woman and her son were attacked by a stray dog in Henan, China. The son received rabies postexposure prophylaxis (wound treatment followed by vaccine, no immunoglobulin), however, the mother did not. Rabies infection was subsequently laboratory confirmed in the mother and she died in December; her son is alive and healthy after 2\u00a0years of follow-up.", "extra_info": {"index": 43, "original_id": "multiclinsum_test_1507_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.", "extra_info": {"index": 37, "original_id": "multiclinsum_test_1298_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10\u00a0h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention.", "extra_info": {"index": 41, "original_id": "multiclinsum_test_885_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "Our patient is a 77-year-old African American female who presented with a systolic blood pressure of 200\u00a0mmHg. Computed tomography showed an enhancing 9\u00a0\u00d7\u20096\u00a0cm mass anterior and medial to the left kidney. The patient underwent a left adrenalectomy with partial nephrectomy. Gross and histologic examinations revealed an adrenal cortical adenoma and renal-adrenal fusion.", "extra_info": {"index": 69, "original_id": "multiclinsum_test_1363_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent.", "extra_info": {"index": 79, "original_id": "multiclinsum_test_2113_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "On per speculum examination, cervix was replaced by an irregular friable growth, which was bleeding on touch. A clinical diagnosis of carcinoma cervix was made but the cervical biopsy revealed granulomatous inflammation with presence of acid-fast bacilli on cervical smear consistent with tuberculosis. The patient responded to six months of anti-tubercular therapy.", "extra_info": {"index": 77, "original_id": "multiclinsum_test_216_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging.", "extra_info": {"index": 67, "original_id": "multiclinsum_test_1780_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis.", "extra_info": {"index": 66, "original_id": "multiclinsum_test_1605_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present the case of a 52-year-old woman with cardiogenic shock and refractory right ventricular failure due to spontaneous dissection of the right coronary artery. She remained dependent on mechanical support for several weeks. Both a right ventricular assist device implant and a bidirectional cavopulmonary anastomosis were explored as long-term support options. A history of malignancy and possible right ventricular functional recovery resulted in a decision in favour of the bidirectional cavopulmonary anastomosis and concomitant tricuspid valve annuloplasty. Postoperatively her clinical condition improved significantly, and she could be discharged home. Echocardiography showed normalization of right ventricular dimensions and slight improvement of right ventricular function.", "extra_info": {"index": 70, "original_id": "multiclinsum_test_3152_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 43-year-old Asian man with a 3-year history of penile cancer presented with metastasis in the right intraocular sites. Magnetic resonance imaging showed hyperintensity in the T1-weighted images and hypointensity in the T2-weighted images of the right eye. After enucleation of his right eye, histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma.", "extra_info": {"index": 82, "original_id": "multiclinsum_test_1233_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "7-year-old male with a diagnosis of acute lymphoid T-cell leukemia, completing a cycle of induction chemotherapy with the PETHEMA 2013 protocol. He presented a 12-day picture characterized by epigastric abdominal pain and vomiting, initially suspected acute pancreatitis, ruled out by normal pancreatic enzymes and abdominal computed tomography. Due to suspected acid-peptic disease associated with steroids, he began treatment with proton pump inhibitors and procinetics. Considering a picture of dyspepsia with alarm signs, such as progression of neutropenia, increased C-reactive protein and clinical deterioration, an esophagogastroduodenoscopy (EGD) compatible with necrotizing gastritis was performed, confirmed by histopathology. He received pharmacological management, zero regimen and parenteral support, and progressive improvement was evidenced in imaging controls. After fasting for 30 days, well tolerated enteral nutrition was initiated, with outpatient follow-up. After improvement, the chemotherapy plan was completed, highlighting complete remission, without complications after 2 years.\n", "extra_info": {"index": 68, "original_id": "multiclinsum_test_3042_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 49-year-old Japanese man visited our department in November 2017 with chief complaints of indolent right scrotum enlargement and a right inguinal mass. History showed that the patient visited our department of gastroenterology with chief complaints of blackish feces and ill complexion in February 1997. Computed tomography (CT) showed a right retroperitoneal tumor, which was removed in the same month. Histopathological examination showed a teratoma and yolk sac tumor. He was diagnosed with primary retroperitoneal EGCT and received three courses of chemotherapy (bleomycin/etoposide/cisplatin; BEP). Periodic imaging and the determination of tumor markers (alpha-fetoprotein", "extra_info": {"index": 84, "original_id": "multiclinsum_test_439_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We present a case in which POCUS was used to rapidly confirm diagnosis in an unstable, severely septic patient presenting to the emergency department with Fournier's gangrene.", "extra_info": {"index": 75, "original_id": "multiclinsum_test_2914_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids.", "extra_info": {"index": 73, "original_id": "multiclinsum_test_2426_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma.", "extra_info": {"index": 81, "original_id": "multiclinsum_test_1888_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor. Contrast-enhanced computed tomography showed a papillary tumor in the fundus of the gallbladder with irregular thickening of the gallbladder wall that spread into the cystic duct. The boundary between the tumor and liver was unclear. The patient was diagnosed with gallbladder cancer with liver invasion. We performed extended cholecystectomy with liver bed resection after confirming the absence of cancer cells in the resection margin of the cystic duct. After pathological examination, the tumor was diagnosed as an ICPN with xanthogranulomatous cholecystitis. The patient was discharged on postoperative day 8 with no complications.", "extra_info": {"index": 74, "original_id": "multiclinsum_test_1559_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 27-year-old man presented with headache and diplopia at our department. Fundoscopy showed left optic nerve atrophy and right papilledema consistent with Foster-Kennedy syndrome. Neurological exams were otherwise normal. A left frontal irregular space-occupying lesion was seen on magnetic resonance imaging (MRI), and enhancement was shown on contrast-enhanced computed tomography (CT) scan. CT angiography (CTA) revealed vascular compression around the lesion. Prior to surgery, meningioma was diagnosed and gross tumor removal was performed. On postoperative pathohistological exam, the tumor proved to be a meningeal melanocytoma, WHO grade I. No skin melanoma was found. After surgery, the patient received radiation therapy. No tumor was seen on follow-up MR images six months after surgery. The patient was well after two and a half years, and there was no tumor recurrence on the follow-up CT.", "extra_info": {"index": 85, "original_id": "multiclinsum_test_568_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In this case report, we present a case of a pleomorphic adenoma arising from the 'tail' of the parotid gland, which on imaging, appears to be extra parotid in location. We also review the anatomy of the parotid 'tail' and relevant literature.", "extra_info": {"index": 76, "original_id": "multiclinsum_test_2421_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A previously healthy 24-yo male (A) presented at the Emergency Department(ED) with recent onset of chest pain and a 3-day history of abdominal pain, fever and diarrhoea. The symptoms began within a few hours of returning from a tourist visit to a central European capital. Vital signs were stable, the Electrocardiogram(ECG) showed generalized ST-elevation, laboratory testing showed increased levels of C-reactive protein(CRP) and high-sensitive Troponin T(hsTnT). Transthoracic echocardiogram (TTE) was normal, stool cultures were positive for C Jejuni and blood cultures were negative. Two days after patient A was admitted to the ED his travel companion (B), also a previously healthy male (23-yo), presented at the same ED with almost identical symptoms: chest pain precipitated by a few days of abdominal pain, fever and diarrhoea. Patient B declared that he and patient A had ingested chicken prior to returning from their tourist trip. Laboratory tests showed elevated CRP and hsTnT but the ECG and TTE were normal. In both cases, the diagnosis of C jejuni-associated perimyocarditis was set based on the typical presentation and positive stool cultures with identical strains. Both patients were given antibiotics, rapidly improved and were fully recovered at 6-week follow up.", "extra_info": {"index": 78, "original_id": "multiclinsum_test_1211_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report an unusual case in which both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently.", "extra_info": {"index": 87, "original_id": "multiclinsum_test_1721_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 66-year-old man affected by DME, with glycated hemoglobin (HbA1c) at 6.9%, refractory to laser grid treatment and intravitreal injections of triamcinolone, was selected to receive a cycle of three subtenon injections/week of IFN\u03b1 (1\u00d7106 IU/ml). BCVA and CMT, using spectral domain ocular coherence tomography (SD-OCT), were evaluated preoperatively and at 1\u00a0week, 1\u00a0month, 4\u00a0months, and 1\u00a0year postoperatively. BCVA and CMT were significantly improved at 1\u00a0week after the three injections (20/200 vs. 20/40 and 498\u00a0\u03bcm vs. 237\u00a0\u03bcm, respectively). BCVA remained stable during the 1-year follow-up. CMT was slightly increased, but was still lower than the baseline value (215\u00a0\u03bcm, 255\u00a0\u03bcm, and 299\u00a0\u03bcm during the follow-up visits). No adverse events were recorded, with the exception of mild subconjunctival hemorrhage at the injection site.", "extra_info": {"index": 80, "original_id": "multiclinsum_test_1558_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 53-year-old female with a history of two prior spinal operations at the L4-S1 levels (11 and 2 years previously) presented over a few weeks with the acute onset of a cauda equina syndrome (e.g., paraparesis and acute urinary incontinence). The patient demonstrated a mildly elevated white blood cell count (12,600/mm3) and abnormally increased C-reactive protein level that correlated with the magnetic resonance imaging that showed a dorsal epidural abscess extending from the L4 to S1 levels. At surgery, an encapsulated posterior epidural abscess was drained. Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid and was removed from the antero-inferior portion of the abscess wall at S1. Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca. After 2 months of ciprofloxacin, the patient's infection cleared but the motor deficit only partially resolved.", "extra_info": {"index": 83, "original_id": "multiclinsum_test_2689_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 42-year-old female with a distant history of SCI developed clinical and imaging findings consistent with acute expansion of PTS immediately following parathyroidectomy. Her symptoms included acute numbness, tingling, and pain in both arms. Magnetic resonance imaging (MRI) revealed a syrinx in the cervical and thoracic spinal cord. However, this was initially misdiagnosed as transverse myelitis and was treated as such without resolution of symptoms. Over the following 6 months, the patient experienced progressive weakness. Repeat MRI demonstrated expansion of the syrinx with new involvement of the brain stem. The patient was diagnosed with PTS and referred for outpatient neurosurgery evaluation at a tertiary facility. Treatment was delayed due to problems with housing and scheduling at the outside facility, allowing for continued worsening of her symptoms. The syrinx was surgically drained and a syringo-subarachnoid shunt was placed. Follow-up MRI confirmed correct placement of the shunt as well as resolved syrinx and decreased thecal sac compression. The procedure effectively halted symptom progression but did not resolve all symptoms completely. The patient has regained her ability to perform much of her activities of daily living but remains in a nursing home facility.", "extra_info": {"index": 86, "original_id": "multiclinsum_test_2005_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 34-year-old female presented with a 1 year history of intermittent pain in the right side of the waist without obvious inducement. All laboratory blood tests were within normal limits. Indocyanine green 15 min retention was rated 2.9%, and Child-Pugh was rated A. Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe with hemangioma of left lobe of liver. After discussion, surgical treatment was performed, which lasted 410 min, with intraoperative bleeding of about 600 mL and postoperative pathological findings of cavernous hemangioma. There were no obvious postoperative complications, and the patient was discharged 10 d after surgery.", "extra_info": {"index": 72, "original_id": "multiclinsum_test_2984_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago. A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant, and that the content consisted of the large omentum. An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously. The postoperative period was uneventful. The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.", "extra_info": {"index": 71, "original_id": "multiclinsum_test_1042_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A four-year-old girl presented with fever and a painful limp in the left hip. Pain characteristics and anemia detected in the blood analyses were the first warning signs that the hip process was not standard. Although the primary suspicion was of septic arthritis, a CT scan of the abdomen revealed an adrenal neuroblastoma.", "extra_info": {"index": 60, "original_id": "multiclinsum_test_1260_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection. The patient presenting a Peripheral arterial ischemic involving the infrarenal aorta, iliac, femoral. The simultaneous intervention consisted of an endovascular aortic stent-graft placement and angioplasty of femoral artery.", "extra_info": {"index": 58, "original_id": "multiclinsum_test_437_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Male school-age child, 8 years old, no relevant history, presented with a 1-year history of conjugate horizontal rapid eye movement jerking and associated mild miosis, 5-10 seconds in duration, occurring 5-6 times daily, with some episodes with a questionable disconnection from the environment or impairment of consciousness, without other accompanying signs or symptoms. General examinations were normal. He was evaluated by ophthalmologists and otolaryngologists who ruled out pathology in those fields. The neurological examination between episodes was normal. The video-electroencephalogram demonstrated an electro-clinical correlate, with epileptiform activity in the left temporal and occipital region that later generalized during episodes. The brain MRI was normal. After initiation of treatment with carbamazepine, he had a good evolution, with no recurrence of episodes at 2 years of follow-up.\n", "extra_info": {"index": 62, "original_id": "multiclinsum_test_3001_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition (PN). There were three episodes of central venous catheter infection with Bacillus pumilus in three months. Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear resulting in the need for removal of the catheter for complete cure.", "extra_info": {"index": 44, "original_id": "multiclinsum_test_1072_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3\u00a0months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72\u2009h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively.", "extra_info": {"index": 56, "original_id": "multiclinsum_test_1266_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We describe the case of a 55-year-old female patient with primary open-angle glaucoma (POAG) who underwent bilateral XEN gel surgery. Her left eye developed a 2 mm postoperative hyphema, which resolved spontaneously within 8 days. Intraocular pressure (IOP) normalized at 12 mm Hg and increased to 50 mm Hg after 1 month in an otherwise normal-looking eye. Intraoperative examination revealed a nonfunctioning XEN gel stent, which was replaced and sent for laboratory analysis. Macroscopic examination of the tube confirmed obstruction with cellular debris. Tube replacement restored good filtration.", "extra_info": {"index": 64, "original_id": "multiclinsum_test_7_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 49-year-old Asian woman presented with disseminated intravascular coagulation due to ruptured primary high-grade ovarian endometrial stromal sarcoma with multiple intraperitoneal metastases. After the initial surgery, the patient underwent adjuvant chemotherapy with three courses of Adriamycin (75\u00a0mg/m2). We performed the secondary debulking operation including total hysterectomy, metastasectomy, omentectomy, peritonectomy, appendectomy, and hyperthermic intraperitoneal chemotherapy (paclitaxel 175\u00a0mg/m2). Currently she has been alive for 28\u00a0months under a new chemotherapy regimen.", "extra_info": {"index": 49, "original_id": "multiclinsum_test_2683_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 38-year-old woman presented with shortness of breath and syncope. Upon investigation, she was found to have a right atrioventricular myxoma. It was associated with tricuspid regurgitation, right-sided heart failure, and pulmonary hypertension.\n\nThe syncopal attacks and shortness of breath resolved completely after tumor resection. Tricuspid regurgitation (grade 1) and mild pulmonary hypertension (right ventricular systolic pressure 35 mmHg) remained as sequelae of delayed presentation. These may be due to recurrent embolization of tumor fragments to segments of the pulmonary artery.", "extra_info": {"index": 51, "original_id": "multiclinsum_test_3149_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 17-year-old male patient presented with pain in the lower left molar region. Clinical examination revealed the absence of Teeth 37 and 38. Tomographic imaging showed Tooth 37 in a transverse position with the crown oriented lingually and Tooth 38 in a vertical position. Extraction of Tooth 37 was performed using a vestibular approach and odontectomy due to space constraints.", "extra_info": {"index": 46, "original_id": "multiclinsum_test_3344_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present a case of a 79-year-old female patient who underwent LAAO device deployment within a surgically occluded LAA with PDL. She underwent 27\u2005mm LAAO device (WATCHMANTM) deployment and all the P.A.S.S. (Position, Anchor, Size, and Seal) criteria were satisfied. Only 1.4\u2005mm PDL was present. She was continued on apixaban and aspirin post-operatively. Post-operative transoesophageal echocardiogram at 6 weeks demonstrated trivial PDL measuring 1.49\u2005mm. Patient was continued on aspirin and clopidogrel, with discontinuation of apixaban.", "extra_info": {"index": 47, "original_id": "multiclinsum_test_1868_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 66-year-old Maori man presented to our hospital with left testicular swelling. His alpha-fetoprotein and beta-human chorionic gonadotrophin levels were within normal limits. His lactate dehydrogenase concentration was elevated to 267 U/L. Ultrasound imaging confirmed a large testicular mass, and he underwent left orchiectomy. His histological examination revealed a neuroendocrine tumor with an immunostaining pattern suggesting Merkel cell carcinoma. He presented to our hospital again 3 months later with right testicular swelling that was confirmed on ultrasound sonography to be a tumor. He underwent a right orchiectomy, and his histological examination revealed metastatic Merkel cell carcinoma. A primary lesion was not identified, and computed tomographic imaging did not reveal spread to other organs. He received six cycles of adjuvant carboplatin and etoposide chemotherapy and remained disease-free 18 months after completion of chemotherapy.", "extra_info": {"index": 52, "original_id": "multiclinsum_test_2759_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present a case of stage IV pleomorphic carcinoma; the patient was a 66-year-old male. He was referred to our hospital because of a right adrenal hemorrhage and a lung tumor. A systemic examination revealed that the lung tumor was a primary lung cancer and that the adrenal hemorrhage was due to a metastatic cancer. We performed an adrenalectomy and resection of the lung tumor and obtained a diagnosis of pleomorphic carcinoma with adrenal metastasis. The patient has remained recurrence-free for 6\u2009years since the surgery.", "extra_info": {"index": 54, "original_id": "multiclinsum_test_2067_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present a 12-year-old girl who presented with bilateral shoulder deformities and difficulty in coordination while writing. On examination, she was noted to have bilateral Sprengel deformities with flexion contractures of upper-limb joints and mirror movements of both upper and lower-limb joints.", "extra_info": {"index": 53, "original_id": "multiclinsum_test_990_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy (CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.", "extra_info": {"index": 48, "original_id": "multiclinsum_test_2808_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 27-year-old man presented to our hospital because of painless and progressive visual impairment of both eyes over two years. He was previously diagnosed with hypocalcemia but did not take calcium supplements regularly. He had no history of anterior neck thyroid surgery. After admission, the biochemical analysis indicated a serum calcium level of 1.21 mmol/L and an intact parathyroid hormone level of 0 pg/mL. Ocular examination revealed bilateral symmetrical opacity of the lens presenting as punctate opacity in the posterior subcapsular cortex together with radial opacity in the peripheral cortex (N1C2P3). Phacoemulsification with an intraocular lens was performed in both eyes sequentially. Postoperatively, the patient had a satisfactory recovery and greatly improved visual acuity.", "extra_info": {"index": 59, "original_id": "multiclinsum_test_1416_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male. The patient presented persistent arterial hypertension and a previous diagnosis of chromophobe renal cell carcinoma. It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma. Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests and peripheral S100 protein expression in sustentacular cells. Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors.", "extra_info": {"index": 45, "original_id": "multiclinsum_test_2717_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 69-year-old man was injured in a motor vehicle accident and suffered from left hemothorax and multiple rib fractures near the heart. A comprehensive assessment raised suspicions of lacerated pericardium and myocardial injury. Consequently, a thoracoscopy was performed 9\u2009h after injury. A penetrating cardiac injury was detected and surgically treated via video-assisted thoracoscopic surgery. The patient recovered uneventfully and was discharged on postoperative day 16.", "extra_info": {"index": 50, "original_id": "multiclinsum_test_2967_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160\u2013200\u2009ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient\u2019s symptoms were successfully alleviated, and he was discharged from the hospital.", "extra_info": {"index": 57, "original_id": "multiclinsum_test_3217_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 62-year-old man diagnosed as IgD-\u03bb/\u03bb myeloma (ISS stage III) was admitted with fatigue and weight loss. The physical examination suggested an anemic face, a few moist rales at the left lung base, and mild concave edema in both lower extremities. Laboratory examinations showed the elevated creatinine levels, \u03b22-microglobulin, lactic dehydrogenase, and erythrocyte sedimentation rate, while the decreased neutrophils, granulocytes, and hemoglobin. In the serum protein electrophoresis, there appeared two inconspicuous M-spikes. Serum IFE indicated an over-representation of lambda light chain and yielded two monoclonal bands in \u03bb region, but only one corresponding heavy chain band in the antisera to IgD region. The BM histology and BM cytology both supported the diagnosis of IgD-\u03bb/\u03bb myeloma.", "extra_info": {"index": 55, "original_id": "multiclinsum_test_710_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We reported a 24-year-old male who came to the emergency department complaining of a history of a sore throat, fever, malaise, fever, and neck swelling with a normal consciousness level. A laboratory examination showed leukocytosis and high C-reactive protein serum. Radiological diagnosis reveals an anterior neck abscess with left jugular vein thrombosis and left epidural abscess. The blood culture was positive for Fusobacterium necrophorum. The patient underwent surgical drainage and, at the same time, was treated with antibiotics and anticoagulant drugs. After 45 days, the patient improved clinically and was discharged. There were no other symptoms after a one-month follow-up clinically and neck ultrasonography.", "extra_info": {"index": 63, "original_id": "multiclinsum_test_1379_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo. He had no history of present or past illness. Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment. Tumor tissue in the fibular bone marrow cavity was removed by curettage, and rapid intraoperative pathological examination suggested fibular fibrous dysplasia. An allograft was implanted into the fibular medullary cavity. However, he was readmitted with clinical symptoms including persistent pain, abnormal gait, and local swelling at the age of 6 years. He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination. He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws. Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up.", "extra_info": {"index": 65, "original_id": "multiclinsum_test_1596_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra, in a 20-year-old male without any neurological deficit. The patient had associated chest injuries. The spine injury was managed surgically with in-situ posterior instrumentation and fusion. The patient tolerated the operation well and postoperatively there was no neurological deterioration or surgical complication.", "extra_info": {"index": 61, "original_id": "multiclinsum_test_1749_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We report a case of annular leukocytoclastic vasculitis induced by anti-tuberculosis medication. A 62-year-old Thai man presented to our facility with a generalized exanthematous rash on his trunk and extremities that resolved shortly afterwards. Subsequently, he developed multiple, erythematous-to-purplish, non-blanchable macules and papules with an annular arrangement on his extremities. The skin rash occurred after two weeks of anti-tuberculosis medication. The histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after discontinuation of the anti-tuberculosis drugs and treatment with oral antihistamine and topical corticosteroid drugs. Streptomycin, ethambutol and ofloxacin were administered as second-line anti-tuberculosis therapy during his hospitalization. No adverse reactions were observed.", "extra_info": {"index": 7, "original_id": "multiclinsum_test_2131_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.", "extra_info": {"index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 27-year-old male with a relapsed acute lymphoblastic leukemia presented with five-day-old polyarthralgia. He also had febrile neutropenia, cellulitis without abscesses, and methicillin-resistant Staphylococcus aureus bacteremia for which he received therapy with oxacillin and cefepime. However, the febrile neutropenia persisted, and an invasive fungal infection was suspected. A new set of blood cultures was taken and antifungal treatment was initiated. Arthroconidia were identified in the blood cultures and a matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp. Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B and four weeks of voriconazole. After a prolonged stay, he was discharged.\n", "extra_info": {"index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "The patient was a 55-year-old woman with a transglottic squamous cell carcinoma of the T3N0M0 stage and PCF development following total laryngectomy surgery with total thyroidectomy and bilateral elective cervical lymph node dissection level I-IV. In spite of conservative treatment, the fistula was not recovered after 3 weeks. It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach. One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test, and the fistula was completely closed.", "extra_info": {"index": 13, "original_id": "multiclinsum_test_112_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine. The patient is a 29-year-old female who received manipulation one week prior to developing symptoms of severe orthostatic headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection. Symptomatic onset corresponded with the recent cervical chiropractic adjustment. We present serial imaging correlating with her symptomatology and review the pertinent literature on complications of chiropractic manipulation.", "extra_info": {"index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We report here another case of primary prostatic MALT lymphoma which is presented by hematuria and diagnosed primarily as BPH. Immunohistochemistry studies demonstrate the diagnosis and MALT lymphoma. Six months after starting the treatment the patient was alive and well.", "extra_info": {"index": 9, "original_id": "multiclinsum_test_2155_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum.", "extra_info": {"index": 12, "original_id": "multiclinsum_test_1808_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 71-year-old female who was being treated for type 2 diabetes with canagliflozin, metformin, and saxagliptin orally presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain. Although her blood glucose was not severely elevated (259 mg/dL), there was notable ketoacidosis (pH\u20096.89; CO2, 11.4\u2009mmHg; HCO3, 1.9\u2009mEq/L; base excess, - 31.3\u2009mmol/L; 3-hydroxybutyric acid > 10,000\u2009\u03bcmol/L) was observed. The uncontrolled acidosis improved following 3\u2009days of continuous renal replacement therapy, but elevated urinary glucose continued for more than 10\u2009days. Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria. Urinary glucose turned negative on day 16, and there was improvement in the patient's overall state; hence, she was discharged on day 18.", "extra_info": {"index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein - CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution.", "extra_info": {"index": 15, "original_id": "multiclinsum_test_723_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "Herein we present a 63-year-old man with idiopathic spontaneous intraperitoneal hemorrhage (ISIH) caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA).", "extra_info": {"index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "33-year-old nulligravid woman with newly diagnosed anaplastic astrocytoma (AA; WHO grade III, IDH1-negative) sought fertility preservation. Prior to chemotherapy and radiation for AA, the patient underwent in vitro fertilization (IVF) for fertility preservation, resulting in 8 vitrified embryos. Following chemo-radiation, the patient underwent two rounds of frozen embryo transfers (FET), each resulting in a successful singleton pregnancy.", "extra_info": {"index": 8, "original_id": "multiclinsum_test_2635_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 62-year-old male presented with a 4-month history of right brachial pain and hyposensitivity in the C5 distribution. The cervical magnetic resonance (MR) imaging scan revealed a C5-C6 right anterolateral disc herniation with syringomyelia extending from C5-C6 to T1. Following a C5-C6 anterior cervical discectomy and fusion (ACDF), the patient's symptoms resolved. The 3-month postoperative MR documented total resolution of the syrinx. Notably, due to residual neuropathic pain, the patient required a subdural spinal cord stimulator which was placed without any complications.", "extra_info": {"index": 6, "original_id": "multiclinsum_test_875_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 34-year-old male patient presented with multiple large tuberous xanthomas related to FH. There were 15 masses in different body parts, including the dorsum of the hands, elbows, buttocks, feet, and Achille's tendon. The largest masses in the buttocks measured 8\u00a0\u00d7\u00a08\u00a0\u00d7\u00a05\u00a0cm. Surgical removal of 13 masses was carried out in combination with medical treatment. The skin incision was oval around the circumference of masses with the longitudinal axis parallel to the Langer's line. Skin defects were closed directly or dissected on both sides of the incision to reduce tension. Wound healing was normal. After 1.5\u00a0months, there was no recurrence of xanthomas.", "extra_info": {"index": 10, "original_id": "multiclinsum_test_1587_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "An 84-year-old male was admitted with a history of difficulty rising from a chair and a fall. Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values. Electromyography (EMG) showed myopathic changes, and FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps. A biopsy was performed revealing lymphocytic predominant infiltrates and myonecrosis. Prednisone and intravenous immunoglobulin (IVIG) were administered with strength improvement. The patient was discharged for further follow-up.", "extra_info": {"index": 17, "original_id": "multiclinsum_test_2937_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "A 63-year-old male presented with a prominent itching sensation and wholebody jaundice. He showed obstructive-pattern jaundice, an elevated IgG4 level, and infiltration of a large number of IgG4-positive cells in the ampulla of Vater. The imaging findings of intrahepatic duct (IHD) and common bile duct dilation, an elevated serum IgG4 level, and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria. We planned to treat the patient with high-dose glucocorticoid (GC), followed by cyclophosphamide pulse therapy. After treatment with high-dose GC and an immunosuppressant, imaging studies showed that IHD dilatation had completely resolved.", "extra_info": {"index": 14, "original_id": "multiclinsum_test_53_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "The patient was referred to our hospital with a 1-month history of disorientation and magnetic resonance imaging showed hydrocephalus with an enhancing lesion in the tectum. Preoperative blood tests showed a high serum soluble interleukin-2 receptor level of 624 U/ml. Through a single burr hole, endoscopic third ventriculostomy and biopsy of the lesion were simultaneously performed with a flexible endoscope. The histological examination confirmed diffuse large B-cell lymphoma. The patient underwent chemotherapy and radiotherapy.", "extra_info": {"index": 11, "original_id": "multiclinsum_test_410_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "We describe a case of a Ashkenazi Jew patient who presented in the typical way that carcinoma of the colon might present but turned out to have a very rare type of tumor in both its histology and its location.", "extra_info": {"index": 18, "original_id": "multiclinsum_test_2722_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by glomerular filtration rate (GFR) decline, proteinuria, and systemic inflammation, and requires longitudinal monitoring with biomarkers such as serum creatinine and estimated GFR to guide therapeutic interventions including pharmacological modulation, dietary restriction, and potential dialysis initiation.\"\n}", "ground_truth": "An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant. At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina. Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage. Seven months later, the fundus examination showed no lesion in the left eye, FA revealed mild tortuous vessels without leakage.", "extra_info": {"index": 20, "original_id": "multiclinsum_test_2309_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction. She had been previously diagnosed with ET; aspirin and anagrelide had been prescribed. Subsequent examination at our hospital revealed cecal cancer. Distant metastasis was absent; laparoscopic ileocecal resection was performed. Anagrelide was discontinued only on the surgery day. She was discharged on the seventh postoperative day without thrombosis or hemorrhage. However, when capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia; thus, anagrelide was discontinued. Five days later, her platelet count recovered. Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy. Her liver function normalized gradually in 4\u2009months. One-year post operation, she is well without tumor recurrence or new metastasis.", "extra_info": {"index": 16, "original_id": "multiclinsum_test_1612_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed.", "extra_info": {"index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "a 1-month-old baby presented with severe AS and CoA. The decision was made to perform a hybrid surgical procedure. The patient underwent a lateral thoracotomy for repair of the CoA and carotid cutdown for aortic balloon valvuloplasty (AoVP).", "extra_info": {"index": 19, "original_id": "multiclinsum_test_2724_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.", "extra_info": {"index": 21, "original_id": "multiclinsum_test_1133_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 56-year-old male on oral anticoagulation presented to the emergency department with epigastric pain, nausea, and left upper quadrant tenderness. There was no history of trauma. Contrast-enhanced CT imaging revealed a large subcapsular haematoma of the spleen. Oral anticoagulation was antagonised with vitamin K and the patient was discharged in good condition after 3 days of clinical observation.", "extra_info": {"index": 92, "original_id": "multiclinsum_test_1095_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 6-year-old girl with Coats plus syndrome presented to the pediatric emergency department with vomiting blood and blood in stool. An upper and lower gastrointestinal endoscopy revealed esophageal varices and vascular telangiectasia in the pyloric antrum, duodenum, and colon. She received palliative care and the bleeding was stopped after receiving intravenous octreotide. She then was followed in the pediatric gastroenterology, neurology, and ophthalmology clinics. She was later hospitalized and admitted to the intensive care unit as she continued to have intermittent gastrointestinal system bleeding. She eventually died due to severe gastrointestinal system bleeding.", "extra_info": {"index": 90, "original_id": "multiclinsum_test_1957_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 73-year-old male suspected to have a urothelial carcinoma was scheduled for elective left nephroureterectomy. During central venous catheterization using the anatomic landmark technique to target the internal jugular vein, a guidewire is inadvertently inserted into the suspected vertebral vein. Following the correction of the catheterization, a radiologist reviewed the preoperative enhanced computed tomography and confirmed that the initially punctured vessel was the vertebral vein. On the third day after surgery, the central venous catheter was removed, and the patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms.", "extra_info": {"index": 88, "original_id": "multiclinsum_test_2805_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Patient concerns:\nA 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral central semiovale, which highly suggested embolic stroke.\n\nDiagnosis:\nThe repeated transthoracic echocardiogram still revealed LV thrombus (1.27 \u00d7 0.90\u200acm), which failed to respond to warfarin therapy.\n\nInterventions:\nDue to acute infarctions occurred under supratherapeutic range of INR, we switched warfarin to edoxaban (dose: 60\u200amg/day) after INR decreased to less than 2.\n\nOutcomes:\nThe thrombus disappeared after receiving edoxaban for 23 days, and no more recurrent stroke was noted for more than 6 months.", "extra_info": {"index": 94, "original_id": "multiclinsum_test_3113_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 35-year-old woman diagnosed to have echo-proven chronic rheumatic heart disease for 25 years. Percutaneous balloon mitral valvotomy was done 6 weeks previously for severe mitral stenosis. Left atrial thrombus was detected after the procedure and anticoagulant (warfarin) was initiated. She presented with severe headache and repeated vomiting of 1 day duration on arrival to the hospital. She had frequent seizure attacks with subsequent loss of consciousness on third day of admission. Diagnosis of status epilepticus secondary to intracranial hemorrhage due to warfarin toxicity was made after CT-scan revealed acute subdural hematoma and ventricular bleeding. Then she was transferred to medical intensive care unit (ICU), intubated and put on mechanical ventilator. Anti-epileptic drugs, antibiotics, vitamin K and fresh frozen plasma were given. She developed paroxysms of hypertension, tachycardia, tachypnea, hyperpyrexia, diaphoresis and decerebrate posturing after 7 days of neurological insult. She had normal inter-ictal EEG tracing during cyclic autonomic surge. CFS score was 11 and DLT score was 10. In sum, PSH-AM score was 21, suggested \"probable\" diagnosis of PSH. Morphine, diazepam, propranolol and gabapentin were given in combination to treat PSH. Severity of autonomic storm started to improve on second week of ICU admission. On the third week of admission, her clinical condition deteriorated suddenly, she developed asystole and died of cardiac arrest despite cardiopulmonary resuscitation (CPR).", "extra_info": {"index": 96, "original_id": "multiclinsum_test_1504_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 52-year-old patient from Bangladesh with dual-origin LAD arising from both left and right sinus with a pre-pulmonary course, presenting with exertional angina and documented myocardial ischaemia. Computed tomography (CT) scan confirmed the anatomical course of the AAOCA. Percutaneous coronary intervention was successfully performed using tailored techniques to treat significant atherosclerotic lesions.", "extra_info": {"index": 100, "original_id": "multiclinsum_test_3124_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B1\u00a0+\u20092 and hyperlobulation between S1\u00a0+\u20092 and S3, while the interlobar fissure between S1\u00a0+\u20092 and S6 was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V1\u00a0+\u20092 joining the left inferior pulmonary vein and a branch of the V1\u00a0+\u20092 running between S1\u00a0+\u20092 and S6. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V1\u00a0+\u20092 and confirm the locations of B1\u00a0+\u20092 and B6 when dividing the fissure.", "extra_info": {"index": 91, "original_id": "multiclinsum_test_2752_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6\u00a0mg/L 24\u00a0hours after ingestion. Seven hours post-ingestion, he experienced tonic-clonic seizures, and 8\u00a0hours later, takotsubo cardiomyopathy was recognized followed by cardiac arrest. The patient was resuscitated with prolonged cardiopulmonary resuscitation including ongoing automatic external compressions during helicopter transportation to a tertiary hospital for extracorporeal membrane oxygenation treatment. Despite a cardiopulmonary resuscitation duration of 2\u00a0hours, 36\u00a0hours of extracorporeal membrane oxygenation, and a total of 30\u00a0days of intensive care, the patient made a full recovery.", "extra_info": {"index": 97, "original_id": "multiclinsum_test_985_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present the case of an adult male patient with cerebral malaria by Plasmodium vivax, who starts with general discomfort and fever, then presents convulsions more than twice a day with loss of consciousness and motor functional limitation. He is given a thick drop where Plasmodium vivax trophozoites and depression of the three blood series are observed. He is given treatment with artesunate and clindamycin for five days, a blood transfusion and continues with primaquine for seven days. The patient shows clinical improvement with neurological sequelae in the left lower extremity.\n", "extra_info": {"index": 95, "original_id": "multiclinsum_test_3364_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In this article, we describe a case of a-69-year-old female with a painful mass in her left breast. Based on intraoperative pathology consult, neoplastic tissue mostly floating in mucinous lakes with invasion to surrounding stroma was seen. Immunohistochemistry profile showed positive estrogen and progesterone receptors and negative for HER2.", "extra_info": {"index": 106, "original_id": "multiclinsum_test_2138_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a clinical case of a combat patient who was injured after the multiple launcher rocket system \"Grad\" shelling, diagnosed with hydrodynamic liver rupture followed by medical management with application of damage control (DC) tactic in conditions of hybrid war. The patient underwent relaparatomy, liver resection, endoscopic papillosphincterotomy, endoscopic retrograde cholecystopancreatography, stenting of the common bile duct, and VAC-therapy. Applied treatment modalities were effective; the patient was discharged on the 49th day after injury.", "extra_info": {"index": 93, "original_id": "multiclinsum_test_2795_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia.", "extra_info": {"index": 89, "original_id": "multiclinsum_test_2918_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 46-year-old male with end-stage renal disease of unknown cause received a cadaveric renal transplant one year ago. Although three antihypertensive medications were administrated, his blood pressure gradually increased to 190/120\u00a0mmHg 3\u00a0weeks posttransplantation. Also the level of creatinine increased to 194\u00a0\u03bcmol/L.Color Doppler ultrasonography indicated a decreased resistance index (RI) in intrarenal arteries and increased blood flow of the transplant renal artery, therefore, a vascular complication of TRAS was suspected. Arteriography was performed and demonstrated TRAS caused by stretch of an artery branch, and the TRAS occurred in the distal site of the anastomosis instead of the anastomosis. Percutaneous transluminal bare stent implantation treatment was successfully performed. Satisfactory clinical efficacy with improvement in transplant renal function and renovascular hypertension was achieved after the interventional treatment.", "extra_info": {"index": 101, "original_id": "multiclinsum_test_1302_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 59-year-old female with a history of recurrent UCS presented with the new onset of the left lower extremity pain, numbness, and episodic urinary incontinence. When the MR revealed an enhancing intradural extramedullary mass posterior to the L1 vertebral body, she underwent a focal decompressive laminectomy. Although she improved neurologically postoperatively, she succumbed to the leptomeningeal spread of her disease within 2 postoperative months.", "extra_info": {"index": 103, "original_id": "multiclinsum_test_2588_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.", "extra_info": {"index": 105, "original_id": "multiclinsum_test_520_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 63-year-old woman with upper gastrointestinal obstruction for almost 10 years, who was pathologically diagnosed with large Brunner's gland adenoma of the duodenum. Postoperatively, no sign of recurrence has been noted until now.", "extra_info": {"index": 108, "original_id": "multiclinsum_test_2813_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 70-years-old woman, who had been diagnosed with SLE at 69\u2009years, was admitted for further examination of liver dysfunction. PBC was confirmed based on elevated serum levels of transaminase, high levels of antimitochondrial antibodies and following a liver biopsy. The oral administration of ursodeoxycholic acid stabilized the liver dysfunction.", "extra_info": {"index": 109, "original_id": "multiclinsum_test_2272_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The six-year-old girl underwent a human leucocyte antigen (HLA) haploidentical hematopoietic stem cell transplant using post-transplant Cyclophosphamide for severe aplastic anemia. In the second week of the transplant, the patient developed macrophage activation syndrome necessitating treatment with steroids and intravenous immunoglobulin. Subsequently, USG abdomen and blood fungal PCR revealed the diagnosis of hepatosplenic candidiasis. Candida-triggered macrophage activation syndrome responded to antifungals, steroids, intravenous immunoglobulin, and alemtuzumab. However, the subsequent clinical course was complicated by thrombotic microangiopathy. The patient developed hypertension in the 2nd week, followed by high lactate dehydrogenase (1010\u2009U/L), schistocytes (5 per hpf), low haptoglobin (<\u20095\u2009mg/dl), thrombocytopenia, and anemia in the 3rd week. Ciclosporin was stopped, and the patient was treated with 10\u2009days of defibrotide without response. The course was further complicated by the involvement of the gastrointestinal tract and kidneys. She had per rectal bleeding with frequent but low-volume stools, severe abdominal pain, and hypoalbuminemia with a rising urine protein:creatinine ratio. Narsoplimab was started in the 5th week of the transplant. A fall in lactate dehydrogenase was observed after starting Narsoplimab. This was followed by the resolution of gastrointestinal symptoms, proteinuria, and recovery of cytopenia. The second episode of TA-TMA occurred with parvoviraemia and was also successfully treated with Narsoplimab.", "extra_info": {"index": 98, "original_id": "multiclinsum_test_2016_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "We report a 9 days-old male neonates weighing 3.85 kg was referred by local hospital to our center and was ventilated with history of respiratory distress and severe infection since he was born. Admitted to our PCICU, 2D echo showed an IAA type A associated with a huge APW type II and restrictif PDA. A PGE1 infusion was started, during the following days the baby experienced several epileptic episodes. After improvement of the clinical condition, surgery was performed on the 20th days of life on year 2011. A successful one-stage repair of such anomalies in which cutting of PDA that arised from PA trunk and distally becoming into descending aorta, extended end to end anastomosis to conduct the ascending aortic blood flow into the descending aorta and intra arterial baffle was used. A 4-0 Gore-Tex baffle was used both to close the APW and separated the RPA from aortic origin with a good result, as his recently grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2.", "extra_info": {"index": 102, "original_id": "multiclinsum_test_2375_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "Here, we present a case study of a patient with oral cancer who underwent surgery. During adjuvant radiotherapy, a metastatic cervical lymph node was diagnosed based on fine-needle aspiration biopsy. To increase the total dose to the metastatic tumor, a stereotactic radiosurgery boost of 1\u2009\u00d7\u200918\u00a0Gy was performed two days after the last fraction of conventional radiotherapy. The early and late tolerance of this treatment were positive. During the 18-month follow-up, locoregional recurrence was not detected. The patient died due to secondary malignancy.", "extra_info": {"index": 104, "original_id": "multiclinsum_test_2840_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.", "extra_info": {"index": 107, "original_id": "multiclinsum_test_1344_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 10-year-old Kurdish boy was presented with generalized bone pain and fever of 1 month's duration which was associated with sweating, easy fatigability, nose bleeding, breathlessness and severe weight loss. On examination, we observed pallor, tachypnea, tachycardia, low blood pressure, fever, petechial hemorrhage, ecchymoses, tortuous dilated veins over the chest and upper part of abdomen, multiple small cervical lymph node enlargements, mildly enlarged spleen, palpable liver and gross abdominal distention. Blood analysis revealed pancytopenia and elevated lactate dehydrogenase and erythrocyte sedimentation rate. Imaging results showed mediastinal widening on a planar chest X-ray and diffuse focal infiltration of the axial bone marrow on magnetic resonance imaging of the lumbosacral vertebrae. Bone marrow aspiration and biopsy examination showed extensive bone marrow necrosis. Immunophenotyping analysis of the bone marrow biopsy confirmed T-cell acute lymphoblastic leukemia, as CD3 and terminal deoxynucleotidyl transferase markers were positive and CD10, CD20 and CD79a markers were negative.", "extra_info": {"index": 99, "original_id": "multiclinsum_test_1185_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 21-year-old man was referred to our hospital for treatment after presenting to a nearby hospital with right inguinal pain. Abdominal magnetic resonance imaging showed an intra-abdominal mass measuring 34 \u00d7 15 \u00d7 8 cm with partial signal hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging, extending from the left abdominal cavity to the pelvic region. Although no definitive diagnosis was obtained preoperatively, surgery was performed under suspicion of gastrointestinal stromal tumor or other significant disease. A mass was identified firmly adherent to the transverse colon, gastric wall, and diaphragm, and these organs were partially resected. The excised specimen measured 38 \u00d7 21 \u00d7 8 cm and weighed 6400 g. Macroscopically, the tumor showed a smooth surface and homogeneous interior. Pathological examination revealed atypical cells with spindle-shaped nuclei and collagen fiber hyperplasia in the stroma, and immunostaining was negative for c-kit, CD34, desmin, S-100, and positive for \u03b2-catenin, leading to a confirmed diagnosis of desmoid tumor. Fifteen months after surgery, a local recurrence with a diameter of 3.0 cm was identified, and the patient remains under careful follow-up.", "extra_info": {"index": 112, "original_id": "multiclinsum_test_3373_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "The patient was a 77-year-old hypertensive male who presented to the emergency following an episode of slip and fall at home. After prompt resuscitation, he was sent for radiological evaluation which revealed fractures of the left inter-trochanteric femur and left proximal humerus. Meanwhile, laboratory investigations showed grossly deranged renal parameters, along with elevated serum creatinine phosphokinase levels (more than 5 times the baseline). A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made. Medical management included adequate intravenous fluid administration combined with strict input-output monitoring. Subsequently, the patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail. However, fracture of the proximal humerus was managed non-operatively with sling immobilization as patient refused to give consent for a second surgery.", "extra_info": {"index": 110, "original_id": "multiclinsum_test_2243_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure.", "extra_info": {"index": 113, "original_id": "multiclinsum_test_1305_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a 30-year-old Caucasian woman who tested positive for COVID-19 after developing nasal congestion and cough. Ten days after testing positive, she developed a systemic rash on her extremities and torso. At the same time, she developed swelling of the tongue lasting 1 hour, with subsequent appearance of oral lesions that resembled geographic tongue. She also had an irritable sensation on her tongue and some mild loss of sense of taste. We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours. The patient used the mouth rinse therapy for 1 month and experienced a 90% improvement in her oral lesions and tongue sensitivity. However, she had repeated flares every 3 weeks over a 6-month period, and the steroid mouthwash achieved incomplete resolution. After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity and the lesions healed.", "extra_info": {"index": 119, "original_id": "multiclinsum_test_778_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction (STEMI). The right radial access was chosen for the performance of percutaneous coronary intervention. After the introduction of 6\u2009F sheath, there was difficulty in the advancement of 0.035\u2009J wire that was exchanged with a Terumo hydrophilic wire. After the procedure and before sheath removal, radial arteriography was done and revealed perforation. Protamine sulfate was administered and prolonged balloon inflation was attempted but failed to seal the perforation, so a 7-F-long vascular sheath was inserted to internally tamponade the vessel, and the patient was sent to the coronary care unit for monitoring. Over the next 3 days, serial radial angiographies were done revealing the persistence of the perforation, and on the fourth day, angiography revealed multiple thrombi. Thrombus aspiration was done using Pronto V4 extraction catheter (Vascular Solutions, USA) and was followed by the deployment of a covered stent. The stent was dislodged and successfully snared. Finally, the perforation was sealed spontaneously and there were no signs of intra-arterial thrombi.", "extra_info": {"index": 120, "original_id": "multiclinsum_test_1116_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "In this case, we present a preterm newborn who developed pneumomediastinum and pneumothorax. The pneumothorax persisted, despite placement of a thorax tube, requiring a thoracotomy to detect and treat the bronchial rupture.", "extra_info": {"index": 116, "original_id": "multiclinsum_test_2176_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A case report of an 84-year old male, who presented with an aggressively recurrent form of MCC on the lower lip, on the background of an 8-year history of untreated CLL. During the recurrences of MCC, coexisting regional lymphadenopathy, posed a problem in the differential diagnosis and treatment of lymph node involvement. Histopathology and immunoistochemistry showed that submandibular lymphadenopathy coexisting with the second recurrence of MCC, was due to B-cell small lymphocytic lymphoma. The subsequent and more aggressive recurrence of the skin tumor had involved the superficial and deep cervical lymph nodes. Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies.", "extra_info": {"index": 128, "original_id": "multiclinsum_test_1953_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a case in which the two technologies are used in combination during acute echocardiographic optimization of left pacing vector in a 63-year-old man, Caucasian, who showed worsening heart failure symptoms a few days after an implant, and the effect of the device\u2019s optimization at 6-month follow-up.", "extra_info": {"index": 126, "original_id": "multiclinsum_test_3317_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm\u00d715 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression.", "extra_info": {"index": 122, "original_id": "multiclinsum_test_2110_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "Patient concerns:\nA 68-year-old man was admitted to our hospital with dyspea and general fatigue. He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy. In order to improve fluid retention and relieve his dyspnea, low-dose TLV (7.5\u200amg qd) was performed. After the 3-day treatment using TLV, we observed that he became delirious and his limbs shook uncontrollably. High serum sodium 173 mmol/L was noted compared to the results of the first examination (137 mmol/L). After intensive rescue, serum sodium was restored to normal (135\u200amol/L). Later, when the patient refused continuous renal replacement therapy (CRRT), we tried again to use a lower dose of TLV to improve diuretic resistance. Two days later, Serum sodium rose again (162 mmol/L).\n\nDiagnoses:\nDuring the course of therapy, we did not strictly require the patient to control the fluid intake. No other medication could cause elevation of serum sodium. Therefore, we suspected a high sensitivity to the side effect of TLV.\n\nIntervention:\nStop the use of TLV and encourage the patient to drink plenty of water. Gastric tube was inserted orally to increase the intake of fresh water.\n\nOutcomes:\nHis serum sodium decreased gradually and his psychiatric symptom recovered. During this period, Overall condition of the patient was stable. After being discharged from the hospital, the patient eventually died of cardiac arrest due to critically ill heart failure.", "extra_info": {"index": 124, "original_id": "multiclinsum_test_3307_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report the case of a patient with a history of multiple diseases and 2 tumor-like lesions with internal lytic areas detected in the fourth right costal arch and in the eighth left costal arc; we describe his clinical manifestations, radiological and laboratory findings as well as the pathological results and outcome.", "extra_info": {"index": 130, "original_id": "multiclinsum_test_2403_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "44-year-old African black patient of Burkinabe origin with no other medical history, admitted for chronic inflammatory low back pain associated with inflammatory right knee pain and a cough with phlegm. This symptomatology had been developing for seven months in a febrile context and with a general deterioration in health. The examination showed oligoarthritis of the right sternoclavicular joint and the left knee, associated with a pulmonary condensation syndrome and pleural effusion, a cold abscess at the level of the right sternoclavicular joint and a fistulous and purulent right inguinal lymphadenopathy. The biology showed an inflammatory syndrome. The GeneXpert test was positive in the sputum, without resistance to rifampicin. The intradermal reaction to the tuberculin was positive. The thoracic tomodensitometry showed a right sternoclavicular osteoarthritis and a spondylodiscitis of the L3-L4 spine. The standard radiography of the left knee objectified signs in favour of arthritis. The diagnosis of tuberculosis with multifocal, pleuropulmonary and ganglionar bone involvement was retained. The patient was given usual analgesics and antituberculous. The evolution was favourable.\n", "extra_info": {"index": 111, "original_id": "multiclinsum_test_3332_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of a 93-year-old Middle Eastern male presenting for longstanding treatment-refractory hiccups. Imaging with computed tomography of the chest and abdomen was unremarkable. An upper endoscopy was normal without any endoscopic finding to suggest eosinophilic esophagitis. Given his elevated peripheral eosinophil count, biopsies were taken from mid- and distal esophagus and revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field, favoring a diagnosis of eosinophilic esophagitis. The hiccups resolved following the initiation of eosinophilic esophagitis treatment.", "extra_info": {"index": 114, "original_id": "multiclinsum_test_3338_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 22-year-old male was admitted for bilateral leg tremor while standing, with symptom onset eight months prior. One month before admission, the tremor disappeared in the left leg but persisted in the right leg. Electromyography recorded from the right gastrocnemius revealed a 6-8\u00a0Hz tremor, which appeared when the patient was standing and disappeared when he was resting or walking. Blood screening showed a phenylalanine/tyrosine ratio of 2.06 and a phenylalanine level of 140\u00a0\u03bcmol/L. Urine metabolic screening was negative. Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G\u2009>\u2009A and c.728G\u2009>\u2009A, in phenylalanine hydroxylase (PAH) gene. After three months of levodopa/benserazide tablets (250\u00a0mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared.", "extra_info": {"index": 115, "original_id": "multiclinsum_test_1859_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A patient from TRITON2 with BRCA-mutated mCRPC had a response to the PARP inhibitor rucaparib and remained on treatment for 32 weeks, which was >2 times longer than the duration of each of his prior therapies (bicalutamide, docetaxel, abiraterone). The patient enrolled in TRITON2 based on results of local genomic testing of an archival biopsy that indicated the presence of a BRCA1 T1399I (allelic fraction, 19%) mutation. Local testing also identified an ATM G1663C mutation, a TP53 P191del mutation, and a BRAF K601E mutation. Analysis of a plasma sample obtained before the patient started rucaparib detected the same alterations as those in the archival biopsy, but it also revealed the presence of a BRCA2 homozygous loss (whole gene, 26 of 26 exons) and several other alterations of unknown functional impact. We hypothesize the response of the patient's tumor to rucaparib was likely driven by DNA damage repair deficiency caused by homozygous loss of all BRCA2 exons. Following discontinuation from rucaparib due to clinical disease progression, the patient received carboplatin and cabazitaxel for \u22483 weeks. The patient died due to progression of his disease.", "extra_info": {"index": 118, "original_id": "multiclinsum_test_759_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In this case report, we present a 16-year-old Ukrainian boy with acute hepatitis B. He had not been previously vaccinated against hepatitis B. Possible sources of infection included: a tattoo made at home, a finger cut made with hairdresser scissors during work, and unprotected sexual encounters. The clinical course of the disease was typical with jaundice and elevated aminotransferases levels without liver failure. During the follow-up visit 16 months after the onset of the disease, chronic hepatitis b was excluded but an ulcer around his anus was found. Additional tests for sexually transmitted diseases were ordered and they were positive for syphilis. The extended interview revealed that the patient had several unprotected bisexual encounters, which may have indicated a potential source of infections including the hepatitis B virus (HBV).", "extra_info": {"index": 123, "original_id": "multiclinsum_test_3310_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 42-year-old female with history of uterine fibroids was admitted with abdominal pain and intraperitoneal fluid of unknown etiology. She was initially managed nonoperatively and empirically treated with broad spectrum antibiotics. Blood and urine cultures were unrevealing. Increasing abdominal pain and peritoneal fluid prompted diagnostic laparoscopy which revealed a dense fibrinous exudate covering the entire peritoneal cavity. Peritoneal fluid and biopsies were sent for cytology and culture. The peritoneal fluid was eventually sent for 16\u2009s ribosomal analysis, which discovered Mycoplasma hominis RNA. Her antibiotics were narrowed, and she eventually made a full recovery.", "extra_info": {"index": 127, "original_id": "multiclinsum_test_1099_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of an isolated intracranial RDD in a 53-year-old man. The patient had an episode of generalized seizures. Imaging studies of the brain were compatible with a meningioma en plaque. The mass was exposed by a right frontotemporal craniotomy. The tumor was adhered tightly to the adjacent cerebral cortex and was permeated by pial arteries of the brain surface. The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor. The patient had incomplete left hemiparesis after the surgery. Brain computed tomography (CT) imaging revealed a postoperative hemorrhage and a low-density lesion in the right frontal lobe. The patient was postoperatively diagnosed with isolated central nervous system RDD.", "extra_info": {"index": 125, "original_id": "multiclinsum_test_1592_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 32\u2009year-old woman with a history of non-diabetic hemodialysis for 3\u2009years suffered from severe involuntary movement, and brain magnetic resonance imaging showed symmetrical T2-weighted imaging (T2WI) and T2/fluid-attenuated inversion recovery (T2FLAIR) hyperintense nonhemorrhagic lesions in the bilateral basal ganglia. She was diagnosed with UE as syndrome of bilateral basal ganglia lesions, due to a combined effect of uremic toxins and hyperthyroidism. After treatment with high frequency and high flux dialysis, hyperbaric oxygen therapy and declining parathyroid hormone, the patient achieved complete remission with normal body movement and was discharged.", "extra_info": {"index": 129, "original_id": "multiclinsum_test_168_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The medical record of a 64-year-old female with Sjogren's syndrome was reviewed. The clinical and pathological data along with chest CT images were obtained. The literature related to the transformation was reviewed. There were no specific clinical manifestations of LIP and its transformation into malignant lymphoma in the patient. The chest CT mainly displayed multiple cystic foci, with multiple nodules and ground-glass shadows in both lungs.", "extra_info": {"index": 131, "original_id": "multiclinsum_test_2470_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6\u2009years and 2\u2009months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7\u2009years and 8\u2009months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1\u2009cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9\u2009years and 7\u2009months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10\u2009years and 5\u2009months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5\u2009cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.", "extra_info": {"index": 117, "original_id": "multiclinsum_test_1775_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of VEO-IBD associated with a monogenic mutation in a 2-year-old girl presenting mainly with gastrointestinal symptoms, including recurrent hematochezia and abdominal pain for more than 3 months. A gastroscopy revealed erosive gastritis and bulbar duodenitis, while a colonoscopy indicated erosive colitis. Abnormal results were obtained from the dihydrohodamine (DHR) assay and immunoglobulin testing. Whole-exome sequencing identified a heterozygous and de novo nonsense mutation (c.388\u00a0C\u2009>\u2009T; p.R130X) in the CYBB gene leading to deficiency of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2) (encoded by CYBB), a critical component of phagocytes. HSCT was performed successfully, and the DHR assay showed that normal neutrophil function was restored. Six months after HSCT, clinical remission was observed, and a repeat colonoscopy revealed intestinal mucosal healing was attained.", "extra_info": {"index": 121, "original_id": "multiclinsum_test_533_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case study with a 44-year-old man from Faryab Province in Afghanistan who presented chest pain and dizziness while suffering a common cold. After full investigation, the patient underwent coronary angiography which showed a myocardial bridge at the middle portion of the left anterior descending artery (LAD) with a significant stenosis causing ischemia. We treated the patient with a calcium channel blocker as initial treatment. The patient tolerated the medication well and remained asymptomatic during two years follow-up.", "extra_info": {"index": 167, "original_id": "multiclinsum_test_3208_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Herein we present a 63-year-old man with idiopathic spontaneous intraperitoneal hemorrhage (ISIH) caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA).", "extra_info": {"index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed.", "extra_info": {"index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 71-year-old female who was being treated for type 2 diabetes with canagliflozin, metformin, and saxagliptin orally presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain. Although her blood glucose was not severely elevated (259 mg/dL), there was notable ketoacidosis (pH\u20096.89; CO2, 11.4\u2009mmHg; HCO3, 1.9\u2009mEq/L; base excess, - 31.3\u2009mmol/L; 3-hydroxybutyric acid > 10,000\u2009\u03bcmol/L) was observed. The uncontrolled acidosis improved following 3\u2009days of continuous renal replacement therapy, but elevated urinary glucose continued for more than 10\u2009days. Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria. Urinary glucose turned negative on day 16, and there was improvement in the patient's overall state; hence, she was discharged on day 18.", "extra_info": {"index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "We presented an interesting case of a 33-year-old female with a solitary polypoid nodule without apparent pigmentation on her vulvar skin. Her medical history was unclear, no ulcer was seen in the lesion area, and dermatoscopy was indicated a possible tumorous change, which has caught the attention of clinicians, and then further examined by the pathologist. The final diagnosis was nodular malignant melanoma (NM) (Breslow thickness 9.5mm, Clark level 4).", "extra_info": {"index": 156, "original_id": "multiclinsum_test_1142_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "A 39-year-old woman, who visited to our hospital complaining of worsened right low back pain and fever, was diagnosed with right hydronephrosis due to ureteropelvic junction obstruction by contrast-enhanced computed tomography. Intraoperatively before the planned robot-assisted laparoscopic pyeloplasty, retrograde pyelography was performed to reveal concomitant ipsilateral retrocaval ureter. Laparoscopically, ureteropelvic junction obstruction due to aberrant blood vessel and coexisting retrocaval ureter was confirmed. Transposition of the ureter from posterior to anterior of the inferior vena cava and following dismembered pyeloplasty was performed. Two years after surgery, her right hydronephrosis improved and she had no complain of any symptom.", "extra_info": {"index": 162, "original_id": "multiclinsum_test_1681_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "An 86-year-old male was admitted to our hospital with congestive heart failure due to low-flow low-gradient severe AS, a membranous VSD, a sub-aortic band, and a double-chambered right ventricle (RV). The patient was not deemed to be a surgical candidate because of advanced age and frailty even though surgical aortic valve replacement, VSD closure, sub-aortic band resection, and myectomy of RV would be considered as definitive treatment. Instead, we performed TAVI and VSD orifice closure using the skirt part of the self-expanding valve (26\u2005mm Evolut Pro Plus\u2122) because VSD occluder is not approved and thus not available in our country. The trans-catheter procedure resulted in a reduction of the mean aortic valve pressure gradient improved from 33 to 2\u2005mmHg and a decrease in the shunt flow (Qp/Qs) from 1.9 to 1.2. The patient\u2019s heart failure improved, and he was discharged to home 7 days after the procedure. He remained well and had not been admitted to hospital since discharge.", "extra_info": {"index": 154, "original_id": "multiclinsum_test_3275_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "52-year-old female patient who reported chronic, burning pain radiating to the distal phalanx of the thumb with no traumatic history, which had been present for two years and limited her daily activities. The exploration was complemented with interphalangeal Doppler ultrasound, which is an excellent alternative due to its easy accessibility. A glomus tumor in the interphalangeal phalanx of the thumb was diagnosed. A H-approach was performed on the interphalangeal fold with subungual dissection and resection of the tumoral piece and follow-up by an external consultation where the surgical wound was found to be healing adequately. Physical exploration with the ability to mobilize the interphalangeal distal joint (IFD) and visual analogue scale (VAS) of 1 point. The anatomopathological evaluation reported the existence of a glomus tumor.\n", "extra_info": {"index": 158, "original_id": "multiclinsum_test_3249_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Here, we report the first clinical case of a cerebral nocardiosis revealed after seizure in a patient treated by pembrolizumab for a metastatic lung cancer, in the absence of any additional immunosuppressive therapy or risk factors for cerebral nocardiosis. The extended evaluation including a brain CT-scan did not reveal any lesion before pembrolizumab. Nevertheless, the 3-month delay between the start of Pembrolizumab and the diagnosis of cerebral nocardiosis suggests that the infection occurred prior to the CPI. Unfortunately, the patient died during treatment for cerebral nocardiosis, while the lung cancer tumor mass had decreased by 80% after the sixth cycle of pembrolizumab.", "extra_info": {"index": 157, "original_id": "multiclinsum_test_2333_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "It is a case report of a 13-year-old girl with the history of swelling over her right hand for 5 months. X-ray revealed that there was an osteolytic fusiform expansible lesion. The biopsy sent and it conferred the diagnosis of GCT. Dorsal approach used for the enbloc resection of the fifth metacarpals (except at the base) and partial excision of the surrounding muscles done. The capsule and collateral ligament of the fifth metacarpophalangeal joint were left. The fourth metatarsal was harvested from the foot along with its capsule and collateral ligament of the metatarsophalangeal joint and sutured to the counter capsuloligamentous structure at the recipient site.", "extra_info": {"index": 163, "original_id": "multiclinsum_test_2668_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "A 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions.", "extra_info": {"index": 164, "original_id": "multiclinsum_test_2219_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 72-year-old Caucasian woman with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage.", "extra_info": {"index": 165, "original_id": "multiclinsum_test_2449_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. On the 5th day of illness he developed intermittent resting tremor in his right arm and leg associated with stiffness, difficulty in carrying out normal work and difficulty in smiling. He denied similar previous episodes. There were no other associated neurological manifestations. Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. The rest of the system examination was normal except for an eschar over the abdomen. His investigations revealed lymphocytic leukocytosis, high erythrocyte sedimentation rate and immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers. With oral doxycycline and azithromycin his fever settled within 48 h and a complete recovery of Parkinson's features was observed within 2 weeks.", "extra_info": {"index": 155, "original_id": "multiclinsum_test_146_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present the case of a 16-year-old Persian man diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B (medullary thyroid cancer, mucosal neuroma of the tongue, lips and inner eyelids). Our patient, who had a positive family history of medullary thyroid cancer, was of normal height with no signs of marfanoid habitus.", "extra_info": {"index": 159, "original_id": "multiclinsum_test_2043_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "We report a 53-year-old female from a rural area in China who was hospitalized for lower limb edema, abdominal distension, cirrhosis, and hypothyroidism. We excluded the common causes of liver disease (drinking alcohol, using traditional Chinese medicines, hepatitis virus infection, autoimmunity, and hepatolenticular degeneration). When she was 23-years-old, she developed night-blindness that worsened to complete blindness, with no obvious cause. Her parents were first cousins, and both were alive. Analysis of the patient's family history indicated that all 5 siblings had night blindness and impaired vision; one sister was completely blind; and another sister had night-blindness complicated with cirrhosis and subclinical hypothyroidism. Entire exome sequencing showed that the patient, parents, and siblings all had mutations in the cytochrome P450 4V2 gene (CYP4V2). The CYP4V2 mutations of the parents and two sisters were heterozygous, and the others were homozygous. Two siblings also had heterozygous dual oxidase activator 2 (DUOXA2) mutations.", "extra_info": {"index": 160, "original_id": "multiclinsum_test_2430_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present the case of a middle-aged patient diagnosed with a giant gastric GIST, which presented for intermittent gastric outlet obstruction symptoms, and emphasize the major imagistic, histopathological, and therapeutic challenges that may be encountered. There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction. Tumor resection should be adapted to every patient's status, focused on en bloc extraction, with preservation of invaded organs as much as possible.", "extra_info": {"index": 169, "original_id": "multiclinsum_test_1842_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a case of 62-year-old male who presented after experiencing syncope and cardiac arrest. Given the clinical presentation and electrocardiographic findings, there was concern for acute coronary syndrome. However, coronary angiogram did not reveal significant coronary obstruction. Due to the unclear nature of his presentation, a bedside echocardiogram was rapidly performed and was indicative of right ventricular strain. Due to these findings, a pulmonary angiogram was performed that revealed massive pulmonary embolism. He successfully underwent catheter-directed thrombolysis and, after a prolonged hospital stay, was discharged home on lifelong anticoagulation.", "extra_info": {"index": 168, "original_id": "multiclinsum_test_2976_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum \u03b2-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar.", "extra_info": {"index": 166, "original_id": "multiclinsum_test_2114_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In this report, we present the case of an RSV-associated death of a child who was born at full-term and developed normally up to the age of 2 years old. Cardiopulmonary arrest occurred within 3 days after the onset of symptoms, which included cough and high fever. Complete brain edema was prominent, and encephalopathy was developing. Viral antigen detection and microbiome analyses of oral swab and nasopharyngeal aspirate specimens verified an RSV infection, while bacterial culture of blood specimens yielded negative results. The RSV strain detected in this patient was subtyped as RSVB9, and no mutation was found in the six antigenic sites for targeted drugs or vaccines.", "extra_info": {"index": 161, "original_id": "multiclinsum_test_3147_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine. The patient is a 29-year-old female who received manipulation one week prior to developing symptoms of severe orthostatic headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection. Symptomatic onset corresponded with the recent cervical chiropractic adjustment. We present serial imaging correlating with her symptomatology and review the pertinent literature on complications of chiropractic manipulation.", "extra_info": {"index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.", "extra_info": {"index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 27-year-old male with a relapsed acute lymphoblastic leukemia presented with five-day-old polyarthralgia. He also had febrile neutropenia, cellulitis without abscesses, and methicillin-resistant Staphylococcus aureus bacteremia for which he received therapy with oxacillin and cefepime. However, the febrile neutropenia persisted, and an invasive fungal infection was suspected. A new set of blood cultures was taken and antifungal treatment was initiated. Arthroconidia were identified in the blood cultures and a matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp. Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B and four weeks of voriconazole. After a prolonged stay, he was discharged.\n", "extra_info": {"index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "Our patient is a 77-year-old African American female who presented with a systolic blood pressure of 200\u00a0mmHg. Computed tomography showed an enhancing 9\u00a0\u00d7\u20096\u00a0cm mass anterior and medial to the left kidney. The patient underwent a left adrenalectomy with partial nephrectomy. Gross and histologic examinations revealed an adrenal cortical adenoma and renal-adrenal fusion.", "extra_info": {"index": 69, "original_id": "multiclinsum_test_1363_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago. A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant, and that the content consisted of the large omentum. An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously. The postoperative period was uneventful. The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.", "extra_info": {"index": 71, "original_id": "multiclinsum_test_1042_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through routine screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and systemic inflammation, and early intervention through biomarker monitoring and pharmacological management is critical to preserving renal function and delaying disease progression.\"\n}", "ground_truth": "In this interesting case, we discover lingering dyspnea in our 79 year old male with a past medical history of asthma and heart failure with preserved ejection fraction admitted for acute heart failure exacerbation with reduced ejection fraction along with a new incidental finding of Chilaiditi's sign on chest radiograph. Patient received optimal diuretics and guideline-directed medical treatment for heart failure exacerbation, but mild dyspnea with pleuritic chest pain persisted. Dyspnea with pleurisy was likely attributed to a structural anatomical defect (Chilaiditi's sign) that can be picked up on imaging.", "extra_info": {"index": 67, "original_id": "multiclinsum_test_1780_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 38-year-old Sri Lankan female presented with sudden onset severe headache, fixed dilated pupil, complete ptosis and ophthalmoplegia on the right side. On imaging, dissection and dilatation was evident in the right internal carotid artery from the origin up to the cavernous segment. She also had stenosis and aneurysmal dilatation of right subclavian artery. Takayasu arteritis was diagnosed subsequently. She was started on aspirin and high dose steroids.", "extra_info": {"index": 73, "original_id": "multiclinsum_test_2426_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a case in which POCUS was used to rapidly confirm diagnosis in an unstable, severely septic patient presenting to the emergency department with Fournier's gangrene.", "extra_info": {"index": 75, "original_id": "multiclinsum_test_2914_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "On per speculum examination, cervix was replaced by an irregular friable growth, which was bleeding on touch. A clinical diagnosis of carcinoma cervix was made but the cervical biopsy revealed granulomatous inflammation with presence of acid-fast bacilli on cervical smear consistent with tuberculosis. The patient responded to six months of anti-tubercular therapy.", "extra_info": {"index": 77, "original_id": "multiclinsum_test_216_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma.", "extra_info": {"index": 81, "original_id": "multiclinsum_test_1888_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 53-year-old female with a history of two prior spinal operations at the L4-S1 levels (11 and 2 years previously) presented over a few weeks with the acute onset of a cauda equina syndrome (e.g., paraparesis and acute urinary incontinence). The patient demonstrated a mildly elevated white blood cell count (12,600/mm3) and abnormally increased C-reactive protein level that correlated with the magnetic resonance imaging that showed a dorsal epidural abscess extending from the L4 to S1 levels. At surgery, an encapsulated posterior epidural abscess was drained. Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid and was removed from the antero-inferior portion of the abscess wall at S1. Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca. After 2 months of ciprofloxacin, the patient's infection cleared but the motor deficit only partially resolved.", "extra_info": {"index": 83, "original_id": "multiclinsum_test_2689_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 27-year-old man presented with headache and diplopia at our department. Fundoscopy showed left optic nerve atrophy and right papilledema consistent with Foster-Kennedy syndrome. Neurological exams were otherwise normal. A left frontal irregular space-occupying lesion was seen on magnetic resonance imaging (MRI), and enhancement was shown on contrast-enhanced computed tomography (CT) scan. CT angiography (CTA) revealed vascular compression around the lesion. Prior to surgery, meningioma was diagnosed and gross tumor removal was performed. On postoperative pathohistological exam, the tumor proved to be a meningeal melanocytoma, WHO grade I. No skin melanoma was found. After surgery, the patient received radiation therapy. No tumor was seen on follow-up MR images six months after surgery. The patient was well after two and a half years, and there was no tumor recurrence on the follow-up CT.", "extra_info": {"index": 85, "original_id": "multiclinsum_test_568_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo. Four days later, he presented to hospital in a state of collapse and died within two hours. He was hyponatraemic and had elevated blood urea, potassium, lactate dehydrogenase and amino transferase values; he was also thrombocytopenic and eosinophilic. Dengue haemorrhagic shock was suspected and a post-mortem examination performed. Investigations for dengue virus were negative. Blood for malaria parasites indicated hyperparasitaemia and single species P. knowlesi infection was confirmed by nested-PCR. Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages, the liver and spleen were enlarged and lungs had features consistent with ARDS. Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney without evidence of chronic inflammatory reaction in the brain or any other organ examined. Brain sections were negative for intracellular adhesion molecule-1. The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells. The kidney had evidence of acute tubular necrosis and endothelial cells in heart sections were prominent.", "extra_info": {"index": 79, "original_id": "multiclinsum_test_2113_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report an unusual case in which both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently.", "extra_info": {"index": 87, "original_id": "multiclinsum_test_1721_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "7-year-old male with a diagnosis of acute lymphoid T-cell leukemia, completing a cycle of induction chemotherapy with the PETHEMA 2013 protocol. He presented a 12-day picture characterized by epigastric abdominal pain and vomiting, initially suspected acute pancreatitis, ruled out by normal pancreatic enzymes and abdominal computed tomography. Due to suspected acid-peptic disease associated with steroids, he began treatment with proton pump inhibitors and procinetics. Considering a picture of dyspepsia with alarm signs, such as progression of neutropenia, increased C-reactive protein and clinical deterioration, an esophagogastroduodenoscopy (EGD) compatible with necrotizing gastritis was performed, confirmed by histopathology. He received pharmacological management, zero regimen and parenteral support, and progressive improvement was evidenced in imaging controls. After fasting for 30 days, well tolerated enteral nutrition was initiated, with outpatient follow-up. After improvement, the chemotherapy plan was completed, highlighting complete remission, without complications after 2 years.\n", "extra_info": {"index": 68, "original_id": "multiclinsum_test_3042_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We present the case of a 52-year-old woman with cardiogenic shock and refractory right ventricular failure due to spontaneous dissection of the right coronary artery. She remained dependent on mechanical support for several weeks. Both a right ventricular assist device implant and a bidirectional cavopulmonary anastomosis were explored as long-term support options. A history of malignancy and possible right ventricular functional recovery resulted in a decision in favour of the bidirectional cavopulmonary anastomosis and concomitant tricuspid valve annuloplasty. Postoperatively her clinical condition improved significantly, and she could be discharged home. Echocardiography showed normalization of right ventricular dimensions and slight improvement of right ventricular function.", "extra_info": {"index": 70, "original_id": "multiclinsum_test_3152_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 34-year-old female presented with a 1 year history of intermittent pain in the right side of the waist without obvious inducement. All laboratory blood tests were within normal limits. Indocyanine green 15 min retention was rated 2.9%, and Child-Pugh was rated A. Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe with hemangioma of left lobe of liver. After discussion, surgical treatment was performed, which lasted 410 min, with intraoperative bleeding of about 600 mL and postoperative pathological findings of cavernous hemangioma. There were no obvious postoperative complications, and the patient was discharged 10 d after surgery.", "extra_info": {"index": 72, "original_id": "multiclinsum_test_2984_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor. Contrast-enhanced computed tomography showed a papillary tumor in the fundus of the gallbladder with irregular thickening of the gallbladder wall that spread into the cystic duct. The boundary between the tumor and liver was unclear. The patient was diagnosed with gallbladder cancer with liver invasion. We performed extended cholecystectomy with liver bed resection after confirming the absence of cancer cells in the resection margin of the cystic duct. After pathological examination, the tumor was diagnosed as an ICPN with xanthogranulomatous cholecystitis. The patient was discharged on postoperative day 8 with no complications.", "extra_info": {"index": 74, "original_id": "multiclinsum_test_1559_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "In this case report, we present a case of a pleomorphic adenoma arising from the 'tail' of the parotid gland, which on imaging, appears to be extra parotid in location. We also review the anatomy of the parotid 'tail' and relevant literature.", "extra_info": {"index": 76, "original_id": "multiclinsum_test_2421_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 43-year-old Asian man with a 3-year history of penile cancer presented with metastasis in the right intraocular sites. Magnetic resonance imaging showed hyperintensity in the T1-weighted images and hypointensity in the T2-weighted images of the right eye. After enucleation of his right eye, histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma.", "extra_info": {"index": 82, "original_id": "multiclinsum_test_1233_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 49-year-old Japanese man visited our department in November 2017 with chief complaints of indolent right scrotum enlargement and a right inguinal mass. History showed that the patient visited our department of gastroenterology with chief complaints of blackish feces and ill complexion in February 1997. Computed tomography (CT) showed a right retroperitoneal tumor, which was removed in the same month. Histopathological examination showed a teratoma and yolk sac tumor. He was diagnosed with primary retroperitoneal EGCT and received three courses of chemotherapy (bleomycin/etoposide/cisplatin; BEP). Periodic imaging and the determination of tumor markers (alpha-fetoprotein", "extra_info": {"index": 84, "original_id": "multiclinsum_test_439_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A previously healthy 24-yo male (A) presented at the Emergency Department(ED) with recent onset of chest pain and a 3-day history of abdominal pain, fever and diarrhoea. The symptoms began within a few hours of returning from a tourist visit to a central European capital. Vital signs were stable, the Electrocardiogram(ECG) showed generalized ST-elevation, laboratory testing showed increased levels of C-reactive protein(CRP) and high-sensitive Troponin T(hsTnT). Transthoracic echocardiogram (TTE) was normal, stool cultures were positive for C Jejuni and blood cultures were negative. Two days after patient A was admitted to the ED his travel companion (B), also a previously healthy male (23-yo), presented at the same ED with almost identical symptoms: chest pain precipitated by a few days of abdominal pain, fever and diarrhoea. Patient B declared that he and patient A had ingested chicken prior to returning from their tourist trip. Laboratory tests showed elevated CRP and hsTnT but the ECG and TTE were normal. In both cases, the diagnosis of C jejuni-associated perimyocarditis was set based on the typical presentation and positive stool cultures with identical strains. Both patients were given antibiotics, rapidly improved and were fully recovered at 6-week follow up.", "extra_info": {"index": 78, "original_id": "multiclinsum_test_1211_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3 underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method. Spirometry, body plethysmography, test of incremental respiratory endurance examination, 6-min walking test, body mass index, airflow obstruction, dyspnea, exercise capacity index, and subjective perception of dyspnea were performed as part of the initial and final examination. The patient performed training at home, and the physiotherapist monitored the patient remotely through a web application that allowed the physiotherapist to evaluate all training parameters in real-time and respond to any problems. After 8 wk of home training, there was a significant increase in all monitored values: maximal inspiratory pressure, a novel parameter sustained maximal inspiratory pressure, forced expiratory volume in 1 s, total lung capacity, forced vital capacity, peak expiratory flow, and inspiratory capacity. There was also an improvement in the perception of dyspnea according to the COPD Assessment Test and a modified Medical Research Council Breathlessness Scale, an increase in exercise tolerance according to the 6-min walking test, and a decrease in the exercise capacity index as a predictor of prognosis.", "extra_info": {"index": 66, "original_id": "multiclinsum_test_1605_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 42-year-old female with a distant history of SCI developed clinical and imaging findings consistent with acute expansion of PTS immediately following parathyroidectomy. Her symptoms included acute numbness, tingling, and pain in both arms. Magnetic resonance imaging (MRI) revealed a syrinx in the cervical and thoracic spinal cord. However, this was initially misdiagnosed as transverse myelitis and was treated as such without resolution of symptoms. Over the following 6 months, the patient experienced progressive weakness. Repeat MRI demonstrated expansion of the syrinx with new involvement of the brain stem. The patient was diagnosed with PTS and referred for outpatient neurosurgery evaluation at a tertiary facility. Treatment was delayed due to problems with housing and scheduling at the outside facility, allowing for continued worsening of her symptoms. The syrinx was surgically drained and a syringo-subarachnoid shunt was placed. Follow-up MRI confirmed correct placement of the shunt as well as resolved syrinx and decreased thecal sac compression. The procedure effectively halted symptom progression but did not resolve all symptoms completely. The patient has regained her ability to perform much of her activities of daily living but remains in a nursing home facility.", "extra_info": {"index": 86, "original_id": "multiclinsum_test_2005_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 66-year-old man affected by DME, with glycated hemoglobin (HbA1c) at 6.9%, refractory to laser grid treatment and intravitreal injections of triamcinolone, was selected to receive a cycle of three subtenon injections/week of IFN\u03b1 (1\u00d7106 IU/ml). BCVA and CMT, using spectral domain ocular coherence tomography (SD-OCT), were evaluated preoperatively and at 1\u00a0week, 1\u00a0month, 4\u00a0months, and 1\u00a0year postoperatively. BCVA and CMT were significantly improved at 1\u00a0week after the three injections (20/200 vs. 20/40 and 498\u00a0\u03bcm vs. 237\u00a0\u03bcm, respectively). BCVA remained stable during the 1-year follow-up. CMT was slightly increased, but was still lower than the baseline value (215\u00a0\u03bcm, 255\u00a0\u03bcm, and 299\u00a0\u03bcm during the follow-up visits). No adverse events were recorded, with the exception of mild subconjunctival hemorrhage at the injection site.", "extra_info": {"index": 80, "original_id": "multiclinsum_test_1558_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 49-year-old Asian woman presented with disseminated intravascular coagulation due to ruptured primary high-grade ovarian endometrial stromal sarcoma with multiple intraperitoneal metastases. After the initial surgery, the patient underwent adjuvant chemotherapy with three courses of Adriamycin (75\u00a0mg/m2). We performed the secondary debulking operation including total hysterectomy, metastasectomy, omentectomy, peritonectomy, appendectomy, and hyperthermic intraperitoneal chemotherapy (paclitaxel 175\u00a0mg/m2). Currently she has been alive for 28\u00a0months under a new chemotherapy regimen.", "extra_info": {"index": 49, "original_id": "multiclinsum_test_2683_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present a case of a 79-year-old female patient who underwent LAAO device deployment within a surgically occluded LAA with PDL. She underwent 27\u2005mm LAAO device (WATCHMANTM) deployment and all the P.A.S.S. (Position, Anchor, Size, and Seal) criteria were satisfied. Only 1.4\u2005mm PDL was present. She was continued on apixaban and aspirin post-operatively. Post-operative transoesophageal echocardiogram at 6 weeks demonstrated trivial PDL measuring 1.49\u2005mm. Patient was continued on aspirin and clopidogrel, with discontinuation of apixaban.", "extra_info": {"index": 47, "original_id": "multiclinsum_test_1868_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 38-year-old woman presented with shortness of breath and syncope. Upon investigation, she was found to have a right atrioventricular myxoma. It was associated with tricuspid regurgitation, right-sided heart failure, and pulmonary hypertension.\n\nThe syncopal attacks and shortness of breath resolved completely after tumor resection. Tricuspid regurgitation (grade 1) and mild pulmonary hypertension (right ventricular systolic pressure 35 mmHg) remained as sequelae of delayed presentation. These may be due to recurrent embolization of tumor fragments to segments of the pulmonary artery.", "extra_info": {"index": 51, "original_id": "multiclinsum_test_3149_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male. The patient presented persistent arterial hypertension and a previous diagnosis of chromophobe renal cell carcinoma. It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma. Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests and peripheral S100 protein expression in sustentacular cells. Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors.", "extra_info": {"index": 45, "original_id": "multiclinsum_test_2717_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 62-year-old man diagnosed as IgD-\u03bb/\u03bb myeloma (ISS stage III) was admitted with fatigue and weight loss. The physical examination suggested an anemic face, a few moist rales at the left lung base, and mild concave edema in both lower extremities. Laboratory examinations showed the elevated creatinine levels, \u03b22-microglobulin, lactic dehydrogenase, and erythrocyte sedimentation rate, while the decreased neutrophils, granulocytes, and hemoglobin. In the serum protein electrophoresis, there appeared two inconspicuous M-spikes. Serum IFE indicated an over-representation of lambda light chain and yielded two monoclonal bands in \u03bb region, but only one corresponding heavy chain band in the antisera to IgD region. The BM histology and BM cytology both supported the diagnosis of IgD-\u03bb/\u03bb myeloma.", "extra_info": {"index": 55, "original_id": "multiclinsum_test_710_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 27-year-old man presented to our hospital because of painless and progressive visual impairment of both eyes over two years. He was previously diagnosed with hypocalcemia but did not take calcium supplements regularly. He had no history of anterior neck thyroid surgery. After admission, the biochemical analysis indicated a serum calcium level of 1.21 mmol/L and an intact parathyroid hormone level of 0 pg/mL. Ocular examination revealed bilateral symmetrical opacity of the lens presenting as punctate opacity in the posterior subcapsular cortex together with radial opacity in the peripheral cortex (N1C2P3). Phacoemulsification with an intraocular lens was performed in both eyes sequentially. Postoperatively, the patient had a satisfactory recovery and greatly improved visual acuity.", "extra_info": {"index": 59, "original_id": "multiclinsum_test_1416_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present a 12-year-old girl who presented with bilateral shoulder deformities and difficulty in coordination while writing. On examination, she was noted to have bilateral Sprengel deformities with flexion contractures of upper-limb joints and mirror movements of both upper and lower-limb joints.", "extra_info": {"index": 53, "original_id": "multiclinsum_test_990_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a case of a 49-year-old man with a history of acromegaly who presented to our hospital with a diagnosis of decompensated systolic heart failure. Serial electrocardiograms showed wide (160\u2013200\u2009ms) QRS duration with left bundle branch block. Echocardiography showed severe left ventricular dysfunction that simultaneously achieved a left ventricular ejection fraction of 16%. Surgical indication was rarely assessed by neurosurgeons. Given that the stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects, cardiac resynchronization therapy was performed. Owing to biventricular synchronization and holding back reverse remodeling, the patient\u2019s symptoms were successfully alleviated, and he was discharged from the hospital.", "extra_info": {"index": 57, "original_id": "multiclinsum_test_3217_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra, in a 20-year-old male without any neurological deficit. The patient had associated chest injuries. The spine injury was managed surgically with in-situ posterior instrumentation and fusion. The patient tolerated the operation well and postoperatively there was no neurological deterioration or surgical complication.", "extra_info": {"index": 61, "original_id": "multiclinsum_test_1749_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We present the case of a 25 y.o. patient with COVID-19 respiratory failure requiring ECMO support for 16-days in which a 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein. Attempts to remove the cannula at the bedside failed due to immobility of the cannula. Ultrasound of the right neck was unremarkable, so he was taken to the hybrid OR where both TEE and fluoroscopy were unrevealing. An upper sternotomy was performed, and the superior vena cava and proximal jugular vein were dissected revealing a 2\u00a0cm segment of the distal SVC and proximal jugular vein that was densely sclerosed and adherent to the cannula. The vessel was opened across the adherent area at the level of the innominate vein and the cannula was then able to be withdrawn. The patient suffered no ill effects and had an unremarkable recovery to discharge.", "extra_info": {"index": 29, "original_id": "multiclinsum_test_2039_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo. He had no history of present or past illness. Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment. Tumor tissue in the fibular bone marrow cavity was removed by curettage, and rapid intraoperative pathological examination suggested fibular fibrous dysplasia. An allograft was implanted into the fibular medullary cavity. However, he was readmitted with clinical symptoms including persistent pain, abnormal gait, and local swelling at the age of 6 years. He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination. He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws. Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up.", "extra_info": {"index": 65, "original_id": "multiclinsum_test_1596_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition (PN). There were three episodes of central venous catheter infection with Bacillus pumilus in three months. Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear resulting in the need for removal of the catheter for complete cure.", "extra_info": {"index": 44, "original_id": "multiclinsum_test_1072_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 17-year-old male patient presented with pain in the lower left molar region. Clinical examination revealed the absence of Teeth 37 and 38. Tomographic imaging showed Tooth 37 in a transverse position with the crown oriented lingually and Tooth 38 in a vertical position. Extraction of Tooth 37 was performed using a vestibular approach and odontectomy due to space constraints.", "extra_info": {"index": 46, "original_id": "multiclinsum_test_3344_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We present a case of stage IV pleomorphic carcinoma; the patient was a 66-year-old male. He was referred to our hospital because of a right adrenal hemorrhage and a lung tumor. A systemic examination revealed that the lung tumor was a primary lung cancer and that the adrenal hemorrhage was due to a metastatic cancer. We performed an adrenalectomy and resection of the lung tumor and obtained a diagnosis of pleomorphic carcinoma with adrenal metastasis. The patient has remained recurrence-free for 6\u2009years since the surgery.", "extra_info": {"index": 54, "original_id": "multiclinsum_test_2067_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We reported a 24-year-old male who came to the emergency department complaining of a history of a sore throat, fever, malaise, fever, and neck swelling with a normal consciousness level. A laboratory examination showed leukocytosis and high C-reactive protein serum. Radiological diagnosis reveals an anterior neck abscess with left jugular vein thrombosis and left epidural abscess. The blood culture was positive for Fusobacterium necrophorum. The patient underwent surgical drainage and, at the same time, was treated with antibiotics and anticoagulant drugs. After 45 days, the patient improved clinically and was discharged. There were no other symptoms after a one-month follow-up clinically and neck ultrasonography.", "extra_info": {"index": 63, "original_id": "multiclinsum_test_1379_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 33-year-old woman was referred to our department with unstable angina. At the age of 6, she had undergone coronary artery bypass grafting of the second diagonal branch using the left internal thoracic artery and the obtuse marginal branch using saphenous vein grafting for left main coronary atresia. Although a coronary angiogram showed a patent left internal thoracic artery graft to the second diagonal branch and a patent saphenous vein graft to the obtuse marginal branch, the left anterior descending artery was not being perfused by the grafts because of a disruption of blood flow to the left anterior descending artery from the left internal thoracic artery. Therefore, we performed a redo coronary artery bypass grafting using the in situ right internal thoracic artery to the first diagonal branch, which was to be connected to the left anterior descending artery, resulting in amelioration of the ischemia of the left anterior wall. The patient was discharged 10\u00a0days after the operation and has been in good health for over 3\u00a0years without recurrence of chest symptoms.", "extra_info": {"index": 31, "original_id": "multiclinsum_test_2205_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We describe a 34-year-old patient with a cutaneous immunodeficiency characterized by recurrent crusted scabies infestation, diffuse tinea, and recurrent staphylococcal cellulitis, who we suspected had an undiagnosed syndrome. The patient also suffered from mental retardation, renal failure, and premature senescence. A cytogenetic fluorescence in situ hybridization analysis revealed a 9.34 Mb duplication within the short (p) arm of chromosome 1, precisely from 1p36.11 to 1p36.21, with an adjacent 193 kb copy gain entirely within 1p36.11. In addition, chromosome 4 had a 906 kb gain in 4p16.1 and chromosome 9 had a 81 kb copy gain in 9p24.3. Over 100 genes localized within these duplicated regions. Gene expression array revealed 82 genes whose expression changed >1.5-fold compared to a healthy age-matched skin control, but among them only the lipolytic enzyme arylacetamide deacetylase-like 3 was found within the duplicated 1p36 region of chromosome 1.", "extra_info": {"index": 33, "original_id": "multiclinsum_test_1677_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 32-year-old woman complained of a mass inside the rectovaginal space for 9 years, which became enlarged within 1 year. A rectal SEL detected by endoscopy was suspected to be a gastrointestinal stromal tumor or exophytic uterine fibroid. Pathological diagnosis was difficult because of unsuccessful transabdominal core needle biopsy with insufficient tissues, as well as vaginal hemorrhage. A second biopsy was suggested after multiple disciplinary treatment discussion, which referred to a transperineal core needle biopsy (CNB) guided by ERUS combined with CEUS. Adequate samples were procured and rectal gastrointestinal stromal tumor was proved to be the pathological diagnosis. Imatinib was recommended for first-line therapy by multiple disciplinary treatment discussion. After the tumor shrunk, resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall. Adjuvant therapy was applied and no recurrence or metastasis has been found by the last follow-up on December 13, 2019.", "extra_info": {"index": 48, "original_id": "multiclinsum_test_2808_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 69-year-old man was injured in a motor vehicle accident and suffered from left hemothorax and multiple rib fractures near the heart. A comprehensive assessment raised suspicions of lacerated pericardium and myocardial injury. Consequently, a thoracoscopy was performed 9\u2009h after injury. A penetrating cardiac injury was detected and surgically treated via video-assisted thoracoscopic surgery. The patient recovered uneventfully and was discharged on postoperative day 16.", "extra_info": {"index": 50, "original_id": "multiclinsum_test_2967_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 20-year-old man presented with periumbilical pain. Physical exam showed a warm, erythematous infra-umbilical mass that was tender to palpation. CT revealed an infected urachal cyst. The patient underwent urachal abscess incision and drainage with cyst excision. The patient returned home on postoperative day two. Two-week outpatient follow-up confirmed an uncomplicated recovery.", "extra_info": {"index": 39, "original_id": "multiclinsum_test_1897_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.", "extra_info": {"index": 37, "original_id": "multiclinsum_test_1298_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 66-year-old Maori man presented to our hospital with left testicular swelling. His alpha-fetoprotein and beta-human chorionic gonadotrophin levels were within normal limits. His lactate dehydrogenase concentration was elevated to 267 U/L. Ultrasound imaging confirmed a large testicular mass, and he underwent left orchiectomy. His histological examination revealed a neuroendocrine tumor with an immunostaining pattern suggesting Merkel cell carcinoma. He presented to our hospital again 3 months later with right testicular swelling that was confirmed on ultrasound sonography to be a tumor. He underwent a right orchiectomy, and his histological examination revealed metastatic Merkel cell carcinoma. A primary lesion was not identified, and computed tomographic imaging did not reveal spread to other organs. He received six cycles of adjuvant carboplatin and etoposide chemotherapy and remained disease-free 18 months after completion of chemotherapy.", "extra_info": {"index": 52, "original_id": "multiclinsum_test_2759_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported, following respiratory, hematology, and coagulation disarrangements, which was triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The first patient, which was presented with a seizure, had hypertension and diabetes mellitus as comorbidities. The latter case had no comorbidity but showed more severe presentations of COVID-19 such as brain and lung thrombosis, although already had several days of intravenous anticoagulant administrations. These two cases also have a different course of disease and outcomes, which were interesting topics to study.", "extra_info": {"index": 27, "original_id": "multiclinsum_test_445_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report a 44-year-old man with end-stage renal disease post failed kidney transplant on low-dose mycophenolate mofetil who presented with acute onset of abdominal pain. He was successfully given the diagnosis of perforated jejunal diverticulum. The patient successfully underwent a segmental jejunal resection and anastomosis. He unfortunately developed a recurrent jejunal perforation a month later and again had the second segmental jejunal resection operation. Mycophenolate mofetil then was discontinued.", "extra_info": {"index": 22, "original_id": "multiclinsum_test_295_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 75-year-old man presented with fever and right chest pain. He was suspected of a giant primary diaphragmatic tumor of extrahepatic origin by imaging studies. The preoperative differential diagnosis included benign masses such as myxoid sarcoma and schwannoma, and we planned a diaphragmatic resection. Intraoperatively, however, dissection of the tumor from the liver was not possible, requiring an extended right posterior segmentectomy with combined resection of the diaphragm. The patient had a good postoperative course and 1\u00a0year has passed since the surgery with no recurrence. The pathology showed that the mass was located just below the hepatic capsule/parenchymal region and was adherent to the diaphragm, but there was no continuity. The morphology suggested a low-grade mesenchymal tumor such as a solitary fibrous tumor and perivascular epithelioid cell tumor, but immunostaining was negative, making the diagnosis difficult. Although some areas of high proliferative activity were observed, finally, the diagnosis of primary spindle cell tumor of the liver with smooth muscle differentiation was made based on the positive results of muscle markers such as \u03b1SMA, desmin, and h-caldesmon.", "extra_info": {"index": 25, "original_id": "multiclinsum_test_447_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 90-year-old female with atrial fibrillation on therapeutic apixaban and status-post TAVR presented with COVID-19 infection and was found to have severe bioprosthetic valvular regurgitation with features suggestive of valve thrombosis. She underwent valve-in-valve TAVR with resolution of valvular dysfunction.", "extra_info": {"index": 35, "original_id": "multiclinsum_test_303_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3\u00a0months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72\u2009h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively.", "extra_info": {"index": 56, "original_id": "multiclinsum_test_1266_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "Male school-age child, 8 years old, no relevant history, presented with a 1-year history of conjugate horizontal rapid eye movement jerking and associated mild miosis, 5-10 seconds in duration, occurring 5-6 times daily, with some episodes with a questionable disconnection from the environment or impairment of consciousness, without other accompanying signs or symptoms. General examinations were normal. He was evaluated by ophthalmologists and otolaryngologists who ruled out pathology in those fields. The neurological examination between episodes was normal. The video-electroencephalogram demonstrated an electro-clinical correlate, with epileptiform activity in the left temporal and occipital region that later generalized during episodes. The brain MRI was normal. After initiation of treatment with carbamazepine, he had a good evolution, with no recurrence of episodes at 2 years of follow-up.\n", "extra_info": {"index": 62, "original_id": "multiclinsum_test_3001_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We describe the case of a 55-year-old female patient with primary open-angle glaucoma (POAG) who underwent bilateral XEN gel surgery. Her left eye developed a 2 mm postoperative hyphema, which resolved spontaneously within 8 days. Intraocular pressure (IOP) normalized at 12 mm Hg and increased to 50 mm Hg after 1 month in an otherwise normal-looking eye. Intraoperative examination revealed a nonfunctioning XEN gel stent, which was replaced and sent for laboratory analysis. Macroscopic examination of the tube confirmed obstruction with cellular debris. Tube replacement restored good filtration.", "extra_info": {"index": 64, "original_id": "multiclinsum_test_7_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection. The patient presenting a Peripheral arterial ischemic involving the infrarenal aorta, iliac, femoral. The simultaneous intervention consisted of an endovascular aortic stent-graft placement and angioplasty of femoral artery.", "extra_info": {"index": 58, "original_id": "multiclinsum_test_437_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A four-year-old girl presented with fever and a painful limp in the left hip. Pain characteristics and anemia detected in the blood analyses were the first warning signs that the hip process was not standard. Although the primary suspicion was of septic arthritis, a CT scan of the abdomen revealed an adrenal neuroblastoma.", "extra_info": {"index": 60, "original_id": "multiclinsum_test_1260_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10\u00a0h. He had recurrent fevers for 1 month before admission. Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve, moderate aortic regurgitation and a possible aortic annular abscess. Blood cultures were negative and empiric antibiotic therapy was begun. The patient did not have fever again and seem to be clinically improved. However, follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm. The patient underwent mechanical prosthetic valve replacement and annulus reconstruction successfully. Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved, which requires us to pay more attention.", "extra_info": {"index": 41, "original_id": "multiclinsum_test_885_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "In August 2012, a woman and her son were attacked by a stray dog in Henan, China. The son received rabies postexposure prophylaxis (wound treatment followed by vaccine, no immunoglobulin), however, the mother did not. Rabies infection was subsequently laboratory confirmed in the mother and she died in December; her son is alive and healthy after 2\u00a0years of follow-up.", "extra_info": {"index": 43, "original_id": "multiclinsum_test_1507_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 65-year-old woman with persistent atrial fibrillation was referred for LAAc. Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus; the LAA shape was tortuous and difficult to assess. A first LAAc procedure was unsuccessful given the unsuitable sheath position. Therefore, a soft three-dimensional (3D) model printing was performed by laser sintering and revealed excessive sheath kinking with an inferior approach, but successful deployment would be feasible using a superior approach. Successful trans-jugular implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved during the subsequent procedure. At 3-month follow-up, and after cessation of oral anticoagulation, the patient's symptoms improved. Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis.", "extra_info": {"index": 145, "original_id": "multiclinsum_test_2065_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 48-year-old female underwent video-assisted thoracoscopic surgery (VATS) combined with left lower lobectomy. The distal end of the left branch of the tracheal tube was lodged by surgical sutures. In this case, the respiratory physician burned the sutures using an argon electrode, after discussion with the thoracic surgery experts.", "extra_info": {"index": 24, "original_id": "multiclinsum_test_1206_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung. Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe. However, intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe, further showing that the bronchi of the posterior segment of the right lung opened into the bronchus intermedius. The procedure was completed uneventfully. Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius.", "extra_info": {"index": 141, "original_id": "multiclinsum_test_2891_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a case of 29 year old male with total rupture of ACL and PCL that underwent reconstruction for both ligaments. We found the failure of the PCL graft 2 years after the surgery was related to the tibial tunnel placement which was placed not in proper anatomical site. We performed revision PCL surgery with transseptal portal technique to ensure the tibial tunnel is placed in appropriate position.", "extra_info": {"index": 23, "original_id": "multiclinsum_test_2913_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We describe the case of a 43-year-old Asian female who has mild vision impairment due to tractional retinal detachment secondary to diabetic retinopathy and how mental health screening and quality of life screening during low vision rehabilitation can improve in the management of this patient.", "extra_info": {"index": 26, "original_id": "multiclinsum_test_2493_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "In this case, we present a young, otherwise healthy patient that was diagnosed with a primary leiomyosarcoma of the small finger. After her diagnosis, she underwent extensive oncologic workup, and subsequently underwent successful ray amputation with an excellent outcome. She remains disease free.", "extra_info": {"index": 143, "original_id": "multiclinsum_test_2201_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a documented case of a 4 years and 8-month-old Syrian Arabic girl with a distinctive course of signs and symptoms of rapid-onset obesity with hypoventilation, hypothalamic dysfunction, and autonomic dysregulation syndrome accompanied by mature ganglioneuroma in her chest, a homogenous mild enlargement of her pituitary gland, generalized cortical brain atrophy, and seizures. Three months after her first marked symptoms were noted she had a sudden progression of severe respiratory distress that ended with her death.", "extra_info": {"index": 139, "original_id": "multiclinsum_test_2845_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 52-year-old woman with primary Sj\u00f6gren's syndrome developed membranous glomerulonephritis and Epstein-Barr virus-positive diffuse large B-cell lymphoma (DLBCL). She was diagnosed with Sj\u00f6gren's syndrome based on the dry eyes, dry mouth, positive anti-nuclear antibody test, anti-Ro (SS-A) antibody, salivary gland biopsy, and salivary scintigraphy. Moreover, renal biopsy confirmed the diagnosis of membranous glomerulonephritis. Three months later, her small bowel was perforated with pneumoperitoneum, and the biopsy revealed Epstein-Barr virus-positive DLBCL.", "extra_info": {"index": 28, "original_id": "multiclinsum_test_2438_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the imaging appearance of dermatofibrosarcoma protuberans on the breast of a 41-year-old Chinese man who initially presented with a palpable lump. A mammogram showed two lesions, one with well circumscribed and the other with an ill defined border, in his right breast. Conventional magnetic resonance imaging was performed and showed the well defined larger lesion with mild central hypointensity while the smaller lesion had an irregular border. Both lesions were well characterized on the fat-suppressed sequences.", "extra_info": {"index": 135, "original_id": "multiclinsum_test_1990_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve.", "extra_info": {"index": 137, "original_id": "multiclinsum_test_2648_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We describe the case of a 65-year-old man, who was referred from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computed tomography of the abdomen with intravenous contrast was performed, which was interpreted as Meckel's diverticulitis complicated, being corroborated during the surgical act and confirmed by pathological anatomy.\n", "extra_info": {"index": 30, "original_id": "multiclinsum_test_3197_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A previously healthy 51-year-old female with history of hypothyroidism presented with acute onset chest pain for 1 day. Patient's electrocardiogram was normal, however, she had elevated troponins and given her typical chest pain, she was diagnosed with acute coronary syndrome (ACS). The patient had been on levothyroxine and was found to have a subnormal thyroid-stimulating hormone level suggesting hyperthyroidism. Echocardiogram was normal. Coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva and no evidence of atherosclerosis. A coronary computed tomography angiogram was done confirming this finding and showed a slit-like deformity of the coronary ostium with at least 50% luminal stenosis. The patient was referred to a cardiothoracic surgeon for potential coronary artery bypass graft.", "extra_info": {"index": 133, "original_id": "multiclinsum_test_2590_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 52-year-old patient from Bangladesh with dual-origin LAD arising from both left and right sinus with a pre-pulmonary course, presenting with exertional angina and documented myocardial ischaemia. Computed tomography (CT) scan confirmed the anatomical course of the AAOCA. Percutaneous coronary intervention was successfully performed using tailored techniques to treat significant atherosclerotic lesions.", "extra_info": {"index": 100, "original_id": "multiclinsum_test_3124_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma. An 82-year old lady suffered from recurrent attacks of hypoglycemia and presented with an abdominal mass, 2 years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma. An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out. Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail, in the peripancreatic tissue and in the surrounding soft tissue consistent with metastatic Merkel cell carcinoma in addition to an insulinoma of the pancreatic body.", "extra_info": {"index": 32, "original_id": "multiclinsum_test_1055_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a case of a giant loose peritoneal body measuring 7 \u00d7 5 cm found incidentally in a 64-year-old Indian man who presented with acute intestinal obstruction. We present the current hypothesis and our opinion on the genesis of such large bodies and discuss the problems in diagnosis.", "extra_info": {"index": 36, "original_id": "multiclinsum_test_2469_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 60-year-old white female with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disorder, Skin changes (POEMS) syndrome and newly diagnosed HTN was referred because of an elevated creatinine level. She denied being an active smoker but reported long-term exposure to cigarette smoke due to living with a heavy smoking family and working as a bartender. Further investigations revealed microscopic hematuria and nephritic range proteinuria. Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity, with negative staining for amyloid, fibrillary glomerulonephritis, and immunoglobulins, leading to a diagnosis of ING.", "extra_info": {"index": 147, "original_id": "multiclinsum_test_3054_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 51 year-old Caucasian right handed housewife lady (weight 61 kg, height 159 cm) presented with a headache of acute onset which proved to be caused by acute subarachnoid hemorrhage. Cerebral computed tomographic angiography revealed multiple aneurysms. The patient underwent a right pterional craniotomy to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms. The post-operative course was uneventful.", "extra_info": {"index": 34, "original_id": "multiclinsum_test_2076_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 21-year-old Japanese patient, suffering from a traumatic hallux deficit with only a portion of the basal phalanx intact, underwent rehabilitation treatment. The thenar area exhibited instability, leading to impaired balance and walking difficulties. Biomechanical assessment revealed the need for a rehabilitation strategy for the foot, as well as the knee, hip, and trunk. A rehabilitation protocol was designed to enhance medial foot loading during walking and standing, including balance and trunk strength training. After a 12-week rehabilitation period, the patient's gait showed significant improvement. Specifically, the load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%, while the pre-swing phase decreased from 14.6% to 11.6%. The vertical component of the ground reaction force rose from 599.8 to 647.5\u00a0N. The enhanced stability from balance training and increased muscle strength contributed to the patient's improved walking and balance.", "extra_info": {"index": 42, "original_id": "multiclinsum_test_1445_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We reported a patient with acute lymphoblastic leukemia suffered from pulmonary TB infection after HSCT. During anti-TB treatment, the patient had a poor response to linezolid-containing regimen, and developed side effects such as gingival bleeding and thrombocytopenia, so the administration was switched to contezolid. After 15 days of continuous treatment, the patient's platelet increased to 58\u00d7109/L, and he was discharged in stable condition. During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable, and no hematological adverse reactions and no symptoms of peripheral neuropathy were observed. Moreover, repeat imaging showed that the bilateral lung lesions were significantly reduced, indicating a good outcome for the patient.", "extra_info": {"index": 40, "original_id": "multiclinsum_test_353_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A HIV-negative 56-year-old male was hospitalized for chest disease with main symptoms of chest tightness, chest pain, fatigue, anorexia, and weight loss. Heart rate 109 times/min, the computed tomography (CT) scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura, right pleural encapsulated effusion, and limited, incomplete expansion of the middle and lower lobes of the right lung, enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups, and multiple slightly low-density nodules in the liver, bone destruction in the 2nd thoracic vertebra, raising the possibility of multiple liver metastases of right lung cancer and malignant pleural fluid. The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally. After comprehensive analysis, the patient was diagnosed with atypical systemic HDTB. After three months of conventional anti-TB treatment, the patient refused our hospital follow-up, and his symptoms improved significantly during the telephone follow-up.", "extra_info": {"index": 38, "original_id": "multiclinsum_test_867_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 35-year-old woman diagnosed to have echo-proven chronic rheumatic heart disease for 25 years. Percutaneous balloon mitral valvotomy was done 6 weeks previously for severe mitral stenosis. Left atrial thrombus was detected after the procedure and anticoagulant (warfarin) was initiated. She presented with severe headache and repeated vomiting of 1 day duration on arrival to the hospital. She had frequent seizure attacks with subsequent loss of consciousness on third day of admission. Diagnosis of status epilepticus secondary to intracranial hemorrhage due to warfarin toxicity was made after CT-scan revealed acute subdural hematoma and ventricular bleeding. Then she was transferred to medical intensive care unit (ICU), intubated and put on mechanical ventilator. Anti-epileptic drugs, antibiotics, vitamin K and fresh frozen plasma were given. She developed paroxysms of hypertension, tachycardia, tachypnea, hyperpyrexia, diaphoresis and decerebrate posturing after 7 days of neurological insult. She had normal inter-ictal EEG tracing during cyclic autonomic surge. CFS score was 11 and DLT score was 10. In sum, PSH-AM score was 21, suggested \"probable\" diagnosis of PSH. Morphine, diazepam, propranolol and gabapentin were given in combination to treat PSH. Severity of autonomic storm started to improve on second week of ICU admission. On the third week of admission, her clinical condition deteriorated suddenly, she developed asystole and died of cardiac arrest despite cardiopulmonary resuscitation (CPR).", "extra_info": {"index": 96, "original_id": "multiclinsum_test_1504_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye and inquired about refractive surgery. The patient denied any previous history of ocular inflammation, trauma, surgery, or use of topical or systemic medications. Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular which showed confluent pigment deposits stellate in shape over the pupillary axis, whereas left eye examination was completely within normal limits. Ophthalmic examination of the posterior segment was normal in both eyes. Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made.", "extra_info": {"index": 149, "original_id": "multiclinsum_test_2126_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "In this article, we describe a case of a-69-year-old female with a painful mass in her left breast. Based on intraoperative pathology consult, neoplastic tissue mostly floating in mucinous lakes with invasion to surrounding stroma was seen. Immunohistochemistry profile showed positive estrogen and progesterone receptors and negative for HER2.", "extra_info": {"index": 106, "original_id": "multiclinsum_test_2138_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 63-year-old woman with upper gastrointestinal obstruction for almost 10 years, who was pathologically diagnosed with large Brunner's gland adenoma of the duodenum. Postoperatively, no sign of recurrence has been noted until now.", "extra_info": {"index": 108, "original_id": "multiclinsum_test_2813_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 6-year-old girl with Coats plus syndrome presented to the pediatric emergency department with vomiting blood and blood in stool. An upper and lower gastrointestinal endoscopy revealed esophageal varices and vascular telangiectasia in the pyloric antrum, duodenum, and colon. She received palliative care and the bleeding was stopped after receiving intravenous octreotide. She then was followed in the pediatric gastroenterology, neurology, and ophthalmology clinics. She was later hospitalized and admitted to the intensive care unit as she continued to have intermittent gastrointestinal system bleeding. She eventually died due to severe gastrointestinal system bleeding.", "extra_info": {"index": 90, "original_id": "multiclinsum_test_1957_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a 9 days-old male neonates weighing 3.85 kg was referred by local hospital to our center and was ventilated with history of respiratory distress and severe infection since he was born. Admitted to our PCICU, 2D echo showed an IAA type A associated with a huge APW type II and restrictif PDA. A PGE1 infusion was started, during the following days the baby experienced several epileptic episodes. After improvement of the clinical condition, surgery was performed on the 20th days of life on year 2011. A successful one-stage repair of such anomalies in which cutting of PDA that arised from PA trunk and distally becoming into descending aorta, extended end to end anastomosis to conduct the ascending aortic blood flow into the descending aorta and intra arterial baffle was used. A 4-0 Gore-Tex baffle was used both to close the APW and separated the RPA from aortic origin with a good result, as his recently grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2.", "extra_info": {"index": 102, "original_id": "multiclinsum_test_2375_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 56-year-old male on oral anticoagulation presented to the emergency department with epigastric pain, nausea, and left upper quadrant tenderness. There was no history of trauma. Contrast-enhanced CT imaging revealed a large subcapsular haematoma of the spleen. Oral anticoagulation was antagonised with vitamin K and the patient was discharged in good condition after 3 days of clinical observation.", "extra_info": {"index": 92, "original_id": "multiclinsum_test_1095_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "The six-year-old girl underwent a human leucocyte antigen (HLA) haploidentical hematopoietic stem cell transplant using post-transplant Cyclophosphamide for severe aplastic anemia. In the second week of the transplant, the patient developed macrophage activation syndrome necessitating treatment with steroids and intravenous immunoglobulin. Subsequently, USG abdomen and blood fungal PCR revealed the diagnosis of hepatosplenic candidiasis. Candida-triggered macrophage activation syndrome responded to antifungals, steroids, intravenous immunoglobulin, and alemtuzumab. However, the subsequent clinical course was complicated by thrombotic microangiopathy. The patient developed hypertension in the 2nd week, followed by high lactate dehydrogenase (1010\u2009U/L), schistocytes (5 per hpf), low haptoglobin (<\u20095\u2009mg/dl), thrombocytopenia, and anemia in the 3rd week. Ciclosporin was stopped, and the patient was treated with 10\u2009days of defibrotide without response. The course was further complicated by the involvement of the gastrointestinal tract and kidneys. She had per rectal bleeding with frequent but low-volume stools, severe abdominal pain, and hypoalbuminemia with a rising urine protein:creatinine ratio. Narsoplimab was started in the 5th week of the transplant. A fall in lactate dehydrogenase was observed after starting Narsoplimab. This was followed by the resolution of gastrointestinal symptoms, proteinuria, and recovery of cytopenia. The second episode of TA-TMA occurred with parvoviraemia and was also successfully treated with Narsoplimab.", "extra_info": {"index": 98, "original_id": "multiclinsum_test_2016_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 73-year-old male suspected to have a urothelial carcinoma was scheduled for elective left nephroureterectomy. During central venous catheterization using the anatomic landmark technique to target the internal jugular vein, a guidewire is inadvertently inserted into the suspected vertebral vein. Following the correction of the catheterization, a radiologist reviewed the preoperative enhanced computed tomography and confirmed that the initially punctured vessel was the vertebral vein. On the third day after surgery, the central venous catheter was removed, and the patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms.", "extra_info": {"index": 88, "original_id": "multiclinsum_test_2805_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Here, we present a case study of a patient with oral cancer who underwent surgery. During adjuvant radiotherapy, a metastatic cervical lymph node was diagnosed based on fine-needle aspiration biopsy. To increase the total dose to the metastatic tumor, a stereotactic radiosurgery boost of 1\u2009\u00d7\u200918\u00a0Gy was performed two days after the last fraction of conventional radiotherapy. The early and late tolerance of this treatment were positive. During the 18-month follow-up, locoregional recurrence was not detected. The patient died due to secondary malignancy.", "extra_info": {"index": 104, "original_id": "multiclinsum_test_2840_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 21-year-old female patient with abdominal pain, irregular menstruation, hyperestrogenemia, and an ovarian mass was included. Brain magnetic resonance imaging (MRI) revealed a pituitary macroadenoma, and transsphenoidal surgery relieved her clinical symptoms. Before transsphenoidal surgery, plasma CA125, estradiol levels were elevated, while prolactin, luteinizing hormone, follicle-stimulating hormone, PROG, cortisol, FT4, thyroid-stimulating hormone, parathyroid hormone, and GH levels were maintained at normal levels. After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma. During follow-up, pelvic ultrasound confirmed normal-sized ovaries in the patient, the menstrual cycle returned to regular, and her hormones were maintained within a normal range. There was no evidence of tumor recurrence after two years of follow-up.", "extra_info": {"index": 151, "original_id": "multiclinsum_test_318_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 58-year-old woman presented with palpitations and diarrhea. Atrial fibrillation with spontaneous conversion to sinus rhythm was noted, along with a left ventricular mass identified on echocardiogram and confirmed via computed tomography as dystrophic calcification. Management included rehydration, antiarrhythmic therapy, and anticoagulation. The calcification, linked to previous myocardial infarctions, was considered an incidental finding, with no significant systolic dysfunction.", "extra_info": {"index": 153, "original_id": "multiclinsum_test_3200_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "Patient concerns:\nA 41-year-old man who presented with acute onset of right-hand clumsiness and aphasia even under high international normalized ratio (INR: 7.64) from warfarin use. He was previously treated with warfarin for the LV thrombus and non-valvular AF. Brain magnetic resonance imaging (MRI) showed multiple acute infarction in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral central semiovale, which highly suggested embolic stroke.\n\nDiagnosis:\nThe repeated transthoracic echocardiogram still revealed LV thrombus (1.27 \u00d7 0.90\u200acm), which failed to respond to warfarin therapy.\n\nInterventions:\nDue to acute infarctions occurred under supratherapeutic range of INR, we switched warfarin to edoxaban (dose: 60\u200amg/day) after INR decreased to less than 2.\n\nOutcomes:\nThe thrombus disappeared after receiving edoxaban for 23 days, and no more recurrent stroke was noted for more than 6 months.", "extra_info": {"index": 94, "original_id": "multiclinsum_test_3113_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a clinical case of a combat patient who was injured after the multiple launcher rocket system \"Grad\" shelling, diagnosed with hydrodynamic liver rupture followed by medical management with application of damage control (DC) tactic in conditions of hybrid war. The patient underwent relaparatomy, liver resection, endoscopic papillosphincterotomy, endoscopic retrograde cholecystopancreatography, stenting of the common bile duct, and VAC-therapy. Applied treatment modalities were effective; the patient was discharged on the 49th day after injury.", "extra_info": {"index": 93, "original_id": "multiclinsum_test_2795_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 59-year-old male with suspected lung cancer in the left lower lobe was scheduled to undergo surgery. Chest computed tomography revealed a displaced B1\u00a0+\u20092 and hyperlobulation between S1\u00a0+\u20092 and S3, while the interlobar fissure between S1\u00a0+\u20092 and S6 was completely fused. Three-dimensional computed tomography (3D-CT) revealed an anomalous V1\u00a0+\u20092 joining the left inferior pulmonary vein and a branch of the V1\u00a0+\u20092 running between S1\u00a0+\u20092 and S6. We performed left lower lobectomy via video-assisted thoracic surgery, while taking care with the abovementioned anatomical structures. The strategy employed in this operation was to preserve V1\u00a0+\u20092 and confirm the locations of B1\u00a0+\u20092 and B6 when dividing the fissure.", "extra_info": {"index": 91, "original_id": "multiclinsum_test_2752_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.", "extra_info": {"index": 136, "original_id": "multiclinsum_test_2394_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report and analyse a case of a 34-year-old female who presented with ataxia. Magnetic Resonance Imaging (MRI) of the brain revealed demyelinating lesions in the white matter. Genetic testing identified the c.4044C > G and c.1186-2A > G variants in the POLR3A gene. The patient was diagnosed with hypomyelinating leukodystrophy type 7 and received neurotrophic and symptomatic supportive therapy. However, after 1 month of follow-up, there was no improvement in her symptoms.", "extra_info": {"index": 134, "original_id": "multiclinsum_test_1579_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful.", "extra_info": {"index": 144, "original_id": "multiclinsum_test_2467_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We present the case of an adult male patient with cerebral malaria by Plasmodium vivax, who starts with general discomfort and fever, then presents convulsions more than twice a day with loss of consciousness and motor functional limitation. He is given a thick drop where Plasmodium vivax trophozoites and depression of the three blood series are observed. He is given treatment with artesunate and clindamycin for five days, a blood transfusion and continues with primaquine for seven days. The patient shows clinical improvement with neurological sequelae in the left lower extremity.\n", "extra_info": {"index": 95, "original_id": "multiclinsum_test_3364_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 46-year-old male with end-stage renal disease of unknown cause received a cadaveric renal transplant one year ago. Although three antihypertensive medications were administrated, his blood pressure gradually increased to 190/120\u00a0mmHg 3\u00a0weeks posttransplantation. Also the level of creatinine increased to 194\u00a0\u03bcmol/L.Color Doppler ultrasonography indicated a decreased resistance index (RI) in intrarenal arteries and increased blood flow of the transplant renal artery, therefore, a vascular complication of TRAS was suspected. Arteriography was performed and demonstrated TRAS caused by stretch of an artery branch, and the TRAS occurred in the distal site of the anastomosis instead of the anastomosis. Percutaneous transluminal bare stent implantation treatment was successfully performed. Satisfactory clinical efficacy with improvement in transplant renal function and renovascular hypertension was achieved after the interventional treatment.", "extra_info": {"index": 101, "original_id": "multiclinsum_test_1302_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We present a case where a combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique (LOR), on a 78-year-old Greek (Caucasian) male undergoing a total hip replacement. Despite being hemodynamically stable throughout the operation, two hours following epidural analgesia the patient manifested a sudden drop in blood pressure and heart rate that required the administration of adrenaline to counter. Pneumomediastinum, pneumorrachis and paravertebral soft tissue emphysema were demonstrated in a Computed Tomography scan. We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum, stimulating the para-aortic ganglia causing parasympathetic stimulation and therefore hypotension and bradycardia.", "extra_info": {"index": 89, "original_id": "multiclinsum_test_2918_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 70-years-old woman, who had been diagnosed with SLE at 69\u2009years, was admitted for further examination of liver dysfunction. PBC was confirmed based on elevated serum levels of transaminase, high levels of antimitochondrial antibodies and following a liver biopsy. The oral administration of ursodeoxycholic acid stabilized the liver dysfunction.", "extra_info": {"index": 109, "original_id": "multiclinsum_test_2272_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 48-year-old caucasian male with an extensive psychiatric history ingested a high dose of venlafaxine causing a serum venlafaxine concentration of 12.6\u00a0mg/L 24\u00a0hours after ingestion. Seven hours post-ingestion, he experienced tonic-clonic seizures, and 8\u00a0hours later, takotsubo cardiomyopathy was recognized followed by cardiac arrest. The patient was resuscitated with prolonged cardiopulmonary resuscitation including ongoing automatic external compressions during helicopter transportation to a tertiary hospital for extracorporeal membrane oxygenation treatment. Despite a cardiopulmonary resuscitation duration of 2\u00a0hours, 36\u00a0hours of extracorporeal membrane oxygenation, and a total of 30\u00a0days of intensive care, the patient made a full recovery.", "extra_info": {"index": 97, "original_id": "multiclinsum_test_985_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A Chinese family with ATS was recruited for the current study. Clinical characteristics (including findings from renal biopsy) of ATS patients were collected from medical records, and potential causative genes were explored by whole-exome sequencing. A heterozygous substitution in intron 22 of COL4A3 (NM_000091 c.2657-1G>A) was found in the patients, which was further confirmed by quantitative polymerase chain reaction.", "extra_info": {"index": 132, "original_id": "multiclinsum_test_1061_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Here case report, a 24-year-old patient from an endemic region of Somalia presented with fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months. Initially, the patient received symptomatic treatment and a blood transfusion but showed no improvement. Physical examination revealed fever, pallor, and hepatosplenomegaly. Laboratory tests showed pancytopenia and positive rapid diagnostic test for plasmodium parasite antigen. Despite three days of anti-malarial treatment, the symptoms persisted, and hepatosplenomegaly worsened. Further investigations, including infectious disease tests, were conducted, ruling out HIV, viral hepatitis, Brucella, and Leishmania antibodies. Peripheral blood smear showed pancytopenia and bone marrow aspiration revealed no evidence of infection or malignancy. A tru-cut biopsy of the spleen was performed, confirming the diagnosis of visceral leishmaniasis. The patient received a combination therapy of sodium stibogluconate and paromomycin, leading to significant improvement. After completing treatment, the patient was discharged with normal spleen biopsy results.", "extra_info": {"index": 146, "original_id": "multiclinsum_test_292_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 59-year-old female with a history of recurrent UCS presented with the new onset of the left lower extremity pain, numbness, and episodic urinary incontinence. When the MR revealed an enhancing intradural extramedullary mass posterior to the L1 vertebral body, she underwent a focal decompressive laminectomy. Although she improved neurologically postoperatively, she succumbed to the leptomeningeal spread of her disease within 2 postoperative months.", "extra_info": {"index": 103, "original_id": "multiclinsum_test_2588_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission. The patient experienced nausea and vomiting in the morning and had no history of seizures or decreased consciousness. Examination of neurological symptoms was completely normal and showed no symptoms of meningeal irritation. In terms of past history, the patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously. The Mount Fuji sign was found on the brain computed tomography (CT) scan of the patient. Treatments such as CBR (complete bed rest), 30-degree head elevation, anti-fever, analgesics and oxygen therapy, along with anti-compulsive drug (phenytoin), were prescribed. At the end of 5 days, the patient's pneumocephalus was resolved completely.", "extra_info": {"index": 105, "original_id": "multiclinsum_test_520_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.", "extra_info": {"index": 107, "original_id": "multiclinsum_test_1344_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 10-year-old Kurdish boy was presented with generalized bone pain and fever of 1 month's duration which was associated with sweating, easy fatigability, nose bleeding, breathlessness and severe weight loss. On examination, we observed pallor, tachypnea, tachycardia, low blood pressure, fever, petechial hemorrhage, ecchymoses, tortuous dilated veins over the chest and upper part of abdomen, multiple small cervical lymph node enlargements, mildly enlarged spleen, palpable liver and gross abdominal distention. Blood analysis revealed pancytopenia and elevated lactate dehydrogenase and erythrocyte sedimentation rate. Imaging results showed mediastinal widening on a planar chest X-ray and diffuse focal infiltration of the axial bone marrow on magnetic resonance imaging of the lumbosacral vertebrae. Bone marrow aspiration and biopsy examination showed extensive bone marrow necrosis. Immunophenotyping analysis of the bone marrow biopsy confirmed T-cell acute lymphoblastic leukemia, as CD3 and terminal deoxynucleotidyl transferase markers were positive and CD10, CD20 and CD79a markers were negative.", "extra_info": {"index": 99, "original_id": "multiclinsum_test_1185_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "This case report presents the case of a 77 year old female patient with degenerative hip disease in the presence of an ipsilateral arthrodesis of the knee. The patient was operated using the DAA. No complications were found and the patient had an excellent follow-up with a forgotten joint score of 93.75 at 1 year. The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy. Using pre-operative templating on X-rays, intraoperative fluoroscopy and the posterior femoral neck the hip biomechanics could be restored.", "extra_info": {"index": 140, "original_id": "multiclinsum_test_2302_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of a 33-year-old man, presenting with a five-month history of bilateral lower extremity pain, as well as paresthesia, and mild weakness in one lateral lower extremity. A lumbar laminectomy of L3 to L5 and en bloc resection of the tumor was performed. Postoperative histopathology and immunohistochemical analysis of the tumor were consistent with that of a carcinoid tumor. There were no clinical or radiological signs of tumor recurrence or metastasis at the patient's two year postoperative follow-up.", "extra_info": {"index": 142, "original_id": "multiclinsum_test_2169_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 70-year-old male patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago. He had poor cognition and his clinical examination findings were as follows: Mini-Mental Status Examination score, 14; and handgrip strength (right/left, kg), 32.3/31.3. DTT revealed serious injuries of the left thalamocingulate tract and right mammillothalamic tract in the Papez circuit, and a partial injury of the anterior part of the fornix.", "extra_info": {"index": 148, "original_id": "multiclinsum_test_1723_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report a case of a 23-year-old patient with Burkitt's lymphoma and graft-versus-host disease admitted with intracerebral hemorrhage and sequential development of 12 anterior circulation aneurysms from disseminated Scedosporium infection. Despite aggressive surgical and antimicrobial treatment, the patient died 6 months later from multiorgan failure. The notable feature of this case is the rapid angioinvasiveness of the infection with new aneurysm formation within days of clear angiographic imaging despite the apparent lack of skull base osteomyelitis.", "extra_info": {"index": 152, "original_id": "multiclinsum_test_2127_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male. His medical history was prostate hypertrophy. Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD. There was heavy corneal stromal opacity with intraocular fluid leakage. The patient underwent transplantation of a donor scleral graft to the burn site. Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration. An intraocular lens was eventually fixed in the ciliary sulcus 7 months later. His visual acuity remains at 2/20 OD.", "extra_info": {"index": 150, "original_id": "multiclinsum_test_1564_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 56-year-old female, with previous history of intestinal pneumonitis, mild pulmonary hypertension and gastroesophageal reflux secondary to systemic scleroderma, is considered for lung transplant. Initially, due to persistent gastroesophageal reflux, a transplant was not a viable. This was corrected with an open gastrectomy with roux-en-Y anastomosis. Follow-up one week later revealed normal anatomy, adequate esophageal-jejunal anastomosis, and adequate contrast medium transit via esophagogram. Additionally, there was no evidence of contrast medium reflux indicating a resolved gastroesophageal reflux disease. This led to the patient becoming a candidate for lung transplant.", "extra_info": {"index": 138, "original_id": "multiclinsum_test_2494_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 71-year-old female who was being treated for type 2 diabetes with canagliflozin, metformin, and saxagliptin orally presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain. Although her blood glucose was not severely elevated (259 mg/dL), there was notable ketoacidosis (pH\u20096.89; CO2, 11.4\u2009mmHg; HCO3, 1.9\u2009mEq/L; base excess, - 31.3\u2009mmol/L; 3-hydroxybutyric acid > 10,000\u2009\u03bcmol/L) was observed. The uncontrolled acidosis improved following 3\u2009days of continuous renal replacement therapy, but elevated urinary glucose continued for more than 10\u2009days. Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria. Urinary glucose turned negative on day 16, and there was improvement in the patient's overall state; hence, she was discharged on day 18.", "extra_info": {"index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 62-year-old male presented with a 4-month history of right brachial pain and hyposensitivity in the C5 distribution. The cervical magnetic resonance (MR) imaging scan revealed a C5-C6 right anterolateral disc herniation with syringomyelia extending from C5-C6 to T1. Following a C5-C6 anterior cervical discectomy and fusion (ACDF), the patient's symptoms resolved. The 3-month postoperative MR documented total resolution of the syrinx. Notably, due to residual neuropathic pain, the patient required a subdural spinal cord stimulator which was placed without any complications.", "extra_info": {"index": 6, "original_id": "multiclinsum_test_875_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed.", "extra_info": {"index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "Herein we present a 63-year-old man with idiopathic spontaneous intraperitoneal hemorrhage (ISIH) caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA).", "extra_info": {"index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 63-year-old male presented with a prominent itching sensation and wholebody jaundice. He showed obstructive-pattern jaundice, an elevated IgG4 level, and infiltration of a large number of IgG4-positive cells in the ampulla of Vater. The imaging findings of intrahepatic duct (IHD) and common bile duct dilation, an elevated serum IgG4 level, and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria. We planned to treat the patient with high-dose glucocorticoid (GC), followed by cyclophosphamide pulse therapy. After treatment with high-dose GC and an immunosuppressant, imaging studies showed that IHD dilatation had completely resolved.", "extra_info": {"index": 14, "original_id": "multiclinsum_test_53_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "We present a case of a patient who suffered a cardiac arrest after a fall during a chronic obstructive pulmonary disease exacerbation, leading to pneumoretroperitoneum.", "extra_info": {"index": 12, "original_id": "multiclinsum_test_1808_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "33-year-old nulligravid woman with newly diagnosed anaplastic astrocytoma (AA; WHO grade III, IDH1-negative) sought fertility preservation. Prior to chemotherapy and radiation for AA, the patient underwent in vitro fertilization (IVF) for fertility preservation, resulting in 8 vitrified embryos. Following chemo-radiation, the patient underwent two rounds of frozen embryo transfers (FET), each resulting in a successful singleton pregnancy.", "extra_info": {"index": 8, "original_id": "multiclinsum_test_2635_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": "A 34-year-old male patient presented with multiple large tuberous xanthomas related to FH. There were 15 masses in different body parts, including the dorsum of the hands, elbows, buttocks, feet, and Achille's tendon. The largest masses in the buttocks measured 8\u00a0\u00d7\u00a08\u00a0\u00d7\u00a05\u00a0cm. Surgical removal of 13 masses was carried out in combination with medical treatment. The skin incision was oval around the circumference of masses with the longitudinal axis parallel to the Langer's line. Skin defects were closed directly or dissected on both sides of the incision to reduce tension. Wound healing was normal. After 1.5\u00a0months, there was no recurrence of xanthomas.", "extra_info": {"index": 10, "original_id": "multiclinsum_test_1587_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction. She had been previously diagnosed with ET; aspirin and anagrelide had been prescribed. Subsequent examination at our hospital revealed cecal cancer. Distant metastasis was absent; laparoscopic ileocecal resection was performed. Anagrelide was discontinued only on the surgery day. She was discharged on the seventh postoperative day without thrombosis or hemorrhage. However, when capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia; thus, anagrelide was discontinued. Five days later, her platelet count recovered. Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy. Her liver function normalized gradually in 4\u2009months. One-year post operation, she is well without tumor recurrence or new metastasis.", "extra_info": {"index": 16, "original_id": "multiclinsum_test_1612_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report here another case of primary prostatic MALT lymphoma which is presented by hematuria and diagnosed primarily as BPH. Immunohistochemistry studies demonstrate the diagnosis and MALT lymphoma. Six months after starting the treatment the patient was alive and well.", "extra_info": {"index": 9, "original_id": "multiclinsum_test_2155_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant. At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina. Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage. Seven months later, the fundus examination showed no lesion in the left eye, FA revealed mild tortuous vessels without leakage.", "extra_info": {"index": 20, "original_id": "multiclinsum_test_2309_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a case of a Ashkenazi Jew patient who presented in the typical way that carcinoma of the colon might present but turned out to have a very rare type of tumor in both its histology and its location.", "extra_info": {"index": 18, "original_id": "multiclinsum_test_2722_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 27-year-old male with a relapsed acute lymphoblastic leukemia presented with five-day-old polyarthralgia. He also had febrile neutropenia, cellulitis without abscesses, and methicillin-resistant Staphylococcus aureus bacteremia for which he received therapy with oxacillin and cefepime. However, the febrile neutropenia persisted, and an invasive fungal infection was suspected. A new set of blood cultures was taken and antifungal treatment was initiated. Arthroconidia were identified in the blood cultures and a matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp. Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B and four weeks of voriconazole. After a prolonged stay, he was discharged.\n", "extra_info": {"index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine. The patient is a 29-year-old female who received manipulation one week prior to developing symptoms of severe orthostatic headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection. Symptomatic onset corresponded with the recent cervical chiropractic adjustment. We present serial imaging correlating with her symptomatology and review the pertinent literature on complications of chiropractic manipulation.", "extra_info": {"index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "The patient was referred to our hospital with a 1-month history of disorientation and magnetic resonance imaging showed hydrocephalus with an enhancing lesion in the tectum. Preoperative blood tests showed a high serum soluble interleukin-2 receptor level of 624 U/ml. Through a single burr hole, endoscopic third ventriculostomy and biopsy of the lesion were simultaneously performed with a flexible endoscope. The histological examination confirmed diffuse large B-cell lymphoma. The patient underwent chemotherapy and radiotherapy.", "extra_info": {"index": 11, "original_id": "multiclinsum_test_410_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.", "extra_info": {"index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a case of annular leukocytoclastic vasculitis induced by anti-tuberculosis medication. A 62-year-old Thai man presented to our facility with a generalized exanthematous rash on his trunk and extremities that resolved shortly afterwards. Subsequently, he developed multiple, erythematous-to-purplish, non-blanchable macules and papules with an annular arrangement on his extremities. The skin rash occurred after two weeks of anti-tuberculosis medication. The histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis. The skin lesion improved after discontinuation of the anti-tuberculosis drugs and treatment with oral antihistamine and topical corticosteroid drugs. Streptomycin, ethambutol and ofloxacin were administered as second-line anti-tuberculosis therapy during his hospitalization. No adverse reactions were observed.", "extra_info": {"index": 7, "original_id": "multiclinsum_test_2131_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "The patient was a 55-year-old woman with a transglottic squamous cell carcinoma of the T3N0M0 stage and PCF development following total laryngectomy surgery with total thyroidectomy and bilateral elective cervical lymph node dissection level I-IV. In spite of conservative treatment, the fistula was not recovered after 3 weeks. It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach. One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test, and the fistula was completely closed.", "extra_info": {"index": 13, "original_id": "multiclinsum_test_112_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "a 1-month-old baby presented with severe AS and CoA. The decision was made to perform a hybrid surgical procedure. The patient underwent a lateral thoracotomy for repair of the CoA and carotid cutdown for aortic balloon valvuloplasty (AoVP).", "extra_info": {"index": 19, "original_id": "multiclinsum_test_2724_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein - CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution.", "extra_info": {"index": 15, "original_id": "multiclinsum_test_723_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "An 84-year-old male was admitted with a history of difficulty rising from a chair and a fall. Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values. Electromyography (EMG) showed myopathic changes, and FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps. A biopsy was performed revealing lymphocytic predominant infiltrates and myonecrosis. Prednisone and intravenous immunoglobulin (IVIG) were administered with strength improvement. The patient was discharged for further follow-up.", "extra_info": {"index": 17, "original_id": "multiclinsum_test_2937_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A young man involved in a car accident and sustained blunt thoracic injuries, among others. As part of primary survey, FAST scan was performed. Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines. Other cardiac windows showed only A-lines, as well. A suspicion of pneumopericardium was raised and CT scan confirmed the diagnosis.", "extra_info": {"index": 21, "original_id": "multiclinsum_test_1133_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a 30-year-old Caucasian woman who tested positive for COVID-19 after developing nasal congestion and cough. Ten days after testing positive, she developed a systemic rash on her extremities and torso. At the same time, she developed swelling of the tongue lasting 1 hour, with subsequent appearance of oral lesions that resembled geographic tongue. She also had an irritable sensation on her tongue and some mild loss of sense of taste. We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours. The patient used the mouth rinse therapy for 1 month and experienced a 90% improvement in her oral lesions and tongue sensitivity. However, she had repeated flares every 3 weeks over a 6-month period, and the steroid mouthwash achieved incomplete resolution. After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity and the lesions healed.", "extra_info": {"index": 119, "original_id": "multiclinsum_test_778_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control can slow disease progression and reduce the risk of end-stage renal disease.\"\n}", "ground_truth": "The medical record of a 64-year-old female with Sjogren's syndrome was reviewed. The clinical and pathological data along with chest CT images were obtained. The literature related to the transformation was reviewed. There were no specific clinical manifestations of LIP and its transformation into malignant lymphoma in the patient. The chest CT mainly displayed multiple cystic foci, with multiple nodules and ground-glass shadows in both lungs.", "extra_info": {"index": 131, "original_id": "multiclinsum_test_2470_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report a case of a 93-year-old Middle Eastern male presenting for longstanding treatment-refractory hiccups. Imaging with computed tomography of the chest and abdomen was unremarkable. An upper endoscopy was normal without any endoscopic finding to suggest eosinophilic esophagitis. Given his elevated peripheral eosinophil count, biopsies were taken from mid- and distal esophagus and revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field, favoring a diagnosis of eosinophilic esophagitis. The hiccups resolved following the initiation of eosinophilic esophagitis treatment.", "extra_info": {"index": 114, "original_id": "multiclinsum_test_3338_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "The patient was a 77-year-old hypertensive male who presented to the emergency following an episode of slip and fall at home. After prompt resuscitation, he was sent for radiological evaluation which revealed fractures of the left inter-trochanteric femur and left proximal humerus. Meanwhile, laboratory investigations showed grossly deranged renal parameters, along with elevated serum creatinine phosphokinase levels (more than 5 times the baseline). A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made. Medical management included adequate intravenous fluid administration combined with strict input-output monitoring. Subsequently, the patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail. However, fracture of the proximal humerus was managed non-operatively with sling immobilization as patient refused to give consent for a second surgery.", "extra_info": {"index": 110, "original_id": "multiclinsum_test_2243_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "In this case, we present a preterm newborn who developed pneumomediastinum and pneumothorax. The pneumothorax persisted, despite placement of a thorax tube, requiring a thoracotomy to detect and treat the bronchial rupture.", "extra_info": {"index": 116, "original_id": "multiclinsum_test_2176_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 21-year-old man was referred to our hospital for treatment after presenting to a nearby hospital with right inguinal pain. Abdominal magnetic resonance imaging showed an intra-abdominal mass measuring 34 \u00d7 15 \u00d7 8 cm with partial signal hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging, extending from the left abdominal cavity to the pelvic region. Although no definitive diagnosis was obtained preoperatively, surgery was performed under suspicion of gastrointestinal stromal tumor or other significant disease. A mass was identified firmly adherent to the transverse colon, gastric wall, and diaphragm, and these organs were partially resected. The excised specimen measured 38 \u00d7 21 \u00d7 8 cm and weighed 6400 g. Macroscopically, the tumor showed a smooth surface and homogeneous interior. Pathological examination revealed atypical cells with spindle-shaped nuclei and collagen fiber hyperplasia in the stroma, and immunostaining was negative for c-kit, CD34, desmin, S-100, and positive for \u03b2-catenin, leading to a confirmed diagnosis of desmoid tumor. Fifteen months after surgery, a local recurrence with a diameter of 3.0 cm was identified, and the patient remains under careful follow-up.", "extra_info": {"index": 112, "original_id": "multiclinsum_test_3373_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "Patient concerns:\nA 68-year-old man was admitted to our hospital with dyspea and general fatigue. He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy. In order to improve fluid retention and relieve his dyspnea, low-dose TLV (7.5\u200amg qd) was performed. After the 3-day treatment using TLV, we observed that he became delirious and his limbs shook uncontrollably. High serum sodium 173 mmol/L was noted compared to the results of the first examination (137 mmol/L). After intensive rescue, serum sodium was restored to normal (135\u200amol/L). Later, when the patient refused continuous renal replacement therapy (CRRT), we tried again to use a lower dose of TLV to improve diuretic resistance. Two days later, Serum sodium rose again (162 mmol/L).\n\nDiagnoses:\nDuring the course of therapy, we did not strictly require the patient to control the fluid intake. No other medication could cause elevation of serum sodium. Therefore, we suspected a high sensitivity to the side effect of TLV.\n\nIntervention:\nStop the use of TLV and encourage the patient to drink plenty of water. Gastric tube was inserted orally to increase the intake of fresh water.\n\nOutcomes:\nHis serum sodium decreased gradually and his psychiatric symptom recovered. During this period, Overall condition of the patient was stable. After being discharged from the hospital, the patient eventually died of cardiac arrest due to critically ill heart failure.", "extra_info": {"index": 124, "original_id": "multiclinsum_test_3307_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A patient from TRITON2 with BRCA-mutated mCRPC had a response to the PARP inhibitor rucaparib and remained on treatment for 32 weeks, which was >2 times longer than the duration of each of his prior therapies (bicalutamide, docetaxel, abiraterone). The patient enrolled in TRITON2 based on results of local genomic testing of an archival biopsy that indicated the presence of a BRCA1 T1399I (allelic fraction, 19%) mutation. Local testing also identified an ATM G1663C mutation, a TP53 P191del mutation, and a BRAF K601E mutation. Analysis of a plasma sample obtained before the patient started rucaparib detected the same alterations as those in the archival biopsy, but it also revealed the presence of a BRCA2 homozygous loss (whole gene, 26 of 26 exons) and several other alterations of unknown functional impact. We hypothesize the response of the patient's tumor to rucaparib was likely driven by DNA damage repair deficiency caused by homozygous loss of all BRCA2 exons. Following discontinuation from rucaparib due to clinical disease progression, the patient received carboplatin and cabazitaxel for \u22483 weeks. The patient died due to progression of his disease.", "extra_info": {"index": 118, "original_id": "multiclinsum_test_759_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction (STEMI). The right radial access was chosen for the performance of percutaneous coronary intervention. After the introduction of 6\u2009F sheath, there was difficulty in the advancement of 0.035\u2009J wire that was exchanged with a Terumo hydrophilic wire. After the procedure and before sheath removal, radial arteriography was done and revealed perforation. Protamine sulfate was administered and prolonged balloon inflation was attempted but failed to seal the perforation, so a 7-F-long vascular sheath was inserted to internally tamponade the vessel, and the patient was sent to the coronary care unit for monitoring. Over the next 3 days, serial radial angiographies were done revealing the persistence of the perforation, and on the fourth day, angiography revealed multiple thrombi. Thrombus aspiration was done using Pronto V4 extraction catheter (Vascular Solutions, USA) and was followed by the deployment of a covered stent. The stent was dislodged and successfully snared. Finally, the perforation was sealed spontaneously and there were no signs of intra-arterial thrombi.", "extra_info": {"index": 120, "original_id": "multiclinsum_test_1116_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We describe a case in which the two technologies are used in combination during acute echocardiographic optimization of left pacing vector in a 63-year-old man, Caucasian, who showed worsening heart failure symptoms a few days after an implant, and the effect of the device\u2019s optimization at 6-month follow-up.", "extra_info": {"index": 126, "original_id": "multiclinsum_test_3317_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm\u00d715 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression.", "extra_info": {"index": 122, "original_id": "multiclinsum_test_2110_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "A 32\u2009year-old woman with a history of non-diabetic hemodialysis for 3\u2009years suffered from severe involuntary movement, and brain magnetic resonance imaging showed symmetrical T2-weighted imaging (T2WI) and T2/fluid-attenuated inversion recovery (T2FLAIR) hyperintense nonhemorrhagic lesions in the bilateral basal ganglia. She was diagnosed with UE as syndrome of bilateral basal ganglia lesions, due to a combined effect of uremic toxins and hyperthyroidism. After treatment with high frequency and high flux dialysis, hyperbaric oxygen therapy and declining parathyroid hormone, the patient achieved complete remission with normal body movement and was discharged.", "extra_info": {"index": 129, "original_id": "multiclinsum_test_168_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "We report the case of a patient with a history of multiple diseases and 2 tumor-like lesions with internal lytic areas detected in the fourth right costal arch and in the eighth left costal arc; we describe his clinical manifestations, radiological and laboratory findings as well as the pathological results and outcome.", "extra_info": {"index": 130, "original_id": "multiclinsum_test_2403_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery. A bonded molar orthodontic tube had dislodged into the wound during the operation. The clinical presentation initially mimics an odontogenic infection until our investigations revealed that it originated from the dislodged appliance. The abscess was drained, the wound site was explored, and the molar tube and neighbouring rigid fixation plates and screws were removed. The patient recovered well following the procedure.", "extra_info": {"index": 113, "original_id": "multiclinsum_test_1305_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 22-year-old male was admitted for bilateral leg tremor while standing, with symptom onset eight months prior. One month before admission, the tremor disappeared in the left leg but persisted in the right leg. Electromyography recorded from the right gastrocnemius revealed a 6-8\u00a0Hz tremor, which appeared when the patient was standing and disappeared when he was resting or walking. Blood screening showed a phenylalanine/tyrosine ratio of 2.06 and a phenylalanine level of 140\u00a0\u03bcmol/L. Urine metabolic screening was negative. Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G\u2009>\u2009A and c.728G\u2009>\u2009A, in phenylalanine hydroxylase (PAH) gene. After three months of levodopa/benserazide tablets (250\u00a0mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared.", "extra_info": {"index": 115, "original_id": "multiclinsum_test_1859_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "In this case report, we present a 16-year-old Ukrainian boy with acute hepatitis B. He had not been previously vaccinated against hepatitis B. Possible sources of infection included: a tattoo made at home, a finger cut made with hairdresser scissors during work, and unprotected sexual encounters. The clinical course of the disease was typical with jaundice and elevated aminotransferases levels without liver failure. During the follow-up visit 16 months after the onset of the disease, chronic hepatitis b was excluded but an ulcer around his anus was found. Additional tests for sexually transmitted diseases were ordered and they were positive for syphilis. The extended interview revealed that the patient had several unprotected bisexual encounters, which may have indicated a potential source of infections including the hepatitis B virus (HBV).", "extra_info": {"index": 123, "original_id": "multiclinsum_test_3310_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report a case of an isolated intracranial RDD in a 53-year-old man. The patient had an episode of generalized seizures. Imaging studies of the brain were compatible with a meningioma en plaque. The mass was exposed by a right frontotemporal craniotomy. The tumor was adhered tightly to the adjacent cerebral cortex and was permeated by pial arteries of the brain surface. The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor. The patient had incomplete left hemiparesis after the surgery. Brain computed tomography (CT) imaging revealed a postoperative hemorrhage and a low-density lesion in the right frontal lobe. The patient was postoperatively diagnosed with isolated central nervous system RDD.", "extra_info": {"index": 125, "original_id": "multiclinsum_test_1592_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "44-year-old African black patient of Burkinabe origin with no other medical history, admitted for chronic inflammatory low back pain associated with inflammatory right knee pain and a cough with phlegm. This symptomatology had been developing for seven months in a febrile context and with a general deterioration in health. The examination showed oligoarthritis of the right sternoclavicular joint and the left knee, associated with a pulmonary condensation syndrome and pleural effusion, a cold abscess at the level of the right sternoclavicular joint and a fistulous and purulent right inguinal lymphadenopathy. The biology showed an inflammatory syndrome. The GeneXpert test was positive in the sputum, without resistance to rifampicin. The intradermal reaction to the tuberculin was positive. The thoracic tomodensitometry showed a right sternoclavicular osteoarthritis and a spondylodiscitis of the L3-L4 spine. The standard radiography of the left knee objectified signs in favour of arthritis. The diagnosis of tuberculosis with multifocal, pleuropulmonary and ganglionar bone involvement was retained. The patient was given usual analgesics and antituberculous. The evolution was favourable.\n", "extra_info": {"index": 111, "original_id": "multiclinsum_test_3332_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A case report of an 84-year old male, who presented with an aggressively recurrent form of MCC on the lower lip, on the background of an 8-year history of untreated CLL. During the recurrences of MCC, coexisting regional lymphadenopathy, posed a problem in the differential diagnosis and treatment of lymph node involvement. Histopathology and immunoistochemistry showed that submandibular lymphadenopathy coexisting with the second recurrence of MCC, was due to B-cell small lymphocytic lymphoma. The subsequent and more aggressive recurrence of the skin tumor had involved the superficial and deep cervical lymph nodes. Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies.", "extra_info": {"index": 128, "original_id": "multiclinsum_test_1953_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 42-year-old female with history of uterine fibroids was admitted with abdominal pain and intraperitoneal fluid of unknown etiology. She was initially managed nonoperatively and empirically treated with broad spectrum antibiotics. Blood and urine cultures were unrevealing. Increasing abdominal pain and peritoneal fluid prompted diagnostic laparoscopy which revealed a dense fibrinous exudate covering the entire peritoneal cavity. Peritoneal fluid and biopsies were sent for cytology and culture. The peritoneal fluid was eventually sent for 16\u2009s ribosomal analysis, which discovered Mycoplasma hominis RNA. Her antibiotics were narrowed, and she eventually made a full recovery.", "extra_info": {"index": 127, "original_id": "multiclinsum_test_1099_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report a case of VEO-IBD associated with a monogenic mutation in a 2-year-old girl presenting mainly with gastrointestinal symptoms, including recurrent hematochezia and abdominal pain for more than 3 months. A gastroscopy revealed erosive gastritis and bulbar duodenitis, while a colonoscopy indicated erosive colitis. Abnormal results were obtained from the dihydrohodamine (DHR) assay and immunoglobulin testing. Whole-exome sequencing identified a heterozygous and de novo nonsense mutation (c.388\u00a0C\u2009>\u2009T; p.R130X) in the CYBB gene leading to deficiency of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2) (encoded by CYBB), a critical component of phagocytes. HSCT was performed successfully, and the DHR assay showed that normal neutrophil function was restored. Six months after HSCT, clinical remission was observed, and a repeat colonoscopy revealed intestinal mucosal healing was attained.", "extra_info": {"index": 121, "original_id": "multiclinsum_test_533_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6\u2009years and 2\u2009months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7\u2009years and 8\u2009months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1\u2009cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9\u2009years and 7\u2009months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10\u2009years and 5\u2009months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5\u2009cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.", "extra_info": {"index": 117, "original_id": "multiclinsum_test_1775_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We present the case of a 16-year-old Persian man diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B (medullary thyroid cancer, mucosal neuroma of the tongue, lips and inner eyelids). Our patient, who had a positive family history of medullary thyroid cancer, was of normal height with no signs of marfanoid habitus.", "extra_info": {"index": 159, "original_id": "multiclinsum_test_2043_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "An 86-year-old male was admitted to our hospital with congestive heart failure due to low-flow low-gradient severe AS, a membranous VSD, a sub-aortic band, and a double-chambered right ventricle (RV). The patient was not deemed to be a surgical candidate because of advanced age and frailty even though surgical aortic valve replacement, VSD closure, sub-aortic band resection, and myectomy of RV would be considered as definitive treatment. Instead, we performed TAVI and VSD orifice closure using the skirt part of the self-expanding valve (26\u2005mm Evolut Pro Plus\u2122) because VSD occluder is not approved and thus not available in our country. The trans-catheter procedure resulted in a reduction of the mean aortic valve pressure gradient improved from 33 to 2\u2005mmHg and a decrease in the shunt flow (Qp/Qs) from 1.9 to 1.2. The patient\u2019s heart failure improved, and he was discharged to home 7 days after the procedure. He remained well and had not been admitted to hospital since discharge.", "extra_info": {"index": 154, "original_id": "multiclinsum_test_3275_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report a case study with a 44-year-old man from Faryab Province in Afghanistan who presented chest pain and dizziness while suffering a common cold. After full investigation, the patient underwent coronary angiography which showed a myocardial bridge at the middle portion of the left anterior descending artery (LAD) with a significant stenosis causing ischemia. We treated the patient with a calcium channel blocker as initial treatment. The patient tolerated the medication well and remained asymptomatic during two years follow-up.", "extra_info": {"index": 167, "original_id": "multiclinsum_test_3208_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": "Here, we report the first clinical case of a cerebral nocardiosis revealed after seizure in a patient treated by pembrolizumab for a metastatic lung cancer, in the absence of any additional immunosuppressive therapy or risk factors for cerebral nocardiosis. The extended evaluation including a brain CT-scan did not reveal any lesion before pembrolizumab. Nevertheless, the 3-month delay between the start of Pembrolizumab and the diagnosis of cerebral nocardiosis suggests that the infection occurred prior to the CPI. Unfortunately, the patient died during treatment for cerebral nocardiosis, while the lung cancer tumor mass had decreased by 80% after the sixth cycle of pembrolizumab.", "extra_info": {"index": 157, "original_id": "multiclinsum_test_2333_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We report the case of a 72-year-old Caucasian woman with full-thickness rectal prolapse associated with fecal incontinence from severe neuromuscular damage.", "extra_info": {"index": 165, "original_id": "multiclinsum_test_2449_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "It is a case report of a 13-year-old girl with the history of swelling over her right hand for 5 months. X-ray revealed that there was an osteolytic fusiform expansible lesion. The biopsy sent and it conferred the diagnosis of GCT. Dorsal approach used for the enbloc resection of the fifth metacarpals (except at the base) and partial excision of the surrounding muscles done. The capsule and collateral ligament of the fifth metacarpophalangeal joint were left. The fourth metatarsal was harvested from the foot along with its capsule and collateral ligament of the metatarsophalangeal joint and sutured to the counter capsuloligamentous structure at the recipient site.", "extra_info": {"index": 163, "original_id": "multiclinsum_test_2668_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "In this report, we present the case of an RSV-associated death of a child who was born at full-term and developed normally up to the age of 2 years old. Cardiopulmonary arrest occurred within 3 days after the onset of symptoms, which included cough and high fever. Complete brain edema was prominent, and encephalopathy was developing. Viral antigen detection and microbiome analyses of oral swab and nasopharyngeal aspirate specimens verified an RSV infection, while bacterial culture of blood specimens yielded negative results. The RSV strain detected in this patient was subtyped as RSVB9, and no mutation was found in the six antigenic sites for targeted drugs or vaccines.", "extra_info": {"index": 161, "original_id": "multiclinsum_test_3147_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We present the case of a middle-aged patient diagnosed with a giant gastric GIST, which presented for intermittent gastric outlet obstruction symptoms, and emphasize the major imagistic, histopathological, and therapeutic challenges that may be encountered. There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction. Tumor resection should be adapted to every patient's status, focused on en bloc extraction, with preservation of invaded organs as much as possible.", "extra_info": {"index": 169, "original_id": "multiclinsum_test_1842_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 71-year-old female who was being treated for type 2 diabetes with canagliflozin, metformin, and saxagliptin orally presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain. Although her blood glucose was not severely elevated (259 mg/dL), there was notable ketoacidosis (pH\u20096.89; CO2, 11.4\u2009mmHg; HCO3, 1.9\u2009mEq/L; base excess, - 31.3\u2009mmol/L; 3-hydroxybutyric acid > 10,000\u2009\u03bcmol/L) was observed. The uncontrolled acidosis improved following 3\u2009days of continuous renal replacement therapy, but elevated urinary glucose continued for more than 10\u2009days. Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria. Urinary glucose turned negative on day 16, and there was improvement in the patient's overall state; hence, she was discharged on day 18.", "extra_info": {"index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "A 27-year-old male with a relapsed acute lymphoblastic leukemia presented with five-day-old polyarthralgia. He also had febrile neutropenia, cellulitis without abscesses, and methicillin-resistant Staphylococcus aureus bacteremia for which he received therapy with oxacillin and cefepime. However, the febrile neutropenia persisted, and an invasive fungal infection was suspected. A new set of blood cultures was taken and antifungal treatment was initiated. Arthroconidia were identified in the blood cultures and a matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp. Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B and four weeks of voriconazole. After a prolonged stay, he was discharged.\n", "extra_info": {"index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": "We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine. The patient is a 29-year-old female who received manipulation one week prior to developing symptoms of severe orthostatic headache, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection. Symptomatic onset corresponded with the recent cervical chiropractic adjustment. We present serial imaging correlating with her symptomatology and review the pertinent literature on complications of chiropractic manipulation.", "extra_info": {"index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We presented an interesting case of a 33-year-old female with a solitary polypoid nodule without apparent pigmentation on her vulvar skin. Her medical history was unclear, no ulcer was seen in the lesion area, and dermatoscopy was indicated a possible tumorous change, which has caught the attention of clinicians, and then further examined by the pathologist. The final diagnosis was nodular malignant melanoma (NM) (Breslow thickness 9.5mm, Clark level 4).", "extra_info": {"index": 156, "original_id": "multiclinsum_test_1142_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "52-year-old female patient who reported chronic, burning pain radiating to the distal phalanx of the thumb with no traumatic history, which had been present for two years and limited her daily activities. The exploration was complemented with interphalangeal Doppler ultrasound, which is an excellent alternative due to its easy accessibility. A glomus tumor in the interphalangeal phalanx of the thumb was diagnosed. A H-approach was performed on the interphalangeal fold with subungual dissection and resection of the tumoral piece and follow-up by an external consultation where the surgical wound was found to be healing adequately. Physical exploration with the ability to mobilize the interphalangeal distal joint (IFD) and visual analogue scale (VAS) of 1 point. The anatomopathological evaluation reported the existence of a glomus tumor.\n", "extra_info": {"index": 158, "original_id": "multiclinsum_test_3249_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka presented with high fever with malaise, myalgia and arthralgia for 17 days. On the 5th day of illness he developed intermittent resting tremor in his right arm and leg associated with stiffness, difficulty in carrying out normal work and difficulty in smiling. He denied similar previous episodes. There were no other associated neurological manifestations. Clinical examination revealed a high amplitude low frequency resting tremor in his right hand, a mask-like face and increased muscle tone limited to the right side with normal reflexes. The rest of the system examination was normal except for an eschar over the abdomen. His investigations revealed lymphocytic leukocytosis, high erythrocyte sedimentation rate and immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers. With oral doxycycline and azithromycin his fever settled within 48 h and a complete recovery of Parkinson's features was observed within 2 weeks.", "extra_info": {"index": 155, "original_id": "multiclinsum_test_146_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 39-year-old woman, who visited to our hospital complaining of worsened right low back pain and fever, was diagnosed with right hydronephrosis due to ureteropelvic junction obstruction by contrast-enhanced computed tomography. Intraoperatively before the planned robot-assisted laparoscopic pyeloplasty, retrograde pyelography was performed to reveal concomitant ipsilateral retrocaval ureter. Laparoscopically, ureteropelvic junction obstruction due to aberrant blood vessel and coexisting retrocaval ureter was confirmed. Transposition of the ureter from posterior to anterior of the inferior vena cava and following dismembered pyeloplasty was performed. Two years after surgery, her right hydronephrosis improved and she had no complain of any symptom.", "extra_info": {"index": 162, "original_id": "multiclinsum_test_1681_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "A 15-year-old boy who was previously diagnosed with SRU presented to our office with rectal bleeding, mucoid discharge, and abdominal pain. Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum. Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma, indicating that SRU had transformed into CP. Based on the assessments, we planned to perform endoscopic mucosal resection of the lesions in multiple sessions.", "extra_info": {"index": 164, "original_id": "multiclinsum_test_2219_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We present a case of 62-year-old male who presented after experiencing syncope and cardiac arrest. Given the clinical presentation and electrocardiographic findings, there was concern for acute coronary syndrome. However, coronary angiogram did not reveal significant coronary obstruction. Due to the unclear nature of his presentation, a bedside echocardiogram was rapidly performed and was indicative of right ventricular strain. Due to these findings, a pulmonary angiogram was performed that revealed massive pulmonary embolism. He successfully underwent catheter-directed thrombolysis and, after a prolonged hospital stay, was discharged home on lifelong anticoagulation.", "extra_info": {"index": 168, "original_id": "multiclinsum_test_2976_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.", "extra_info": {"index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report the case of a 51-year-old Caucasian woman who presented with SAPHO syndrome with mainly axial involvement. She had been treated with sulfasalazine and anti-inflammatory drugs for many years without any success. A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved. Imaging also showed considerable regression of the vertebral and pelvic lesions. However, tofacitinib had to be discontinued due to the occurrence of pulmonary embolism. Consequently, recurrence of bone pain and biologic inflammation was rapidly observed.", "extra_info": {"index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum \u03b2-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar.", "extra_info": {"index": 166, "original_id": "multiclinsum_test_2114_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "We report a 53-year-old female from a rural area in China who was hospitalized for lower limb edema, abdominal distension, cirrhosis, and hypothyroidism. We excluded the common causes of liver disease (drinking alcohol, using traditional Chinese medicines, hepatitis virus infection, autoimmunity, and hepatolenticular degeneration). When she was 23-years-old, she developed night-blindness that worsened to complete blindness, with no obvious cause. Her parents were first cousins, and both were alive. Analysis of the patient's family history indicated that all 5 siblings had night blindness and impaired vision; one sister was completely blind; and another sister had night-blindness complicated with cirrhosis and subclinical hypothyroidism. Entire exome sequencing showed that the patient, parents, and siblings all had mutations in the cytochrome P450 4V2 gene (CYP4V2). The CYP4V2 mutations of the parents and two sisters were heterozygous, and the others were homozygous. Two siblings also had heterozygous dual oxidase activator 2 (DUOXA2) mutations.", "extra_info": {"index": 160, "original_id": "multiclinsum_test_2430_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying etiologies such as diabetes, hypertension, and glomerular injury, with biomarkers like estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) serving as key indicators of disease severity and progression. Management strategies include pharmacological interventions, blood pressure control, dietary modifications, and monitoring of renal function over time to prevent end-stage renal disease (ESRD).\"\n}", "ground_truth": "Herein we present a 63-year-old man with idiopathic spontaneous intraperitoneal hemorrhage (ISIH) caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenalartery (IPDA).", "extra_info": {"index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 75-year-old man.", "The patient presented with fever.", "The patient presented with right chest pain.", "The blood biochemical tests showed lactate dehydrogenase (LDH) of 251 IU/L.", "The blood biochemical tests showed alkaline phosphatase (ALP) of 469 IU/L.", "The blood biochemical tests showed gamma-glutamyl transferase (\u03b3-GTP) of 125 IU/L.", "The blood biochemical tests showed creatinine (Cre) of 1.43 mg/dL.", "The blood biochemical tests showed C-reactive protein (CRP) of 3.04 mg/dL.", "The blood biochemical tests showed squamous cell carcinoma-related antigen (SCC) of 1.8 ng/mL.", "The blood biochemical tests showed nerve specific enolase (NSE) of 21.6 ng/mL.", "The blood biochemical tests showed soluble interleukin-2 receptor (SIL-2R) of 614 U/mL.", "Computed tomography (CT) showed a huge 10-cm mass under the right diaphragm.", "The tumor showed minor enhancement in the lower density areas close to the fat.", "The tumor showed gradual, heterogeneous mild enhancement of tumor and liver margins.", "The main feeder for the tumor is the right inferior phrenic artery.", "The tumor was supposed to be a sarcomatoid malignancy originating from the diaphragm.", "No findings were suggesting obvious pulmonary invasion.", "Magnetic resonance imaging (MRI) demonstrated heterogeneous high signal intensity on T2-weighted images (T2WI).", "Magnetic resonance imaging (MRI) demonstrated heterogeneous high signal intensity on diffusion-weighted images (DWI).", "Contrast-enhanced MRI showed gradual heterogeneous enhancement similar to CT findings.", "Findings of extrahepatic development were also obtained.", "The possibility of adhesion to the liver was suspected.", "Fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed abnormal uptake in the tumor with a maximal standardized uptake value (SUVmax) of 4.6.", "The uptake was not so high.", "A myxoid type sarcoma, such as myxoid liposarcoma, or benign tumor was considered.", "A definitive diagnosis could not be achieved.", "We scheduled a diaphragmatic resection for suspicion of benign tumors of the diaphragm.", "We performed extended right posterior segmentectomy with combined resection of the diaphragm.", "The total operation time was 8 h 10 m.", "The total blood loss was 1459 mL.", "The major diameter of the diaphragmatic defect was 12 cm.", "Simple closure was possible.", "The patient\u2019s postoperative course was uneventful.", "The patient was discharged 14 days after surgery.", "Pathological findings showed the mass was located just below the hepatic capsule/intraparenchymal space.", "The mass was adherent to the diaphragm.", "There was no continuity with the diaphragm.", "Mitosis was unremarkable, about 0\u20131 cells/10 HPF.", "The morphology suggested low-grade mesenchymal tumors such as solitary fibrous tumor (SFT) and perivascular epithelioid cell tumor (PEComa).", "Immunostaining was negative for these tumors.", "The diagnosis was difficult.", "The tumor was diagnosed as a spindle cell tumor with smooth muscle differentiation.", "The diagnosis was based on positive results of myosin markers such as \u03b1SMA, desmin, and h-caldesmon.", "Some areas with high proliferative activity were observed.", "1 year has passed since the surgery with no recurrence."], "summary_subclaims": ["A 75-year-old man presented with fever and right chest pain.", "He was suspected of a giant primary diaphragmatic tumor of extrahepatic origin by imaging studies.", "The preoperative differential diagnosis included benign masses such as myxoid sarcoma and schwannoma.", "We planned a diaphragmatic resection.", "Intraoperatively, dissection of the tumor from the liver was not possible.", "An extended right posterior segmentectomy with combined resection of the diaphragm was required.", "The patient had a good postoperative course.", "One year has passed since the surgery with no recurrence.", "The mass was located just below the hepatic capsule/parenchymal region.", "The mass was adherent to the diaphragm, but there was no continuity.", "The morphology suggested a low-grade mesenchymal tumor such as a solitary fibrous tumor and perivascular epithelioid cell tumor.", "Immunostaining was negative.", "Some areas of high proliferative activity were observed.", "The diagnosis of primary spindle cell tumor of the liver with smooth muscle differentiation was made.", "The diagnosis was based on the positive results of muscle markers such as \u03b1SMA, desmin, and h-caldesmon."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 75-year-old man.", "The patient presented with fever.", "The patient presented with right chest pain.", "The blood biochemical tests showed lactate dehydrogenase (LDH) of 251 IU/L.", "The blood biochemical tests showed alkaline phosphatase (ALP) of 469 IU/L.", "The blood biochemical tests showed gamma-glutamyl transferase (\u03b3-GTP) of 125 IU/L.", "The blood biochemical tests showed creatinine (Cre) of 1.43 mg/dL.", "The blood biochemical tests showed C-reactive protein (CRP) of 3.04 mg/dL.", "The blood biochemical tests showed squamous cell carcinoma-related antigen (SCC) of 1.8 ng/mL.", "The blood biochemical tests showed nerve specific enolase (NSE) of 21.6 ng/mL.", "The blood biochemical tests showed soluble interleukin-2 receptor (SIL-2R) of 614 U/mL.", "Computed tomography (CT) showed a huge 10-cm mass under the right diaphragm.", "The tumor showed minor enhancement in the lower density areas close to the fat.", "The tumor showed gradual, heterogeneous mild enhancement of tumor and liver margins.", "The main feeder for the tumor is the right inferior phrenic artery.", "The tumor was supposed to be a sarcomatoid malignancy originating from the diaphragm.", "No findings were suggesting obvious pulmonary invasion.", "Magnetic resonance imaging (MRI) demonstrated heterogeneous high signal intensity on T2-weighted images (T2WI).", "Magnetic resonance imaging (MRI) demonstrated heterogeneous high signal intensity on diffusion-weighted images (DWI).", "Contrast-enhanced MRI showed gradual heterogeneous enhancement similar to CT findings.", "Findings of extrahepatic development were also obtained.", "The possibility of adhesion to the liver was suspected.", "Fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed abnormal uptake in the tumor with a maximal standardized uptake value (SUVmax) of 4.6.", "The uptake was not so high.", "A myxoid type sarcoma, such as myxoid liposarcoma, or benign tumor was considered.", "A definitive diagnosis could not be achieved.", "We scheduled a diaphragmatic resection for suspicion of benign tumors of the diaphragm.", "We performed extended right posterior segmentectomy with combined resection of the diaphragm.", "The total operation time was 8 h 10 m.", "The total blood loss was 1459 mL.", "The major diameter of the diaphragmatic defect was 12 cm.", "Simple closure was possible.", "The patient\u2019s postoperative course was uneventful.", "The patient was discharged 14 days after surgery.", "Pathological findings showed the mass was located just below the hepatic capsule/intraparenchymal space.", "The mass was adherent to the diaphragm.", "There was no continuity with the diaphragm.", "Mitosis was unremarkable, about 0\u20131 cells/10 HPF.", "The morphology suggested low-grade mesenchymal tumors such as solitary fibrous tumor (SFT) and perivascular epithelioid cell tumor (PEComa).", "Immunostaining was negative for these tumors.", "The diagnosis was difficult.", "The tumor was diagnosed as a spindle cell tumor with smooth muscle differentiation.", "The diagnosis was based on positive results of myosin markers such as \u03b1SMA, desmin, and h-caldesmon.", "Some areas with high proliferative activity were observed.", "1 year has passed since the surgery with no recurrence."], "index": 25, "original_id": "multiclinsum_test_447_en.txt", "split": "test", "summary_subclaims": ["A 75-year-old man presented with fever and right chest pain.", "He was suspected of a giant primary diaphragmatic tumor of extrahepatic origin by imaging studies.", "The preoperative differential diagnosis included benign masses such as myxoid sarcoma and schwannoma.", "We planned a diaphragmatic resection.", "Intraoperatively, dissection of the tumor from the liver was not possible.", "An extended right posterior segmentectomy with combined resection of the diaphragm was required.", "The patient had a good postoperative course.", "One year has passed since the surgery with no recurrence.", "The mass was located just below the hepatic capsule/parenchymal region.", "The mass was adherent to the diaphragm, but there was no continuity.", "The morphology suggested a low-grade mesenchymal tumor such as a solitary fibrous tumor and perivascular epithelioid cell tumor.", "Immunostaining was negative.", "Some areas of high proliferative activity were observed.", "The diagnosis of primary spindle cell tumor of the liver with smooth muscle differentiation was made.", "The diagnosis was based on the positive results of muscle markers such as \u03b1SMA, desmin, and h-caldesmon."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 33-year-old woman.", "She was referred to the department with unstable angina.", "At the age of six, she underwent CABG to the second diagonal branch using the left internal thoracic artery.", "At the age of six, she underwent CABG to the obtuse marginal branch using a saphenous vein graft.", "At the age of six, she underwent mitral annuloplasty.", "The initial CABG was performed for congenital LMCA.", "The initial CABG was performed for moderate mitral regurgitation.", "After the initial operation, 18 years passed without any signs of angina.", "At the age of 24, she started to experience occasional chest pain on exertion.", "By the age of 32, the chest pain had become more frequent.", "Exercise stress myocardial perfusion scintigraphy revealed an extensive ischemic lesion on the left ventricular anterior wall.", "A coronary angiogram showed a patent LITA to the second diagonal branch.", "A coronary angiogram showed a patent SVG to the obtuse marginal branch.", "The LAD was not perfused by the LITA.", "The LAD was mainly supplied by collateral flow from the right coronary artery.", "Multidetector-row computed tomography demonstrated a disruption of blood flow to the LAD from the LITA.", "The disruption of blood flow to the LAD was due to an occlusion of the proximal part of the second diagonal branch.", "To improve the ischemia of the LAD lesion, a redo CABG using the right internal thoracic artery was performed.", "The distal LAD was too small to be grafted.", "The proximal LAD was deep in the myocardium.", "A bypass was performed to the first diagonal branch, which was connected to the LAD.", "Postoperative coronary angiogram showed that all bypass grafts, including the RITA, were patent.", "Postoperative coronary angiogram showed blood flow communication between the first diagonal branch and the LAD.", "Pharmacologic stress perfusion scintigraphy revealed an improvement in the ischemia, especially in the left intraventricular septum.", "The patient\u2019s symptoms improved.", "She was discharged 10 days after surgery.", "She has been in good health for over 3 years without recurrence of chest symptoms."], "summary_subclaims": ["The patient is a 33-year-old woman.", "She was referred to the department with unstable angina.", "At the age of 6, she had undergone coronary artery bypass grafting of the second diagonal branch using the left internal thoracic artery.", "At the age of 6, she had undergone coronary artery bypass grafting of the obtuse marginal branch using saphenous vein grafting.", "The bypass grafting at age 6 was performed for left main coronary atresia.", "A coronary angiogram showed a patent left internal thoracic artery graft to the second diagonal branch.", "A coronary angiogram showed a patent saphenous vein graft to the obtuse marginal branch.", "The left anterior descending artery was not being perfused by the grafts.", "The disruption of blood flow to the left anterior descending artery was from the left internal thoracic artery.", "We performed a redo coronary artery bypass grafting using the in situ right internal thoracic artery to the first diagonal branch.", "The graft was to be connected to the left anterior descending artery.", "The redo bypass grafting resulted in amelioration of the ischemia of the left anterior wall.", "The patient was discharged 10 days after the operation.", "The patient has been in good health for over 3 years without recurrence of chest symptoms."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 33-year-old woman.", "She was referred to the department with unstable angina.", "At the age of six, she underwent CABG to the second diagonal branch using the left internal thoracic artery.", "At the age of six, she underwent CABG to the obtuse marginal branch using a saphenous vein graft.", "At the age of six, she underwent mitral annuloplasty.", "The initial CABG was performed for congenital LMCA.", "The initial CABG was performed for moderate mitral regurgitation.", "After the initial operation, 18 years passed without any signs of angina.", "At the age of 24, she started to experience occasional chest pain on exertion.", "By the age of 32, the chest pain had become more frequent.", "Exercise stress myocardial perfusion scintigraphy revealed an extensive ischemic lesion on the left ventricular anterior wall.", "A coronary angiogram showed a patent LITA to the second diagonal branch.", "A coronary angiogram showed a patent SVG to the obtuse marginal branch.", "The LAD was not perfused by the LITA.", "The LAD was mainly supplied by collateral flow from the right coronary artery.", "Multidetector-row computed tomography demonstrated a disruption of blood flow to the LAD from the LITA.", "The disruption of blood flow to the LAD was due to an occlusion of the proximal part of the second diagonal branch.", "To improve the ischemia of the LAD lesion, a redo CABG using the right internal thoracic artery was performed.", "The distal LAD was too small to be grafted.", "The proximal LAD was deep in the myocardium.", "A bypass was performed to the first diagonal branch, which was connected to the LAD.", "Postoperative coronary angiogram showed that all bypass grafts, including the RITA, were patent.", "Postoperative coronary angiogram showed blood flow communication between the first diagonal branch and the LAD.", "Pharmacologic stress perfusion scintigraphy revealed an improvement in the ischemia, especially in the left intraventricular septum.", "The patient\u2019s symptoms improved.", "She was discharged 10 days after surgery.", "She has been in good health for over 3 years without recurrence of chest symptoms."], "index": 31, "original_id": "multiclinsum_test_2205_en.txt", "split": "test", "summary_subclaims": ["The patient is a 33-year-old woman.", "She was referred to the department with unstable angina.", "At the age of 6, she had undergone coronary artery bypass grafting of the second diagonal branch using the left internal thoracic artery.", "At the age of 6, she had undergone coronary artery bypass grafting of the obtuse marginal branch using saphenous vein grafting.", "The bypass grafting at age 6 was performed for left main coronary atresia.", "A coronary angiogram showed a patent left internal thoracic artery graft to the second diagonal branch.", "A coronary angiogram showed a patent saphenous vein graft to the obtuse marginal branch.", "The left anterior descending artery was not being perfused by the grafts.", "The disruption of blood flow to the left anterior descending artery was from the left internal thoracic artery.", "We performed a redo coronary artery bypass grafting using the in situ right internal thoracic artery to the first diagonal branch.", "The graft was to be connected to the left anterior descending artery.", "The redo bypass grafting resulted in amelioration of the ischemia of the left anterior wall.", "The patient was discharged 10 days after the operation.", "The patient has been in good health for over 3 years without recurrence of chest symptoms."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 25-year-old male.", "He presented to an outside emergency department with a five-day history of cough.", "He had a five-day history of shortness of breath.", "He had a five-day history of nasal congestion.", "He had a five-day history of fatigue.", "He had a five-day history of loss of taste and smell.", "He had a past medical history of asthma.", "He had morbid obesity with a BMI of 50.5 kg/m2.", "He had no known connective tissue disease.", "He had no known hypertrophic scarring reactions.", "He had a 2-year history of vaping.", "He quit vaping one month prior to presentation.", "He had a positive COVID-19 test three days prior to admission.", "He was hypoxic to 88% on room air in the ED.", "He improved to 90% saturation on 3 L nasal cannula.", "Venous blood gas revealed a normal venous pH of 7.4.", "Venous blood gas revealed an increased PCO2 of 50.", "Chest x-ray revealed bilateral airspace disease consistent with known COVID-19 infection.", "He was admitted to the MICU.", "He was treated with Remdesivir.", "He was treated with high dose steroids.", "He became febrile to 102.9 F.", "He required 15 L O2 via high-flow nasal cannula.", "D-dimer was normal at 0.28.", "His respiratory status continued to decline over the night of admission.", "He required BiPAP with a minute volume of 25 L.", "He required BiPAP with a respiratory rate of 40.", "He required intubation.", "He was started on ceftriaxone due to SIRS criteria.", "He was started on azithromycin due to SIRS criteria.", "He was started on ceftriaxone due to an elevated procalcitonin.", "He was started on azithromycin due to an elevated procalcitonin.", "Oxygen saturation was 92% on 100% FiO2 via ventilator.", "Repeat CXR revealed diffuse bilateral interstitial infiltrates.", "A SARS-COV-2-IGG antibody was non-reactive.", "He received a transfusion of convalescent plasma.", "Oxygen saturation was 53% despite maximal ventilatory support.", "He was transferred to our institution for ECMO consideration.", "Upon arrival, he went directly to the hybrid operating room.", "He underwent unremarkable cannulation with no repositioning required.", "He was supported on V-V ECMO for 14 days.", "He was weaned gradually from the circuit for bedside decannulation on POD 16.", "He was maintained on heparin for anticoagulation.", "Chart review showed he was never subtherapeutic on unfractionated heparin.", "Attempts to remove the cannula at the bedside failed due to immobility of the cannula.", "An ultrasound of the right neck was unremarkable.", "A longitudinal cutdown from the insertion site proceeding caudally was performed.", "The cannula was freely mobile to the level of the first rib and clavicle.", "The cannula was not obstructing the vein.", "An upper sternotomy, confined to the manubrium, was performed.", "The superior vena cava and proximal jugular vein were dissected.", "A 2 cm segment of the distal SVC and proximal jugular vein was densely sclerosed and adherent to the cannula.", "The vessel was opened across the adherent area at the level of the innominate vein.", "The cannula was then able to be withdrawn without difficulty.", "There was no evidence of thrombosis at the site of cannula adhesion.", "There was no evidence of scarring at the site of cannula adhesion.", "There was no evidence of local inflammation at the site of cannula adhesion.", "The distal SVC was repaired to the level of the innominate vein entry to the SVC.", "The jugular vein was ligated proximally and distally.", "The patient suffered no ill effects.", "The patient had an unremarkable recovery to discharge.", "Clinic follow-up demonstrated no sequelae or serious adverse events.", "The Crescent catheter was examined by pathology at our institution.", "The Crescent catheter was returned to the company.", "Neither the catheter nor the company found any defects.", "At our institution, we use Avalon, Crescent, and ProTek Duo cannulas.", "We have never experienced adhesions with any of the cannulas."], "summary_subclaims": ["The patient was a 25 y.o. with COVID-19 respiratory failure.", "The patient required ECMO support for 16-days.", "A 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein.", "Attempts to remove the cannula at the bedside failed due to immobility of the cannula.", "Ultrasound of the right neck was unremarkable.", "The patient was taken to the hybrid OR.", "TEE and fluoroscopy were unrevealing.", "An upper sternotomy was performed.", "The superior vena cava and proximal jugular vein were dissected.", "A 2 cm segment of the distal SVC and proximal jugular vein was densely sclerosed and adherent to the cannula.", "The vessel was opened across the adherent area at the level of the innominate vein.", "The cannula was then able to be withdrawn.", "The patient suffered no ill effects.", "The patient had an unremarkable recovery to discharge."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 25-year-old male.", "He presented to an outside emergency department with a five-day history of cough.", "He had a five-day history of shortness of breath.", "He had a five-day history of nasal congestion.", "He had a five-day history of fatigue.", "He had a five-day history of loss of taste and smell.", "He had a past medical history of asthma.", "He had morbid obesity with a BMI of 50.5 kg/m2.", "He had no known connective tissue disease.", "He had no known hypertrophic scarring reactions.", "He had a 2-year history of vaping.", "He quit vaping one month prior to presentation.", "He had a positive COVID-19 test three days prior to admission.", "He was hypoxic to 88% on room air in the ED.", "He improved to 90% saturation on 3 L nasal cannula.", "Venous blood gas revealed a normal venous pH of 7.4.", "Venous blood gas revealed an increased PCO2 of 50.", "Chest x-ray revealed bilateral airspace disease consistent with known COVID-19 infection.", "He was admitted to the MICU.", "He was treated with Remdesivir.", "He was treated with high dose steroids.", "He became febrile to 102.9 F.", "He required 15 L O2 via high-flow nasal cannula.", "D-dimer was normal at 0.28.", "His respiratory status continued to decline over the night of admission.", "He required BiPAP with a minute volume of 25 L.", "He required BiPAP with a respiratory rate of 40.", "He required intubation.", "He was started on ceftriaxone due to SIRS criteria.", "He was started on azithromycin due to SIRS criteria.", "He was started on ceftriaxone due to an elevated procalcitonin.", "He was started on azithromycin due to an elevated procalcitonin.", "Oxygen saturation was 92% on 100% FiO2 via ventilator.", "Repeat CXR revealed diffuse bilateral interstitial infiltrates.", "A SARS-COV-2-IGG antibody was non-reactive.", "He received a transfusion of convalescent plasma.", "Oxygen saturation was 53% despite maximal ventilatory support.", "He was transferred to our institution for ECMO consideration.", "Upon arrival, he went directly to the hybrid operating room.", "He underwent unremarkable cannulation with no repositioning required.", "He was supported on V-V ECMO for 14 days.", "He was weaned gradually from the circuit for bedside decannulation on POD 16.", "He was maintained on heparin for anticoagulation.", "Chart review showed he was never subtherapeutic on unfractionated heparin.", "Attempts to remove the cannula at the bedside failed due to immobility of the cannula.", "An ultrasound of the right neck was unremarkable.", "A longitudinal cutdown from the insertion site proceeding caudally was performed.", "The cannula was freely mobile to the level of the first rib and clavicle.", "The cannula was not obstructing the vein.", "An upper sternotomy, confined to the manubrium, was performed.", "The superior vena cava and proximal jugular vein were dissected.", "A 2 cm segment of the distal SVC and proximal jugular vein was densely sclerosed and adherent to the cannula.", "The vessel was opened across the adherent area at the level of the innominate vein.", "The cannula was then able to be withdrawn without difficulty.", "There was no evidence of thrombosis at the site of cannula adhesion.", "There was no evidence of scarring at the site of cannula adhesion.", "There was no evidence of local inflammation at the site of cannula adhesion.", "The distal SVC was repaired to the level of the innominate vein entry to the SVC.", "The jugular vein was ligated proximally and distally.", "The patient suffered no ill effects.", "The patient had an unremarkable recovery to discharge.", "Clinic follow-up demonstrated no sequelae or serious adverse events.", "The Crescent catheter was examined by pathology at our institution.", "The Crescent catheter was returned to the company.", "Neither the catheter nor the company found any defects.", "At our institution, we use Avalon, Crescent, and ProTek Duo cannulas.", "We have never experienced adhesions with any of the cannulas."], "index": 29, "original_id": "multiclinsum_test_2039_en.txt", "split": "test", "summary_subclaims": ["The patient was a 25 y.o. with COVID-19 respiratory failure.", "The patient required ECMO support for 16-days.", "A 32 Fr crescent cannula became adherent to the SVC and proximal jugular vein.", "Attempts to remove the cannula at the bedside failed due to immobility of the cannula.", "Ultrasound of the right neck was unremarkable.", "The patient was taken to the hybrid OR.", "TEE and fluoroscopy were unrevealing.", "An upper sternotomy was performed.", "The superior vena cava and proximal jugular vein were dissected.", "A 2 cm segment of the distal SVC and proximal jugular vein was densely sclerosed and adherent to the cannula.", "The vessel was opened across the adherent area at the level of the innominate vein.", "The cannula was then able to be withdrawn.", "The patient suffered no ill effects.", "The patient had an unremarkable recovery to discharge."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["On the 5th of August, 2020, a 58-year-old woman presented in our emergency department with seizures and hemiparesis.", "She had a prior fever, malaise, and dry cough a week before admission.", "She has had a history of hypertension since a year ago.", "The vital sign is within normal limit except the blood pressure is 170/110 mmHg.", "The results of the laboratory test were high blood glucose 254 mg/dL and HbA1C 6.5%.", "Leukocytosis with white blood cells (WBC) was 14/L and neutrophil-lymphocyte ratio (NLR) was 33.", "Increase level of erythrocyte sedimentation rate (ESR) 93 mm/h, D-dimer 21,176 ng/mL, and fibrinogen 446 mg/dL.", "The result of the reverse transcription-polymerase chain reaction (rt-PCR) test from the nasal swab was observed to be positive for SARS-CoV-2.", "Head contrast computed tomography (HCCT) showed cerebral edema at the right parietal lobe.", "There were hyperdense veins and sinuses at the right parietal lobe area, superior sagittal sinus (SSS), and bilateral transverse sinuses (TS), which suggested the presence of a cerebral sinus venous thrombosis (CSVT), with a sign of venal hypertension.", "CT venography (CTV) was also confirmed CSVT at SSS, bilateral TS, and bilateral sigmoid sinus.", "The thorax CT scan showed ground-glass opacity and subpleural bilateral, with a fibrotic appearance in the left lung.", "During the patient\u2019s treatment of COVID-19, 60 mg subcutaneous enoxaparin was administered twice daily, for 5 days.", "On the 5th day of treatment, D-dimer was decreased to 2092 ng/ml.", "The decision was made to continue with enoxaparin until the normal D-dimer or the patient\u2019s negative status for the COVID-19 virus is attained.", "Other clinical manifestations also improved and the patient was discharged from the hospital on the 10th day.", "The second case, a 72-year-old male, was consulted from the intensive care unit (ICU) because of sudden decreases in consciousness.", "He had a history of high fever, dry cough, and shortness of breath a week before hospitalization.", "The patient was being treated as severe COVID-19 with ARDS for 10 days in ICU.", "He had no previous history of hypertension, diabetes mellitus, or cardiovascular disease.", "He already received heparin intravenously for 10 days and halted, due to good recovery of shortness of breath and hypoxemia.", "A day after heparin cessation, the patient suddenly unconscious and intubated due to severe hypoxia.", "Upon examination, his consciousness is coma with a slow response to the light of both eyes.", "He had hypothermia with a temperature of 35.4 \u00b0C, blood pressure of 140/69 mmHg on vasoconstrictor epinephrine support, and 90% oxygen saturation.", "Laboratory test showed, critical increase level of WBC (53.09 \u00d7 103/L) and NLR 58.1.", "We did not do a peripheral blood smear to examine any hematological disorder.", "Coagulation function tests were APTT 20.2 s, PT 11.9 s, INR 1.11, D-dimer 5.308 ng/mL (previous was > 50,000), and fibrinogen 525 mg/dL.", "The rt-PCR test from a nasopharyngeal swab sample was negative for SARS-CoV-2 on the 11th day.", "Head non-contrast computed tomography (NCCT) showed hyperdense at superior sagittal sinus and right transverse sinuses, which suggested the manifestations of CSVT.", "There was associated cerebral edema at the left frontal, parietal lobe, and cerebellum.", "Thorax CT scan showed ground-glass opacity and subpleural bilateral with the fibrotic appearance in both lung and pulmonary angiography.", "Thrombosis at segments 8 and 9 of both lungs was also observed.", "The pulmonary CT-angiography (CTA) results were pulmonary embolism and thrombosis of both the left and right pulmonary arteries.", "Due to the massive thrombosis, a decision was made to administer streptokinase and heparin, to the patient intravenously.", "After 3 days of this treatment, the patient became desaturated (40% oxygen saturation) with spontaneous pneumothorax and passed away the next day."], "summary_subclaims": ["Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported.", "The cases were following respiratory, hematology, and coagulation disarrangements.", "The disarrangements were triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.", "The first patient was presented with a seizure.", "The first patient had hypertension as a comorbidity.", "The first patient had diabetes mellitus as a comorbidity.", "The latter case had no comorbidity.", "The latter case showed more severe presentations of COVID-19 such as brain and lung thrombosis.", "The latter case already had several days of intravenous anticoagulant administrations.", "These two cases also have a different course of disease and outcomes."]}, "extra_info": {"fulltext_subclaims": ["On the 5th of August, 2020, a 58-year-old woman presented in our emergency department with seizures and hemiparesis.", "She had a prior fever, malaise, and dry cough a week before admission.", "She has had a history of hypertension since a year ago.", "The vital sign is within normal limit except the blood pressure is 170/110 mmHg.", "The results of the laboratory test were high blood glucose 254 mg/dL and HbA1C 6.5%.", "Leukocytosis with white blood cells (WBC) was 14/L and neutrophil-lymphocyte ratio (NLR) was 33.", "Increase level of erythrocyte sedimentation rate (ESR) 93 mm/h, D-dimer 21,176 ng/mL, and fibrinogen 446 mg/dL.", "The result of the reverse transcription-polymerase chain reaction (rt-PCR) test from the nasal swab was observed to be positive for SARS-CoV-2.", "Head contrast computed tomography (HCCT) showed cerebral edema at the right parietal lobe.", "There were hyperdense veins and sinuses at the right parietal lobe area, superior sagittal sinus (SSS), and bilateral transverse sinuses (TS), which suggested the presence of a cerebral sinus venous thrombosis (CSVT), with a sign of venal hypertension.", "CT venography (CTV) was also confirmed CSVT at SSS, bilateral TS, and bilateral sigmoid sinus.", "The thorax CT scan showed ground-glass opacity and subpleural bilateral, with a fibrotic appearance in the left lung.", "During the patient\u2019s treatment of COVID-19, 60 mg subcutaneous enoxaparin was administered twice daily, for 5 days.", "On the 5th day of treatment, D-dimer was decreased to 2092 ng/ml.", "The decision was made to continue with enoxaparin until the normal D-dimer or the patient\u2019s negative status for the COVID-19 virus is attained.", "Other clinical manifestations also improved and the patient was discharged from the hospital on the 10th day.", "The second case, a 72-year-old male, was consulted from the intensive care unit (ICU) because of sudden decreases in consciousness.", "He had a history of high fever, dry cough, and shortness of breath a week before hospitalization.", "The patient was being treated as severe COVID-19 with ARDS for 10 days in ICU.", "He had no previous history of hypertension, diabetes mellitus, or cardiovascular disease.", "He already received heparin intravenously for 10 days and halted, due to good recovery of shortness of breath and hypoxemia.", "A day after heparin cessation, the patient suddenly unconscious and intubated due to severe hypoxia.", "Upon examination, his consciousness is coma with a slow response to the light of both eyes.", "He had hypothermia with a temperature of 35.4 \u00b0C, blood pressure of 140/69 mmHg on vasoconstrictor epinephrine support, and 90% oxygen saturation.", "Laboratory test showed, critical increase level of WBC (53.09 \u00d7 103/L) and NLR 58.1.", "We did not do a peripheral blood smear to examine any hematological disorder.", "Coagulation function tests were APTT 20.2 s, PT 11.9 s, INR 1.11, D-dimer 5.308 ng/mL (previous was > 50,000), and fibrinogen 525 mg/dL.", "The rt-PCR test from a nasopharyngeal swab sample was negative for SARS-CoV-2 on the 11th day.", "Head non-contrast computed tomography (NCCT) showed hyperdense at superior sagittal sinus and right transverse sinuses, which suggested the manifestations of CSVT.", "There was associated cerebral edema at the left frontal, parietal lobe, and cerebellum.", "Thorax CT scan showed ground-glass opacity and subpleural bilateral with the fibrotic appearance in both lung and pulmonary angiography.", "Thrombosis at segments 8 and 9 of both lungs was also observed.", "The pulmonary CT-angiography (CTA) results were pulmonary embolism and thrombosis of both the left and right pulmonary arteries.", "Due to the massive thrombosis, a decision was made to administer streptokinase and heparin, to the patient intravenously.", "After 3 days of this treatment, the patient became desaturated (40% oxygen saturation) with spontaneous pneumothorax and passed away the next day."], "index": 27, "original_id": "multiclinsum_test_445_en.txt", "split": "test", "summary_subclaims": ["Two cases of cerebral sinus venous thrombosis in COVID-19 patients were reported.", "The cases were following respiratory, hematology, and coagulation disarrangements.", "The disarrangements were triggered by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.", "The first patient was presented with a seizure.", "The first patient had hypertension as a comorbidity.", "The first patient had diabetes mellitus as a comorbidity.", "The latter case had no comorbidity.", "The latter case showed more severe presentations of COVID-19 such as brain and lung thrombosis.", "The latter case already had several days of intravenous anticoagulant administrations.", "These two cases also have a different course of disease and outcomes."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 20-year-old man presented to the emergency department after four days of progressively worsening periumbilical pain.", "He was moving heavy boxes for his job when he began experiencing pain.", "He reported pain with defecation.", "He denied fever, chills, nausea, emesis, weight loss, and recent travel or illness.", "Past surgical history included branchial cleft cyst excision as a child.", "On abdominal exam, a one square-centimeter erythematous infra-umbilical mass was exquisitely tender to palpation.", "Laboratory data on admission demonstrated a WBC count of 10.7 \u00d7 103 cells/\u03bcL.", "Urinalysis was unremarkable.", "The patient underwent diagnostic evaluation for suspected incarcerated umbilical hernia.", "CT abdomen/pelvis revealed a four-centimeter segment of organized periumbilical inflammation with central lucency passing the ventral abdominal wall into the anterior abdominal compartment.", "The process was extraperitoneal.", "There was no evidence of communication with the urinary bladder.", "These findings were consistent with an inflamed urachal remnant complicated by abscess.", "The patient received intravenous antibiotics in preparation for an operation.", "The patient underwent abscess incision and drainage followed immediately by urachal cyst excision through a four-centimeter infra-umbilical midline mini-laparotomy.", "The urachal cyst and remnants were dissected inferiorly to confirm no communication with the urinary bladder before total excision.", "Investigation of the cyst contents revealed white sebaceous material.", "Pathology examined the 4 \u00d7 3 x 0.7-centimeter segment of fibromembranous tissue.", "Pathology confirmed intraoperative impressions of the specimen.", "The patient was admitted to the surgical floor.", "The patient noted his pain was markedly improved.", "The patient was discharged to home on post-operative day two with adequate pain control.", "Two-week follow up in the outpatient surgery clinic confirmed an uncomplicated recovery."], "summary_subclaims": ["The patient is a 20-year-old man.", "The patient presented with periumbilical pain.", "Physical exam showed a warm, erythematous infra-umbilical mass.", "The mass was tender to palpation.", "CT revealed an infected urachal cyst.", "The patient underwent urachal abscess incision and drainage.", "The patient underwent cyst excision.", "The patient returned home on postoperative day two.", "Two-week outpatient follow-up confirmed an uncomplicated recovery."]}, "extra_info": {"fulltext_subclaims": ["A 20-year-old man presented to the emergency department after four days of progressively worsening periumbilical pain.", "He was moving heavy boxes for his job when he began experiencing pain.", "He reported pain with defecation.", "He denied fever, chills, nausea, emesis, weight loss, and recent travel or illness.", "Past surgical history included branchial cleft cyst excision as a child.", "On abdominal exam, a one square-centimeter erythematous infra-umbilical mass was exquisitely tender to palpation.", "Laboratory data on admission demonstrated a WBC count of 10.7 \u00d7 103 cells/\u03bcL.", "Urinalysis was unremarkable.", "The patient underwent diagnostic evaluation for suspected incarcerated umbilical hernia.", "CT abdomen/pelvis revealed a four-centimeter segment of organized periumbilical inflammation with central lucency passing the ventral abdominal wall into the anterior abdominal compartment.", "The process was extraperitoneal.", "There was no evidence of communication with the urinary bladder.", "These findings were consistent with an inflamed urachal remnant complicated by abscess.", "The patient received intravenous antibiotics in preparation for an operation.", "The patient underwent abscess incision and drainage followed immediately by urachal cyst excision through a four-centimeter infra-umbilical midline mini-laparotomy.", "The urachal cyst and remnants were dissected inferiorly to confirm no communication with the urinary bladder before total excision.", "Investigation of the cyst contents revealed white sebaceous material.", "Pathology examined the 4 \u00d7 3 x 0.7-centimeter segment of fibromembranous tissue.", "Pathology confirmed intraoperative impressions of the specimen.", "The patient was admitted to the surgical floor.", "The patient noted his pain was markedly improved.", "The patient was discharged to home on post-operative day two with adequate pain control.", "Two-week follow up in the outpatient surgery clinic confirmed an uncomplicated recovery."], "index": 39, "original_id": "multiclinsum_test_1897_en.txt", "split": "test", "summary_subclaims": ["The patient is a 20-year-old man.", "The patient presented with periumbilical pain.", "Physical exam showed a warm, erythematous infra-umbilical mass.", "The mass was tender to palpation.", "CT revealed an infected urachal cyst.", "The patient underwent urachal abscess incision and drainage.", "The patient underwent cyst excision.", "The patient returned home on postoperative day two.", "Two-week outpatient follow-up confirmed an uncomplicated recovery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 29-year-old male.", "The patient's chief complaints were pain and instability on his left knee.", "He got injured when playing futsal with knee twisted externally.", "He suffered severe pain, swollen and difficult to walk.", "The MRI examination after the injury revealed ACL and PCL rupture of the left knee.", "He underwent arthroscopic surgical reconstruction for both ACL and PCL by previous surgeon.", "Two years after surgery, he felt instability, swollen knee without pain.", "On the physical examination, posterior sagging was found.", "The posterior drawer test was positive.", "The quadriceps active test was positive.", "The anterior Lachman test for anterior cruciate ligament was negative.", "On the MRI, failure of PCL graft with intact ACL was found.", "On the MRI and three dimensional CT scan, the tibial tunnel placement done in previous surgery was not placed on its anatomical position.", "The tunnel was placed too anterior to the PCL footprint.", "We performed the PCL revision reconstruction surgery.", "We performed the arthroscopic-assisted reconstruction surgery using transseptal portal approach.", "We avoided to use only the jig to guide us when tunnelling the tibia.", "We used additional technique to see the posterior aspect of proximal tibia clearly.", "We chose to make a transseptal portal that penetrated from posteromedial side of the knee inside-out to the posterolateral side of the knee.", "An incision was made on the posteromedial side of the knee with guidance of arthroscopic view and also transiluminatic arthroscopic light.", "Blunt obturator with sheath was inserted gently passed through intercondylar notch to posterolateral side of the knee.", "We made inside-out incision on it.", "During arthroscopy procedure, the PCL was gone with small PCL remnant on femoral site.", "The ACL was still intact and adequately attached.", "We performed the reconstruction of PCL using peroneus longus tendon as the graft from the left ankle.", "When tunneling the tibia, we used jig guide for tibial tunnel placement.", "We also made a transseptal portal from medial to lateral in order to get better view of posterior aspect of the tibia.", "We used it as the graft because hamstring tendon was already used in previous surgery.", "The post-operative X-ray of the left knee showed tibial tunnel was revised to appropriate site of its footprint.", "The shadow of two endobuttons on the medial femoral condyle was seen because the endobutton of previous surgery was not removed."], "summary_subclaims": ["The patient is a 29 year old male.", "The patient had total rupture of ACL and PCL.", "The patient underwent reconstruction for both ACL and PCL.", "The failure of the PCL graft occurred 2 years after the surgery.", "The failure of the PCL graft was related to the tibial tunnel placement.", "The tibial tunnel was placed not in proper anatomical site.", "We performed revision PCL surgery.", "We used transseptal portal technique.", "The transseptal portal technique was used to ensure the tibial tunnel is placed in appropriate position."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 29-year-old male.", "The patient's chief complaints were pain and instability on his left knee.", "He got injured when playing futsal with knee twisted externally.", "He suffered severe pain, swollen and difficult to walk.", "The MRI examination after the injury revealed ACL and PCL rupture of the left knee.", "He underwent arthroscopic surgical reconstruction for both ACL and PCL by previous surgeon.", "Two years after surgery, he felt instability, swollen knee without pain.", "On the physical examination, posterior sagging was found.", "The posterior drawer test was positive.", "The quadriceps active test was positive.", "The anterior Lachman test for anterior cruciate ligament was negative.", "On the MRI, failure of PCL graft with intact ACL was found.", "On the MRI and three dimensional CT scan, the tibial tunnel placement done in previous surgery was not placed on its anatomical position.", "The tunnel was placed too anterior to the PCL footprint.", "We performed the PCL revision reconstruction surgery.", "We performed the arthroscopic-assisted reconstruction surgery using transseptal portal approach.", "We avoided to use only the jig to guide us when tunnelling the tibia.", "We used additional technique to see the posterior aspect of proximal tibia clearly.", "We chose to make a transseptal portal that penetrated from posteromedial side of the knee inside-out to the posterolateral side of the knee.", "An incision was made on the posteromedial side of the knee with guidance of arthroscopic view and also transiluminatic arthroscopic light.", "Blunt obturator with sheath was inserted gently passed through intercondylar notch to posterolateral side of the knee.", "We made inside-out incision on it.", "During arthroscopy procedure, the PCL was gone with small PCL remnant on femoral site.", "The ACL was still intact and adequately attached.", "We performed the reconstruction of PCL using peroneus longus tendon as the graft from the left ankle.", "When tunneling the tibia, we used jig guide for tibial tunnel placement.", "We also made a transseptal portal from medial to lateral in order to get better view of posterior aspect of the tibia.", "We used it as the graft because hamstring tendon was already used in previous surgery.", "The post-operative X-ray of the left knee showed tibial tunnel was revised to appropriate site of its footprint.", "The shadow of two endobuttons on the medial femoral condyle was seen because the endobutton of previous surgery was not removed."], "index": 23, "original_id": "multiclinsum_test_2913_en.txt", "split": "test", "summary_subclaims": ["The patient is a 29 year old male.", "The patient had total rupture of ACL and PCL.", "The patient underwent reconstruction for both ACL and PCL.", "The failure of the PCL graft occurred 2 years after the surgery.", "The failure of the PCL graft was related to the tibial tunnel placement.", "The tibial tunnel was placed not in proper anatomical site.", "We performed revision PCL surgery.", "We used transseptal portal technique.", "The transseptal portal technique was used to ensure the tibial tunnel is placed in appropriate position."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 38-year-old woman in her 19th wk of pregnancy (G2P1).", "She was referred to the clinic for a sudden persistent pain on the left side of the waist on July 28, 2017.", "The patient\u2019s physical examination revealed tenderness over the left kidney area.", "Her blood pressure was 120/85 mmHg.", "Her heart rate was 86 beats/min.", "Her body temperature was 36.8 \u00b0C.", "The patient had no significant medical history.", "She had not undergone any related abdominal examination previously.", "The patient was hospitalized and given conservative treatment.", "Her left-side waist pain continued to be intense.", "Because the size of the tumor was so large, and the fetal heart rate was unstable, the patient decided to undergo left nephrectomy after the induction of labor.", "Laboratory tests indicated that the patient\u2019s hemoglobin level was 80 g/L.", "The hematocrit was 0.242 L/L.", "On the 2nd d, hemoglobin was 95 g/L.", "The hematocrit was 0.286 L/L.", "Ultrasound examination of the urinary system revealed a giant nonhomogenous lump in the left kidney area.", "The lump had caused the left kidney to move to the midabdomen.", "The size of the lump was approximately 159 mm \u00d7 100 mm.", "The border of the lump was faintly visible.", "The lump showed a \u201cstriped sign\u201d in which the outer part was hypoechoic with a strong stripe echo.", "The inner part near the left kidney was hyperechoic.", "A stripe-shaped echoless zone was seen around the lump.", "Color Doppler flow image showed some spot-like blood flow signals around the lump.", "A hyperechoic nodule was seen in the right kidney with a size of 30 mm \u00d7 25 mm.", "There was a fetus echo in the uterus.", "Preoperative CT showed a large, mixed-density mass in the left kidney.", "The density of the area adjacent to the kidney was low.", "The area far from the kidney showed high density."], "summary_subclaims": ["The patient is a 38-year-old woman in her 19th wk of pregnancy.", "She was referred to the clinic for a sudden, persistent pain on the left side of the waist.", "She had not undergone any previous related abdominal examination.", "Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.", "The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.", "Her left-side waist pain continued to be intense.", "She underwent computed tomography, which led to the same diagnosis.", "The patient underwent left nephrectomy after the induction of labor.", "The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 38-year-old woman in her 19th wk of pregnancy (G2P1).", "She was referred to the clinic for a sudden persistent pain on the left side of the waist on July 28, 2017.", "The patient\u2019s physical examination revealed tenderness over the left kidney area.", "Her blood pressure was 120/85 mmHg.", "Her heart rate was 86 beats/min.", "Her body temperature was 36.8 \u00b0C.", "The patient had no significant medical history.", "She had not undergone any related abdominal examination previously.", "The patient was hospitalized and given conservative treatment.", "Her left-side waist pain continued to be intense.", "Because the size of the tumor was so large, and the fetal heart rate was unstable, the patient decided to undergo left nephrectomy after the induction of labor.", "Laboratory tests indicated that the patient\u2019s hemoglobin level was 80 g/L.", "The hematocrit was 0.242 L/L.", "On the 2nd d, hemoglobin was 95 g/L.", "The hematocrit was 0.286 L/L.", "Ultrasound examination of the urinary system revealed a giant nonhomogenous lump in the left kidney area.", "The lump had caused the left kidney to move to the midabdomen.", "The size of the lump was approximately 159 mm \u00d7 100 mm.", "The border of the lump was faintly visible.", "The lump showed a \u201cstriped sign\u201d in which the outer part was hypoechoic with a strong stripe echo.", "The inner part near the left kidney was hyperechoic.", "A stripe-shaped echoless zone was seen around the lump.", "Color Doppler flow image showed some spot-like blood flow signals around the lump.", "A hyperechoic nodule was seen in the right kidney with a size of 30 mm \u00d7 25 mm.", "There was a fetus echo in the uterus.", "Preoperative CT showed a large, mixed-density mass in the left kidney.", "The density of the area adjacent to the kidney was low.", "The area far from the kidney showed high density."], "index": 37, "original_id": "multiclinsum_test_1298_en.txt", "split": "test", "summary_subclaims": ["The patient is a 38-year-old woman in her 19th wk of pregnancy.", "She was referred to the clinic for a sudden, persistent pain on the left side of the waist.", "She had not undergone any previous related abdominal examination.", "Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.", "The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.", "Her left-side waist pain continued to be intense.", "She underwent computed tomography, which led to the same diagnosis.", "The patient underwent left nephrectomy after the induction of labor.", "The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 90-year-old female.", "The patient has atrial fibrillation.", "The patient is treated with therapeutic apixaban.", "The patient has aortic stenosis.", "The patient had a TAVR with a 29\u2005mm self-expanding Medtronic core-valve placed 7 years prior.", "The patient presented to the clinic for the evaluation of acute onset chest pain.", "The patient had elevated blood pressure on home monitoring of 190/90\u2005mmHg.", "The patient described the chest pain as substernal, severe, radiating posteriorly, and lasting for 45\u2005min before resolving spontaneously.", "A routine echocardiogram performed 2 months prior showed a properly functioning bioprosthetic aortic valve with normal haemodynamic performance.", "The Doppler measured peak transaortic gradient was 4\u2005mmHg.", "The mean transaortic gradient was 2\u2005mmHg.", "Vital signs in the clinic were noted as unremarkable.", "The patient was referred to the emergency department for assessment of the coronary anatomy and to rule out aortic dissection.", "During imaging, the patient developed acute respiratory failure with severe pruritis and urticaria.", "The patient was admitted for inpatient management.", "Evaluation in the emergency department was notable for the absence of hives, stridor, or other associated signs or symptoms of anaphylaxis.", "Lab evaluation demonstrated a troponin-I value of 0.22\u2005ng/mL.", "The troponin-I reference value is <0.04\u2005ng/mL.", "BNP was 514\u2005pg/mL.", "The BNP reference value is <100\u2005pg/mL.", "The patient\u2019s baseline BNP was 22\u201371\u2005pg/mL.", "The patient had a positive COVID-19 polymerase chain reaction rapid test.", "Chest x-ray was notable for diffuse interstitial pulmonary oedema.", "Electrocardiogram demonstrated sinus tachycardia with the left bundle branch block unchanged from prior.", "CT angiography of the chest ruled out acute aortic dissection.", "CT angiography ruled out pulmonary embolism.", "The patient was hospitalized for acute decompensated heart failure.", "The patient was treated with non-invasive positive pressure ventilation.", "The patient was treated with nitroglycerine infusion.", "The patient was treated with intravenous furosemide 40\u2005mg twice daily.", "The patient\u2019s respiratory status improved by Day 1 of the hospital admission.", "The peak BNP was 1649\u2005pg/mL.", "POCUS performed on hospital Day 2 was suggestive of a significant diastolic flow across the TAVR valve.", "POCUS directed further investigation for the diagnosis of prosthetic valve failure.", "TTE on hospital Day 3 revealed severe aortic regurgitation with an eccentric and anteriorly directed jet.", "TTE showed holodiastolic flow reversal in the descending thoracic aorta.", "The peak measured transaortic gradient was 9\u2005mmHg.", "The mean transaortic gradient was 5\u2005mmHg.", "The hospital system was experiencing staffing shortages and resource limitations related to an ongoing community COVID-19 surge.", "The hospital policy at the time was to delay routine TEE until patients were designated as COVID-19 recovered.", "The patient was treated for 2 days with continuous heparin infusion for presumptive treatment of acute coronary syndrome.", "The patient was restarted on therapeutic apixaban 5\u2005mg twice daily.", "The patient was discharged after 7 days.", "The patient was transitioned from intravenous furosemide to oral torsemide 20\u2005mg twice daily.", "Three days after hospital discharge, TEE confirmed proper positioning of the bioprosthetic stent-valve.", "TEE showed leaflet thickening.", "TEE showed abnormal cusp mobility.", "TEE showed restriction of the non-coronary cusp prosthetic leaflet.", "TEE showed an eccentric regurgitant jet consistent with severe aortic regurgitation.", "The acute TAVR valve regurgitation was treated with a valve-in-valve TAVR 17 days post-discharge.", "The patient was seen in the clinic 30 days after valve-in-valve TAVR.", "The patient denied chest pain.", "The patient denied dyspnoea.", "A TTE demonstrated bioprosthetic stent-valve in the aortic position.", "The TTE showed normal leaflet mobility.", "The TTE showed no paravalvular aortic regurgitation."], "summary_subclaims": ["The patient is a 90-year-old female.", "She has atrial fibrillation.", "She is on therapeutic apixaban.", "She had a transcatheter aortic valve replacement (TAVR).", "She presented with a COVID-19 infection.", "She was found to have severe bioprosthetic valvular regurgitation.", "Features were suggestive of valve thrombosis.", "She underwent valve-in-valve TAVR.", "Valvular dysfunction resolved."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 90-year-old female.", "The patient has atrial fibrillation.", "The patient is treated with therapeutic apixaban.", "The patient has aortic stenosis.", "The patient had a TAVR with a 29\u2005mm self-expanding Medtronic core-valve placed 7 years prior.", "The patient presented to the clinic for the evaluation of acute onset chest pain.", "The patient had elevated blood pressure on home monitoring of 190/90\u2005mmHg.", "The patient described the chest pain as substernal, severe, radiating posteriorly, and lasting for 45\u2005min before resolving spontaneously.", "A routine echocardiogram performed 2 months prior showed a properly functioning bioprosthetic aortic valve with normal haemodynamic performance.", "The Doppler measured peak transaortic gradient was 4\u2005mmHg.", "The mean transaortic gradient was 2\u2005mmHg.", "Vital signs in the clinic were noted as unremarkable.", "The patient was referred to the emergency department for assessment of the coronary anatomy and to rule out aortic dissection.", "During imaging, the patient developed acute respiratory failure with severe pruritis and urticaria.", "The patient was admitted for inpatient management.", "Evaluation in the emergency department was notable for the absence of hives, stridor, or other associated signs or symptoms of anaphylaxis.", "Lab evaluation demonstrated a troponin-I value of 0.22\u2005ng/mL.", "The troponin-I reference value is <0.04\u2005ng/mL.", "BNP was 514\u2005pg/mL.", "The BNP reference value is <100\u2005pg/mL.", "The patient\u2019s baseline BNP was 22\u201371\u2005pg/mL.", "The patient had a positive COVID-19 polymerase chain reaction rapid test.", "Chest x-ray was notable for diffuse interstitial pulmonary oedema.", "Electrocardiogram demonstrated sinus tachycardia with the left bundle branch block unchanged from prior.", "CT angiography of the chest ruled out acute aortic dissection.", "CT angiography ruled out pulmonary embolism.", "The patient was hospitalized for acute decompensated heart failure.", "The patient was treated with non-invasive positive pressure ventilation.", "The patient was treated with nitroglycerine infusion.", "The patient was treated with intravenous furosemide 40\u2005mg twice daily.", "The patient\u2019s respiratory status improved by Day 1 of the hospital admission.", "The peak BNP was 1649\u2005pg/mL.", "POCUS performed on hospital Day 2 was suggestive of a significant diastolic flow across the TAVR valve.", "POCUS directed further investigation for the diagnosis of prosthetic valve failure.", "TTE on hospital Day 3 revealed severe aortic regurgitation with an eccentric and anteriorly directed jet.", "TTE showed holodiastolic flow reversal in the descending thoracic aorta.", "The peak measured transaortic gradient was 9\u2005mmHg.", "The mean transaortic gradient was 5\u2005mmHg.", "The hospital system was experiencing staffing shortages and resource limitations related to an ongoing community COVID-19 surge.", "The hospital policy at the time was to delay routine TEE until patients were designated as COVID-19 recovered.", "The patient was treated for 2 days with continuous heparin infusion for presumptive treatment of acute coronary syndrome.", "The patient was restarted on therapeutic apixaban 5\u2005mg twice daily.", "The patient was discharged after 7 days.", "The patient was transitioned from intravenous furosemide to oral torsemide 20\u2005mg twice daily.", "Three days after hospital discharge, TEE confirmed proper positioning of the bioprosthetic stent-valve.", "TEE showed leaflet thickening.", "TEE showed abnormal cusp mobility.", "TEE showed restriction of the non-coronary cusp prosthetic leaflet.", "TEE showed an eccentric regurgitant jet consistent with severe aortic regurgitation.", "The acute TAVR valve regurgitation was treated with a valve-in-valve TAVR 17 days post-discharge.", "The patient was seen in the clinic 30 days after valve-in-valve TAVR.", "The patient denied chest pain.", "The patient denied dyspnoea.", "A TTE demonstrated bioprosthetic stent-valve in the aortic position.", "The TTE showed normal leaflet mobility.", "The TTE showed no paravalvular aortic regurgitation."], "index": 35, "original_id": "multiclinsum_test_303_en.txt", "split": "test", "summary_subclaims": ["The patient is a 90-year-old female.", "She has atrial fibrillation.", "She is on therapeutic apixaban.", "She had a transcatheter aortic valve replacement (TAVR).", "She presented with a COVID-19 infection.", "She was found to have severe bioprosthetic valvular regurgitation.", "Features were suggestive of valve thrombosis.", "She underwent valve-in-valve TAVR.", "Valvular dysfunction resolved."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["On 24 November 2012, a 31-year-old woman was diagnosed as a suspected rabies case by the First Affiliated Hospital of Zhengzhou University.", "The hospital reported the case to the Henan Center for Disease Control and Prevention (CDC).", "A detailed epidemiological investigation of the suspected rabies case was performed.", "The woman was a farmer living in a rural area of Xuchang, Henan Province, China.", "She lived with her husband and two sons.", "She said she had not travelled anywhere recently.", "At about 17:00 on 25 August 2012, the woman and her 7-year-old son were attacked by a stray dog while walking nearby to their village.", "The woman sustained bites on her right thigh.", "Her son had bites on his left calf.", "Villagers caught and killed the dog.", "The dog was buried on the village outskirts without laboratory investigation for RV.", "The mother washed the son\u2019s bites with municipal tap water shortly after the incident.", "On 26 August, the son received a rabies vaccine at the healthcare unit in their village.", "He completed a full course of standard vaccines.", "The vaccine used was freeze-dried rabies vaccine for human use [Vero cells], produced by Liaoning Chengda Biotechnology Co., Ltd.", "The vaccination regimen was five doses on days 0, 3, 7, 14, and 28.", "The mother did not recognize the risk posed to her by the dog bite.", "She only washed her own wounds the following day, following the doctor\u2019s advice.", "She declined the rabies vaccine for economic reasons.", "Both the mother\u2019s and son\u2019s wounds were determined by the doctor to constitute category III exposure bites.", "Category III exposure bites are defined by the World Health Organization (WHO) as single or multiple transdermal bites or scratches; contamination of mucous membrane with saliva.", "Neither the mother nor her son were treated as recommended by the WHO for category III rabies exposure.", "WHO-recommended treatment for category III rabies exposure includes wound cleaning, rabies vaccination, and direct wound infiltration with rabies immunoglobulin (RIG).", "The rabies vaccine is not in the Chinese National Immunization Scheme.", "Rabies vaccine and RIG are currently provided for a fee in China.", "On 20 November 2012, the woman presented with a persistent fever (39 \u00b0C), nausea, vomiting, chest tightness, and agitation to the Xiangcheng County People\u2019s Hospital.", "She received a diagnosis of encephalitis.", "She was treated for 2 days with cefoperazone, sulbactam, levofloxacin, and supportive treatment.", "On 22 November, her symptoms worsened and she developed a mild coma, drooling, and melena.", "She was then transferred to the Xuchang City Central Hospital.", "On 24 November, she was transferred to the First Affiliated Hospital of Zhengzhou University.", "She received a diagnosis of suspected rabies.", "She was treated with symptomatic and supportive therapies.", "Her condition continued to deteriorate.", "She died on 6 December 2012.", "On 4 December 2012, saliva, serum, and cerebrospinal fluid (CSF) from the patient were collected.", "On 15 December 2012, a serum sample was collected from her son, who was in good health when sampled.", "Both sets of specimens were transported under refrigeration to the Henan CDC for testing.", "Total ribonucleic acid (RNA) was extracted from the CSF and saliva.", "RNA was reverse transcribed to cDNA.", "RV N and G genes were amplified using nested polymerase chain reaction (PCR).", "Negative controls (RNAse-free water) and positive controls were included in each set of reactions.", "Amplification products were detected after electrophoresis using 2% agarose gel.", "The N and G genes were amplified from the woman patient\u2019s saliva.", "The N and G genes were not amplified from her CSF.", "Amplification products were purified and sequenced using an automated ABI 3730 DNA Sequencer.", "Molecular phylogenetic analysis was conducted using the maximum likelihood method based on the Kimura\u2019s two parameter model with MEGA 5 software.", "The nucleotide sequence from the female (Henan) patient (Henan JSS, GenBank accession number KP221203) G protein was compared against nucleotide sequences of G protein genes from RV identified in GenBank.", "Henan JSS, along with previous Henan RV strains, the Chinese vaccine strain, and 8743THA, were grouped into GT1.", "Rabies virus neutralizing antibody (RVNA) titers in the sera were assayed by a standard rapid fluorescent focus inhibition test with some modifications.", "A serum specimen from the patient was collected on day 12 of her illness.", "Her son\u2019s serum was collected 3 months after the bites.", "The mother\u2019s serum RVNA titer was 0.68 IU/ml.", "The son\u2019s serum RVNA titer was 2.29 IU/ml.", "The mother and son were considered positive according to the diagnosis criteria for RVNA reactions.", "The diagnosis criteria for RVNA reactions define RVNA titers \u22650.05 IU/ml as the WHO recommended protective level.", "Because the son did not receive immediate RIG treatment, he remained at possible risk for RV infection.", "RVNA of the son has been actively monitored.", "His health condition has been assessed every 6 months post his initial result.", "The son is alive and healthy after 2 years of follow-up."], "summary_subclaims": ["In August 2012, a woman and her son were attacked by a stray dog in Henan, China.", "The son received rabies postexposure prophylaxis.", "The son's postexposure prophylaxis included wound treatment followed by vaccine.", "The son's postexposure prophylaxis did not include immunoglobulin.", "The mother did not receive rabies postexposure prophylaxis.", "Rabies infection was laboratory confirmed in the mother.", "The mother died in December.", "The son is alive and healthy after 2 years of follow-up."]}, "extra_info": {"fulltext_subclaims": ["On 24 November 2012, a 31-year-old woman was diagnosed as a suspected rabies case by the First Affiliated Hospital of Zhengzhou University.", "The hospital reported the case to the Henan Center for Disease Control and Prevention (CDC).", "A detailed epidemiological investigation of the suspected rabies case was performed.", "The woman was a farmer living in a rural area of Xuchang, Henan Province, China.", "She lived with her husband and two sons.", "She said she had not travelled anywhere recently.", "At about 17:00 on 25 August 2012, the woman and her 7-year-old son were attacked by a stray dog while walking nearby to their village.", "The woman sustained bites on her right thigh.", "Her son had bites on his left calf.", "Villagers caught and killed the dog.", "The dog was buried on the village outskirts without laboratory investigation for RV.", "The mother washed the son\u2019s bites with municipal tap water shortly after the incident.", "On 26 August, the son received a rabies vaccine at the healthcare unit in their village.", "He completed a full course of standard vaccines.", "The vaccine used was freeze-dried rabies vaccine for human use [Vero cells], produced by Liaoning Chengda Biotechnology Co., Ltd.", "The vaccination regimen was five doses on days 0, 3, 7, 14, and 28.", "The mother did not recognize the risk posed to her by the dog bite.", "She only washed her own wounds the following day, following the doctor\u2019s advice.", "She declined the rabies vaccine for economic reasons.", "Both the mother\u2019s and son\u2019s wounds were determined by the doctor to constitute category III exposure bites.", "Category III exposure bites are defined by the World Health Organization (WHO) as single or multiple transdermal bites or scratches; contamination of mucous membrane with saliva.", "Neither the mother nor her son were treated as recommended by the WHO for category III rabies exposure.", "WHO-recommended treatment for category III rabies exposure includes wound cleaning, rabies vaccination, and direct wound infiltration with rabies immunoglobulin (RIG).", "The rabies vaccine is not in the Chinese National Immunization Scheme.", "Rabies vaccine and RIG are currently provided for a fee in China.", "On 20 November 2012, the woman presented with a persistent fever (39 \u00b0C), nausea, vomiting, chest tightness, and agitation to the Xiangcheng County People\u2019s Hospital.", "She received a diagnosis of encephalitis.", "She was treated for 2 days with cefoperazone, sulbactam, levofloxacin, and supportive treatment.", "On 22 November, her symptoms worsened and she developed a mild coma, drooling, and melena.", "She was then transferred to the Xuchang City Central Hospital.", "On 24 November, she was transferred to the First Affiliated Hospital of Zhengzhou University.", "She received a diagnosis of suspected rabies.", "She was treated with symptomatic and supportive therapies.", "Her condition continued to deteriorate.", "She died on 6 December 2012.", "On 4 December 2012, saliva, serum, and cerebrospinal fluid (CSF) from the patient were collected.", "On 15 December 2012, a serum sample was collected from her son, who was in good health when sampled.", "Both sets of specimens were transported under refrigeration to the Henan CDC for testing.", "Total ribonucleic acid (RNA) was extracted from the CSF and saliva.", "RNA was reverse transcribed to cDNA.", "RV N and G genes were amplified using nested polymerase chain reaction (PCR).", "Negative controls (RNAse-free water) and positive controls were included in each set of reactions.", "Amplification products were detected after electrophoresis using 2% agarose gel.", "The N and G genes were amplified from the woman patient\u2019s saliva.", "The N and G genes were not amplified from her CSF.", "Amplification products were purified and sequenced using an automated ABI 3730 DNA Sequencer.", "Molecular phylogenetic analysis was conducted using the maximum likelihood method based on the Kimura\u2019s two parameter model with MEGA 5 software.", "The nucleotide sequence from the female (Henan) patient (Henan JSS, GenBank accession number KP221203) G protein was compared against nucleotide sequences of G protein genes from RV identified in GenBank.", "Henan JSS, along with previous Henan RV strains, the Chinese vaccine strain, and 8743THA, were grouped into GT1.", "Rabies virus neutralizing antibody (RVNA) titers in the sera were assayed by a standard rapid fluorescent focus inhibition test with some modifications.", "A serum specimen from the patient was collected on day 12 of her illness.", "Her son\u2019s serum was collected 3 months after the bites.", "The mother\u2019s serum RVNA titer was 0.68 IU/ml.", "The son\u2019s serum RVNA titer was 2.29 IU/ml.", "The mother and son were considered positive according to the diagnosis criteria for RVNA reactions.", "The diagnosis criteria for RVNA reactions define RVNA titers \u22650.05 IU/ml as the WHO recommended protective level.", "Because the son did not receive immediate RIG treatment, he remained at possible risk for RV infection.", "RVNA of the son has been actively monitored.", "His health condition has been assessed every 6 months post his initial result.", "The son is alive and healthy after 2 years of follow-up."], "index": 43, "original_id": "multiclinsum_test_1507_en.txt", "split": "test", "summary_subclaims": ["In August 2012, a woman and her son were attacked by a stray dog in Henan, China.", "The son received rabies postexposure prophylaxis.", "The son's postexposure prophylaxis included wound treatment followed by vaccine.", "The son's postexposure prophylaxis did not include immunoglobulin.", "The mother did not receive rabies postexposure prophylaxis.", "Rabies infection was laboratory confirmed in the mother.", "The mother died in December.", "The son is alive and healthy after 2 years of follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 44-year-old man.", "He presented with right limb weakness and unclear speech for the past 10 h.", "He had repeated fever.", "He was diagnosed with diabetes one month before admission.", "On admission, he was delirious.", "His temperature was 38.8 \u2103.", "His right limb muscle strength was Grade IV.", "Brain MRI revealed left basal ganglia and right parietal lobe cerebral infarction.", "The infarction was consistent with embolic stroke.", "White cell count was 14.31 \u00d7 10^9/L.", "The normal range for white cell count is 3.5\u20139.5 \u00d7 10^9/L.", "Highly sensitive Troponin I was 0.08 ng/ml.", "The normal range for highly sensitive Troponin I is 0-0.0268 ng/ml.", "Chest CT showed bilateral lung markings were heavier.", "Transthoracic echocardiography showed the aortic valve was bicuspid combined with calcification.", "Transthoracic echocardiography showed moderate regurgitation.", "A 16.4 mm*7.8 mm vegetation was seen on the right posterior aortic valve.", "The patient was diagnosed with infective endocarditis.", "According to the AHA/ACC guideline, delaying valve surgery for at least 4 weeks may be considered for patients with IE and major ischemic stroke if hemodynamically stable.", "The patient was prescribed vancomycin 0.5 g every 6 h.", "Transesophageal echocardiography 10 days later showed the vegetation was smaller than before.", "The patient had no fever again.", "The patient was hemodynamically stable.", "Blood cultures were negative twice.", "Transesophageal echocardiography one month later revealed a large periaortic abscess.", "The abscess led to formation of an aortic sinus pseudoaneurysm.", "Flows were in from the pseudoaneurysm and out to the left ventricular.", "Moderate mitral valve regurgitation was present.", "Cardiopulmonary bypass and aortic valve replacement surgery via median sternotomy were performed.", "During the operation, bicuspid deformity combined with vegetation was confirmed.", "An aortic annular abscess eroded into the base of the anterior mitral leaflet.", "The anterior mitral leaflet prolapsed.", "Aortic valve vegetations and perivalvular abscesses were completely removed.", "5/0 Prolene suture was used to continuously suture bovine pericardium.", "The tissue culture of the diseased aortic valve showed no bacterial growth.", "No pathogenic microorganism was identified.", "The patient was discharged two weeks later.", "He received antibiotics for six weeks.", "During one-month follow-up, the patient felt well.", "Laboratory testing revealed that blood white cell count and percentage were normal."], "summary_subclaims": ["A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h.", "He had recurrent fevers for 1 month before admission.", "Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve.", "Transthoracic echocardiography showed moderate aortic regurgitation.", "Transthoracic echocardiography showed a possible aortic annular abscess.", "Blood cultures were negative.", "Empiric antibiotic therapy was begun.", "The patient did not have fever again.", "The patient seem to be clinically improved.", "Follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm.", "The patient underwent mechanical prosthetic valve replacement.", "The patient underwent annulus reconstruction.", "Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 44-year-old man.", "He presented with right limb weakness and unclear speech for the past 10 h.", "He had repeated fever.", "He was diagnosed with diabetes one month before admission.", "On admission, he was delirious.", "His temperature was 38.8 \u2103.", "His right limb muscle strength was Grade IV.", "Brain MRI revealed left basal ganglia and right parietal lobe cerebral infarction.", "The infarction was consistent with embolic stroke.", "White cell count was 14.31 \u00d7 10^9/L.", "The normal range for white cell count is 3.5\u20139.5 \u00d7 10^9/L.", "Highly sensitive Troponin I was 0.08 ng/ml.", "The normal range for highly sensitive Troponin I is 0-0.0268 ng/ml.", "Chest CT showed bilateral lung markings were heavier.", "Transthoracic echocardiography showed the aortic valve was bicuspid combined with calcification.", "Transthoracic echocardiography showed moderate regurgitation.", "A 16.4 mm*7.8 mm vegetation was seen on the right posterior aortic valve.", "The patient was diagnosed with infective endocarditis.", "According to the AHA/ACC guideline, delaying valve surgery for at least 4 weeks may be considered for patients with IE and major ischemic stroke if hemodynamically stable.", "The patient was prescribed vancomycin 0.5 g every 6 h.", "Transesophageal echocardiography 10 days later showed the vegetation was smaller than before.", "The patient had no fever again.", "The patient was hemodynamically stable.", "Blood cultures were negative twice.", "Transesophageal echocardiography one month later revealed a large periaortic abscess.", "The abscess led to formation of an aortic sinus pseudoaneurysm.", "Flows were in from the pseudoaneurysm and out to the left ventricular.", "Moderate mitral valve regurgitation was present.", "Cardiopulmonary bypass and aortic valve replacement surgery via median sternotomy were performed.", "During the operation, bicuspid deformity combined with vegetation was confirmed.", "An aortic annular abscess eroded into the base of the anterior mitral leaflet.", "The anterior mitral leaflet prolapsed.", "Aortic valve vegetations and perivalvular abscesses were completely removed.", "5/0 Prolene suture was used to continuously suture bovine pericardium.", "The tissue culture of the diseased aortic valve showed no bacterial growth.", "No pathogenic microorganism was identified.", "The patient was discharged two weeks later.", "He received antibiotics for six weeks.", "During one-month follow-up, the patient felt well.", "Laboratory testing revealed that blood white cell count and percentage were normal."], "index": 41, "original_id": "multiclinsum_test_885_en.txt", "split": "test", "summary_subclaims": ["A 44-year-old man was admitted due to weakness of his right limbs and unclear speech for 10 h.", "He had recurrent fevers for 1 month before admission.", "Transthoracic echocardiography showed a mix-echoic vegetation attached to the bicuspid aortic valve.", "Transthoracic echocardiography showed moderate aortic regurgitation.", "Transthoracic echocardiography showed a possible aortic annular abscess.", "Blood cultures were negative.", "Empiric antibiotic therapy was begun.", "The patient did not have fever again.", "The patient seem to be clinically improved.", "Follow-up transesophageal echocardiography revealed a large periaortic abscess led to aortic sinus pseudoaneurysm.", "The patient underwent mechanical prosthetic valve replacement.", "The patient underwent annulus reconstruction.", "Perivalvular abscess may be insidious deterioration in patients who seem to be clinically improved."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 34-year-old Caucasian woman.", "The patient was referred to the department of dermatology.", "The patient had recurrent and diffuse tinea corporis.", "The patient had recalcitrant crusted scabies.", "All studies of human subjects were approved by the Institutional Review Board of University Hospitals Case Medical Center.", "The patient provided written informed consent.", "Earlier treatments included topical ketoconazole 2% cream.", "Earlier treatments included oxiconazole nitrate 1% cream.", "Earlier treatments included permethrin 5% cream.", "The patient reported that her skin problems had been intermittent over the preceding 3 years.", "The medical history of this patient revealed end-stage renal disease requiring hemodialysis.", "The medical history of this patient revealed obesity.", "The medical history of this patient revealed non-insulin-dependent diabetes.", "The medical history of this patient revealed hypertension.", "The medical history of this patient revealed recurrent cellulitis.", "The medical history of this patient revealed methicillin-resistant Staphylococcus aureus bacteremia.", "The patient was diagnosed with bilateral cataracts.", "The patient was diagnosed with mild sensorineural hearing loss in one ear.", "Diabetes and hypertension were diagnosed with nephrotic syndrome at age 29.", "The patient began hemodialysis.", "The patient had frequent admissions for dialysis catheter site cellulitis.", "The patient had methicillin-resistant S. aureus bacteremia secondary to catheter line infections.", "The patient has lived with her maternal grandmother since birth.", "The patient had no known siblings.", "The father was unknown to the family.", "The mother reportedly died from a prescription narcotic overdose at age 29.", "There was no evidence of birth defects or immunodeficiency in the maternal family.", "The patient exhibited coarse facial features with a prominent brow ridge.", "The patient exhibited midface hypoplasia.", "The patient exhibited prognathia.", "The patient exhibited slight down slanting of palpebral fissures.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the palms.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the soles.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the digits.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques under the distal nails.", "Moist erosions and bright erythema along many of the proximal nail folds were noted.", "The nail plates appeared normal except distal onycholysis overlying the plaques.", "There were crusted papules and erosions diffusely scattered on the face, ears, trunk, and extremities.", "Earlier mineral oil scrapings had revealed multiple live mites.", "The exam was consistent with crusted scabies.", "A fungal culture from the nail fold grew unidentified, non-Candida yeast.", "It was recommended to the referring dermatologist that the patient continues topical antifungal treatment as needed.", "It was recommended to the referring dermatologist to begin oral ivermectin 0.2 mg/kg daily on days 1, 2, 8, 9, 15, 22, and 29.", "An undiagnosed immune syndrome with cutaneous-specific immunodeficiency was suspected.", "The patient was referred to medical genetics for evaluation.", "The patient was HIV negative.", "The patient had a normal serum protein electrophoresis interpretation.", "The patient was negative for antinuclear antibodies.", "Electrolyte panels were consistent with renal failure and routine dialysis.", "No renal biopsy had been performed.", "The white blood cell count would fluctuate between admissions.", "The patient\u2019s lymphocyte count was consistently within normal limits.", "The scabies infection resolved after 3 months using routine maintenance doses of ivermectin.", "The tinea corporis infection resolved using the daily application of topical antifungal creams."], "summary_subclaims": ["The patient was a 34-year-old.", "The patient had a cutaneous immunodeficiency.", "The patient had recurrent crusted scabies infestation.", "The patient had diffuse tinea.", "The patient had recurrent staphylococcal cellulitis.", "The patient was suspected to have an undiagnosed syndrome.", "The patient had mental retardation.", "The patient had renal failure.", "The patient had premature senescence.", "A cytogenetic fluorescence in situ hybridization analysis was performed.", "A 9.34 Mb duplication was found within the short (p) arm of chromosome 1.", "The duplication was from 1p36.11 to 1p36.21.", "An adjacent 193 kb copy gain was entirely within 1p36.11.", "Chromosome 4 had a 906 kb gain in 4p16.1.", "Chromosome 9 had an 81 kb copy gain in 9p24.3.", "Over 100 genes were localized within these duplicated regions.", "A gene expression array was performed.", "82 genes had expression changed >1.5-fold compared to a healthy age-matched skin control.", "The lipolytic enzyme arylacetamide deacetylase-like 3 was found within the duplicated 1p36 region of chromosome 1."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 34-year-old Caucasian woman.", "The patient was referred to the department of dermatology.", "The patient had recurrent and diffuse tinea corporis.", "The patient had recalcitrant crusted scabies.", "All studies of human subjects were approved by the Institutional Review Board of University Hospitals Case Medical Center.", "The patient provided written informed consent.", "Earlier treatments included topical ketoconazole 2% cream.", "Earlier treatments included oxiconazole nitrate 1% cream.", "Earlier treatments included permethrin 5% cream.", "The patient reported that her skin problems had been intermittent over the preceding 3 years.", "The medical history of this patient revealed end-stage renal disease requiring hemodialysis.", "The medical history of this patient revealed obesity.", "The medical history of this patient revealed non-insulin-dependent diabetes.", "The medical history of this patient revealed hypertension.", "The medical history of this patient revealed recurrent cellulitis.", "The medical history of this patient revealed methicillin-resistant Staphylococcus aureus bacteremia.", "The patient was diagnosed with bilateral cataracts.", "The patient was diagnosed with mild sensorineural hearing loss in one ear.", "Diabetes and hypertension were diagnosed with nephrotic syndrome at age 29.", "The patient began hemodialysis.", "The patient had frequent admissions for dialysis catheter site cellulitis.", "The patient had methicillin-resistant S. aureus bacteremia secondary to catheter line infections.", "The patient has lived with her maternal grandmother since birth.", "The patient had no known siblings.", "The father was unknown to the family.", "The mother reportedly died from a prescription narcotic overdose at age 29.", "There was no evidence of birth defects or immunodeficiency in the maternal family.", "The patient exhibited coarse facial features with a prominent brow ridge.", "The patient exhibited midface hypoplasia.", "The patient exhibited prognathia.", "The patient exhibited slight down slanting of palpebral fissures.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the palms.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the soles.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques on the digits.", "The skin examination was significant for thick, hyperkeratotic, white, and flaking plaques under the distal nails.", "Moist erosions and bright erythema along many of the proximal nail folds were noted.", "The nail plates appeared normal except distal onycholysis overlying the plaques.", "There were crusted papules and erosions diffusely scattered on the face, ears, trunk, and extremities.", "Earlier mineral oil scrapings had revealed multiple live mites.", "The exam was consistent with crusted scabies.", "A fungal culture from the nail fold grew unidentified, non-Candida yeast.", "It was recommended to the referring dermatologist that the patient continues topical antifungal treatment as needed.", "It was recommended to the referring dermatologist to begin oral ivermectin 0.2 mg/kg daily on days 1, 2, 8, 9, 15, 22, and 29.", "An undiagnosed immune syndrome with cutaneous-specific immunodeficiency was suspected.", "The patient was referred to medical genetics for evaluation.", "The patient was HIV negative.", "The patient had a normal serum protein electrophoresis interpretation.", "The patient was negative for antinuclear antibodies.", "Electrolyte panels were consistent with renal failure and routine dialysis.", "No renal biopsy had been performed.", "The white blood cell count would fluctuate between admissions.", "The patient\u2019s lymphocyte count was consistently within normal limits.", "The scabies infection resolved after 3 months using routine maintenance doses of ivermectin.", "The tinea corporis infection resolved using the daily application of topical antifungal creams."], "index": 33, "original_id": "multiclinsum_test_1677_en.txt", "split": "test", "summary_subclaims": ["The patient was a 34-year-old.", "The patient had a cutaneous immunodeficiency.", "The patient had recurrent crusted scabies infestation.", "The patient had diffuse tinea.", "The patient had recurrent staphylococcal cellulitis.", "The patient was suspected to have an undiagnosed syndrome.", "The patient had mental retardation.", "The patient had renal failure.", "The patient had premature senescence.", "A cytogenetic fluorescence in situ hybridization analysis was performed.", "A 9.34 Mb duplication was found within the short (p) arm of chromosome 1.", "The duplication was from 1p36.11 to 1p36.21.", "An adjacent 193 kb copy gain was entirely within 1p36.11.", "Chromosome 4 had a 906 kb gain in 4p16.1.", "Chromosome 9 had an 81 kb copy gain in 9p24.3.", "Over 100 genes were localized within these duplicated regions.", "A gene expression array was performed.", "82 genes had expression changed >1.5-fold compared to a healthy age-matched skin control.", "The lipolytic enzyme arylacetamide deacetylase-like 3 was found within the duplicated 1p36 region of chromosome 1."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including tubular atrophy, interstitial fibrosis, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 44-year-old man.", "He presented with acute onset of abdominal pain.", "The pain started 2 days before presentation.", "The pain was diffuse across his mid-to-lower abdomen.", "The patient had normal bowel movements.", "He denied fever.", "He denied chills.", "He denied nausea.", "He denied vomiting.", "His medical history was significant for end-stage renal disease from congenital renal hypoplasia.", "He received a kidney transplant 7 years ago.", "He developed acute antibody rejection.", "He had been requiring intermittent hemodialysis for the past 2 years.", "He was on immunosuppression with oral prednisone (5 mg/day).", "He was on immunosuppression with mycophenolate mofetil (250 mg/day).", "On physical examination, his blood pressure was 105/60.", "His heart rate was 103.", "His respiratory rate was 20.", "His body temperature was 37.1\u00b0C.", "His abdominal examination demonstrated generalized tenderness.", "There was remarkable lower abdomen rebound tenderness.", "Bowel sound was absent.", "Computed tomography of the abdomen and pelvis with intravenous contrast was performed.", "Abdominal CT demonstrated ruptured jejunal diverticulum.", "There was associated free intraperitoneal air.", "There was surrounding mesenteric edema.", "Numerous small bowel diverticuli were noted.", "Marked jejunal diverticulosis was noted.", "The patient underwent a segmental jejunal resection and anastomosis.", "His postoperative course was uneventful.", "The patient was dismissed from the hospital.", "He continued his immunosuppression, including prednisone.", "He continued his immunosuppression, including mycophenolate mofetil.", "One month later, the patient presented with the same symptoms.", "He was found to have recurrent jejunal diverticulum perforation.", "He again underwent a segmental jejunal resection and anastomosis.", "Nephrology was consulted.", "Information on the risks and benefits of mycophenolate mofetil was provided.", "Information on alternative options such as azathioprine was provided.", "Mycophenolate mofetil was discontinued.", "Three months after hospitalization, the patient continued to do well.", "He had no further episode of abdominal pain."], "summary_subclaims": ["The patient is a 44-year-old man.", "The patient has end-stage renal disease.", "The patient had a failed kidney transplant.", "The patient was on low-dose mycophenolate mofetil.", "The patient presented with acute onset of abdominal pain.", "The patient was given the diagnosis of perforated jejunal diverticulum.", "The patient underwent a segmental jejunal resection and anastomosis.", "The patient developed a recurrent jejunal perforation a month later.", "The patient had a second segmental jejunal resection operation.", "Mycophenolate mofetil was discontinued."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 44-year-old man.", "He presented with acute onset of abdominal pain.", "The pain started 2 days before presentation.", "The pain was diffuse across his mid-to-lower abdomen.", "The patient had normal bowel movements.", "He denied fever.", "He denied chills.", "He denied nausea.", "He denied vomiting.", "His medical history was significant for end-stage renal disease from congenital renal hypoplasia.", "He received a kidney transplant 7 years ago.", "He developed acute antibody rejection.", "He had been requiring intermittent hemodialysis for the past 2 years.", "He was on immunosuppression with oral prednisone (5 mg/day).", "He was on immunosuppression with mycophenolate mofetil (250 mg/day).", "On physical examination, his blood pressure was 105/60.", "His heart rate was 103.", "His respiratory rate was 20.", "His body temperature was 37.1\u00b0C.", "His abdominal examination demonstrated generalized tenderness.", "There was remarkable lower abdomen rebound tenderness.", "Bowel sound was absent.", "Computed tomography of the abdomen and pelvis with intravenous contrast was performed.", "Abdominal CT demonstrated ruptured jejunal diverticulum.", "There was associated free intraperitoneal air.", "There was surrounding mesenteric edema.", "Numerous small bowel diverticuli were noted.", "Marked jejunal diverticulosis was noted.", "The patient underwent a segmental jejunal resection and anastomosis.", "His postoperative course was uneventful.", "The patient was dismissed from the hospital.", "He continued his immunosuppression, including prednisone.", "He continued his immunosuppression, including mycophenolate mofetil.", "One month later, the patient presented with the same symptoms.", "He was found to have recurrent jejunal diverticulum perforation.", "He again underwent a segmental jejunal resection and anastomosis.", "Nephrology was consulted.", "Information on the risks and benefits of mycophenolate mofetil was provided.", "Information on alternative options such as azathioprine was provided.", "Mycophenolate mofetil was discontinued.", "Three months after hospitalization, the patient continued to do well.", "He had no further episode of abdominal pain."], "index": 22, "original_id": "multiclinsum_test_295_en.txt", "split": "test", "summary_subclaims": ["The patient is a 44-year-old man.", "The patient has end-stage renal disease.", "The patient had a failed kidney transplant.", "The patient was on low-dose mycophenolate mofetil.", "The patient presented with acute onset of abdominal pain.", "The patient was given the diagnosis of perforated jejunal diverticulum.", "The patient underwent a segmental jejunal resection and anastomosis.", "The patient developed a recurrent jejunal perforation a month later.", "The patient had a second segmental jejunal resection operation.", "Mycophenolate mofetil was discontinued."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 43-year-old Malay female.", "She was referred to the low vision clinic by an ophthalmologist.", "She was diagnosed with tractional retinal detachment secondary to diabetic retinopathy.", "She was diagnosed with diabetes mellitus 5 years ago.", "She is currently on treatment for diabetes mellitus at a government hospital.", "Her treatment includes metformin 500 mg twice daily.", "Her treatment includes glicazide 60 mg daily.", "Her treatment includes insulin 18 unit/day (nocte).", "Her glycosylated hemoglobin (HbAIc) was 7 mmol/L at her last visit.", "She is on treatment for hypertension with hydrochlorothiazide 12.5 mg daily.", "She is on treatment for cholesterol with atorvastatin 20 mg daily.", "There was no evidence of diabetic nephropathy.", "There was no evidence of diabetic neuropathy.", "There was no family history of diabetes mellitus.", "There was no family history of retinal detachment.", "Her main complaint at presentation was blurred vision at both distance and near.", "She had never used nor was ever prescribed contact lens or glasses.", "She reported difficulty in recognizing faces.", "She reported difficulty with orientation and mobility.", "She had been told that 'nothing more can be done' to alleviate her condition.", "She agreed to be referred to the low vision clinic as a last attempt.", "Her distance vision for right eye was 6/48.", "Her distance vision for left eye was 6/48.", "Subjective refraction improved her distance vision to 6/48 using -1.75Ds in the right eye.", "Subjective refraction improved her distance vision to 6/38 with a +3.50 Ds in the left eye.", "Addition of +2.50 Ds enabled her to read N24 for the right eye.", "Addition of +2.50 Ds enabled her to read N16 for the left eye.", "Visual field assessment testing at near using an Amsler\u2019s chart revealed no abnormality.", "Examination of her fundi showed diabetic retinopathy changes.", "Examination of her fundi showed tractional retinal detachment.", "The DASS score showed she was in a state of severe stress (score = 34).", "The DASS score showed she was severely anxious (score = 16).", "The DASS score showed she was depressed (score = 38).", "The LVQoL questionnaire assessment score was 43.", "Using a +6.00 Ds spectacle magnifier, she improved her near vision to N10 at 20 cm.", "A 3\u00d7 monocular telescope improved her left eye distance vision to 6/12.", "She was introduced to eccentric viewing techniques.", "A pair of distance spectacles with prescription RE-1.75 Ds, LE +3.50 Ds was prescribed.", "A 3x monocular telescope was prescribed.", "She was referred to an orientation & mobility clinic.", "She agreed to a referral to the Social Welfare Department.", "She was referred to a clinical psychology clinic.", "She was referred to an occupational therapy clinic.", "She was advised to return for a review in 3 months.", "After 3 months, the patient returned for a follow-up.", "Her visual acuity for both eyes remained the same at 6/48.", "Subjective refraction and visual field status were unchanged.", "The DASS score for stress decreased from 34 to 14.", "The DASS score for depression decreased from 38 to 18.", "The LVQoL score improved from 43 to 98.", "A further three months review was given.", "She was advised to continue with sessions at the psychology clinic.", "She was advised to continue with sessions at the occupational therapy clinic.", "She was advised to continue with sessions at the orientation & mobility clinic."], "summary_subclaims": ["The patient is a 43-year-old Asian female.", "The patient has mild vision impairment.", "The patient has tractional retinal detachment.", "The tractional retinal detachment is secondary to diabetic retinopathy.", "Mental health screening was performed during low vision rehabilitation.", "Quality of life screening was performed during low vision rehabilitation.", "Mental health screening and quality of life screening can improve the management of this patient."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 43-year-old Malay female.", "She was referred to the low vision clinic by an ophthalmologist.", "She was diagnosed with tractional retinal detachment secondary to diabetic retinopathy.", "She was diagnosed with diabetes mellitus 5 years ago.", "She is currently on treatment for diabetes mellitus at a government hospital.", "Her treatment includes metformin 500 mg twice daily.", "Her treatment includes glicazide 60 mg daily.", "Her treatment includes insulin 18 unit/day (nocte).", "Her glycosylated hemoglobin (HbAIc) was 7 mmol/L at her last visit.", "She is on treatment for hypertension with hydrochlorothiazide 12.5 mg daily.", "She is on treatment for cholesterol with atorvastatin 20 mg daily.", "There was no evidence of diabetic nephropathy.", "There was no evidence of diabetic neuropathy.", "There was no family history of diabetes mellitus.", "There was no family history of retinal detachment.", "Her main complaint at presentation was blurred vision at both distance and near.", "She had never used nor was ever prescribed contact lens or glasses.", "She reported difficulty in recognizing faces.", "She reported difficulty with orientation and mobility.", "She had been told that 'nothing more can be done' to alleviate her condition.", "She agreed to be referred to the low vision clinic as a last attempt.", "Her distance vision for right eye was 6/48.", "Her distance vision for left eye was 6/48.", "Subjective refraction improved her distance vision to 6/48 using -1.75Ds in the right eye.", "Subjective refraction improved her distance vision to 6/38 with a +3.50 Ds in the left eye.", "Addition of +2.50 Ds enabled her to read N24 for the right eye.", "Addition of +2.50 Ds enabled her to read N16 for the left eye.", "Visual field assessment testing at near using an Amsler\u2019s chart revealed no abnormality.", "Examination of her fundi showed diabetic retinopathy changes.", "Examination of her fundi showed tractional retinal detachment.", "The DASS score showed she was in a state of severe stress (score = 34).", "The DASS score showed she was severely anxious (score = 16).", "The DASS score showed she was depressed (score = 38).", "The LVQoL questionnaire assessment score was 43.", "Using a +6.00 Ds spectacle magnifier, she improved her near vision to N10 at 20 cm.", "A 3\u00d7 monocular telescope improved her left eye distance vision to 6/12.", "She was introduced to eccentric viewing techniques.", "A pair of distance spectacles with prescription RE-1.75 Ds, LE +3.50 Ds was prescribed.", "A 3x monocular telescope was prescribed.", "She was referred to an orientation & mobility clinic.", "She agreed to a referral to the Social Welfare Department.", "She was referred to a clinical psychology clinic.", "She was referred to an occupational therapy clinic.", "She was advised to return for a review in 3 months.", "After 3 months, the patient returned for a follow-up.", "Her visual acuity for both eyes remained the same at 6/48.", "Subjective refraction and visual field status were unchanged.", "The DASS score for stress decreased from 34 to 14.", "The DASS score for depression decreased from 38 to 18.", "The LVQoL score improved from 43 to 98.", "A further three months review was given.", "She was advised to continue with sessions at the psychology clinic.", "She was advised to continue with sessions at the occupational therapy clinic.", "She was advised to continue with sessions at the orientation & mobility clinic."], "index": 26, "original_id": "multiclinsum_test_2493_en.txt", "split": "test", "summary_subclaims": ["The patient is a 43-year-old Asian female.", "The patient has mild vision impairment.", "The patient has tractional retinal detachment.", "The tractional retinal detachment is secondary to diabetic retinopathy.", "Mental health screening was performed during low vision rehabilitation.", "Quality of life screening was performed during low vision rehabilitation.", "Mental health screening and quality of life screening can improve the management of this patient."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 48-year-old female.", "The patient had a left lower lobe nodule in the lung.", "The patient was scheduled for thoracoscopic wedge resection of the left lower lobe.", "Anesthesia was induced with 0.04 mg/kg of midazolam.", "Anesthesia was induced with 0.6 \u03bcg/kg of sufentanil.", "Anesthesia was induced with 2 mg/kg of propofol.", "Anesthesia was induced with 0.6 mg/kg of rocuronium.", "A left 35 Fr endobronchial tube was successfully intubated at a depth of 28 cm to incisors.", "Fiberoptic bronchoscopy was used to confirm the location of the tube after the patient was placed in the right lateral decubitus position.", "Anesthesia was maintained with sevoflurane 1.5 vol%.", "Anesthesia was maintained with oxygen 2 L/min.", "Anesthesia was maintained with remifentanil 250 mcg/hr.", "Anesthesia was maintained with 4 mg/kg/h of propofol.", "The intraoperative pathological diagnosis of the excised mass was invasive adenocarcinoma.", "The patient underwent VATS combined with left lower lobectomy.", "The operation time was 1.5 h.", "The patient was transferred to the post-anesthesia care unit for decannulation.", "The patient recovered consciousness from anesthesia after 30 min.", "The patient exhibited effective spontaneous ventilation.", "The patient met extubation criteria.", "The tracheal tube seemed to be mechanically constrained.", "The endotracheal tube could not be withdrawn.", "Propofol and remifentanil were administered intravenously for sedation.", "A fiberoptic bronchoscope revealed that the surgical suture of the bronchial membrane was inserted into the distal end of the left branch of the tracheal tube.", "Detailed consultations were held with respiratory physicians and thoracic surgeons.", "The thoracic surgeon assured that breaking the suture will not cause adverse effects on the patient.", "The respiratory doctor burned the sutures using an argon electrode (ERBE 20132\u2013177) with the aid of fiberoptic bronchoscope.", "The mode of the argon electrode was strong electrocoagulation.", "The power of the argon electrode was 35 W.", "The bronchial tube was pulled out smoothly.", "The patient was safely sent back to the ward after CT review.", "CT review showed no abnormalities.", "The patient was followed-up on the 1, 3, and 7 days after the operation.", "There were no related complications such as bronchial leak or bronchial rupture."], "summary_subclaims": ["The patient is a 48-year-old female.", "The patient underwent video-assisted thoracoscopic surgery.", "The surgery was combined with left lower lobectomy.", "The distal end of the left branch of the tracheal tube was lodged by surgical sutures.", "The respiratory physician burned the sutures using an argon electrode.", "The physician discussed the procedure with thoracic surgery experts."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 48-year-old female.", "The patient had a left lower lobe nodule in the lung.", "The patient was scheduled for thoracoscopic wedge resection of the left lower lobe.", "Anesthesia was induced with 0.04 mg/kg of midazolam.", "Anesthesia was induced with 0.6 \u03bcg/kg of sufentanil.", "Anesthesia was induced with 2 mg/kg of propofol.", "Anesthesia was induced with 0.6 mg/kg of rocuronium.", "A left 35 Fr endobronchial tube was successfully intubated at a depth of 28 cm to incisors.", "Fiberoptic bronchoscopy was used to confirm the location of the tube after the patient was placed in the right lateral decubitus position.", "Anesthesia was maintained with sevoflurane 1.5 vol%.", "Anesthesia was maintained with oxygen 2 L/min.", "Anesthesia was maintained with remifentanil 250 mcg/hr.", "Anesthesia was maintained with 4 mg/kg/h of propofol.", "The intraoperative pathological diagnosis of the excised mass was invasive adenocarcinoma.", "The patient underwent VATS combined with left lower lobectomy.", "The operation time was 1.5 h.", "The patient was transferred to the post-anesthesia care unit for decannulation.", "The patient recovered consciousness from anesthesia after 30 min.", "The patient exhibited effective spontaneous ventilation.", "The patient met extubation criteria.", "The tracheal tube seemed to be mechanically constrained.", "The endotracheal tube could not be withdrawn.", "Propofol and remifentanil were administered intravenously for sedation.", "A fiberoptic bronchoscope revealed that the surgical suture of the bronchial membrane was inserted into the distal end of the left branch of the tracheal tube.", "Detailed consultations were held with respiratory physicians and thoracic surgeons.", "The thoracic surgeon assured that breaking the suture will not cause adverse effects on the patient.", "The respiratory doctor burned the sutures using an argon electrode (ERBE 20132\u2013177) with the aid of fiberoptic bronchoscope.", "The mode of the argon electrode was strong electrocoagulation.", "The power of the argon electrode was 35 W.", "The bronchial tube was pulled out smoothly.", "The patient was safely sent back to the ward after CT review.", "CT review showed no abnormalities.", "The patient was followed-up on the 1, 3, and 7 days after the operation.", "There were no related complications such as bronchial leak or bronchial rupture."], "index": 24, "original_id": "multiclinsum_test_1206_en.txt", "split": "test", "summary_subclaims": ["The patient is a 48-year-old female.", "The patient underwent video-assisted thoracoscopic surgery.", "The surgery was combined with left lower lobectomy.", "The distal end of the left branch of the tracheal tube was lodged by surgical sutures.", "The respiratory physician burned the sutures using an argon electrode.", "The physician discussed the procedure with thoracic surgery experts."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 52-year-old woman.", "She was admitted for evaluation of intermittent abdominal tenderness, dry eye, and dry mouth.", "The dry eye and dry mouth had been present for several years.", "She had not sought medical treatment for the dry eye and dry mouth.", "She had a history of dilated cardiomyopathy.", "She had a history of glaucoma of the left eye.", "She was being treated with loop diuretics.", "She was being treated with proton pump inhibitors.", "She was being treated with anthocyanosides for glaucoma.", "In the physical examination, her lower extremities were in an edematous state.", "Her body temperature was 36.5\u00b0C.", "Her blood pressure was normal.", "The white blood cell count was 8,600/mm3.", "The neutrophil percentage was 73.4%.", "The sodium level was 141 mEq/L.", "The chloride level was 108 mEq/L.", "The blood urea nitrogen was 15.7 mg/dL.", "The creatinine was 0.6 mg/dL.", "The total serum protein was 5.5 g/dL.", "The serum albumin was 1.5 g/dL.", "The total cholesterol was 257 mg/dL.", "Urinalysis showed proteinuria of 6.3 g/day.", "Urinalysis showed 30\u201349 red blood cells per high-power field.", "Serologic investigation revealed the presence of anti-nuclear antibody (ANA; 1:80, homogeneous plus speckled pattern).", "Serologic investigation revealed the presence of rheumatoid factor (390 IU/mL).", "Serologic investigation was positive for autoantibody to the Ro (SS-A) antigen (>200 U/mL).", "Serology was negative for antibodies against double-stranded DNA.", "Serology was negative for antibodies against La (SS-B).", "Serology was negative for antibodies against Sm.", "Serology was negative for antibodies against ribonucleoproteins.", "Serology was negative for antineutrophil cytoplasmic antibodies.", "Serology was negative for lupus anticoagulant.", "Serology was negative for IgG/IgM anti-cardiolipin.", "Serology was negative for IgG \u03b22-glycoprotein-1.", "C3 levels had decreased to 38 mg/dL.", "C4 levels were within normal ranges at 16 mg/dL.", "Total hemolytic complement 50 levels were within normal ranges at 33.1 U/mL.", "Tests for hepatitis B surface antigen were negative.", "Tests for hepatitis C antibodies were negative.", "Tests for cryoglobulins were negative.", "Tests for human immunodeficiency virus antibodies were negative.", "Minor salivary gland biopsy showed diffuse lymphocytic infiltrations with a focus score of 3.", "Salivary scintigraphy showed non-visualization in both salivary glands.", "The findings were consistent with the class 4 Schall grading system.", "She was diagnosed with Sj\u00f6gren\u2019s syndrome.", "The diagnosis fulfilled the 2002 American-European consensus classification criteria.", "She underwent a percutaneous renal biopsy due to nephrotic syndrome.", "Glomerular basement membrane thickening was observed by light microscopy.", "Mesangial matrix widening was observed by light microscopy.", "Mild tubular atrophy was noted.", "Moderate interstitial fibrosis was noted.", "Weakly positive staining for IgG, IgA, IgM, and C3 on the outer surface of capillary walls was revealed by immunofluorescent staining.", "Diffuse subepithelial electron-dense deposit was observed by electron microscopy.", "The histopathological findings were consistent with membranous glomerulonephritis.", "Abdominal computed tomography (CT) and colonoscopy were performed due to intermittent abdominal tenderness.", "No malignancy was observed at admission.", "No bowel perforation was observed at admission.", "She had sudden onset of severe abdominal pain 3 months later.", "Abdominal CT showed newly developed pneumoperitoneum with peritonitis.", "Abdominal CT showed small bowel perforation.", "An emergency operation and small bowel biopsy were performed.", "The specimen had a necrotic and ulcerous lesion measuring 4.5 \u00d7 5 cm.", "Immunohistochemical examination showed expression of CD20.", "Immunohistochemical examination showed expression of CD79a.", "Immunohistochemical examination showed expression of BCL-2.", "Immunohistochemical examination did not show expression of CD3.", "Immunohistochemical examination did not show expression of CD10.", "Immunohistochemical examination did not show expression of BCL-6.", "The proliferation fraction as determined by Ki-67 was 50%\u201360%.", "The majority of tumor cells were positive for EBV by in situ hybridization.", "Biopsy revealed EBV-positive DLBCL.", "The patient declined treatment with chemotherapy.", "She had been receiving intermittent low-dose oral corticosteroid.", "She had been receiving hydroxychloroquine.", "There was improvement in proteinuria (1.79 g/day) after 1 year of follow-up.", "There was improvement in sicca symptoms after 1 year of follow-up.", "One year of follow-up positron emission tomography-CT scan showed a stable disease state for the malignant lymphoma."], "summary_subclaims": ["The patient is a 52-year-old woman.", "She has primary Sj\u00f6gren's syndrome.", "She developed membranous glomerulonephritis.", "She developed Epstein-Barr virus-positive diffuse large B-cell lymphoma.", "The diagnosis of Sj\u00f6gren's syndrome was based on dry eyes.", "The diagnosis of Sj\u00f6gren's syndrome was based on dry mouth.", "The diagnosis of Sj\u00f6gren's syndrome was based on a positive anti-nuclear antibody test.", "The diagnosis of Sj\u00f6gren's syndrome was based on anti-Ro (SS-A) antibody.", "The diagnosis of Sj\u00f6gren's syndrome was based on a salivary gland biopsy.", "The diagnosis of Sj\u00f6gren's syndrome was based on salivary scintigraphy.", "Renal biopsy confirmed the diagnosis of membranous glomerulonephritis.", "Three months later, her small bowel was perforated with pneumoperitoneum.", "The biopsy revealed Epstein-Barr virus-positive diffuse large B-cell lymphoma."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 52-year-old woman.", "She was admitted for evaluation of intermittent abdominal tenderness, dry eye, and dry mouth.", "The dry eye and dry mouth had been present for several years.", "She had not sought medical treatment for the dry eye and dry mouth.", "She had a history of dilated cardiomyopathy.", "She had a history of glaucoma of the left eye.", "She was being treated with loop diuretics.", "She was being treated with proton pump inhibitors.", "She was being treated with anthocyanosides for glaucoma.", "In the physical examination, her lower extremities were in an edematous state.", "Her body temperature was 36.5\u00b0C.", "Her blood pressure was normal.", "The white blood cell count was 8,600/mm3.", "The neutrophil percentage was 73.4%.", "The sodium level was 141 mEq/L.", "The chloride level was 108 mEq/L.", "The blood urea nitrogen was 15.7 mg/dL.", "The creatinine was 0.6 mg/dL.", "The total serum protein was 5.5 g/dL.", "The serum albumin was 1.5 g/dL.", "The total cholesterol was 257 mg/dL.", "Urinalysis showed proteinuria of 6.3 g/day.", "Urinalysis showed 30\u201349 red blood cells per high-power field.", "Serologic investigation revealed the presence of anti-nuclear antibody (ANA; 1:80, homogeneous plus speckled pattern).", "Serologic investigation revealed the presence of rheumatoid factor (390 IU/mL).", "Serologic investigation was positive for autoantibody to the Ro (SS-A) antigen (>200 U/mL).", "Serology was negative for antibodies against double-stranded DNA.", "Serology was negative for antibodies against La (SS-B).", "Serology was negative for antibodies against Sm.", "Serology was negative for antibodies against ribonucleoproteins.", "Serology was negative for antineutrophil cytoplasmic antibodies.", "Serology was negative for lupus anticoagulant.", "Serology was negative for IgG/IgM anti-cardiolipin.", "Serology was negative for IgG \u03b22-glycoprotein-1.", "C3 levels had decreased to 38 mg/dL.", "C4 levels were within normal ranges at 16 mg/dL.", "Total hemolytic complement 50 levels were within normal ranges at 33.1 U/mL.", "Tests for hepatitis B surface antigen were negative.", "Tests for hepatitis C antibodies were negative.", "Tests for cryoglobulins were negative.", "Tests for human immunodeficiency virus antibodies were negative.", "Minor salivary gland biopsy showed diffuse lymphocytic infiltrations with a focus score of 3.", "Salivary scintigraphy showed non-visualization in both salivary glands.", "The findings were consistent with the class 4 Schall grading system.", "She was diagnosed with Sj\u00f6gren\u2019s syndrome.", "The diagnosis fulfilled the 2002 American-European consensus classification criteria.", "She underwent a percutaneous renal biopsy due to nephrotic syndrome.", "Glomerular basement membrane thickening was observed by light microscopy.", "Mesangial matrix widening was observed by light microscopy.", "Mild tubular atrophy was noted.", "Moderate interstitial fibrosis was noted.", "Weakly positive staining for IgG, IgA, IgM, and C3 on the outer surface of capillary walls was revealed by immunofluorescent staining.", "Diffuse subepithelial electron-dense deposit was observed by electron microscopy.", "The histopathological findings were consistent with membranous glomerulonephritis.", "Abdominal computed tomography (CT) and colonoscopy were performed due to intermittent abdominal tenderness.", "No malignancy was observed at admission.", "No bowel perforation was observed at admission.", "She had sudden onset of severe abdominal pain 3 months later.", "Abdominal CT showed newly developed pneumoperitoneum with peritonitis.", "Abdominal CT showed small bowel perforation.", "An emergency operation and small bowel biopsy were performed.", "The specimen had a necrotic and ulcerous lesion measuring 4.5 \u00d7 5 cm.", "Immunohistochemical examination showed expression of CD20.", "Immunohistochemical examination showed expression of CD79a.", "Immunohistochemical examination showed expression of BCL-2.", "Immunohistochemical examination did not show expression of CD3.", "Immunohistochemical examination did not show expression of CD10.", "Immunohistochemical examination did not show expression of BCL-6.", "The proliferation fraction as determined by Ki-67 was 50%\u201360%.", "The majority of tumor cells were positive for EBV by in situ hybridization.", "Biopsy revealed EBV-positive DLBCL.", "The patient declined treatment with chemotherapy.", "She had been receiving intermittent low-dose oral corticosteroid.", "She had been receiving hydroxychloroquine.", "There was improvement in proteinuria (1.79 g/day) after 1 year of follow-up.", "There was improvement in sicca symptoms after 1 year of follow-up.", "One year of follow-up positron emission tomography-CT scan showed a stable disease state for the malignant lymphoma."], "index": 28, "original_id": "multiclinsum_test_2438_en.txt", "split": "test", "summary_subclaims": ["The patient is a 52-year-old woman.", "She has primary Sj\u00f6gren's syndrome.", "She developed membranous glomerulonephritis.", "She developed Epstein-Barr virus-positive diffuse large B-cell lymphoma.", "The diagnosis of Sj\u00f6gren's syndrome was based on dry eyes.", "The diagnosis of Sj\u00f6gren's syndrome was based on dry mouth.", "The diagnosis of Sj\u00f6gren's syndrome was based on a positive anti-nuclear antibody test.", "The diagnosis of Sj\u00f6gren's syndrome was based on anti-Ro (SS-A) antibody.", "The diagnosis of Sj\u00f6gren's syndrome was based on a salivary gland biopsy.", "The diagnosis of Sj\u00f6gren's syndrome was based on salivary scintigraphy.", "Renal biopsy confirmed the diagnosis of membranous glomerulonephritis.", "Three months later, her small bowel was perforated with pneumoperitoneum.", "The biopsy revealed Epstein-Barr virus-positive diffuse large B-cell lymphoma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 65-year-old man.", "The patient has a history of hypertension.", "The patient has a history of smoking.", "The patient was admitted from another institution.", "The patient was diagnosed with acute abdomen.", "The patient reported approximately 48 hours of pain in the lower abdominal area.", "The pain did not subside with common analgesics.", "The patient had associated nausea.", "On admission, the patient had a positive Blumberg sign.", "A blood count showed a leukocytosis of 18,320 mm\u00b3.", "A blood count showed a neutrophilia of 85%.", "A computed tomography (CT) of the abdomen with intravenous contrast was performed.", "The CT showed a saccular image of 52 x 41 mm dependent on the loop of the terminal ileum.", "The CT showed a pattern of bread crumbs.", "The CT showed peripheral enhancement.", "The CT showed rarefaction of adjacent fat.", "The CT showed findings related to Meckel's diverticulitis.", "The CT showed pneumoperitoneum.", "The CT showed free liquid in the abdominal cavity.", "Signs of associated peritonitis were considered.", "Laparoscopic surgery was performed.", "The surgery showed a prominent diverticulum dependent on the small intestine.", "The diverticulum was located 25 cm from the ileocecal valve.", "The diverticulum was perforated.", "An enterotomy of approximately 5 cm of the small intestine was performed.", "A lateral-lateral anastomosis with mechanical suture was performed.", "The abdominal cavity was washed.", "The abdominal wall was closed.", "The pathological anatomy described a segment of the small intestine with a lesion of saccular appearance.", "The lesion measured 35 x 25 mm.", "Histological cuts showed ulceration of the mucosa and submucosa.", "Histological cuts showed acute inflammation in the serosa.", "There was no significant alteration of the enteric wall away from the lesion.", "The description confirmed the diagnosis of perforated Meckel's diverticulitis."], "summary_subclaims": ["The patient is a 65-year-old man.", "The patient was referred from another institution.", "The patient was diagnosed with acute abdomen.", "On physical examination, the patient presented signs of peritoneal irritation.", "The admission blood count showed leukocytosis.", "The admission blood count showed neutrophilia.", "Computed tomography of the abdomen with intravenous contrast was performed.", "The computed tomography was interpreted as Meckel's diverticulitis complicated.", "The diagnosis was corroborated during the surgical act.", "The diagnosis was confirmed by pathological anatomy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 65-year-old man.", "The patient has a history of hypertension.", "The patient has a history of smoking.", "The patient was admitted from another institution.", "The patient was diagnosed with acute abdomen.", "The patient reported approximately 48 hours of pain in the lower abdominal area.", "The pain did not subside with common analgesics.", "The patient had associated nausea.", "On admission, the patient had a positive Blumberg sign.", "A blood count showed a leukocytosis of 18,320 mm\u00b3.", "A blood count showed a neutrophilia of 85%.", "A computed tomography (CT) of the abdomen with intravenous contrast was performed.", "The CT showed a saccular image of 52 x 41 mm dependent on the loop of the terminal ileum.", "The CT showed a pattern of bread crumbs.", "The CT showed peripheral enhancement.", "The CT showed rarefaction of adjacent fat.", "The CT showed findings related to Meckel's diverticulitis.", "The CT showed pneumoperitoneum.", "The CT showed free liquid in the abdominal cavity.", "Signs of associated peritonitis were considered.", "Laparoscopic surgery was performed.", "The surgery showed a prominent diverticulum dependent on the small intestine.", "The diverticulum was located 25 cm from the ileocecal valve.", "The diverticulum was perforated.", "An enterotomy of approximately 5 cm of the small intestine was performed.", "A lateral-lateral anastomosis with mechanical suture was performed.", "The abdominal cavity was washed.", "The abdominal wall was closed.", "The pathological anatomy described a segment of the small intestine with a lesion of saccular appearance.", "The lesion measured 35 x 25 mm.", "Histological cuts showed ulceration of the mucosa and submucosa.", "Histological cuts showed acute inflammation in the serosa.", "There was no significant alteration of the enteric wall away from the lesion.", "The description confirmed the diagnosis of perforated Meckel's diverticulitis."], "index": 30, "original_id": "multiclinsum_test_3197_en.txt", "split": "test", "summary_subclaims": ["The patient is a 65-year-old man.", "The patient was referred from another institution.", "The patient was diagnosed with acute abdomen.", "On physical examination, the patient presented signs of peritoneal irritation.", "The admission blood count showed leukocytosis.", "The admission blood count showed neutrophilia.", "Computed tomography of the abdomen with intravenous contrast was performed.", "The computed tomography was interpreted as Meckel's diverticulitis complicated.", "The diagnosis was corroborated during the surgical act.", "The diagnosis was confirmed by pathological anatomy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 64-year-old Indian man.", "He had complaints of abdominal pain, vomiting, and not passing flatus or feces for four days.", "The patient's general condition was poor.", "He was febrile.", "His pulse rate was 124/minute.", "His blood pressure was 90 mm/Hg.", "X-rays of the abdomen showed multiple air fluid levels.", "The X-rays were suggestive of acute intestinal obstruction.", "The provisional diagnosis was acute abdomen (acute intestinal obstruction).", "The patient was resuscitated.", "The patient was sent for an urgent laparotomy.", "On exploration, the patient had severely dilated small gut loops.", "The terminal ileal loop was twisted around the omental band.", "The ileal loop was adherent to the left pelvic wall.", "On releasing the omental band, the ileal loop was dissected free from the left pelvic wall.", "A large, white, oval shaped, extra-luminal body was found in the region of the sigmoid colon.", "The body was soft to firm in consistency.", "The body resembled a boiled hen's egg.", "The body was attached to the omentum.", "Part of the appendices epiploicae attached to the sigmoid colon were calcified.", "The stalks of the calcified appendices epiploicae were constricted.", "The peritoneal loose body was largely parasitized to the omentum.", "The body had a separate feeding vessel supplying it from the omentum.", "The body measured 7 cm in length and 5 cm in width.", "The body weighed 74 g.", "On the cut surface, it had a classic appearance like a boiled egg.", "The white peripheral part was smooth and soft in consistency.", "The central yellow part was slightly firm in the periphery.", "The central yellow part was hard (calcified) at the central point.", "The surfaces were smooth and shiny.", "Histological examination showed laminated strands of a fibrinoid substance.", "The peripheral white part contained a large amount of proteinaceous material.", "The peripheral white part resembled boiled albumin with high collagen deposition.", "The central yellow part contained saponified fat with calcification.", "The patient did well post-operatively.", "He resumed his oral diet on the third post-operative day.", "He was discharged from the hospital five days after the operation."], "summary_subclaims": ["A giant loose peritoneal body measuring 7 \u00d7 5 cm was found incidentally in a 64-year-old Indian man.", "The patient presented with acute intestinal obstruction.", "The current hypothesis and opinion on the genesis of such large bodies are presented.", "The problems in diagnosis are discussed."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 64-year-old Indian man.", "He had complaints of abdominal pain, vomiting, and not passing flatus or feces for four days.", "The patient's general condition was poor.", "He was febrile.", "His pulse rate was 124/minute.", "His blood pressure was 90 mm/Hg.", "X-rays of the abdomen showed multiple air fluid levels.", "The X-rays were suggestive of acute intestinal obstruction.", "The provisional diagnosis was acute abdomen (acute intestinal obstruction).", "The patient was resuscitated.", "The patient was sent for an urgent laparotomy.", "On exploration, the patient had severely dilated small gut loops.", "The terminal ileal loop was twisted around the omental band.", "The ileal loop was adherent to the left pelvic wall.", "On releasing the omental band, the ileal loop was dissected free from the left pelvic wall.", "A large, white, oval shaped, extra-luminal body was found in the region of the sigmoid colon.", "The body was soft to firm in consistency.", "The body resembled a boiled hen's egg.", "The body was attached to the omentum.", "Part of the appendices epiploicae attached to the sigmoid colon were calcified.", "The stalks of the calcified appendices epiploicae were constricted.", "The peritoneal loose body was largely parasitized to the omentum.", "The body had a separate feeding vessel supplying it from the omentum.", "The body measured 7 cm in length and 5 cm in width.", "The body weighed 74 g.", "On the cut surface, it had a classic appearance like a boiled egg.", "The white peripheral part was smooth and soft in consistency.", "The central yellow part was slightly firm in the periphery.", "The central yellow part was hard (calcified) at the central point.", "The surfaces were smooth and shiny.", "Histological examination showed laminated strands of a fibrinoid substance.", "The peripheral white part contained a large amount of proteinaceous material.", "The peripheral white part resembled boiled albumin with high collagen deposition.", "The central yellow part contained saponified fat with calcification.", "The patient did well post-operatively.", "He resumed his oral diet on the third post-operative day.", "He was discharged from the hospital five days after the operation."], "index": 36, "original_id": "multiclinsum_test_2469_en.txt", "split": "test", "summary_subclaims": ["A giant loose peritoneal body measuring 7 \u00d7 5 cm was found incidentally in a 64-year-old Indian man.", "The patient presented with acute intestinal obstruction.", "The current hypothesis and opinion on the genesis of such large bodies are presented.", "The problems in diagnosis are discussed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is an 82-year-old lady.", "She presented with recurrent attacks of hypoglycemia.", "Diagnostic tests repeatedly documented glucose levels below 40 mg/dl.", "A CT scan of the abdomen revealed a large lesion of around 5 to 6 cm in relation to the pancreatic body and tail.", "There were also large masses of about 3\u20135 cm in the retroperitoneum and in the area of the celiac trunk and around the mesenteric artery.", "In the pancreatic body there was a hypervascularized area suspicious for an insulinoma.", "The patient reported a weight loss of 12 kilograms over the previous 4 months.", "A somatostatin receptor scintigraphy showed an enhanced uptake in the region of the pancreatic body/tail.", "A somatostatin receptor scintigraphy showed an enhanced uptake in the right axilla.", "A palpable mass was noted in the right axilla.", "The scintigraphy excluded the possibility of other involved areas.", "The patient had a past history of an operation on the right eyebrow 2 years prior.", "The eyebrow lesion was reported as a Merkel cell carcinoma.", "Histopathology showed rather uniform tumor cells in a trabecular growth pattern.", "The tumor cells had monomorphous pale-stained nuclei.", "There were many mitoses.", "There was invasion of dermal lymphatics and blood vessels.", "Immunohistochemistry revealed strong positivity for cytokeratin 20.", "Immunohistochemistry revealed a dot-like pattern of cytokeratin 20.", "There was a weak expression of chromogranin A.", "After excision, radiation therapy was administered at the site of the primary lesion.", "Radiation therapy was also administered at the draining lymphatic vessels.", "Radiation therapy was also administered at the first lymph node station.", "A year later, a large abdominal mass was noted of uncertain origin.", "An ultrasound guided biopsy showed an unspecified small cell cancer.", "Palliative radiotherapy of 30 Gray over 2 months was administered.", "No definitive diagnosis of metastasis in the spleen, left adrenal gland, and axilla was established.", "The working clinical diagnosis was symptomatic insulinoma not responding to medical measures.", "A decision for surgical resection of the large lesion was made.", "Surgical exploration revealed a large mass of about 5 cm in the tail of the pancreas.", "The mass was in close proximity to the spleen and the splenic flexure of the transverse colon.", "There was no evidence of any metastatic disease to the liver, peritoneum, and the adnexae.", "A distal pancreatectomy, splenectomy, adrenalectomy, and resection of the splenic flexure of the colon were performed.", "Pathological examination revealed a tumor in the pancreatic tail.", "The tumor was also present in the adrenal gland.", "The tumor was also present in the peripancreatic tissue.", "The tumor was also present in the surrounding soft tissue.", "Grossly, the mass displayed a whitish and glassy cut surface.", "The mass contained extended areas of haemorrhage and necrosis.", "Histologically, the tumor displayed endocrine architecture with mostly solid formations of rather monomorphic cells.", "The tumor was mitotically highly active (mitotic count >10 per high power field).", "The tumor contained abundant areas of necrosis.", "Immunohistochemically, the tumor cells were strongly positive for synaptophysin.", "Immunohistochemically, the tumor cells were strongly positive for cytokeratin 20.", "There was no expression of insulin.", "The proliferative activity (MIB-1) reached approximately 80%.", "Gross examination of the resected specimen revealed a well demarcated, brownish tumor of the pancreatic body.", "The tumor measured 1.2 cm in diameter.", "Microscopically, the tumor displayed endocrine architecture with trabecular arrangements of uniform tumor cells.", "There was no mitotic activity.", "Immunohistochemistry revealed strong positivity for synaptophysin.", "Immunohistochemistry revealed focal positivity for insulin.", "The proliferative activity (MIB-1) was approximately 1%.", "The diagnosis of a poorly differentiated endocrine carcinoma (Merkel cell carcinoma) was made.", "The diagnosis of a benign pancreatic insulinoma was made.", "The patient had a smooth postoperative recovery.", "The bouts of hypoglycaemia completely disappeared.", "She was discharged home within 3 weeks of surgery.", "She is presently asymptomatic.", "She remains on regular follow up."], "summary_subclaims": ["We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma.", "An 82-year old lady suffered from recurrent attacks of hypoglycemia.", "She presented with an abdominal mass.", "Two years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma.", "An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out.", "Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail.", "Final histopathology showed the tumor in the peripancreatic tissue.", "Final histopathology showed the tumor in the surrounding soft tissue.", "The histopathology was consistent with metastatic Merkel cell carcinoma.", "An insulinoma of the pancreatic body was also found."]}, "extra_info": {"fulltext_subclaims": ["The patient is an 82-year-old lady.", "She presented with recurrent attacks of hypoglycemia.", "Diagnostic tests repeatedly documented glucose levels below 40 mg/dl.", "A CT scan of the abdomen revealed a large lesion of around 5 to 6 cm in relation to the pancreatic body and tail.", "There were also large masses of about 3\u20135 cm in the retroperitoneum and in the area of the celiac trunk and around the mesenteric artery.", "In the pancreatic body there was a hypervascularized area suspicious for an insulinoma.", "The patient reported a weight loss of 12 kilograms over the previous 4 months.", "A somatostatin receptor scintigraphy showed an enhanced uptake in the region of the pancreatic body/tail.", "A somatostatin receptor scintigraphy showed an enhanced uptake in the right axilla.", "A palpable mass was noted in the right axilla.", "The scintigraphy excluded the possibility of other involved areas.", "The patient had a past history of an operation on the right eyebrow 2 years prior.", "The eyebrow lesion was reported as a Merkel cell carcinoma.", "Histopathology showed rather uniform tumor cells in a trabecular growth pattern.", "The tumor cells had monomorphous pale-stained nuclei.", "There were many mitoses.", "There was invasion of dermal lymphatics and blood vessels.", "Immunohistochemistry revealed strong positivity for cytokeratin 20.", "Immunohistochemistry revealed a dot-like pattern of cytokeratin 20.", "There was a weak expression of chromogranin A.", "After excision, radiation therapy was administered at the site of the primary lesion.", "Radiation therapy was also administered at the draining lymphatic vessels.", "Radiation therapy was also administered at the first lymph node station.", "A year later, a large abdominal mass was noted of uncertain origin.", "An ultrasound guided biopsy showed an unspecified small cell cancer.", "Palliative radiotherapy of 30 Gray over 2 months was administered.", "No definitive diagnosis of metastasis in the spleen, left adrenal gland, and axilla was established.", "The working clinical diagnosis was symptomatic insulinoma not responding to medical measures.", "A decision for surgical resection of the large lesion was made.", "Surgical exploration revealed a large mass of about 5 cm in the tail of the pancreas.", "The mass was in close proximity to the spleen and the splenic flexure of the transverse colon.", "There was no evidence of any metastatic disease to the liver, peritoneum, and the adnexae.", "A distal pancreatectomy, splenectomy, adrenalectomy, and resection of the splenic flexure of the colon were performed.", "Pathological examination revealed a tumor in the pancreatic tail.", "The tumor was also present in the adrenal gland.", "The tumor was also present in the peripancreatic tissue.", "The tumor was also present in the surrounding soft tissue.", "Grossly, the mass displayed a whitish and glassy cut surface.", "The mass contained extended areas of haemorrhage and necrosis.", "Histologically, the tumor displayed endocrine architecture with mostly solid formations of rather monomorphic cells.", "The tumor was mitotically highly active (mitotic count >10 per high power field).", "The tumor contained abundant areas of necrosis.", "Immunohistochemically, the tumor cells were strongly positive for synaptophysin.", "Immunohistochemically, the tumor cells were strongly positive for cytokeratin 20.", "There was no expression of insulin.", "The proliferative activity (MIB-1) reached approximately 80%.", "Gross examination of the resected specimen revealed a well demarcated, brownish tumor of the pancreatic body.", "The tumor measured 1.2 cm in diameter.", "Microscopically, the tumor displayed endocrine architecture with trabecular arrangements of uniform tumor cells.", "There was no mitotic activity.", "Immunohistochemistry revealed strong positivity for synaptophysin.", "Immunohistochemistry revealed focal positivity for insulin.", "The proliferative activity (MIB-1) was approximately 1%.", "The diagnosis of a poorly differentiated endocrine carcinoma (Merkel cell carcinoma) was made.", "The diagnosis of a benign pancreatic insulinoma was made.", "The patient had a smooth postoperative recovery.", "The bouts of hypoglycaemia completely disappeared.", "She was discharged home within 3 weeks of surgery.", "She is presently asymptomatic.", "She remains on regular follow up."], "index": 32, "original_id": "multiclinsum_test_1055_en.txt", "split": "test", "summary_subclaims": ["We report an unusual occurrence of pancreatic metastases from a previously diagnosed Merkel cell carcinoma with the discovery of a concomitant insulinoma.", "An 82-year old lady suffered from recurrent attacks of hypoglycemia.", "She presented with an abdominal mass.", "Two years prior she had an excision done on her eyebrow that was reported as Merkel cell carcinoma.", "An extended distal pancreatectomy and splenectomy along with resection of the left flexure of the colon for her abdominal mass was carried out.", "Final histopathology of the mass was a poorly differentiated endocrine carcinoma in the pancreatic tail.", "Final histopathology showed the tumor in the peripancreatic tissue.", "Final histopathology showed the tumor in the surrounding soft tissue.", "The histopathology was consistent with metastatic Merkel cell carcinoma.", "An insulinoma of the pancreatic body was also found."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 56-year-old male.", "The patient was admitted on 2022-09-19.", "The patient had chest tightness and chest pain for more than 2 months.", "The patient had a weight loss of 10 kilogram in the past 2 months.", "The patient had a history of afternoon low fever before 1 week.", "The patient had a clear consciousness.", "The patient had anemia.", "The patient had enlarged superficial lymph nodes.", "The patient had barrel-shaped chest.", "The patient had swollen skin on the right side of the chest.", "The patient had solid percussion sounds on the right side of the chest.", "The patient had enlarged liver on the right side.", "The patient had deep yellow urine.", "The patient had a history of mitral valvuloplasty and aortic valve replacement at the Second Affiliated Hospital of Nanchang University on 2021-08-11.", "The patient had long-term oral treatment with warfarin anticoagulation.", "The patient had long-term oral treatment with metoprolol.", "The patient was a smoker for 40 years, 10 cigarettes per day.", "The patient had no history of contact with a chronically coughing person suspected of or treated for TB.", "The CT examination showed multiple wall nodules in the right pleura.", "The CT examination showed right pleural encapsulated effusion.", "The CT examination showed bone destruction in the 2nd thoracic vertebra.", "The CT examination showed multiple slightly hypodense nodules in the liver.", "The possibility of multiple metastases of right lung cancer with malignant pleural fluid was considered.", "The histopathology showed coagulative necrosis combining with granulomatous inflammation.", "Acid-fast bacilli staining was positive.", "The diagnosis of TB infection was definite."], "summary_subclaims": ["The patient is a 56-year-old male.", "The patient is HIV-negative.", "The patient was hospitalized for chest disease.", "The patient's main symptoms included chest tightness.", "The patient's main symptoms included chest pain.", "The patient's main symptoms included fatigue.", "The patient's main symptoms included anorexia.", "The patient's main symptoms included weight loss.", "The patient's heart rate was 109 times/min.", "CT scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura.", "CT scans revealed right pleural encapsulated effusion.", "CT scans showed limited, incomplete expansion of the middle and lower lobes of the right lung.", "CT scans showed enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups.", "CT scans showed multiple slightly low-density nodules in the liver.", "CT scans showed bone destruction in the 2nd thoracic vertebra.", "The findings raised the possibility of multiple liver metastases of right lung cancer.", "The findings raised the possibility of malignant pleural fluid.", "The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally.", "The patient was diagnosed with atypical systemic HDTB.", "The patient received three months of conventional anti-TB treatment.", "The patient refused follow-up at our hospital.", "The patient's symptoms improved significantly during telephone follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 56-year-old male.", "The patient was admitted on 2022-09-19.", "The patient had chest tightness and chest pain for more than 2 months.", "The patient had a weight loss of 10 kilogram in the past 2 months.", "The patient had a history of afternoon low fever before 1 week.", "The patient had a clear consciousness.", "The patient had anemia.", "The patient had enlarged superficial lymph nodes.", "The patient had barrel-shaped chest.", "The patient had swollen skin on the right side of the chest.", "The patient had solid percussion sounds on the right side of the chest.", "The patient had enlarged liver on the right side.", "The patient had deep yellow urine.", "The patient had a history of mitral valvuloplasty and aortic valve replacement at the Second Affiliated Hospital of Nanchang University on 2021-08-11.", "The patient had long-term oral treatment with warfarin anticoagulation.", "The patient had long-term oral treatment with metoprolol.", "The patient was a smoker for 40 years, 10 cigarettes per day.", "The patient had no history of contact with a chronically coughing person suspected of or treated for TB.", "The CT examination showed multiple wall nodules in the right pleura.", "The CT examination showed right pleural encapsulated effusion.", "The CT examination showed bone destruction in the 2nd thoracic vertebra.", "The CT examination showed multiple slightly hypodense nodules in the liver.", "The possibility of multiple metastases of right lung cancer with malignant pleural fluid was considered.", "The histopathology showed coagulative necrosis combining with granulomatous inflammation.", "Acid-fast bacilli staining was positive.", "The diagnosis of TB infection was definite."], "index": 38, "original_id": "multiclinsum_test_867_en.txt", "split": "test", "summary_subclaims": ["The patient is a 56-year-old male.", "The patient is HIV-negative.", "The patient was hospitalized for chest disease.", "The patient's main symptoms included chest tightness.", "The patient's main symptoms included chest pain.", "The patient's main symptoms included fatigue.", "The patient's main symptoms included anorexia.", "The patient's main symptoms included weight loss.", "The patient's heart rate was 109 times/min.", "CT scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura.", "CT scans revealed right pleural encapsulated effusion.", "CT scans showed limited, incomplete expansion of the middle and lower lobes of the right lung.", "CT scans showed enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups.", "CT scans showed multiple slightly low-density nodules in the liver.", "CT scans showed bone destruction in the 2nd thoracic vertebra.", "The findings raised the possibility of multiple liver metastases of right lung cancer.", "The findings raised the possibility of malignant pleural fluid.", "The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally.", "The patient was diagnosed with atypical systemic HDTB.", "The patient received three months of conventional anti-TB treatment.", "The patient refused follow-up at our hospital.", "The patient's symptoms improved significantly during telephone follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 51-year-old Caucasian left-handed housewife.", "The patient had a weight of 61 kg and height of 159 cm.", "The patient was admitted due to severe sudden onset headache.", "The patient had transient loss of consciousness.", "The patient vomited.", "On examination, the patient was fully conscious and oriented.", "The patient complained of severe headache.", "Nuchal rigidity was evident.", "No focal neurological deficit was found.", "Temperature was 38\u00b0C.", "CT scan of the head revealed acute subarachnoid hemorrhage.", "CT angiography was performed.", "The cerebral vasculature harbored three saccular aneurysms.", "The right MCA aneurysm was presumed to be the ruptured aneurysm.", "A right pterional craniotomy was performed.", "The sphenoid ridge was drilled flush with the orbital roof.", "Gentle frontal lobe retraction allowed CSF drainage.", "The Sylvian fissure was opened from medial to lateral.", "A saccular aneurysm was found in the MCA trifurcation.", "The aneurysm was clipped.", "The distal basilar artery aneurysm was located between the right PCA and right SCA.", "The aneurysm dome projected laterally to the right.", "Successful clipping was achieved.", "The left ICA bifurcation aneurysm was identified.", "The aneurysm projected superiorly.", "The aneurysm was clipped.", "The patient experienced an uneventful post-operative period.", "The patient was discharged within 5 days of surgery.", "A follow-up CT angiography confirmed successful obliteration of all lesions."], "summary_subclaims": ["The patient is a 51 year-old Caucasian right handed housewife lady.", "The patient presented with a headache of acute onset.", "The headache was caused by acute subarachnoid hemorrhage.", "Cerebral computed tomographic angiography revealed multiple aneurysms.", "The patient underwent a right pterional craniotomy.", "The right pterional craniotomy was performed to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms.", "The post-operative course was uneventful."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 51-year-old Caucasian left-handed housewife.", "The patient had a weight of 61 kg and height of 159 cm.", "The patient was admitted due to severe sudden onset headache.", "The patient had transient loss of consciousness.", "The patient vomited.", "On examination, the patient was fully conscious and oriented.", "The patient complained of severe headache.", "Nuchal rigidity was evident.", "No focal neurological deficit was found.", "Temperature was 38\u00b0C.", "CT scan of the head revealed acute subarachnoid hemorrhage.", "CT angiography was performed.", "The cerebral vasculature harbored three saccular aneurysms.", "The right MCA aneurysm was presumed to be the ruptured aneurysm.", "A right pterional craniotomy was performed.", "The sphenoid ridge was drilled flush with the orbital roof.", "Gentle frontal lobe retraction allowed CSF drainage.", "The Sylvian fissure was opened from medial to lateral.", "A saccular aneurysm was found in the MCA trifurcation.", "The aneurysm was clipped.", "The distal basilar artery aneurysm was located between the right PCA and right SCA.", "The aneurysm dome projected laterally to the right.", "Successful clipping was achieved.", "The left ICA bifurcation aneurysm was identified.", "The aneurysm projected superiorly.", "The aneurysm was clipped.", "The patient experienced an uneventful post-operative period.", "The patient was discharged within 5 days of surgery.", "A follow-up CT angiography confirmed successful obliteration of all lesions."], "index": 34, "original_id": "multiclinsum_test_2076_en.txt", "split": "test", "summary_subclaims": ["The patient is a 51 year-old Caucasian right handed housewife lady.", "The patient presented with a headache of acute onset.", "The headache was caused by acute subarachnoid hemorrhage.", "Cerebral computed tomographic angiography revealed multiple aneurysms.", "The patient underwent a right pterional craniotomy.", "The right pterional craniotomy was performed to obliterate right middle cerebral, distal basilar and left carotid bifurcation aneurysms.", "The post-operative course was uneventful."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 21-year-old male Japanese student.", "He is an active member of an equestrian club.", "He sustained a right toe injury during an accident in a club-related activity.", "The injury resulted in the severance of his right toe above the interphalangeal joint.", "He was directed to the rehabilitation department 2 weeks post-injury.", "He had no remarkable medical or family history.", "The patient agreed to provide the case report and consented to its publication, including any accompanying images.", "The ethics committee of our institution waived the need for ethical review, as the patient provided written consent for the case report.", "Initial assessments indicated pain localized to the injury site, primarily during walking.", "One month post-injury, the patient also reported pain in the right knee joint while engaging in riding or walking.", "The pain in the area of the hallux deficit hindered his ability to apply pressure on the thenars.", "Diagnostic tests, including walking cycle analysis, temporospatial gait parameters, foot pressure distribution, ground reaction force measurements, toe grip force, and one-leg standing tests, were conducted.", "The foot pressure during a comfortable walk were recorded using a Zebris plantar pressure platform.", "The center of pressure (COP) during a comfortable walking pace was captured using force plates.", "A diminished foot pressure was observed not just in the hallux but also in the metatarsal head of toes two to five on the injured side.", "The left-foot COP shifted toward the left toe in the late stance phase.", "The right-foot COP transitioned toward the second toe, exhibiting greater spatial variability.", "Assessing the walking cycle using a Zebris plantar pressure platform, the load response and single-support durations were reduced.", "The pre-swing phase was extended.", "Vertical ground reaction force during the second peak of walking was diminished on the right side.", "The patient was unable to maintain a one-leg stand for 10 seconds on the right foot.", "Pain levels for the toe and knee were rated 5 out of 10 on a numerical rating scale (NRS).", "A rehabilitation protocol was designed to enhance medial foot loading and improve foot pressure during walking and standing.", "The regimen included balance and trunk strength training.", "Starting from the fifth week, the focus shifted to lower limb strength training.", "From the ninth week, dynamic joint stability exercises were introduced to enhance neuromuscular coordination for movement stabilization.", "After 3 months, foot pressure and COP movement during walking improved.", "Pressure distribution across toes two to five and the metatarsal head improved.", "There were negligible discrepancies between the left and right sides in both the vertical and anterior\u2013posterior directions.", "The pressure was consistently distributed from the second toe of the right foot.", "Notable enhancements were also observed in the pre-leg phase.", "The second peak of the vertical component of the ground reaction force increased.", "One-leg standing on the right foot became stable for 10 seconds, even on a balance mat.", "NRS scores for the toe and knee pain reduced to 0, indicating a return to pre-injury levels of activity."], "summary_subclaims": ["The patient is a 21-year-old Japanese individual.", "The patient had a traumatic hallux deficit.", "Only a portion of the basal phalanx was intact.", "The thenar area exhibited instability.", "The instability led to impaired balance.", "The instability led to walking difficulties.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the foot.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the knee.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the hip.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the trunk.", "A rehabilitation protocol was designed to enhance medial foot loading during walking.", "A rehabilitation protocol was designed to enhance medial foot loading during standing.", "The rehabilitation protocol included balance training.", "The rehabilitation protocol included trunk strength training.", "The rehabilitation period lasted 12 weeks.", "The load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%.", "The pre-swing phase of the gait cycle on the affected side decreased from 14.6% to 11.6%.", "The vertical component of the ground reaction force rose from 599.8 to 647.5 N.", "Enhanced stability from balance training contributed to the patient's improved walking.", "Enhanced stability from balance training contributed to the patient's improved balance.", "Increased muscle strength contributed to the patient's improved walking.", "Increased muscle strength contributed to the patient's improved balance."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 21-year-old male Japanese student.", "He is an active member of an equestrian club.", "He sustained a right toe injury during an accident in a club-related activity.", "The injury resulted in the severance of his right toe above the interphalangeal joint.", "He was directed to the rehabilitation department 2 weeks post-injury.", "He had no remarkable medical or family history.", "The patient agreed to provide the case report and consented to its publication, including any accompanying images.", "The ethics committee of our institution waived the need for ethical review, as the patient provided written consent for the case report.", "Initial assessments indicated pain localized to the injury site, primarily during walking.", "One month post-injury, the patient also reported pain in the right knee joint while engaging in riding or walking.", "The pain in the area of the hallux deficit hindered his ability to apply pressure on the thenars.", "Diagnostic tests, including walking cycle analysis, temporospatial gait parameters, foot pressure distribution, ground reaction force measurements, toe grip force, and one-leg standing tests, were conducted.", "The foot pressure during a comfortable walk were recorded using a Zebris plantar pressure platform.", "The center of pressure (COP) during a comfortable walking pace was captured using force plates.", "A diminished foot pressure was observed not just in the hallux but also in the metatarsal head of toes two to five on the injured side.", "The left-foot COP shifted toward the left toe in the late stance phase.", "The right-foot COP transitioned toward the second toe, exhibiting greater spatial variability.", "Assessing the walking cycle using a Zebris plantar pressure platform, the load response and single-support durations were reduced.", "The pre-swing phase was extended.", "Vertical ground reaction force during the second peak of walking was diminished on the right side.", "The patient was unable to maintain a one-leg stand for 10 seconds on the right foot.", "Pain levels for the toe and knee were rated 5 out of 10 on a numerical rating scale (NRS).", "A rehabilitation protocol was designed to enhance medial foot loading and improve foot pressure during walking and standing.", "The regimen included balance and trunk strength training.", "Starting from the fifth week, the focus shifted to lower limb strength training.", "From the ninth week, dynamic joint stability exercises were introduced to enhance neuromuscular coordination for movement stabilization.", "After 3 months, foot pressure and COP movement during walking improved.", "Pressure distribution across toes two to five and the metatarsal head improved.", "There were negligible discrepancies between the left and right sides in both the vertical and anterior\u2013posterior directions.", "The pressure was consistently distributed from the second toe of the right foot.", "Notable enhancements were also observed in the pre-leg phase.", "The second peak of the vertical component of the ground reaction force increased.", "One-leg standing on the right foot became stable for 10 seconds, even on a balance mat.", "NRS scores for the toe and knee pain reduced to 0, indicating a return to pre-injury levels of activity."], "index": 42, "original_id": "multiclinsum_test_1445_en.txt", "split": "test", "summary_subclaims": ["The patient is a 21-year-old Japanese individual.", "The patient had a traumatic hallux deficit.", "Only a portion of the basal phalanx was intact.", "The thenar area exhibited instability.", "The instability led to impaired balance.", "The instability led to walking difficulties.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the foot.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the knee.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the hip.", "Biomechanical assessment revealed the need for a rehabilitation strategy for the trunk.", "A rehabilitation protocol was designed to enhance medial foot loading during walking.", "A rehabilitation protocol was designed to enhance medial foot loading during standing.", "The rehabilitation protocol included balance training.", "The rehabilitation protocol included trunk strength training.", "The rehabilitation period lasted 12 weeks.", "The load response and single-support phases of the gait cycle on the affected side increased from 46.9% to 49.3%.", "The pre-swing phase of the gait cycle on the affected side decreased from 14.6% to 11.6%.", "The vertical component of the ground reaction force rose from 599.8 to 647.5 N.", "Enhanced stability from balance training contributed to the patient's improved walking.", "Enhanced stability from balance training contributed to the patient's improved balance.", "Increased muscle strength contributed to the patient's improved walking.", "Increased muscle strength contributed to the patient's improved balance."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 58-year-old male.", "The patient was admitted to the hospital on November 10, 2021.", "The patient was admitted due to complaining of fever for 7 days.", "There was no family history.", "On November 2019, he was diagnosed with B-cell acute lymphoblastic leukemia.", "He received multiple chemotherapy sessions.", "His bone marrow was retested as minimal residual disease-negative complete remission.", "On November 26, 2020, the patient underwent allogeneic HSCT.", "He received treatment such as leukocytosis.", "He received GVHD prophylaxis.", "He received infection prophylaxis.", "On December 29, 2020, he developed thrombocytopenia.", "He was treated with platelet transfusion.", "Bone marrow CR and MDR were repeatedly rechecked.", "The results were negative.", "The results showed complete implantation of FISH donor.", "Fever occurred repeatedly in February, March, and May 2021.", "After anti-infection, anti-fungal, and anti-viral treatment, the patient improved.", "The patient was discharged.", "7 days before admission, the patient developed a fever.", "The highest temperature was 39.3\u00b0C.", "The patient was hospitalized in a tertiary hospital in Guangzhou.", "The chest CT showed multiple inflammations in both lungs.", "He was given imipenem/cilastatin.", "He was given caspofungin.", "He was given liposomal amphotericin B.", "He still had recurrent fevers.", "The tracheoscopy was completed.", "The bronchial fluid was found positive for MTB complex nucleic acid.", "MTB was detected again in the NGS.", "The patient was considered to be post-HSCT TB.", "He was admitted to our hospital after consultation."], "summary_subclaims": ["The patient had acute lymphoblastic leukemia.", "The patient suffered from pulmonary TB infection after HSCT.", "The patient had a poor response to linezolid-containing regimen.", "The patient developed side effects such as gingival bleeding and thrombocytopenia.", "The administration was switched to contezolid.", "After 15 days of continuous treatment, the patient's platelet increased to 58\u00d7109/L.", "The patient was discharged in stable condition.", "During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable.", "No hematological adverse reactions were observed.", "No symptoms of peripheral neuropathy were observed.", "Repeat imaging showed that the bilateral lung lesions were significantly reduced."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 58-year-old male.", "The patient was admitted to the hospital on November 10, 2021.", "The patient was admitted due to complaining of fever for 7 days.", "There was no family history.", "On November 2019, he was diagnosed with B-cell acute lymphoblastic leukemia.", "He received multiple chemotherapy sessions.", "His bone marrow was retested as minimal residual disease-negative complete remission.", "On November 26, 2020, the patient underwent allogeneic HSCT.", "He received treatment such as leukocytosis.", "He received GVHD prophylaxis.", "He received infection prophylaxis.", "On December 29, 2020, he developed thrombocytopenia.", "He was treated with platelet transfusion.", "Bone marrow CR and MDR were repeatedly rechecked.", "The results were negative.", "The results showed complete implantation of FISH donor.", "Fever occurred repeatedly in February, March, and May 2021.", "After anti-infection, anti-fungal, and anti-viral treatment, the patient improved.", "The patient was discharged.", "7 days before admission, the patient developed a fever.", "The highest temperature was 39.3\u00b0C.", "The patient was hospitalized in a tertiary hospital in Guangzhou.", "The chest CT showed multiple inflammations in both lungs.", "He was given imipenem/cilastatin.", "He was given caspofungin.", "He was given liposomal amphotericin B.", "He still had recurrent fevers.", "The tracheoscopy was completed.", "The bronchial fluid was found positive for MTB complex nucleic acid.", "MTB was detected again in the NGS.", "The patient was considered to be post-HSCT TB.", "He was admitted to our hospital after consultation."], "index": 40, "original_id": "multiclinsum_test_353_en.txt", "split": "test", "summary_subclaims": ["The patient had acute lymphoblastic leukemia.", "The patient suffered from pulmonary TB infection after HSCT.", "The patient had a poor response to linezolid-containing regimen.", "The patient developed side effects such as gingival bleeding and thrombocytopenia.", "The administration was switched to contezolid.", "After 15 days of continuous treatment, the patient's platelet increased to 58\u00d7109/L.", "The patient was discharged in stable condition.", "During subsequent anti-TB treatment with contezolid for more than 7 months, the platelets remained stable.", "No hematological adverse reactions were observed.", "No symptoms of peripheral neuropathy were observed.", "Repeat imaging showed that the bilateral lung lesions were significantly reduced."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A four-year-old girl presented to the emergency service with painful left hip and fever.", "There was no previous relevant medical history.", "There were no other local or systemic symptoms, except for a cervical adenopathy.", "On physical examination, she walked with a limp.", "Movements of the left hip were painful (mainly external rotation), but not restricted.", "Blood exam revealed anemia (Hb 8.7 gr/dL).", "Blood exam showed normal WBC.", "ESB was 123 mm.", "Reactive C protein was 149.7 mg/L.", "An initial X-ray to the pelvis revealed no changes.", "An ultrasound of the left hip was performed.", "The ultrasound revealed small infusion and synovitis.", "Guided puncture was performed.", "The puncture was macroscopically compatible with reactive arthritis.", "General and bacteriological tests were demanded.", "A CT scan to the abdomen and pelvis was performed.", "The CT scan revealed a left adrenal mass.", "The CT scan revealed retroperitoneal adenopathies in the celiac trunk and superior mesenteric artery.", "No bone or articular involvement was found in the CT scan.", "No further alterations were reported in the thoracic CT scan.", "No alterations were reported in peripheral blood smears.", "Bacteriological examination of the hip effusion was negative.", "MRI was also performed.", "The direct myelogram was compatible with infiltration from neuroblastoma.", "Bone marrow biopsy and cervical adenopathy specimens were collected to perform histological diagnosis.", "Skeletal scintigraphy demonstrated numerous points of osteoblastic activity compatible with metastatic activity.", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'Abdominal mass with low expression of noradrenergic transporters.'", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'Diffuse bone metastasization with high expression of noradrenergic transporters.'", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'No other soft tissue involvement was detected.'", "In the histological report of the cervical adenopathy, the diagnosis of neuroblastoma NOS was performed.", "Immunohistochemistry revealed extensive expression for synaptophysin.", "Immunohistochemistry revealed extensive expression for CD56 (NCAM).", "Immunohistochemistry revealed absence of expression of myogenin.", "Bone marrow biopsy revealed extensive metastatic involvement.", "The patient started chemotherapy two weeks after admission.", "The patient received 8 cycles of rapid COJEC protocol.", "After six months of follow-up, the primary tumor was still without criteria for resection.", "Despite a decrease in the metastatic involvement, the primary tumor was still without criteria for resection.", "Given the chemotherapy-related renal toxicity, it was decided to proceed with irinotecan in combination with temozolomide (TEMIRI).", "After thirteen months of follow-up, no significant regression of the primary tumor occurred.", "Surgery was contraindicated.", "The patient was proposed for stem cell treatment."], "summary_subclaims": ["A four-year-old girl presented with fever and a painful limp in the left hip.", "Pain characteristics and anemia detected in the blood analyses were the first warning signs that the hip process was not standard.", "The primary suspicion was of septic arthritis.", "A CT scan of the abdomen revealed an adrenal neuroblastoma."]}, "extra_info": {"fulltext_subclaims": ["A four-year-old girl presented to the emergency service with painful left hip and fever.", "There was no previous relevant medical history.", "There were no other local or systemic symptoms, except for a cervical adenopathy.", "On physical examination, she walked with a limp.", "Movements of the left hip were painful (mainly external rotation), but not restricted.", "Blood exam revealed anemia (Hb 8.7 gr/dL).", "Blood exam showed normal WBC.", "ESB was 123 mm.", "Reactive C protein was 149.7 mg/L.", "An initial X-ray to the pelvis revealed no changes.", "An ultrasound of the left hip was performed.", "The ultrasound revealed small infusion and synovitis.", "Guided puncture was performed.", "The puncture was macroscopically compatible with reactive arthritis.", "General and bacteriological tests were demanded.", "A CT scan to the abdomen and pelvis was performed.", "The CT scan revealed a left adrenal mass.", "The CT scan revealed retroperitoneal adenopathies in the celiac trunk and superior mesenteric artery.", "No bone or articular involvement was found in the CT scan.", "No further alterations were reported in the thoracic CT scan.", "No alterations were reported in peripheral blood smears.", "Bacteriological examination of the hip effusion was negative.", "MRI was also performed.", "The direct myelogram was compatible with infiltration from neuroblastoma.", "Bone marrow biopsy and cervical adenopathy specimens were collected to perform histological diagnosis.", "Skeletal scintigraphy demonstrated numerous points of osteoblastic activity compatible with metastatic activity.", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'Abdominal mass with low expression of noradrenergic transporters.'", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'Diffuse bone metastasization with high expression of noradrenergic transporters.'", "The 12 iodine-123 metaiodobenzylguanidine scintigraphy concluded: 'No other soft tissue involvement was detected.'", "In the histological report of the cervical adenopathy, the diagnosis of neuroblastoma NOS was performed.", "Immunohistochemistry revealed extensive expression for synaptophysin.", "Immunohistochemistry revealed extensive expression for CD56 (NCAM).", "Immunohistochemistry revealed absence of expression of myogenin.", "Bone marrow biopsy revealed extensive metastatic involvement.", "The patient started chemotherapy two weeks after admission.", "The patient received 8 cycles of rapid COJEC protocol.", "After six months of follow-up, the primary tumor was still without criteria for resection.", "Despite a decrease in the metastatic involvement, the primary tumor was still without criteria for resection.", "Given the chemotherapy-related renal toxicity, it was decided to proceed with irinotecan in combination with temozolomide (TEMIRI).", "After thirteen months of follow-up, no significant regression of the primary tumor occurred.", "Surgery was contraindicated.", "The patient was proposed for stem cell treatment."], "index": 60, "original_id": "multiclinsum_test_1260_en.txt", "split": "test", "summary_subclaims": ["A four-year-old girl presented with fever and a painful limp in the left hip.", "Pain characteristics and anemia detected in the blood analyses were the first warning signs that the hip process was not standard.", "The primary suspicion was of septic arthritis.", "A CT scan of the abdomen revealed an adrenal neuroblastoma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 52-year-old woman.", "She was admitted with acute myocardial infarction due to a spontaneous right coronary artery dissection.", "Her medical history included a conservatively managed left posterolateral branch myocardial infarction at the age of 39.", "At 51, she was treated for breast cancer with a curative intent.", "An emergency percutaneous coronary intervention of the right coronary artery was performed.", "The post-procedural course was complicated by ventricular tachycardia and fibrillation.", "She was successfully resuscitated.", "She developed cardiogenic shock due to failure of the right ventricle.", "The cardiogenic shock was refractory to fluid resuscitation and inotropes.", "She was stabilized using peripheral veno-arterial extracorporeal membrane oxygenation.", "Echocardiography showed a dilated right ventricle with severely impaired function.", "Echocardiography showed paradoxical septal motion with signs of right ventricular volume overload.", "Echocardiography showed severe tricuspid regurgitation with elevated filling pressures.", "The left ventricular function was slightly impaired.", "She developed heparin-induced thrombocytopaenia.", "She was rejected for an urgent heart transplant listing due to the recent oncological history.", "The veno-arterial extracorporeal membrane oxygenation was exchanged for percutaneous veno-pulmonary extracorporeal membrane oxygenation.", "Weaning from extracorporeal membrane oxygenation was initially successful.", "Within days after discontinuation of the extracorporeal membrane oxygenation, she developed fast recurrent ventricular tachycardias.", "The ventricular tachycardias were haemodynamically poorly tolerated.", "Intravenous administration of amiodarone resulted in further progression of right ventricular failure.", "Amiodarone caused a slow junctional rhythm that was poorly tolerated haemodynamically.", "Escalation in the inotropic regimen in the days after extracorporeal membrane oxygenation weaning further contributed to the incessant ventricular tachycardias.", "A decision was made to perform a bidirectional cavopulmonary anastomosis with a concomitant tricuspid valve annuloplasty.", "In a bidirectional cavopulmonary anastomosis, the superior vena cava is disconnected from the right atrium and anastomosed end-to-side to the right pulmonary artery.", "The bidirectional cavopulmonary anastomosis redirects a substantial proportion of the venous return directly to the lungs, bypassing the right ventricle.", "The patient underwent bidirectional cavopulmonary anastomosis and restrictive tricuspid valve annuloplasty.", "She had an arterial oxygen saturation of 95% in ambient air.", "She could be weaned off veno-arterial extracorporeal membrane oxygenation and inotropes within 3 weeks after the operation.", "Echocardiography showed normalization of right ventricular dimensions.", "Echocardiography showed moderate to severely impaired right ventricular function.", "Echocardiography showed trivial tricuspid valve regurgitation.", "A subcutaneous implantable cardioverter-defibrillator seemed most appropriate.", "Implanting the subcutaneous implantable cardioverter-defibrillator was postponed due to a sternal wound infection.", "She was discharged home with a LifeVest Wearable Defibrillator.", "The peripheral oxygen saturation at discharge was 99%.", "She completed a cardiac rehabilitation program.", "Her New York Heart Association functional class IV improved to III at the 6-month follow-up examination.", "There have not been any heart failure-related admissions."], "summary_subclaims": ["The patient is a 52-year-old woman.", "She had cardiogenic shock.", "She had refractory right ventricular failure.", "The cause was spontaneous dissection of the right coronary artery.", "She remained dependent on mechanical support for several weeks.", "A right ventricular assist device implant was explored as a long-term support option.", "A bidirectional cavopulmonary anastomosis was explored as a long-term support option.", "A history of malignancy was present.", "Possible right ventricular functional recovery was considered.", "A decision in favour of the bidirectional cavopulmonary anastomosis was made.", "A concomitant tricuspid valve annuloplasty was performed.", "Postoperatively, her clinical condition improved significantly.", "She could be discharged home.", "Echocardiography showed normalization of right ventricular dimensions.", "Echocardiography showed slight improvement of right ventricular function."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 52-year-old woman.", "She was admitted with acute myocardial infarction due to a spontaneous right coronary artery dissection.", "Her medical history included a conservatively managed left posterolateral branch myocardial infarction at the age of 39.", "At 51, she was treated for breast cancer with a curative intent.", "An emergency percutaneous coronary intervention of the right coronary artery was performed.", "The post-procedural course was complicated by ventricular tachycardia and fibrillation.", "She was successfully resuscitated.", "She developed cardiogenic shock due to failure of the right ventricle.", "The cardiogenic shock was refractory to fluid resuscitation and inotropes.", "She was stabilized using peripheral veno-arterial extracorporeal membrane oxygenation.", "Echocardiography showed a dilated right ventricle with severely impaired function.", "Echocardiography showed paradoxical septal motion with signs of right ventricular volume overload.", "Echocardiography showed severe tricuspid regurgitation with elevated filling pressures.", "The left ventricular function was slightly impaired.", "She developed heparin-induced thrombocytopaenia.", "She was rejected for an urgent heart transplant listing due to the recent oncological history.", "The veno-arterial extracorporeal membrane oxygenation was exchanged for percutaneous veno-pulmonary extracorporeal membrane oxygenation.", "Weaning from extracorporeal membrane oxygenation was initially successful.", "Within days after discontinuation of the extracorporeal membrane oxygenation, she developed fast recurrent ventricular tachycardias.", "The ventricular tachycardias were haemodynamically poorly tolerated.", "Intravenous administration of amiodarone resulted in further progression of right ventricular failure.", "Amiodarone caused a slow junctional rhythm that was poorly tolerated haemodynamically.", "Escalation in the inotropic regimen in the days after extracorporeal membrane oxygenation weaning further contributed to the incessant ventricular tachycardias.", "A decision was made to perform a bidirectional cavopulmonary anastomosis with a concomitant tricuspid valve annuloplasty.", "In a bidirectional cavopulmonary anastomosis, the superior vena cava is disconnected from the right atrium and anastomosed end-to-side to the right pulmonary artery.", "The bidirectional cavopulmonary anastomosis redirects a substantial proportion of the venous return directly to the lungs, bypassing the right ventricle.", "The patient underwent bidirectional cavopulmonary anastomosis and restrictive tricuspid valve annuloplasty.", "She had an arterial oxygen saturation of 95% in ambient air.", "She could be weaned off veno-arterial extracorporeal membrane oxygenation and inotropes within 3 weeks after the operation.", "Echocardiography showed normalization of right ventricular dimensions.", "Echocardiography showed moderate to severely impaired right ventricular function.", "Echocardiography showed trivial tricuspid valve regurgitation.", "A subcutaneous implantable cardioverter-defibrillator seemed most appropriate.", "Implanting the subcutaneous implantable cardioverter-defibrillator was postponed due to a sternal wound infection.", "She was discharged home with a LifeVest Wearable Defibrillator.", "The peripheral oxygen saturation at discharge was 99%.", "She completed a cardiac rehabilitation program.", "Her New York Heart Association functional class IV improved to III at the 6-month follow-up examination.", "There have not been any heart failure-related admissions."], "index": 70, "original_id": "multiclinsum_test_3152_en.txt", "split": "test", "summary_subclaims": ["The patient is a 52-year-old woman.", "She had cardiogenic shock.", "She had refractory right ventricular failure.", "The cause was spontaneous dissection of the right coronary artery.", "She remained dependent on mechanical support for several weeks.", "A right ventricular assist device implant was explored as a long-term support option.", "A bidirectional cavopulmonary anastomosis was explored as a long-term support option.", "A history of malignancy was present.", "Possible right ventricular functional recovery was considered.", "A decision in favour of the bidirectional cavopulmonary anastomosis was made.", "A concomitant tricuspid valve annuloplasty was performed.", "Postoperatively, her clinical condition improved significantly.", "She could be discharged home.", "Echocardiography showed normalization of right ventricular dimensions.", "Echocardiography showed slight improvement of right ventricular function."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 69-year-old man.", "The patient had untreated hypertension.", "The patient was transported to the hospital 4 h after being injured in a motor vehicle accident.", "The patient was conscious.", "The patient's body temperature was 36.6\u00b0C.", "The patient's heart rate was 75 bpm.", "The patient's blood pressure was 186/115 mmHg.", "The patient's oxygen saturation was 96% on nasal cannula at 1 L.", "The troponin I level was 0.149 ng/mL.", "The CK-MB level was 27.3 U/L.", "Electrocardiography revealed premature ventricular contraction.", "Electrocardiography revealed an incomplete right bundle branch block.", "Contrast-enhanced computed tomography showed serial fractures from the left fourth to seventh ribs.", "The sixth rib was protruding into the thoracic cavity toward the heart.", "The fifth rib was fractured near the heart.", "The seventh rib was fractured near the diaphragm.", "A small pleural effusion, suspected to be a hemothorax, was observed in the left thorax.", "The pleural effusion was not increasing in size.", "Drainage was not conducted.", "Extravasation into a liver cyst was identified.", "The bleeding needed to be stopped by interventional radiology prior to surgery.", "Nine hours after the injury, the CK-MB level decreased to 15.7 U/L.", "Nine hours after the injury, the troponin I level increased to 1.009 ng/mL.", "Cardiac injury was suspected.", "Exploratory VATS was immediately performed.", "The left ventricular wall was crushed below the injured pericardium on the anterior side of the phrenic nerve.", "The phrenic nerve was intact.", "The diaphragm was damaged.", "No penetrating injury to the abdominal cavity was observed.", "The coronary arteries were not injured.", "There was no bleeding in the damaged area.", "A fragment of the sixth rib was protruding into the thoracic cavity.", "No pulmonary fistula was observed.", "The injury to the left ventricular wall did not penetrate deep into the lumen.", "The injury was closed horizontally using a U-shaped suture with 4-0 non-resorbable polypropylene with felt.", "The injury was covered with collagen-fibrin patch (TachoSil\u00ae).", "The lacerated pericardium was sparsely sutured.", "The scattered bone fragments were removed.", "The fifth and sixth ribs were repaired using bioresorbable plates (SUPER FIXSORB-MX\u00ae) as braces.", "The diaphragm was not repaired.", "A 20-Fr. double lumen chest tube was placed to the anterior side.", "A 28-Fr. single lumen chest tube was placed to the posterior side.", "The patient was extubated on postoperative day 2.", "The chest tubes were removed on postoperative day 4.", "Paroxysmal atrial fibrillation appeared transiently.", "The atrial fibrillation improved after the administration of beta-blockers.", "The patient's myocardial enzyme levels gradually decreased.", "The patient was discharged from the hospital on postoperative day 16.", "No major abnormalities were noted 3 months postoperatively."], "summary_subclaims": ["The patient is a 69-year-old man.", "The patient was injured in a motor vehicle accident.", "The patient suffered from left hemothorax.", "The patient had multiple rib fractures near the heart.", "A comprehensive assessment raised suspicions of lacerated pericardium.", "A comprehensive assessment raised suspicions of myocardial injury.", "A thoracoscopy was performed 9\u2009h after injury.", "A penetrating cardiac injury was detected.", "The injury was surgically treated via video-assisted thoracoscopic surgery.", "The patient recovered uneventfully.", "The patient was discharged on postoperative day 16."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 69-year-old man.", "The patient had untreated hypertension.", "The patient was transported to the hospital 4 h after being injured in a motor vehicle accident.", "The patient was conscious.", "The patient's body temperature was 36.6\u00b0C.", "The patient's heart rate was 75 bpm.", "The patient's blood pressure was 186/115 mmHg.", "The patient's oxygen saturation was 96% on nasal cannula at 1 L.", "The troponin I level was 0.149 ng/mL.", "The CK-MB level was 27.3 U/L.", "Electrocardiography revealed premature ventricular contraction.", "Electrocardiography revealed an incomplete right bundle branch block.", "Contrast-enhanced computed tomography showed serial fractures from the left fourth to seventh ribs.", "The sixth rib was protruding into the thoracic cavity toward the heart.", "The fifth rib was fractured near the heart.", "The seventh rib was fractured near the diaphragm.", "A small pleural effusion, suspected to be a hemothorax, was observed in the left thorax.", "The pleural effusion was not increasing in size.", "Drainage was not conducted.", "Extravasation into a liver cyst was identified.", "The bleeding needed to be stopped by interventional radiology prior to surgery.", "Nine hours after the injury, the CK-MB level decreased to 15.7 U/L.", "Nine hours after the injury, the troponin I level increased to 1.009 ng/mL.", "Cardiac injury was suspected.", "Exploratory VATS was immediately performed.", "The left ventricular wall was crushed below the injured pericardium on the anterior side of the phrenic nerve.", "The phrenic nerve was intact.", "The diaphragm was damaged.", "No penetrating injury to the abdominal cavity was observed.", "The coronary arteries were not injured.", "There was no bleeding in the damaged area.", "A fragment of the sixth rib was protruding into the thoracic cavity.", "No pulmonary fistula was observed.", "The injury to the left ventricular wall did not penetrate deep into the lumen.", "The injury was closed horizontally using a U-shaped suture with 4-0 non-resorbable polypropylene with felt.", "The injury was covered with collagen-fibrin patch (TachoSil\u00ae).", "The lacerated pericardium was sparsely sutured.", "The scattered bone fragments were removed.", "The fifth and sixth ribs were repaired using bioresorbable plates (SUPER FIXSORB-MX\u00ae) as braces.", "The diaphragm was not repaired.", "A 20-Fr. double lumen chest tube was placed to the anterior side.", "A 28-Fr. single lumen chest tube was placed to the posterior side.", "The patient was extubated on postoperative day 2.", "The chest tubes were removed on postoperative day 4.", "Paroxysmal atrial fibrillation appeared transiently.", "The atrial fibrillation improved after the administration of beta-blockers.", "The patient's myocardial enzyme levels gradually decreased.", "The patient was discharged from the hospital on postoperative day 16.", "No major abnormalities were noted 3 months postoperatively."], "index": 50, "original_id": "multiclinsum_test_2967_en.txt", "split": "test", "summary_subclaims": ["The patient is a 69-year-old man.", "The patient was injured in a motor vehicle accident.", "The patient suffered from left hemothorax.", "The patient had multiple rib fractures near the heart.", "A comprehensive assessment raised suspicions of lacerated pericardium.", "A comprehensive assessment raised suspicions of myocardial injury.", "A thoracoscopy was performed 9\u2009h after injury.", "A penetrating cardiac injury was detected.", "The injury was surgically treated via video-assisted thoracoscopic surgery.", "The patient recovered uneventfully.", "The patient was discharged on postoperative day 16."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is an 8-year-old boy.", "He had no personal or family history of interest.", "He presented to the paediatric emergency department with abnormal ocular movements of a year's duration.", "The family reported about 5-6 episodes a day of about 5-10 seconds duration.", "The episodes consisted of horizontal conjugate ocular movements with rapid jerks.", "There was slight associated miosis.", "There were no associated head or limb movements.", "The episodes did not associate with fixation of the gaze.", "The episodes did not associate with position or movements of the head.", "The patient could not self-provoke the episodes.", "The patient could identify the onset of the episodes.", "The episodes were of sudden onset and cessation.", "Some episodes gave the impression of disconnection from the environment or loss of consciousness.", "There was no postictal period.", "There was no headache.", "The episodes always occurred in the waking state.", "The episodes never occurred during sleep.", "The parents observed a higher frequency of episodes on days of greater stress.", "The parents observed a higher frequency of episodes on days of greater physical fatigue.", "There were no other triggers identified.", "There was no ataxia.", "There was no tinnitus.", "There were no autonomic symptoms.", "There was no hearing loss.", "There was no history of head trauma.", "There was no consumption of drugs.", "There was no consumption of other toxic substances.", "The symptoms had not changed or progressed since their onset.", "The neurological examination between episodes was normal.", "Ophthalmologic evaluation ruled out visual pathology.", "Otolaryngologic evaluation ruled out pathology in that area.", "Otolaryngologic evaluation described a high intensity, low amplitude jerk nystagmus episode.", "The patient was hospitalized for further evaluation.", "General laboratory tests showed no pathological findings.", "Videotaping of the episodes by the family was of great help in the diagnostic orientation.", "The video-electroencephalogram demonstrated an electro-clinical correlate of the episodes.", "The VEEG was performed in the waking state.", "The VEEG recorded two separate events of about 8-10 seconds duration.", "The background tracing was normal for his age.", "Epileptiform activity was recorded in the left temporal and occipital region.", "The epileptiform activity later generalized.", "Treatment with carbamazepine was initiated orally at an ascending dose.", "A brain magnetic resonance study with contrast was completed.", "The MRI showed no evidence of structural alterations.", "The MRI showed no evidence of cortical development anomalies.", "The final diagnosis was ictal nystagmus.", "He was discharged to home with a dose of carbamazepine of 13 mg/kg/day.", "The dose was increased to 17 mg/kg/day.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, good adherence was noted.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, absence of side effects to treatment was noted.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, there were no new episodes."], "summary_subclaims": ["The patient is an 8-year-old male school-age child.", "The patient has no relevant medical history.", "He presented with a 1-year history of conjugate horizontal rapid eye movement jerking.", "The eye movement jerking was associated with mild miosis.", "The episodes lasted 5-10 seconds.", "The episodes occurred 5-6 times daily.", "Some episodes had a questionable disconnection from the environment.", "Some episodes had questionable impairment of consciousness.", "There were no other accompanying signs or symptoms.", "General examinations were normal.", "Ophthalmologists ruled out pathology.", "Otolaryngologists ruled out pathology.", "The neurological examination between episodes was normal.", "The video-electroencephalogram demonstrated an electro-clinical correlate.", "Epileptiform activity was noted in the left temporal and occipital region.", "The epileptiform activity later generalized during episodes.", "The brain MRI was normal.", "Treatment with carbamazepine was initiated.", "The patient had a good evolution after treatment.", "There was no recurrence of episodes at 2 years of follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient is an 8-year-old boy.", "He had no personal or family history of interest.", "He presented to the paediatric emergency department with abnormal ocular movements of a year's duration.", "The family reported about 5-6 episodes a day of about 5-10 seconds duration.", "The episodes consisted of horizontal conjugate ocular movements with rapid jerks.", "There was slight associated miosis.", "There were no associated head or limb movements.", "The episodes did not associate with fixation of the gaze.", "The episodes did not associate with position or movements of the head.", "The patient could not self-provoke the episodes.", "The patient could identify the onset of the episodes.", "The episodes were of sudden onset and cessation.", "Some episodes gave the impression of disconnection from the environment or loss of consciousness.", "There was no postictal period.", "There was no headache.", "The episodes always occurred in the waking state.", "The episodes never occurred during sleep.", "The parents observed a higher frequency of episodes on days of greater stress.", "The parents observed a higher frequency of episodes on days of greater physical fatigue.", "There were no other triggers identified.", "There was no ataxia.", "There was no tinnitus.", "There were no autonomic symptoms.", "There was no hearing loss.", "There was no history of head trauma.", "There was no consumption of drugs.", "There was no consumption of other toxic substances.", "The symptoms had not changed or progressed since their onset.", "The neurological examination between episodes was normal.", "Ophthalmologic evaluation ruled out visual pathology.", "Otolaryngologic evaluation ruled out pathology in that area.", "Otolaryngologic evaluation described a high intensity, low amplitude jerk nystagmus episode.", "The patient was hospitalized for further evaluation.", "General laboratory tests showed no pathological findings.", "Videotaping of the episodes by the family was of great help in the diagnostic orientation.", "The video-electroencephalogram demonstrated an electro-clinical correlate of the episodes.", "The VEEG was performed in the waking state.", "The VEEG recorded two separate events of about 8-10 seconds duration.", "The background tracing was normal for his age.", "Epileptiform activity was recorded in the left temporal and occipital region.", "The epileptiform activity later generalized.", "Treatment with carbamazepine was initiated orally at an ascending dose.", "A brain magnetic resonance study with contrast was completed.", "The MRI showed no evidence of structural alterations.", "The MRI showed no evidence of cortical development anomalies.", "The final diagnosis was ictal nystagmus.", "He was discharged to home with a dose of carbamazepine of 13 mg/kg/day.", "The dose was increased to 17 mg/kg/day.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, good adherence was noted.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, absence of side effects to treatment was noted.", "In outpatient follow-up in Neuropediatric consultations, 2 years after the start of treatment, there were no new episodes."], "index": 62, "original_id": "multiclinsum_test_3001_en.txt", "split": "test", "summary_subclaims": ["The patient is an 8-year-old male school-age child.", "The patient has no relevant medical history.", "He presented with a 1-year history of conjugate horizontal rapid eye movement jerking.", "The eye movement jerking was associated with mild miosis.", "The episodes lasted 5-10 seconds.", "The episodes occurred 5-6 times daily.", "Some episodes had a questionable disconnection from the environment.", "Some episodes had questionable impairment of consciousness.", "There were no other accompanying signs or symptoms.", "General examinations were normal.", "Ophthalmologists ruled out pathology.", "Otolaryngologists ruled out pathology.", "The neurological examination between episodes was normal.", "The video-electroencephalogram demonstrated an electro-clinical correlate.", "Epileptiform activity was noted in the left temporal and occipital region.", "The epileptiform activity later generalized during episodes.", "The brain MRI was normal.", "Treatment with carbamazepine was initiated.", "The patient had a good evolution after treatment.", "There was no recurrence of episodes at 2 years of follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 66-year-old Maori man.", "He had a history of an enlarged left testicle for 10 weeks.", "Clinical examination revealed nontender swelling of the left testicle.", "His alpha-fetoprotein (AFP) levels were within normal limits.", "His beta-human chorionic gonadotropin (BHCG) levels were within normal limits.", "His lactate dehydrogenase (LDH) concentration was 267 U/L.", "Ultrasonography showed an enlarged left testicle measuring 7 \u00d7 5.5 \u00d7 4.3 cm.", "The estimated volume of the left testicle was 87 ml.", "A large, heterogeneous mass involved the entire testicle.", "The mass showed increased vascularity.", "The right testicle measured 3.7 \u00d7 2.5 \u00d7 1.8 cm.", "The estimated volume of the right testicle was 8.8 ml.", "The patient underwent left orchiectomy.", "The macroscopic specimen had well-circumscribed nodular lesions of varying sizes.", "The largest lesion measured 45 \u00d7 15 mm.", "The largest lesion contained solid and gelatinous components.", "Sections showed tumor composed of sheets of small, blue, round cells.", "The tumor was divided into nodules by fibrous septae.", "Immunostaining showed the tumor to be cytokeratin 20 (CK20)-positive.", "The CK20 staining pattern was typical paranuclear dotlike.", "The tumor was positive for CD56.", "The tumor was positive for CD117.", "The tumor was positive for CK (paranuclear dots).", "The tumor was negative for CK7.", "The tumor was negative for placental alkaline phosphatase (PLAP).", "The tumor was negative for CD30.", "The tumor was negative for CD20.", "The tumor was negative for AFP.", "The tumor was negative for S100.", "The tumor was negative for SOX10.", "The tumor was negative for prostate-specific antigen (PSA).", "The tumor was negative for chromogranin.", "The tumor was negative for thyroid transcription factor 1 (TTF-1).", "The Ki-67 level was >50%.", "The immunostaining pattern raised the possibility of metastatic Merkel cell carcinoma (MCC).", "The patient presented again 3 months later with a right testicular mass.", "Tumor markers, including LDH, AFP, and BHCG, were within normal limits.", "Ultrasonographic imaging showed a new lesion in the right testis measuring 3 \u00d7 2.6 \u00d7 2.3 cm.", "The patient underwent right orchiectomy.", "Sections showed diffuse infiltration of small, blue, round cells.", "Immunostains were positive for CD117.", "Immunostains were positive for CD56.", "Immunostains were positive for synaptophysin.", "Immunostains were positive for CK20 (dotlike).", "Immunostains were positive for cytokeratin AE1/AE3 (dotlike).", "The tumor cells were negative for inhibin.", "The tumor cells were negative for PLAP.", "The tumor cells were negative for PSA.", "The tumor cells were negative for S100.", "The tumor cells were negative for CD30.", "The tumor cells were negative for CD45.", "The tumor cells were negative for CD3.", "The tumor cells were negative for CD20.", "The tumor cells were negative for TTF-1.", "The tumor cells were negative for napsin A.", "The Ki-67 level was 80%.", "The pattern was consistent with a poorly differentiated neuroendocrine tumor.", "The pattern was in keeping with metastatic MCC.", "A primary site was not identified.", "A staging computed tomographic scan did not show evidence of other metastases.", "The patient received six cycles of adjuvant carboplatin and etoposide chemotherapy.", "He remained disease-free 18 months following completion of chemotherapy."], "summary_subclaims": ["A 66-year-old Maori man presented to our hospital with left testicular swelling.", "His alpha-fetoprotein and beta-human chorionic gonadotrophin levels were within normal limits.", "His lactate dehydrogenase concentration was elevated to 267 U/L.", "Ultrasound imaging confirmed a large testicular mass.", "He underwent left orchiectomy.", "His histological examination revealed a neuroendocrine tumor with an immunostaining pattern suggesting Merkel cell carcinoma.", "He presented to our hospital again 3 months later with right testicular swelling.", "Right testicular swelling was confirmed on ultrasound sonography to be a tumor.", "He underwent a right orchiectomy.", "His histological examination revealed metastatic Merkel cell carcinoma.", "A primary lesion was not identified.", "Computed tomographic imaging did not reveal spread to other organs.", "He received six cycles of adjuvant carboplatin and etoposide chemotherapy.", "He remained disease-free 18 months after completion of chemotherapy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 66-year-old Maori man.", "He had a history of an enlarged left testicle for 10 weeks.", "Clinical examination revealed nontender swelling of the left testicle.", "His alpha-fetoprotein (AFP) levels were within normal limits.", "His beta-human chorionic gonadotropin (BHCG) levels were within normal limits.", "His lactate dehydrogenase (LDH) concentration was 267 U/L.", "Ultrasonography showed an enlarged left testicle measuring 7 \u00d7 5.5 \u00d7 4.3 cm.", "The estimated volume of the left testicle was 87 ml.", "A large, heterogeneous mass involved the entire testicle.", "The mass showed increased vascularity.", "The right testicle measured 3.7 \u00d7 2.5 \u00d7 1.8 cm.", "The estimated volume of the right testicle was 8.8 ml.", "The patient underwent left orchiectomy.", "The macroscopic specimen had well-circumscribed nodular lesions of varying sizes.", "The largest lesion measured 45 \u00d7 15 mm.", "The largest lesion contained solid and gelatinous components.", "Sections showed tumor composed of sheets of small, blue, round cells.", "The tumor was divided into nodules by fibrous septae.", "Immunostaining showed the tumor to be cytokeratin 20 (CK20)-positive.", "The CK20 staining pattern was typical paranuclear dotlike.", "The tumor was positive for CD56.", "The tumor was positive for CD117.", "The tumor was positive for CK (paranuclear dots).", "The tumor was negative for CK7.", "The tumor was negative for placental alkaline phosphatase (PLAP).", "The tumor was negative for CD30.", "The tumor was negative for CD20.", "The tumor was negative for AFP.", "The tumor was negative for S100.", "The tumor was negative for SOX10.", "The tumor was negative for prostate-specific antigen (PSA).", "The tumor was negative for chromogranin.", "The tumor was negative for thyroid transcription factor 1 (TTF-1).", "The Ki-67 level was >50%.", "The immunostaining pattern raised the possibility of metastatic Merkel cell carcinoma (MCC).", "The patient presented again 3 months later with a right testicular mass.", "Tumor markers, including LDH, AFP, and BHCG, were within normal limits.", "Ultrasonographic imaging showed a new lesion in the right testis measuring 3 \u00d7 2.6 \u00d7 2.3 cm.", "The patient underwent right orchiectomy.", "Sections showed diffuse infiltration of small, blue, round cells.", "Immunostains were positive for CD117.", "Immunostains were positive for CD56.", "Immunostains were positive for synaptophysin.", "Immunostains were positive for CK20 (dotlike).", "Immunostains were positive for cytokeratin AE1/AE3 (dotlike).", "The tumor cells were negative for inhibin.", "The tumor cells were negative for PLAP.", "The tumor cells were negative for PSA.", "The tumor cells were negative for S100.", "The tumor cells were negative for CD30.", "The tumor cells were negative for CD45.", "The tumor cells were negative for CD3.", "The tumor cells were negative for CD20.", "The tumor cells were negative for TTF-1.", "The tumor cells were negative for napsin A.", "The Ki-67 level was 80%.", "The pattern was consistent with a poorly differentiated neuroendocrine tumor.", "The pattern was in keeping with metastatic MCC.", "A primary site was not identified.", "A staging computed tomographic scan did not show evidence of other metastases.", "The patient received six cycles of adjuvant carboplatin and etoposide chemotherapy.", "He remained disease-free 18 months following completion of chemotherapy."], "index": 52, "original_id": "multiclinsum_test_2759_en.txt", "split": "test", "summary_subclaims": ["A 66-year-old Maori man presented to our hospital with left testicular swelling.", "His alpha-fetoprotein and beta-human chorionic gonadotrophin levels were within normal limits.", "His lactate dehydrogenase concentration was elevated to 267 U/L.", "Ultrasound imaging confirmed a large testicular mass.", "He underwent left orchiectomy.", "His histological examination revealed a neuroendocrine tumor with an immunostaining pattern suggesting Merkel cell carcinoma.", "He presented to our hospital again 3 months later with right testicular swelling.", "Right testicular swelling was confirmed on ultrasound sonography to be a tumor.", "He underwent a right orchiectomy.", "His histological examination revealed metastatic Merkel cell carcinoma.", "A primary lesion was not identified.", "Computed tomographic imaging did not reveal spread to other organs.", "He received six cycles of adjuvant carboplatin and etoposide chemotherapy.", "He remained disease-free 18 months after completion of chemotherapy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 34-year-old female.", "She had a 1 year history of intermittent pain in the right side of the waist without obvious inducement.", "She did not notice other symptoms such as nausea and vomiting, chills, high fever, chest tightness, frequent urination, urgency of urination, and painful urination.", "The symptoms gradually worsened in the recent 2 mo.", "She had no previous history of viral hepatitis B or cirrhosis.", "She denied smoking or drinking.", "Clinical examination showed no obvious abnormality.", "All laboratory blood tests were within normal limits.", "Indocyanine green 15 min retention was rated 2.9%.", "Child-Pugh was rated A.", "Abdominal CT showed multiple nodules and abnormal lumpy low-density shadows in the liver parenchyma.", "The larger lesions were located in the left lobe and caudate lobe of the liver.", "The larger lesions measured about 9.5 cm \u00d7 6.3 cm and 8.1 cm \u00d7 6.5 cm.", "Abdominal MRI revealed multiple space-occupying lesions in the liver.", "Combined with enhanced CT scan, hemangioma was considered.", "Compression of the main portal vein and right portal vein was noted.", "The inferior vena cava narrowed.", "The total liver volume was about 1739 cm3.", "The lesion liver volume was about 571 cm3.", "The residual liver volume was about 1168 cm3."], "summary_subclaims": ["The patient is a 34-year-old female.", "She had a 1 year history of intermittent pain in the right side of the waist.", "The pain had no obvious inducement.", "All laboratory blood tests were within normal limits.", "Indocyanine green 15 min retention was rated 2.9%.", "Child-Pugh was rated A.", "Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe.", "Computed tomography and magnetic resonance imaging diagnosed hemangioma of the left lobe of the liver.", "Surgical treatment was performed after discussion.", "The surgical treatment lasted 410 min.", "Intraoperative bleeding was about 600 mL.", "Postoperative pathological findings were cavernous hemangioma.", "There were no obvious postoperative complications.", "The patient was discharged 10 d after surgery."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 34-year-old female.", "She had a 1 year history of intermittent pain in the right side of the waist without obvious inducement.", "She did not notice other symptoms such as nausea and vomiting, chills, high fever, chest tightness, frequent urination, urgency of urination, and painful urination.", "The symptoms gradually worsened in the recent 2 mo.", "She had no previous history of viral hepatitis B or cirrhosis.", "She denied smoking or drinking.", "Clinical examination showed no obvious abnormality.", "All laboratory blood tests were within normal limits.", "Indocyanine green 15 min retention was rated 2.9%.", "Child-Pugh was rated A.", "Abdominal CT showed multiple nodules and abnormal lumpy low-density shadows in the liver parenchyma.", "The larger lesions were located in the left lobe and caudate lobe of the liver.", "The larger lesions measured about 9.5 cm \u00d7 6.3 cm and 8.1 cm \u00d7 6.5 cm.", "Abdominal MRI revealed multiple space-occupying lesions in the liver.", "Combined with enhanced CT scan, hemangioma was considered.", "Compression of the main portal vein and right portal vein was noted.", "The inferior vena cava narrowed.", "The total liver volume was about 1739 cm3.", "The lesion liver volume was about 571 cm3.", "The residual liver volume was about 1168 cm3."], "index": 72, "original_id": "multiclinsum_test_2984_en.txt", "split": "test", "summary_subclaims": ["The patient is a 34-year-old female.", "She had a 1 year history of intermittent pain in the right side of the waist.", "The pain had no obvious inducement.", "All laboratory blood tests were within normal limits.", "Indocyanine green 15 min retention was rated 2.9%.", "Child-Pugh was rated A.", "Computed tomography and magnetic resonance imaging diagnosed giant hemangioma of the caudate lobe.", "Computed tomography and magnetic resonance imaging diagnosed hemangioma of the left lobe of the liver.", "Surgical treatment was performed after discussion.", "The surgical treatment lasted 410 min.", "Intraoperative bleeding was about 600 mL.", "Postoperative pathological findings were cavernous hemangioma.", "There were no obvious postoperative complications.", "The patient was discharged 10 d after surgery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 66-year-old man was admitted to the clinic of a primary care doctor.", "He complained of a sudden deterioration in right hypochondrial pain persisting for 2 weeks.", "A computed tomography (CT) scan revealed a right adrenal hemorrhage.", "A computed tomography (CT) scan revealed an abnormal tumor in the upper lobe of his left lung.", "He was referred to our hospital for further examination and treatment.", "His past medical history and family history were unremarkable.", "He was a current smoker with a history of 46 pack-years.", "An enhanced CT scan showed a massive shadow in the left lung S1 + 2 progressing to S6 beyond the lung lobe.", "The maximum diameter of the left lung lesion was about 42 mm.", "The right adrenal lesion showed no active bleeding.", "The carcinoembryonic antigen (CEA) was 5.6 ng/mL.", "The neuron-specific enolase (NSE) was 18.52 ng/mL.", "The patient had mild anemia with a hemoglobin of 10.3 g/dL.", "A bronchoscopic trans-bronchial lung biopsy showed no evidence of malignancy.", "A CT-guided percutaneous needle biopsy was performed.", "The pathological examination showed a non-small cell lung cancer.", "The adrenal lesion was diagnosed as a nonfunctional tumor based on endocrine examinations and adrenal medulla scintigraphy.", "18-Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the left lung nodule with an SUVmax of 17.0.", "18-Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the right adrenal lesion with an SUVmax of 4.1.", "The clinical stage was classified as cT2bN0M1b, stage IV (TNM classification 7th edition).", "A right adrenalectomy was performed.", "A complete resection of the primary lung cancer was considered possible.", "The lung tumor showed areas of atypical cells with eosinophilic cytoplasms.", "The lung tumor showed a sarcomatous component with extensive necrosis.", "The tumor cells were positive for cytokeratin AE1/3, CAM5.2, CK7, and p63 (partial).", "The tumor cells were negative for 34\u03b2E12, CK20, TTF-1, calretinin, and D2-40.", "The adrenal tumor was similar in pathologic and immunohistochemical analyses.", "The final diagnosis was pleomorphic carcinoma of the lung with an adrenal metastasis, pT2bN0M1b, stage IV (TNM classification 7th edition).", "The patient received chemotherapy as stage IV NSCLC.", "The chemotherapy regimen included 60 mg/m2 of cisplatin on day 1.", "The chemotherapy regimen included 40 mg/m2 of TS-1 twice a day on days 1 to 14.", "The chemotherapy regimen was repeated every 4 weeks.", "After two courses, he decided to quit the intravenous chemotherapy.", "He refused to take TS-1 because he feared adverse events.", "He began taking UFT (600 mg/day).", "He continued UFT treatment for 2 years.", "He has survived without any recurrences for 6 years since the surgery."], "summary_subclaims": ["The patient was a 66-year-old male.", "The patient was referred to the hospital because of a right adrenal hemorrhage.", "The patient was referred to the hospital because of a lung tumor.", "The lung tumor was a primary lung cancer.", "The adrenal hemorrhage was due to a metastatic cancer.", "An adrenalectomy was performed.", "Resection of the lung tumor was performed.", "The diagnosis was pleomorphic carcinoma with adrenal metastasis.", "The patient has remained recurrence-free for 6\u2009years since the surgery."]}, "extra_info": {"fulltext_subclaims": ["A 66-year-old man was admitted to the clinic of a primary care doctor.", "He complained of a sudden deterioration in right hypochondrial pain persisting for 2 weeks.", "A computed tomography (CT) scan revealed a right adrenal hemorrhage.", "A computed tomography (CT) scan revealed an abnormal tumor in the upper lobe of his left lung.", "He was referred to our hospital for further examination and treatment.", "His past medical history and family history were unremarkable.", "He was a current smoker with a history of 46 pack-years.", "An enhanced CT scan showed a massive shadow in the left lung S1 + 2 progressing to S6 beyond the lung lobe.", "The maximum diameter of the left lung lesion was about 42 mm.", "The right adrenal lesion showed no active bleeding.", "The carcinoembryonic antigen (CEA) was 5.6 ng/mL.", "The neuron-specific enolase (NSE) was 18.52 ng/mL.", "The patient had mild anemia with a hemoglobin of 10.3 g/dL.", "A bronchoscopic trans-bronchial lung biopsy showed no evidence of malignancy.", "A CT-guided percutaneous needle biopsy was performed.", "The pathological examination showed a non-small cell lung cancer.", "The adrenal lesion was diagnosed as a nonfunctional tumor based on endocrine examinations and adrenal medulla scintigraphy.", "18-Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the left lung nodule with an SUVmax of 17.0.", "18-Fluorodeoxyglucose positron emission tomography (FDG-PET) showed FDG accumulation in the right adrenal lesion with an SUVmax of 4.1.", "The clinical stage was classified as cT2bN0M1b, stage IV (TNM classification 7th edition).", "A right adrenalectomy was performed.", "A complete resection of the primary lung cancer was considered possible.", "The lung tumor showed areas of atypical cells with eosinophilic cytoplasms.", "The lung tumor showed a sarcomatous component with extensive necrosis.", "The tumor cells were positive for cytokeratin AE1/3, CAM5.2, CK7, and p63 (partial).", "The tumor cells were negative for 34\u03b2E12, CK20, TTF-1, calretinin, and D2-40.", "The adrenal tumor was similar in pathologic and immunohistochemical analyses.", "The final diagnosis was pleomorphic carcinoma of the lung with an adrenal metastasis, pT2bN0M1b, stage IV (TNM classification 7th edition).", "The patient received chemotherapy as stage IV NSCLC.", "The chemotherapy regimen included 60 mg/m2 of cisplatin on day 1.", "The chemotherapy regimen included 40 mg/m2 of TS-1 twice a day on days 1 to 14.", "The chemotherapy regimen was repeated every 4 weeks.", "After two courses, he decided to quit the intravenous chemotherapy.", "He refused to take TS-1 because he feared adverse events.", "He began taking UFT (600 mg/day).", "He continued UFT treatment for 2 years.", "He has survived without any recurrences for 6 years since the surgery."], "index": 54, "original_id": "multiclinsum_test_2067_en.txt", "split": "test", "summary_subclaims": ["The patient was a 66-year-old male.", "The patient was referred to the hospital because of a right adrenal hemorrhage.", "The patient was referred to the hospital because of a lung tumor.", "The lung tumor was a primary lung cancer.", "The adrenal hemorrhage was due to a metastatic cancer.", "An adrenalectomy was performed.", "Resection of the lung tumor was performed.", "The diagnosis was pleomorphic carcinoma with adrenal metastasis.", "The patient has remained recurrence-free for 6\u2009years since the surgery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 56-years-old woman.", "The patient has a history of hypertension.", "The patient has decompensated diabetes mellitus.", "The patient was referred to the hospital with critical limb ischemia.", "The patient had rest pain on the left leg.", "The patient had an ulcer on the left leg.", "The patient had negative COVID-19.", "The patient's blood pressure was 160/90 mmHg.", "The patient's heart rate was 130 beats per minute.", "A mesogastrium systolic bruit was heard on abdominal auscultation.", "Electrocardiogram showed signs of ST segment depression.", "Coronary angiography showed severe coronary artery disease.", "Duplex ultrasound showed widespread irregularities of the aortic wall.", "Duplex ultrasound showed monophasic wave on the right common femoral artery.", "Duplex ultrasound showed direct flow on the left femoral axis.", "Duplex ultrasound showed diffuse disease of both superficial femoral arteries.", "Duplex ultrasound showed distal occlusion in the left superficial femoral artery.", "CT-scan showed atherosclerotic disease on the infrarenal abdominal aorta.", "CT-scan showed focal dissection of the infrarenal abdominal aorta.", "CT-scan showed occlusion of the right common iliac artery origin.", "CT-scan showed short dissection of the left common iliac artery origin.", "The presence of ulcers in the left leg was the indication to address the left superficial femoral artery.", "The intervention was carried out through an antegrade percutaneous homolateral access.", "A drug eluting balloon (6.0 \u00d7 60 mm Luminor\u00ae) was used in the proximal left superficial femoral artery.", "A stent (5.0x80mm iVolution) was placed in the distal left superficial femoral artery.", "The final result was complete lesion healing in the left foot at three weeks.", "After two months, the patient was readmitted due to gangrene of the right foot.", "The patient had asymptomatic COVID-19 infection.", "Control CT showed a similar vascular pattern on the right side.", "The rapid and aggressive right foot lesions evolution was the indication to address vascular lesions in the right axis.", "The intervention was carried under general anesthesia.", "Surgical exposure of both common femoral arteries was performed.", "Aorto-iliac repair was performed using an AFX aortic endograft.", "Stenting of the right common iliac artery was performed with a balloon expandable stent (Isthmus 10 \u00d7 39).", "A drug eluting balloon (Luminor 5 \u00d7 200) was used in the right superficial femoral artery.", "The multiple intervention determined the increase of the distal flow.", "The reappearance of dorsalis pedis pulse was noted.", "The patient was asymptomatic for right foot pain after two days.", "The patient underwent right foot minor amputation.", "The patient was discharged after a week with double antiplatelet therapy.", "CT angiography performed after two months confirmed the proper positioning of the aortic stent-graft.", "CT angiography confirmed good patency of the iliac-femoral axis.", "CT angiography confirmed right foot ulcers healing."], "summary_subclaims": ["We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection.", "The patient presenting a Peripheral arterial ischemic involving the infrarenal aorta, iliac, femoral.", "The simultaneous intervention consisted of an endovascular aortic stent-graft placement and angioplasty of femoral artery."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 56-years-old woman.", "The patient has a history of hypertension.", "The patient has decompensated diabetes mellitus.", "The patient was referred to the hospital with critical limb ischemia.", "The patient had rest pain on the left leg.", "The patient had an ulcer on the left leg.", "The patient had negative COVID-19.", "The patient's blood pressure was 160/90 mmHg.", "The patient's heart rate was 130 beats per minute.", "A mesogastrium systolic bruit was heard on abdominal auscultation.", "Electrocardiogram showed signs of ST segment depression.", "Coronary angiography showed severe coronary artery disease.", "Duplex ultrasound showed widespread irregularities of the aortic wall.", "Duplex ultrasound showed monophasic wave on the right common femoral artery.", "Duplex ultrasound showed direct flow on the left femoral axis.", "Duplex ultrasound showed diffuse disease of both superficial femoral arteries.", "Duplex ultrasound showed distal occlusion in the left superficial femoral artery.", "CT-scan showed atherosclerotic disease on the infrarenal abdominal aorta.", "CT-scan showed focal dissection of the infrarenal abdominal aorta.", "CT-scan showed occlusion of the right common iliac artery origin.", "CT-scan showed short dissection of the left common iliac artery origin.", "The presence of ulcers in the left leg was the indication to address the left superficial femoral artery.", "The intervention was carried out through an antegrade percutaneous homolateral access.", "A drug eluting balloon (6.0 \u00d7 60 mm Luminor\u00ae) was used in the proximal left superficial femoral artery.", "A stent (5.0x80mm iVolution) was placed in the distal left superficial femoral artery.", "The final result was complete lesion healing in the left foot at three weeks.", "After two months, the patient was readmitted due to gangrene of the right foot.", "The patient had asymptomatic COVID-19 infection.", "Control CT showed a similar vascular pattern on the right side.", "The rapid and aggressive right foot lesions evolution was the indication to address vascular lesions in the right axis.", "The intervention was carried under general anesthesia.", "Surgical exposure of both common femoral arteries was performed.", "Aorto-iliac repair was performed using an AFX aortic endograft.", "Stenting of the right common iliac artery was performed with a balloon expandable stent (Isthmus 10 \u00d7 39).", "A drug eluting balloon (Luminor 5 \u00d7 200) was used in the right superficial femoral artery.", "The multiple intervention determined the increase of the distal flow.", "The reappearance of dorsalis pedis pulse was noted.", "The patient was asymptomatic for right foot pain after two days.", "The patient underwent right foot minor amputation.", "The patient was discharged after a week with double antiplatelet therapy.", "CT angiography performed after two months confirmed the proper positioning of the aortic stent-graft.", "CT angiography confirmed good patency of the iliac-femoral axis.", "CT angiography confirmed right foot ulcers healing."], "index": 58, "original_id": "multiclinsum_test_437_en.txt", "split": "test", "summary_subclaims": ["We report a case of complex revascularization in a diabetic patient with aggressive right foot lesions evolution after COVID-19 infection.", "The patient presenting a Peripheral arterial ischemic involving the infrarenal aorta, iliac, femoral.", "The simultaneous intervention consisted of an endovascular aortic stent-graft placement and angioplasty of femoral artery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 58-year-old Japanese man was presented to our out-patient unit complaining of posterior cervical pain.", "The pain firstly appeared 3 months before the first contact to us without any particular triggers such as trauma.", "He was relieved from the pain when lying flat.", "He kept working as a plumber and the pain got worse over the time period.", "A brain computed tomography (CT) was performed 1.5 months after the onset in another clinic.", "The brain CT revealed bilateral subdural effusion.", "No treatment was given at this point.", "Later on, when he was presented to our hospital, numbness and weakness of extremities also appeared.", "He had a medical history of hemorrhoid.", "He had no particular familial history.", "A hand-held dynamometer revealed his weakened grip strength of both of his hands by 30\u201340 kg.", "He was presented with bilateral muscle weakness in his lower extremities which was 4 of 5 in the Manual Muscle Test (MMT) score.", "His Japanese Orthopedic Association (JOA) score was 13.5.", "A fat suppression T2-weighted MRI without gadolinium enhancement of the cervical spine illustrated a fluid collection in the soft tissue spaces of the retrospinal region at C1-C2 level.", "The MRI demonstrated spinal canal stenosis at C3/4 level.", "A cisternoscintigram and a CT myelogram were performed with intradural injection of 111In-DTPA.", "The 111In-DTPA cisternoscintigram clearly revealed CSF leakage into the retrospinal region at C1-C2 level.", "The CT myelogram also suggested blockage at lower level of the cervical spinal canal.", "72 h of conservative therapy, including bed rest, intravenous fluid hydration, muscle relaxants and non-steroidal anti-inflammatory drugs, was ineffective at improving his symptoms.", "The re-examination of brain CT showed progression of the bilateral subdural effusions to bilateral subdural hematomas.", "We gave a diagnosis of intracranial hypotension due to the CSF leakage from C1-C2 level.", "We performed burr-hole drainage of the subdural hematoma.", "We performed blood-patch therapy at C1/2 level.", "We performed laminoplasty at C3\u20134.", "In the laminoplasty, CSF flew out from the epidural space subsequently to the opening of lamina.", "After sufficient decompression, the CSF flow was reduced in the operation field, without detection and restoration of dural tear.", "In the blood-patch therapy, an epidural catheter was inserted from the surgical field at C3\u20134 level to C1-C2 level under x-ray fluoroscopy observation.", "Approximately 5 ml of autologous blood sampled from patient\u2019s peripheral vein was injected to the epidural site at C1-C2 level.", "The blood-patch therapy was achieved.", "Postoperative response was significantly favorable.", "His symptoms completely improved.", "The imaging features that suggested CSF leak and intracranial hypotension disappeared.", "He discharged on postoperative day 10 with satisfaction.", "No signs of recurrence were observed for 5 months postoperatively up to this point.", "The patient returned to his daily life as well as his occupation."], "summary_subclaims": ["The patient was a 58-year-old man.", "The patient had posterior cervical pain persisting for 3 months.", "The patient had numbness and muscle weakness of extremities.", "A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level.", "An 111In-DTPA cisternoscintigram revealed the presence of CSF leakage into the same region.", "The MRI showed stenosis in spinal canal at C3/4 level.", "A CT myelogram suggested a blockage at the C3/4 level.", "The diagnosis was intracranial hypotension due to the CSF leakage.", "The CSF leakage might be caused by the spinal canal stenosis at C3/4 level.", "Despite 72\u2009h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas.", "Burr-hole drainage of the subdural hematoma was performed.", "Blood-patch therapy at C1/2 level was performed.", "Laminoplasty at C3-4 was performed.", "Improvement of symptoms was obtained post-operatively.", "Imaging features suggesting the CSF leak and subdural hematoma were obtained post-operatively."]}, "extra_info": {"fulltext_subclaims": ["A 58-year-old Japanese man was presented to our out-patient unit complaining of posterior cervical pain.", "The pain firstly appeared 3 months before the first contact to us without any particular triggers such as trauma.", "He was relieved from the pain when lying flat.", "He kept working as a plumber and the pain got worse over the time period.", "A brain computed tomography (CT) was performed 1.5 months after the onset in another clinic.", "The brain CT revealed bilateral subdural effusion.", "No treatment was given at this point.", "Later on, when he was presented to our hospital, numbness and weakness of extremities also appeared.", "He had a medical history of hemorrhoid.", "He had no particular familial history.", "A hand-held dynamometer revealed his weakened grip strength of both of his hands by 30\u201340 kg.", "He was presented with bilateral muscle weakness in his lower extremities which was 4 of 5 in the Manual Muscle Test (MMT) score.", "His Japanese Orthopedic Association (JOA) score was 13.5.", "A fat suppression T2-weighted MRI without gadolinium enhancement of the cervical spine illustrated a fluid collection in the soft tissue spaces of the retrospinal region at C1-C2 level.", "The MRI demonstrated spinal canal stenosis at C3/4 level.", "A cisternoscintigram and a CT myelogram were performed with intradural injection of 111In-DTPA.", "The 111In-DTPA cisternoscintigram clearly revealed CSF leakage into the retrospinal region at C1-C2 level.", "The CT myelogram also suggested blockage at lower level of the cervical spinal canal.", "72 h of conservative therapy, including bed rest, intravenous fluid hydration, muscle relaxants and non-steroidal anti-inflammatory drugs, was ineffective at improving his symptoms.", "The re-examination of brain CT showed progression of the bilateral subdural effusions to bilateral subdural hematomas.", "We gave a diagnosis of intracranial hypotension due to the CSF leakage from C1-C2 level.", "We performed burr-hole drainage of the subdural hematoma.", "We performed blood-patch therapy at C1/2 level.", "We performed laminoplasty at C3\u20134.", "In the laminoplasty, CSF flew out from the epidural space subsequently to the opening of lamina.", "After sufficient decompression, the CSF flow was reduced in the operation field, without detection and restoration of dural tear.", "In the blood-patch therapy, an epidural catheter was inserted from the surgical field at C3\u20134 level to C1-C2 level under x-ray fluoroscopy observation.", "Approximately 5 ml of autologous blood sampled from patient\u2019s peripheral vein was injected to the epidural site at C1-C2 level.", "The blood-patch therapy was achieved.", "Postoperative response was significantly favorable.", "His symptoms completely improved.", "The imaging features that suggested CSF leak and intracranial hypotension disappeared.", "He discharged on postoperative day 10 with satisfaction.", "No signs of recurrence were observed for 5 months postoperatively up to this point.", "The patient returned to his daily life as well as his occupation."], "index": 56, "original_id": "multiclinsum_test_1266_en.txt", "split": "test", "summary_subclaims": ["The patient was a 58-year-old man.", "The patient had posterior cervical pain persisting for 3 months.", "The patient had numbness and muscle weakness of extremities.", "A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level.", "An 111In-DTPA cisternoscintigram revealed the presence of CSF leakage into the same region.", "The MRI showed stenosis in spinal canal at C3/4 level.", "A CT myelogram suggested a blockage at the C3/4 level.", "The diagnosis was intracranial hypotension due to the CSF leakage.", "The CSF leakage might be caused by the spinal canal stenosis at C3/4 level.", "Despite 72\u2009h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas.", "Burr-hole drainage of the subdural hematoma was performed.", "Blood-patch therapy at C1/2 level was performed.", "Laminoplasty at C3-4 was performed.", "Improvement of symptoms was obtained post-operatively.", "Imaging features suggesting the CSF leak and subdural hematoma were obtained post-operatively."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor detected by abdominal ultrasonography.", "Contrast-enhanced computed tomography revealed a papillary lesion (25 mm in diameter) in the fundus of the gallbladder.", "The boundary between the tumor and liver was unclear.", "Endoscopic retrograde cholangiography showed a complete filling defect in the cystic duct.", "Serum carcinoembryonic antigen level was 2.1 ng/ml.", "Serum carbohydrate antigen 19-9 level was 24 U/ml.", "We diagnosed the tumor as gallbladder cancer invading the liver and cystic duct.", "We decided to perform extended cholecystectomy.", "The gallbladder wall was thickened.", "Intraoperative ultrasonography revealed the tumor did not invade liver obviously.", "The intraoperative frozen section of the cystic duct stump and 2 sentinel lymph nodes were negative for malignancy.", "Macroscopic examination showed a superficially spreading papillary tumor with thick mucus on its surface.", "The gallbladder wall was diffusely thickened.", "The tumor was noninvasive and showed no evidence of lymph node metastasis.", "These pathological findings were compatible with ICPN.", "In immunohistochemical staining, MUC5AC and MUC6 were strongly positive.", "CK7 and MUC1 were also positive, but not CK20, MUC2, estrogen receptor, and progesterone receptor.", "Immunohistochemistry indicated that ICPN was predominantly gastric type, with focal pancreatobiliary type.", "Many lymphocytes and multinucleated giant cells had infiltrated the thickened gallbladder wall with prominent Rokitansky\u2013Aschoff sinuses.", "These findings were especially seen at the fundus and were indicative of chronic granulomatous changes within the fundus.", "Based on these pathological findings, we diagnosed the tumor as an ICPN concomitant with XGC.", "The patient was discharged on postoperative day 8 with no complications.", "She was clinically well with no evidence of recurrence at 3 months after resection."], "summary_subclaims": ["A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor.", "Contrast-enhanced computed tomography showed a papillary tumor in the fundus of the gallbladder.", "The gallbladder wall had irregular thickening that spread into the cystic duct.", "The boundary between the tumor and liver was unclear.", "The patient was diagnosed with gallbladder cancer with liver invasion.", "We performed extended cholecystectomy with liver bed resection.", "The absence of cancer cells in the resection margin of the cystic duct was confirmed.", "After pathological examination, the tumor was diagnosed as an ICPN with xanthogranulomatous cholecystitis.", "The patient was discharged on postoperative day 8 with no complications."]}, "extra_info": {"fulltext_subclaims": ["A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor detected by abdominal ultrasonography.", "Contrast-enhanced computed tomography revealed a papillary lesion (25 mm in diameter) in the fundus of the gallbladder.", "The boundary between the tumor and liver was unclear.", "Endoscopic retrograde cholangiography showed a complete filling defect in the cystic duct.", "Serum carcinoembryonic antigen level was 2.1 ng/ml.", "Serum carbohydrate antigen 19-9 level was 24 U/ml.", "We diagnosed the tumor as gallbladder cancer invading the liver and cystic duct.", "We decided to perform extended cholecystectomy.", "The gallbladder wall was thickened.", "Intraoperative ultrasonography revealed the tumor did not invade liver obviously.", "The intraoperative frozen section of the cystic duct stump and 2 sentinel lymph nodes were negative for malignancy.", "Macroscopic examination showed a superficially spreading papillary tumor with thick mucus on its surface.", "The gallbladder wall was diffusely thickened.", "The tumor was noninvasive and showed no evidence of lymph node metastasis.", "These pathological findings were compatible with ICPN.", "In immunohistochemical staining, MUC5AC and MUC6 were strongly positive.", "CK7 and MUC1 were also positive, but not CK20, MUC2, estrogen receptor, and progesterone receptor.", "Immunohistochemistry indicated that ICPN was predominantly gastric type, with focal pancreatobiliary type.", "Many lymphocytes and multinucleated giant cells had infiltrated the thickened gallbladder wall with prominent Rokitansky\u2013Aschoff sinuses.", "These findings were especially seen at the fundus and were indicative of chronic granulomatous changes within the fundus.", "Based on these pathological findings, we diagnosed the tumor as an ICPN concomitant with XGC.", "The patient was discharged on postoperative day 8 with no complications.", "She was clinically well with no evidence of recurrence at 3 months after resection."], "index": 74, "original_id": "multiclinsum_test_1559_en.txt", "split": "test", "summary_subclaims": ["A 65-year-old woman was referred to our hospital for assessment of a gallbladder tumor.", "Contrast-enhanced computed tomography showed a papillary tumor in the fundus of the gallbladder.", "The gallbladder wall had irregular thickening that spread into the cystic duct.", "The boundary between the tumor and liver was unclear.", "The patient was diagnosed with gallbladder cancer with liver invasion.", "We performed extended cholecystectomy with liver bed resection.", "The absence of cancer cells in the resection margin of the cystic duct was confirmed.", "After pathological examination, the tumor was diagnosed as an ICPN with xanthogranulomatous cholecystitis.", "The patient was discharged on postoperative day 8 with no complications."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 43-year-old Asian man.", "He had a 3-year history of progressively invasive PC.", "He presented with pain in his right eye.", "He had been staged T4N3M1 (TNM classification).", "He had lost his vision more than a month earlier.", "He was diagnosed as having metastasis in the bilateral inguinal lymph nodes.", "He had ipsilateral iliac node metastasis.", "He had systemic metastasis to his liver and lungs.", "His medical history was remarkable due to several surgeries.", "He denied any family history of inherited diseases.", "He denied any psychological illness.", "On presentation, his best corrected visual acuity was no light perception in his right eye.", "On presentation, his best corrected visual acuity was 20/20 in his left eye.", "His intraocular pressure was 13.0 mmHg in his right eye.", "His intraocular pressure was 11.0 mmHg in his left eye.", "The right eye pupil dilated to 5 mm.", "The right eye pupillary reaction disappeared.", "An external examination revealed mild proptosis.", "A dilated fundus examination of his right eye showed post equatorial retinal detachment.", "A dilated fundus examination showed a black eminence.", "A dilated fundus examination showed a pale optic disk.", "There were no obvious abnormalities in his left eye.", "An ophthalmic B-scan ultrasound showed retinal detachment with hemorrhage.", "Orbital MRI confirmed thickening and strengthening of the right lateral wall.", "The internal rectus and lateral rectus muscles were thickened and hardened.", "The 2-cm-long optic nerve was thickened.", "The optic nerve stump was invaded by the metastasis.", "T1-weighted images showed hyperintensity.", "T2-weighted images showed hypointensity.", "A contrast-enhanced MRI scan revealed inhomogeneous enhancement of the posterior wall.", "The presence of lesions was associated with invasion of the optic nerve.", "The presence of lesions was associated with invasion of the choroid.", "The presence of lesions was associated with invasion of the sclera.", "The deep layer, including the choroid, was infiltrated by cancerous tissue.", "The patient had undergone right eyeball enucleation on February 3, 2015.", "The procedure was under general anesthesia.", "Histopathological examination led to a diagnosis of metastatic moderately differentiated penile squamous cell carcinoma.", "The cancer infiltrated the sclera.", "The cancer infiltrated the choroid.", "The cancer infiltrated the retina.", "The cancer infiltrated the optic nerve.", "The cancer infiltrated external intraocular sites.", "Hematoxylin-and-eosin staining showed keratin pearls.", "Hematoxylin-and-eosin staining showed infiltrative growth of keratinized cells.", "Intercellular bridges were seen in the nests of moderately differentiated squamous carcinoma cells.", "The patient received chemotherapy and radiotherapy during 6 months of follow-up.", "The patient died due to brain metastasis."], "summary_subclaims": ["The patient is a 43-year-old Asian man.", "The patient has a 3-year history of penile cancer.", "The patient presented with metastasis in the right intraocular sites.", "Magnetic resonance imaging showed hyperintensity in the T1-weighted images of the right eye.", "Magnetic resonance imaging showed hypointensity in the T2-weighted images of the right eye.", "The patient underwent enucleation of his right eye.", "Histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 43-year-old Asian man.", "He had a 3-year history of progressively invasive PC.", "He presented with pain in his right eye.", "He had been staged T4N3M1 (TNM classification).", "He had lost his vision more than a month earlier.", "He was diagnosed as having metastasis in the bilateral inguinal lymph nodes.", "He had ipsilateral iliac node metastasis.", "He had systemic metastasis to his liver and lungs.", "His medical history was remarkable due to several surgeries.", "He denied any family history of inherited diseases.", "He denied any psychological illness.", "On presentation, his best corrected visual acuity was no light perception in his right eye.", "On presentation, his best corrected visual acuity was 20/20 in his left eye.", "His intraocular pressure was 13.0 mmHg in his right eye.", "His intraocular pressure was 11.0 mmHg in his left eye.", "The right eye pupil dilated to 5 mm.", "The right eye pupillary reaction disappeared.", "An external examination revealed mild proptosis.", "A dilated fundus examination of his right eye showed post equatorial retinal detachment.", "A dilated fundus examination showed a black eminence.", "A dilated fundus examination showed a pale optic disk.", "There were no obvious abnormalities in his left eye.", "An ophthalmic B-scan ultrasound showed retinal detachment with hemorrhage.", "Orbital MRI confirmed thickening and strengthening of the right lateral wall.", "The internal rectus and lateral rectus muscles were thickened and hardened.", "The 2-cm-long optic nerve was thickened.", "The optic nerve stump was invaded by the metastasis.", "T1-weighted images showed hyperintensity.", "T2-weighted images showed hypointensity.", "A contrast-enhanced MRI scan revealed inhomogeneous enhancement of the posterior wall.", "The presence of lesions was associated with invasion of the optic nerve.", "The presence of lesions was associated with invasion of the choroid.", "The presence of lesions was associated with invasion of the sclera.", "The deep layer, including the choroid, was infiltrated by cancerous tissue.", "The patient had undergone right eyeball enucleation on February 3, 2015.", "The procedure was under general anesthesia.", "Histopathological examination led to a diagnosis of metastatic moderately differentiated penile squamous cell carcinoma.", "The cancer infiltrated the sclera.", "The cancer infiltrated the choroid.", "The cancer infiltrated the retina.", "The cancer infiltrated the optic nerve.", "The cancer infiltrated external intraocular sites.", "Hematoxylin-and-eosin staining showed keratin pearls.", "Hematoxylin-and-eosin staining showed infiltrative growth of keratinized cells.", "Intercellular bridges were seen in the nests of moderately differentiated squamous carcinoma cells.", "The patient received chemotherapy and radiotherapy during 6 months of follow-up.", "The patient died due to brain metastasis."], "index": 82, "original_id": "multiclinsum_test_1233_en.txt", "split": "test", "summary_subclaims": ["The patient is a 43-year-old Asian man.", "The patient has a 3-year history of penile cancer.", "The patient presented with metastasis in the right intraocular sites.", "Magnetic resonance imaging showed hyperintensity in the T1-weighted images of the right eye.", "Magnetic resonance imaging showed hypointensity in the T2-weighted images of the right eye.", "The patient underwent enucleation of his right eye.", "Histopathological analysis led to a diagnosis of metastatic, moderately differentiated penile squamous cell carcinoma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 66-year-old man.", "The patient has type II diabetes mellitus for 4 years.", "The patient has arterial hypertension for 10 years.", "The patient developed severe non-proliferative diabetic retinopathy without macular edema 2 years after diabetes diagnosis.", "The patient was treated with panretinal photocoagulation.", "The patient had poor glycometabolic control.", "The patient was unable to adhere to a close follow-up.", "One year after panretinal photocoagulation, the patient developed severe visual loss due to diffuse non tractional bilateral diabetic macular edema.", "The right eye was treated with an intravitreal triamcinolone injection.", "The left eye was treated with an intravitreal triamcinolone injection 1 month after the right eye.", "Laser grid photocoagulation was performed in both eyes 2 weeks after intravitreal injection.", "After no visual recovery for over 2 months, an intravitreal injection of bevacizumab was given in the right eye.", "One week after the bevacizumab injection, anterior ischemic optic neuropathy was observed.", "The patient had a residual visual acuity of hand motion.", "The patient had glycated hemoglobin >9%.", "The patient had high hypertension.", "The patient had hypercholesterolemia.", "The patient had poor adherence to therapy.", "The patient refused an intravitreal injection of bevacizumab in his left eye.", "The patient signed an informed consent for subtenon injections of IFN\u03b1.", "Before treatment, the best corrected visual acuity in the left eye was 20/200.", "The patient received posterior subtenon injections of IFN\u03b1 three times in one week.", "The injections were given on Monday, Wednesday, and Friday.", "Topical 0.4% oxybuprocaine surface anesthesia was used.", "One ml of IFN\u03b1 was injected into the inferotemporal quadrant under the Tenon\u2019s capsule.", "A 27-gauge needle on a 2.5-ml syringe was used.", "Topical 0.3% netilmicin eye drops were prescribed three times a day for 7 days.", "The patient had a good systemic condition during IFN-\u03b1 therapy.", "The patient had a glycated hemoglobin of 6.9%.", "A complete ophthalmic examination was conducted preoperatively.", "A complete ophthalmic examination was conducted 1 week after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 1 month after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 4 months after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 1 year after the last injection of IFN\u03b1.", "Spectralis OCT was used for macular scans.", "Fifteen months after treatment, the best corrected visual acuity in the left eye was 20/40.", "The patient gave written consent for the use of his data and images."], "summary_subclaims": ["The patient is a 66-year-old man.", "The patient was affected by DME.", "The patient's HbA1c was 6.9%.", "The patient had refractory DME to laser grid treatment.", "The patient had refractory DME to intravitreal injections of triamcinolone.", "The patient received a cycle of three subtenon injections/week of IFN\u03b1 (1\u00d7106 IU/ml).", "BCVA and CMT were evaluated preoperatively.", "BCVA and CMT were evaluated at 1 week postoperatively.", "BCVA and CMT were evaluated at 1 month postoperatively.", "BCVA and CMT were evaluated at 4 months postoperatively.", "BCVA and CMT were evaluated at 1 year postoperatively.", "BCVA was 20/200 preoperatively.", "BCVA was 20/40 at 1 week postoperatively.", "CMT was 498 \u03bcm preoperatively.", "CMT was 237 \u03bcm at 1 week postoperatively.", "BCVA remained stable during the 1-year follow-up.", "CMT was 215 \u03bcm during the first follow-up visit.", "CMT was 255 \u03bcm during the second follow-up visit.", "CMT was 299 \u03bcm during the third follow-up visit.", "CMT was still lower than the baseline value during the follow-up visits.", "No adverse events were recorded.", "Mild subconjunctival hemorrhage at the injection site was recorded."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 66-year-old man.", "The patient has type II diabetes mellitus for 4 years.", "The patient has arterial hypertension for 10 years.", "The patient developed severe non-proliferative diabetic retinopathy without macular edema 2 years after diabetes diagnosis.", "The patient was treated with panretinal photocoagulation.", "The patient had poor glycometabolic control.", "The patient was unable to adhere to a close follow-up.", "One year after panretinal photocoagulation, the patient developed severe visual loss due to diffuse non tractional bilateral diabetic macular edema.", "The right eye was treated with an intravitreal triamcinolone injection.", "The left eye was treated with an intravitreal triamcinolone injection 1 month after the right eye.", "Laser grid photocoagulation was performed in both eyes 2 weeks after intravitreal injection.", "After no visual recovery for over 2 months, an intravitreal injection of bevacizumab was given in the right eye.", "One week after the bevacizumab injection, anterior ischemic optic neuropathy was observed.", "The patient had a residual visual acuity of hand motion.", "The patient had glycated hemoglobin >9%.", "The patient had high hypertension.", "The patient had hypercholesterolemia.", "The patient had poor adherence to therapy.", "The patient refused an intravitreal injection of bevacizumab in his left eye.", "The patient signed an informed consent for subtenon injections of IFN\u03b1.", "Before treatment, the best corrected visual acuity in the left eye was 20/200.", "The patient received posterior subtenon injections of IFN\u03b1 three times in one week.", "The injections were given on Monday, Wednesday, and Friday.", "Topical 0.4% oxybuprocaine surface anesthesia was used.", "One ml of IFN\u03b1 was injected into the inferotemporal quadrant under the Tenon\u2019s capsule.", "A 27-gauge needle on a 2.5-ml syringe was used.", "Topical 0.3% netilmicin eye drops were prescribed three times a day for 7 days.", "The patient had a good systemic condition during IFN-\u03b1 therapy.", "The patient had a glycated hemoglobin of 6.9%.", "A complete ophthalmic examination was conducted preoperatively.", "A complete ophthalmic examination was conducted 1 week after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 1 month after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 4 months after the last injection of IFN\u03b1.", "A complete ophthalmic examination was conducted 1 year after the last injection of IFN\u03b1.", "Spectralis OCT was used for macular scans.", "Fifteen months after treatment, the best corrected visual acuity in the left eye was 20/40.", "The patient gave written consent for the use of his data and images."], "index": 80, "original_id": "multiclinsum_test_1558_en.txt", "split": "test", "summary_subclaims": ["The patient is a 66-year-old man.", "The patient was affected by DME.", "The patient's HbA1c was 6.9%.", "The patient had refractory DME to laser grid treatment.", "The patient had refractory DME to intravitreal injections of triamcinolone.", "The patient received a cycle of three subtenon injections/week of IFN\u03b1 (1\u00d7106 IU/ml).", "BCVA and CMT were evaluated preoperatively.", "BCVA and CMT were evaluated at 1 week postoperatively.", "BCVA and CMT were evaluated at 1 month postoperatively.", "BCVA and CMT were evaluated at 4 months postoperatively.", "BCVA and CMT were evaluated at 1 year postoperatively.", "BCVA was 20/200 preoperatively.", "BCVA was 20/40 at 1 week postoperatively.", "CMT was 498 \u03bcm preoperatively.", "CMT was 237 \u03bcm at 1 week postoperatively.", "BCVA remained stable during the 1-year follow-up.", "CMT was 215 \u03bcm during the first follow-up visit.", "CMT was 255 \u03bcm during the second follow-up visit.", "CMT was 299 \u03bcm during the third follow-up visit.", "CMT was still lower than the baseline value during the follow-up visits.", "No adverse events were recorded.", "Mild subconjunctival hemorrhage at the injection site was recorded."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A previously healthy 24-year-old male presented at the emergency department with chest pain and diarrhoea.", "The chest pain began 2 h prior to hospital admission.", "The chest pain was described as a constant light chest pressure.", "The chest pain was without correlation to breathing or body position.", "3 days earlier, the patient and a friend had had chicken in a restaurant before boarding a flight to Sweden.", "One hour after arrival in Sweden the patient experienced sudden abdominal pain, chills and diarrhoea.", "During the following three days the patient had 6 diarrhoeas per day.", "The patient had mucous but no visible blood in the stool.", "The patient was diagnosed with C jejuni gastroenteritis after stool culture at a primary care facility.", "No antibiotics were given at the primary care facility.", "Upon admission to the ED the abdominal pain had subsided.", "The patient was afebrile (37 \u00b0C or 98.6 \u00b0F) upon admission.", "The patient was still experiencing diarrhoea upon admission.", "Heart auscultation showed regular rhythm, no murmurs or extra sounds.", "Laboratory examinations showed C-reactive protein at 89.1 mg/L.", "Laboratory examinations showed leukocyte count at 11.3 \u00d7 109/L.", "Laboratory examinations showed high-sensitive Troponin T at 108 ng/L.", "ECG showed regular sinus rhythm, 64/min.", "ECG showed general 1 mm ST-elevation.", "The patient was treated with Brufen 200 mg (tid).", "The patient was treated with Omeprazol 20 mg (qd).", "The patient was treated with Loperamid 2 mg.", "The patient was admitted to a cardiac care unit for cardiac monitoring.", "During the following 4 days the hsTnT reached a maximum value of 504.", "Stool culture confirmed the diagnosis of C jejuni.", "Blood cultures were negative.", "Transthoracic echocardiogram showed normal right and left ventricle function.", "Transthoracic echocardiogram showed ejection fraction 60\u201365 %.", "Transthoracic echocardiogram showed normal valvular structure and function.", "Transthoracic echocardiogram showed no hypokinesia or pericardial effusion.", "After one day the ECG-changes had resolved.", "The patient was started on ciprofloxacin.", "The patient developed urticarial rashes and severe itching.", "The treatment with ciprofloxacin was discontinued.", "The chest pain subsided after 2 days.", "The patient left the hospital after 4 days.", "The patient was given a 10 day prescription of Azithromycin 500 mg (qd) upon hospital release.", "The diagnosis was determined to be C jejuni-associated perimyocarditis.", "At follow-up visit 4 weeks after discharge the patient was without complaints.", "At follow-up visit 4 weeks after discharge physical examination was normal.", "At follow-up visit 4 weeks after discharge both ECG and TTE were normal."], "summary_subclaims": ["A previously healthy 24-yo male presented at the Emergency Department with recent onset of chest pain and a 3-day history of abdominal pain, fever and diarrhoea.", "The symptoms began within a few hours of returning from a tourist visit to a central European capital.", "Vital signs were stable.", "The Electrocardiogram showed generalized ST-elevation.", "Laboratory testing showed increased levels of C-reactive protein and high-sensitive Troponin T.", "Transthoracic echocardiogram was normal.", "Stool cultures were positive for C Jejuni.", "Blood cultures were negative.", "Two days after patient A was admitted to the ED his travel companion, also a previously healthy male, presented at the same ED with almost identical symptoms.", "Patient B declared that he and patient A had ingested chicken prior to returning from their tourist trip.", "Laboratory tests showed elevated CRP and hsTnT.", "The ECG and TTE were normal.", "In both cases, the diagnosis of C jejuni-associated perimyocarditis was set based on the typical presentation and positive stool cultures with identical strains.", "Both patients were given antibiotics.", "Both patients rapidly improved and were fully recovered at 6-week follow up."]}, "extra_info": {"fulltext_subclaims": ["A previously healthy 24-year-old male presented at the emergency department with chest pain and diarrhoea.", "The chest pain began 2 h prior to hospital admission.", "The chest pain was described as a constant light chest pressure.", "The chest pain was without correlation to breathing or body position.", "3 days earlier, the patient and a friend had had chicken in a restaurant before boarding a flight to Sweden.", "One hour after arrival in Sweden the patient experienced sudden abdominal pain, chills and diarrhoea.", "During the following three days the patient had 6 diarrhoeas per day.", "The patient had mucous but no visible blood in the stool.", "The patient was diagnosed with C jejuni gastroenteritis after stool culture at a primary care facility.", "No antibiotics were given at the primary care facility.", "Upon admission to the ED the abdominal pain had subsided.", "The patient was afebrile (37 \u00b0C or 98.6 \u00b0F) upon admission.", "The patient was still experiencing diarrhoea upon admission.", "Heart auscultation showed regular rhythm, no murmurs or extra sounds.", "Laboratory examinations showed C-reactive protein at 89.1 mg/L.", "Laboratory examinations showed leukocyte count at 11.3 \u00d7 109/L.", "Laboratory examinations showed high-sensitive Troponin T at 108 ng/L.", "ECG showed regular sinus rhythm, 64/min.", "ECG showed general 1 mm ST-elevation.", "The patient was treated with Brufen 200 mg (tid).", "The patient was treated with Omeprazol 20 mg (qd).", "The patient was treated with Loperamid 2 mg.", "The patient was admitted to a cardiac care unit for cardiac monitoring.", "During the following 4 days the hsTnT reached a maximum value of 504.", "Stool culture confirmed the diagnosis of C jejuni.", "Blood cultures were negative.", "Transthoracic echocardiogram showed normal right and left ventricle function.", "Transthoracic echocardiogram showed ejection fraction 60\u201365 %.", "Transthoracic echocardiogram showed normal valvular structure and function.", "Transthoracic echocardiogram showed no hypokinesia or pericardial effusion.", "After one day the ECG-changes had resolved.", "The patient was started on ciprofloxacin.", "The patient developed urticarial rashes and severe itching.", "The treatment with ciprofloxacin was discontinued.", "The chest pain subsided after 2 days.", "The patient left the hospital after 4 days.", "The patient was given a 10 day prescription of Azithromycin 500 mg (qd) upon hospital release.", "The diagnosis was determined to be C jejuni-associated perimyocarditis.", "At follow-up visit 4 weeks after discharge the patient was without complaints.", "At follow-up visit 4 weeks after discharge physical examination was normal.", "At follow-up visit 4 weeks after discharge both ECG and TTE were normal."], "index": 78, "original_id": "multiclinsum_test_1211_en.txt", "split": "test", "summary_subclaims": ["A previously healthy 24-yo male presented at the Emergency Department with recent onset of chest pain and a 3-day history of abdominal pain, fever and diarrhoea.", "The symptoms began within a few hours of returning from a tourist visit to a central European capital.", "Vital signs were stable.", "The Electrocardiogram showed generalized ST-elevation.", "Laboratory testing showed increased levels of C-reactive protein and high-sensitive Troponin T.", "Transthoracic echocardiogram was normal.", "Stool cultures were positive for C Jejuni.", "Blood cultures were negative.", "Two days after patient A was admitted to the ED his travel companion, also a previously healthy male, presented at the same ED with almost identical symptoms.", "Patient B declared that he and patient A had ingested chicken prior to returning from their tourist trip.", "Laboratory tests showed elevated CRP and hsTnT.", "The ECG and TTE were normal.", "In both cases, the diagnosis of C jejuni-associated perimyocarditis was set based on the typical presentation and positive stool cultures with identical strains.", "Both patients were given antibiotics.", "Both patients rapidly improved and were fully recovered at 6-week follow up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 65 yr old female presented to the ENT clinic with a one-month history of a lump in the right neck.", "On examination, a mobile lump was palpable in the angle of the mandible/upper cervical region.", "Flexible endoscopy did not reveal any mucosal lesion in the posterior nasal space.", "Flexible endoscopy did not reveal any mucosal lesion in the oropharynx.", "Flexible endoscopy did not reveal any mucosal lesion in the hypopharynx.", "Flexible endoscopy did not reveal any mucosal lesion in the larynx.", "Clinically a lymph node mass was considered as a possible diagnosis.", "Fine needle aspiration and MRI were performed.", "MRI showed a well-defined oval shaped mass measuring 3 \u00d7 2 cm just inferior to the right parotid gland.", "The epicenter of the lesion was in the intermuscular plane.", "The lesion was medial to the sternocleidomastoid muscle but separate from it.", "The lesion was heterogeneous on both T1 & T2 W images.", "The lesion had a well defined margin.", "Following contrast administration, there was moderate heterogeneous enhancement.", "A differential diagnosis of lymph nodal mass & Spinal Accessory nerve Schwannoma were considered.", "FNA of the lesion showed a mix of bland epithelial cell.", "FNA showed clusters of spindle cells.", "FNA showed myxoid matrix.", "The FNA findings were typical of a pleomorphic adenoma.", "A decision to perform an excision biopsy was made.", "At surgery, the tumor was found to be a pedunculated mass arising from the inferior aspect of the tail of the parotid gland.", "The tumor was closely related and superficial to the spinal accessory nerve but separate from it.", "The mass was excised completely incorporating a limited cuff of macroscopically normal parotid tissue.", "The inferior branches of the facial nerve were not injured.", "Histopathology showed uniform proliferation of epithelial elements within a partially myxo-chondroid stroma.", "The histopathology findings were consistent with a diagnosis of a pleomorphic adenoma.", "There was no definite salivary gland tissue within the specimen."], "summary_subclaims": ["We present a case of a pleomorphic adenoma arising from the 'tail' of the parotid gland.", "On imaging, the tumor appears to be extra parotid in location.", "We review the anatomy of the parotid 'tail'.", "We review relevant literature."]}, "extra_info": {"fulltext_subclaims": ["A 65 yr old female presented to the ENT clinic with a one-month history of a lump in the right neck.", "On examination, a mobile lump was palpable in the angle of the mandible/upper cervical region.", "Flexible endoscopy did not reveal any mucosal lesion in the posterior nasal space.", "Flexible endoscopy did not reveal any mucosal lesion in the oropharynx.", "Flexible endoscopy did not reveal any mucosal lesion in the hypopharynx.", "Flexible endoscopy did not reveal any mucosal lesion in the larynx.", "Clinically a lymph node mass was considered as a possible diagnosis.", "Fine needle aspiration and MRI were performed.", "MRI showed a well-defined oval shaped mass measuring 3 \u00d7 2 cm just inferior to the right parotid gland.", "The epicenter of the lesion was in the intermuscular plane.", "The lesion was medial to the sternocleidomastoid muscle but separate from it.", "The lesion was heterogeneous on both T1 & T2 W images.", "The lesion had a well defined margin.", "Following contrast administration, there was moderate heterogeneous enhancement.", "A differential diagnosis of lymph nodal mass & Spinal Accessory nerve Schwannoma were considered.", "FNA of the lesion showed a mix of bland epithelial cell.", "FNA showed clusters of spindle cells.", "FNA showed myxoid matrix.", "The FNA findings were typical of a pleomorphic adenoma.", "A decision to perform an excision biopsy was made.", "At surgery, the tumor was found to be a pedunculated mass arising from the inferior aspect of the tail of the parotid gland.", "The tumor was closely related and superficial to the spinal accessory nerve but separate from it.", "The mass was excised completely incorporating a limited cuff of macroscopically normal parotid tissue.", "The inferior branches of the facial nerve were not injured.", "Histopathology showed uniform proliferation of epithelial elements within a partially myxo-chondroid stroma.", "The histopathology findings were consistent with a diagnosis of a pleomorphic adenoma.", "There was no definite salivary gland tissue within the specimen."], "index": 76, "original_id": "multiclinsum_test_2421_en.txt", "split": "test", "summary_subclaims": ["We present a case of a pleomorphic adenoma arising from the 'tail' of the parotid gland.", "On imaging, the tumor appears to be extra parotid in location.", "We review the anatomy of the parotid 'tail'.", "We review relevant literature."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 49-year-old Japanese man.", "He visited the department in November 2017.", "His chief complaints were indolent right scrotum enlargement and a right inguinal mass.", "He had a history of blackish feces and ill complexion in February 1997.", "Gastrointestinal fiberscopy was used to treat duodenal ulcer bleeding.", "Computed tomography showed a right retroperitoneal tumor.", "The tumor was removed in the same month as the CT scan.", "Histopathological examination showed a teratoma and yolk sac tumor.", "He was diagnosed with primary retroperitoneal EGCT.", "He underwent three courses of chemotherapy starting in May 1997.", "The chemotherapy regimen was bleomycin/etoposide/cisplatin (BEP).", "He was followed using periodic imaging, tumor markers determination, and self-palpation.", "He was followed up on an outpatient basis 5 years after treatment.", "He was subsequently lost to follow-up.", "In August 1999, he underwent surgery of the right hydrocele.", "Perioperative findings were unremarkable.", "There was no clear tumor in either testicle at the time of hydrocele surgery.", "At the first visit, his height was 163 cm.", "His weight was 58.5 kg.", "Blood pressure was 128/78 mmHg.", "Heart rate was regular at 62 beats per minute.", "Body temperature was 36.4 \u00b0C.", "He had no history of smoking or drinking.", "There was nothing remarkable in the family history.", "On physical examination, the right testicle was elastic, hard, and enlarged to 40 \u00d7 40 mm.", "A 45 \u00d7 40 mm sized induration was palpable in the right inguinal area.", "The inguinal induration was adequately mobile.", "Neurological examination showed no abnormal findings.", "Blood biochemistry, urinalysis, and tumor markers showed no abnormal findings.", "Ultrasound showed a mosaic shadow inside the right testicle.", "The left testicle showed no abnormal findings on ultrasound.", "Enlargements of the right external iliac lymph node (24 \u00d7 14 mm) and right inguinal lymph node (43 \u00d7 29 mm) were found.", "A 31 \u00d7 22 mm mass with uneven contents was found in the right testicle.", "There was no evidence of distant metastasis.", "The patient underwent high orchiectomy and resection of the right inguinal lymph nodes in November 2017.", "The testicular tumor was 40 \u00d7 40 \u00d7 30 mm in size and weighed 34 g.", "The lymph node was 40 \u00d7 40 \u00d7 30 mm in size and weighed 21 g.", "The cut surfaces of both specimens were yellowish and solid.", "The testicular tumor was localized in the testicle.", "Histopathological findings showed irregular cobblestone proliferations of germ cell-like atypical cells with clear nucleoli.", "Massive necrotic changes were present in the tumor.", "The tumor did not extend into the tunica albuginea.", "No vascular infiltration was found.", "Spermatic cord stumps were negative.", "The tumor diagnosis was a classical seminoma with no other elements.", "Lymph node metastases were diagnosed as a result of the seminoma.", "The seminoma was diagnosed as pT1, pN2, M0, S0.", "The TNM stage was IIB.", "The patient received one course of BEP therapy and three courses of EP therapy.", "Post-chemotherapy CT confirmed a complete clinical response at the right external iliac lymph node.", "The complete clinical response continued 12 months later."], "summary_subclaims": ["The patient is a 49-year-old Japanese man.", "He visited the department in November 2017.", "His chief complaints were indolent right scrotum enlargement and a right inguinal mass.", "He had visited the department of gastroenterology in February 1997.", "Computed tomography showed a right retroperitoneal tumor.", "The tumor was removed in the same month as the CT scan.", "Histopathological examination showed a teratoma and yolk sac tumor.", "He was diagnosed with primary retroperitoneal EGCT.", "He received three courses of chemotherapy.", "The chemotherapy regimen was bleomycin/etoposide/cisplatin (BEP)."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 49-year-old Japanese man.", "He visited the department in November 2017.", "His chief complaints were indolent right scrotum enlargement and a right inguinal mass.", "He had a history of blackish feces and ill complexion in February 1997.", "Gastrointestinal fiberscopy was used to treat duodenal ulcer bleeding.", "Computed tomography showed a right retroperitoneal tumor.", "The tumor was removed in the same month as the CT scan.", "Histopathological examination showed a teratoma and yolk sac tumor.", "He was diagnosed with primary retroperitoneal EGCT.", "He underwent three courses of chemotherapy starting in May 1997.", "The chemotherapy regimen was bleomycin/etoposide/cisplatin (BEP).", "He was followed using periodic imaging, tumor markers determination, and self-palpation.", "He was followed up on an outpatient basis 5 years after treatment.", "He was subsequently lost to follow-up.", "In August 1999, he underwent surgery of the right hydrocele.", "Perioperative findings were unremarkable.", "There was no clear tumor in either testicle at the time of hydrocele surgery.", "At the first visit, his height was 163 cm.", "His weight was 58.5 kg.", "Blood pressure was 128/78 mmHg.", "Heart rate was regular at 62 beats per minute.", "Body temperature was 36.4 \u00b0C.", "He had no history of smoking or drinking.", "There was nothing remarkable in the family history.", "On physical examination, the right testicle was elastic, hard, and enlarged to 40 \u00d7 40 mm.", "A 45 \u00d7 40 mm sized induration was palpable in the right inguinal area.", "The inguinal induration was adequately mobile.", "Neurological examination showed no abnormal findings.", "Blood biochemistry, urinalysis, and tumor markers showed no abnormal findings.", "Ultrasound showed a mosaic shadow inside the right testicle.", "The left testicle showed no abnormal findings on ultrasound.", "Enlargements of the right external iliac lymph node (24 \u00d7 14 mm) and right inguinal lymph node (43 \u00d7 29 mm) were found.", "A 31 \u00d7 22 mm mass with uneven contents was found in the right testicle.", "There was no evidence of distant metastasis.", "The patient underwent high orchiectomy and resection of the right inguinal lymph nodes in November 2017.", "The testicular tumor was 40 \u00d7 40 \u00d7 30 mm in size and weighed 34 g.", "The lymph node was 40 \u00d7 40 \u00d7 30 mm in size and weighed 21 g.", "The cut surfaces of both specimens were yellowish and solid.", "The testicular tumor was localized in the testicle.", "Histopathological findings showed irregular cobblestone proliferations of germ cell-like atypical cells with clear nucleoli.", "Massive necrotic changes were present in the tumor.", "The tumor did not extend into the tunica albuginea.", "No vascular infiltration was found.", "Spermatic cord stumps were negative.", "The tumor diagnosis was a classical seminoma with no other elements.", "Lymph node metastases were diagnosed as a result of the seminoma.", "The seminoma was diagnosed as pT1, pN2, M0, S0.", "The TNM stage was IIB.", "The patient received one course of BEP therapy and three courses of EP therapy.", "Post-chemotherapy CT confirmed a complete clinical response at the right external iliac lymph node.", "The complete clinical response continued 12 months later."], "index": 84, "original_id": "multiclinsum_test_439_en.txt", "split": "test", "summary_subclaims": ["The patient is a 49-year-old Japanese man.", "He visited the department in November 2017.", "His chief complaints were indolent right scrotum enlargement and a right inguinal mass.", "He had visited the department of gastroenterology in February 1997.", "Computed tomography showed a right retroperitoneal tumor.", "The tumor was removed in the same month as the CT scan.", "Histopathological examination showed a teratoma and yolk sac tumor.", "He was diagnosed with primary retroperitoneal EGCT.", "He received three courses of chemotherapy.", "The chemotherapy regimen was bleomycin/etoposide/cisplatin (BEP)."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 32-year-old woman.", "She was admitted with a progressively enlarged mass in the rectovaginal space for 9 years.", "The mass was found during a routine examination 9 years ago.", "No obvious progression was seen in following annual examinations until a year ago.", "The maximum diameter of the mass had significantly grown from 4.0 cm to 9.7 cm in a year.", "Dents in stools were caused by tumor compression.", "Endoscopy in a local hospital showed a submucosal protrusion.", "No absolute tumor tissue but only inflammation was found after several times of endoscopic biopsies in the latest 2 years.", "The patient had no previous medical history.", "The patient and family had no history of previous similar illness.", "The anterior rectum wall was plump during digital rectal examination.", "Contrast-enhanced CT showed a mass with liquefaction necrosis inside the rectovaginal space.", "Transabdominal US showed a heterogeneous hypoechoic mass with a maximum diameter of 9.7 cm in the rectovaginal space.", "The mass was suspected to be a rectal GIST or exophytic uterine fibroid.", "Transabdominal CNB was performed to make a definite diagnosis.", "Written informed consent was obtained from the patient before the operation.", "Some hemorrhage occurred from the vagina, causing premature end of the biopsy.", "The hemorrhage spontaneously relieved several days later.", "Strips of greyish shattered tissue were obtained, with the largest diameter smaller than 0.3 cm.", "Pathology indicated inadequate biopsy tissue for diagnosis.", "Another biopsy after ERUS assessment was recommended by multiple disciplinary treatment.", "ERUS was performed with the MyLab Twice US system.", "CEUS was performed with a bolus injection of 2.4 mL SonoVue.", "CEUS was performed right before puncture to confirm the substantial part of the tumor for biopsy guidance.", "The probe was switched to linear mode.", "The transperineal puncture site and path were decided.", "A freehand biopsy of the lesion was performed with the guidance of in-plane needle.", "The needle tip and its movements were continuously monitored in real time by ERUS during the whole puncture procedure.", "Several strips of greyish tissue were obtained with a length of 0.3-1.2 cm.", "No complications occurred."], "summary_subclaims": ["The patient is a 32-year-old woman.", "She complained of a mass inside the rectovaginal space for 9 years.", "The mass became enlarged within 1 year.", "A rectal SEL was detected by endoscopy.", "The rectal SEL was suspected to be a gastrointestinal stromal tumor.", "The rectal SEL was suspected to be an exophytic uterine fibroid.", "A transabdominal core needle biopsy was unsuccessful.", "The transabdominal core needle biopsy resulted in insufficient tissues.", "Vaginal hemorrhage occurred.", "A second biopsy was suggested after multiple disciplinary treatment discussion.", "A transperineal core needle biopsy was guided by ERUS combined with CEUS.", "Adequate samples were procured.", "The pathological diagnosis was rectal gastrointestinal stromal tumor.", "Imatinib was recommended for first-line therapy.", "The tumor shrank after treatment.", "Resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall.", "Adjuvant therapy was applied.", "No recurrence or metastasis has been found by the last follow-up on December 13, 2019."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 32-year-old woman.", "She was admitted with a progressively enlarged mass in the rectovaginal space for 9 years.", "The mass was found during a routine examination 9 years ago.", "No obvious progression was seen in following annual examinations until a year ago.", "The maximum diameter of the mass had significantly grown from 4.0 cm to 9.7 cm in a year.", "Dents in stools were caused by tumor compression.", "Endoscopy in a local hospital showed a submucosal protrusion.", "No absolute tumor tissue but only inflammation was found after several times of endoscopic biopsies in the latest 2 years.", "The patient had no previous medical history.", "The patient and family had no history of previous similar illness.", "The anterior rectum wall was plump during digital rectal examination.", "Contrast-enhanced CT showed a mass with liquefaction necrosis inside the rectovaginal space.", "Transabdominal US showed a heterogeneous hypoechoic mass with a maximum diameter of 9.7 cm in the rectovaginal space.", "The mass was suspected to be a rectal GIST or exophytic uterine fibroid.", "Transabdominal CNB was performed to make a definite diagnosis.", "Written informed consent was obtained from the patient before the operation.", "Some hemorrhage occurred from the vagina, causing premature end of the biopsy.", "The hemorrhage spontaneously relieved several days later.", "Strips of greyish shattered tissue were obtained, with the largest diameter smaller than 0.3 cm.", "Pathology indicated inadequate biopsy tissue for diagnosis.", "Another biopsy after ERUS assessment was recommended by multiple disciplinary treatment.", "ERUS was performed with the MyLab Twice US system.", "CEUS was performed with a bolus injection of 2.4 mL SonoVue.", "CEUS was performed right before puncture to confirm the substantial part of the tumor for biopsy guidance.", "The probe was switched to linear mode.", "The transperineal puncture site and path were decided.", "A freehand biopsy of the lesion was performed with the guidance of in-plane needle.", "The needle tip and its movements were continuously monitored in real time by ERUS during the whole puncture procedure.", "Several strips of greyish tissue were obtained with a length of 0.3-1.2 cm.", "No complications occurred."], "index": 48, "original_id": "multiclinsum_test_2808_en.txt", "split": "test", "summary_subclaims": ["The patient is a 32-year-old woman.", "She complained of a mass inside the rectovaginal space for 9 years.", "The mass became enlarged within 1 year.", "A rectal SEL was detected by endoscopy.", "The rectal SEL was suspected to be a gastrointestinal stromal tumor.", "The rectal SEL was suspected to be an exophytic uterine fibroid.", "A transabdominal core needle biopsy was unsuccessful.", "The transabdominal core needle biopsy resulted in insufficient tissues.", "Vaginal hemorrhage occurred.", "A second biopsy was suggested after multiple disciplinary treatment discussion.", "A transperineal core needle biopsy was guided by ERUS combined with CEUS.", "Adequate samples were procured.", "The pathological diagnosis was rectal gastrointestinal stromal tumor.", "Imatinib was recommended for first-line therapy.", "The tumor shrank after treatment.", "Resection of the rectal gastrointestinal stromal tumor was performed through the posterior vaginal wall.", "Adjuvant therapy was applied.", "No recurrence or metastasis has been found by the last follow-up on December 13, 2019."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 17-year-old male.", "The patient presented with pain in the lower left posterior region of the mandible.", "The patient had no significant systemic history.", "The patient reported no previous extractions in the mentioned area.", "Clinical examination revealed the absence of Teeth 37 and 38.", "Palpation of the alveolar ridge showed no swelling or bony prominences.", "Radiographic examination revealed that Tooth 37 was impacted transversely between Teeth 36 and 38.", "Tooth 38 was in a vertical position close to the occlusal plane.", "Tooth 38 was Stage Nolla 8.", "Tomographic imaging indicated that the crown of Tooth 37 was oriented lingually.", "The roots of Tooth 37 were separated.", "The mesial root of Tooth 37 was curved and thin.", "The distal root of Tooth 37 was straight and thick.", "The diagnosis was an impacted Tooth 37 in a transverse position with the crown oriented lingually.", "Tooth 38 was retained in a vertical position.", "A consultation with the orthodontics department was made to define the treatment plan.", "Flap extraction of Tooth 37 was planned.", "Subsequent eruption of Tooth 38 was planned.", "Fixed orthodontic treatment was planned.", "The ultimate goal was to restore masticatory function by positioning the third molar in place of the second molar.", "The patient was informed regarding the surgical procedure.", "The patient was informed regarding the risks associated with the procedure.", "The patient was informed regarding the alternative treatments.", "The patient signed the informed consent.", "The surgical intervention for flap extraction of Tooth 37 was scheduled.", "The procedure involved block anesthesia for the inferior alveolar nerve.", "The procedure involved block anesthesia for the lingual nerve.", "The procedure involved block anesthesia for the buccal nerve.", "An L-shaped or monoangular incision was made at the level of the second molar.", "The mucoperiosteal flap was elevated to expose the bone plate.", "An osteotomy was performed in the occlusal bone to visualize the crown of the second molar.", "The separated roots were sectioned for removal.", "The distal segment (crown and root) was extracted first.", "The mesial segment (crown and root) was removed after the distal segment.", "Both segments were luxated with a flag elevator.", "An alveolar curette was used to clean the bony crypt corresponding to the crown.", "The pericoronal sac was removed.", "The procedure was completed with discontinuous suturing using 3/0 polyglycolic acid.", "Five simple sutures were placed.", "The extracted molar was observed in two parts.", "Amoxicillin 500\u2009mg every 8\u2009h for 5 days was prescribed.", "Sodium diclofenac 50\u2009mg every 8\u2009h for 3 days was prescribed.", "Dexamethasone 4\u2009mg every 8\u2009h for 3 days was prescribed.", "The patient was evaluated 6 months after the surgical intervention.", "Bone healing was favorable according to an x-ray.", "The report confirms 'alveolar walls preserved, no evidence of spicules or bony defects; defined borders, no radiographic signs of osteitis'."], "summary_subclaims": ["The patient is a 17-year-old male.", "The patient presented with pain in the lower left molar region.", "Clinical examination revealed the absence of Teeth 37 and 38.", "Tomographic imaging showed Tooth 37 in a transverse position.", "Tomographic imaging showed the crown of Tooth 37 oriented lingually.", "Tomographic imaging showed Tooth 38 in a vertical position.", "Extraction of Tooth 37 was performed.", "A vestibular approach was used for the extraction of Tooth 37.", "Odontectomy was performed for the extraction of Tooth 37.", "Space constraints were a factor in the extraction of Tooth 37."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 17-year-old male.", "The patient presented with pain in the lower left posterior region of the mandible.", "The patient had no significant systemic history.", "The patient reported no previous extractions in the mentioned area.", "Clinical examination revealed the absence of Teeth 37 and 38.", "Palpation of the alveolar ridge showed no swelling or bony prominences.", "Radiographic examination revealed that Tooth 37 was impacted transversely between Teeth 36 and 38.", "Tooth 38 was in a vertical position close to the occlusal plane.", "Tooth 38 was Stage Nolla 8.", "Tomographic imaging indicated that the crown of Tooth 37 was oriented lingually.", "The roots of Tooth 37 were separated.", "The mesial root of Tooth 37 was curved and thin.", "The distal root of Tooth 37 was straight and thick.", "The diagnosis was an impacted Tooth 37 in a transverse position with the crown oriented lingually.", "Tooth 38 was retained in a vertical position.", "A consultation with the orthodontics department was made to define the treatment plan.", "Flap extraction of Tooth 37 was planned.", "Subsequent eruption of Tooth 38 was planned.", "Fixed orthodontic treatment was planned.", "The ultimate goal was to restore masticatory function by positioning the third molar in place of the second molar.", "The patient was informed regarding the surgical procedure.", "The patient was informed regarding the risks associated with the procedure.", "The patient was informed regarding the alternative treatments.", "The patient signed the informed consent.", "The surgical intervention for flap extraction of Tooth 37 was scheduled.", "The procedure involved block anesthesia for the inferior alveolar nerve.", "The procedure involved block anesthesia for the lingual nerve.", "The procedure involved block anesthesia for the buccal nerve.", "An L-shaped or monoangular incision was made at the level of the second molar.", "The mucoperiosteal flap was elevated to expose the bone plate.", "An osteotomy was performed in the occlusal bone to visualize the crown of the second molar.", "The separated roots were sectioned for removal.", "The distal segment (crown and root) was extracted first.", "The mesial segment (crown and root) was removed after the distal segment.", "Both segments were luxated with a flag elevator.", "An alveolar curette was used to clean the bony crypt corresponding to the crown.", "The pericoronal sac was removed.", "The procedure was completed with discontinuous suturing using 3/0 polyglycolic acid.", "Five simple sutures were placed.", "The extracted molar was observed in two parts.", "Amoxicillin 500\u2009mg every 8\u2009h for 5 days was prescribed.", "Sodium diclofenac 50\u2009mg every 8\u2009h for 3 days was prescribed.", "Dexamethasone 4\u2009mg every 8\u2009h for 3 days was prescribed.", "The patient was evaluated 6 months after the surgical intervention.", "Bone healing was favorable according to an x-ray.", "The report confirms 'alveolar walls preserved, no evidence of spicules or bony defects; defined borders, no radiographic signs of osteitis'."], "index": 46, "original_id": "multiclinsum_test_3344_en.txt", "split": "test", "summary_subclaims": ["The patient is a 17-year-old male.", "The patient presented with pain in the lower left molar region.", "Clinical examination revealed the absence of Teeth 37 and 38.", "Tomographic imaging showed Tooth 37 in a transverse position.", "Tomographic imaging showed the crown of Tooth 37 oriented lingually.", "Tomographic imaging showed Tooth 38 in a vertical position.", "Extraction of Tooth 37 was performed.", "A vestibular approach was used for the extraction of Tooth 37.", "Odontectomy was performed for the extraction of Tooth 37.", "Space constraints were a factor in the extraction of Tooth 37."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 71-year-old male.", "The patient has a past medical history significant for diabetes mellitus.", "The patient has a past medical history significant for coronary artery disease.", "The patient has a past medical history significant for chronic hypotension.", "The patient has a past medical history significant for chronic obstructive pulmonary disease.", "The patient has a past medical history significant for obstructive sleep apnea.", "The patient has a past medical history significant for peripheral artery disease.", "The patient presented to the ED with right buttock and scrotal swelling for three days.", "The patient reported generalized weakness.", "The patient reported shortness of breath.", "The patient reported urinary retention with dysuria.", "The patient noticed non-traumatic bruising to his scrotum one day prior to presentation.", "The patient reported increasing buttock pain not controlled by home oxycodone/acetaminophen 5/325 mg tablets.", "Upon arrival, the patient's oral temperature was 38.2\u00b0C.", "The patient's blood pressure was 119/54 mm Hg.", "The patient's heart rate was 93 beats per minute.", "The patient's respiratory rate was 25 breaths per minute.", "The patient's oxygen saturation was 97% on room air.", "The physical examination was notable for an ill-appearing gentleman.", "The patient was awake and alert.", "Heart sounds were unremarkable aside from tachycardia.", "Lungs were clear to auscultation.", "The abdominal examination was soft, protuberant, and nontender.", "A focused genitourinary examination revealed an edematous, erythematous, and exquisitely tender scrotum.", "There was a coin-sized, ecchymotic-appearing lesion on the scrotum.", "Erythema and induration extended from the scrotum and perineum to the right buttock.", "No crepitus or fluctuance was palpated on examination.", "Laboratory results were remarkable for leukocytosis to 15,000 K/mm3.", "The patient had lactic acidosis of 3.4 mmol/L.", "The patient had marked acute kidney injury with creatinine of 5 mg/dL.", "The patient had a venous blood gas pH of 7.22.", "The patient was mildly hyponatremic at 133 mmol/L.", "The patient was hyperkalemic at 5.3 mmol/L.", "Intravenous antibiotics were initiated.", "Emergent consultations with surgery and urology were obtained.", "The patient decompensated into septic shock.", "The patient's blood pressure decreased to 88/41 mm Hg during the ED course.", "The patient was not stable for transport or advanced imaging.", "The ecchymotic-appearing lesion and edema had expanded across his scrotum and perineum.", "POCUS was used for the rapid assessment of the patient\u2019s presumed clinical diagnosis of Fournier\u2019s gangrene.", "Transverse and sagittal views of the perineum and scrotum were obtained using a high-frequency linear probe.", "The POCUS imaging revealed diffuse hyperechoic foci with posterior 'dirty' shadowing, representative of subcutaneous air.", "The POCUS imaging revealed small fluid collections tracking along the fascial planes.", "The patient was taken directly from the ED to the operating room for immediate surgical debridement.", "An area of tissue measuring 25 cm \u00d7 30 cm was debrided from the scrotum, perineum, and right buttock.", "Dark, necrotic tissue and foul-smelling fluid were noted during surgery, consistent with Fournier\u2019s gangrene.", "The patient was admitted to the intensive care unit.", "The patient was transferred to a tertiary care center.", "The patient ultimately died of complications related to his illness."], "summary_subclaims": ["POCUS was used to rapidly confirm diagnosis.", "The patient was unstable.", "The patient had severe sepsis.", "The patient presented to the emergency department.", "The patient had Fournier's gangrene."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 71-year-old male.", "The patient has a past medical history significant for diabetes mellitus.", "The patient has a past medical history significant for coronary artery disease.", "The patient has a past medical history significant for chronic hypotension.", "The patient has a past medical history significant for chronic obstructive pulmonary disease.", "The patient has a past medical history significant for obstructive sleep apnea.", "The patient has a past medical history significant for peripheral artery disease.", "The patient presented to the ED with right buttock and scrotal swelling for three days.", "The patient reported generalized weakness.", "The patient reported shortness of breath.", "The patient reported urinary retention with dysuria.", "The patient noticed non-traumatic bruising to his scrotum one day prior to presentation.", "The patient reported increasing buttock pain not controlled by home oxycodone/acetaminophen 5/325 mg tablets.", "Upon arrival, the patient's oral temperature was 38.2\u00b0C.", "The patient's blood pressure was 119/54 mm Hg.", "The patient's heart rate was 93 beats per minute.", "The patient's respiratory rate was 25 breaths per minute.", "The patient's oxygen saturation was 97% on room air.", "The physical examination was notable for an ill-appearing gentleman.", "The patient was awake and alert.", "Heart sounds were unremarkable aside from tachycardia.", "Lungs were clear to auscultation.", "The abdominal examination was soft, protuberant, and nontender.", "A focused genitourinary examination revealed an edematous, erythematous, and exquisitely tender scrotum.", "There was a coin-sized, ecchymotic-appearing lesion on the scrotum.", "Erythema and induration extended from the scrotum and perineum to the right buttock.", "No crepitus or fluctuance was palpated on examination.", "Laboratory results were remarkable for leukocytosis to 15,000 K/mm3.", "The patient had lactic acidosis of 3.4 mmol/L.", "The patient had marked acute kidney injury with creatinine of 5 mg/dL.", "The patient had a venous blood gas pH of 7.22.", "The patient was mildly hyponatremic at 133 mmol/L.", "The patient was hyperkalemic at 5.3 mmol/L.", "Intravenous antibiotics were initiated.", "Emergent consultations with surgery and urology were obtained.", "The patient decompensated into septic shock.", "The patient's blood pressure decreased to 88/41 mm Hg during the ED course.", "The patient was not stable for transport or advanced imaging.", "The ecchymotic-appearing lesion and edema had expanded across his scrotum and perineum.", "POCUS was used for the rapid assessment of the patient\u2019s presumed clinical diagnosis of Fournier\u2019s gangrene.", "Transverse and sagittal views of the perineum and scrotum were obtained using a high-frequency linear probe.", "The POCUS imaging revealed diffuse hyperechoic foci with posterior 'dirty' shadowing, representative of subcutaneous air.", "The POCUS imaging revealed small fluid collections tracking along the fascial planes.", "The patient was taken directly from the ED to the operating room for immediate surgical debridement.", "An area of tissue measuring 25 cm \u00d7 30 cm was debrided from the scrotum, perineum, and right buttock.", "Dark, necrotic tissue and foul-smelling fluid were noted during surgery, consistent with Fournier\u2019s gangrene.", "The patient was admitted to the intensive care unit.", "The patient was transferred to a tertiary care center.", "The patient ultimately died of complications related to his illness."], "index": 75, "original_id": "multiclinsum_test_2914_en.txt", "split": "test", "summary_subclaims": ["POCUS was used to rapidly confirm diagnosis.", "The patient was unstable.", "The patient had severe sepsis.", "The patient presented to the emergency department.", "The patient had Fournier's gangrene."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is an 8 year old girl.", "The patient has tufting enteropathy.", "The patient is on long-term parenteral nutrition.", "The patient presented on 3 occasions with central venous catheter infection due to Bacillus species.", "On each occasion, she had fever after flushing of the central venous catheter.", "She had initially presented in the first few months of life with chronic watery diarrhoea.", "She had impaired growth.", "She was found to have tufting enteropathy.", "Tufting enteropathy is a rare congenital enteropathy.", "Tufting enteropathy requires indefinite dependence on parenteral nutrition from early infancy.", "The child is on regular parenteral nutrition.", "The child has had no previous history of significant infections, except for central venous catheter infections with coagulase negative staphylococci.", "Immunoglobulins, neutrophil and lymphocyte counts were within the normal range.", "There was no history of significant trauma, injuries or skin infections prior to this episode, except a small cut on her finger.", "The small cut on her finger healed very well.", "She lives with her parents.", "There is no history of contact with plant growth products.", "There is no history of contact with animal probiotics.", "The child presented with fever and rigors to her local hospital.", "Bacillus species was isolated from blood taken from the central venous catheter.", "The organism was reported sensitive to flucloxacillin.", "She was treated with 4 weeks of intravenous flucloxacillin.", "Bacteraemia had persisted despite 14 days of treatment.", "The child was transferred to our hospital with recurrence of fever and rigors.", "Empirical treatment was started with intravenous cefotaxime and flucloxacillin.", "Bacillus species was isolated from central venous catheter cultures both before and whilst on cefotaxime and flucloxacillin.", "The organism was later identified as Bacillus pumilus at the National Reference Laboratory.", "The methods used to identify the organism included gram stain to determine whether spores are produced.", "The methods used to identify the organism included a short biochemical profile based on ammonia salt sugars, Lecithinase and mannitol.", "Bacillus pumilus is lecithinase negative.", "Bacillus pumilus is mannitol positive.", "The methods used to identify the organism included DNA sequencing.", "Bacillus pumilus was reported to be sensitive to vancomycin.", "Bacillus pumilus was reported to be sensitive to erythromycin.", "There were concerns that the patient had previously reacted to systemic vancomycin.", "Antibiotics were changed to intravenous clindamycin with vancomycin line locks given for 2 weeks.", "Blood cultures, taken both during and after this treatment, were negative.", "Echocardiography showed no evidence of vegetations at the tip of the catheter or in the heart.", "Ten days after stopping the intravenous antibiotics the child presented for the third time with fever and rigors.", "A Bacillus species was again grown from blood taken from the central venous catheter.", "The central venous catheter was removed after 5 days treatment with intravenous vancomycin.", "A new central venous catheter was inserted.", "Subsequent blood cultures were negative.", "There has been no recurrence of further fever or infections over a 9-month period.", "The infection has been eradicated."], "summary_subclaims": ["We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition.", "There were three episodes of central venous catheter infection with Bacillus pumilus in three months.", "Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear.", "The infection resulted in the need for removal of the catheter for complete cure."]}, "extra_info": {"fulltext_subclaims": ["The patient is an 8 year old girl.", "The patient has tufting enteropathy.", "The patient is on long-term parenteral nutrition.", "The patient presented on 3 occasions with central venous catheter infection due to Bacillus species.", "On each occasion, she had fever after flushing of the central venous catheter.", "She had initially presented in the first few months of life with chronic watery diarrhoea.", "She had impaired growth.", "She was found to have tufting enteropathy.", "Tufting enteropathy is a rare congenital enteropathy.", "Tufting enteropathy requires indefinite dependence on parenteral nutrition from early infancy.", "The child is on regular parenteral nutrition.", "The child has had no previous history of significant infections, except for central venous catheter infections with coagulase negative staphylococci.", "Immunoglobulins, neutrophil and lymphocyte counts were within the normal range.", "There was no history of significant trauma, injuries or skin infections prior to this episode, except a small cut on her finger.", "The small cut on her finger healed very well.", "She lives with her parents.", "There is no history of contact with plant growth products.", "There is no history of contact with animal probiotics.", "The child presented with fever and rigors to her local hospital.", "Bacillus species was isolated from blood taken from the central venous catheter.", "The organism was reported sensitive to flucloxacillin.", "She was treated with 4 weeks of intravenous flucloxacillin.", "Bacteraemia had persisted despite 14 days of treatment.", "The child was transferred to our hospital with recurrence of fever and rigors.", "Empirical treatment was started with intravenous cefotaxime and flucloxacillin.", "Bacillus species was isolated from central venous catheter cultures both before and whilst on cefotaxime and flucloxacillin.", "The organism was later identified as Bacillus pumilus at the National Reference Laboratory.", "The methods used to identify the organism included gram stain to determine whether spores are produced.", "The methods used to identify the organism included a short biochemical profile based on ammonia salt sugars, Lecithinase and mannitol.", "Bacillus pumilus is lecithinase negative.", "Bacillus pumilus is mannitol positive.", "The methods used to identify the organism included DNA sequencing.", "Bacillus pumilus was reported to be sensitive to vancomycin.", "Bacillus pumilus was reported to be sensitive to erythromycin.", "There were concerns that the patient had previously reacted to systemic vancomycin.", "Antibiotics were changed to intravenous clindamycin with vancomycin line locks given for 2 weeks.", "Blood cultures, taken both during and after this treatment, were negative.", "Echocardiography showed no evidence of vegetations at the tip of the catheter or in the heart.", "Ten days after stopping the intravenous antibiotics the child presented for the third time with fever and rigors.", "A Bacillus species was again grown from blood taken from the central venous catheter.", "The central venous catheter was removed after 5 days treatment with intravenous vancomycin.", "A new central venous catheter was inserted.", "Subsequent blood cultures were negative.", "There has been no recurrence of further fever or infections over a 9-month period.", "The infection has been eradicated."], "index": 44, "original_id": "multiclinsum_test_1072_en.txt", "split": "test", "summary_subclaims": ["We report a case of central venous catheter infection with Bacillus pumilus in an immunocompetent child with tufting enteropathy on long-term parenteral nutrition.", "There were three episodes of central venous catheter infection with Bacillus pumilus in three months.", "Despite adequate and appropriate use of intravenous antibiotics, the infection failed to clear.", "The infection resulted in the need for removal of the catheter for complete cure."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring are often recommended to support kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., hyperkalemia, metabolic acidosis), and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Declining glomerular filtration rate (GFR) is a key biomarker for chronic kidney disease progression, and early intervention through pharmacological management, dietary modification, and monitoring of biomarkers such as serum creatinine and proteinuria is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 55-year-old lady of Central African origin.", "The patient has primary open-angle glaucoma.", "The patient underwent bilateral XEN gel surgery.", "The patient was referred with intraocular pressures of 38 mm Hg in the right eye.", "The patient was referred with intraocular pressures of 22 mm Hg in the left eye.", "The patient had been diagnosed with POAG several years before.", "The patient had two selective laser trabeculoplasties.", "The patient was on maximal medical therapy including oral acetazolamide.", "The patient had mediocre self-reported compliance.", "The patient had a positive family history for open-angle glaucoma in her mother.", "Best-corrected visual acuity was 10/10 in both eyes.", "Cup/disk ratio was 0.8 in the right eye with an inferior notch.", "Cup/disk ratio was 0.7 in the left eye with a superior notch.", "Gonioscopy showed bilaterally open angles.", "Pachymetry was 580 \u03bcm in the right eye.", "Pachymetry was 585 \u03bcm in the left eye.", "Automated visual field examination showed bilateral nasal quadrantanopsia.", "Optical coherence tomography imaging showed generally reduced RNFL thicknesses bilaterally.", "Brain MRI imaging was unremarkable.", "Bilateral mitomycin C-augmented XEN gel stent implantation was organized.", "The target IOP was \u226418 mm Hg.", "Surgeries were performed following standard protocols described in the literature.", "No intraoperative complications were noted.", "The patient received topical combined tobramycin and dexamethasone.", "The right eye recovered uneventfully.", "The right eye had IOP normalizing between 12 mm Hg and 16 mm Hg at 3 months.", "The left eye developed a 2-mm hyphema on the first day following surgery.", "The initial intraocular pressure in the left eye was 2 mm Hg.", "The hyphema in the left eye had completely resolved after 8 days.", "IOP was stable at 12 mm Hg after 8 days.", "After 1 month, the patient presented with an IOP of 50 mm Hg in the left eye.", "The filtration bleb was shallow but diffuse.", "The XEN gel stent was well-positioned.", "An emergency revision procedure was organized.", "The absence of filtration through the stent was confirmed intraoperatively.", "The blocked tube was removed.", "The tube was sent for macroscopic analysis.", "The patient made good recovery without any postoperative complications.", "At 1-month, her IOP was stable at 17 mm Hg.", "Macroscopic examination confirmed obstruction of the XEN gel stent on its AC extremity.", "Translucent cell fragments were identified within the obstructed tube."], "summary_subclaims": ["The patient is a 55-year-old female.", "The patient has primary open-angle glaucoma.", "The patient underwent bilateral XEN gel surgery.", "The left eye developed a 2 mm postoperative hyphema.", "The hyphema resolved spontaneously within 8 days.", "Intraocular pressure normalized at 12 mm Hg.", "Intraocular pressure increased to 50 mm Hg after 1 month.", "The eye was otherwise normal-looking.", "Intraoperative examination revealed a nonfunctioning XEN gel stent.", "The stent was replaced and sent for laboratory analysis.", "Macroscopic examination of the tube confirmed obstruction with cellular debris.", "Tube replacement restored good filtration."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 55-year-old lady of Central African origin.", "The patient has primary open-angle glaucoma.", "The patient underwent bilateral XEN gel surgery.", "The patient was referred with intraocular pressures of 38 mm Hg in the right eye.", "The patient was referred with intraocular pressures of 22 mm Hg in the left eye.", "The patient had been diagnosed with POAG several years before.", "The patient had two selective laser trabeculoplasties.", "The patient was on maximal medical therapy including oral acetazolamide.", "The patient had mediocre self-reported compliance.", "The patient had a positive family history for open-angle glaucoma in her mother.", "Best-corrected visual acuity was 10/10 in both eyes.", "Cup/disk ratio was 0.8 in the right eye with an inferior notch.", "Cup/disk ratio was 0.7 in the left eye with a superior notch.", "Gonioscopy showed bilaterally open angles.", "Pachymetry was 580 \u03bcm in the right eye.", "Pachymetry was 585 \u03bcm in the left eye.", "Automated visual field examination showed bilateral nasal quadrantanopsia.", "Optical coherence tomography imaging showed generally reduced RNFL thicknesses bilaterally.", "Brain MRI imaging was unremarkable.", "Bilateral mitomycin C-augmented XEN gel stent implantation was organized.", "The target IOP was \u226418 mm Hg.", "Surgeries were performed following standard protocols described in the literature.", "No intraoperative complications were noted.", "The patient received topical combined tobramycin and dexamethasone.", "The right eye recovered uneventfully.", "The right eye had IOP normalizing between 12 mm Hg and 16 mm Hg at 3 months.", "The left eye developed a 2-mm hyphema on the first day following surgery.", "The initial intraocular pressure in the left eye was 2 mm Hg.", "The hyphema in the left eye had completely resolved after 8 days.", "IOP was stable at 12 mm Hg after 8 days.", "After 1 month, the patient presented with an IOP of 50 mm Hg in the left eye.", "The filtration bleb was shallow but diffuse.", "The XEN gel stent was well-positioned.", "An emergency revision procedure was organized.", "The absence of filtration through the stent was confirmed intraoperatively.", "The blocked tube was removed.", "The tube was sent for macroscopic analysis.", "The patient made good recovery without any postoperative complications.", "At 1-month, her IOP was stable at 17 mm Hg.", "Macroscopic examination confirmed obstruction of the XEN gel stent on its AC extremity.", "Translucent cell fragments were identified within the obstructed tube."], "index": 64, "original_id": "multiclinsum_test_7_en.txt", "split": "test", "summary_subclaims": ["The patient is a 55-year-old female.", "The patient has primary open-angle glaucoma.", "The patient underwent bilateral XEN gel surgery.", "The left eye developed a 2 mm postoperative hyphema.", "The hyphema resolved spontaneously within 8 days.", "Intraocular pressure normalized at 12 mm Hg.", "Intraocular pressure increased to 50 mm Hg after 1 month.", "The eye was otherwise normal-looking.", "Intraoperative examination revealed a nonfunctioning XEN gel stent.", "The stent was replaced and sent for laboratory analysis.", "Macroscopic examination of the tube confirmed obstruction with cellular debris.", "Tube replacement restored good filtration."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 49-year-old man with a history of acromegaly.", "He was admitted with recurrent shortness of breath and dyspnea on exertion during the previous 2 years.", "He had experienced an episode of presyncope 2 weeks prior.", "He had no past history of hypertension, diabetes mellitus, sleep apnea, or sudden cardiac death.", "He did not smoke or consume alcohol.", "He had a history of stereotactic radiosurgeries twice in a decade or so.", "He was adherent to treatment with octreotide 40 mg once per month through intramuscular injection.", "He was 1.85 m tall, weighed 134 kg, and had a body mass index of 39 kg/m2.", "His blood pressure was 110/60 mmHg.", "His heart rate was 92 beats/min with sinus rhythm.", "He had prominent superciliary arches and nose bridge.", "He had enlargement of the tongue and lip.", "He had large hands and feet.", "Cardiac auscultation revealed irregular premature beats.", "An electrocardiogram demonstrated sinus rhythm with wide (160 ms) QRS duration of left bundle branch block.", "The patient\u2019s condition was classified as New York Heart Association stage III\u2013IV.", "Magnetic resonance imaging showed pituitary macroadenoma.", "Blood testing showed an elevated brain natriuretic peptide level of 740 pg/ml.", "Hormone laboratory tests demonstrated excessive secretion of GH and IGF-1, twofold greater than the reference normal upper limit.", "A Holter monitor showed frequent ventricular premature beats.", "A chest x-ray showed a cardiothoracic ratio of 78%.", "Echocardiography showed diffuse impairment of left ventricular systolic motion, reaching an LVEF of 16%.", "The right ventricle and atrium and the left atrium were dilated.", "There was moderate mitral regurgitation.", "There was no associated systolic anterior motion of the mitral valve.", "Coronary angiography showed normal coronary arteries without stenosis.", "Left ventriculography revealed an EF of 20% with diffuse LV hypokinesis.", "Acromegaly-induced cardiomyopathy was confirmed.", "The patient was diagnosed with secondary dilated cardiomyopathy due to acromegaly.", "The patient was diagnosed with congestive heart failure secondary to acromegaly-induced dilated cardiomyopathy.", "The mainstay of treatment acknowledged globally is surgical resection of the pituitary adenoma.", "Surgical resection was considered high-risk given the patient\u2019s cardiac condition.", "The patient was administered diuretics, vasodilators, an ACEI, \u03b2-blockers, and spironolactone.", "Octreotide (200 \u03bcg/day) was administered for the control of GH excess.", "After half a year, the serum GH concentration decreased from 32.50 ng/ml to 1.98 ng/ml.", "The patient was hospitalized again because of uncontrollable cardiac failure.", "Echocardiography showed a recovered EF value from 16% to 28%.", "A significant ventricular mechanical dyssynchrony was detected.", "Electrophysiological study revealed a nonsustained ventricular monomorphic tachycardia.", "We recommended cardiac resynchronization therapy with defibrillator implantation.", "The patient underwent CRT insertion.", "The patient was discharged to home 5 days after CRT insertion.", "The patient claimed symptom improvement following device insertion 1 month later.", "Echocardiography at the last visit identified improved LVEF of 54%.", "A chest x-ray showed reduced CTR of 60%.", "The patient was in NYHA functional class II."], "summary_subclaims": ["The patient is a 49-year-old man.", "The patient has a history of acromegaly.", "The patient presented with decompensated systolic heart failure.", "Serial electrocardiograms showed wide (160\u2013200\u2009ms) QRS duration.", "Echocardiography showed severe left ventricular dysfunction.", "The left ventricular ejection fraction was 16%.", "Surgical indication was rarely assessed by neurosurgeons.", "Stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects.", "Cardiac resynchronization therapy was performed.", "The patient\u2019s symptoms were successfully alleviated.", "The patient was discharged from the hospital."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 49-year-old man with a history of acromegaly.", "He was admitted with recurrent shortness of breath and dyspnea on exertion during the previous 2 years.", "He had experienced an episode of presyncope 2 weeks prior.", "He had no past history of hypertension, diabetes mellitus, sleep apnea, or sudden cardiac death.", "He did not smoke or consume alcohol.", "He had a history of stereotactic radiosurgeries twice in a decade or so.", "He was adherent to treatment with octreotide 40 mg once per month through intramuscular injection.", "He was 1.85 m tall, weighed 134 kg, and had a body mass index of 39 kg/m2.", "His blood pressure was 110/60 mmHg.", "His heart rate was 92 beats/min with sinus rhythm.", "He had prominent superciliary arches and nose bridge.", "He had enlargement of the tongue and lip.", "He had large hands and feet.", "Cardiac auscultation revealed irregular premature beats.", "An electrocardiogram demonstrated sinus rhythm with wide (160 ms) QRS duration of left bundle branch block.", "The patient\u2019s condition was classified as New York Heart Association stage III\u2013IV.", "Magnetic resonance imaging showed pituitary macroadenoma.", "Blood testing showed an elevated brain natriuretic peptide level of 740 pg/ml.", "Hormone laboratory tests demonstrated excessive secretion of GH and IGF-1, twofold greater than the reference normal upper limit.", "A Holter monitor showed frequent ventricular premature beats.", "A chest x-ray showed a cardiothoracic ratio of 78%.", "Echocardiography showed diffuse impairment of left ventricular systolic motion, reaching an LVEF of 16%.", "The right ventricle and atrium and the left atrium were dilated.", "There was moderate mitral regurgitation.", "There was no associated systolic anterior motion of the mitral valve.", "Coronary angiography showed normal coronary arteries without stenosis.", "Left ventriculography revealed an EF of 20% with diffuse LV hypokinesis.", "Acromegaly-induced cardiomyopathy was confirmed.", "The patient was diagnosed with secondary dilated cardiomyopathy due to acromegaly.", "The patient was diagnosed with congestive heart failure secondary to acromegaly-induced dilated cardiomyopathy.", "The mainstay of treatment acknowledged globally is surgical resection of the pituitary adenoma.", "Surgical resection was considered high-risk given the patient\u2019s cardiac condition.", "The patient was administered diuretics, vasodilators, an ACEI, \u03b2-blockers, and spironolactone.", "Octreotide (200 \u03bcg/day) was administered for the control of GH excess.", "After half a year, the serum GH concentration decreased from 32.50 ng/ml to 1.98 ng/ml.", "The patient was hospitalized again because of uncontrollable cardiac failure.", "Echocardiography showed a recovered EF value from 16% to 28%.", "A significant ventricular mechanical dyssynchrony was detected.", "Electrophysiological study revealed a nonsustained ventricular monomorphic tachycardia.", "We recommended cardiac resynchronization therapy with defibrillator implantation.", "The patient underwent CRT insertion.", "The patient was discharged to home 5 days after CRT insertion.", "The patient claimed symptom improvement following device insertion 1 month later.", "Echocardiography at the last visit identified improved LVEF of 54%.", "A chest x-ray showed reduced CTR of 60%.", "The patient was in NYHA functional class II."], "index": 57, "original_id": "multiclinsum_test_3217_en.txt", "split": "test", "summary_subclaims": ["The patient is a 49-year-old man.", "The patient has a history of acromegaly.", "The patient presented with decompensated systolic heart failure.", "Serial electrocardiograms showed wide (160\u2013200\u2009ms) QRS duration.", "Echocardiography showed severe left ventricular dysfunction.", "The left ventricular ejection fraction was 16%.", "Surgical indication was rarely assessed by neurosurgeons.", "Stereotactic radiosurgery together with pharmacotherapy produced infinitesimal effects.", "Cardiac resynchronization therapy was performed.", "The patient\u2019s symptoms were successfully alleviated.", "The patient was discharged from the hospital."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 42-year-old Native American female.", "She presented to University of South Dakota Sanford Medical Center in December of 2020.", "She developed numbness, tingling, and a sharp shooting pain in both arms immediately following parathyroidectomy for parathyroid adenoma.", "The numbness, tingling, and pain were worse in the right arm.", "The symptoms radiated across the upper back and chest.", "Medical history was significant for a traumatic SCI caused by a motor vehicle collision at the age of 15.", "She experienced paralysis of her bilateral lower extremities, classified by the American Spinal Injury Association (ASIA) as an ASIA B injury.", "Her injury required thoracolumbar stabilization with Harrington rods.", "She had resulting chronic foot drop.", "She was only able to ambulate with a walker.", "She did not report any history of upper extremity symptoms prior to parathyroidectomy.", "Examination was significant for morbid obesity with a body mass index (BMI) of 51.", "She had decreased temperature and light touch sensation in the upper extremities and neck in dermatomes C3 through T10.", "Proprioception and vibration sense were preserved.", "Hypocalcemia was suspected as a cause of her paresthesias.", "Calcium levels were normal.", "Cervical MRI 2 days after symptoms onset demonstrated a T2 signal hyperintense area, just to the right of midline, that extended throughout the length of the central cervical spinal cord.", "The MRI was consistent with an expanding syrinx.", "Thoracic MRI showed the syrinx extended throughout the thoracic spinal cord as well.", "The reading radiologist initially misread this MRI as longitudinally extensive transverse myelitis.", "The radiologist specifically reported that they did not believe this was a syrinx because it was located in the lateral aspect of the spinal cord rather than in the central spinal cord canal.", "There was mild peripheral contrast-enhancement around the syrinx.", "An extensive infectious, autoimmune, and metabolic workup was negative.", "A working diagnosis of longitudinal extensive transverse myelitis was made.", "The patient was treated with 5 days of intravenous methylprednisolone.", "Repeat cervical MRI 2 weeks after symptom onset revealed no changes from the previous MRI.", "Her paresthesias and pain persisted.", "Six months after discharge, the patient presented to our neurology clinic for increasing weakness in the lower extremities.", "She had worsening dexterity of her right hand.", "She had more frequent falls.", "These symptoms had progressed to the point of requiring her to move to an assisted living facility.", "On examination, there was new pronator drift.", "There was decreased right hip flexion strength.", "There was decreased reflexes in the right upper extremity.", "Based on the patient\u2019s current and previous symptoms along with the previous imaging, we were able to arrive at a diagnosis of PTS, which had previously been missed.", "Cervical MRI was repeated and showed rostral expansion of the syrinx into the brain stem.", "With the advancement of her symptoms and growth of the syrinx into the brainstem, the patient received an urgent referral to an outside facility for neurosurgical evaluation.", "The consulting neurosurgeon at the outside facility did not believe her condition warranted hospital admission.", "The patient was not seen by the neurosurgeon for another 6 weeks.", "During that time period, the patient became progressively weaker.", "She had more frequent falls.", "She developed a hoarse voice, concerning for vocal cord paralysis.", "She developed dysphagia with several episodes of choking.", "On evaluation at the outside facility, the evaluating neurosurgeon concluded that the patient\u2019s symptom severity and rapid progression were indications for surgical drainage of the syrinx.", "The patient was taken to the operating room, and a C7-T2 laminectomy was performed.", "After removing the C7 through T2 lamina and entering the dura, the cord was noted to be quite dilated, nearly filling the entire dural tube.", "The cord was rotated 90\u00b0 within the dura.", "A 2 mm hole was made in the dorsal root entry zone of the cord below the C8 nerve root to insert the shunt.", "The syrinx cavity was encountered at a depth of <1 mm.", "The cord immediately deflated after penetration of the syrinx.", "A syringo-subarachnoid shunt was placed to allow the syrinx to continuously drain.", "The surgery and immediate postsurgical period were uncomplicated.", "She was discharged back to her previous nursing home 9 days following the operation.", "The patient was ambulating back at her baseline with a walker.", "Follow-up 2 months after surgery noted subjective persistent but not worsened right arm and leg weakness.", "She had a weakened voice.", "At this point, the patient was able to complete her ADLs independently although she had assistance at home.", "It was determined that the surgery stabilized as well as halted the progression of her neurological symptoms but did not reverse them.", "Cervical MRI 4 months after surgery showed dramatic reduction in syrinx size, with only a small residual fluid collection.", "This confirmed that the shunt was patent and functioning.", "Thoracic MRI showed possible persistent syringomyelia with slight enlargement compared to previous.", "This was significantly limited due to hardware artifact.", "The patient continues to live in a nursing home with assistance with her ADLs and frequent physical therapy.", "Patient consent and hospital approval were obtained before the writing of this report."], "summary_subclaims": ["The patient is a 42-year-old female.", "She has a distant history of spinal cord injury.", "She developed clinical and imaging findings consistent with acute expansion of post-traumatic syringomyelia.", "The acute expansion occurred immediately following parathyroidectomy.", "Her symptoms included acute numbness, tingling, and pain in both arms.", "Magnetic resonance imaging revealed a syrinx in the cervical and thoracic spinal cord.", "The syrinx was initially misdiagnosed as transverse myelitis.", "She was treated for transverse myelitis without resolution of symptoms.", "Over the following 6 months, the patient experienced progressive weakness.", "Repeat MRI demonstrated expansion of the syrinx with new involvement of the brain stem.", "The patient was diagnosed with post-traumatic syringomyelia.", "She was referred for outpatient neurosurgery evaluation at a tertiary facility.", "Treatment was delayed due to problems with housing and scheduling at the outside facility.", "The syrinx was surgically drained.", "A syringo-subarachnoid shunt was placed.", "Follow-up MRI confirmed correct placement of the shunt.", "The procedure effectively halted symptom progression.", "The procedure did not resolve all symptoms completely.", "The patient has regained her ability to perform much of her activities of daily living.", "The patient remains in a nursing home facility."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 42-year-old Native American female.", "She presented to University of South Dakota Sanford Medical Center in December of 2020.", "She developed numbness, tingling, and a sharp shooting pain in both arms immediately following parathyroidectomy for parathyroid adenoma.", "The numbness, tingling, and pain were worse in the right arm.", "The symptoms radiated across the upper back and chest.", "Medical history was significant for a traumatic SCI caused by a motor vehicle collision at the age of 15.", "She experienced paralysis of her bilateral lower extremities, classified by the American Spinal Injury Association (ASIA) as an ASIA B injury.", "Her injury required thoracolumbar stabilization with Harrington rods.", "She had resulting chronic foot drop.", "She was only able to ambulate with a walker.", "She did not report any history of upper extremity symptoms prior to parathyroidectomy.", "Examination was significant for morbid obesity with a body mass index (BMI) of 51.", "She had decreased temperature and light touch sensation in the upper extremities and neck in dermatomes C3 through T10.", "Proprioception and vibration sense were preserved.", "Hypocalcemia was suspected as a cause of her paresthesias.", "Calcium levels were normal.", "Cervical MRI 2 days after symptoms onset demonstrated a T2 signal hyperintense area, just to the right of midline, that extended throughout the length of the central cervical spinal cord.", "The MRI was consistent with an expanding syrinx.", "Thoracic MRI showed the syrinx extended throughout the thoracic spinal cord as well.", "The reading radiologist initially misread this MRI as longitudinally extensive transverse myelitis.", "The radiologist specifically reported that they did not believe this was a syrinx because it was located in the lateral aspect of the spinal cord rather than in the central spinal cord canal.", "There was mild peripheral contrast-enhancement around the syrinx.", "An extensive infectious, autoimmune, and metabolic workup was negative.", "A working diagnosis of longitudinal extensive transverse myelitis was made.", "The patient was treated with 5 days of intravenous methylprednisolone.", "Repeat cervical MRI 2 weeks after symptom onset revealed no changes from the previous MRI.", "Her paresthesias and pain persisted.", "Six months after discharge, the patient presented to our neurology clinic for increasing weakness in the lower extremities.", "She had worsening dexterity of her right hand.", "She had more frequent falls.", "These symptoms had progressed to the point of requiring her to move to an assisted living facility.", "On examination, there was new pronator drift.", "There was decreased right hip flexion strength.", "There was decreased reflexes in the right upper extremity.", "Based on the patient\u2019s current and previous symptoms along with the previous imaging, we were able to arrive at a diagnosis of PTS, which had previously been missed.", "Cervical MRI was repeated and showed rostral expansion of the syrinx into the brain stem.", "With the advancement of her symptoms and growth of the syrinx into the brainstem, the patient received an urgent referral to an outside facility for neurosurgical evaluation.", "The consulting neurosurgeon at the outside facility did not believe her condition warranted hospital admission.", "The patient was not seen by the neurosurgeon for another 6 weeks.", "During that time period, the patient became progressively weaker.", "She had more frequent falls.", "She developed a hoarse voice, concerning for vocal cord paralysis.", "She developed dysphagia with several episodes of choking.", "On evaluation at the outside facility, the evaluating neurosurgeon concluded that the patient\u2019s symptom severity and rapid progression were indications for surgical drainage of the syrinx.", "The patient was taken to the operating room, and a C7-T2 laminectomy was performed.", "After removing the C7 through T2 lamina and entering the dura, the cord was noted to be quite dilated, nearly filling the entire dural tube.", "The cord was rotated 90\u00b0 within the dura.", "A 2 mm hole was made in the dorsal root entry zone of the cord below the C8 nerve root to insert the shunt.", "The syrinx cavity was encountered at a depth of <1 mm.", "The cord immediately deflated after penetration of the syrinx.", "A syringo-subarachnoid shunt was placed to allow the syrinx to continuously drain.", "The surgery and immediate postsurgical period were uncomplicated.", "She was discharged back to her previous nursing home 9 days following the operation.", "The patient was ambulating back at her baseline with a walker.", "Follow-up 2 months after surgery noted subjective persistent but not worsened right arm and leg weakness.", "She had a weakened voice.", "At this point, the patient was able to complete her ADLs independently although she had assistance at home.", "It was determined that the surgery stabilized as well as halted the progression of her neurological symptoms but did not reverse them.", "Cervical MRI 4 months after surgery showed dramatic reduction in syrinx size, with only a small residual fluid collection.", "This confirmed that the shunt was patent and functioning.", "Thoracic MRI showed possible persistent syringomyelia with slight enlargement compared to previous.", "This was significantly limited due to hardware artifact.", "The patient continues to live in a nursing home with assistance with her ADLs and frequent physical therapy.", "Patient consent and hospital approval were obtained before the writing of this report."], "index": 86, "original_id": "multiclinsum_test_2005_en.txt", "split": "test", "summary_subclaims": ["The patient is a 42-year-old female.", "She has a distant history of spinal cord injury.", "She developed clinical and imaging findings consistent with acute expansion of post-traumatic syringomyelia.", "The acute expansion occurred immediately following parathyroidectomy.", "Her symptoms included acute numbness, tingling, and pain in both arms.", "Magnetic resonance imaging revealed a syrinx in the cervical and thoracic spinal cord.", "The syrinx was initially misdiagnosed as transverse myelitis.", "She was treated for transverse myelitis without resolution of symptoms.", "Over the following 6 months, the patient experienced progressive weakness.", "Repeat MRI demonstrated expansion of the syrinx with new involvement of the brain stem.", "The patient was diagnosed with post-traumatic syringomyelia.", "She was referred for outpatient neurosurgery evaluation at a tertiary facility.", "Treatment was delayed due to problems with housing and scheduling at the outside facility.", "The syrinx was surgically drained.", "A syringo-subarachnoid shunt was placed.", "Follow-up MRI confirmed correct placement of the shunt.", "The procedure effectively halted symptom progression.", "The procedure did not resolve all symptoms completely.", "The patient has regained her ability to perform much of her activities of daily living.", "The patient remains in a nursing home facility."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 76-year-old male.", "The patient's BMI is 21.5 kg/m2.", "The patient was admitted to the General Surgery Department.", "The patient had local abdominal distension in the left lower flank.", "The patient had intermittent abdominal pain for one year.", "The patient had undergone laparoscopic rectal resection one year ago.", "Five trocars were used during the laparoscopic rectal resection.", "A 10 mm trocar was inserted at the umbilical site.", "Two 5 mm trocars were placed in the left flank.", "A 12 mm trocar and a 5 mm trocar were placed in the right flank.", "Fascia layers were closed by an absorbable suture at the \u2265 10 mm trocar site.", "A 20 FR soft rubber tube was inserted in the left lower quadrant stoma port.", "The drainage tube was removed five days postoperatively.", "The drainage liquid was \u2264 20 mL/d.", "The fascia layer at the drain site was not closed due to a tiny defect.", "The patient was discharged on the ninth day after the operation.", "The patient reported no discomfort postoperatively.", "One month later, there was abdominal bulging in the left lower flank in the standing position.", "The abdominal bulge disappeared in the supine position.", "The patient felt a gradual progression of the abdominal bulge.", "The patient had occasional dull abdominal pain over time.", "The patient had a history of chronic bronchitis.", "The patient had intermittent cough.", "The patient had a history of hypertension.", "The patient had a history of coronary heart disease.", "The patient had a history of laparoscopic cholecystectomy.", "The patient's blood pressure was well controlled.", "There were no cardiovascular system symptoms.", "There were no restrictions on the patient's daily activities.", "The patient had no remarkable personal and family history.", "A local palpable mass (3 cm in length) was found in the left lower flank above the former drain-site.", "An abdominal wall defect (2 cm in length) was found.", "Tenderness and rebound tenderness were not observed in the abdomen.", "Routine serological examinations showed no obvious abnormalities.", "A preoperative computed tomography scan confirmed the diagnosis.", "The computed tomography scan showed an abdominal wall hernia at the drainage site in the left lower quadrant.", "The hernia content consisted of the omentum majus.", "The detected abdominal wall fascial defect was 2 cm in diameter."], "summary_subclaims": ["The patient was a 76-year-old male.", "The patient was admitted with intermittent abdominal pain.", "The patient had a local abdominal mass.", "The abdominal mass occurred one month after laparoscopic radical resection of rectal cancer.", "The rectal cancer resection had occurred one year before admission.", "A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant.", "The hernia content consisted of the large omentum.", "An elective herniorrhaphy was performed.", "The fascial defect was closed during the herniorrhaphy.", "The abdominal wall was reinforced with a synthetic mesh.", "The postoperative period was uneventful.", "The patient was discharged seven days after the operation.", "There were no surgery-related complications at the 1-mo follow-up visit."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 76-year-old male.", "The patient's BMI is 21.5 kg/m2.", "The patient was admitted to the General Surgery Department.", "The patient had local abdominal distension in the left lower flank.", "The patient had intermittent abdominal pain for one year.", "The patient had undergone laparoscopic rectal resection one year ago.", "Five trocars were used during the laparoscopic rectal resection.", "A 10 mm trocar was inserted at the umbilical site.", "Two 5 mm trocars were placed in the left flank.", "A 12 mm trocar and a 5 mm trocar were placed in the right flank.", "Fascia layers were closed by an absorbable suture at the \u2265 10 mm trocar site.", "A 20 FR soft rubber tube was inserted in the left lower quadrant stoma port.", "The drainage tube was removed five days postoperatively.", "The drainage liquid was \u2264 20 mL/d.", "The fascia layer at the drain site was not closed due to a tiny defect.", "The patient was discharged on the ninth day after the operation.", "The patient reported no discomfort postoperatively.", "One month later, there was abdominal bulging in the left lower flank in the standing position.", "The abdominal bulge disappeared in the supine position.", "The patient felt a gradual progression of the abdominal bulge.", "The patient had occasional dull abdominal pain over time.", "The patient had a history of chronic bronchitis.", "The patient had intermittent cough.", "The patient had a history of hypertension.", "The patient had a history of coronary heart disease.", "The patient had a history of laparoscopic cholecystectomy.", "The patient's blood pressure was well controlled.", "There were no cardiovascular system symptoms.", "There were no restrictions on the patient's daily activities.", "The patient had no remarkable personal and family history.", "A local palpable mass (3 cm in length) was found in the left lower flank above the former drain-site.", "An abdominal wall defect (2 cm in length) was found.", "Tenderness and rebound tenderness were not observed in the abdomen.", "Routine serological examinations showed no obvious abnormalities.", "A preoperative computed tomography scan confirmed the diagnosis.", "The computed tomography scan showed an abdominal wall hernia at the drainage site in the left lower quadrant.", "The hernia content consisted of the omentum majus.", "The detected abdominal wall fascial defect was 2 cm in diameter."], "index": 71, "original_id": "multiclinsum_test_1042_en.txt", "split": "test", "summary_subclaims": ["The patient was a 76-year-old male.", "The patient was admitted with intermittent abdominal pain.", "The patient had a local abdominal mass.", "The abdominal mass occurred one month after laparoscopic radical resection of rectal cancer.", "The rectal cancer resection had occurred one year before admission.", "A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant.", "The hernia content consisted of the large omentum.", "An elective herniorrhaphy was performed.", "The fascial defect was closed during the herniorrhaphy.", "The abdominal wall was reinforced with a synthetic mesh.", "The postoperative period was uneventful.", "The patient was discharged seven days after the operation.", "There were no surgery-related complications at the 1-mo follow-up visit."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 12-year-old girl.", "She presented with non-progressive congenital flexion deformities of bilateral elbows.", "She had difficulty in writing.", "She had difficulty in typing.", "She had difficulty in jogging.", "She had difficulty in using the Indian toilet.", "She had to sit with one leg extended for balance.", "She was the firstborn child of a second-degree consanguineous marriage.", "Her mother gave a history of delayed and decreased fetal movements during pregnancy.", "Her motor milestones were delayed.", "Her social adaptive and language milestones were normal.", "She was good at academics.", "She had attained menarche at the age of 12 years.", "She has normal menstrual cycles.", "Family history was unremarkable.", "On clinical examination, she had prominence in the suprascapular region on both sides.", "She had trapezii contracture.", "She had mild-to-moderate restriction of cervical spine range of motion in rotation and lateral bending.", "She had 20\u00b0 of internal rotation deformity bilaterally.", "Abduction was restricted to 120\u00b0 at both the shoulders.", "She had 22\u00b0 of fixed flexion deformity at the left elbow.", "She had 20\u00b0 of fixed flexion deformity at the right elbow.", "Bilateral passive forearm supination was restricted to 60\u00b0.", "Bilateral passive wrist dorsiflexion was restricted to 35\u00b0.", "Clinodactyly was noticed in bilateral ring fingers.", "Her fingers were hyperextensible at the interphalangeal joints.", "There were no signs of generalized ligamentous laxity.", "She had hypoplastic left thenar eminence.", "She had MRC Grade III power of the thenar muscles.", "She had bilateral tendo Achilles contractures.", "There was no passive dorsiflexion possible from neutral.", "Plantar flexion was full.", "She had a propulsive gait.", "She had a restricted arm swing on both sides.", "Mirror movements were demonstrated in bilateral fingers.", "Mirror movements were demonstrated in bilateral elbows.", "Mirror movements were demonstrated in bilateral toes.", "Mirror movements were demonstrated in bilateral ankles.", "Mirror movements of the toes and fingers worsened with fatigue.", "Mirror movements at the elbows and ankles became less frequent as voluntary movements were continued.", "Neurological examination was otherwise normal.", "Her height for her age was normal.", "There were no craniofacial malformations.", "There was no hearing impairment.", "There were no visual defects.", "X-rays and 3-D CT scan revealed bilateral Rigault Grade II Sprengel deformities.", "X-rays and 3-D CT scan revealed mild scoliosis at the cervical spine segment.", "X-rays and 3-D CT scan revealed mild scoliosis at the cervicothoracic junction.", "X-rays and 3-D CT scan revealed mild scoliosis at the thoracolumbar junction.", "There was no fusion at any vertebral level.", "MRI revealed no central nervous system (CNS) or spinal cord malformations.", "Ultrasonography revealed no renal or genitourinary anomalies.", "ECHO showed mild aortic regurgitation.", "She started on regular joint range of motion exercises.", "She started on muscle stretching and strengthening physiotherapy.", "She started on retraining therapy with techniques for increasing wanted movements.", "She started on retraining therapy with techniques for restricting unwanted movements.", "Her frequency of mirror movements decreased.", "Her writing and typing coordination was getting better.", "She is compliant with therapy.", "She is on regular follow-up."], "summary_subclaims": ["The patient is a 12-year-old girl.", "She presented with bilateral shoulder deformities.", "She had difficulty in coordination while writing.", "On examination, she was noted to have bilateral Sprengel deformities.", "She had flexion contractures of upper-limb joints.", "She had mirror movements of both upper and lower-limb joints."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 12-year-old girl.", "She presented with non-progressive congenital flexion deformities of bilateral elbows.", "She had difficulty in writing.", "She had difficulty in typing.", "She had difficulty in jogging.", "She had difficulty in using the Indian toilet.", "She had to sit with one leg extended for balance.", "She was the firstborn child of a second-degree consanguineous marriage.", "Her mother gave a history of delayed and decreased fetal movements during pregnancy.", "Her motor milestones were delayed.", "Her social adaptive and language milestones were normal.", "She was good at academics.", "She had attained menarche at the age of 12 years.", "She has normal menstrual cycles.", "Family history was unremarkable.", "On clinical examination, she had prominence in the suprascapular region on both sides.", "She had trapezii contracture.", "She had mild-to-moderate restriction of cervical spine range of motion in rotation and lateral bending.", "She had 20\u00b0 of internal rotation deformity bilaterally.", "Abduction was restricted to 120\u00b0 at both the shoulders.", "She had 22\u00b0 of fixed flexion deformity at the left elbow.", "She had 20\u00b0 of fixed flexion deformity at the right elbow.", "Bilateral passive forearm supination was restricted to 60\u00b0.", "Bilateral passive wrist dorsiflexion was restricted to 35\u00b0.", "Clinodactyly was noticed in bilateral ring fingers.", "Her fingers were hyperextensible at the interphalangeal joints.", "There were no signs of generalized ligamentous laxity.", "She had hypoplastic left thenar eminence.", "She had MRC Grade III power of the thenar muscles.", "She had bilateral tendo Achilles contractures.", "There was no passive dorsiflexion possible from neutral.", "Plantar flexion was full.", "She had a propulsive gait.", "She had a restricted arm swing on both sides.", "Mirror movements were demonstrated in bilateral fingers.", "Mirror movements were demonstrated in bilateral elbows.", "Mirror movements were demonstrated in bilateral toes.", "Mirror movements were demonstrated in bilateral ankles.", "Mirror movements of the toes and fingers worsened with fatigue.", "Mirror movements at the elbows and ankles became less frequent as voluntary movements were continued.", "Neurological examination was otherwise normal.", "Her height for her age was normal.", "There were no craniofacial malformations.", "There was no hearing impairment.", "There were no visual defects.", "X-rays and 3-D CT scan revealed bilateral Rigault Grade II Sprengel deformities.", "X-rays and 3-D CT scan revealed mild scoliosis at the cervical spine segment.", "X-rays and 3-D CT scan revealed mild scoliosis at the cervicothoracic junction.", "X-rays and 3-D CT scan revealed mild scoliosis at the thoracolumbar junction.", "There was no fusion at any vertebral level.", "MRI revealed no central nervous system (CNS) or spinal cord malformations.", "Ultrasonography revealed no renal or genitourinary anomalies.", "ECHO showed mild aortic regurgitation.", "She started on regular joint range of motion exercises.", "She started on muscle stretching and strengthening physiotherapy.", "She started on retraining therapy with techniques for increasing wanted movements.", "She started on retraining therapy with techniques for restricting unwanted movements.", "Her frequency of mirror movements decreased.", "Her writing and typing coordination was getting better.", "She is compliant with therapy.", "She is on regular follow-up."], "index": 53, "original_id": "multiclinsum_test_990_en.txt", "split": "test", "summary_subclaims": ["The patient is a 12-year-old girl.", "She presented with bilateral shoulder deformities.", "She had difficulty in coordination while writing.", "On examination, she was noted to have bilateral Sprengel deformities.", "She had flexion contractures of upper-limb joints.", "She had mirror movements of both upper and lower-limb joints."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 38-year-old Sri Lankan female.", "She presented with sudden onset severe right side headache.", "She had vomiting at the time of presentation.", "She developed right-sided complete ptosis.", "She developed right-sided ophthalmoplegia.", "The headache and vomiting lasted for one day.", "The ptosis and ophthalmoplegia persisted.", "She did not have a history of diabetes.", "She did not have a history of hypertension.", "She did not have a history of dyslipidemia.", "She did not have a history of any connective tissue disorder.", "On examination, she had complete ptosis on the right side.", "On examination, she had ophthalmoplegia on the right side.", "On examination, she had a fixed dilated pupil (5 mm) on the right side.", "Direct and consensual light reflexes were absent on the right side.", "Vision and fundoscopic examination were normal.", "Left eye had full eye movements.", "Left eye had normal light reflexes.", "Other cranial nerves including the sensory component of the trigeminal nerve were normal.", "She did not have scalp tenderness.", "She did not have tenderness over the superficial temporal artery.", "Upper limbs were neurologically normal.", "Lower limbs were neurologically normal.", "She did not have any cerebellar signs.", "Brachial pulse was decreased on the right side compared to the left side.", "Blood pressure on the right arm was 90/60 mmHg.", "Blood pressure on the left arm was 120/80 mmHg.", "She had a bruit over the right subclavian artery.", "She had a bruit over the right carotid artery.", "The rest of the cardiovascular, respiratory, and abdominal examination was normal.", "She did not have features of Ehlers\u2013Danlos syndrome.", "She did not have features of Marfan syndrome.", "She did not have manifestations of connective tissue disorder.", "Noncontrast CT brain was done soon after admission.", "Noncontrast CT brain was normal.", "Cerebrospinal fluid analysis was performed on day 2.", "Cerebrospinal fluid analysis showed absent cells.", "Cerebrospinal fluid analysis showed normal protein level.", "Cerebrospinal fluid analysis did not reveal xanthochromia.", "CT cerebral angiogram was done on day 4.", "CT cerebral angiogram revealed generalized caliber reduction of the right ICA.", "MRI done on day 23 showed significantly narrowed right ICA.", "Dissection of the right ICA was noted in the cavernous sinus.", "The dissection had a false lumen of 1.5 \u00d7 1 cm.", "The false lumen was thrombosed.", "The thrombosed lumen was of intermediate signal intensity in T1, T2, and FLAIR images.", "The thrombosed lumen did not enhance with contrast.", "The thrombosed lumen was compressing the right cavernous sinus.", "Multiple focal T2 and FLAIR hyperintensities with partially restricted diffusion were seen in the right parietal lobe.", "These hyperintensities were suggestive of acute infarcts.", "Cerebral digital subtraction angiogram showed total occlusion of the right ICA from its origin.", "Blood supply to the right middle cerebral artery was maintained via the anterior communicating artery.", "Blood supply to the right middle cerebral artery was maintained via the posterior communicating artery.", "Aneurysmal dilation and stenosis were evident at the right proximal subclavian artery.", "CT angiogram revealed aneurysmal dilatation (20 \u00d7 11 mm) of the first part of the right subclavian artery.", "CT angiogram revealed stenosis of the first part of the right subclavian artery.", "Tapering of the distal part of the right carotid bulb at the origin of the right ICA was seen.", "This tapering was suggestive of right ICA dissection with thrombosis.", "The rest of the angiogram was normal.", "Fluorescent angiogram of the retina was normal.", "Full blood count showed neutrophil leukocytosis.", "Low hemoglobin was seen in the blood picture.", "Normochromic normocytic anemia was seen in the blood picture.", "Liver function tests revealed low albumin.", "Liver enzyme levels were normal.", "Serum creatinine was 150 \u03bcmol/L on admission.", "eGFR using MDRD was 35.8 ml/min/1.73m2 on admission.", "Serum creatinine later came down to 100 \u03bcmol/L.", "eGFR using MDRD later came down to 57.2 ml/min/1.73m2.", "Urine full report was normal.", "Ultrasound revealed kidney sizes of 8.9 cm on the right and 8.7 cm on the left.", "Ionized calcium was 1.11 mmol/L.", "Phosphorus was 1.0 mmol/L.", "ESR was persistently high at 130 mm in the first hour.", "CRP was 95 mg/L.", "CRP later came down to 7 mg/L.", "She was negative for HIV serology.", "VDRL was nonreactive.", "Mantoux test was negative.", "Chest x-ray was normal.", "ANA was negative.", "p-ANCA was negative.", "c-ANCA was negative.", "Hepatitis B and C serology were negative.", "Fasting blood sugar was within normal range.", "HbA1C was within normal range.", "Thyroid function tests were within normal range.", "Lipid profile was within normal range.", "Bilateral cervical ribs were noted in chest x-ray.", "Bilateral cervical ribs were noted in cervical x-ray.", "Takayasu arteritis was diagnosed.", "She was started on high dose prednisolone (1 mg/kg).", "Aspirin was also started.", "Neurosurgical and vascular surgical opinion was taken.", "No surgical intervention was planned.", "After 2 weeks of steroids, ESR came down to 50 mm in the first hour.", "After one month of steroids, ESR was 30 mm in the first hour.", "Ophthalmoplegia and ptosis remained the same.", "Steroids were gradually tapered.", "Azathioprine was added as a steroid-sparing agent.", "The difference between right and left brachial pulses reduced.", "The right arm blood pressure increased.", "She did not have any further vascular events.", "A follow-up angiogram was planned in six months.", "The authors followed the CARE guidelines when writing this case report."], "summary_subclaims": ["The patient is a 38-year-old Sri Lankan female.", "She had sudden onset severe headache.", "She had fixed dilated pupil on the right side.", "She had complete ptosis on the right side.", "She had ophthalmoplegia on the right side.", "Imaging showed dissection and dilatation in the right internal carotid artery.", "The dissection and dilatation extended from the origin up to the cavernous segment.", "She had stenosis and aneurysmal dilatation of the right subclavian artery.", "Takayasu arteritis was diagnosed.", "She was started on aspirin.", "She was started on high dose steroids."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 38-year-old Sri Lankan female.", "She presented with sudden onset severe right side headache.", "She had vomiting at the time of presentation.", "She developed right-sided complete ptosis.", "She developed right-sided ophthalmoplegia.", "The headache and vomiting lasted for one day.", "The ptosis and ophthalmoplegia persisted.", "She did not have a history of diabetes.", "She did not have a history of hypertension.", "She did not have a history of dyslipidemia.", "She did not have a history of any connective tissue disorder.", "On examination, she had complete ptosis on the right side.", "On examination, she had ophthalmoplegia on the right side.", "On examination, she had a fixed dilated pupil (5 mm) on the right side.", "Direct and consensual light reflexes were absent on the right side.", "Vision and fundoscopic examination were normal.", "Left eye had full eye movements.", "Left eye had normal light reflexes.", "Other cranial nerves including the sensory component of the trigeminal nerve were normal.", "She did not have scalp tenderness.", "She did not have tenderness over the superficial temporal artery.", "Upper limbs were neurologically normal.", "Lower limbs were neurologically normal.", "She did not have any cerebellar signs.", "Brachial pulse was decreased on the right side compared to the left side.", "Blood pressure on the right arm was 90/60 mmHg.", "Blood pressure on the left arm was 120/80 mmHg.", "She had a bruit over the right subclavian artery.", "She had a bruit over the right carotid artery.", "The rest of the cardiovascular, respiratory, and abdominal examination was normal.", "She did not have features of Ehlers\u2013Danlos syndrome.", "She did not have features of Marfan syndrome.", "She did not have manifestations of connective tissue disorder.", "Noncontrast CT brain was done soon after admission.", "Noncontrast CT brain was normal.", "Cerebrospinal fluid analysis was performed on day 2.", "Cerebrospinal fluid analysis showed absent cells.", "Cerebrospinal fluid analysis showed normal protein level.", "Cerebrospinal fluid analysis did not reveal xanthochromia.", "CT cerebral angiogram was done on day 4.", "CT cerebral angiogram revealed generalized caliber reduction of the right ICA.", "MRI done on day 23 showed significantly narrowed right ICA.", "Dissection of the right ICA was noted in the cavernous sinus.", "The dissection had a false lumen of 1.5 \u00d7 1 cm.", "The false lumen was thrombosed.", "The thrombosed lumen was of intermediate signal intensity in T1, T2, and FLAIR images.", "The thrombosed lumen did not enhance with contrast.", "The thrombosed lumen was compressing the right cavernous sinus.", "Multiple focal T2 and FLAIR hyperintensities with partially restricted diffusion were seen in the right parietal lobe.", "These hyperintensities were suggestive of acute infarcts.", "Cerebral digital subtraction angiogram showed total occlusion of the right ICA from its origin.", "Blood supply to the right middle cerebral artery was maintained via the anterior communicating artery.", "Blood supply to the right middle cerebral artery was maintained via the posterior communicating artery.", "Aneurysmal dilation and stenosis were evident at the right proximal subclavian artery.", "CT angiogram revealed aneurysmal dilatation (20 \u00d7 11 mm) of the first part of the right subclavian artery.", "CT angiogram revealed stenosis of the first part of the right subclavian artery.", "Tapering of the distal part of the right carotid bulb at the origin of the right ICA was seen.", "This tapering was suggestive of right ICA dissection with thrombosis.", "The rest of the angiogram was normal.", "Fluorescent angiogram of the retina was normal.", "Full blood count showed neutrophil leukocytosis.", "Low hemoglobin was seen in the blood picture.", "Normochromic normocytic anemia was seen in the blood picture.", "Liver function tests revealed low albumin.", "Liver enzyme levels were normal.", "Serum creatinine was 150 \u03bcmol/L on admission.", "eGFR using MDRD was 35.8 ml/min/1.73m2 on admission.", "Serum creatinine later came down to 100 \u03bcmol/L.", "eGFR using MDRD later came down to 57.2 ml/min/1.73m2.", "Urine full report was normal.", "Ultrasound revealed kidney sizes of 8.9 cm on the right and 8.7 cm on the left.", "Ionized calcium was 1.11 mmol/L.", "Phosphorus was 1.0 mmol/L.", "ESR was persistently high at 130 mm in the first hour.", "CRP was 95 mg/L.", "CRP later came down to 7 mg/L.", "She was negative for HIV serology.", "VDRL was nonreactive.", "Mantoux test was negative.", "Chest x-ray was normal.", "ANA was negative.", "p-ANCA was negative.", "c-ANCA was negative.", "Hepatitis B and C serology were negative.", "Fasting blood sugar was within normal range.", "HbA1C was within normal range.", "Thyroid function tests were within normal range.", "Lipid profile was within normal range.", "Bilateral cervical ribs were noted in chest x-ray.", "Bilateral cervical ribs were noted in cervical x-ray.", "Takayasu arteritis was diagnosed.", "She was started on high dose prednisolone (1 mg/kg).", "Aspirin was also started.", "Neurosurgical and vascular surgical opinion was taken.", "No surgical intervention was planned.", "After 2 weeks of steroids, ESR came down to 50 mm in the first hour.", "After one month of steroids, ESR was 30 mm in the first hour.", "Ophthalmoplegia and ptosis remained the same.", "Steroids were gradually tapered.", "Azathioprine was added as a steroid-sparing agent.", "The difference between right and left brachial pulses reduced.", "The right arm blood pressure increased.", "She did not have any further vascular events.", "A follow-up angiogram was planned in six months.", "The authors followed the CARE guidelines when writing this case report."], "index": 73, "original_id": "multiclinsum_test_2426_en.txt", "split": "test", "summary_subclaims": ["The patient is a 38-year-old Sri Lankan female.", "She had sudden onset severe headache.", "She had fixed dilated pupil on the right side.", "She had complete ptosis on the right side.", "She had ophthalmoplegia on the right side.", "Imaging showed dissection and dilatation in the right internal carotid artery.", "The dissection and dilatation extended from the origin up to the cavernous segment.", "She had stenosis and aneurysmal dilatation of the right subclavian artery.", "Takayasu arteritis was diagnosed.", "She was started on aspirin.", "She was started on high dose steroids."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A case of tuberculosis of the cervix presenting as cervical carcinoma is being reported for its rarity.", "The patient was a 26-year-old P2L2 Indian lady.", "She had pain abdomen, irregular bleeding, and discharge per vaginum for three years.", "She had a history of post-coital bleeding and inter-menstrual bleeding.", "She had significant weight loss over the last two years.", "There was no history of genitourinary malignancy or tuberculosis in the past or in the family.", "The patient was a non-smoker, non-alcoholic, and did not have any other significant medical or surgical illness in the past.", "On per speculum examination, the cervix was replaced by an irregular friable growth that was bleeding on touch.", "PAP smear showed epitheloid like cell clusters without any dysplasia.", "Biopsy taken from the cervical growth revealed granulomatous inflammation with caseous necrosis.", "Smear from cervix was found positive for acid-fast bacilli.", "Endometrial biopsy was normal with no AFB.", "Sputum and urine samples were negative for AFB and failed to culture mycobacterium.", "CECT abdomen showed a bulky cervix with evidence of soft tissue streaking in parametrium.", "HIV 1 and 2 were negative.", "The patient was started on antitubercular treatment with four drugs: isoniazid, ethambutol, rifampicin, and pyrazinamide.", "At six months, the cervix had an almost normal appearance and there was complete relief from symptoms."], "summary_subclaims": ["On per speculum examination, cervix was replaced by an irregular friable growth.", "The growth was bleeding on touch.", "A clinical diagnosis of carcinoma cervix was made.", "The cervical biopsy revealed granulomatous inflammation.", "Acid-fast bacilli were present on cervical smear.", "The findings were consistent with tuberculosis.", "The patient responded to six months of anti-tubercular therapy."]}, "extra_info": {"fulltext_subclaims": ["A case of tuberculosis of the cervix presenting as cervical carcinoma is being reported for its rarity.", "The patient was a 26-year-old P2L2 Indian lady.", "She had pain abdomen, irregular bleeding, and discharge per vaginum for three years.", "She had a history of post-coital bleeding and inter-menstrual bleeding.", "She had significant weight loss over the last two years.", "There was no history of genitourinary malignancy or tuberculosis in the past or in the family.", "The patient was a non-smoker, non-alcoholic, and did not have any other significant medical or surgical illness in the past.", "On per speculum examination, the cervix was replaced by an irregular friable growth that was bleeding on touch.", "PAP smear showed epitheloid like cell clusters without any dysplasia.", "Biopsy taken from the cervical growth revealed granulomatous inflammation with caseous necrosis.", "Smear from cervix was found positive for acid-fast bacilli.", "Endometrial biopsy was normal with no AFB.", "Sputum and urine samples were negative for AFB and failed to culture mycobacterium.", "CECT abdomen showed a bulky cervix with evidence of soft tissue streaking in parametrium.", "HIV 1 and 2 were negative.", "The patient was started on antitubercular treatment with four drugs: isoniazid, ethambutol, rifampicin, and pyrazinamide.", "At six months, the cervix had an almost normal appearance and there was complete relief from symptoms."], "index": 77, "original_id": "multiclinsum_test_216_en.txt", "split": "test", "summary_subclaims": ["On per speculum examination, cervix was replaced by an irregular friable growth.", "The growth was bleeding on touch.", "A clinical diagnosis of carcinoma cervix was made.", "The cervical biopsy revealed granulomatous inflammation.", "Acid-fast bacilli were present on cervical smear.", "The findings were consistent with tuberculosis.", "The patient responded to six months of anti-tubercular therapy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 27-year-old man.", "He had painless and progressive visual impairment of both eyes over two years.", "The patient had no other positive symptoms apart from blurred vision.", "The patient had no history of ocular diseases.", "He was diagnosed with hypocalcemia when he was young.", "He did not know the serum calcium concentration at the time of the hypocalcemia diagnosis.", "He relied on a diet of milk or calcium-containing foods and calcium tablets to supplement his calcium levels at that time.", "He did not take regular calcium supplements subsequently.", "He started to experience muscle cramps in his upper extremities approximately ten years ago.", "He did not seek help for the muscle cramps until the occurrence of epilepsy.", "Seven years ago, he underwent cerebral surgery for epileptic seizures.", "The ocular examination revealed a preoperative binocular visual acuity of 16/200.", "The best-corrected visual acuity (BCVA) was not improved.", "The intraocular pressure in the right eye was 15 mmHg.", "The intraocular pressure in the left eye was 16 mmHg.", "There was bilateral symmetrical opacity of the lens.", "The lens opacity presented as punctate opacity in the posterior subcapsular cortex.", "The lens opacity also presented as radial opacity in the peripheral cortex.", "Fundus examination showed no pathological changes.", "The serum total calcium level was 1.21 mmol/L.", "The serum ionized calcium level was 0.72 mmol/L.", "The serum phosphorus level was 1.67 mmol/L.", "The serum magnesium level was 0.62 mmol/L.", "The intact PTH level was 0 pg/mL.", "An electrocardiogram showed a prolonged QT interval.", "Anterior segment photography revealed punctuate opacity in the posterior subcapsular cortex.", "Anterior segment photography also revealed radial opacity in the peripheral cortex."], "summary_subclaims": ["The patient is a 27-year-old man.", "He had painless and progressive visual impairment of both eyes over two years.", "He was previously diagnosed with hypocalcemia.", "He did not take calcium supplements regularly.", "He had no history of anterior neck thyroid surgery.", "The serum calcium level was 1.21 mmol/L.", "The intact parathyroid hormone level was 0 pg/mL.", "Ocular examination revealed bilateral symmetrical opacity of the lens.", "The lens opacity presented as punctate opacity in the posterior subcapsular cortex.", "The lens opacity also presented as radial opacity in the peripheral cortex.", "Phacoemulsification with an intraocular lens was performed in both eyes.", "The surgeries were performed sequentially.", "Postoperatively, the patient had a satisfactory recovery.", "The patient had greatly improved visual acuity."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 27-year-old man.", "He had painless and progressive visual impairment of both eyes over two years.", "The patient had no other positive symptoms apart from blurred vision.", "The patient had no history of ocular diseases.", "He was diagnosed with hypocalcemia when he was young.", "He did not know the serum calcium concentration at the time of the hypocalcemia diagnosis.", "He relied on a diet of milk or calcium-containing foods and calcium tablets to supplement his calcium levels at that time.", "He did not take regular calcium supplements subsequently.", "He started to experience muscle cramps in his upper extremities approximately ten years ago.", "He did not seek help for the muscle cramps until the occurrence of epilepsy.", "Seven years ago, he underwent cerebral surgery for epileptic seizures.", "The ocular examination revealed a preoperative binocular visual acuity of 16/200.", "The best-corrected visual acuity (BCVA) was not improved.", "The intraocular pressure in the right eye was 15 mmHg.", "The intraocular pressure in the left eye was 16 mmHg.", "There was bilateral symmetrical opacity of the lens.", "The lens opacity presented as punctate opacity in the posterior subcapsular cortex.", "The lens opacity also presented as radial opacity in the peripheral cortex.", "Fundus examination showed no pathological changes.", "The serum total calcium level was 1.21 mmol/L.", "The serum ionized calcium level was 0.72 mmol/L.", "The serum phosphorus level was 1.67 mmol/L.", "The serum magnesium level was 0.62 mmol/L.", "The intact PTH level was 0 pg/mL.", "An electrocardiogram showed a prolonged QT interval.", "Anterior segment photography revealed punctuate opacity in the posterior subcapsular cortex.", "Anterior segment photography also revealed radial opacity in the peripheral cortex."], "index": 59, "original_id": "multiclinsum_test_1416_en.txt", "split": "test", "summary_subclaims": ["The patient is a 27-year-old man.", "He had painless and progressive visual impairment of both eyes over two years.", "He was previously diagnosed with hypocalcemia.", "He did not take calcium supplements regularly.", "He had no history of anterior neck thyroid surgery.", "The serum calcium level was 1.21 mmol/L.", "The intact parathyroid hormone level was 0 pg/mL.", "Ocular examination revealed bilateral symmetrical opacity of the lens.", "The lens opacity presented as punctate opacity in the posterior subcapsular cortex.", "The lens opacity also presented as radial opacity in the peripheral cortex.", "Phacoemulsification with an intraocular lens was performed in both eyes.", "The surgeries were performed sequentially.", "Postoperatively, the patient had a satisfactory recovery.", "The patient had greatly improved visual acuity."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 62-year-old male farmer.", "He was hospitalized for fatigue and weight loss for more than 1 mo.", "He had no fever or bone pain.", "The peripheral blood examination in a local hospital indicated severe anemia with a hemoglobin level of 54 g/L.", "The peripheral blood examination suggested a potentially malignant tumor from the blood system.", "He was admitted to Huaihe Hospital of Henan University.", "The patient had no history of exposure to industrial poisons or radioactive substances.", "The patient was not smoking or drinking alcohol.", "The family history was unremarkable.", "The patient presented an anemic face.", "The percussion of the lungs presented a little dullness.", "A few moist rales were heard at the left lung base.", "Mild concave edema was seen in both lower extremities.", "Laboratory evaluation at the Huaihe Hospital showed a hemoglobin level of 61 g/L.", "Further blood examination indicated renal dysfunction.", "Erythrocyte sedimentation rate was elevated.", "NT-PROBNP was elevated.", "Serum protein electrophoresis suggested an elevation of \u03b12-globulin and \u03b3-globulin.", "Two slight M-spikes appeared.", "A band within the \u03b3 fraction was seen.", "The other band within \u03b12 fraction was obscure.", "Serum IFE showed two monoclonal bands in the \u03bb region without corresponding heavy chain bands.", "The results corresponded to the distinct elevation of serum \u03bb FLC.", "A second serum IFE showed two monoclonal bands in antisera to \u03bb.", "A second serum IFE showed one corresponding heavy chain band in antisera to IgD.", "The diagnosis was IgD-\u03bb/\u03bb myeloma.", "BM cytomorphologic examination found 82% plasma cells, mainly immature, of the BM nucleated cells.", "Flow cytometry suggested positivity of monoclonal plasma cells at 70.12% of total nucleated red blood cells.", "The immunophenotype was CD38, cytoplasmic lambda, and CD229.", "All monoclonal plasma cells expressed CD229, CD38, and cytoplasmic lambda.", "BM cytomorphologic examination and flow cytometry supported the diagnosis of plasma cell myeloma.", "Chromosome karyotype analysis showed 46,XY;46,Y,t(X;4)(p11.2;q21).", "Gene analysis of the blood tumor mutant group was mainly normal.", "The patient was diagnosed with stage ISS III myeloma."], "summary_subclaims": ["The patient is a 62-year-old man.", "The patient was diagnosed as IgD-\u03bb/\u03bb myeloma.", "The patient was admitted with fatigue.", "The patient was admitted with weight loss.", "The physical examination suggested an anemic face.", "The physical examination found a few moist rales at the left lung base.", "The physical examination found mild concave edema in both lower extremities.", "Laboratory examinations showed elevated creatinine levels.", "Laboratory examinations showed elevated \u03b22-microglobulin.", "Laboratory examinations showed elevated lactic dehydrogenase.", "Laboratory examinations showed elevated erythrocyte sedimentation rate.", "Laboratory examinations showed decreased neutrophils.", "Laboratory examinations showed decreased granulocytes.", "Laboratory examinations showed decreased hemoglobin.", "Serum protein electrophoresis showed two inconspicuous M-spikes.", "Serum IFE indicated an over-representation of lambda light chain.", "Serum IFE yielded two monoclonal bands in \u03bb region.", "Serum IFE yielded one corresponding heavy chain band in the antisera to IgD region.", "BM histology supported the diagnosis of IgD-\u03bb/\u03bb myeloma.", "BM cytology supported the diagnosis of IgD-\u03bb/\u03bb myeloma."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 62-year-old male farmer.", "He was hospitalized for fatigue and weight loss for more than 1 mo.", "He had no fever or bone pain.", "The peripheral blood examination in a local hospital indicated severe anemia with a hemoglobin level of 54 g/L.", "The peripheral blood examination suggested a potentially malignant tumor from the blood system.", "He was admitted to Huaihe Hospital of Henan University.", "The patient had no history of exposure to industrial poisons or radioactive substances.", "The patient was not smoking or drinking alcohol.", "The family history was unremarkable.", "The patient presented an anemic face.", "The percussion of the lungs presented a little dullness.", "A few moist rales were heard at the left lung base.", "Mild concave edema was seen in both lower extremities.", "Laboratory evaluation at the Huaihe Hospital showed a hemoglobin level of 61 g/L.", "Further blood examination indicated renal dysfunction.", "Erythrocyte sedimentation rate was elevated.", "NT-PROBNP was elevated.", "Serum protein electrophoresis suggested an elevation of \u03b12-globulin and \u03b3-globulin.", "Two slight M-spikes appeared.", "A band within the \u03b3 fraction was seen.", "The other band within \u03b12 fraction was obscure.", "Serum IFE showed two monoclonal bands in the \u03bb region without corresponding heavy chain bands.", "The results corresponded to the distinct elevation of serum \u03bb FLC.", "A second serum IFE showed two monoclonal bands in antisera to \u03bb.", "A second serum IFE showed one corresponding heavy chain band in antisera to IgD.", "The diagnosis was IgD-\u03bb/\u03bb myeloma.", "BM cytomorphologic examination found 82% plasma cells, mainly immature, of the BM nucleated cells.", "Flow cytometry suggested positivity of monoclonal plasma cells at 70.12% of total nucleated red blood cells.", "The immunophenotype was CD38, cytoplasmic lambda, and CD229.", "All monoclonal plasma cells expressed CD229, CD38, and cytoplasmic lambda.", "BM cytomorphologic examination and flow cytometry supported the diagnosis of plasma cell myeloma.", "Chromosome karyotype analysis showed 46,XY;46,Y,t(X;4)(p11.2;q21).", "Gene analysis of the blood tumor mutant group was mainly normal.", "The patient was diagnosed with stage ISS III myeloma."], "index": 55, "original_id": "multiclinsum_test_710_en.txt", "split": "test", "summary_subclaims": ["The patient is a 62-year-old man.", "The patient was diagnosed as IgD-\u03bb/\u03bb myeloma.", "The patient was admitted with fatigue.", "The patient was admitted with weight loss.", "The physical examination suggested an anemic face.", "The physical examination found a few moist rales at the left lung base.", "The physical examination found mild concave edema in both lower extremities.", "Laboratory examinations showed elevated creatinine levels.", "Laboratory examinations showed elevated \u03b22-microglobulin.", "Laboratory examinations showed elevated lactic dehydrogenase.", "Laboratory examinations showed elevated erythrocyte sedimentation rate.", "Laboratory examinations showed decreased neutrophils.", "Laboratory examinations showed decreased granulocytes.", "Laboratory examinations showed decreased hemoglobin.", "Serum protein electrophoresis showed two inconspicuous M-spikes.", "Serum IFE indicated an over-representation of lambda light chain.", "Serum IFE yielded two monoclonal bands in \u03bb region.", "Serum IFE yielded one corresponding heavy chain band in the antisera to IgD region.", "BM histology supported the diagnosis of IgD-\u03bb/\u03bb myeloma.", "BM cytology supported the diagnosis of IgD-\u03bb/\u03bb myeloma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a forty year-old male.", "He was brought to the Queen Elizabeth Hospital, Kota Kinabalu, Sabah at 8.30 am.", "He was in a state of collapse.", "He was unable to give a history himself.", "He was unable to stand.", "On examination his blood pressure was unrecordable.", "Oxygen saturations were recorded as low.", "The patient had no past medical history.", "He had spent two weeks in the jungles of Borneo before leaving for an urban setting.", "Ten days after leaving the jungle he experienced the onset of fever and body aches.", "Two days later, he sought treatment at a government outpatient clinic.", "He continued to complain of fever and myalgia.", "A specific diagnosis was not made.", "He was able to work.", "He developed rashes the next day.", "He remained unwell for the next two days.", "He presented in a state of collapse.", "He had developed abdominal pain.", "Resuscitation measures were begun.", "The patient was immediately intubated.", "He was given adrenaline/atropine.", "He was given sodium bicarbonate.", "After resuscitation measures, his blood pressure was 58/44 mm Hg.", "His pulse rate was 40-50 per minute.", "He had poor peripheral perfusion.", "He had cyanosis.", "He had generalized petechiae.", "His abdomen was tense and distended.", "Resuscitation measures continued for one hour.", "Coffee grounds were observed in the nasogastric aspirate.", "The patient became asystolic after one hour.", "Cardiopulmonary resuscitation was given for a further 20 minutes.", "There was no response.", "The patient was pronounced dead two hours after admission.", "Dengue haemorrhagic shock was suspected.", "A post-mortem examination was performed approximately 24 hours later.", "The patient was not anemic.", "He was thrombocytopenic.", "He had an eosinophilia.", "He was hyponatraemic.", "He had elevated blood urea.", "He had elevated potassium.", "He had elevated lactate dehydrogenase.", "He had elevated amino transferase values.", "Serum creatinine was not available.", "A blood sample taken 24 hours post-mortem showed >10% of erythrocytes infected with predominantly pigmented parasites.", "Heavily pigmented monocytes were also present.", "Plasmodium knowlesi, as a single species infection, was confirmed by nested-PCR.", "Post-mortem dengue serology was negative.", "Dengue, respiratory syncytial virus and enterovirus were not isolated in organ samples.", "External examination showed a well-nourished adult male.", "The conjunctivae showed tinges of jaundice.", "The right eye had subconjunctival haemorrhages.", "There were multiple petechial haemorrhages on the body.", "Venepuncture sites were associated with marked bruising.", "Coffee ground material was noted in the mouth.", "The external surfaces of the cerebrum were dusky.", "The cut sections showed multiple petechial haemorrhages.", "The cerebellum also showed petechial haemorrhages externally and on multiple cut sections.", "The brain stem and upper spinal chord were grossly normal.", "Both lungs were heavy.", "The right lung weighed 720 g.", "The left lung weighed 690 g.", "The cut sections were congested and 'beefy' in appearance.", "Petechial haemorrhages were present on the endocardium.", "There were extensive subendocardial haemorrhages involving the left ventricular wall.", "The haemorrhages were most prominent at the apex of the heart.", "The liver weighed 2640 g.", "The spleen weighed 340 g.", "The cut surfaces of the spleen were soft and friable.", "The gallbladder, pancreas and kidneys were grossly normal.", "Haematoxylin and eosin stained sections from various organs were available for examination.", "Parasitized red blood cells were abundant.", "Parasite bodies were obscured by haemozoin pigment.", "Chemical removal of pigment and oil immersion (\u00d71,000) magnification revealed trophozoites that were discernibly bigger than those of P. falciparum.", "Immunohistochemistry stained sections from the brain were Plasmodium anti-aldolase positive.", "Immunohistochemistry stained sections from the brain were negative for P. falciparum-specific staining.", "Many petechial haemorrhages (up to 600 \u03bcm diameter) arising from the rupture of the small vessels of the cerebrum and cerebellum were observed.", "Sequestration of PRBC was evident within small blood vessels.", "Congested larger vessels and areas of haemorrhage showed considerable amounts of malaria pigment.", "Clumps of platelets or evidence of thrombi in vessels were not seen.", "There was no evidence of vasculitis or perivascular chronic inflammatory reaction in the brain.", "There was no evidence of perivascular or diffuse parenchymal oedema in the brain.", "Diffuse astrocytosis or microgliosis was not observed.", "There was no evidence for acute gliotic reactions about the haemorrhages.", "There was no aggregation of polymorphs in the vessels.", "There was no perivascular inflammation.", "There was no generalized encephalitis.", "There was no diffuse thrombotic microangiopathy.", "Within one haemorrhage there was probably some fibrin at the site of the vessel.", "Immunohistochemistry of sections from the brain was negative for CD54.", "Sections from the spleen showed some autolysis.", "Expansion of the red pulp and atrophy of the white pulp was noted.", "Germinal centers were not observed.", "Abundant pigment-containing macrophages and some haemophagocytosis was evident in the red pulp.", "Parasitized red cells were plentiful.", "There was no necrosis or fibrin deposition in the spleen.", "There were many PRBC's in the liver sinusoids.", "Haemozoin pigment was in Kupffer cells.", "Evidence of haemophagocytosis was present.", "The portal tracts and sinusoids had moderate chronic lymphoplasmacytic inflammation.", "The liver was non-cirrhotic.", "The liver had severe macrovesicular steatosis.", "There was no cholestasis.", "There was no regional necrosis.", "There was no thrombotic microangiopathy.", "The renal cortex showed dilated and congested blood vessels.", "Many PRBC were observed within glomerular capillaries.", "Pigment deposition was in the mesangium.", "There was no evidence of thrombotic microangiopathy.", "The tubules showed acute tubular necrosis and regeneration.", "There were a small number of eosinophilic intra-tubular casts.", "Sequestration of PRBC's was evident in the small vessels of the heart.", "Endothelial cells were prominent.", "There was no evidence of myocarditis.", "The heart muscle fibers appeared normal.", "There was focal petechial haemorrhage in the subendocardium.", "The focal petechial haemorrhage may relate to resuscitation.", "The focal petechial haemorrhage may be secondary to malaria.", "The adrenal gland appeared active.", "There was eosinophilic cytoplasm in the fasciculata layer.", "There was no evidence of PRBC sequestration.", "There was no parenchymal haemorrhage.", "Samples of lung, intestine or bone marrow were not available for histopathology examination.", "The overall picture was one of systemic malaria infection with multi-organ damage.", "There was much vascular rupture and petechial haemorrhaging in the brain."], "summary_subclaims": ["A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo.", "He presented to hospital in a state of collapse and died within two hours.", "He was hyponatraemic.", "He had elevated blood urea.", "He had elevated potassium.", "He had elevated lactate dehydrogenase.", "He had elevated amino transferase values.", "He was thrombocytopenic.", "He was eosinophilic.", "Dengue haemorrhagic shock was suspected.", "A post-mortem examination was performed.", "Investigations for dengue virus were negative.", "Blood for malaria parasites indicated hyperparasitaemia.", "Single species P. knowlesi infection was confirmed by nested-PCR.", "Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages.", "The liver and spleen were enlarged.", "The lungs had features consistent with ARDS.", "Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney.", "There was no evidence of chronic inflammatory reaction in the brain or any other organ examined.", "Brain sections were negative for intracellular adhesion molecule-1.", "The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells.", "The kidney had evidence of acute tubular necrosis.", "Endothelial cells in heart sections were prominent."]}, "extra_info": {"fulltext_subclaims": ["The patient was a forty year-old male.", "He was brought to the Queen Elizabeth Hospital, Kota Kinabalu, Sabah at 8.30 am.", "He was in a state of collapse.", "He was unable to give a history himself.", "He was unable to stand.", "On examination his blood pressure was unrecordable.", "Oxygen saturations were recorded as low.", "The patient had no past medical history.", "He had spent two weeks in the jungles of Borneo before leaving for an urban setting.", "Ten days after leaving the jungle he experienced the onset of fever and body aches.", "Two days later, he sought treatment at a government outpatient clinic.", "He continued to complain of fever and myalgia.", "A specific diagnosis was not made.", "He was able to work.", "He developed rashes the next day.", "He remained unwell for the next two days.", "He presented in a state of collapse.", "He had developed abdominal pain.", "Resuscitation measures were begun.", "The patient was immediately intubated.", "He was given adrenaline/atropine.", "He was given sodium bicarbonate.", "After resuscitation measures, his blood pressure was 58/44 mm Hg.", "His pulse rate was 40-50 per minute.", "He had poor peripheral perfusion.", "He had cyanosis.", "He had generalized petechiae.", "His abdomen was tense and distended.", "Resuscitation measures continued for one hour.", "Coffee grounds were observed in the nasogastric aspirate.", "The patient became asystolic after one hour.", "Cardiopulmonary resuscitation was given for a further 20 minutes.", "There was no response.", "The patient was pronounced dead two hours after admission.", "Dengue haemorrhagic shock was suspected.", "A post-mortem examination was performed approximately 24 hours later.", "The patient was not anemic.", "He was thrombocytopenic.", "He had an eosinophilia.", "He was hyponatraemic.", "He had elevated blood urea.", "He had elevated potassium.", "He had elevated lactate dehydrogenase.", "He had elevated amino transferase values.", "Serum creatinine was not available.", "A blood sample taken 24 hours post-mortem showed >10% of erythrocytes infected with predominantly pigmented parasites.", "Heavily pigmented monocytes were also present.", "Plasmodium knowlesi, as a single species infection, was confirmed by nested-PCR.", "Post-mortem dengue serology was negative.", "Dengue, respiratory syncytial virus and enterovirus were not isolated in organ samples.", "External examination showed a well-nourished adult male.", "The conjunctivae showed tinges of jaundice.", "The right eye had subconjunctival haemorrhages.", "There were multiple petechial haemorrhages on the body.", "Venepuncture sites were associated with marked bruising.", "Coffee ground material was noted in the mouth.", "The external surfaces of the cerebrum were dusky.", "The cut sections showed multiple petechial haemorrhages.", "The cerebellum also showed petechial haemorrhages externally and on multiple cut sections.", "The brain stem and upper spinal chord were grossly normal.", "Both lungs were heavy.", "The right lung weighed 720 g.", "The left lung weighed 690 g.", "The cut sections were congested and 'beefy' in appearance.", "Petechial haemorrhages were present on the endocardium.", "There were extensive subendocardial haemorrhages involving the left ventricular wall.", "The haemorrhages were most prominent at the apex of the heart.", "The liver weighed 2640 g.", "The spleen weighed 340 g.", "The cut surfaces of the spleen were soft and friable.", "The gallbladder, pancreas and kidneys were grossly normal.", "Haematoxylin and eosin stained sections from various organs were available for examination.", "Parasitized red blood cells were abundant.", "Parasite bodies were obscured by haemozoin pigment.", "Chemical removal of pigment and oil immersion (\u00d71,000) magnification revealed trophozoites that were discernibly bigger than those of P. falciparum.", "Immunohistochemistry stained sections from the brain were Plasmodium anti-aldolase positive.", "Immunohistochemistry stained sections from the brain were negative for P. falciparum-specific staining.", "Many petechial haemorrhages (up to 600 \u03bcm diameter) arising from the rupture of the small vessels of the cerebrum and cerebellum were observed.", "Sequestration of PRBC was evident within small blood vessels.", "Congested larger vessels and areas of haemorrhage showed considerable amounts of malaria pigment.", "Clumps of platelets or evidence of thrombi in vessels were not seen.", "There was no evidence of vasculitis or perivascular chronic inflammatory reaction in the brain.", "There was no evidence of perivascular or diffuse parenchymal oedema in the brain.", "Diffuse astrocytosis or microgliosis was not observed.", "There was no evidence for acute gliotic reactions about the haemorrhages.", "There was no aggregation of polymorphs in the vessels.", "There was no perivascular inflammation.", "There was no generalized encephalitis.", "There was no diffuse thrombotic microangiopathy.", "Within one haemorrhage there was probably some fibrin at the site of the vessel.", "Immunohistochemistry of sections from the brain was negative for CD54.", "Sections from the spleen showed some autolysis.", "Expansion of the red pulp and atrophy of the white pulp was noted.", "Germinal centers were not observed.", "Abundant pigment-containing macrophages and some haemophagocytosis was evident in the red pulp.", "Parasitized red cells were plentiful.", "There was no necrosis or fibrin deposition in the spleen.", "There were many PRBC's in the liver sinusoids.", "Haemozoin pigment was in Kupffer cells.", "Evidence of haemophagocytosis was present.", "The portal tracts and sinusoids had moderate chronic lymphoplasmacytic inflammation.", "The liver was non-cirrhotic.", "The liver had severe macrovesicular steatosis.", "There was no cholestasis.", "There was no regional necrosis.", "There was no thrombotic microangiopathy.", "The renal cortex showed dilated and congested blood vessels.", "Many PRBC were observed within glomerular capillaries.", "Pigment deposition was in the mesangium.", "There was no evidence of thrombotic microangiopathy.", "The tubules showed acute tubular necrosis and regeneration.", "There were a small number of eosinophilic intra-tubular casts.", "Sequestration of PRBC's was evident in the small vessels of the heart.", "Endothelial cells were prominent.", "There was no evidence of myocarditis.", "The heart muscle fibers appeared normal.", "There was focal petechial haemorrhage in the subendocardium.", "The focal petechial haemorrhage may relate to resuscitation.", "The focal petechial haemorrhage may be secondary to malaria.", "The adrenal gland appeared active.", "There was eosinophilic cytoplasm in the fasciculata layer.", "There was no evidence of PRBC sequestration.", "There was no parenchymal haemorrhage.", "Samples of lung, intestine or bone marrow were not available for histopathology examination.", "The overall picture was one of systemic malaria infection with multi-organ damage.", "There was much vascular rupture and petechial haemorrhaging in the brain."], "index": 79, "original_id": "multiclinsum_test_2113_en.txt", "split": "test", "summary_subclaims": ["A formerly healthy 40 year-old male became symptomatic 10 days after spending time in the jungle of North Borneo.", "He presented to hospital in a state of collapse and died within two hours.", "He was hyponatraemic.", "He had elevated blood urea.", "He had elevated potassium.", "He had elevated lactate dehydrogenase.", "He had elevated amino transferase values.", "He was thrombocytopenic.", "He was eosinophilic.", "Dengue haemorrhagic shock was suspected.", "A post-mortem examination was performed.", "Investigations for dengue virus were negative.", "Blood for malaria parasites indicated hyperparasitaemia.", "Single species P. knowlesi infection was confirmed by nested-PCR.", "Macroscopic pathology of the brain and endocardium showed multiple petechial haemorrhages.", "The liver and spleen were enlarged.", "The lungs had features consistent with ARDS.", "Microscopic pathology showed sequestration of pigmented parasitized red blood cells in the vessels of the cerebrum, cerebellum, heart and kidney.", "There was no evidence of chronic inflammatory reaction in the brain or any other organ examined.", "Brain sections were negative for intracellular adhesion molecule-1.", "The spleen and liver had abundant pigment containing macrophages and parasitized red blood cells.", "The kidney had evidence of acute tubular necrosis.", "Endothelial cells in heart sections were prominent."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 27-year-old man.", "He presented with headache and diplopia for three days.", "The headache was a dull pain.", "The headache was not accompanied by vomiting.", "The headache was not accompanied by dizziness.", "Fundoscopy showed left optic nerve atrophy.", "Fundoscopy showed right papilledema.", "The findings were consistent with Foster-Kennedy syndrome.", "Neurological examinations were otherwise normal.", "Laboratory results were unremarkable.", "A left frontal irregular space-occupying lesion was seen on MRI.", "Enhancement was shown on contrast-enhanced scan.", "The lesion appeared hyperintense on T1-weighted images.", "Hypointense signals were noted on T2-weighted images.", "The tumor was primarily located at the frontal lobe.", "Ventricular compression was noted.", "Midline shift was noted.", "Brain CTA showed compression of the anterior and middle cerebral arteries.", "Small branches from the middle and anterior cerebral arteries supplied blood to the tumor.", "Meningioma was diagnosed prior to surgery.", "Surgery was performed via the left frontotemporoparietal approach.", "The tumor was removed four days after admission.", "The tumor was located at the anterior cranial fossa.", "The tumor adhered closely to the dura of the skull base.", "Only the infiltrated dura was not removed.", "The resection was Simpson\u2019s grade II.", "Grossly, the tumor was a soft, well-circumscribed pigmented lesion with a capsule.", "The tumor proved to be meningeal melanocytoma on histopathological examination.", "Immunohistochemistry was positive for HMB-45.", "Immunohistochemistry was positive for vimentin.", "Immunohistochemistry was positive for S-100 protein.", "Immunohistochemistry was negative for EMA.", "Immunohistochemistry was negative for CK.", "Immunohistochemistry was negative for PR.", "Ki-67 was positive.", "Ki-67 was less than 1%.", "The tumor was adjudged WHO grade I.", "A detailed physical examination was performed.", "No skin melanoma was found.", "The patient denied a history of melanocytoma.", "The patient received one-time 30 Gray radiation therapy after surgery.", "The duration of radiation therapy was one day.", "No tumor relapse was seen on follow-up MRI six months after surgery.", "At follow-up two and a half years after surgery, the patient was free of symptoms.", "No tumor recurrence was shown on the CT scan."], "summary_subclaims": ["A 27-year-old man presented with headache and diplopia at our department.", "Fundoscopy showed left optic nerve atrophy.", "Fundoscopy showed right papilledema.", "The findings were consistent with Foster-Kennedy syndrome.", "Neurological exams were otherwise normal.", "A left frontal irregular space-occupying lesion was seen on magnetic resonance imaging (MRI).", "Enhancement was shown on contrast-enhanced computed tomography (CT) scan.", "CT angiography (CTA) revealed vascular compression around the lesion.", "Prior to surgery, meningioma was diagnosed.", "Gross tumor removal was performed.", "On postoperative pathohistological exam, the tumor proved to be a meningeal melanocytoma.", "The tumor was WHO grade I.", "No skin melanoma was found.", "After surgery, the patient received radiation therapy.", "No tumor was seen on follow-up MR images six months after surgery.", "The patient was well after two and a half years.", "There was no tumor recurrence on the follow-up CT."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 27-year-old man.", "He presented with headache and diplopia for three days.", "The headache was a dull pain.", "The headache was not accompanied by vomiting.", "The headache was not accompanied by dizziness.", "Fundoscopy showed left optic nerve atrophy.", "Fundoscopy showed right papilledema.", "The findings were consistent with Foster-Kennedy syndrome.", "Neurological examinations were otherwise normal.", "Laboratory results were unremarkable.", "A left frontal irregular space-occupying lesion was seen on MRI.", "Enhancement was shown on contrast-enhanced scan.", "The lesion appeared hyperintense on T1-weighted images.", "Hypointense signals were noted on T2-weighted images.", "The tumor was primarily located at the frontal lobe.", "Ventricular compression was noted.", "Midline shift was noted.", "Brain CTA showed compression of the anterior and middle cerebral arteries.", "Small branches from the middle and anterior cerebral arteries supplied blood to the tumor.", "Meningioma was diagnosed prior to surgery.", "Surgery was performed via the left frontotemporoparietal approach.", "The tumor was removed four days after admission.", "The tumor was located at the anterior cranial fossa.", "The tumor adhered closely to the dura of the skull base.", "Only the infiltrated dura was not removed.", "The resection was Simpson\u2019s grade II.", "Grossly, the tumor was a soft, well-circumscribed pigmented lesion with a capsule.", "The tumor proved to be meningeal melanocytoma on histopathological examination.", "Immunohistochemistry was positive for HMB-45.", "Immunohistochemistry was positive for vimentin.", "Immunohistochemistry was positive for S-100 protein.", "Immunohistochemistry was negative for EMA.", "Immunohistochemistry was negative for CK.", "Immunohistochemistry was negative for PR.", "Ki-67 was positive.", "Ki-67 was less than 1%.", "The tumor was adjudged WHO grade I.", "A detailed physical examination was performed.", "No skin melanoma was found.", "The patient denied a history of melanocytoma.", "The patient received one-time 30 Gray radiation therapy after surgery.", "The duration of radiation therapy was one day.", "No tumor relapse was seen on follow-up MRI six months after surgery.", "At follow-up two and a half years after surgery, the patient was free of symptoms.", "No tumor recurrence was shown on the CT scan."], "index": 85, "original_id": "multiclinsum_test_568_en.txt", "split": "test", "summary_subclaims": ["A 27-year-old man presented with headache and diplopia at our department.", "Fundoscopy showed left optic nerve atrophy.", "Fundoscopy showed right papilledema.", "The findings were consistent with Foster-Kennedy syndrome.", "Neurological exams were otherwise normal.", "A left frontal irregular space-occupying lesion was seen on magnetic resonance imaging (MRI).", "Enhancement was shown on contrast-enhanced computed tomography (CT) scan.", "CT angiography (CTA) revealed vascular compression around the lesion.", "Prior to surgery, meningioma was diagnosed.", "Gross tumor removal was performed.", "On postoperative pathohistological exam, the tumor proved to be a meningeal melanocytoma.", "The tumor was WHO grade I.", "No skin melanoma was found.", "After surgery, the patient received radiation therapy.", "No tumor was seen on follow-up MR images six months after surgery.", "The patient was well after two and a half years.", "There was no tumor recurrence on the follow-up CT."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 13-year-old young man was admitted to our hospital with non-sustained ventricular tachycardia episode.", "The non-sustained ventricular tachycardia episode was noticed during routine athletic evaluation.", "Resting ECG was normal, with sinus rhythm.", "The heart rate on resting ECG was normal.", "There were no significant alterations of the ventricular repolarization phase on resting ECG.", "QTma was 413 ms.", "QTmin was 383 ms.", "QTd was 39 ms.", "QTcd was 44 ms.", "Exercise stress test (treadmill) didn\u2019t show signs of inducible ischemia through maximal effort.", "The METS achieved during the treadmill test were 21.", "The maximal heart rate during the treadmill test was 194 beats per minute.", "The treadmill test induced asymptomatic non-sustained ventricular tachycardia.", "The non-sustained ventricular tachycardia had left bundle branch morphology.", "The non-sustained ventricular tachycardia had an inferior axis.", "The rate of the non-sustained ventricular tachycardia was 150 beats per minute.", "The non-sustained ventricular tachycardia occurred during the second minute of the recovery phase.", "Standard echocardiographic views showed a not clearly normal coronary pattern.", "The right coronary artery appeared with high take-off from the aortic wall.", "The right coronary artery ostium was not clearly identified.", "Genetic screening for catecholaminergic tachycardia was performed.", "Beta-blocking therapy with nadolol was started.", "Beta-blocking therapy with nadolol was continued until the first cardiological follow up.", "Coronary computed tomography angiography was performed.", "The scan showed anomalous origin of all three branches of coronary arteries from a single origin from the left coronary sinus.", "The right coronary artery had a malignant course, squeezed between the pulmonary trunk and the proximal ascending aorta.", "The distal part of the right coronary artery took its normal course.", "The left anterior descending artery caliber appeared to be normal.", "The circumflex artery caliber appeared to be normal.", "All the data from coronary computed tomography angiography were confirmed by cardiac magnetic resonance.", "Myocardial scintigraphy with protocol of two days steps and treadmill stress test (exercise) was performed.", "Myocardial scintigraphy showed no significant evidences of perfusion defects.", "Catheter coronary angiography was performed.", "The coronary angiography showed the rare coronary anomaly pattern.", "The exam showed a significant milking effect at the middle segment of the left anterior descending artery.", "Fractional Flow Reserve (FFR) was 0.74.", "Invasive Fractional Flow Reserve (iFFR) was 0.83.", "Intravascular ultrasound (IVUS) showed a slit like right coronary ostium.", "Intravascular ultrasound (IVUS) showed eccentric systolic compression in the proximal bridge segment of the right coronary artery.", "The depth of the bridging muscle segment was 16 mm.", "The length of the bridging muscle segment was 25 mm.", "Planned on pump surgery was discussed.", "A surgical unroofing of the right coronary artery intramural section was performed.", "Resuspension of the intercoronary commissure was performed.", "The resuspension resulted in relocation of the coronary artery into the appropriate aortic sinus.", "Surgical myotomy involving resection of the overlying muscle fibers on the middle segment of the left anterior descending artery was performed.", "The patient's postoperative course was uneventful.", "The patient stayed overnight in the intensive care unit.", "The patient left the hospital on postoperative day 7.", "No complications occurred during the first six months of follow-up."], "summary_subclaims": ["Both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently."]}, "extra_info": {"fulltext_subclaims": ["A 13-year-old young man was admitted to our hospital with non-sustained ventricular tachycardia episode.", "The non-sustained ventricular tachycardia episode was noticed during routine athletic evaluation.", "Resting ECG was normal, with sinus rhythm.", "The heart rate on resting ECG was normal.", "There were no significant alterations of the ventricular repolarization phase on resting ECG.", "QTma was 413 ms.", "QTmin was 383 ms.", "QTd was 39 ms.", "QTcd was 44 ms.", "Exercise stress test (treadmill) didn\u2019t show signs of inducible ischemia through maximal effort.", "The METS achieved during the treadmill test were 21.", "The maximal heart rate during the treadmill test was 194 beats per minute.", "The treadmill test induced asymptomatic non-sustained ventricular tachycardia.", "The non-sustained ventricular tachycardia had left bundle branch morphology.", "The non-sustained ventricular tachycardia had an inferior axis.", "The rate of the non-sustained ventricular tachycardia was 150 beats per minute.", "The non-sustained ventricular tachycardia occurred during the second minute of the recovery phase.", "Standard echocardiographic views showed a not clearly normal coronary pattern.", "The right coronary artery appeared with high take-off from the aortic wall.", "The right coronary artery ostium was not clearly identified.", "Genetic screening for catecholaminergic tachycardia was performed.", "Beta-blocking therapy with nadolol was started.", "Beta-blocking therapy with nadolol was continued until the first cardiological follow up.", "Coronary computed tomography angiography was performed.", "The scan showed anomalous origin of all three branches of coronary arteries from a single origin from the left coronary sinus.", "The right coronary artery had a malignant course, squeezed between the pulmonary trunk and the proximal ascending aorta.", "The distal part of the right coronary artery took its normal course.", "The left anterior descending artery caliber appeared to be normal.", "The circumflex artery caliber appeared to be normal.", "All the data from coronary computed tomography angiography were confirmed by cardiac magnetic resonance.", "Myocardial scintigraphy with protocol of two days steps and treadmill stress test (exercise) was performed.", "Myocardial scintigraphy showed no significant evidences of perfusion defects.", "Catheter coronary angiography was performed.", "The coronary angiography showed the rare coronary anomaly pattern.", "The exam showed a significant milking effect at the middle segment of the left anterior descending artery.", "Fractional Flow Reserve (FFR) was 0.74.", "Invasive Fractional Flow Reserve (iFFR) was 0.83.", "Intravascular ultrasound (IVUS) showed a slit like right coronary ostium.", "Intravascular ultrasound (IVUS) showed eccentric systolic compression in the proximal bridge segment of the right coronary artery.", "The depth of the bridging muscle segment was 16 mm.", "The length of the bridging muscle segment was 25 mm.", "Planned on pump surgery was discussed.", "A surgical unroofing of the right coronary artery intramural section was performed.", "Resuspension of the intercoronary commissure was performed.", "The resuspension resulted in relocation of the coronary artery into the appropriate aortic sinus.", "Surgical myotomy involving resection of the overlying muscle fibers on the middle segment of the left anterior descending artery was performed.", "The patient's postoperative course was uneventful.", "The patient stayed overnight in the intensive care unit.", "The patient left the hospital on postoperative day 7.", "No complications occurred during the first six months of follow-up."], "index": 87, "original_id": "multiclinsum_test_1721_en.txt", "split": "test", "summary_subclaims": ["Both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 49-year-old Asian woman.", "She presented with severe abdominal distension and dyspnea.", "She had a feeling of swelling abdomen.", "She had dull nature abdominal discomfort and pain.", "She had edema in both legs.", "She had dyspnea for 3 weeks before her visit.", "She visited another hospital 2 days prior to her visit.", "She was transferred to the emergency room due to a huge ovarian cystic mass.", "The CT scan showed a large amount of left pleural effusion.", "On initial vital sign assessment, she had tachycardia.", "Her hemoglobin was 8.3 g/dL.", "Her white blood cells were 21.00 \u00d7 103/\u03bcL.", "Her C-reactive protein was 25.8 mg/dL.", "Her prothrombin time was 90.4 seconds.", "Her PT international normalized ratio was prolonged.", "Her activated partial thromboplastin time was not reported.", "The coagulation tests could possibly imply disseminated intravascular coagulation.", "Physical examination showed abdominal distension.", "Physical examination showed severe tenderness in the whole abdomen.", "Chest tube insertion at the left lung was performed.", "Paracentesis was performed.", "Approximately 850 mL of pleural fluid was drained.", "Approximately 2 L of ascites was drained.", "A dynamic abdomen-pelvis CT scan showed a 30-cm-sized multiseptated cystic mass.", "The CT scan showed peritoneal thickening.", "The CT scan showed large amount of ascites.", "The findings suggested ovarian malignancy.", "The findings suggested peritoneal carcinomatosis.", "The patient's CA125 level was 674.3 U/mL.", "The patient's HE4 was 286.4 pmol/L.", "The premenopausal ROMA index was 86.67%.", "The postmenopausal ROMA index was 92.83%.", "CA19-9, CEA, and AFP were within normal range.", "Rupture of a malignant ovarian tumor was suspected.", "An emergent operation was planned.", "The initial operation identified a ruptured 30-cm-sized right ovarian multiseptated cystic mass.", "The mass showed diffuse adhesion to the retroperitoneum.", "The mass showed diffuse adhesion to the abdominal wall.", "The mass showed diffuse adhesion to the uterus.", "Frozen section biopsy revealed poorly differentiated carcinoma.", "Debulking surgery including hysterectomy could not be performed.", "Bilateral salpingo-oophorectomy was performed.", "Partial omentectomy was performed.", "The pathologic diagnosis was high-grade stromal sarcoma.", "The tumor showed features of brisk mitosis.", "The tumor showed focal necrosis.", "The tumor had an adenofibromatous component.", "The tumor had endometriosis with mucinous metaplasia.", "The tumor had hypercellular stroma.", "The tumor consisted of monotonous uniform cells with endometrial stromal differentiation.", "Mitotic figures were frequent.", "Highly atypical neoplastic cells were noted.", "Metastasis to the omentum was identified.", "Tumor cells were positive for CD10.", "Tumor cells were positive for Cyclin D1.", "Tumor cells were positive for FOXL2.", "Tumor cells were focally positive for desmin.", "Tumor cells were focally positive for smooth muscle actin.", "Tumor cells were negative for beta-catenin.", "Tumor cells were negative for inhibin A.", "Endometrial biopsy was performed.", "The endometrial biopsy result was nonspecific.", "The patient underwent three courses of Adriamycin chemotherapy.", "A follow-up CT scan showed new 11-mm-sized probable seeding nodules in the right omentum.", "A follow-up CT scan showed new 11-mm-sized probable seeding nodules in the left paracolic gutter.", "A 1.5-cm-sized partly solid nodule was identified in the right upper lung field.", "The lung lesion was considered both primary and metastatic.", "A secondary debulking operation was planned.", "The secondary debulking operation included total hysterectomy.", "The secondary debulking operation included metastasectomy.", "The secondary debulking operation included omentectomy.", "The secondary debulking operation included peritonectomy.", "The secondary debulking operation included appendectomy.", "HIPEC with paclitaxel 175 mg/m2 was performed.", "The final pathologic report confirmed no specific findings in the uterine cervix, myometrium, and endometrium.", "The peritoneum, omentum, and appendix were confirmed as metastatic high-grade endometrial stromal sarcoma.", "A right upper lung lobectomy was performed.", "The lung biopsy was revealed as adenocarcinoma.", "The patient has double primary malignancy.", "The patient is currently alive 28 months after diagnosis.", "The patient is under a new chemotherapy regimen: paclitaxel 175 mg/m2 and ifosfamide 1.6 g/m2."], "summary_subclaims": ["The patient is a 49-year-old Asian woman.", "She presented with disseminated intravascular coagulation.", "The cause of disseminated intravascular coagulation was ruptured primary high-grade ovarian endometrial stromal sarcoma.", "The sarcoma had multiple intraperitoneal metastases.", "The patient underwent adjuvant chemotherapy with three courses of Adriamycin.", "The Adriamycin dose was 75 mg/m2.", "The secondary debulking operation included total hysterectomy.", "The secondary debulking operation included metastasectomy.", "The secondary debulking operation included omentectomy.", "The secondary debulking operation included peritonectomy.", "The secondary debulking operation included appendectomy.", "The secondary debulking operation included hyperthermic intraperitoneal chemotherapy.", "The hyperthermic intraperitoneal chemotherapy used paclitaxel 175 mg/m2.", "The patient has been alive for 28 months.", "The patient is under a new chemotherapy regimen."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 49-year-old Asian woman.", "She presented with severe abdominal distension and dyspnea.", "She had a feeling of swelling abdomen.", "She had dull nature abdominal discomfort and pain.", "She had edema in both legs.", "She had dyspnea for 3 weeks before her visit.", "She visited another hospital 2 days prior to her visit.", "She was transferred to the emergency room due to a huge ovarian cystic mass.", "The CT scan showed a large amount of left pleural effusion.", "On initial vital sign assessment, she had tachycardia.", "Her hemoglobin was 8.3 g/dL.", "Her white blood cells were 21.00 \u00d7 103/\u03bcL.", "Her C-reactive protein was 25.8 mg/dL.", "Her prothrombin time was 90.4 seconds.", "Her PT international normalized ratio was prolonged.", "Her activated partial thromboplastin time was not reported.", "The coagulation tests could possibly imply disseminated intravascular coagulation.", "Physical examination showed abdominal distension.", "Physical examination showed severe tenderness in the whole abdomen.", "Chest tube insertion at the left lung was performed.", "Paracentesis was performed.", "Approximately 850 mL of pleural fluid was drained.", "Approximately 2 L of ascites was drained.", "A dynamic abdomen-pelvis CT scan showed a 30-cm-sized multiseptated cystic mass.", "The CT scan showed peritoneal thickening.", "The CT scan showed large amount of ascites.", "The findings suggested ovarian malignancy.", "The findings suggested peritoneal carcinomatosis.", "The patient's CA125 level was 674.3 U/mL.", "The patient's HE4 was 286.4 pmol/L.", "The premenopausal ROMA index was 86.67%.", "The postmenopausal ROMA index was 92.83%.", "CA19-9, CEA, and AFP were within normal range.", "Rupture of a malignant ovarian tumor was suspected.", "An emergent operation was planned.", "The initial operation identified a ruptured 30-cm-sized right ovarian multiseptated cystic mass.", "The mass showed diffuse adhesion to the retroperitoneum.", "The mass showed diffuse adhesion to the abdominal wall.", "The mass showed diffuse adhesion to the uterus.", "Frozen section biopsy revealed poorly differentiated carcinoma.", "Debulking surgery including hysterectomy could not be performed.", "Bilateral salpingo-oophorectomy was performed.", "Partial omentectomy was performed.", "The pathologic diagnosis was high-grade stromal sarcoma.", "The tumor showed features of brisk mitosis.", "The tumor showed focal necrosis.", "The tumor had an adenofibromatous component.", "The tumor had endometriosis with mucinous metaplasia.", "The tumor had hypercellular stroma.", "The tumor consisted of monotonous uniform cells with endometrial stromal differentiation.", "Mitotic figures were frequent.", "Highly atypical neoplastic cells were noted.", "Metastasis to the omentum was identified.", "Tumor cells were positive for CD10.", "Tumor cells were positive for Cyclin D1.", "Tumor cells were positive for FOXL2.", "Tumor cells were focally positive for desmin.", "Tumor cells were focally positive for smooth muscle actin.", "Tumor cells were negative for beta-catenin.", "Tumor cells were negative for inhibin A.", "Endometrial biopsy was performed.", "The endometrial biopsy result was nonspecific.", "The patient underwent three courses of Adriamycin chemotherapy.", "A follow-up CT scan showed new 11-mm-sized probable seeding nodules in the right omentum.", "A follow-up CT scan showed new 11-mm-sized probable seeding nodules in the left paracolic gutter.", "A 1.5-cm-sized partly solid nodule was identified in the right upper lung field.", "The lung lesion was considered both primary and metastatic.", "A secondary debulking operation was planned.", "The secondary debulking operation included total hysterectomy.", "The secondary debulking operation included metastasectomy.", "The secondary debulking operation included omentectomy.", "The secondary debulking operation included peritonectomy.", "The secondary debulking operation included appendectomy.", "HIPEC with paclitaxel 175 mg/m2 was performed.", "The final pathologic report confirmed no specific findings in the uterine cervix, myometrium, and endometrium.", "The peritoneum, omentum, and appendix were confirmed as metastatic high-grade endometrial stromal sarcoma.", "A right upper lung lobectomy was performed.", "The lung biopsy was revealed as adenocarcinoma.", "The patient has double primary malignancy.", "The patient is currently alive 28 months after diagnosis.", "The patient is under a new chemotherapy regimen: paclitaxel 175 mg/m2 and ifosfamide 1.6 g/m2."], "index": 49, "original_id": "multiclinsum_test_2683_en.txt", "split": "test", "summary_subclaims": ["The patient is a 49-year-old Asian woman.", "She presented with disseminated intravascular coagulation.", "The cause of disseminated intravascular coagulation was ruptured primary high-grade ovarian endometrial stromal sarcoma.", "The sarcoma had multiple intraperitoneal metastases.", "The patient underwent adjuvant chemotherapy with three courses of Adriamycin.", "The Adriamycin dose was 75 mg/m2.", "The secondary debulking operation included total hysterectomy.", "The secondary debulking operation included metastasectomy.", "The secondary debulking operation included omentectomy.", "The secondary debulking operation included peritonectomy.", "The secondary debulking operation included appendectomy.", "The secondary debulking operation included hyperthermic intraperitoneal chemotherapy.", "The hyperthermic intraperitoneal chemotherapy used paclitaxel 175 mg/m2.", "The patient has been alive for 28 months.", "The patient is under a new chemotherapy regimen."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was referred for percutaneous LAAO.", "Past medical history was significant for mitral regurgitation.", "Past medical history was significant for tricuspid regurgitation.", "Past medical history was significant for persistent atrial fibrillation.", "Persistent atrial fibrillation was complicated by recurrent significant gastrointestinal haemorrhage on anticoagulation.", "The gastrointestinal haemorrhage was secondary to diverticulosis.", "Five months prior to referral, she underwent surgical mitral and tricuspid valve repair.", "Five months prior to referral, she underwent LAA ligation with 35\u2005mm AtriClip.", "The LAA ligation was due to elevated stroke risk (CHA2DS2-VASc score 5).", "The patient had intolerance to oral anticoagulation.", "Initial pre-procedural clinical examination revealed a haemodynamically stable, well-appearing female.", "Initial pre-procedural clinical examination revealed a regular heart rate.", "Initial pre-procedural clinical examination revealed an irregular rhythm.", "Pre-operative laboratory assessment revealed normal kidney function (serum creatinine 0.81\u2005mg/dL).", "Pre-operative laboratory assessment revealed mild anaemia (haemoglobin 10.8\u2005g/dL).", "Intra-operative transoesophageal echocardiogram demonstrated closure of the LAA.", "40-day post-operative TEE demonstrated a significant persistent communication between the left atrium and LAA.", "40-day post-operative cardiac CT imaging demonstrated a significant persistent communication between the left atrium and LAA.", "There was no evidence of LAA thrombus.", "A 27\u2005mm LAAO device (WATCHMAN\u2122) was selected.", "The LAAO device was deployed with all the P.A.S.S. criteria satisfied.", "Only 1.4\u2005mm PDL was present.", "She continued on apixaban 5\u2005mg twice daily post-operatively.", "She continued on aspirin 81\u2005mg daily post-operatively.", "Follow-up TEE at 6 weeks demonstrated a trivial PDL measuring 1.9\u2005mm along posterior aspect.", "There was no thrombus seen at 6 weeks.", "The decision was made to continue aspirin 81\u2005mg daily.", "The decision was made to continue clopidogrel 75\u2005mg daily.", "The decision was made to discontinue apixaban.", "The patient has not experienced any further episodes of major bleeding.", "We are tentatively planning to stop clopidogrel at 6 months post-operatively.", "We are tentatively planning to continue aspirin 81\u2005mg daily indefinitely thereafter."], "summary_subclaims": ["The patient was a 79-year-old female.", "The patient underwent LAAO device deployment within a surgically occluded LAA with PDL.", "A 27\u2005mm LAAO device (WATCHMANTM) was deployed.", "All the P.A.S.S. criteria were satisfied.", "Only 1.4\u2005mm PDL was present.", "The patient was continued on apixaban and aspirin post-operatively.", "A post-operative transoesophageal echocardiogram was performed at 6 weeks.", "The 6-week transoesophageal echocardiogram demonstrated trivial PDL measuring 1.49\u2005mm.", "The patient was continued on aspirin and clopidogrel.", "Apixaban was discontinued."]}, "extra_info": {"fulltext_subclaims": ["The patient was referred for percutaneous LAAO.", "Past medical history was significant for mitral regurgitation.", "Past medical history was significant for tricuspid regurgitation.", "Past medical history was significant for persistent atrial fibrillation.", "Persistent atrial fibrillation was complicated by recurrent significant gastrointestinal haemorrhage on anticoagulation.", "The gastrointestinal haemorrhage was secondary to diverticulosis.", "Five months prior to referral, she underwent surgical mitral and tricuspid valve repair.", "Five months prior to referral, she underwent LAA ligation with 35\u2005mm AtriClip.", "The LAA ligation was due to elevated stroke risk (CHA2DS2-VASc score 5).", "The patient had intolerance to oral anticoagulation.", "Initial pre-procedural clinical examination revealed a haemodynamically stable, well-appearing female.", "Initial pre-procedural clinical examination revealed a regular heart rate.", "Initial pre-procedural clinical examination revealed an irregular rhythm.", "Pre-operative laboratory assessment revealed normal kidney function (serum creatinine 0.81\u2005mg/dL).", "Pre-operative laboratory assessment revealed mild anaemia (haemoglobin 10.8\u2005g/dL).", "Intra-operative transoesophageal echocardiogram demonstrated closure of the LAA.", "40-day post-operative TEE demonstrated a significant persistent communication between the left atrium and LAA.", "40-day post-operative cardiac CT imaging demonstrated a significant persistent communication between the left atrium and LAA.", "There was no evidence of LAA thrombus.", "A 27\u2005mm LAAO device (WATCHMAN\u2122) was selected.", "The LAAO device was deployed with all the P.A.S.S. criteria satisfied.", "Only 1.4\u2005mm PDL was present.", "She continued on apixaban 5\u2005mg twice daily post-operatively.", "She continued on aspirin 81\u2005mg daily post-operatively.", "Follow-up TEE at 6 weeks demonstrated a trivial PDL measuring 1.9\u2005mm along posterior aspect.", "There was no thrombus seen at 6 weeks.", "The decision was made to continue aspirin 81\u2005mg daily.", "The decision was made to continue clopidogrel 75\u2005mg daily.", "The decision was made to discontinue apixaban.", "The patient has not experienced any further episodes of major bleeding.", "We are tentatively planning to stop clopidogrel at 6 months post-operatively.", "We are tentatively planning to continue aspirin 81\u2005mg daily indefinitely thereafter."], "index": 47, "original_id": "multiclinsum_test_1868_en.txt", "split": "test", "summary_subclaims": ["The patient was a 79-year-old female.", "The patient underwent LAAO device deployment within a surgically occluded LAA with PDL.", "A 27\u2005mm LAAO device (WATCHMANTM) was deployed.", "All the P.A.S.S. criteria were satisfied.", "Only 1.4\u2005mm PDL was present.", "The patient was continued on apixaban and aspirin post-operatively.", "A post-operative transoesophageal echocardiogram was performed at 6 weeks.", "The 6-week transoesophageal echocardiogram demonstrated trivial PDL measuring 1.49\u2005mm.", "The patient was continued on aspirin and clopidogrel.", "Apixaban was discontinued."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 79 year old male.", "The patient has a history of atrial fibrillation.", "The patient was previously on apixaban and was switched to aspirin only.", "The patient has type II diabetes mellitus.", "The patient has asthma, well controlled on home inhalers.", "The patient has hypertension.", "The patient tested positive for coronavirus disease 2019 (COVID-19) on April 7th, 2021.", "The patient is fully vaccinated with Moderna.", "The patient presented to the emergency department with progressive worsening of bilateral lower extremity edema and dyspnea over one month.", "The patient had a chronic two-pillow orthopnea.", "The patient performed all activities of daily living independently at baseline.", "This work has been reported in accordance with SCARE.", "At presentation, the patient denied chest pain.", "At presentation, the patient denied fever.", "At presentation, the patient denied nausea.", "At presentation, the patient denied vomiting.", "At presentation, the patient denied diarrhea.", "At presentation, the patient denied dysuria.", "At presentation, the patient denied travel.", "At presentation, the patient denied trauma.", "At presentation, the patient denied drug use.", "At presentation, the patient denied cough.", "Vital signs were all within normal limits on admission.", "Physical exam was notable for bibasilar crackles in the lungs.", "Physical exam was notable for bilateral lower extremity 2+ pitting edema.", "Physical exam was notable for jugular venous distention up to 9 cm.", "Labs were notable for a pro B-type natriuretic peptide of 8458 pg/mL.", "The pro B-type natriuretic peptide reference range is 1\u2013450 pg/mL.", "The pro B-type natriuretic peptide was a significant increase from 3301 pg/mL during a previous admission.", "The D-dimer was unremarkable.", "A chest radiograph obtained during admission showed bilateral ground glass opacities from prior COVID-19.", "A chest radiograph obtained during admission showed pulmonary congestion.", "A chest radiograph obtained during admission showed interposition of the right hepatic flexure of the colon between subdiaphragmatic space and the right dome of the liver (Chilaiditi's sign).", "The comparison was made from a prior chest radiograph that showed normal anatomy of the right subdiaphragmatic space.", "Electrocardiogram demonstrated atrial fibrillation with low voltage.", "Electrocardiogram showed no acute ischemic features.", "Echocardiogram showed an ejection fraction of 40%.", "The ejection fraction was reduced from 70% only a year ago.", "Echocardiogram showed normal right ventricular (RV) size.", "Echocardiogram showed reduced RV contractility.", "Echocardiogram showed a dilated right atrium.", "The patient did not have any prior COVID-19 complications.", "The patient did not have intubation.", "The patient did not have development of pulmonary embolism.", "The patient did not require supplemental oxygen.", "A negative D-dimer and CT chest without contrast showed no evidence of embolism.", "Acute pulmonary embolism was effectively ruled out.", "The patient was admitted for congestive heart failure exacerbation.", "The patient was started on furosemide 40 mg IV twice a day.", "The patient had a net negative urine output of 6.8 L over 48 hours since admission.", "Home medications were resumed, including Losartan 25 mg daily.", "Home medications were resumed, including carvedilol 3.125 mg twice daily.", "Home medications were resumed, including atorvastatin 40 mg.", "Home medications were resumed, including aspirin 81mg.", "Home medications were resumed, including albuterol inhaler as needed every 6 hours.", "Home medications were resumed, including montelukast 10 mg daily.", "The patient was diuresed for 3 days.", "The patient successfully achieved euvolemic status.", "The patient had resolution of bilateral leg edema.", "The patient had improvement of jugular venous distention.", "Cardiology was consulted for a new reduction in ejection fraction to rule out acute coronary syndrome.", "An electrocardiogram showed no ischemic features.", "Troponin was negative on three separate assessments.", "It was concluded that the patient did not have acute coronary syndrome.", "The patient received coronary angiography.", "Coronary angiography found non-obstructive coronary artery disease.", "The patient continued to have persistent dyspnea.", "The patient had some mild pleuritic chest pain on the right subcostal region.", "The patient did not need supplemental oxygen.", "The aforementioned medications were continued for a total of 5 days.", "Community or hospital acquired pneumonia was ruled out.", "Normal cultures were obtained.", "There was an absence of inflammatory response.", "There were no fevers.", "Procalcitonin was normal.", "There were no imaging findings concerning pneumonia.", "A computed tomography scan of the chest without contrast was repeated.", "The CT scan showed colonic interposition between the diaphragm and right lobe of the liver.", "Surgery was consulted for potential Chilaiditi syndrome.", "The patient refused to undergo any surgery.", "The patient preferred to be discharged from the hospital.", "The patient was discharged with guidelines for long-term medical treatment for heart failure.", "The patient was discharged with Lasix 40mg by mouth twice daily.", "The patient was discharged with carvedilol 3.125 mg twice daily.", "The patient was discharged with Losartan 25mg daily.", "The patient was discharged with aspirin 81mg.", "The patient was discharged with albuterol inhaler as needed.", "The patient was discharged with montelukast 10mg daily."], "summary_subclaims": ["The patient is a 79 year old male.", "The patient has a past medical history of asthma.", "The patient has a past medical history of heart failure with preserved ejection fraction.", "The patient was admitted for acute heart failure exacerbation with reduced ejection fraction.", "A new incidental finding of Chilaiditi's sign was noted on chest radiograph.", "The patient received optimal diuretics.", "The patient received guideline-directed medical treatment for heart failure exacerbation.", "Mild dyspnea with pleuritic chest pain persisted.", "Dyspnea with pleurisy was likely attributed to a structural anatomical defect.", "Chilaiditi's sign can be picked up on imaging."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 79 year old male.", "The patient has a history of atrial fibrillation.", "The patient was previously on apixaban and was switched to aspirin only.", "The patient has type II diabetes mellitus.", "The patient has asthma, well controlled on home inhalers.", "The patient has hypertension.", "The patient tested positive for coronavirus disease 2019 (COVID-19) on April 7th, 2021.", "The patient is fully vaccinated with Moderna.", "The patient presented to the emergency department with progressive worsening of bilateral lower extremity edema and dyspnea over one month.", "The patient had a chronic two-pillow orthopnea.", "The patient performed all activities of daily living independently at baseline.", "This work has been reported in accordance with SCARE.", "At presentation, the patient denied chest pain.", "At presentation, the patient denied fever.", "At presentation, the patient denied nausea.", "At presentation, the patient denied vomiting.", "At presentation, the patient denied diarrhea.", "At presentation, the patient denied dysuria.", "At presentation, the patient denied travel.", "At presentation, the patient denied trauma.", "At presentation, the patient denied drug use.", "At presentation, the patient denied cough.", "Vital signs were all within normal limits on admission.", "Physical exam was notable for bibasilar crackles in the lungs.", "Physical exam was notable for bilateral lower extremity 2+ pitting edema.", "Physical exam was notable for jugular venous distention up to 9 cm.", "Labs were notable for a pro B-type natriuretic peptide of 8458 pg/mL.", "The pro B-type natriuretic peptide reference range is 1\u2013450 pg/mL.", "The pro B-type natriuretic peptide was a significant increase from 3301 pg/mL during a previous admission.", "The D-dimer was unremarkable.", "A chest radiograph obtained during admission showed bilateral ground glass opacities from prior COVID-19.", "A chest radiograph obtained during admission showed pulmonary congestion.", "A chest radiograph obtained during admission showed interposition of the right hepatic flexure of the colon between subdiaphragmatic space and the right dome of the liver (Chilaiditi's sign).", "The comparison was made from a prior chest radiograph that showed normal anatomy of the right subdiaphragmatic space.", "Electrocardiogram demonstrated atrial fibrillation with low voltage.", "Electrocardiogram showed no acute ischemic features.", "Echocardiogram showed an ejection fraction of 40%.", "The ejection fraction was reduced from 70% only a year ago.", "Echocardiogram showed normal right ventricular (RV) size.", "Echocardiogram showed reduced RV contractility.", "Echocardiogram showed a dilated right atrium.", "The patient did not have any prior COVID-19 complications.", "The patient did not have intubation.", "The patient did not have development of pulmonary embolism.", "The patient did not require supplemental oxygen.", "A negative D-dimer and CT chest without contrast showed no evidence of embolism.", "Acute pulmonary embolism was effectively ruled out.", "The patient was admitted for congestive heart failure exacerbation.", "The patient was started on furosemide 40 mg IV twice a day.", "The patient had a net negative urine output of 6.8 L over 48 hours since admission.", "Home medications were resumed, including Losartan 25 mg daily.", "Home medications were resumed, including carvedilol 3.125 mg twice daily.", "Home medications were resumed, including atorvastatin 40 mg.", "Home medications were resumed, including aspirin 81mg.", "Home medications were resumed, including albuterol inhaler as needed every 6 hours.", "Home medications were resumed, including montelukast 10 mg daily.", "The patient was diuresed for 3 days.", "The patient successfully achieved euvolemic status.", "The patient had resolution of bilateral leg edema.", "The patient had improvement of jugular venous distention.", "Cardiology was consulted for a new reduction in ejection fraction to rule out acute coronary syndrome.", "An electrocardiogram showed no ischemic features.", "Troponin was negative on three separate assessments.", "It was concluded that the patient did not have acute coronary syndrome.", "The patient received coronary angiography.", "Coronary angiography found non-obstructive coronary artery disease.", "The patient continued to have persistent dyspnea.", "The patient had some mild pleuritic chest pain on the right subcostal region.", "The patient did not need supplemental oxygen.", "The aforementioned medications were continued for a total of 5 days.", "Community or hospital acquired pneumonia was ruled out.", "Normal cultures were obtained.", "There was an absence of inflammatory response.", "There were no fevers.", "Procalcitonin was normal.", "There were no imaging findings concerning pneumonia.", "A computed tomography scan of the chest without contrast was repeated.", "The CT scan showed colonic interposition between the diaphragm and right lobe of the liver.", "Surgery was consulted for potential Chilaiditi syndrome.", "The patient refused to undergo any surgery.", "The patient preferred to be discharged from the hospital.", "The patient was discharged with guidelines for long-term medical treatment for heart failure.", "The patient was discharged with Lasix 40mg by mouth twice daily.", "The patient was discharged with carvedilol 3.125 mg twice daily.", "The patient was discharged with Losartan 25mg daily.", "The patient was discharged with aspirin 81mg.", "The patient was discharged with albuterol inhaler as needed.", "The patient was discharged with montelukast 10mg daily."], "index": 67, "original_id": "multiclinsum_test_1780_en.txt", "split": "test", "summary_subclaims": ["The patient is a 79 year old male.", "The patient has a past medical history of asthma.", "The patient has a past medical history of heart failure with preserved ejection fraction.", "The patient was admitted for acute heart failure exacerbation with reduced ejection fraction.", "A new incidental finding of Chilaiditi's sign was noted on chest radiograph.", "The patient received optimal diuretics.", "The patient received guideline-directed medical treatment for heart failure exacerbation.", "Mild dyspnea with pleuritic chest pain persisted.", "Dyspnea with pleurisy was likely attributed to a structural anatomical defect.", "Chilaiditi's sign can be picked up on imaging."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 71-year-old man.", "The patient has severe COPD.", "The patient has rapidly progressing dyspnea.", "The patient has low exercise tolerance.", "The patient has hypoxemia.", "The patient was diagnosed with COPD in 2010.", "Over the last 5 years, the patient experienced a gradual progression of dyspnea.", "The dyspnea limited the patient's performance of everyday activities.", "In 2019, the patient underwent Bentall\u2019s heart surgery with resection of the left atrial appendage.", "The patient did not claim any diseases of affluence.", "The patient has a 30 pack-year history.", "The patient has not smoked since 2008.", "The patient works as a managing director.", "The patient denies any risk factors for lung disease from his occupation.", "The patient\u2019s father contracted tuberculosis after the Second World War.", "The patient\u2019s father died of lung cancer.", "The patient\u2019s brother has diabetes mellitus.", "The patient was afebrile.", "The patient had alveolar respiration.", "The patient had sinus rhythm.", "The patient\u2019s lower limbs were without swelling.", "Alpha1-antitrypsin levels were normal.", "Arterial blood gas examination showed an oxygen partial pressure pO2 = 7.67 kPa.", "Arterial blood gas examination showed a carbon dioxide partial pressure pCO2 = 4.56 kPa.", "Arterial blood gas examination showed a pH = 7.46.", "Arterial blood gas examination showed blood saturation SpO2 = 90%.", "Computed tomography results demonstrated centrilobular emphysema bilaterally.", "The centrilobular emphysema reflects a severe obstructive ventilation disorder.", "The patient underwent spirometry and body plethysmography examinations.", "Forced expiratory volume in 1 s was 1.07 L.", "Forced vital capacity was 1.94 L.", "Inspiratory capacity was 1.57 L.", "Total lung capacity (TLC) was 5.51 L.", "Peak expiratory flow was 3.38 L.", "Inspiratory muscle performance was examined with the PrO2 device.", "Maximal inspiratory pressure (MIP) was 57 cmH2O.", "Sustained maximal inspiratory pressure (SMIP) was 404 PTU.", "Inspiratory duration (ID) was 7.7s.", "Fatigue index test (FIT) was 12.1.", "The COPD Assessment Test score was 15.", "The modified Medical Research Council Breathlessness score was 3.", "The six-minute walk test (6-MWT) was used to assess exercise tolerance.", "The distance walked during the 6-MWT was 270 m.", "Oxygen saturation decreased from 95% at baseline to 75% during the 6-MWT.", "The BODE index was used as a predictor of prognosis.", "The initial BODE index score was 5.", "The Charlson Comorbidity Index calculated the 10-year mortality risk to be 53%."], "summary_subclaims": ["The patient was a 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3.", "The patient underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.", "Spirometry was performed as part of the initial and final examination.", "Body plethysmography was performed as part of the initial and final examination.", "The test of incremental respiratory endurance examination was performed as part of the initial and final examination.", "The 6-min walking test was performed as part of the initial and final examination.", "Body mass index was measured as part of the initial and final examination.", "Airflow obstruction was assessed as part of the initial and final examination.", "Dyspnea was assessed as part of the initial and final examination.", "Exercise capacity index was measured as part of the initial and final examination.", "Subjective perception of dyspnea was assessed as part of the initial and final examination.", "The patient performed training at home.", "The physiotherapist monitored the patient remotely through a web application.", "The web application allowed the physiotherapist to evaluate all training parameters in real-time.", "The web application allowed the physiotherapist to respond to any problems.", "After 8 wk of home training, there was a significant increase in maximal inspiratory pressure.", "After 8 wk of home training, there was a significant increase in a novel parameter sustained maximal inspiratory pressure.", "After 8 wk of home training, there was a significant increase in forced expiratory volume in 1 s.", "After 8 wk of home training, there was a significant increase in total lung capacity.", "After 8 wk of home training, there was a significant increase in forced vital capacity.", "After 8 wk of home training, there was a significant increase in peak expiratory flow.", "After 8 wk of home training, there was a significant increase in inspiratory capacity.", "There was an improvement in the perception of dyspnea according to the COPD Assessment Test.", "There was an improvement in the perception of dyspnea according to the modified Medical Research Council Breathlessness Scale.", "There was an increase in exercise tolerance according to the 6-min walking test.", "There was a decrease in the exercise capacity index as a predictor of prognosis."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 71-year-old man.", "The patient has severe COPD.", "The patient has rapidly progressing dyspnea.", "The patient has low exercise tolerance.", "The patient has hypoxemia.", "The patient was diagnosed with COPD in 2010.", "Over the last 5 years, the patient experienced a gradual progression of dyspnea.", "The dyspnea limited the patient's performance of everyday activities.", "In 2019, the patient underwent Bentall\u2019s heart surgery with resection of the left atrial appendage.", "The patient did not claim any diseases of affluence.", "The patient has a 30 pack-year history.", "The patient has not smoked since 2008.", "The patient works as a managing director.", "The patient denies any risk factors for lung disease from his occupation.", "The patient\u2019s father contracted tuberculosis after the Second World War.", "The patient\u2019s father died of lung cancer.", "The patient\u2019s brother has diabetes mellitus.", "The patient was afebrile.", "The patient had alveolar respiration.", "The patient had sinus rhythm.", "The patient\u2019s lower limbs were without swelling.", "Alpha1-antitrypsin levels were normal.", "Arterial blood gas examination showed an oxygen partial pressure pO2 = 7.67 kPa.", "Arterial blood gas examination showed a carbon dioxide partial pressure pCO2 = 4.56 kPa.", "Arterial blood gas examination showed a pH = 7.46.", "Arterial blood gas examination showed blood saturation SpO2 = 90%.", "Computed tomography results demonstrated centrilobular emphysema bilaterally.", "The centrilobular emphysema reflects a severe obstructive ventilation disorder.", "The patient underwent spirometry and body plethysmography examinations.", "Forced expiratory volume in 1 s was 1.07 L.", "Forced vital capacity was 1.94 L.", "Inspiratory capacity was 1.57 L.", "Total lung capacity (TLC) was 5.51 L.", "Peak expiratory flow was 3.38 L.", "Inspiratory muscle performance was examined with the PrO2 device.", "Maximal inspiratory pressure (MIP) was 57 cmH2O.", "Sustained maximal inspiratory pressure (SMIP) was 404 PTU.", "Inspiratory duration (ID) was 7.7s.", "Fatigue index test (FIT) was 12.1.", "The COPD Assessment Test score was 15.", "The modified Medical Research Council Breathlessness score was 3.", "The six-minute walk test (6-MWT) was used to assess exercise tolerance.", "The distance walked during the 6-MWT was 270 m.", "Oxygen saturation decreased from 95% at baseline to 75% during the 6-MWT.", "The BODE index was used as a predictor of prognosis.", "The initial BODE index score was 5.", "The Charlson Comorbidity Index calculated the 10-year mortality risk to be 53%."], "index": 66, "original_id": "multiclinsum_test_1605_en.txt", "split": "test", "summary_subclaims": ["The patient was a 71-year-old man with severe COPD, Global Initiative for Obstructive Lung Diseases stage 3.", "The patient underwent an 8-wk remotely monitored inspiratory muscle training with a device based on the test of incremental respiratory endurance method.", "Spirometry was performed as part of the initial and final examination.", "Body plethysmography was performed as part of the initial and final examination.", "The test of incremental respiratory endurance examination was performed as part of the initial and final examination.", "The 6-min walking test was performed as part of the initial and final examination.", "Body mass index was measured as part of the initial and final examination.", "Airflow obstruction was assessed as part of the initial and final examination.", "Dyspnea was assessed as part of the initial and final examination.", "Exercise capacity index was measured as part of the initial and final examination.", "Subjective perception of dyspnea was assessed as part of the initial and final examination.", "The patient performed training at home.", "The physiotherapist monitored the patient remotely through a web application.", "The web application allowed the physiotherapist to evaluate all training parameters in real-time.", "The web application allowed the physiotherapist to respond to any problems.", "After 8 wk of home training, there was a significant increase in maximal inspiratory pressure.", "After 8 wk of home training, there was a significant increase in a novel parameter sustained maximal inspiratory pressure.", "After 8 wk of home training, there was a significant increase in forced expiratory volume in 1 s.", "After 8 wk of home training, there was a significant increase in total lung capacity.", "After 8 wk of home training, there was a significant increase in forced vital capacity.", "After 8 wk of home training, there was a significant increase in peak expiratory flow.", "After 8 wk of home training, there was a significant increase in inspiratory capacity.", "There was an improvement in the perception of dyspnea according to the COPD Assessment Test.", "There was an improvement in the perception of dyspnea according to the modified Medical Research Council Breathlessness Scale.", "There was an increase in exercise tolerance according to the 6-min walking test.", "There was a decrease in the exercise capacity index as a predictor of prognosis."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 38-year-old female.", "She presented to the emergency department in September 2019.", "She had a history of exertional shortness of breath since 1 month before admission.", "She had 2 attacks of syncope during the 1 month before admission.", "She reported 8-kg weight loss within the last 2 months.", "On physical examination, her heart rate was 112 beats/min.", "Heart examination revealed a pansystolic murmur at the lower left sternal edge.", "The murmur increased with inspiration.", "The murmur was concordant with tricuspid regurgitation.", "Electrocardiography showed sinus tachycardia.", "Electrocardiography showed right bundle branch block.", "Electrocardiography showed frequent ventricular ectopic rhythm.", "Holter ECG monitoring showed sinus tachycardia reaching 136\u2013140 bpm.", "Transthoracic and transesophageal echocardiography revealed a large mass in the right atrium.", "The mass measured 5.6\u00d73.8 cm.", "The mass originated below the fossa ovalis.", "The mass affected the tricuspid valve.", "The mass extended to the RV wall.", "The mass caused RV outflow obstruction.", "The mass caused pulmonary hypertension.", "The right side of the heart was dilated.", "RV dimension was 3.2 cm.", "RV systolic pressure was 50\u201355 mmHg.", "Hemoglobin was 11.3 g/dL.", "Erythrocyte sedimentation rate was 53 mm/h.", "C-reactive protein was 145 mg/L.", "International normalized ratio was 1.6.", "Alanine transaminase was 61 IU/L.", "Aspartate transaminase was 94 IU/L.", "Serum albumin was 26 g/L.", "Brain-type natriuretic peptide was 822 pg/mL.", "An initial diagnosis of cardiac myxoma was made.", "Surgical resection of the mass was planned.", "The patient underwent cardiac surgery after 4 days of admission.", "Intraoperatively, 400 mL of pericardial effusion was found.", "The mass was attached to the interatrial septum below the fossa ovalis by a thin stalk.", "The mass was resected.", "The base of the stalk was cauterized.", "The patient came out of cardiopulmonary bypass without the need for direct-current shock.", "The patient was intubated for 12 h postoperatively.", "The patient was kept in the intensive care unit for 24 h.", "The mass was sent for histopathologic examination.", "Macroscopic examination showed myxoid areas with other areas of hemorrhage and necrosis.", "Microscopic examination showed stellate myxoma cells with abundant eosinophilic cytoplasm.", "There was no evidence of malignancy.", "The intrapericardial drain was removed on the third postoperative day.", "The patient was discharged without any complications.", "She was seen in the clinic at 1-month, 2-month, 5-month, and 1-year intervals postoperatively.", "She was doing well without any complaint.", "Her liver transaminases returned to normal levels.", "Repeated TTE 5 months and nearly 1 year postoperatively was free of any cardiac masses.", "Repeated TTE showed grade 1 TR.", "The right atrium and right ventricle were still dilated.", "RVSP was 35 mmHg."], "summary_subclaims": ["The patient is a 38-year-old woman.", "She presented with shortness of breath.", "She presented with syncope.", "She was found to have a right atrioventricular myxoma.", "The myxoma was associated with tricuspid regurgitation.", "The myxoma was associated with right-sided heart failure.", "The myxoma was associated with pulmonary hypertension.", "The syncopal attacks resolved completely after tumor resection.", "The shortness of breath resolved completely after tumor resection.", "Tricuspid regurgitation (grade 1) remained as a sequela of delayed presentation.", "Mild pulmonary hypertension (right ventricular systolic pressure 35 mmHg) remained as a sequela of delayed presentation.", "These may be due to recurrent embolization of tumor fragments to segments of the pulmonary artery."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 38-year-old female.", "She presented to the emergency department in September 2019.", "She had a history of exertional shortness of breath since 1 month before admission.", "She had 2 attacks of syncope during the 1 month before admission.", "She reported 8-kg weight loss within the last 2 months.", "On physical examination, her heart rate was 112 beats/min.", "Heart examination revealed a pansystolic murmur at the lower left sternal edge.", "The murmur increased with inspiration.", "The murmur was concordant with tricuspid regurgitation.", "Electrocardiography showed sinus tachycardia.", "Electrocardiography showed right bundle branch block.", "Electrocardiography showed frequent ventricular ectopic rhythm.", "Holter ECG monitoring showed sinus tachycardia reaching 136\u2013140 bpm.", "Transthoracic and transesophageal echocardiography revealed a large mass in the right atrium.", "The mass measured 5.6\u00d73.8 cm.", "The mass originated below the fossa ovalis.", "The mass affected the tricuspid valve.", "The mass extended to the RV wall.", "The mass caused RV outflow obstruction.", "The mass caused pulmonary hypertension.", "The right side of the heart was dilated.", "RV dimension was 3.2 cm.", "RV systolic pressure was 50\u201355 mmHg.", "Hemoglobin was 11.3 g/dL.", "Erythrocyte sedimentation rate was 53 mm/h.", "C-reactive protein was 145 mg/L.", "International normalized ratio was 1.6.", "Alanine transaminase was 61 IU/L.", "Aspartate transaminase was 94 IU/L.", "Serum albumin was 26 g/L.", "Brain-type natriuretic peptide was 822 pg/mL.", "An initial diagnosis of cardiac myxoma was made.", "Surgical resection of the mass was planned.", "The patient underwent cardiac surgery after 4 days of admission.", "Intraoperatively, 400 mL of pericardial effusion was found.", "The mass was attached to the interatrial septum below the fossa ovalis by a thin stalk.", "The mass was resected.", "The base of the stalk was cauterized.", "The patient came out of cardiopulmonary bypass without the need for direct-current shock.", "The patient was intubated for 12 h postoperatively.", "The patient was kept in the intensive care unit for 24 h.", "The mass was sent for histopathologic examination.", "Macroscopic examination showed myxoid areas with other areas of hemorrhage and necrosis.", "Microscopic examination showed stellate myxoma cells with abundant eosinophilic cytoplasm.", "There was no evidence of malignancy.", "The intrapericardial drain was removed on the third postoperative day.", "The patient was discharged without any complications.", "She was seen in the clinic at 1-month, 2-month, 5-month, and 1-year intervals postoperatively.", "She was doing well without any complaint.", "Her liver transaminases returned to normal levels.", "Repeated TTE 5 months and nearly 1 year postoperatively was free of any cardiac masses.", "Repeated TTE showed grade 1 TR.", "The right atrium and right ventricle were still dilated.", "RVSP was 35 mmHg."], "index": 51, "original_id": "multiclinsum_test_3149_en.txt", "split": "test", "summary_subclaims": ["The patient is a 38-year-old woman.", "She presented with shortness of breath.", "She presented with syncope.", "She was found to have a right atrioventricular myxoma.", "The myxoma was associated with tricuspid regurgitation.", "The myxoma was associated with right-sided heart failure.", "The myxoma was associated with pulmonary hypertension.", "The syncopal attacks resolved completely after tumor resection.", "The shortness of breath resolved completely after tumor resection.", "Tricuspid regurgitation (grade 1) remained as a sequela of delayed presentation.", "Mild pulmonary hypertension (right ventricular systolic pressure 35 mmHg) remained as a sequela of delayed presentation.", "These may be due to recurrent embolization of tumor fragments to segments of the pulmonary artery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 77-year-old African American woman.", "The patient has a medical history of hypertension.", "The patient's systolic blood pressure was 200 mmHg.", "A renal ultrasound showed a 12 \u00d7 9 \u00d7 7.5 cm mass medial to the left kidney.", "A follow-up CT scan showed an enhancing 9 \u00d7 6 cm mass anterior and medial to the left kidney.", "The dexamethasone suppression test was normal.", "The androstenedione level was 182 ng/dl.", "An androgen-producing adrenal tumor was suspected.", "The differential diagnosis included pheochromocytoma, lymphoma, and mesenteric gastrointestinal stromal tumor.", "The patient underwent robotic-assisted left adrenalectomy.", "The intraoperative finding of 'focal invasion' into the renal parenchyma raised the possibility of adrenal cortical carcinoma.", "An additional left upper pole partial nephrectomy was performed.", "The specimen received was an 11 \u00d7 7.2 \u00d7 6.8 cm adrenal mass with attached portion of kidney.", "The mass was golden yellow, well circumscribed, and grossly adherent to the kidney.", "Histologic evaluation revealed an adrenal cortical adenoma without any features of malignancy.", "The Weiss score was 0.", "The adjacent adrenal parenchyma shared an incomplete capsule with the kidney.", "The adjacent adrenal parenchyma was in direct contact with the renal cortex.", "The diagnosis was fusion between the adrenal gland and the kidney.", "The postoperative course was uneventful."], "summary_subclaims": ["The patient is a 77-year-old African American female.", "The patient presented with a systolic blood pressure of 200\u00a0mmHg.", "Computed tomography showed an enhancing 9\u00a0\u00d7\u20096\u00a0cm mass anterior and medial to the left kidney.", "The patient underwent a left adrenalectomy with partial nephrectomy.", "Gross and histologic examinations revealed an adrenal cortical adenoma.", "Gross and histologic examinations revealed renal-adrenal fusion."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 77-year-old African American woman.", "The patient has a medical history of hypertension.", "The patient's systolic blood pressure was 200 mmHg.", "A renal ultrasound showed a 12 \u00d7 9 \u00d7 7.5 cm mass medial to the left kidney.", "A follow-up CT scan showed an enhancing 9 \u00d7 6 cm mass anterior and medial to the left kidney.", "The dexamethasone suppression test was normal.", "The androstenedione level was 182 ng/dl.", "An androgen-producing adrenal tumor was suspected.", "The differential diagnosis included pheochromocytoma, lymphoma, and mesenteric gastrointestinal stromal tumor.", "The patient underwent robotic-assisted left adrenalectomy.", "The intraoperative finding of 'focal invasion' into the renal parenchyma raised the possibility of adrenal cortical carcinoma.", "An additional left upper pole partial nephrectomy was performed.", "The specimen received was an 11 \u00d7 7.2 \u00d7 6.8 cm adrenal mass with attached portion of kidney.", "The mass was golden yellow, well circumscribed, and grossly adherent to the kidney.", "Histologic evaluation revealed an adrenal cortical adenoma without any features of malignancy.", "The Weiss score was 0.", "The adjacent adrenal parenchyma shared an incomplete capsule with the kidney.", "The adjacent adrenal parenchyma was in direct contact with the renal cortex.", "The diagnosis was fusion between the adrenal gland and the kidney.", "The postoperative course was uneventful."], "index": 69, "original_id": "multiclinsum_test_1363_en.txt", "split": "test", "summary_subclaims": ["The patient is a 77-year-old African American female.", "The patient presented with a systolic blood pressure of 200\u00a0mmHg.", "Computed tomography showed an enhancing 9\u00a0\u00d7\u20096\u00a0cm mass anterior and medial to the left kidney.", "The patient underwent a left adrenalectomy with partial nephrectomy.", "Gross and histologic examinations revealed an adrenal cortical adenoma.", "Gross and histologic examinations revealed renal-adrenal fusion."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 61-year-old obese male.", "The patient underwent laparoscopic partial nephrectomy.", "The tumor was found incidentally during a work-up for hypertension.", "The tumor was located in the left kidney.", "Microscopic examination of the tumor revealed chromophobe renal cell carcinoma.", "After one year of surveillance, a tumor was found in the left seminal vesicle.", "MRI showed a well-circumscribed heterogeneous solid tumor in the left seminal vesicle.", "The tumor measured 32 mm across its largest dimension.", "The tumor had well-defined cleavage planes with the rectum and bladder walls.", "The patient underwent laparoscopic surgical excision of the left seminal vesicle.", "Grossly, the seminal vesicle measured 6 x 3 x 2 cm.", "The cut surface showed a solid, well-circumscribed, brownish and smooth nodule.", "The nodule measured 30 mm across its largest dimension.", "The surgical margins were free from tumor.", "Microscopic examination disclosed well-defined nests of cuboidal cells.", "The nests were separated by vascular fibrous septa.", "There was no evidence of vascular invasion.", "There were no mitotic figures.", "There was no necrosis.", "Gland-like structures were identified focally.", "The tumor cells had a large central nucleus.", "The tumor cells had small to medium-sized nucleoli.", "The tumor cells had granular eosinophilic cytoplasm.", "The diagnostic possibilities included metastasis of the previous chromophobe renal cell carcinoma.", "The diagnostic possibilities included adenocarcinoma of the seminal vesicle.", "The diagnostic possibilities included paraganglioma.", "Immunohistochemical characterization was used for the differential diagnosis.", "The tumor cells were immunoreactive for chromogranin.", "The tumor cells were immunoreactive for synaptophysin.", "S100 protein-positive cells were identified at the periphery of the tumor nests.", "The tumor cells did not express keratins (AE1/AE3, CK7 and CK8/18).", "The absence of keratin immunoreactivity ruled out the hypothesis of primary or metastatic carcinoma.", "The diagnosis was supported as seminal vesicle paraganglioma.", "The Ki-67 labeling index was less than 2%.", "VHL and SDHB mutations were investigated using genomic DNA.", "No genetic alterations were found in the VHL gene.", "No genetic alterations were found in the SDHB gene.", "Thorough imaging analysis showed no tumor elsewhere.", "The diagnosis was reinforced as primary seminal vesicle paraganglioma.", "The patient is still alive after 14 months of follow-up.", "The patient's blood pressure is under control."], "summary_subclaims": ["This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male.", "The patient presented persistent arterial hypertension.", "The patient had a previous diagnosis of chromophobe renal cell carcinoma.", "It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma.", "Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests.", "Immunohistochemical characterization revealed peripheral S100 protein expression in sustentacular cells.", "Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 61-year-old obese male.", "The patient underwent laparoscopic partial nephrectomy.", "The tumor was found incidentally during a work-up for hypertension.", "The tumor was located in the left kidney.", "Microscopic examination of the tumor revealed chromophobe renal cell carcinoma.", "After one year of surveillance, a tumor was found in the left seminal vesicle.", "MRI showed a well-circumscribed heterogeneous solid tumor in the left seminal vesicle.", "The tumor measured 32 mm across its largest dimension.", "The tumor had well-defined cleavage planes with the rectum and bladder walls.", "The patient underwent laparoscopic surgical excision of the left seminal vesicle.", "Grossly, the seminal vesicle measured 6 x 3 x 2 cm.", "The cut surface showed a solid, well-circumscribed, brownish and smooth nodule.", "The nodule measured 30 mm across its largest dimension.", "The surgical margins were free from tumor.", "Microscopic examination disclosed well-defined nests of cuboidal cells.", "The nests were separated by vascular fibrous septa.", "There was no evidence of vascular invasion.", "There were no mitotic figures.", "There was no necrosis.", "Gland-like structures were identified focally.", "The tumor cells had a large central nucleus.", "The tumor cells had small to medium-sized nucleoli.", "The tumor cells had granular eosinophilic cytoplasm.", "The diagnostic possibilities included metastasis of the previous chromophobe renal cell carcinoma.", "The diagnostic possibilities included adenocarcinoma of the seminal vesicle.", "The diagnostic possibilities included paraganglioma.", "Immunohistochemical characterization was used for the differential diagnosis.", "The tumor cells were immunoreactive for chromogranin.", "The tumor cells were immunoreactive for synaptophysin.", "S100 protein-positive cells were identified at the periphery of the tumor nests.", "The tumor cells did not express keratins (AE1/AE3, CK7 and CK8/18).", "The absence of keratin immunoreactivity ruled out the hypothesis of primary or metastatic carcinoma.", "The diagnosis was supported as seminal vesicle paraganglioma.", "The Ki-67 labeling index was less than 2%.", "VHL and SDHB mutations were investigated using genomic DNA.", "No genetic alterations were found in the VHL gene.", "No genetic alterations were found in the SDHB gene.", "Thorough imaging analysis showed no tumor elsewhere.", "The diagnosis was reinforced as primary seminal vesicle paraganglioma.", "The patient is still alive after 14 months of follow-up.", "The patient's blood pressure is under control."], "index": 45, "original_id": "multiclinsum_test_2717_en.txt", "split": "test", "summary_subclaims": ["This report describes, for the first time to the best of our knowledge, a primary paraganglioma of the seminal vesicle occurring in a 61-year-old male.", "The patient presented persistent arterial hypertension.", "The patient had a previous diagnosis of chromophobe renal cell carcinoma.", "It was hypothesized that the seminal vesicle tumor could be a metastasis from the chromophobe renal cell carcinoma.", "Immunohistochemical characterization revealed expression of synaptophysin and chromogranin in tumor cell nests.", "Immunohistochemical characterization revealed peripheral S100 protein expression in sustentacular cells.", "Succinate dehydrogenase A and B-related (SDHA and SDHB) expression was present in both tumors."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 7-year-old male.", "The patient has a diagnosis of acute lymphoid leukemia of T precursors.", "The patient was finishing the cycle of induction chemotherapy with the PETHEMA 2013 protocol.", "The PETHEMA 2013 protocol includes L asparaginase, Vincristine, and Daunorrubicin.", "The PETHEMA 2013 protocol includes continuous prednisone for more than a month.", "The patient developed 12 days of epigastric abdominal pain.", "The patient had occasional vomiting.", "The physical examination showed exquisite pain to palpation in the epigastric region.", "The physical examination showed peristalsis present.", "The physical examination showed no data of obstruction.", "The laboratory examinations showed moderate neutropenia.", "The laboratory examinations showed increased c reactive protein.", "Acute pancreatitis was initially suspected.", "Acute pancreatitis was ruled out as pancreatic enzymes were normal.", "Acute pancreatitis was ruled out as abdominal computed tomography was normal.", "Steroid acid-peptic disease was then suspected.", "Medical treatment with proton pump inhibitors was continued.", "Medical treatment with prokinetic was continued.", "Medical treatment with oral tolerance was continued.", "The next day, the patient presented with increasing abdominal pain at night.", "The next day, the patient had emetic episodes on multiple occasions.", "The next day, the patient had haematemesis.", "The next day, the patient had severe hypokalaemia.", "The next day, the patient had hyperglycaemia.", "The next day, the patient had severe neutropenia.", "The next day, the patient had signs of shock.", "The patient was transferred to the paediatric intensive care unit.", "Emergency esophagogastroduodenoscopy was performed.", "An acute erosive haemorrhagic pangastritis was reported.", "The EGD was consistent with necrotizing gastritis.", "Necrotizing gastritis was confirmed by biopsy.", "Management was initiated with fasting.", "Management was initiated with potassium replacement.", "Management was initiated with fluid replacement.", "Management was initiated with omeprazole in continuous infusion.", "Management was initiated with ondansetron.", "Laboratory tests were negative with no bacterial isolation.", "Blood cultures were negative with no bacterial isolation.", "The patient progressed to catecholamine refractory shock.", "Mechanical ventilation was required.", "Antibiotic management was initiated.", "Multiple vasoactive support with norepinephrine, epinephrine, and vasopressin was initiated.", "The critical condition was overcome.", "Parenteral nutrition was indicated on the second day.", "The EGD on the sixth day showed persistence of necrotizing gastritis.", "Intestinal rest, proton pump inhibitors, and sucralfate were maintained.", "A control EGD was performed 30 days after intestinal rest.", "The control EGD showed significant improvement of extensive necrosis of the body, fundus, and gastric antrum.", "The control EGD showed persistence of necrosis area that compromised 20% of the greater curvature of the gastric body.", "The start of enteral nutrition was evaluated.", "The enteral nutrition was a polymeric diet.", "The start of enteral nutrition progressed to bland diet without irritants or lactose.", "The enteral nutrition was initiated orally.", "The patient had adequate intrahospital tolerance for 72 hours.", "Hospital discharge was indicated.", "Double dose of proton pump inhibitors was prescribed.", "Sucralfate was prescribed.", "Attention to warning signs was advised.", "On control at 2 months of discharge, the patient was hemodynamically stable.", "The control EGD showed complete improvement of the necrotizing gastritis.", "The control EGD showed remaining areas of fibrosis at the level of the corpus antrum region.", "Chemotherapy treatment was postponed for a month and a half.", "The same high-risk PETHEMA protocol was initiated.", "In the intensification stage, the doses were reduced to 50% of the cytostatic.", "In the next stage, the protocol was continued with the usual dose.", "End of treatment studies were done.", "The patient is in complete remission.", "The patient has no complications associated with the underlying pathology.", "The patient has been in remission for two years."], "summary_subclaims": ["The patient is a 7-year-old male.", "The patient has a diagnosis of acute lymphoid T-cell leukemia.", "The patient completed a cycle of induction chemotherapy with the PETHEMA 2013 protocol.", "The patient had epigastric abdominal pain for 12 days.", "The patient had vomiting for 12 days.", "Acute pancreatitis was initially suspected.", "Acute pancreatitis was ruled out by normal pancreatic enzymes.", "Acute pancreatitis was ruled out by abdominal computed tomography.", "Treatment with proton pump inhibitors was initiated.", "Treatment with procinetics was initiated.", "An esophagogastroduodenoscopy was performed.", "The esophagogastroduodenoscopy was compatible with necrotizing gastritis.", "Necrotizing gastritis was confirmed by histopathology.", "Pharmacological management was provided.", "A zero regimen was provided.", "Parenteral support was provided.", "Progressive improvement was evidenced in imaging controls.", "Fasting lasted 30 days.", "Enteral nutrition was initiated after fasting.", "Enteral nutrition was well tolerated.", "The chemotherapy plan was completed after improvement.", "Complete remission was achieved.", "There were no complications after 2 years."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 7-year-old male.", "The patient has a diagnosis of acute lymphoid leukemia of T precursors.", "The patient was finishing the cycle of induction chemotherapy with the PETHEMA 2013 protocol.", "The PETHEMA 2013 protocol includes L asparaginase, Vincristine, and Daunorrubicin.", "The PETHEMA 2013 protocol includes continuous prednisone for more than a month.", "The patient developed 12 days of epigastric abdominal pain.", "The patient had occasional vomiting.", "The physical examination showed exquisite pain to palpation in the epigastric region.", "The physical examination showed peristalsis present.", "The physical examination showed no data of obstruction.", "The laboratory examinations showed moderate neutropenia.", "The laboratory examinations showed increased c reactive protein.", "Acute pancreatitis was initially suspected.", "Acute pancreatitis was ruled out as pancreatic enzymes were normal.", "Acute pancreatitis was ruled out as abdominal computed tomography was normal.", "Steroid acid-peptic disease was then suspected.", "Medical treatment with proton pump inhibitors was continued.", "Medical treatment with prokinetic was continued.", "Medical treatment with oral tolerance was continued.", "The next day, the patient presented with increasing abdominal pain at night.", "The next day, the patient had emetic episodes on multiple occasions.", "The next day, the patient had haematemesis.", "The next day, the patient had severe hypokalaemia.", "The next day, the patient had hyperglycaemia.", "The next day, the patient had severe neutropenia.", "The next day, the patient had signs of shock.", "The patient was transferred to the paediatric intensive care unit.", "Emergency esophagogastroduodenoscopy was performed.", "An acute erosive haemorrhagic pangastritis was reported.", "The EGD was consistent with necrotizing gastritis.", "Necrotizing gastritis was confirmed by biopsy.", "Management was initiated with fasting.", "Management was initiated with potassium replacement.", "Management was initiated with fluid replacement.", "Management was initiated with omeprazole in continuous infusion.", "Management was initiated with ondansetron.", "Laboratory tests were negative with no bacterial isolation.", "Blood cultures were negative with no bacterial isolation.", "The patient progressed to catecholamine refractory shock.", "Mechanical ventilation was required.", "Antibiotic management was initiated.", "Multiple vasoactive support with norepinephrine, epinephrine, and vasopressin was initiated.", "The critical condition was overcome.", "Parenteral nutrition was indicated on the second day.", "The EGD on the sixth day showed persistence of necrotizing gastritis.", "Intestinal rest, proton pump inhibitors, and sucralfate were maintained.", "A control EGD was performed 30 days after intestinal rest.", "The control EGD showed significant improvement of extensive necrosis of the body, fundus, and gastric antrum.", "The control EGD showed persistence of necrosis area that compromised 20% of the greater curvature of the gastric body.", "The start of enteral nutrition was evaluated.", "The enteral nutrition was a polymeric diet.", "The start of enteral nutrition progressed to bland diet without irritants or lactose.", "The enteral nutrition was initiated orally.", "The patient had adequate intrahospital tolerance for 72 hours.", "Hospital discharge was indicated.", "Double dose of proton pump inhibitors was prescribed.", "Sucralfate was prescribed.", "Attention to warning signs was advised.", "On control at 2 months of discharge, the patient was hemodynamically stable.", "The control EGD showed complete improvement of the necrotizing gastritis.", "The control EGD showed remaining areas of fibrosis at the level of the corpus antrum region.", "Chemotherapy treatment was postponed for a month and a half.", "The same high-risk PETHEMA protocol was initiated.", "In the intensification stage, the doses were reduced to 50% of the cytostatic.", "In the next stage, the protocol was continued with the usual dose.", "End of treatment studies were done.", "The patient is in complete remission.", "The patient has no complications associated with the underlying pathology.", "The patient has been in remission for two years."], "index": 68, "original_id": "multiclinsum_test_3042_en.txt", "split": "test", "summary_subclaims": ["The patient is a 7-year-old male.", "The patient has a diagnosis of acute lymphoid T-cell leukemia.", "The patient completed a cycle of induction chemotherapy with the PETHEMA 2013 protocol.", "The patient had epigastric abdominal pain for 12 days.", "The patient had vomiting for 12 days.", "Acute pancreatitis was initially suspected.", "Acute pancreatitis was ruled out by normal pancreatic enzymes.", "Acute pancreatitis was ruled out by abdominal computed tomography.", "Treatment with proton pump inhibitors was initiated.", "Treatment with procinetics was initiated.", "An esophagogastroduodenoscopy was performed.", "The esophagogastroduodenoscopy was compatible with necrotizing gastritis.", "Necrotizing gastritis was confirmed by histopathology.", "Pharmacological management was provided.", "A zero regimen was provided.", "Parenteral support was provided.", "Progressive improvement was evidenced in imaging controls.", "Fasting lasted 30 days.", "Enteral nutrition was initiated after fasting.", "Enteral nutrition was well tolerated.", "The chemotherapy plan was completed after improvement.", "Complete remission was achieved.", "There were no complications after 2 years."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 24-year-old male.", "The patient complains of a history of sore throat.", "The patient complains of malaise.", "The patient complains of fever.", "The patient complains of neck and facial swelling.", "The patient has a normal consciousness level.", "On examination, there is tonsilar swelling.", "On examination, there is tonsilar tenderness.", "On examination, there is bilateral cervical lymphadenopathy.", "The blood pressure is normal.", "The heart rate is normal.", "The patient has no previous history of chronic disease.", "The patient has no previous history of chronic drug usage.", "The patient has no previous history of allergy.", "A laboratory examination showed leukocytosis.", "A laboratory examination showed high C-reactive protein serum.", "An ultrasound examination demonstrates left jugular vein thrombosis.", "Contrast-enhanced neck Computed tomography reveals fluid and air density collections.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the anterior cervical region.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in both soft tissue of the anterior mandibular ramus.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the peritonsillar area.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the left parapharyngeal area.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the left carotid space.", "Contrast-enhanced neck Computed tomography reveals left jugular vein thrombosis.", "Preliminary differential diagnoses reveal Ludwig's angina.", "Preliminary differential diagnoses reveal Lemierre's syndrome.", "The patient underwent surgical drainage in the ENT department.", "The patient was treated with Penicillin g 1.2 unit 1 \u00d7 1 im for one dose.", "The patient was treated with metrodenzol 3 \u00d7 1 iv.", "The patient was treated with unacefen 1g 2 \u00d7 1.", "The patient was treated with Clexane 4000 IU 1 \u00d7 1.", "The blood culture was positive for Fusobacterium necrophorum.", "The patient develops headaches after 10 days.", "The patient develops fever after 10 days.", "A contrast-enhanced MRI showed an intracranial epidural abscess on the left side of the brain.", "The patient was added to the treatment with intravenous clindamycin 600mg 1 \u00d7 3.", "The patient was added to the treatment with intravenous vancomycin 1g 3 \u00d7 1.", "After 45 days, the patient improved clinically.", "The patient was discharged for a home treatment regimen with clavulanate 1000 mg 1 \u00d7 2.", "The patient was discharged for a home treatment regimen with metro 500mg 1 \u00d7 3.", "The patient was discharged for a home treatment regimen with warfarin 5 mg 1 \u00d7 1.", "There were no other symptoms after a one-month follow-up.", "There were no other symptoms after a one-month follow-up with neck ultrasonography.", "This work has been reported in line with the SCARE 2020."], "summary_subclaims": ["The patient was a 24-year-old male.", "The patient came to the emergency department.", "The patient complained of a history of a sore throat.", "The patient complained of fever.", "The patient complained of malaise.", "The patient complained of neck swelling.", "The patient had a normal consciousness level.", "A laboratory examination showed leukocytosis.", "A laboratory examination showed high C-reactive protein serum.", "Radiological diagnosis revealed an anterior neck abscess.", "Radiological diagnosis revealed left jugular vein thrombosis.", "Radiological diagnosis revealed left epidural abscess.", "The blood culture was positive for Fusobacterium necrophorum.", "The patient underwent surgical drainage.", "The patient was treated with antibiotics.", "The patient was treated with anticoagulant drugs.", "After 45 days, the patient improved clinically.", "The patient was discharged.", "There were no other symptoms after a one-month follow-up.", "Neck ultrasonography was performed."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 24-year-old male.", "The patient complains of a history of sore throat.", "The patient complains of malaise.", "The patient complains of fever.", "The patient complains of neck and facial swelling.", "The patient has a normal consciousness level.", "On examination, there is tonsilar swelling.", "On examination, there is tonsilar tenderness.", "On examination, there is bilateral cervical lymphadenopathy.", "The blood pressure is normal.", "The heart rate is normal.", "The patient has no previous history of chronic disease.", "The patient has no previous history of chronic drug usage.", "The patient has no previous history of allergy.", "A laboratory examination showed leukocytosis.", "A laboratory examination showed high C-reactive protein serum.", "An ultrasound examination demonstrates left jugular vein thrombosis.", "Contrast-enhanced neck Computed tomography reveals fluid and air density collections.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the anterior cervical region.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in both soft tissue of the anterior mandibular ramus.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the peritonsillar area.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the left parapharyngeal area.", "Contrast-enhanced neck Computed tomography reveals soft tissue phlegmon formation in the left carotid space.", "Contrast-enhanced neck Computed tomography reveals left jugular vein thrombosis.", "Preliminary differential diagnoses reveal Ludwig's angina.", "Preliminary differential diagnoses reveal Lemierre's syndrome.", "The patient underwent surgical drainage in the ENT department.", "The patient was treated with Penicillin g 1.2 unit 1 \u00d7 1 im for one dose.", "The patient was treated with metrodenzol 3 \u00d7 1 iv.", "The patient was treated with unacefen 1g 2 \u00d7 1.", "The patient was treated with Clexane 4000 IU 1 \u00d7 1.", "The blood culture was positive for Fusobacterium necrophorum.", "The patient develops headaches after 10 days.", "The patient develops fever after 10 days.", "A contrast-enhanced MRI showed an intracranial epidural abscess on the left side of the brain.", "The patient was added to the treatment with intravenous clindamycin 600mg 1 \u00d7 3.", "The patient was added to the treatment with intravenous vancomycin 1g 3 \u00d7 1.", "After 45 days, the patient improved clinically.", "The patient was discharged for a home treatment regimen with clavulanate 1000 mg 1 \u00d7 2.", "The patient was discharged for a home treatment regimen with metro 500mg 1 \u00d7 3.", "The patient was discharged for a home treatment regimen with warfarin 5 mg 1 \u00d7 1.", "There were no other symptoms after a one-month follow-up.", "There were no other symptoms after a one-month follow-up with neck ultrasonography.", "This work has been reported in line with the SCARE 2020."], "index": 63, "original_id": "multiclinsum_test_1379_en.txt", "split": "test", "summary_subclaims": ["The patient was a 24-year-old male.", "The patient came to the emergency department.", "The patient complained of a history of a sore throat.", "The patient complained of fever.", "The patient complained of malaise.", "The patient complained of neck swelling.", "The patient had a normal consciousness level.", "A laboratory examination showed leukocytosis.", "A laboratory examination showed high C-reactive protein serum.", "Radiological diagnosis revealed an anterior neck abscess.", "Radiological diagnosis revealed left jugular vein thrombosis.", "Radiological diagnosis revealed left epidural abscess.", "The blood culture was positive for Fusobacterium necrophorum.", "The patient underwent surgical drainage.", "The patient was treated with antibiotics.", "The patient was treated with anticoagulant drugs.", "After 45 days, the patient improved clinically.", "The patient was discharged.", "There were no other symptoms after a one-month follow-up.", "Neck ultrasonography was performed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 4-year-old boy was admitted because of persistent lower limb pain and claudication in the left lower limb over the past 9 mo.", "The patient had mild persistent lower limb pain and claudication without any inducement.", "Claudication worsened in one day.", "The child had no fever, urinary frequency or urgency, numbness, fatigue, or lameness.", "He was admitted to our joint hand surgery department.", "The child had no history past illness.", "The child had no history of family illness, and his medical history was unremarkable.", "Pressing pain and local swelling were present in the left shank.", "The results of sensation and strengthening test, and tendon reflex test were normal in both lower limbs.", "No pathological signs were observed upon physical examination.", "Laboratory examinations were normal.", "Preoperative imaging examinations showed erosion-like changes with bone expansion of the left middle and lower fibular segment.", "No invasion of circumferential soft tissue or pathological fracture of the lesion site was observed.", "Initial pathological examination revealed fibular fibrous dysplasia.", "Postoperative photography showed that an allograft bone was implanted into the fibular medullary cavity.", "Recurrent fibular fibrous dysplasia was observed at the age of 6 years."], "summary_subclaims": ["A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo.", "He had no history of present or past illness.", "Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment.", "Tumor tissue in the fibular bone marrow cavity was removed by curettage.", "Rapid intraoperative pathological examination suggested fibular fibrous dysplasia.", "An allograft was implanted into the fibular medullary cavity.", "He was readmitted with clinical symptoms including persistent pain, abnormal gait, and local swelling at the age of 6 years.", "He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination.", "He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws.", "Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up."]}, "extra_info": {"fulltext_subclaims": ["A 4-year-old boy was admitted because of persistent lower limb pain and claudication in the left lower limb over the past 9 mo.", "The patient had mild persistent lower limb pain and claudication without any inducement.", "Claudication worsened in one day.", "The child had no fever, urinary frequency or urgency, numbness, fatigue, or lameness.", "He was admitted to our joint hand surgery department.", "The child had no history past illness.", "The child had no history of family illness, and his medical history was unremarkable.", "Pressing pain and local swelling were present in the left shank.", "The results of sensation and strengthening test, and tendon reflex test were normal in both lower limbs.", "No pathological signs were observed upon physical examination.", "Laboratory examinations were normal.", "Preoperative imaging examinations showed erosion-like changes with bone expansion of the left middle and lower fibular segment.", "No invasion of circumferential soft tissue or pathological fracture of the lesion site was observed.", "Initial pathological examination revealed fibular fibrous dysplasia.", "Postoperative photography showed that an allograft bone was implanted into the fibular medullary cavity.", "Recurrent fibular fibrous dysplasia was observed at the age of 6 years."], "index": 65, "original_id": "multiclinsum_test_1596_en.txt", "split": "test", "summary_subclaims": ["A 4-year-old boy was admitted for persistent pain in the left lower limb and abnormal gait over the previous 9 mo.", "He had no history of present or past illness.", "Preoperative imaging data showed erosion-like changes with bone expansion of the left middle and lower fibular segment.", "Tumor tissue in the fibular bone marrow cavity was removed by curettage.", "Rapid intraoperative pathological examination suggested fibular fibrous dysplasia.", "An allograft was implanted into the fibular medullary cavity.", "He was readmitted with clinical symptoms including persistent pain, abnormal gait, and local swelling at the age of 6 years.", "He was diagnosed with recurrent fibular fibrous dysplasia based on the second medical examination.", "He underwent fibular bone tumor radical resection and longus fibular allograft transplantation combined with fibular bone locking plate and screws.", "Good host bone to allogenic bone graft fusion was observed by the physician on postoperative regular follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 53-year-old female.", "She has a long history of low back pain.", "She had undergone an L5-S1 discectomy 11 years ago.", "She had undergone an L4-L5 decompressive laminectomy 2 years ago.", "She presented with an acute cauda equina syndrome.", "The acute cauda equina syndrome was characterized by paraparesis.", "The acute cauda equina syndrome was characterized by acute urinary incontinence.", "On examination, she had mild tenderness over the lower back region.", "Laboratory tests revealed a white blood cell count of 12,600/mm3.", "Laboratory tests revealed a high C-reactive protein level.", "Plain X-rays showed laminectomy defects from L4 to L5.", "The MRI showed an oblong posterior epidural lesion compressing the thecal sac from L4 to S1.", "The lesion was hypointense on T1-weighted images.", "The lesion was hyperintense on T2-weighted images.", "The lesion demonstrated ring enhancement with gadolinium injection.", "An epidural abscess was suspected.", "She underwent a decompressive laminectomy.", "At surgery, there was an encapsulated posterior epidural abscess that required drainage.", "A granulomatous lesion was noted at the antero-inferior part of the abscess wall at the level of S1.", "The granulomatous lesion was completely removed.", "The granulomatous lesion was unsuspected surgical cottonoid.", "Culture of the capsule revealed Klebsiella oxytoca.", "The infection required 2 months of ciprofloxacin.", "The infection fully resolved.", "The patient's paraparesis only partially recovered.", "The histopathological examination confirmed a textiloma.", "There was chronic inflammation and fibrosis surrounding the retained cottonoid.", "After the first postoperative year, there was no evidence of infection recurrence."], "summary_subclaims": ["The patient is a 53-year-old female.", "The patient had two prior spinal operations at the L4-S1 levels.", "The prior spinal operations were 11 and 2 years previously.", "The patient presented over a few weeks with the acute onset of a cauda equina syndrome.", "The cauda equina syndrome included paraparesis and acute urinary incontinence.", "The patient had a mildly elevated white blood cell count of 12,600/mm3.", "The patient had an abnormally increased C-reactive protein level.", "Magnetic resonance imaging showed a dorsal epidural abscess extending from the L4 to S1 levels.", "At surgery, an encapsulated posterior epidural abscess was drained.", "Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid.", "The granulomatous lesion was removed from the antero-inferior portion of the abscess wall at S1.", "Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca.", "After 2 months of ciprofloxacin, the patient's infection cleared.", "The motor deficit only partially resolved."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 53-year-old female.", "She has a long history of low back pain.", "She had undergone an L5-S1 discectomy 11 years ago.", "She had undergone an L4-L5 decompressive laminectomy 2 years ago.", "She presented with an acute cauda equina syndrome.", "The acute cauda equina syndrome was characterized by paraparesis.", "The acute cauda equina syndrome was characterized by acute urinary incontinence.", "On examination, she had mild tenderness over the lower back region.", "Laboratory tests revealed a white blood cell count of 12,600/mm3.", "Laboratory tests revealed a high C-reactive protein level.", "Plain X-rays showed laminectomy defects from L4 to L5.", "The MRI showed an oblong posterior epidural lesion compressing the thecal sac from L4 to S1.", "The lesion was hypointense on T1-weighted images.", "The lesion was hyperintense on T2-weighted images.", "The lesion demonstrated ring enhancement with gadolinium injection.", "An epidural abscess was suspected.", "She underwent a decompressive laminectomy.", "At surgery, there was an encapsulated posterior epidural abscess that required drainage.", "A granulomatous lesion was noted at the antero-inferior part of the abscess wall at the level of S1.", "The granulomatous lesion was completely removed.", "The granulomatous lesion was unsuspected surgical cottonoid.", "Culture of the capsule revealed Klebsiella oxytoca.", "The infection required 2 months of ciprofloxacin.", "The infection fully resolved.", "The patient's paraparesis only partially recovered.", "The histopathological examination confirmed a textiloma.", "There was chronic inflammation and fibrosis surrounding the retained cottonoid.", "After the first postoperative year, there was no evidence of infection recurrence."], "index": 83, "original_id": "multiclinsum_test_2689_en.txt", "split": "test", "summary_subclaims": ["The patient is a 53-year-old female.", "The patient had two prior spinal operations at the L4-S1 levels.", "The prior spinal operations were 11 and 2 years previously.", "The patient presented over a few weeks with the acute onset of a cauda equina syndrome.", "The cauda equina syndrome included paraparesis and acute urinary incontinence.", "The patient had a mildly elevated white blood cell count of 12,600/mm3.", "The patient had an abnormally increased C-reactive protein level.", "Magnetic resonance imaging showed a dorsal epidural abscess extending from the L4 to S1 levels.", "At surgery, an encapsulated posterior epidural abscess was drained.", "Surgical findings included a granulomatous lesion consistent with a retained surgical cottonoid.", "The granulomatous lesion was removed from the antero-inferior portion of the abscess wall at S1.", "Culture of the thick fibrotic abscess wall grew Klebsiella oxytoca.", "After 2 months of ciprofloxacin, the patient's infection cleared.", "The motor deficit only partially resolved."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 20-year-old male.", "He fell from a height of about 30 feet.", "He was initially managed at a nearby community hospital.", "He was diagnosed to have multiple rib fractures on both sides.", "He had bilateral hemopneumothorax.", "The primary management was performed with bilateral intercostal chest drains.", "Positive pressure ventilation was used for lung contusion.", "The patient had no neurological deficit at initial presentation.", "He was referred to our center after four weeks.", "On examination, there was tenderness over the tenth thoracic vertebrae.", "There was mild knuckle deformity.", "There was no motor or sensory deficit at any level.", "Superficial and deep tendon reflexes were normal.", "Radiographs showed a fracture dislocation with spondyloptosis of the ninth thoracic vertebra (T9) over the tenth thoracic vertebra (T10).", "The vertebral body of the eighth thoracic vertebra was fractured.", "The pedicles of both T9 and T10 vertebrae were fractured bilaterally.", "The posterior elements were separated from their respective vertebral bodies.", "There was complete spondyloptosis of T9 over T10 vertebral body.", "Both T9 and T10 vertebral bodies could be seen in a single transverse section of computerized tomography.", "The patient was scheduled for surgery after improvement in general and lung condition.", "The spine was approached through a standard posterior midline incision.", "There was no significant kyphosis seen.", "The posterior elements of the eighth and ninth thoracic vertebrae were lying almost in place.", "The fractures in the lamina of the eighth and ninth thoracic vertebrae were undisplaced.", "Pedicle screws were inserted in the fifth, sixth, and seventh thoracic vertebrae proximally.", "Pedicle screws were inserted in the tenth, eleventh, and twelfth thoracic vertebrae distally.", "An in-situ posterior instrumentation with laminectomy of T8 and T9 vertebrae was performed.", "Posterolateral fusion from the fifth to twelfth thoracic vertebrae was performed.", "No attempt was made to reduce spondyloptosis of T9 over the T10 vertebrae.", "The patient tolerated the operation well.", "There was no postoperative neurological deterioration.", "He was mobilized with the help of a customized dorsolumbar rigid orthosis on the fifth postoperative day.", "He was followed up at monthly intervals.", "Radiographs showed satisfactory in situ fusion between T9 and T10 vertebral bodies.", "Computerized tomography showed satisfactory in situ fusion between T9 and T10 vertebral bodies.", "The patient returned to his previous occupation."], "summary_subclaims": ["We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra.", "The patient was a 20-year-old male.", "The patient had no neurological deficit.", "The patient had associated chest injuries.", "The spine injury was managed surgically with in-situ posterior instrumentation and fusion.", "The patient tolerated the operation well.", "Postoperatively there was no neurological deterioration.", "Postoperatively there was no surgical complication."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 20-year-old male.", "He fell from a height of about 30 feet.", "He was initially managed at a nearby community hospital.", "He was diagnosed to have multiple rib fractures on both sides.", "He had bilateral hemopneumothorax.", "The primary management was performed with bilateral intercostal chest drains.", "Positive pressure ventilation was used for lung contusion.", "The patient had no neurological deficit at initial presentation.", "He was referred to our center after four weeks.", "On examination, there was tenderness over the tenth thoracic vertebrae.", "There was mild knuckle deformity.", "There was no motor or sensory deficit at any level.", "Superficial and deep tendon reflexes were normal.", "Radiographs showed a fracture dislocation with spondyloptosis of the ninth thoracic vertebra (T9) over the tenth thoracic vertebra (T10).", "The vertebral body of the eighth thoracic vertebra was fractured.", "The pedicles of both T9 and T10 vertebrae were fractured bilaterally.", "The posterior elements were separated from their respective vertebral bodies.", "There was complete spondyloptosis of T9 over T10 vertebral body.", "Both T9 and T10 vertebral bodies could be seen in a single transverse section of computerized tomography.", "The patient was scheduled for surgery after improvement in general and lung condition.", "The spine was approached through a standard posterior midline incision.", "There was no significant kyphosis seen.", "The posterior elements of the eighth and ninth thoracic vertebrae were lying almost in place.", "The fractures in the lamina of the eighth and ninth thoracic vertebrae were undisplaced.", "Pedicle screws were inserted in the fifth, sixth, and seventh thoracic vertebrae proximally.", "Pedicle screws were inserted in the tenth, eleventh, and twelfth thoracic vertebrae distally.", "An in-situ posterior instrumentation with laminectomy of T8 and T9 vertebrae was performed.", "Posterolateral fusion from the fifth to twelfth thoracic vertebrae was performed.", "No attempt was made to reduce spondyloptosis of T9 over the T10 vertebrae.", "The patient tolerated the operation well.", "There was no postoperative neurological deterioration.", "He was mobilized with the help of a customized dorsolumbar rigid orthosis on the fifth postoperative day.", "He was followed up at monthly intervals.", "Radiographs showed satisfactory in situ fusion between T9 and T10 vertebral bodies.", "Computerized tomography showed satisfactory in situ fusion between T9 and T10 vertebral bodies.", "The patient returned to his previous occupation."], "index": 61, "original_id": "multiclinsum_test_1749_en.txt", "split": "test", "summary_subclaims": ["We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra.", "The patient was a 20-year-old male.", "The patient had no neurological deficit.", "The patient had associated chest injuries.", "The spine injury was managed surgically with in-situ posterior instrumentation and fusion.", "The patient tolerated the operation well.", "Postoperatively there was no neurological deterioration.", "Postoperatively there was no surgical complication."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is an 80-year-old woman.", "She has a history of coronary artery disease.", "She has a history of atrial fibrillation.", "She has a history of hypertension.", "She has a history of diabetes mellitus.", "She has a history of basal cell carcinoma removed via Mohs procedure on the nose.", "She has a history of diabetic retinopathy.", "She has a history of macular degeneration.", "She presented with a recent increase in the number of falls.", "The falls were due to a recent, sudden deterioration of vision bilaterally.", "She was initially seen by the ophthalmologist 2 months ago for loss of vision in her right eye.", "The loss of vision in her right eye was thought to be related to previously diagnosed diabetic retinopathy.", "She underwent focal laser photocoagulation for diabetic retinopathy in her right eye.", "There was no significant improvement in vision after focal laser photocoagulation.", "A fleshy, salmon colored conjunctival tumor was identified in her left eye.", "She was referred to the ocular oncology service.", "The conjunctival tumor was biopsied.", "Histopathologic examination revealed sheets of large neoplastic lymphoid cells with moderate nuclear pleomorphism, vesicular chromatin, and large nucleoli.", "The large neoplastic lymphoid cells were found underlying the normal conjunctival epithelium.", "Small lymphocytes were observed admixed with the atypical large lymphoid cells.", "Immunohistochemical studies showed the large lymphoid cells stained positive (diffuse, strong) for CD20.", "Immunohistochemical studies showed the large lymphoid cells stained positive for MUM-1.", "Immunohistochemical studies showed the large lymphoid cells stained less intensely positive for Pax-5.", "Immunohistochemical studies showed the large lymphoid cells stained weakly positive for Bcl-6.", "Immunohistochemical studies showed the large lymphoid cells were negative for CD10.", "The small background lymphocytes were CD3-positive.", "Histopathological findings were consistent with diffuse large B-cell lymphoma.", "The immunophenotypic profile was consistent with nongerminal center origin.", "The proliferation index estimated by Ki-67 labeling was 80%.", "The large lymphoid cells were positive for c-myc rearrangement.", "The patient's laboratory workup, including complete blood count with differential, comprehensive metabolic panel, and coagulation profile, was within normal limits.", "Serum lactate dehydrogenase (LDH) level was 506 U/L.", "The normal range for serum lactate dehydrogenase (LDH) is 313-618 U/L.", "The patient's hepatitis screen was negative.", "Orbital computed tomography (CT) scans failed to reveal any discrete masses.", "Magnetic resonance imaging (MRI) scans revealed mild asymmetric thickening and enhancement of the sclera in the anterior left globe.", "Positron emission tomography-CT (PET-CT) failed to reveal any other systemic central nervous system (CNS) involvement.", "An MRI of the brain failed to reveal any other systemic central nervous system (CNS) involvement.", "Cerebrospinal fluid (CSF) analysis did not reveal any malignant cells.", "The patient was presumed to have CNS involvement.", "She was treated with high dose systemic methotrexate in addition to rituximab.", "She received three cycles of methotrexate at 1.5 g/m2.", "The methotrexate dose was reduced by 50% due to age and low creatinine clearance.", "She received rituximab at a dose of 375 mg/m2.", "The first cycle was complicated by severe diarrhea related to Clostridium difficile infection.", "The first cycle was complicated by dehydration.", "The third cycle was complicated by acute renal insufficiency.", "The third cycle was complicated by fluid overload.", "The third cycle was complicated by insufficient methotrexate clearance.", "The third cycle was complicated by prolonged hospital stay.", "Further chemotherapy had to be stopped in view of the side effects.", "Ophthalmic follow-up revealed improved vision in her right eye.", "Interval MRI revealed interval improvement in nonspecific scleral thickening and enhancement along the anterior aspect of the left globe.", "Based on the documented improvement, the patient was to be continued on the same chemotherapy regimen.", "The patient declined further treatment.", "She was evaluated by radiation oncology.", "She opted to decline further treatment at this time.", "She has not followed up by physicians at this hospital after that.", "She has been lost to follow-up."], "summary_subclaims": ["The patient is an 80-year-old female.", "The patient has a history of diabetic retinopathy.", "The patient has a history of macular degeneration.", "The patient presented with a sudden deterioration of vision.", "The sudden deterioration of vision was initially attributed to diabetic retinopathy.", "The patient was noted to have a salmon patch lesion in her conjunctiva.", "The salmon patch lesion was diagnosed on biopsy to be a diffuse large B-cell lymphoma."]}, "extra_info": {"fulltext_subclaims": ["The patient is an 80-year-old woman.", "She has a history of coronary artery disease.", "She has a history of atrial fibrillation.", "She has a history of hypertension.", "She has a history of diabetes mellitus.", "She has a history of basal cell carcinoma removed via Mohs procedure on the nose.", "She has a history of diabetic retinopathy.", "She has a history of macular degeneration.", "She presented with a recent increase in the number of falls.", "The falls were due to a recent, sudden deterioration of vision bilaterally.", "She was initially seen by the ophthalmologist 2 months ago for loss of vision in her right eye.", "The loss of vision in her right eye was thought to be related to previously diagnosed diabetic retinopathy.", "She underwent focal laser photocoagulation for diabetic retinopathy in her right eye.", "There was no significant improvement in vision after focal laser photocoagulation.", "A fleshy, salmon colored conjunctival tumor was identified in her left eye.", "She was referred to the ocular oncology service.", "The conjunctival tumor was biopsied.", "Histopathologic examination revealed sheets of large neoplastic lymphoid cells with moderate nuclear pleomorphism, vesicular chromatin, and large nucleoli.", "The large neoplastic lymphoid cells were found underlying the normal conjunctival epithelium.", "Small lymphocytes were observed admixed with the atypical large lymphoid cells.", "Immunohistochemical studies showed the large lymphoid cells stained positive (diffuse, strong) for CD20.", "Immunohistochemical studies showed the large lymphoid cells stained positive for MUM-1.", "Immunohistochemical studies showed the large lymphoid cells stained less intensely positive for Pax-5.", "Immunohistochemical studies showed the large lymphoid cells stained weakly positive for Bcl-6.", "Immunohistochemical studies showed the large lymphoid cells were negative for CD10.", "The small background lymphocytes were CD3-positive.", "Histopathological findings were consistent with diffuse large B-cell lymphoma.", "The immunophenotypic profile was consistent with nongerminal center origin.", "The proliferation index estimated by Ki-67 labeling was 80%.", "The large lymphoid cells were positive for c-myc rearrangement.", "The patient's laboratory workup, including complete blood count with differential, comprehensive metabolic panel, and coagulation profile, was within normal limits.", "Serum lactate dehydrogenase (LDH) level was 506 U/L.", "The normal range for serum lactate dehydrogenase (LDH) is 313-618 U/L.", "The patient's hepatitis screen was negative.", "Orbital computed tomography (CT) scans failed to reveal any discrete masses.", "Magnetic resonance imaging (MRI) scans revealed mild asymmetric thickening and enhancement of the sclera in the anterior left globe.", "Positron emission tomography-CT (PET-CT) failed to reveal any other systemic central nervous system (CNS) involvement.", "An MRI of the brain failed to reveal any other systemic central nervous system (CNS) involvement.", "Cerebrospinal fluid (CSF) analysis did not reveal any malignant cells.", "The patient was presumed to have CNS involvement.", "She was treated with high dose systemic methotrexate in addition to rituximab.", "She received three cycles of methotrexate at 1.5 g/m2.", "The methotrexate dose was reduced by 50% due to age and low creatinine clearance.", "She received rituximab at a dose of 375 mg/m2.", "The first cycle was complicated by severe diarrhea related to Clostridium difficile infection.", "The first cycle was complicated by dehydration.", "The third cycle was complicated by acute renal insufficiency.", "The third cycle was complicated by fluid overload.", "The third cycle was complicated by insufficient methotrexate clearance.", "The third cycle was complicated by prolonged hospital stay.", "Further chemotherapy had to be stopped in view of the side effects.", "Ophthalmic follow-up revealed improved vision in her right eye.", "Interval MRI revealed interval improvement in nonspecific scleral thickening and enhancement along the anterior aspect of the left globe.", "Based on the documented improvement, the patient was to be continued on the same chemotherapy regimen.", "The patient declined further treatment.", "She was evaluated by radiation oncology.", "She opted to decline further treatment at this time.", "She has not followed up by physicians at this hospital after that.", "She has been lost to follow-up."], "index": 81, "original_id": "multiclinsum_test_1888_en.txt", "split": "test", "summary_subclaims": ["The patient is an 80-year-old female.", "The patient has a history of diabetic retinopathy.", "The patient has a history of macular degeneration.", "The patient presented with a sudden deterioration of vision.", "The sudden deterioration of vision was initially attributed to diabetic retinopathy.", "The patient was noted to have a salmon patch lesion in her conjunctiva.", "The salmon patch lesion was diagnosed on biopsy to be a diffuse large B-cell lymphoma."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 62-year-old Thai man.", "He presented with a generalized erythematous maculopapular rash on his trunk and extremities.", "He had been diagnosed as having pulmonary tuberculosis two weeks earlier.", "He had long-standing hypertension and diabetes mellitus.", "His treatment included daily amlodipine 5mg, metformin 500mg, and glipizide 5mg.", "Anti-tuberculosis therapy of isoniazid 300mg, rifampicin 450mg, and ethambutol 800mg daily was administered.", "After two weeks of anti-tuberculosis medication, a generalized exanthematous rash appeared on his trunk and extremities.", "All anti-tuberculosis drugs were stopped after his admission due to a clinical suspicion of drug-induced adverse cutaneous reactions.", "The exanthematous rash resolved within three days of admission, leaving post-inflammatory hyperpigmentation.", "One day later, multiple well-defined, non-blanchable, erythematous-to-purplish macules and papules, some of which showed an annular arrangement, were noticed.", "He had no history of drug allergy.", "A review of systems was unremarkable.", "Laboratory findings showed leukocytes 12.8\u00d7103 cells/mm3.", "Neutrophils were 86 percent.", "Hemoglobin was 7.9g/dL.", "Platelet count was 215\u00d7103 cells/mm3.", "Creatinine was 1.2mg/dL.", "Alkaline phosphatase was 582U/L.", "\u03b3-glutamyl transferase was 393U/L.", "Total bilirubin was 9.6mg/dL.", "Direct bilirubin was 8.4mg/dL.", "Hepatitis B surface antigen, anti-hepatitis C virus, and anti-HIV test results were all negative.", "Anti-nuclear antibody and anti-neutrophil cytoplasmic antibody test results were also negative.", "Urine analysis showed no evidence of proteinuria or hematuria.", "The findings from an abdominal ultrasound were unremarkable.", "A skin biopsy from a purpuric annular lesion on his leg showed peri-vascular and interstitial infiltration of neutrophils with extravasation of erythrocytes and fibrin deposition.", "A direct immunofluorescence study was positive for IgA, IgM, and C3 along superficial dermal blood vessels.", "These findings were diagnostic for annular leukocytoclastic vasculitis associated with anti-tuberculosis drugs and drug-induced cholestasis.", "The patient was treated with an oral antihistamine and topical corticosteroids.", "The skin eruption cleared within one week without hyperpigmentation.", "Liver function test results returned to normal limits three weeks after the anti-tuberculosis drugs were withdrawn.", "Streptomycin (750mg per day), ethambutol (800mg per day), and ofloxacin (400mg per day) were administered as second-line anti-tuberculosis therapy.", "No adverse reactions were observed.", "He was subsequently treated with ethambutol, ofloxacin, and streptomycin without recurrence of the skin rash."], "summary_subclaims": ["We report a case of annular leukocytoclastic vasculitis induced by anti-tuberculosis medication.", "A 62-year-old Thai man presented to our facility with a generalized exanthematous rash on his trunk and extremities that resolved shortly afterwards.", "Subsequently, he developed multiple, erythematous-to-purplish, non-blanchable macules and papules with an annular arrangement on his extremities.", "The skin rash occurred after two weeks of anti-tuberculosis medication.", "The histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis.", "The skin lesion improved after discontinuation of the anti-tuberculosis drugs and treatment with oral antihistamine and topical corticosteroid drugs.", "Streptomycin, ethambutol and ofloxacin were administered as second-line anti-tuberculosis therapy during his hospitalization.", "No adverse reactions were observed."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 62-year-old Thai man.", "He presented with a generalized erythematous maculopapular rash on his trunk and extremities.", "He had been diagnosed as having pulmonary tuberculosis two weeks earlier.", "He had long-standing hypertension and diabetes mellitus.", "His treatment included daily amlodipine 5mg, metformin 500mg, and glipizide 5mg.", "Anti-tuberculosis therapy of isoniazid 300mg, rifampicin 450mg, and ethambutol 800mg daily was administered.", "After two weeks of anti-tuberculosis medication, a generalized exanthematous rash appeared on his trunk and extremities.", "All anti-tuberculosis drugs were stopped after his admission due to a clinical suspicion of drug-induced adverse cutaneous reactions.", "The exanthematous rash resolved within three days of admission, leaving post-inflammatory hyperpigmentation.", "One day later, multiple well-defined, non-blanchable, erythematous-to-purplish macules and papules, some of which showed an annular arrangement, were noticed.", "He had no history of drug allergy.", "A review of systems was unremarkable.", "Laboratory findings showed leukocytes 12.8\u00d7103 cells/mm3.", "Neutrophils were 86 percent.", "Hemoglobin was 7.9g/dL.", "Platelet count was 215\u00d7103 cells/mm3.", "Creatinine was 1.2mg/dL.", "Alkaline phosphatase was 582U/L.", "\u03b3-glutamyl transferase was 393U/L.", "Total bilirubin was 9.6mg/dL.", "Direct bilirubin was 8.4mg/dL.", "Hepatitis B surface antigen, anti-hepatitis C virus, and anti-HIV test results were all negative.", "Anti-nuclear antibody and anti-neutrophil cytoplasmic antibody test results were also negative.", "Urine analysis showed no evidence of proteinuria or hematuria.", "The findings from an abdominal ultrasound were unremarkable.", "A skin biopsy from a purpuric annular lesion on his leg showed peri-vascular and interstitial infiltration of neutrophils with extravasation of erythrocytes and fibrin deposition.", "A direct immunofluorescence study was positive for IgA, IgM, and C3 along superficial dermal blood vessels.", "These findings were diagnostic for annular leukocytoclastic vasculitis associated with anti-tuberculosis drugs and drug-induced cholestasis.", "The patient was treated with an oral antihistamine and topical corticosteroids.", "The skin eruption cleared within one week without hyperpigmentation.", "Liver function test results returned to normal limits three weeks after the anti-tuberculosis drugs were withdrawn.", "Streptomycin (750mg per day), ethambutol (800mg per day), and ofloxacin (400mg per day) were administered as second-line anti-tuberculosis therapy.", "No adverse reactions were observed.", "He was subsequently treated with ethambutol, ofloxacin, and streptomycin without recurrence of the skin rash."], "index": 7, "original_id": "multiclinsum_test_2131_en.txt", "split": "test", "summary_subclaims": ["We report a case of annular leukocytoclastic vasculitis induced by anti-tuberculosis medication.", "A 62-year-old Thai man presented to our facility with a generalized exanthematous rash on his trunk and extremities that resolved shortly afterwards.", "Subsequently, he developed multiple, erythematous-to-purplish, non-blanchable macules and papules with an annular arrangement on his extremities.", "The skin rash occurred after two weeks of anti-tuberculosis medication.", "The histopathology of the purpuric skin lesion was consistent with leukocytoclastic vasculitis.", "The skin lesion improved after discontinuation of the anti-tuberculosis drugs and treatment with oral antihistamine and topical corticosteroid drugs.", "Streptomycin, ethambutol and ofloxacin were administered as second-line anti-tuberculosis therapy during his hospitalization.", "No adverse reactions were observed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 29-year-old Asian female.", "She had previously been in good health.", "She presented with recurrent episodes of severe headache, nausea, and vomiting.", "She described the headache as 'pulling' downward.", "The headache was triggered by standing.", "The headache resolved when supine.", "She reported axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms.", "She denied immediate symptoms after the chiropractic manipulation.", "She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation.", "She had no known prior history of trauma.", "She had no known prior history of dural structural pathology.", "She had no known prior history of connective tissue disease.", "Physical exam was normal with no neurological deficits.", "Previous cervical MRI with and without contrast had been unremarkable.", "Cervical MRI at presentation revealed a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine.", "There was no mass effect on the thecal sac.", "There was no meningeal enhancement.", "There was no perineural cyst.", "There was no dural ectasia.", "There was no abnormal venous engorgement.", "The patient was managed conservatively with bed rest for 2 weeks.", "She made a complete spontaneous recovery.", "Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection.", "The patient is doing well presently."], "summary_subclaims": ["We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine.", "The patient is a 29-year-old female.", "The patient received manipulation one week prior to developing symptoms.", "The patient developed symptoms of severe orthostatic headache, nausea, and vomiting.", "Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection.", "Symptomatic onset corresponded with the recent cervical chiropractic adjustment.", "We present serial imaging correlating with her symptomatology.", "We review the pertinent literature on complications of chiropractic manipulation."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 29-year-old Asian female.", "She had previously been in good health.", "She presented with recurrent episodes of severe headache, nausea, and vomiting.", "She described the headache as 'pulling' downward.", "The headache was triggered by standing.", "The headache resolved when supine.", "She reported axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms.", "She denied immediate symptoms after the chiropractic manipulation.", "She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation.", "She had no known prior history of trauma.", "She had no known prior history of dural structural pathology.", "She had no known prior history of connective tissue disease.", "Physical exam was normal with no neurological deficits.", "Previous cervical MRI with and without contrast had been unremarkable.", "Cervical MRI at presentation revealed a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine.", "There was no mass effect on the thecal sac.", "There was no meningeal enhancement.", "There was no perineural cyst.", "There was no dural ectasia.", "There was no abnormal venous engorgement.", "The patient was managed conservatively with bed rest for 2 weeks.", "She made a complete spontaneous recovery.", "Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection.", "The patient is doing well presently."], "index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "summary_subclaims": ["We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine.", "The patient is a 29-year-old female.", "The patient received manipulation one week prior to developing symptoms.", "The patient developed symptoms of severe orthostatic headache, nausea, and vomiting.", "Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection.", "Symptomatic onset corresponded with the recent cervical chiropractic adjustment.", "We present serial imaging correlating with her symptomatology.", "We review the pertinent literature on complications of chiropractic manipulation."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 24-year-old Caucasian man.", "He had fever and upper quadrant abdominal pain over the previous 20 days.", "Before admission, ciprofloxacin and metronidazole, followed by cefixime had been prescribed.", "Six years prior, the patient had been diagnosed with PSC.", "Six years prior, the patient had been diagnosed with UC.", "Six years prior, the patient had been diagnosed with suspected retroperitoneal fibrosis.", "Six years prior, the patient had been diagnosed with bile sludge.", "Six years prior, the patient had been diagnosed with splenomegaly.", "At that time, ursodiol 300mg BID was prescribed.", "At that time, mesalamine 4g per day was prescribed.", "At that time, exploratory laparotomy and a biopsy of the perihepatic, retroperitoneal tissue were performed.", "The biopsy excluded malignancy.", "Over this six-year period, the patient presented with recurrent episodes of cholangitis.", "The serum level of aminotransferases remained substantially normal.", "There was a progressive worsening of cholestatic test results.", "There was a progressive liver enlargement along with fibrosis.", "Gamma glutamyl transpeptidase (GGT) increased from 141UI/L to 344UI/L.", "Alkaline phosphatase (ALP) increased from 847UI/L to 2534UI/L.", "Hepatic tissue stiffness, measured by FibroScan\u00ae, progressed from 12.6 to 17.3kPa.", "The patient was never treated with immunosuppressive therapy.", "The patient was never treated with corticosteroids.", "One month before admission, an upper endoscopy was performed.", "The upper endoscopy excluded esophageal varices.", "One week before admission, a magnetic resonance of his abdomen and bile ducts was performed.", "The magnetic resonance revealed further enlargement of the liver.", "The magnetic resonance revealed further enlargement of the spleen.", "The magnetic resonance revealed further enlargement of the tissue surrounding his hepatic hilum.", "The tissue surrounding his hepatic hilum caused a compression of his second duodenal tract.", "The tissue surrounding his hepatic hilum caused a wrapping of the splenic and hepatic arteries.", "Beading and narrowing of the intra-hepatic and common bile ducts were reported.", "A narrowing of the pancreatic duct was also reported.", "At admission, the patient had a fever of 38.8\u00b0C.", "Physical examination revealed tenderness of his epigastrium.", "Physical examination revealed tenderness of his right upper hypochondrium.", "Microbiological blood and urine investigations were negative for bacteria.", "A chest radiograph was normal.", "An abdominal sonography revealed an enlarged liver.", "An abdominal sonography revealed thickened choledocus.", "An abdominal sonography revealed dilatation of the intra-hepatic biliary tree.", "An abdominal sonography revealed splenomegaly.", "An abdominal sonography revealed lymphadenopathy of the hepatic hilus.", "A colonoscopy showed erythema of the colonic mucosa from the rectum to the cecum.", "Random biopsy showed focal atrophy of the colonic mucosa with edema.", "Random biopsy showed chronic inflammatory infiltrates.", "Specific investigations for CMV were not carried out.", "Imipenem 500mg IV four times daily was administered.", "Three days later, imipenem was substituted with tigecycline 50mg IV BID.", "Further blood and urine cultures for bacteria were negative.", "The erythrocyte sedimentation rate (ESR) remained high.", "The C-reactive protein level (C-RP) remained high.", "The white blood cell (WBC) count decreased.", "The neutrophil count decreased.", "The procalcitonin level was 0.38ng/ml.", "The fever persisted.", "The upper abdominal pain subsided slightly.", "Investigations for HIV were negative.", "Investigations for Toxoplasma gondii were negative.", "Investigations for CMV were negative.", "Investigations for measles were negative.", "Investigations for parotitis were negative.", "Investigations for hepatitis C virus (HCV) were negative.", "Results for varicella zoster virus indicated previous infection.", "Results for human herpes virus indicated previous infection.", "Results for Epstein Barr indicated previous infection.", "Results for rubella indicated previous infection.", "Results for parvo virus B19 indicated previous infection.", "CD4?+?T lymphocytes were 1055mm3 (20.3%).", "CD3?+?T lymphocytes were 3193mm3 (67%).", "Mycobacterium tuberculosis interferon gamma release assay showed negative results.", "Twelve days after admission, teicoplanin 400mg die was prescribed.", "Twelve days after admission, gentamicin 80mg TID was prescribed.", "Twelve days after admission, metronidazole 500mg TID was prescribed.", "Tigecycline was stopped.", "Two days later, DNA Cytomegalovirus was detected in the blood with \u2264253 copies/mL.", "Three days later, this value increased to 6189 copies/mL.", "Three days later, 1431 copies/mL were evidenced from a urine sample.", "CMV pp65-antigen was also positive.", "CMV serology indicated acute CMV infection.", "The patient\u2019s fever rose to 39.2\u00b0C.", "The patient\u2019s abdominal pain extended to the right lower abdominal quadrant.", "The patient\u2019s abdominal pain radiated to the right groin.", "The patient\u2019s abdominal pain radiated to the right testicle.", "Ultrasound suggested acute appendicitis.", "He underwent surgery.", "Histology showed inflammatory infiltrates, including lymphocytes and neutrophils.", "Histochemistry was positive for CMV early antigens.", "Real time reaction of the appendix tissue was positive.", "Shell vial culture of the appendix tissue was positive.", "Microbiological investigations for bacteria showed Peptococcus spp.", "Microbiological investigations for fungi showed Candida albicans.", "Teicoplanin, gentamicin and metronidazole were administered for a total of 12 days.", "Intravenous ganciclovir 5mg/kg twice was administered for 15 days.", "After discharge, oral valganciclovir 900mg BID was prescribed for 10 days.", "After this, the CMV nucleic acid in the blood and urine was negative.", "After this, ESR remained abnormally high.", "After this, cholestatic liver test results remained abnormally high."], "summary_subclaims": ["The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man.", "The patient also suffered from primary sclerosing cholangitis and ulcerative colitis.", "Diagnosis was based on clinical manifestations.", "Diagnosis was based on serology results.", "Diagnosis was based on microbiological findings.", "Diagnosis was based on histological findings.", "Treatment consisted of surgery.", "Treatment consisted of anti-Cytomegalovirus therapy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 24-year-old Caucasian man.", "He had fever and upper quadrant abdominal pain over the previous 20 days.", "Before admission, ciprofloxacin and metronidazole, followed by cefixime had been prescribed.", "Six years prior, the patient had been diagnosed with PSC.", "Six years prior, the patient had been diagnosed with UC.", "Six years prior, the patient had been diagnosed with suspected retroperitoneal fibrosis.", "Six years prior, the patient had been diagnosed with bile sludge.", "Six years prior, the patient had been diagnosed with splenomegaly.", "At that time, ursodiol 300mg BID was prescribed.", "At that time, mesalamine 4g per day was prescribed.", "At that time, exploratory laparotomy and a biopsy of the perihepatic, retroperitoneal tissue were performed.", "The biopsy excluded malignancy.", "Over this six-year period, the patient presented with recurrent episodes of cholangitis.", "The serum level of aminotransferases remained substantially normal.", "There was a progressive worsening of cholestatic test results.", "There was a progressive liver enlargement along with fibrosis.", "Gamma glutamyl transpeptidase (GGT) increased from 141UI/L to 344UI/L.", "Alkaline phosphatase (ALP) increased from 847UI/L to 2534UI/L.", "Hepatic tissue stiffness, measured by FibroScan\u00ae, progressed from 12.6 to 17.3kPa.", "The patient was never treated with immunosuppressive therapy.", "The patient was never treated with corticosteroids.", "One month before admission, an upper endoscopy was performed.", "The upper endoscopy excluded esophageal varices.", "One week before admission, a magnetic resonance of his abdomen and bile ducts was performed.", "The magnetic resonance revealed further enlargement of the liver.", "The magnetic resonance revealed further enlargement of the spleen.", "The magnetic resonance revealed further enlargement of the tissue surrounding his hepatic hilum.", "The tissue surrounding his hepatic hilum caused a compression of his second duodenal tract.", "The tissue surrounding his hepatic hilum caused a wrapping of the splenic and hepatic arteries.", "Beading and narrowing of the intra-hepatic and common bile ducts were reported.", "A narrowing of the pancreatic duct was also reported.", "At admission, the patient had a fever of 38.8\u00b0C.", "Physical examination revealed tenderness of his epigastrium.", "Physical examination revealed tenderness of his right upper hypochondrium.", "Microbiological blood and urine investigations were negative for bacteria.", "A chest radiograph was normal.", "An abdominal sonography revealed an enlarged liver.", "An abdominal sonography revealed thickened choledocus.", "An abdominal sonography revealed dilatation of the intra-hepatic biliary tree.", "An abdominal sonography revealed splenomegaly.", "An abdominal sonography revealed lymphadenopathy of the hepatic hilus.", "A colonoscopy showed erythema of the colonic mucosa from the rectum to the cecum.", "Random biopsy showed focal atrophy of the colonic mucosa with edema.", "Random biopsy showed chronic inflammatory infiltrates.", "Specific investigations for CMV were not carried out.", "Imipenem 500mg IV four times daily was administered.", "Three days later, imipenem was substituted with tigecycline 50mg IV BID.", "Further blood and urine cultures for bacteria were negative.", "The erythrocyte sedimentation rate (ESR) remained high.", "The C-reactive protein level (C-RP) remained high.", "The white blood cell (WBC) count decreased.", "The neutrophil count decreased.", "The procalcitonin level was 0.38ng/ml.", "The fever persisted.", "The upper abdominal pain subsided slightly.", "Investigations for HIV were negative.", "Investigations for Toxoplasma gondii were negative.", "Investigations for CMV were negative.", "Investigations for measles were negative.", "Investigations for parotitis were negative.", "Investigations for hepatitis C virus (HCV) were negative.", "Results for varicella zoster virus indicated previous infection.", "Results for human herpes virus indicated previous infection.", "Results for Epstein Barr indicated previous infection.", "Results for rubella indicated previous infection.", "Results for parvo virus B19 indicated previous infection.", "CD4?+?T lymphocytes were 1055mm3 (20.3%).", "CD3?+?T lymphocytes were 3193mm3 (67%).", "Mycobacterium tuberculosis interferon gamma release assay showed negative results.", "Twelve days after admission, teicoplanin 400mg die was prescribed.", "Twelve days after admission, gentamicin 80mg TID was prescribed.", "Twelve days after admission, metronidazole 500mg TID was prescribed.", "Tigecycline was stopped.", "Two days later, DNA Cytomegalovirus was detected in the blood with \u2264253 copies/mL.", "Three days later, this value increased to 6189 copies/mL.", "Three days later, 1431 copies/mL were evidenced from a urine sample.", "CMV pp65-antigen was also positive.", "CMV serology indicated acute CMV infection.", "The patient\u2019s fever rose to 39.2\u00b0C.", "The patient\u2019s abdominal pain extended to the right lower abdominal quadrant.", "The patient\u2019s abdominal pain radiated to the right groin.", "The patient\u2019s abdominal pain radiated to the right testicle.", "Ultrasound suggested acute appendicitis.", "He underwent surgery.", "Histology showed inflammatory infiltrates, including lymphocytes and neutrophils.", "Histochemistry was positive for CMV early antigens.", "Real time reaction of the appendix tissue was positive.", "Shell vial culture of the appendix tissue was positive.", "Microbiological investigations for bacteria showed Peptococcus spp.", "Microbiological investigations for fungi showed Candida albicans.", "Teicoplanin, gentamicin and metronidazole were administered for a total of 12 days.", "Intravenous ganciclovir 5mg/kg twice was administered for 15 days.", "After discharge, oral valganciclovir 900mg BID was prescribed for 10 days.", "After this, the CMV nucleic acid in the blood and urine was negative.", "After this, ESR remained abnormally high.", "After this, cholestatic liver test results remained abnormally high."], "index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "summary_subclaims": ["The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man.", "The patient also suffered from primary sclerosing cholangitis and ulcerative colitis.", "Diagnosis was based on clinical manifestations.", "Diagnosis was based on serology results.", "Diagnosis was based on microbiological findings.", "Diagnosis was based on histological findings.", "Treatment consisted of surgery.", "Treatment consisted of anti-Cytomegalovirus therapy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was diagnosed with high-risk CD20+ common-type B-cell precursor acute lymphoblastic leukemia.", "The patient received two cycles of HyperCVAD.", "The patient consulted the National Cancer Institute for a relapse and five-day polyarthralgia.", "The patient was initiated into the protocol established in 2003 by the Adult Acute Lymphoblastic Leukemia Research Group (GRAALL-2003).", "The patient developed febrile neutropenia.", "The patient had cellulitis of the left hand without abscess.", "The patient had methicillin-sensitive Staphylococcus aureus bacteremia.", "Cefapime and oxacillin were administered.", "The bacteremia resolved.", "On day 21 of hospitalization, the patient presented lesions on the back of the left hand.", "The lesions on the back of the left hand were of the type erythematoedematosa plaque.", "The lesions on the back of the left hand had mild and fine desquamation on the surface.", "The lesions on the back of the left hand had central blood crust.", "The patient had lesions in the right scapular and infra-scapular region.", "The lesions in the right scapular and infra-scapular region were 3 mm non-follicular papules.", "The lesions in the right scapular and infra-scapular region were grouped.", "The lesions in the right scapular and infra-scapular region were some erythematous and others erythemoparous.", "The lesions were assessed by the Dermatology Service.", "A skin biopsy was taken for histopathological study.", "The results were inconclusive for the diagnosis of mycosis.", "No culture was done for fungi of the biopsy.", "An invasive fungal infection was suspected.", "Caspofungin was initiated.", "The chest and sinus computed tomography (CT) scans were negative for invasive aspergillosis.", "The serum galactomannan detection was negative for invasive aspergillosis.", "Despite antimicrobial and antifungal treatment, the patient did not show significant improvement.", "The patient persisted with a fever of up to 40 \u00b0C.", "The patient had 1 cm nodules, soft, depressible, painless and in the previous sites of venipuncture.", "The blood count showed a profound neutropenia (20 white blood cells per \u00b5l).", "The C reactive protein was 6.15 mg/dl.", "The control CT scan of the paranasal sinuses showed incipient chronic inflammatory changes in the right maxillary sinus.", "The abdomen scan documented hepatosplenomegaly.", "The three blood cultures and the urine culture from day 28 of hospitalization showed yeast-like structures.", "The yeast-like structures were not identified in the automated panel Yeast ID (BD Phoenix\u2122 100).", "Arthroconidia were observed by microscopy.", "Colonies compatible with Geotrichum spp. were documented.", "The diagnosis was confirmed by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry.", "Treatment with amphotericin B deoxycholate was given at a daily dose of 1 mg/kg for 14 days.", "400 mg/day of voriconazole was given for four weeks.", "Clinical symptoms resolved.", "The patient recovered from neutropenia on day 24 of the combined antifungal treatment.", "The patient was discharged on day 101 of hospitalisation due to clinical improvement."], "summary_subclaims": ["The patient is a 27-year-old male.", "The patient has relapsed acute lymphoblastic leukemia.", "The patient had five-day-old polyarthralgia.", "The patient had febrile neutropenia.", "The patient had cellulitis without abscesses.", "The patient had methicillin-resistant Staphylococcus aureus bacteremia.", "The patient received therapy with oxacillin and cefepime.", "The febrile neutropenia persisted.", "An invasive fungal infection was suspected.", "A new set of blood cultures was taken.", "Antifungal treatment was initiated.", "Arthroconidia were identified in the blood cultures.", "Matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp.", "Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B.", "Antifungal treatment was adjusted to four weeks of voriconazole.", "The patient was discharged after a prolonged stay."]}, "extra_info": {"fulltext_subclaims": ["The patient was diagnosed with high-risk CD20+ common-type B-cell precursor acute lymphoblastic leukemia.", "The patient received two cycles of HyperCVAD.", "The patient consulted the National Cancer Institute for a relapse and five-day polyarthralgia.", "The patient was initiated into the protocol established in 2003 by the Adult Acute Lymphoblastic Leukemia Research Group (GRAALL-2003).", "The patient developed febrile neutropenia.", "The patient had cellulitis of the left hand without abscess.", "The patient had methicillin-sensitive Staphylococcus aureus bacteremia.", "Cefapime and oxacillin were administered.", "The bacteremia resolved.", "On day 21 of hospitalization, the patient presented lesions on the back of the left hand.", "The lesions on the back of the left hand were of the type erythematoedematosa plaque.", "The lesions on the back of the left hand had mild and fine desquamation on the surface.", "The lesions on the back of the left hand had central blood crust.", "The patient had lesions in the right scapular and infra-scapular region.", "The lesions in the right scapular and infra-scapular region were 3 mm non-follicular papules.", "The lesions in the right scapular and infra-scapular region were grouped.", "The lesions in the right scapular and infra-scapular region were some erythematous and others erythemoparous.", "The lesions were assessed by the Dermatology Service.", "A skin biopsy was taken for histopathological study.", "The results were inconclusive for the diagnosis of mycosis.", "No culture was done for fungi of the biopsy.", "An invasive fungal infection was suspected.", "Caspofungin was initiated.", "The chest and sinus computed tomography (CT) scans were negative for invasive aspergillosis.", "The serum galactomannan detection was negative for invasive aspergillosis.", "Despite antimicrobial and antifungal treatment, the patient did not show significant improvement.", "The patient persisted with a fever of up to 40 \u00b0C.", "The patient had 1 cm nodules, soft, depressible, painless and in the previous sites of venipuncture.", "The blood count showed a profound neutropenia (20 white blood cells per \u00b5l).", "The C reactive protein was 6.15 mg/dl.", "The control CT scan of the paranasal sinuses showed incipient chronic inflammatory changes in the right maxillary sinus.", "The abdomen scan documented hepatosplenomegaly.", "The three blood cultures and the urine culture from day 28 of hospitalization showed yeast-like structures.", "The yeast-like structures were not identified in the automated panel Yeast ID (BD Phoenix\u2122 100).", "Arthroconidia were observed by microscopy.", "Colonies compatible with Geotrichum spp. were documented.", "The diagnosis was confirmed by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry.", "Treatment with amphotericin B deoxycholate was given at a daily dose of 1 mg/kg for 14 days.", "400 mg/day of voriconazole was given for four weeks.", "Clinical symptoms resolved.", "The patient recovered from neutropenia on day 24 of the combined antifungal treatment.", "The patient was discharged on day 101 of hospitalisation due to clinical improvement."], "index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "summary_subclaims": ["The patient is a 27-year-old male.", "The patient has relapsed acute lymphoblastic leukemia.", "The patient had five-day-old polyarthralgia.", "The patient had febrile neutropenia.", "The patient had cellulitis without abscesses.", "The patient had methicillin-resistant Staphylococcus aureus bacteremia.", "The patient received therapy with oxacillin and cefepime.", "The febrile neutropenia persisted.", "An invasive fungal infection was suspected.", "A new set of blood cultures was taken.", "Antifungal treatment was initiated.", "Arthroconidia were identified in the blood cultures.", "Matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp.", "Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B.", "Antifungal treatment was adjusted to four weeks of voriconazole.", "The patient was discharged after a prolonged stay."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 63-year-old man.", "He presented with hematuria and urinary obstruction symptoms.", "He came to the hospital four times each with presence of gross hematuria.", "The patient suffered from frequency and nocturia at least for six months.", "Physical examination revealed enlargement of prostate.", "There was no palpable nodule on the digital rectal examination.", "PSA was normal.", "There was no evidence of hepatomegaly.", "There was no evidence of splenomegaly.", "The first transurethral resection of the prostate (TURP) and biopsy was done.", "Pathologic results showed the evidence of BPH.", "After 28 days, the patient was admitted again due to gross hematuria.", "Rectal examination was normal.", "Pelvic CT-scan revealed a big clot in bladder without any lymphadenopathy.", "There was significant heterogeneity in prostate.", "In second TURP, clot evacuation and biopsy were performed on more than 15 different areas of prostate.", "During the next 2 weeks, the patient underwent 3 other trans-urethral coagulation and clot evacuations due to hematuria.", "Prothrombin time (PT) was normal.", "Partial thromboplastin time (PTT) was normal.", "Clotting time (CT) was normal.", "Bleeding time (BT) was normal.", "Platelet count was normal.", "After 15 days hematuria was stopped.", "Hematuria was not repeated.", "Sections from prostate show foci of hemorrhage.", "The first transfusion was 2 units of PC during the second surgery.", "The second transfusion was 2 units of PC and 2 FFP, two days later.", "The consecutive third and fourth transfusions were done two days later.", "During the third and fourth transfusions, the patient received 3 units of FFP.", "During the third and fourth transfusions, the patient received 3 units of whole blood.", "Immunohistochemistry studies demonstrate CD20-positive in 90% of lymphoid cells.", "Immunohistochemistry studies demonstrate CD20-positive in the lymphoepithelial lesions.", "CD5-positive in background lymphocytes.", "CD43-positive in 90% of lymphoid cells.", "CD3-positive in background lymphocytes.", "CK markers are negative in neoplastic cells.", "PSA markers are negative in neoplastic cells.", "Bone marrow biopsy did not show other involvement.", "Abdominal and pelvic CT-scan did not show other involvement.", "In the last follow up, around eight months after discharging, the patient was alive.", "In the last follow up, around eight months after discharging, the patient was asymptomatic.", "There is no evidence of other organ involvement."], "summary_subclaims": ["We report here another case of primary prostatic MALT lymphoma.", "The case is presented by hematuria.", "The diagnosis was primarily considered as BPH.", "Immunohistochemistry studies demonstrate the diagnosis.", "Immunohistochemistry studies demonstrate MALT lymphoma.", "Six months after starting the treatment the patient was alive and well."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 63-year-old man.", "He presented with hematuria and urinary obstruction symptoms.", "He came to the hospital four times each with presence of gross hematuria.", "The patient suffered from frequency and nocturia at least for six months.", "Physical examination revealed enlargement of prostate.", "There was no palpable nodule on the digital rectal examination.", "PSA was normal.", "There was no evidence of hepatomegaly.", "There was no evidence of splenomegaly.", "The first transurethral resection of the prostate (TURP) and biopsy was done.", "Pathologic results showed the evidence of BPH.", "After 28 days, the patient was admitted again due to gross hematuria.", "Rectal examination was normal.", "Pelvic CT-scan revealed a big clot in bladder without any lymphadenopathy.", "There was significant heterogeneity in prostate.", "In second TURP, clot evacuation and biopsy were performed on more than 15 different areas of prostate.", "During the next 2 weeks, the patient underwent 3 other trans-urethral coagulation and clot evacuations due to hematuria.", "Prothrombin time (PT) was normal.", "Partial thromboplastin time (PTT) was normal.", "Clotting time (CT) was normal.", "Bleeding time (BT) was normal.", "Platelet count was normal.", "After 15 days hematuria was stopped.", "Hematuria was not repeated.", "Sections from prostate show foci of hemorrhage.", "The first transfusion was 2 units of PC during the second surgery.", "The second transfusion was 2 units of PC and 2 FFP, two days later.", "The consecutive third and fourth transfusions were done two days later.", "During the third and fourth transfusions, the patient received 3 units of FFP.", "During the third and fourth transfusions, the patient received 3 units of whole blood.", "Immunohistochemistry studies demonstrate CD20-positive in 90% of lymphoid cells.", "Immunohistochemistry studies demonstrate CD20-positive in the lymphoepithelial lesions.", "CD5-positive in background lymphocytes.", "CD43-positive in 90% of lymphoid cells.", "CD3-positive in background lymphocytes.", "CK markers are negative in neoplastic cells.", "PSA markers are negative in neoplastic cells.", "Bone marrow biopsy did not show other involvement.", "Abdominal and pelvic CT-scan did not show other involvement.", "In the last follow up, around eight months after discharging, the patient was alive.", "In the last follow up, around eight months after discharging, the patient was asymptomatic.", "There is no evidence of other organ involvement."], "index": 9, "original_id": "multiclinsum_test_2155_en.txt", "split": "test", "summary_subclaims": ["We report here another case of primary prostatic MALT lymphoma.", "The case is presented by hematuria.", "The diagnosis was primarily considered as BPH.", "Immunohistochemistry studies demonstrate the diagnosis.", "Immunohistochemistry studies demonstrate MALT lymphoma.", "Six months after starting the treatment the patient was alive and well."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidneys don\u2019t work properly, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing kidney health and preventing complications.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration and tubular reabsorption. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance, and fluid overload, which can manifest clinically as fatigue, hypertension, and edema. Chronic kidney disease progression is influenced by underlying pathophysiological mechanisms including glomerulosclerosis, tubular atrophy, and vascular remodeling, and early intervention through biomarker monitoring and targeted therapies is critical to mitigate disease progression.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 53-year-old man.", "The patient had a history of testicular seminoma that was removed twice.", "The patient had been experiencing disorientation and difficulty in thinking for 1 month before the visit.", "Contrast-enhanced magnetic resonance imaging showed a markedly contrast-enhanced mass in the dorsal midbrain.", "Systemic examination showed no obvious abnormalities.", "Blood samples showed a high serum soluble interleukin-2 receptor level of 624 U/ml.", "\u03b1-fetoprotein was within normal limits.", "Human chorionic gonadotropin was within normal limits.", "Neoplastic diseases such as PCNSL, tectal glioma, or intracranial metastasis of seminoma were considered in the differential diagnosis.", "Endoscopic tumor biopsy was performed with endoscopic third ventriculostomy.", "The burr hole was located 11 cm from the nasion and 2 cm to the right of the midline.", "A Neuroport mini was inserted into the anterior horn.", "The aqueduct was stenotic due to the tumor.", "A biopsy of the swollen area was performed.", "The lesion was pale pink, soft, and had minimal bleeding after the biopsy.", "A third ventriculostomy was performed using an expanding balloon catheter.", "Intraoperative cerebrospinal fluid cytology showed a small number of atypical cells with bifurcated nuclear irregularities.", "The tumor cells were CD3 negative.", "The tumor cells were CD20 positive.", "The tumor cells were CD79a positive.", "The final histopathological diagnosis of the tumor was diffuse large B-cell lymphoma.", "The patient underwent three courses of high-dose methotrexate.", "The patient underwent whole-brain irradiation.", "The patient\u2019s KPS was 100 when he was discharged home."], "summary_subclaims": ["The patient was referred to our hospital with a 1-month history of disorientation.", "Magnetic resonance imaging showed hydrocephalus.", "Magnetic resonance imaging showed an enhancing lesion in the tectum.", "Preoperative blood tests showed a high serum soluble interleukin-2 receptor level of 624 U/ml.", "Through a single burr hole, endoscopic third ventriculostomy and biopsy of the lesion were simultaneously performed with a flexible endoscope.", "The histological examination confirmed diffuse large B-cell lymphoma.", "The patient underwent chemotherapy.", "The patient underwent radiotherapy."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 53-year-old man.", "The patient had a history of testicular seminoma that was removed twice.", "The patient had been experiencing disorientation and difficulty in thinking for 1 month before the visit.", "Contrast-enhanced magnetic resonance imaging showed a markedly contrast-enhanced mass in the dorsal midbrain.", "Systemic examination showed no obvious abnormalities.", "Blood samples showed a high serum soluble interleukin-2 receptor level of 624 U/ml.", "\u03b1-fetoprotein was within normal limits.", "Human chorionic gonadotropin was within normal limits.", "Neoplastic diseases such as PCNSL, tectal glioma, or intracranial metastasis of seminoma were considered in the differential diagnosis.", "Endoscopic tumor biopsy was performed with endoscopic third ventriculostomy.", "The burr hole was located 11 cm from the nasion and 2 cm to the right of the midline.", "A Neuroport mini was inserted into the anterior horn.", "The aqueduct was stenotic due to the tumor.", "A biopsy of the swollen area was performed.", "The lesion was pale pink, soft, and had minimal bleeding after the biopsy.", "A third ventriculostomy was performed using an expanding balloon catheter.", "Intraoperative cerebrospinal fluid cytology showed a small number of atypical cells with bifurcated nuclear irregularities.", "The tumor cells were CD3 negative.", "The tumor cells were CD20 positive.", "The tumor cells were CD79a positive.", "The final histopathological diagnosis of the tumor was diffuse large B-cell lymphoma.", "The patient underwent three courses of high-dose methotrexate.", "The patient underwent whole-brain irradiation.", "The patient\u2019s KPS was 100 when he was discharged home."], "index": 11, "original_id": "multiclinsum_test_410_en.txt", "split": "test", "summary_subclaims": ["The patient was referred to our hospital with a 1-month history of disorientation.", "Magnetic resonance imaging showed hydrocephalus.", "Magnetic resonance imaging showed an enhancing lesion in the tectum.", "Preoperative blood tests showed a high serum soluble interleukin-2 receptor level of 624 U/ml.", "Through a single burr hole, endoscopic third ventriculostomy and biopsy of the lesion were simultaneously performed with a flexible endoscope.", "The histological examination confirmed diffuse large B-cell lymphoma.", "The patient underwent chemotherapy.", "The patient underwent radiotherapy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 51-year-old Caucasian woman.", "She presented with spinal, pelvic, and sternal inflammatory pain lasting for many years.", "The symptoms had a strong negative impact on her quality of life.", "She did not present palmoplantar pustulosis.", "There was no context of fever.", "She had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome at the age of 40 years.", "She had received sulfasalazine and nonsteroidal anti-inflammatory drugs (NSAIDs) for many years with incomplete pain relief.", "She also had a history of cervical and lumbar arthrodesis.", "She had a history of hypertension.", "She had a history of thyroidectomy.", "Total spine and pelvis magnetic resonance imaging (MRI) showed a short tau inversion recovery (STIR) hypersignal on several thoracic vertebrae (T6, T7, T8, and T9).", "Total spine and pelvis MRI showed a short tau inversion recovery (STIR) hypersignal on the sternal part of the right clavicle.", "Bone marrow oedema was also found on the right iliac bone.", "The sacroiliac joints were preserved.", "Bone scintigraphy showed anterior chest wall involvement.", "Right sternoclavicular hyperostosis was found on computed tomography.", "The C-reactive protein (CRP) was found to be 89.2 mg/L.", "The reference range for CRP is 0\u20135 mg/L.", "Several blood tests performed earlier had already shown elevation of inflammation parameters.", "HLA B27 antigen was negative.", "The diagnosis of active SAPHO syndrome was confirmed.", "Conventional synthetic disease-modifying antirheumatic drug (csDMARD) as methotrexate was not considered.", "Methotrexate is more effective on peripheral arthritis.", "Methotrexate has not shown comparable activity in axial disease in patients with axial spondyloarthritis.", "Anti-tumour necrosis factor (TNF) drugs could not be prescribed because the criteria for reimbursement of these drugs in Belgium were not met.", "The criteria for reimbursement were not met in the absence of sacroiliitis.", "JAK-inhibitors were initiated.", "Tofacitinib 5 mg twice daily was initiated.", "The patient reported rapid and significant reduction of pain within weeks of starting the treatment.", "Blood tests performed one month after the onset of treatment showed a clear regression of inflammatory parameters.", "The CRP was 25.5 mg/L one month after the onset of treatment.", "The CRP was 14 mg/L after 4 months of treatment.", "The CRP was 9.9 mg/L after 10 months of treatment.", "Total spine and pelvis MRI performed after 3 months of treatment showed regression of the STIR hypersignal on the body of the thoracic vertebrae.", "The hypersignal of the right iliac bone disappeared after 3 months of treatment.", "The rheumatic evolution was favourable from a clinical, biological, and radiological point of view since the introduction of a JAK-inhibitor.", "The treatment had to be discontinued due to pulmonary embolism occurring after 8 months on tofacitinib.", "Spinal, pelvic, and chest (sternal and costal) pain reappeared after discontinuation of tofacitinib.", "Elevation of inflammatory parameters occurred after discontinuation of tofacitinib.", "Written informed consent was obtained from the patient for the publication of this report and its accompanying images."], "summary_subclaims": ["The patient was a 51-year-old Caucasian woman.", "She had SAPHO syndrome with mainly axial involvement.", "She had been treated with sulfasalazine and anti-inflammatory drugs for many years.", "The treatment with sulfasalazine and anti-inflammatory drugs was without any success.", "A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved.", "Imaging showed considerable regression of the vertebral and pelvic lesions.", "Tofacitinib had to be discontinued due to the occurrence of pulmonary embolism.", "Recurrence of bone pain and biologic inflammation was rapidly observed."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 51-year-old Caucasian woman.", "She presented with spinal, pelvic, and sternal inflammatory pain lasting for many years.", "The symptoms had a strong negative impact on her quality of life.", "She did not present palmoplantar pustulosis.", "There was no context of fever.", "She had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome at the age of 40 years.", "She had received sulfasalazine and nonsteroidal anti-inflammatory drugs (NSAIDs) for many years with incomplete pain relief.", "She also had a history of cervical and lumbar arthrodesis.", "She had a history of hypertension.", "She had a history of thyroidectomy.", "Total spine and pelvis magnetic resonance imaging (MRI) showed a short tau inversion recovery (STIR) hypersignal on several thoracic vertebrae (T6, T7, T8, and T9).", "Total spine and pelvis MRI showed a short tau inversion recovery (STIR) hypersignal on the sternal part of the right clavicle.", "Bone marrow oedema was also found on the right iliac bone.", "The sacroiliac joints were preserved.", "Bone scintigraphy showed anterior chest wall involvement.", "Right sternoclavicular hyperostosis was found on computed tomography.", "The C-reactive protein (CRP) was found to be 89.2 mg/L.", "The reference range for CRP is 0\u20135 mg/L.", "Several blood tests performed earlier had already shown elevation of inflammation parameters.", "HLA B27 antigen was negative.", "The diagnosis of active SAPHO syndrome was confirmed.", "Conventional synthetic disease-modifying antirheumatic drug (csDMARD) as methotrexate was not considered.", "Methotrexate is more effective on peripheral arthritis.", "Methotrexate has not shown comparable activity in axial disease in patients with axial spondyloarthritis.", "Anti-tumour necrosis factor (TNF) drugs could not be prescribed because the criteria for reimbursement of these drugs in Belgium were not met.", "The criteria for reimbursement were not met in the absence of sacroiliitis.", "JAK-inhibitors were initiated.", "Tofacitinib 5 mg twice daily was initiated.", "The patient reported rapid and significant reduction of pain within weeks of starting the treatment.", "Blood tests performed one month after the onset of treatment showed a clear regression of inflammatory parameters.", "The CRP was 25.5 mg/L one month after the onset of treatment.", "The CRP was 14 mg/L after 4 months of treatment.", "The CRP was 9.9 mg/L after 10 months of treatment.", "Total spine and pelvis MRI performed after 3 months of treatment showed regression of the STIR hypersignal on the body of the thoracic vertebrae.", "The hypersignal of the right iliac bone disappeared after 3 months of treatment.", "The rheumatic evolution was favourable from a clinical, biological, and radiological point of view since the introduction of a JAK-inhibitor.", "The treatment had to be discontinued due to pulmonary embolism occurring after 8 months on tofacitinib.", "Spinal, pelvic, and chest (sternal and costal) pain reappeared after discontinuation of tofacitinib.", "Elevation of inflammatory parameters occurred after discontinuation of tofacitinib.", "Written informed consent was obtained from the patient for the publication of this report and its accompanying images."], "index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "summary_subclaims": ["The patient was a 51-year-old Caucasian woman.", "She had SAPHO syndrome with mainly axial involvement.", "She had been treated with sulfasalazine and anti-inflammatory drugs for many years.", "The treatment with sulfasalazine and anti-inflammatory drugs was without any success.", "A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved.", "Imaging showed considerable regression of the vertebral and pelvic lesions.", "Tofacitinib had to be discontinued due to the occurrence of pulmonary embolism.", "Recurrence of bone pain and biologic inflammation was rapidly observed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 62-year-old male.", "The patient had a 4-month history of right brachial/shoulder pain and numbness.", "The patient had hyposensitivity in the C5 distribution.", "The MRI scan showed degenerative cervical spondylosis from the C3\u2013C4 to C5\u2013C6 levels.", "The MRI scan showed a C5\u2013C6 right anterolateral disc herniation with foraminal stenosis.", "The MRI scan showed syringomyelia extending from the C5\u2013C6 to the T1 level.", "The patient underwent C5\u2013C6 anterior cervical discectomy and fusion (ACDF) with placement of a polyetheretherketone cage.", "The patient\u2019s symptoms markedly improved following the ACDF.", "Three months later, the MRI scan confirmed adequate decompression of the spinal cord.", "Three months later, the MRI scan confirmed the total resolution of the syrinx.", "The patient underwent placement of an eight-electrode subdural spinal cord stimulator from the C3 to C4 through the C5\u2013C6 levels.", "The patient significantly improved after the subdural spinal cord stimulator placement.", "Syringomyelia is usually attributed to Chiari malformations, spinal arachnoiditis, intramedullary tumors, and trauma.", "Syringomyelia is seldom associated with cervical disc disease or spondylosis.", "In two cases, ACDF resulted in complete radiological and clinical resolution of the syrinx.", "Younger patient age, a longer history of disease, and lower functional scores were associated with syringomyelia.", "Postoperative outcomes and progression-free survival for patients with syringomyelia did not differ significantly versus those without syringomyelia.", "The authors presented a rare case of syringomyelia attributed to cervical disc disease/stenosis.", "The syringomyelia in this case fully resolved following a C5\u2013C6 ACDF.", "The complete radiological resolution indicates that cervical disc disease/spondylosis might alter cerebrospinal fluid flow.", "The cerebrospinal fluid flow was adequately restored to normal with surgery."], "summary_subclaims": ["The patient is a 62-year-old male.", "The patient had a 4-month history of right brachial pain.", "The patient had hyposensitivity in the C5 distribution.", "The cervical MR imaging scan showed a C5-C6 right anterolateral disc herniation.", "The cervical MR imaging scan showed syringomyelia extending from C5-C6 to T1.", "The patient underwent C5-C6 anterior cervical discectomy and fusion.", "The patient's symptoms resolved following the C5-C6 anterior cervical discectomy and fusion.", "The 3-month postoperative MR documented total resolution of the syrinx.", "The patient required a subdural spinal cord stimulator due to residual neuropathic pain.", "The subdural spinal cord stimulator was placed without any complications."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 62-year-old male.", "The patient had a 4-month history of right brachial/shoulder pain and numbness.", "The patient had hyposensitivity in the C5 distribution.", "The MRI scan showed degenerative cervical spondylosis from the C3\u2013C4 to C5\u2013C6 levels.", "The MRI scan showed a C5\u2013C6 right anterolateral disc herniation with foraminal stenosis.", "The MRI scan showed syringomyelia extending from the C5\u2013C6 to the T1 level.", "The patient underwent C5\u2013C6 anterior cervical discectomy and fusion (ACDF) with placement of a polyetheretherketone cage.", "The patient\u2019s symptoms markedly improved following the ACDF.", "Three months later, the MRI scan confirmed adequate decompression of the spinal cord.", "Three months later, the MRI scan confirmed the total resolution of the syrinx.", "The patient underwent placement of an eight-electrode subdural spinal cord stimulator from the C3 to C4 through the C5\u2013C6 levels.", "The patient significantly improved after the subdural spinal cord stimulator placement.", "Syringomyelia is usually attributed to Chiari malformations, spinal arachnoiditis, intramedullary tumors, and trauma.", "Syringomyelia is seldom associated with cervical disc disease or spondylosis.", "In two cases, ACDF resulted in complete radiological and clinical resolution of the syrinx.", "Younger patient age, a longer history of disease, and lower functional scores were associated with syringomyelia.", "Postoperative outcomes and progression-free survival for patients with syringomyelia did not differ significantly versus those without syringomyelia.", "The authors presented a rare case of syringomyelia attributed to cervical disc disease/stenosis.", "The syringomyelia in this case fully resolved following a C5\u2013C6 ACDF.", "The complete radiological resolution indicates that cervical disc disease/spondylosis might alter cerebrospinal fluid flow.", "The cerebrospinal fluid flow was adequately restored to normal with surgery."], "index": 6, "original_id": "multiclinsum_test_875_en.txt", "split": "test", "summary_subclaims": ["The patient is a 62-year-old male.", "The patient had a 4-month history of right brachial pain.", "The patient had hyposensitivity in the C5 distribution.", "The cervical MR imaging scan showed a C5-C6 right anterolateral disc herniation.", "The cervical MR imaging scan showed syringomyelia extending from C5-C6 to T1.", "The patient underwent C5-C6 anterior cervical discectomy and fusion.", "The patient's symptoms resolved following the C5-C6 anterior cervical discectomy and fusion.", "The 3-month postoperative MR documented total resolution of the syrinx.", "The patient required a subdural spinal cord stimulator due to residual neuropathic pain.", "The subdural spinal cord stimulator was placed without any complications."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 71-year-old female.", "She had been undergoing oral treatment for diabetes with canagliflozin 100 mg/day, metformin 1,000 mg/day, and saxagliptin 5 mg/day.", "She noticed general malaise a month before her emergency department visit.", "Two weeks before her emergency department visit, her oral intake decreased because of reduced appetite.", "She continued oral medications at their initial dose.", "The day prior to her emergency department visit, her malaise worsened.", "She developed nausea and abdominal pain.", "A local doctor discovered notable metabolic acidosis (pH, 6.860; CO2, 8 mmHg; HCO3, \u22121.0 mEq/L; base excess measurement, below sensitivity).", "She was urgently transferred to Kurume University Hospital Advanced Emergency Medical Service Center.", "On admission, her body temperature was 35.0 \u00b0C.", "On admission, her pulse was 118/min.", "On admission, her respiratory rate was 28/min.", "On admission, her blood pressure was 111/75 mmHg.", "The findings on consultation included notable dryness inside the oral cavity.", "The findings on consultation included a cold sensation on distal regions of the limbs.", "Chest auscultation revealed no significant findings.", "There was mild tenderness in the lower abdominal region.", "Blood gases demonstrated notable metabolic acidosis (pH, 6.89; CO2, 11.4 mmHg; HCO3, 1.9 mEq/L; base excess, \u221231.3 mmol/L).", "Lactic acid was mildly elevated at 3.3 mmol/L.", "Blood sugar was mildly elevated at 259 mg/dL.", "Hyperkalemia was observed accompanying the acidosis.", "No significant kidney function impairment was observed.", "A diagnosis of lactic acidosis secondary to metformin was considered.", "The patient had not recently been exposed to a contrast agent.", "Lactate was only mildly elevated.", "Point-of-care urine testing showed strongly positive urinary ketones.", "Point-of-care urine testing showed strongly positive urinary glucose.", "Plasma 3-hydroxybutyric acid was markedly high (>10,000 \u03bcmol/L).", "DKA was suspected.", "An injection of 0.45% sodium chloride was given as an intravenous drip at 800 mL/h.", "Blood sugar dropped to 180 mg/dL after using two units of short-acting insulin.", "Insulin was not used continuously.", "An intravenous drip of glucose was started.", "Around 6 units/day of insulin were used as appropriate.", "Sodium bicarbonate was given as an intravenous drip.", "Continuous renal replacement therapy (CRRT) was started from day 2 after hospital admission.", "The acidosis improved because of CRRT over 3 days.", "Hyperketonemia reduced notably after a few days.", "Urinary sugar continued to rise.", "Osmotic diuresis set in with urinary glucose as the cause.", "Polyurea was observed.", "Fluid replacement was carried out using Ringer\u2019s solution.", "Urinary sugar turned negative on day 16 after admission.", "She was discharged on day 18 after admission."], "summary_subclaims": ["The patient was a 71-year-old female.", "She was being treated for type 2 diabetes.", "She was taking canagliflozin, metformin, and saxagliptin orally.", "She presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain.", "Her blood glucose was 259 mg/dL.", "There was notable ketoacidosis.", "The pH was 6.89.", "The CO2 was 11.4 mmHg.", "The HCO3 was 1.9 mEq/L.", "The base excess was -31.3 mmol/L.", "The 3-hydroxybutyric acid was > 10,000 \u03bcmol/L.", "The uncontrolled acidosis improved following 3 days of continuous renal replacement therapy.", "Elevated urinary glucose continued for more than 10 days.", "Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria.", "Urinary glucose turned negative on day 16.", "There was improvement in the patient's overall state.", "She was discharged on day 18."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 71-year-old female.", "She had been undergoing oral treatment for diabetes with canagliflozin 100 mg/day, metformin 1,000 mg/day, and saxagliptin 5 mg/day.", "She noticed general malaise a month before her emergency department visit.", "Two weeks before her emergency department visit, her oral intake decreased because of reduced appetite.", "She continued oral medications at their initial dose.", "The day prior to her emergency department visit, her malaise worsened.", "She developed nausea and abdominal pain.", "A local doctor discovered notable metabolic acidosis (pH, 6.860; CO2, 8 mmHg; HCO3, \u22121.0 mEq/L; base excess measurement, below sensitivity).", "She was urgently transferred to Kurume University Hospital Advanced Emergency Medical Service Center.", "On admission, her body temperature was 35.0 \u00b0C.", "On admission, her pulse was 118/min.", "On admission, her respiratory rate was 28/min.", "On admission, her blood pressure was 111/75 mmHg.", "The findings on consultation included notable dryness inside the oral cavity.", "The findings on consultation included a cold sensation on distal regions of the limbs.", "Chest auscultation revealed no significant findings.", "There was mild tenderness in the lower abdominal region.", "Blood gases demonstrated notable metabolic acidosis (pH, 6.89; CO2, 11.4 mmHg; HCO3, 1.9 mEq/L; base excess, \u221231.3 mmol/L).", "Lactic acid was mildly elevated at 3.3 mmol/L.", "Blood sugar was mildly elevated at 259 mg/dL.", "Hyperkalemia was observed accompanying the acidosis.", "No significant kidney function impairment was observed.", "A diagnosis of lactic acidosis secondary to metformin was considered.", "The patient had not recently been exposed to a contrast agent.", "Lactate was only mildly elevated.", "Point-of-care urine testing showed strongly positive urinary ketones.", "Point-of-care urine testing showed strongly positive urinary glucose.", "Plasma 3-hydroxybutyric acid was markedly high (>10,000 \u03bcmol/L).", "DKA was suspected.", "An injection of 0.45% sodium chloride was given as an intravenous drip at 800 mL/h.", "Blood sugar dropped to 180 mg/dL after using two units of short-acting insulin.", "Insulin was not used continuously.", "An intravenous drip of glucose was started.", "Around 6 units/day of insulin were used as appropriate.", "Sodium bicarbonate was given as an intravenous drip.", "Continuous renal replacement therapy (CRRT) was started from day 2 after hospital admission.", "The acidosis improved because of CRRT over 3 days.", "Hyperketonemia reduced notably after a few days.", "Urinary sugar continued to rise.", "Osmotic diuresis set in with urinary glucose as the cause.", "Polyurea was observed.", "Fluid replacement was carried out using Ringer\u2019s solution.", "Urinary sugar turned negative on day 16 after admission.", "She was discharged on day 18 after admission."], "index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "summary_subclaims": ["The patient was a 71-year-old female.", "She was being treated for type 2 diabetes.", "She was taking canagliflozin, metformin, and saxagliptin orally.", "She presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain.", "Her blood glucose was 259 mg/dL.", "There was notable ketoacidosis.", "The pH was 6.89.", "The CO2 was 11.4 mmHg.", "The HCO3 was 1.9 mEq/L.", "The base excess was -31.3 mmol/L.", "The 3-hydroxybutyric acid was > 10,000 \u03bcmol/L.", "The uncontrolled acidosis improved following 3 days of continuous renal replacement therapy.", "Elevated urinary glucose continued for more than 10 days.", "Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria.", "Urinary glucose turned negative on day 16.", "There was improvement in the patient's overall state.", "She was discharged on day 18."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 33-year-old nulligravid woman.", "The patient had newly diagnosed AA (WHO grade III, IDH1 negative).", "The patient had undergone a craniotomy with complete resection of her right parietal lobe tumor one month prior.", "The patient was scheduled to start chemotherapy and radiation in the next month.", "The patient\u2019s neuro-oncologist recommended fertility preservation prior to chemo-radiation.", "The fertility preservation did not delay the anticipated start of her chemo-radiation treatment.", "The patient had no significant medical or gynecological history.", "On physical exam, the patient was a healthy-appearing woman.", "Transvaginal ultrasound demonstrated a normal-appearing uterus and ovaries bilaterally.", "A dominant follicle was noted on the patient\u2019s right ovary.", "It was decided to administer HCG 10,000 IU at the time of her presentation to trigger ovulation.", "The patient had a high antral follicle count (6 on right, 7 on left).", "The patient received low dose gonadotropins: 1 ampule of Human Menopausal Gonadotropin (Menopur\u00ae), 75\u2013187.5 IU of FSH (Gonal F\u00ae) for 10 days.", "The patient received cetrorelix acetate (Ganirelex\u00ae) for the last 6 days.", "Final oocyte maturation was triggered with Lupron Luprolide Acetate (Lupron\u00ae) 40u.", "Twelve oocytes were retrieved transvaginally under ultrasound guidance.", "Eight embryos developed and were vitrified in liquid nitrogen.", "The patient returned to the Center one year later after being cleared by her neuro-oncologist.", "The patient had 6 weeks of radiation therapy with Temozolomide (Temodar\u00ae).", "The patient had 6 months of maintenance dose chemotherapy.", "The patient\u2019s last dose of chemotherapy was one month prior to returning to the office.", "The patient had maintained regular cycles post chemotherapy.", "The patient underwent a frozen-thaw natural cycle embryo transfer of a single day-3 embryo.", "The patient used vaginal progesterone (Crinone\u00ae) for luteal phase support.", "A viable singleton pregnancy was seen on ultrasound 1 month later.", "The patient delivered a healthy female baby weighing 7lbs 5 oz. at term.", "The patient returned two years later desirous of another pregnancy.", "The patient was tumor free and cleared by her oncologist to conceive again.", "This time the patient was treated with Estrace\u00ae 6 mg a day.", "The patient underwent a frozen-thaw cycle with a single day-5 blastocyst transferred.", "The patient conceived with a viable singleton pregnancy.", "The patient delivered a healthy male at term weighing 6lbs.", "Throughout the patient\u2019s treatment regimen for fertility preservation and frozen embryo transfers, no adverse or unanticipated events were encountered."], "summary_subclaims": ["The patient is a 33-year-old nulligravid woman.", "The patient has newly diagnosed anaplastic astrocytoma.", "The anaplastic astrocytoma is WHO grade III.", "The anaplastic astrocytoma is IDH1-negative.", "The patient sought fertility preservation.", "The patient underwent in vitro fertilization for fertility preservation.", "The in vitro fertilization resulted in 8 vitrified embryos.", "The patient underwent two rounds of frozen embryo transfers.", "Each frozen embryo transfer resulted in a successful singleton pregnancy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 33-year-old nulligravid woman.", "The patient had newly diagnosed AA (WHO grade III, IDH1 negative).", "The patient had undergone a craniotomy with complete resection of her right parietal lobe tumor one month prior.", "The patient was scheduled to start chemotherapy and radiation in the next month.", "The patient\u2019s neuro-oncologist recommended fertility preservation prior to chemo-radiation.", "The fertility preservation did not delay the anticipated start of her chemo-radiation treatment.", "The patient had no significant medical or gynecological history.", "On physical exam, the patient was a healthy-appearing woman.", "Transvaginal ultrasound demonstrated a normal-appearing uterus and ovaries bilaterally.", "A dominant follicle was noted on the patient\u2019s right ovary.", "It was decided to administer HCG 10,000 IU at the time of her presentation to trigger ovulation.", "The patient had a high antral follicle count (6 on right, 7 on left).", "The patient received low dose gonadotropins: 1 ampule of Human Menopausal Gonadotropin (Menopur\u00ae), 75\u2013187.5 IU of FSH (Gonal F\u00ae) for 10 days.", "The patient received cetrorelix acetate (Ganirelex\u00ae) for the last 6 days.", "Final oocyte maturation was triggered with Lupron Luprolide Acetate (Lupron\u00ae) 40u.", "Twelve oocytes were retrieved transvaginally under ultrasound guidance.", "Eight embryos developed and were vitrified in liquid nitrogen.", "The patient returned to the Center one year later after being cleared by her neuro-oncologist.", "The patient had 6 weeks of radiation therapy with Temozolomide (Temodar\u00ae).", "The patient had 6 months of maintenance dose chemotherapy.", "The patient\u2019s last dose of chemotherapy was one month prior to returning to the office.", "The patient had maintained regular cycles post chemotherapy.", "The patient underwent a frozen-thaw natural cycle embryo transfer of a single day-3 embryo.", "The patient used vaginal progesterone (Crinone\u00ae) for luteal phase support.", "A viable singleton pregnancy was seen on ultrasound 1 month later.", "The patient delivered a healthy female baby weighing 7lbs 5 oz. at term.", "The patient returned two years later desirous of another pregnancy.", "The patient was tumor free and cleared by her oncologist to conceive again.", "This time the patient was treated with Estrace\u00ae 6 mg a day.", "The patient underwent a frozen-thaw cycle with a single day-5 blastocyst transferred.", "The patient conceived with a viable singleton pregnancy.", "The patient delivered a healthy male at term weighing 6lbs.", "Throughout the patient\u2019s treatment regimen for fertility preservation and frozen embryo transfers, no adverse or unanticipated events were encountered."], "index": 8, "original_id": "multiclinsum_test_2635_en.txt", "split": "test", "summary_subclaims": ["The patient is a 33-year-old nulligravid woman.", "The patient has newly diagnosed anaplastic astrocytoma.", "The anaplastic astrocytoma is WHO grade III.", "The anaplastic astrocytoma is IDH1-negative.", "The patient sought fertility preservation.", "The patient underwent in vitro fertilization for fertility preservation.", "The in vitro fertilization resulted in 8 vitrified embryos.", "The patient underwent two rounds of frozen embryo transfers.", "Each frozen embryo transfer resulted in a successful singleton pregnancy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 63-year-old man was referred to Modarres Hospital, Tehran.", "He had gradual onset of obscure generalized abdominal pain six hours before admission.", "His pain was located in the epigastric and periumbilical region.", "There was no radiation of pain to anywhere else.", "He had one episode of vomiting.", "There was moderate abdominal distension.", "There was periumbilical abdominal tenderness.", "There was no guarding.", "Initial blood tests showed white cell count (WBC) of 21.7 \u00d7 109/L.", "Initial blood tests showed neutrophils 84.2%.", "Initial blood tests showed hemoglobin (Hb) 15.2 g/dL.", "C reactive protein was +2.", "Amylase was 63 U/L.", "Abdominal x-ray was normal.", "Ultrasonography was normal.", "About five hours after resuscitation and appropriate fluid therapy, he has not felt better.", "Blood tests were deranged.", "WBC was 18.4\u00d7109/L.", "Neutrophils were 76.5%.", "Hb was 8.1 g/dL.", "Abdominopelvic CT-scan showed evidence of hematoma near the head of pancreas.", "Abdominopelvic CT-scan showed perihepatic and perisplenic fluid.", "BP fell to 95/55 mmHg.", "Pulse rose to 105/min.", "He was transferred to operating room emergently.", "Midline laparotomy was performed.", "Massive intraperitoneal hematoma was evacuated.", "Right medial visceral rotation, the Cattell-Braasch maneuver, was performed.", "Active bleeding in the base of IPDA was detected.", "IPDA was suture ligated at the base with 4/0 nonabsorbable stitch.", "Hemostasis was achieved.", "The post-operative period was uneventful.", "Oral fluids were started the day after the surgery.", "The patient was discharged from the hospital two days after the surgery.", "One week after discharge, he had a normal follow-up.", "There were no concerning problems one week after discharge."], "summary_subclaims": ["The patient is a 63-year-old man.", "The patient had idiopathic spontaneous intraperitoneal hemorrhage.", "The hemorrhage was caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenal artery."]}, "extra_info": {"fulltext_subclaims": ["A 63-year-old man was referred to Modarres Hospital, Tehran.", "He had gradual onset of obscure generalized abdominal pain six hours before admission.", "His pain was located in the epigastric and periumbilical region.", "There was no radiation of pain to anywhere else.", "He had one episode of vomiting.", "There was moderate abdominal distension.", "There was periumbilical abdominal tenderness.", "There was no guarding.", "Initial blood tests showed white cell count (WBC) of 21.7 \u00d7 109/L.", "Initial blood tests showed neutrophils 84.2%.", "Initial blood tests showed hemoglobin (Hb) 15.2 g/dL.", "C reactive protein was +2.", "Amylase was 63 U/L.", "Abdominal x-ray was normal.", "Ultrasonography was normal.", "About five hours after resuscitation and appropriate fluid therapy, he has not felt better.", "Blood tests were deranged.", "WBC was 18.4\u00d7109/L.", "Neutrophils were 76.5%.", "Hb was 8.1 g/dL.", "Abdominopelvic CT-scan showed evidence of hematoma near the head of pancreas.", "Abdominopelvic CT-scan showed perihepatic and perisplenic fluid.", "BP fell to 95/55 mmHg.", "Pulse rose to 105/min.", "He was transferred to operating room emergently.", "Midline laparotomy was performed.", "Massive intraperitoneal hematoma was evacuated.", "Right medial visceral rotation, the Cattell-Braasch maneuver, was performed.", "Active bleeding in the base of IPDA was detected.", "IPDA was suture ligated at the base with 4/0 nonabsorbable stitch.", "Hemostasis was achieved.", "The post-operative period was uneventful.", "Oral fluids were started the day after the surgery.", "The patient was discharged from the hospital two days after the surgery.", "One week after discharge, he had a normal follow-up.", "There were no concerning problems one week after discharge."], "index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "summary_subclaims": ["The patient is a 63-year-old man.", "The patient had idiopathic spontaneous intraperitoneal hemorrhage.", "The hemorrhage was caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenal artery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 34-year-old male.", "The patient had multiple yellowish elevated masses in different locations of the body.", "The masses were located on the dorsum of the hands, elbows, buttocks, and feet.", "The patient had bilateral arcus cornealis.", "The patient had Achille tendon masses.", "The total number of masses was 15.", "The size of the masses varied from 1 \u00d7 1 \u00d7 1 cm to 8 \u00d7 8 \u00d7 5 cm.", "The masses were initially asymptomatic.", "The masses appeared 10 years ago.", "The masses increased progressively in size.", "The patient reported discomfort and difficulty dressing and sitting due to large masses in the buttocks.", "The patient reported difficulty wearing sandals due to the masses in the feet.", "The patient's hygiene was affected.", "The patient felt inferior when in contact with others.", "The patient decided to divorce because of psychological influences related to abnormalities in the body.", "The chest X-ray, abdominal ultrasound, electrocardiogram, and echocardiogram of the patient were normal.", "The patient's family medical history was not taken because the patient did not wish to disclose it.", "The patient's LDL-C level was 10.04 mmol/L.", "The reference value for LDL-C is <2.6 mmol/L.", "The patient was diagnosed with Familial hypercholesterolemia (FH) based on the Simon Broome Criteria.", "The patient agreed to be admitted to the hospital for surgery to remove the masses.", "Lipid-lowering therapy was administered with Atorvastatin 40 mg/day.", "After 4 days of hospitalization, the patient underwent surgery to remove the masses.", "The resected masses had a surface of normal skin.", "The core of the masses looked yellowish-colored, uniform, relatively solid, without necrosis.", "The masses were localized in the subcutaneous layer without invading the muscle or joint capsule.", "The skin incision was oval around the circumference of the masses with the longitudinal axis parallel to the Langer's line.", "The excision margins were normal skin.", "After removing the masses, all defects were sutured directly.", "A total of 13 masses were removed.", "The remaining 2 masses on the finger were not removed because the patient still had to use the fingers to take care of himself.", "The remaining 2 masses would be removed during the next surgery.", "Histopathology showed a typical xanthoma with infiltration of foam cells.", "All sutures were removed 14 days after surgery.", "The patient was discharged and continued treatment with atorvastatin 40 mg/day.", "Gene sequencing test showed homozygous LDL-C receptor gene mutation on chromosome 19.", "The patient's family members did not undergo gene sequencing to find mutations causing FH.", "At 1.5 months postoperatively, the LDL-C level of the patient was reduced to 8.8 mmol/L.", "At 1.5 months postoperatively, the wounds healed well.", "At 1.5 months postoperatively, no re-appearance of masses was observed."], "summary_subclaims": ["The patient is a 34-year-old male.", "The patient had multiple large tuberous xanthomas related to FH.", "There were 15 masses in different body parts.", "The masses were located on the dorsum of the hands, elbows, buttocks, feet, and Achille's tendon.", "The largest masses in the buttocks measured 8\u00a0\u00d7\u00a08\u00a0\u00d7\u00a05\u00a0cm.", "Surgical removal of 13 masses was carried out in combination with medical treatment.", "The skin incision was oval around the circumference of masses with the longitudinal axis parallel to the Langer's line.", "Skin defects were closed directly or dissected on both sides of the incision to reduce tension.", "Wound healing was normal.", "After 1.5\u00a0months, there was no recurrence of xanthomas."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 34-year-old male.", "The patient had multiple yellowish elevated masses in different locations of the body.", "The masses were located on the dorsum of the hands, elbows, buttocks, and feet.", "The patient had bilateral arcus cornealis.", "The patient had Achille tendon masses.", "The total number of masses was 15.", "The size of the masses varied from 1 \u00d7 1 \u00d7 1 cm to 8 \u00d7 8 \u00d7 5 cm.", "The masses were initially asymptomatic.", "The masses appeared 10 years ago.", "The masses increased progressively in size.", "The patient reported discomfort and difficulty dressing and sitting due to large masses in the buttocks.", "The patient reported difficulty wearing sandals due to the masses in the feet.", "The patient's hygiene was affected.", "The patient felt inferior when in contact with others.", "The patient decided to divorce because of psychological influences related to abnormalities in the body.", "The chest X-ray, abdominal ultrasound, electrocardiogram, and echocardiogram of the patient were normal.", "The patient's family medical history was not taken because the patient did not wish to disclose it.", "The patient's LDL-C level was 10.04 mmol/L.", "The reference value for LDL-C is <2.6 mmol/L.", "The patient was diagnosed with Familial hypercholesterolemia (FH) based on the Simon Broome Criteria.", "The patient agreed to be admitted to the hospital for surgery to remove the masses.", "Lipid-lowering therapy was administered with Atorvastatin 40 mg/day.", "After 4 days of hospitalization, the patient underwent surgery to remove the masses.", "The resected masses had a surface of normal skin.", "The core of the masses looked yellowish-colored, uniform, relatively solid, without necrosis.", "The masses were localized in the subcutaneous layer without invading the muscle or joint capsule.", "The skin incision was oval around the circumference of the masses with the longitudinal axis parallel to the Langer's line.", "The excision margins were normal skin.", "After removing the masses, all defects were sutured directly.", "A total of 13 masses were removed.", "The remaining 2 masses on the finger were not removed because the patient still had to use the fingers to take care of himself.", "The remaining 2 masses would be removed during the next surgery.", "Histopathology showed a typical xanthoma with infiltration of foam cells.", "All sutures were removed 14 days after surgery.", "The patient was discharged and continued treatment with atorvastatin 40 mg/day.", "Gene sequencing test showed homozygous LDL-C receptor gene mutation on chromosome 19.", "The patient's family members did not undergo gene sequencing to find mutations causing FH.", "At 1.5 months postoperatively, the LDL-C level of the patient was reduced to 8.8 mmol/L.", "At 1.5 months postoperatively, the wounds healed well.", "At 1.5 months postoperatively, no re-appearance of masses was observed."], "index": 10, "original_id": "multiclinsum_test_1587_en.txt", "split": "test", "summary_subclaims": ["The patient is a 34-year-old male.", "The patient had multiple large tuberous xanthomas related to FH.", "There were 15 masses in different body parts.", "The masses were located on the dorsum of the hands, elbows, buttocks, feet, and Achille's tendon.", "The largest masses in the buttocks measured 8\u00a0\u00d7\u00a08\u00a0\u00d7\u00a05\u00a0cm.", "Surgical removal of 13 masses was carried out in combination with medical treatment.", "The skin incision was oval around the circumference of masses with the longitudinal axis parallel to the Langer's line.", "Skin defects were closed directly or dissected on both sides of the incision to reduce tension.", "Wound healing was normal.", "After 1.5\u00a0months, there was no recurrence of xanthomas."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 57-year-old Ashkenazi Jew woman.", "She had iron deficiency anemia.", "She had no family or personal history of malignancy.", "She was admitted to the department of general surgery for treatment of her transverse colon tumor.", "Four months prior, she had begun experiencing periumbilical abdominal pain.", "She had hematochezia.", "She had a 10-kg weight loss.", "Upon physical examination, no masses were palpated.", "There were no other pathologic findings.", "She underwent a colonoscopy.", "The colonoscopy revealed a large mass that involved nearly the whole circumference of the colon.", "The mass seemed to be adjacent to the cecum.", "Biopsies were taken.", "The biopsies failed to demonstrate any colonic pathology.", "She underwent computed tomography (CT) of the chest and abdomen.", "The CT demonstrated a huge mass that occupied the whole colonic lumen.", "The mass caused a colocolic intussusception.", "Considerable mesenteric lymphadenopathy was seen.", "The nodes were up to 28 \u00d7 21 mm in diameter.", "The lymphadenopathy was deemed to be evidence of positive tumoral lymph node involvement.", "No inguinal, pelvic, retroperitoneal, or other lymphadenopathy was seen.", "She was scheduled for surgery.", "A laparoscopic right extended hemicolectomy was performed.", "The surgery was uncomplicated.", "During surgery, considerable mesocolic lymphadenopathy was seen.", "The mesocolic lymphadenopathy was widely resected accordingly.", "Pathology of the surgical specimen showed findings consistent with small B cell lymphoproliferative disorders with plasmacytoid differentiation.", "Primary lymphoma of the colon was considered in the differential diagnosis.", "The disease was thought to be part of systemic dissemination of lymphoma.", "The patient was referred to the hematology clinic for further investigation.", "A bone marrow biopsy was performed.", "The bone marrow biopsy result was normal.", "Positron emission tomography-CT showed no other focus of lymphoma.", "A test for Epstein-Barr virus infection was negative.", "These results support the diagnosis of a primary colonic NHL small B-cell LPD with plasmacytoid differentiation.", "The disease is an exceedingly rare disease.", "There are only two such reports in the current literature."], "summary_subclaims": ["We describe a case of an Ashkenazi Jew patient.", "The patient presented in the typical way that carcinoma of the colon might present.", "The patient turned out to have a very rare type of tumor.", "The tumor was rare in its histology.", "The tumor was rare in its location."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 57-year-old Ashkenazi Jew woman.", "She had iron deficiency anemia.", "She had no family or personal history of malignancy.", "She was admitted to the department of general surgery for treatment of her transverse colon tumor.", "Four months prior, she had begun experiencing periumbilical abdominal pain.", "She had hematochezia.", "She had a 10-kg weight loss.", "Upon physical examination, no masses were palpated.", "There were no other pathologic findings.", "She underwent a colonoscopy.", "The colonoscopy revealed a large mass that involved nearly the whole circumference of the colon.", "The mass seemed to be adjacent to the cecum.", "Biopsies were taken.", "The biopsies failed to demonstrate any colonic pathology.", "She underwent computed tomography (CT) of the chest and abdomen.", "The CT demonstrated a huge mass that occupied the whole colonic lumen.", "The mass caused a colocolic intussusception.", "Considerable mesenteric lymphadenopathy was seen.", "The nodes were up to 28 \u00d7 21 mm in diameter.", "The lymphadenopathy was deemed to be evidence of positive tumoral lymph node involvement.", "No inguinal, pelvic, retroperitoneal, or other lymphadenopathy was seen.", "She was scheduled for surgery.", "A laparoscopic right extended hemicolectomy was performed.", "The surgery was uncomplicated.", "During surgery, considerable mesocolic lymphadenopathy was seen.", "The mesocolic lymphadenopathy was widely resected accordingly.", "Pathology of the surgical specimen showed findings consistent with small B cell lymphoproliferative disorders with plasmacytoid differentiation.", "Primary lymphoma of the colon was considered in the differential diagnosis.", "The disease was thought to be part of systemic dissemination of lymphoma.", "The patient was referred to the hematology clinic for further investigation.", "A bone marrow biopsy was performed.", "The bone marrow biopsy result was normal.", "Positron emission tomography-CT showed no other focus of lymphoma.", "A test for Epstein-Barr virus infection was negative.", "These results support the diagnosis of a primary colonic NHL small B-cell LPD with plasmacytoid differentiation.", "The disease is an exceedingly rare disease.", "There are only two such reports in the current literature."], "index": 18, "original_id": "multiclinsum_test_2722_en.txt", "split": "test", "summary_subclaims": ["We describe a case of an Ashkenazi Jew patient.", "The patient presented in the typical way that carcinoma of the colon might present.", "The patient turned out to have a very rare type of tumor.", "The tumor was rare in its histology.", "The tumor was rare in its location."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 50-year-old female.", "She presented to the emergency department in significant respiratory distress.", "She had a known past medical history of tobacco dependence.", "She had a known past medical history of chronic obstructive pulmonary disease.", "She had a known past medical history of hypertension.", "On arrival, the patient was noted to be apneic.", "She was actively being ventilated with a bag-valve-mask ventilation.", "She rapidly progressed from an irregularly irregular cardiac rhythm to sinus bradycardia.", "She then progressed into a pulseless electrical activity (PEA) arrest within minutes of arrival.", "She underwent approximately 30 minutes of cardiopulmonary resuscitation.", "Endotracheal intubation was performed via video laryngoscopy.", "After intubation, she was noted to have significant resistance to bagging.", "After return of spontaneous circulation, she was noted to have high peak pressures on the ventilator.", "She was persistently hypotensive.", "On examination, she was noted to have distant, rhonchorous, and wheezy breath sounds bilaterally.", "She was treated for her bronchospasm with nebulized albuterol-ipratropium solution.", "She was treated with continuous nebulized albuterol.", "She was treated with magnesium sulfate.", "She was treated with methylprednisolone.", "She was treated with subcutaneous terbutaline.", "She was treated with titratable epinephrine.", "She was noted to have continuously high peak pressures.", "An intravenous push of vecuronium was given.", "There was no improvement in ventilation after vecuronium.", "There were continuously high peak airway pressures noted on the ventilator.", "She had an electrocardiogram concerning for new-onset atrial fibrillation with rapid ventricular response.", "She had an electrocardiogram showing left axis deviation.", "She had an electrocardiogram showing a new right bundle branch block.", "She had an electrocardiogram showing a left anterior fascicular block.", "The electrocardiogram showed signs of right heart strain.", "Given her difficulty with ventilation and hypotension, she was taken for a computed tomography (CT) with pulmonary embolism protocol.", "The CT revealed no evidence of pulmonary embolism.", "The CT showed evidence of alveolar rupture with pneumomediastinum consistent with the Macklin effect.", "The CT showed a small left-sided pneumothorax.", "The CT showed associated medial left hemi diaphragmatic rupture.", "The CT showed pneumoretroperitoneum tracking along the left upper abdomen.", "The CT showed pneumoretroperitoneum tracking along the left perinephric space.", "The CT showed left-sided nondisplaced rib fractures of the fifth and sixth ribs.", "A CT of the abdomen and pelvis showed a small amount of free air consistent with pneumoretroperitoneum.", "The CT of the abdomen and pelvis showed free air adjacent to the gastric cardia.", "The CT of the abdomen and pelvis showed free air adjacent to the left kidney.", "The CT of the abdomen and pelvis showed free air adjacent to the left adrenal gland.", "There was no definitively identified intra-abdominal traumatic injury.", "Further history from the family revealed she had been complaining of difficulty breathing earlier in the day.", "She subsequently suffered a witnessed fall down a flight of stairs.", "The fall was associated with head trauma.", "The fall was associated with apparent loss of consciousness.", "The patient\u2019s physical examination revealed no external signs of trauma on initial arrival.", "The patient was admitted to the medical intensive care unit.", "The admission was in the setting of cardiac arrest with prolonged down time.", "The patient\u2019s pneumomediastinum improved with lung-protective ventilation strategies.", "The patient\u2019s pneumoretroperitoneum improved with lung-protective ventilation strategies.", "The patient was treated with paralytics.", "The patient\u2019s treatment for her COPD exacerbation included continuous albuterol nebulization of 40 milligrams (mg) over four hours.", "The patient\u2019s treatment included intermittent scheduled three-milliliter ipratroprium-albuterol nebulizers every six hours.", "The patient\u2019s treatment included 0.25 mg of budesonide twice daily.", "The patient\u2019s treatment included 0.5 mg of ipratroprium four times daily.", "The patient\u2019s treatment included isolated two mg of magnesium sulfate administration daily if worsening wheeze on examination.", "The patient\u2019s treatment included 80 mg of methylprednisolone daily.", "The patient received a one-time dose of 0.25 mg of subcutaneous terbutaline.", "The patient received a one-time dose of one microgram (\u03bcg) of epinephrine.", "Sedation was maintained with ketamine at 1.5 mg per kilogram (kg) per hour.", "Sedation was maintained with propofol at 20 \u03bcg/kg per minute.", "The patient was treated with epinephrine as the first-line vasopressor choice.", "The patient\u2019s cardiac arrest resulted in severe hypoxic brain injury.", "The patient had subsequent diffuse cerebral edema.", "The patient had effacement of the basal cisterns.", "The patient had tonsillar herniation seen on CT of her head.", "The patient became increasingly hypertensive.", "The patient was weaned off vasopressors.", "The patient was started on titratable nicardipine at a maximum of 12.5 mg per hour.", "The patient was given a hypertonic saline bolus.", "The patient lost all evidence of brainstem reflexes five days after suffering cardiac arrest.", "The patient continued to trigger some spontaneous breaths on the ventilator.", "Multiple family meetings were held regarding patient prognosis.", "The patient was palliatively extubated.", "The patient died 26 days after arrival."], "summary_subclaims": ["The patient suffered a cardiac arrest after a fall.", "The cardiac arrest occurred during a chronic obstructive pulmonary disease exacerbation.", "The patient had pneumoretroperitoneum."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 50-year-old female.", "She presented to the emergency department in significant respiratory distress.", "She had a known past medical history of tobacco dependence.", "She had a known past medical history of chronic obstructive pulmonary disease.", "She had a known past medical history of hypertension.", "On arrival, the patient was noted to be apneic.", "She was actively being ventilated with a bag-valve-mask ventilation.", "She rapidly progressed from an irregularly irregular cardiac rhythm to sinus bradycardia.", "She then progressed into a pulseless electrical activity (PEA) arrest within minutes of arrival.", "She underwent approximately 30 minutes of cardiopulmonary resuscitation.", "Endotracheal intubation was performed via video laryngoscopy.", "After intubation, she was noted to have significant resistance to bagging.", "After return of spontaneous circulation, she was noted to have high peak pressures on the ventilator.", "She was persistently hypotensive.", "On examination, she was noted to have distant, rhonchorous, and wheezy breath sounds bilaterally.", "She was treated for her bronchospasm with nebulized albuterol-ipratropium solution.", "She was treated with continuous nebulized albuterol.", "She was treated with magnesium sulfate.", "She was treated with methylprednisolone.", "She was treated with subcutaneous terbutaline.", "She was treated with titratable epinephrine.", "She was noted to have continuously high peak pressures.", "An intravenous push of vecuronium was given.", "There was no improvement in ventilation after vecuronium.", "There were continuously high peak airway pressures noted on the ventilator.", "She had an electrocardiogram concerning for new-onset atrial fibrillation with rapid ventricular response.", "She had an electrocardiogram showing left axis deviation.", "She had an electrocardiogram showing a new right bundle branch block.", "She had an electrocardiogram showing a left anterior fascicular block.", "The electrocardiogram showed signs of right heart strain.", "Given her difficulty with ventilation and hypotension, she was taken for a computed tomography (CT) with pulmonary embolism protocol.", "The CT revealed no evidence of pulmonary embolism.", "The CT showed evidence of alveolar rupture with pneumomediastinum consistent with the Macklin effect.", "The CT showed a small left-sided pneumothorax.", "The CT showed associated medial left hemi diaphragmatic rupture.", "The CT showed pneumoretroperitoneum tracking along the left upper abdomen.", "The CT showed pneumoretroperitoneum tracking along the left perinephric space.", "The CT showed left-sided nondisplaced rib fractures of the fifth and sixth ribs.", "A CT of the abdomen and pelvis showed a small amount of free air consistent with pneumoretroperitoneum.", "The CT of the abdomen and pelvis showed free air adjacent to the gastric cardia.", "The CT of the abdomen and pelvis showed free air adjacent to the left kidney.", "The CT of the abdomen and pelvis showed free air adjacent to the left adrenal gland.", "There was no definitively identified intra-abdominal traumatic injury.", "Further history from the family revealed she had been complaining of difficulty breathing earlier in the day.", "She subsequently suffered a witnessed fall down a flight of stairs.", "The fall was associated with head trauma.", "The fall was associated with apparent loss of consciousness.", "The patient\u2019s physical examination revealed no external signs of trauma on initial arrival.", "The patient was admitted to the medical intensive care unit.", "The admission was in the setting of cardiac arrest with prolonged down time.", "The patient\u2019s pneumomediastinum improved with lung-protective ventilation strategies.", "The patient\u2019s pneumoretroperitoneum improved with lung-protective ventilation strategies.", "The patient was treated with paralytics.", "The patient\u2019s treatment for her COPD exacerbation included continuous albuterol nebulization of 40 milligrams (mg) over four hours.", "The patient\u2019s treatment included intermittent scheduled three-milliliter ipratroprium-albuterol nebulizers every six hours.", "The patient\u2019s treatment included 0.25 mg of budesonide twice daily.", "The patient\u2019s treatment included 0.5 mg of ipratroprium four times daily.", "The patient\u2019s treatment included isolated two mg of magnesium sulfate administration daily if worsening wheeze on examination.", "The patient\u2019s treatment included 80 mg of methylprednisolone daily.", "The patient received a one-time dose of 0.25 mg of subcutaneous terbutaline.", "The patient received a one-time dose of one microgram (\u03bcg) of epinephrine.", "Sedation was maintained with ketamine at 1.5 mg per kilogram (kg) per hour.", "Sedation was maintained with propofol at 20 \u03bcg/kg per minute.", "The patient was treated with epinephrine as the first-line vasopressor choice.", "The patient\u2019s cardiac arrest resulted in severe hypoxic brain injury.", "The patient had subsequent diffuse cerebral edema.", "The patient had effacement of the basal cisterns.", "The patient had tonsillar herniation seen on CT of her head.", "The patient became increasingly hypertensive.", "The patient was weaned off vasopressors.", "The patient was started on titratable nicardipine at a maximum of 12.5 mg per hour.", "The patient was given a hypertonic saline bolus.", "The patient lost all evidence of brainstem reflexes five days after suffering cardiac arrest.", "The patient continued to trigger some spontaneous breaths on the ventilator.", "Multiple family meetings were held regarding patient prognosis.", "The patient was palliatively extubated.", "The patient died 26 days after arrival."], "index": 12, "original_id": "multiclinsum_test_1808_en.txt", "split": "test", "summary_subclaims": ["The patient suffered a cardiac arrest after a fall.", "The cardiac arrest occurred during a chronic obstructive pulmonary disease exacerbation.", "The patient had pneumoretroperitoneum."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 63-year-old male.", "The patient was admitted with an uncontrolled itching sensation.", "The patient had whole body jaundice.", "Six months prior, the patient had experienced intractable itching.", "The patient had obstructive-pattern jaundice.", "Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde biliary drainage were performed.", "ERCP and endoscopic retrograde biliary drainage ruled out malignancy.", "The patient's medical history included hypertension.", "The patient's medical history included diabetes mellitus.", "The patient's hypertension and diabetes mellitus were well controlled by medication.", "The patient was an ex-smoker of ten years.", "The patient was a social drinker.", "No previous illnesses were reported.", "There was no family history of oncologic diseases.", "There was no family history of rheumatic diseases.", "The physical examination revealed icteric sclerae.", "The physical examination revealed multiple itching scratches on the skin.", "The patient\u2019s hemoglobin was 10 g/dL.", "The patient\u2019s hematocrit was 30.6%.", "The patient\u2019s platelet count was 348000/L.", "The patient\u2019s aspartate aminotransferase was 71 U/L.", "The patient\u2019s alanine aminotransferase level was 44 U/L.", "The patient\u2019s gamma-glutamyl transferase level was 233 U/L.", "The patient\u2019s alkaline phosphatase level was 315 U/L.", "The patient\u2019s total bilirubin level was 8.6 mg/dL.", "The patient\u2019s BUN level was 26.7 mg/dL.", "The patient\u2019s creatinine level was 1.37 mg/dL.", "The patient\u2019s erythrocyte sedimentation rate was 120 mm/h.", "The patient\u2019s C reactive protein (CRP) level was 1.81 mg/dL.", "The patient\u2019s antinuclear antibody titer was 1:2560.", "The patient\u2019s antinuclear antibody titer had a nucleolar pattern.", "The patient\u2019s IgG level was 2416 mg/dL.", "The patient\u2019s serum IgG4 level was 465 mg/dL.", "Abdominal computed tomography (CT) showed intrahepatic duct (IHD) dilatation.", "Abdominal CT showed intraductal soft tissue attenuation.", "Abdominal CT showed periductal enhancement.", "The common bile duct (CBD) was dilated.", "The CBD had mild luminal narrowing.", "There were no findings of AIP.", "There was no definite obstructive lesion.", "There was no suspected malignancy.", "CT showed fibrotic enhancement around the infrarenal aorta."], "summary_subclaims": ["The patient is a 63-year-old male.", "The patient had a prominent itching sensation.", "The patient had wholebody jaundice.", "The patient showed obstructive-pattern jaundice.", "The patient had an elevated IgG4 level.", "The patient had infiltration of a large number of IgG4-positive cells in the ampulla of Vater.", "The imaging findings included intrahepatic duct and common bile duct dilation.", "The diagnosis was IgG4-SC compatible with the 2019 ACR/EULAR classification criteria.", "The planned treatment was high-dose glucocorticoid followed by cyclophosphamide pulse therapy.", "After treatment with high-dose GC and an immunosuppressant, imaging studies showed that intrahepatic duct dilatation had completely resolved."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 63-year-old male.", "The patient was admitted with an uncontrolled itching sensation.", "The patient had whole body jaundice.", "Six months prior, the patient had experienced intractable itching.", "The patient had obstructive-pattern jaundice.", "Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde biliary drainage were performed.", "ERCP and endoscopic retrograde biliary drainage ruled out malignancy.", "The patient's medical history included hypertension.", "The patient's medical history included diabetes mellitus.", "The patient's hypertension and diabetes mellitus were well controlled by medication.", "The patient was an ex-smoker of ten years.", "The patient was a social drinker.", "No previous illnesses were reported.", "There was no family history of oncologic diseases.", "There was no family history of rheumatic diseases.", "The physical examination revealed icteric sclerae.", "The physical examination revealed multiple itching scratches on the skin.", "The patient\u2019s hemoglobin was 10 g/dL.", "The patient\u2019s hematocrit was 30.6%.", "The patient\u2019s platelet count was 348000/L.", "The patient\u2019s aspartate aminotransferase was 71 U/L.", "The patient\u2019s alanine aminotransferase level was 44 U/L.", "The patient\u2019s gamma-glutamyl transferase level was 233 U/L.", "The patient\u2019s alkaline phosphatase level was 315 U/L.", "The patient\u2019s total bilirubin level was 8.6 mg/dL.", "The patient\u2019s BUN level was 26.7 mg/dL.", "The patient\u2019s creatinine level was 1.37 mg/dL.", "The patient\u2019s erythrocyte sedimentation rate was 120 mm/h.", "The patient\u2019s C reactive protein (CRP) level was 1.81 mg/dL.", "The patient\u2019s antinuclear antibody titer was 1:2560.", "The patient\u2019s antinuclear antibody titer had a nucleolar pattern.", "The patient\u2019s IgG level was 2416 mg/dL.", "The patient\u2019s serum IgG4 level was 465 mg/dL.", "Abdominal computed tomography (CT) showed intrahepatic duct (IHD) dilatation.", "Abdominal CT showed intraductal soft tissue attenuation.", "Abdominal CT showed periductal enhancement.", "The common bile duct (CBD) was dilated.", "The CBD had mild luminal narrowing.", "There were no findings of AIP.", "There was no definite obstructive lesion.", "There was no suspected malignancy.", "CT showed fibrotic enhancement around the infrarenal aorta."], "index": 14, "original_id": "multiclinsum_test_53_en.txt", "split": "test", "summary_subclaims": ["The patient is a 63-year-old male.", "The patient had a prominent itching sensation.", "The patient had wholebody jaundice.", "The patient showed obstructive-pattern jaundice.", "The patient had an elevated IgG4 level.", "The patient had infiltration of a large number of IgG4-positive cells in the ampulla of Vater.", "The imaging findings included intrahepatic duct and common bile duct dilation.", "The diagnosis was IgG4-SC compatible with the 2019 ACR/EULAR classification criteria.", "The planned treatment was high-dose glucocorticoid followed by cyclophosphamide pulse therapy.", "After treatment with high-dose GC and an immunosuppressant, imaging studies showed that intrahepatic duct dilatation had completely resolved."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 40-year-old female.", "She had mild hepatic dysfunction.", "She did not smoke.", "She had a drinking habit.", "At age 28, she had elevated platelet counts (> 100 \u00d7 104/\u03bcL).", "ET had been diagnosed based on bone marrow biopsy results.", "She was prescribed aspirin (100 mg/day) and anagrelide (2.5 mg/day).", "She had been prescribed ebastine for itching.", "On admission, her ALT level was 82 IU/L.", "Her ALT level had improved from that recorded previously.", "Her platelet count was 62.4 \u00d7 104/\u03bcL.", "Prothrombin time and activated partial thromboplastin time were normal.", "Abdominal ultrasonography revealed a cecal tumor.", "Colonoscopy revealed advanced cecal cancer.", "CT indicated cecal wall thickening.", "The patient recovered from liver dysfunction without treatment.", "She stopped taking oral aspirin 1 week prior to surgery.", "She continued anagrelide until the day before surgery.", "To prevent thrombosis, she wore elastic stockings.", "Intermittent pneumatic compression was performed during surgery.", "Laparoscopic-assisted ileocecal resection was performed.", "The operative duration was 202 min.", "Blood loss was 34 mL.", "From the first postoperative day, she started walking.", "From the first postoperative day, she started drinking water.", "From the first postoperative day, she resumed oral anagrelide intake.", "She resumed oral aspirin intake on the fifth postoperative day.", "Her perioperative platelet count was controlled to approximately 40\u201360 \u00d7 104/\u03bcL.", "Prothrombin time and activated partial thromboplastin time did not show abnormal values during the perioperative period.", "The postoperative course was uneventful.", "She was discharged on the seventh postoperative day.", "The tumor pathological stage was T3N1M0 (Stage IIIB).", "She received intravenous oxaliplatin plus oral capecitabine as postoperative adjuvant chemotherapy.", "After one course, she again experienced liver dysfunction (AST 388 IU/L; ALT 531 IU/L).", "Her platelet count decreased to 17.8 \u00d7 104/\u03bcL.", "She was asked to discontinue anagrelide and aspirin that day onwards.", "Five days later, her platelet count recovered to 50 \u00d7 104/\u03bcL.", "She resumed taking anagrelide and aspirin.", "She refused to resume any adjuvant chemotherapy after this incident.", "Her liver function normalized gradually in 4 months.", "There were no clinical signs of thrombosis.", "There was no appearance of a new thrombus on contrast-enhanced CT 6 months after the operation.", "One-year post operation, she is well without tumor recurrence or new metastasis."], "summary_subclaims": ["A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction.", "She had been previously diagnosed with ET.", "Aspirin and anagrelide had been prescribed.", "Subsequent examination at our hospital revealed cecal cancer.", "Distant metastasis was absent.", "Laparoscopic ileocecal resection was performed.", "Anagrelide was discontinued only on the surgery day.", "She was discharged on the seventh postoperative day without thrombosis or hemorrhage.", "When capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia.", "Anagrelide was discontinued.", "Five days later, her platelet count recovered.", "Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy.", "Her liver function normalized gradually in 4\u2009months.", "One-year post operation, she is well without tumor recurrence or new metastasis."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 40-year-old female.", "She had mild hepatic dysfunction.", "She did not smoke.", "She had a drinking habit.", "At age 28, she had elevated platelet counts (> 100 \u00d7 104/\u03bcL).", "ET had been diagnosed based on bone marrow biopsy results.", "She was prescribed aspirin (100 mg/day) and anagrelide (2.5 mg/day).", "She had been prescribed ebastine for itching.", "On admission, her ALT level was 82 IU/L.", "Her ALT level had improved from that recorded previously.", "Her platelet count was 62.4 \u00d7 104/\u03bcL.", "Prothrombin time and activated partial thromboplastin time were normal.", "Abdominal ultrasonography revealed a cecal tumor.", "Colonoscopy revealed advanced cecal cancer.", "CT indicated cecal wall thickening.", "The patient recovered from liver dysfunction without treatment.", "She stopped taking oral aspirin 1 week prior to surgery.", "She continued anagrelide until the day before surgery.", "To prevent thrombosis, she wore elastic stockings.", "Intermittent pneumatic compression was performed during surgery.", "Laparoscopic-assisted ileocecal resection was performed.", "The operative duration was 202 min.", "Blood loss was 34 mL.", "From the first postoperative day, she started walking.", "From the first postoperative day, she started drinking water.", "From the first postoperative day, she resumed oral anagrelide intake.", "She resumed oral aspirin intake on the fifth postoperative day.", "Her perioperative platelet count was controlled to approximately 40\u201360 \u00d7 104/\u03bcL.", "Prothrombin time and activated partial thromboplastin time did not show abnormal values during the perioperative period.", "The postoperative course was uneventful.", "She was discharged on the seventh postoperative day.", "The tumor pathological stage was T3N1M0 (Stage IIIB).", "She received intravenous oxaliplatin plus oral capecitabine as postoperative adjuvant chemotherapy.", "After one course, she again experienced liver dysfunction (AST 388 IU/L; ALT 531 IU/L).", "Her platelet count decreased to 17.8 \u00d7 104/\u03bcL.", "She was asked to discontinue anagrelide and aspirin that day onwards.", "Five days later, her platelet count recovered to 50 \u00d7 104/\u03bcL.", "She resumed taking anagrelide and aspirin.", "She refused to resume any adjuvant chemotherapy after this incident.", "Her liver function normalized gradually in 4 months.", "There were no clinical signs of thrombosis.", "There was no appearance of a new thrombus on contrast-enhanced CT 6 months after the operation.", "One-year post operation, she is well without tumor recurrence or new metastasis."], "index": 16, "original_id": "multiclinsum_test_1612_en.txt", "split": "test", "summary_subclaims": ["A 40-year-old woman was admitted to our hospital after presenting with liver dysfunction.", "She had been previously diagnosed with ET.", "Aspirin and anagrelide had been prescribed.", "Subsequent examination at our hospital revealed cecal cancer.", "Distant metastasis was absent.", "Laparoscopic ileocecal resection was performed.", "Anagrelide was discontinued only on the surgery day.", "She was discharged on the seventh postoperative day without thrombosis or hemorrhage.", "When capecitabine and oxaliplatin were administered as adjuvant chemotherapy with continued anagrelide administration, she experienced hepatic dysfunction and thrombocytopenia.", "Anagrelide was discontinued.", "Five days later, her platelet count recovered.", "Subsequently, anagrelide and aspirin administration was resumed, without any adjuvant chemotherapy.", "Her liver function normalized gradually in 4\u2009months.", "One-year post operation, she is well without tumor recurrence or new metastasis."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 55-year-old woman.", "The patient had a history of smoking.", "The patient had a history of prolonged opium inhalation.", "The patient was referred to Ghaem clinic in Mashhad.", "The patient had dysphonia.", "The patient had hoarseness.", "The patient had occasional aspiration since last year.", "No sign of odynodysphagia was observed.", "No sign of stridor was observed.", "No sign of dyspnea was observed.", "The patient did not previously undergo any treatment.", "In laryngoscopy, prior to surgery, left arytenoid was tumoral.", "In laryngoscopy, prior to surgery, left aryepiglottic fold was tumoral.", "In laryngoscopy, prior to surgery, left false vocal cord was tumoral.", "In laryngoscopy, prior to surgery, left true vocal cord was tumoral.", "In laryngoscopy, prior to surgery, anterior commissure was tumoral.", "In laryngoscopy, prior to surgery, subglottic region was tumoral.", "In laryngoscopy, prior to surgery, other parts of the larynx and hypopharynx were normal.", "The left vocal cord was fixed.", "In the preoperative computed tomography scan, there was transglottic involvement on the left side.", "In the preoperative computed tomography scan, cervical lymphadenopathy was not detected.", "Laryngeal cartilage and hyoid bone were reported to be normal.", "The right paraglottic space was involved.", "The epiglottis was normal.", "The tongue was normal.", "The esophagus was normal.", "The trachea was normal.", "The thyroid was normal.", "The biopsy of the affected areas represented well-differentiated squamous cell carcinoma.", "Chest X-rays were normal.", "Liver function tests were normal.", "The patient was ultimately diagnosed with transglottic squamous cell carcinoma of the T3N0M0 stage.", "Total laryngectomy with total thyroidectomy was performed.", "Bilateral elective cervical lymph node dissection level I-IV was performed.", "The tumor was macroscopically removed.", "The surgical margin was checked with a frozen section for the presence of the tumor.", "The neopharynx was closed with the suturing technique.", "The patient was diagnosed with salivary fistula.", "The patient was initially treated with conservative management.", "Total parenteral nutrition was part of the conservative management.", "Pressure dressing was part of the conservative management.", "Broad-spectrum antibiotic therapy was part of the conservative management.", "In spite of conservative treatment, the fistula was not recovered after 3 weeks.", "Jejunostomy was inserted instead of gastrostomy.", "Intestinal gavage was initiated.", "There was no evidence of positive surgical margins on permanent specimen pathology.", "A thoracic surgeon was consulted about gastric pull-up.", "It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach.", "Informed consent was obtained from the patient before the surgery.", "The case underwent an endoscopy to locate internal fistula orifice.", "In gastrointestinal endoscopy, a fistula was identified in the anterior wall of the neopharynx.", "Fibrin glue was prepared from the patient\u2019s blood sample.", "The PCF tract was endoscopically localized.", "An ERCP catheter passed through the fistula.", "The de-epithelialization of fistula orifice was performed.", "Fibrin glue was endoscopically injected into the fistula tract via the catheter.", "A nasogastric tube was inserted under the endoscopic view.", "Following the administration of fibrin glue, the patient underwent pressure dressing.", "Two weeks later, the case was discharged with an NG tube and antibiotics.", "One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test.", "The fistula was completely closed one month after the fibrin glue injection.", "The NG tube was drawn one month after the fibrin administration.", "The patient returned to normal oral feeding without any problems.", "Fibrin glue preparation required two components: fibrinogen and thrombin.", "Fibrinogen is prepared after the extraction of blood from the patient's vein or blood bank.", "Thrombin is produced as a ready-to-use commercial solution.", "Thrombin is extractable from the plasma of the patient.", "Thrombin is diluted in distilled water and combined with aminocaproic acid.", "The first method of fibrinogen preparation is plasma.", "The second method of fibrinogen preparation is plasma cryoprecipitate.", "The third method of fibrinogen preparation is plasma cryoprecipitate.", "In this study, the second method was used for the preparation of fibrin glue.", "In this case, fibrin glue was injected by endoscopy.", "Under intravenous sedation and left lateral decubitus position, the endoscope entered into neopharynx through the mouth.", "The location of the fistula was observed in the anterior neopharyngeal wall.", "The ERCP catheter passed through the endoscope into the fistula.", "The de-epithelialization of fistula orifice was performed.", "Five cc of the fibrin glue was endoscopically injected into the fistula tract via the catheter.", "Some fibrin glue was percutaneously injected into the outer orifice of the fistula.", "The patient follow-up showed that the fistula was completely closed three months after the administration.", "The NG tube was removed.", "Oral nutrition was successfully started.", "The subsequent follow-up demonstrated that the patient tolerated a soft diet and fluids without any problems."], "summary_subclaims": ["The patient was a 55-year-old woman.", "She had a transglottic squamous cell carcinoma of the T3N0M0 stage.", "She had PCF development following total laryngectomy surgery.", "She had total thyroidectomy and bilateral elective cervical lymph node dissection level I-IV.", "The fistula was not recovered after 3 weeks of conservative treatment.", "It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach.", "One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test.", "The fistula was completely closed."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 55-year-old woman.", "The patient had a history of smoking.", "The patient had a history of prolonged opium inhalation.", "The patient was referred to Ghaem clinic in Mashhad.", "The patient had dysphonia.", "The patient had hoarseness.", "The patient had occasional aspiration since last year.", "No sign of odynodysphagia was observed.", "No sign of stridor was observed.", "No sign of dyspnea was observed.", "The patient did not previously undergo any treatment.", "In laryngoscopy, prior to surgery, left arytenoid was tumoral.", "In laryngoscopy, prior to surgery, left aryepiglottic fold was tumoral.", "In laryngoscopy, prior to surgery, left false vocal cord was tumoral.", "In laryngoscopy, prior to surgery, left true vocal cord was tumoral.", "In laryngoscopy, prior to surgery, anterior commissure was tumoral.", "In laryngoscopy, prior to surgery, subglottic region was tumoral.", "In laryngoscopy, prior to surgery, other parts of the larynx and hypopharynx were normal.", "The left vocal cord was fixed.", "In the preoperative computed tomography scan, there was transglottic involvement on the left side.", "In the preoperative computed tomography scan, cervical lymphadenopathy was not detected.", "Laryngeal cartilage and hyoid bone were reported to be normal.", "The right paraglottic space was involved.", "The epiglottis was normal.", "The tongue was normal.", "The esophagus was normal.", "The trachea was normal.", "The thyroid was normal.", "The biopsy of the affected areas represented well-differentiated squamous cell carcinoma.", "Chest X-rays were normal.", "Liver function tests were normal.", "The patient was ultimately diagnosed with transglottic squamous cell carcinoma of the T3N0M0 stage.", "Total laryngectomy with total thyroidectomy was performed.", "Bilateral elective cervical lymph node dissection level I-IV was performed.", "The tumor was macroscopically removed.", "The surgical margin was checked with a frozen section for the presence of the tumor.", "The neopharynx was closed with the suturing technique.", "The patient was diagnosed with salivary fistula.", "The patient was initially treated with conservative management.", "Total parenteral nutrition was part of the conservative management.", "Pressure dressing was part of the conservative management.", "Broad-spectrum antibiotic therapy was part of the conservative management.", "In spite of conservative treatment, the fistula was not recovered after 3 weeks.", "Jejunostomy was inserted instead of gastrostomy.", "Intestinal gavage was initiated.", "There was no evidence of positive surgical margins on permanent specimen pathology.", "A thoracic surgeon was consulted about gastric pull-up.", "It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach.", "Informed consent was obtained from the patient before the surgery.", "The case underwent an endoscopy to locate internal fistula orifice.", "In gastrointestinal endoscopy, a fistula was identified in the anterior wall of the neopharynx.", "Fibrin glue was prepared from the patient\u2019s blood sample.", "The PCF tract was endoscopically localized.", "An ERCP catheter passed through the fistula.", "The de-epithelialization of fistula orifice was performed.", "Fibrin glue was endoscopically injected into the fistula tract via the catheter.", "A nasogastric tube was inserted under the endoscopic view.", "Following the administration of fibrin glue, the patient underwent pressure dressing.", "Two weeks later, the case was discharged with an NG tube and antibiotics.", "One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test.", "The fistula was completely closed one month after the fibrin glue injection.", "The NG tube was drawn one month after the fibrin administration.", "The patient returned to normal oral feeding without any problems.", "Fibrin glue preparation required two components: fibrinogen and thrombin.", "Fibrinogen is prepared after the extraction of blood from the patient's vein or blood bank.", "Thrombin is produced as a ready-to-use commercial solution.", "Thrombin is extractable from the plasma of the patient.", "Thrombin is diluted in distilled water and combined with aminocaproic acid.", "The first method of fibrinogen preparation is plasma.", "The second method of fibrinogen preparation is plasma cryoprecipitate.", "The third method of fibrinogen preparation is plasma cryoprecipitate.", "In this study, the second method was used for the preparation of fibrin glue.", "In this case, fibrin glue was injected by endoscopy.", "Under intravenous sedation and left lateral decubitus position, the endoscope entered into neopharynx through the mouth.", "The location of the fistula was observed in the anterior neopharyngeal wall.", "The ERCP catheter passed through the endoscope into the fistula.", "The de-epithelialization of fistula orifice was performed.", "Five cc of the fibrin glue was endoscopically injected into the fistula tract via the catheter.", "Some fibrin glue was percutaneously injected into the outer orifice of the fistula.", "The patient follow-up showed that the fistula was completely closed three months after the administration.", "The NG tube was removed.", "Oral nutrition was successfully started.", "The subsequent follow-up demonstrated that the patient tolerated a soft diet and fluids without any problems."], "index": 13, "original_id": "multiclinsum_test_112_en.txt", "split": "test", "summary_subclaims": ["The patient was a 55-year-old woman.", "She had a transglottic squamous cell carcinoma of the T3N0M0 stage.", "She had PCF development following total laryngectomy surgery.", "She had total thyroidectomy and bilateral elective cervical lymph node dissection level I-IV.", "The fistula was not recovered after 3 weeks of conservative treatment.", "It was decided to perform fibrin glue injection into the fistula tract via the endoscopic approach.", "One month after the fibrin glue injection, no evidence of contrast extravasation was observed on barium swallow test.", "The fistula was completely closed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 4-day-old male infant.", "He was born at 40 weeks\u2019 gestational age.", "He weighed 3660 g at birth.", "He was delivered at term by episiotomy combined with forceps.", "He was admitted to the Department of Neonatology of The Second Hospital of Jilin University due to dyspnea in February 2022.", "No cutaneous lesions were observed.", "Brain MRI showed a short T1 strip signal shadow (hemorrhage) under the cranial plate of the occipital region on both sides.", "The right eye appeared normal in the routine retinal screening performed with RetCam 3.", "A color fundus photograph of the left eye revealed a solitary yellowish-white flat mass with an approximate size of 1.5-disc diameters located in the nasal retina.", "Fluorescein angiography showed diffuse hyperfluorescence with slight fluorescence leakage.", "On B-scan ultrasound, the mass was inapparent, with no distinct foci of calcification.", "No treatment was administered.", "Follow-up reexaminations were recommended.", "Three months later, regression in the size of the retinal mass was observed.", "Fluorescein angiography showed decreased vascularization of the lesion and slight mottled hyperfluorescence over its surface.", "Seven months later, the fundus examination indicated no lesion in the left eye.", "Fluorescein angiography showed mild tortuous vessels without leakage.", "The right retina was normal.", "The clinical course suggested that the isolated RAH may undergo spontaneous regression."], "summary_subclaims": ["An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant.", "At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina.", "Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage.", "Seven months later, the fundus examination showed no lesion in the left eye.", "Fluorescein angiography revealed mild tortuous vessels without leakage."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 4-day-old male infant.", "He was born at 40 weeks\u2019 gestational age.", "He weighed 3660 g at birth.", "He was delivered at term by episiotomy combined with forceps.", "He was admitted to the Department of Neonatology of The Second Hospital of Jilin University due to dyspnea in February 2022.", "No cutaneous lesions were observed.", "Brain MRI showed a short T1 strip signal shadow (hemorrhage) under the cranial plate of the occipital region on both sides.", "The right eye appeared normal in the routine retinal screening performed with RetCam 3.", "A color fundus photograph of the left eye revealed a solitary yellowish-white flat mass with an approximate size of 1.5-disc diameters located in the nasal retina.", "Fluorescein angiography showed diffuse hyperfluorescence with slight fluorescence leakage.", "On B-scan ultrasound, the mass was inapparent, with no distinct foci of calcification.", "No treatment was administered.", "Follow-up reexaminations were recommended.", "Three months later, regression in the size of the retinal mass was observed.", "Fluorescein angiography showed decreased vascularization of the lesion and slight mottled hyperfluorescence over its surface.", "Seven months later, the fundus examination indicated no lesion in the left eye.", "Fluorescein angiography showed mild tortuous vessels without leakage.", "The right retina was normal.", "The clinical course suggested that the isolated RAH may undergo spontaneous regression."], "index": 20, "original_id": "multiclinsum_test_2309_en.txt", "split": "test", "summary_subclaims": ["An isolated retinal astrocytic hamartoma was detected in the nasal retina of the left eye of a 4-day-old male infant.", "At the time of initial presentation, we detected a solitary yellowish-white flat mass with an approximate size of 1.5 disc diameters in the nasal retina.", "Fluorescein angiography (FA) revealed a diffuse hyperfluorescence with slight fluorescence leakage.", "Seven months later, the fundus examination showed no lesion in the left eye.", "Fluorescein angiography revealed mild tortuous vessels without leakage."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 27-year-old male involved in a motor vehicle accident was brought to Emergency Department room with respiratory distress.", "He was intubated upon arrival due to low Glasgow Coma Scale (GCS) with extensive maxillofacial injuries.", "Thoracic examination showed reduced air entry at right chest wall region.", "Palpable crepitus on his right neck region was due to subcutaneous emphysema from the neck to the anterior chest wall.", "A curvilinear transducer on the right second intercostal ribs showed the absence of sliding signs, suggestive of right pneumothorax.", "A FAST scan was performed.", "On subxiphoid view of the heart, only the right ventricle was seen during diastole.", "Part of the cardiac image was obscured by A-lines.", "This raised a suspicion of pneumopericardium.", "Only A-lines were visible on parasternal long axis (PLAX), parasternal short axis (PSAX), and apical four chamber (A4C) views.", "The patient underwent head and chest CT scan.", "The CT scan confirmed the diagnosis of Le Fort II facial bone injury.", "The CT scan confirmed the diagnosis of right pneumothorax.", "The CT scan confirmed the diagnosis of right pulmonary contusion.", "The CT scan confirmed the diagnosis of pneumopericardium.", "The pneumopericardium was treated conservatively."], "summary_subclaims": ["A young man involved in a car accident and sustained blunt thoracic injuries, among others.", "As part of primary survey, FAST scan was performed.", "Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines.", "Other cardiac windows showed only A-lines, as well.", "A suspicion of pneumopericardium was raised.", "CT scan confirmed the diagnosis."]}, "extra_info": {"fulltext_subclaims": ["A 27-year-old male involved in a motor vehicle accident was brought to Emergency Department room with respiratory distress.", "He was intubated upon arrival due to low Glasgow Coma Scale (GCS) with extensive maxillofacial injuries.", "Thoracic examination showed reduced air entry at right chest wall region.", "Palpable crepitus on his right neck region was due to subcutaneous emphysema from the neck to the anterior chest wall.", "A curvilinear transducer on the right second intercostal ribs showed the absence of sliding signs, suggestive of right pneumothorax.", "A FAST scan was performed.", "On subxiphoid view of the heart, only the right ventricle was seen during diastole.", "Part of the cardiac image was obscured by A-lines.", "This raised a suspicion of pneumopericardium.", "Only A-lines were visible on parasternal long axis (PLAX), parasternal short axis (PSAX), and apical four chamber (A4C) views.", "The patient underwent head and chest CT scan.", "The CT scan confirmed the diagnosis of Le Fort II facial bone injury.", "The CT scan confirmed the diagnosis of right pneumothorax.", "The CT scan confirmed the diagnosis of right pulmonary contusion.", "The CT scan confirmed the diagnosis of pneumopericardium.", "The pneumopericardium was treated conservatively."], "index": 21, "original_id": "multiclinsum_test_1133_en.txt", "split": "test", "summary_subclaims": ["A young man involved in a car accident and sustained blunt thoracic injuries, among others.", "As part of primary survey, FAST scan was performed.", "Subxiphoid view to look for evidence of pericardial effusion showed part of the cardiac image obscured by A-lines.", "Other cardiac windows showed only A-lines, as well.", "A suspicion of pneumopericardium was raised.", "CT scan confirmed the diagnosis."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 2 years and 5-month-old boy.", "The patient was admitted for fever with onset 3 days before admission.", "The fever was associated with abdominal pain and diarrhea within the last 24 hours.", "The anamnesis did not reveal any possible exposure to COVID-19 infections.", "The clinical exam at admission revealed bilateral palpebral edema.", "The clinical exam at admission revealed conjunctivitis.", "The clinical exam at admission revealed mucocutaneous signs of dehydration.", "The clinical exam at admission revealed abdominal tenderness at palpation.", "The patient weighed 15 kilograms.", "The laboratory test showed lymphopenia (1560/mm3).", "The laboratory test showed thrombocytopenia (108x103/mm3).", "The laboratory test showed anemia (hemoglobin \u2013 Hb 10.9 g/dL).", "The laboratory test showed elevated C-reactive protein \u2013 CRP (162 mg/L).", "The laboratory test showed elevated ferritin levels (389.3 ng/mL).", "The laboratory test showed hyponatremia (132 mmol/L).", "The laboratory test showed hypokalemia (3.94 mmol/L).", "The laboratory test showed hypertriglyceridemia (476.3 mg/dL).", "The laboratory test showed elevated D-dimer (>5 \u03bcg/ml).", "The laboratory test showed increased troponin (16.6 ng/L).", "The laboratory test showed increased NT-proBNP (19,831 pg/ml).", "The rapid urine exam was negative.", "The chest X-ray showed no pathological findings.", "The abdominal ultrasound showed no pathological findings.", "The echocardiography showed no pathological findings.", "The blood culture was negative.", "The urine culture was negative.", "We raised the suspicion of pediatric inflammatory multisystem syndrome possibly associated to COVID-19.", "The RT-PCR test for SARS-CoV-2 infection was negative.", "The serology (IgG anti-SARS-CoV-2) was positive.", "We established the diagnosis of PIMS-TS.", "We initiated intravenous immunoglobulin in a dose of 2 g/kg/day.", "We initiated empirical antibiotic (ceftriaxone).", "We initiated anticoagulation therapy (low-molecular weight heparin).", "We administered symptomatic drugs (antipyretics, antiemetics, and antidiarrheics).", "The fever persisted for the following 36 hours with no clinical improvement.", "The laboratory test on the 3rd day showed an increase of the CRP value (216.65 mg/L).", "The laboratory test on the 3rd day showed persistence of elevated NT-proBNP (9,884.2 pg/mL).", "The laboratory test on the 3rd day showed persistence of elevated D-dimer (1,198 ng/mL).", "The laboratory test on the 3rd day showed hypoalbuminemia (2.45 g/dL).", "We initiated intravenous methylprednisolone (10 mg/kg/day) for 3 days.", "We initiated substitutive treatment with human albumin.", "The echocardiography showed minimal pericardial effusion.", "The echocardiography showed slight dilation of the left cavities.", "The echocardiography showed regional wall motion abnormalities with dyskinesia of the inferior and infero-septal basal segments of the LV.", "The echocardiography showed LV systolic dysfunction with LV ejection fraction of 40%.", "The echocardiography showed mild mitral regurgitation.", "The echocardiography showed no coronary impairment.", "We associated angiotensin converting enzyme inhibitors (Lisinopril).", "We associated Spironolactone.", "We associated Hydrochlorothiazide.", "Serial echocardiography showed resorption of the pericardial effusion.", "Serial echocardiography showed improvement of LV function.", "Serial echocardiography showed decreased serum levels of NT-proBNP (123.1 pg/mL).", "Serial echocardiography showed decreased serum levels of troponin (5.2 pg/mL).", "The patient was discharged on the 11th day of admission.", "The patient was discharged without any complaints.", "Most of the laboratory parameters were within normal ranges at discharge.", "D-dimer was not within normal ranges at discharge.", "We recommended continuation of anticoagulant therapy for another week.", "We recommended continuation of Lisinopril for the following 2 weeks.", "We recommended continuation of Spironolactone for the following 2 weeks.", "We recommended continuation of Hydrochlorothiazide for the following 2 weeks."], "summary_subclaims": ["The patient was a 2 years and 5-month-old boy.", "The patient was admitted for fever, abdominal pain, and diarrhea.", "The clinical exam at admission revealed influenced general status.", "The clinical exam at admission revealed bilateral palpebral edema.", "The clinical exam at admission revealed conjunctivitis.", "The clinical exam at admission revealed mucocutaneous signs of dehydration.", "The clinical exam at admission revealed abdominal tenderness at palpation.", "The laboratory tests showed lymphopenia.", "The laboratory tests showed thrombocytopenia.", "The laboratory tests showed anemia.", "The laboratory tests showed elevated C-reactive protein.", "The laboratory tests showed elevated erythrocyte sedimentation rate.", "The laboratory tests showed elevated ferritin levels.", "The laboratory tests showed hyponatremia.", "The laboratory tests showed hypokalemia.", "The laboratory tests showed hypertriglyceridemia.", "The laboratory tests showed elevated D-dimer.", "The laboratory tests showed increased troponin.", "The laboratory tests showed increased NT-proBNP.", "The RT-PCR test for SARS-CoV-2 infection was negative.", "The serology for SARS-CoV-2 was positive.", "The diagnosis of PIMS-TS was established.", "Intravenous immunoglobulin was initiated.", "Empirical antibiotic therapy was initiated.", "Anticoagulation therapy was initiated.", "Symptomatic drugs were initiated.", "The clinical course and laboratory parameters worsened.", "The 2nd echocardiography showed minimal pericardial effusion.", "The 2nd echocardiography showed slight dilation of the left cavities.", "The 2nd echocardiography showed dyskinesia of the inferior and septal basal segments of the left ventricle.", "The 2nd echocardiography showed left ventricular systolic dysfunction.", "Intravenous methylprednisolone was added.", "Angiotensin converting enzyme inhibitors were added.", "Spironolactone was added.", "Hydrochlorothiazide was added.", "The clinical evolution was outstandingly favorable."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 2 years and 5-month-old boy.", "The patient was admitted for fever with onset 3 days before admission.", "The fever was associated with abdominal pain and diarrhea within the last 24 hours.", "The anamnesis did not reveal any possible exposure to COVID-19 infections.", "The clinical exam at admission revealed bilateral palpebral edema.", "The clinical exam at admission revealed conjunctivitis.", "The clinical exam at admission revealed mucocutaneous signs of dehydration.", "The clinical exam at admission revealed abdominal tenderness at palpation.", "The patient weighed 15 kilograms.", "The laboratory test showed lymphopenia (1560/mm3).", "The laboratory test showed thrombocytopenia (108x103/mm3).", "The laboratory test showed anemia (hemoglobin \u2013 Hb 10.9 g/dL).", "The laboratory test showed elevated C-reactive protein \u2013 CRP (162 mg/L).", "The laboratory test showed elevated ferritin levels (389.3 ng/mL).", "The laboratory test showed hyponatremia (132 mmol/L).", "The laboratory test showed hypokalemia (3.94 mmol/L).", "The laboratory test showed hypertriglyceridemia (476.3 mg/dL).", "The laboratory test showed elevated D-dimer (>5 \u03bcg/ml).", "The laboratory test showed increased troponin (16.6 ng/L).", "The laboratory test showed increased NT-proBNP (19,831 pg/ml).", "The rapid urine exam was negative.", "The chest X-ray showed no pathological findings.", "The abdominal ultrasound showed no pathological findings.", "The echocardiography showed no pathological findings.", "The blood culture was negative.", "The urine culture was negative.", "We raised the suspicion of pediatric inflammatory multisystem syndrome possibly associated to COVID-19.", "The RT-PCR test for SARS-CoV-2 infection was negative.", "The serology (IgG anti-SARS-CoV-2) was positive.", "We established the diagnosis of PIMS-TS.", "We initiated intravenous immunoglobulin in a dose of 2 g/kg/day.", "We initiated empirical antibiotic (ceftriaxone).", "We initiated anticoagulation therapy (low-molecular weight heparin).", "We administered symptomatic drugs (antipyretics, antiemetics, and antidiarrheics).", "The fever persisted for the following 36 hours with no clinical improvement.", "The laboratory test on the 3rd day showed an increase of the CRP value (216.65 mg/L).", "The laboratory test on the 3rd day showed persistence of elevated NT-proBNP (9,884.2 pg/mL).", "The laboratory test on the 3rd day showed persistence of elevated D-dimer (1,198 ng/mL).", "The laboratory test on the 3rd day showed hypoalbuminemia (2.45 g/dL).", "We initiated intravenous methylprednisolone (10 mg/kg/day) for 3 days.", "We initiated substitutive treatment with human albumin.", "The echocardiography showed minimal pericardial effusion.", "The echocardiography showed slight dilation of the left cavities.", "The echocardiography showed regional wall motion abnormalities with dyskinesia of the inferior and infero-septal basal segments of the LV.", "The echocardiography showed LV systolic dysfunction with LV ejection fraction of 40%.", "The echocardiography showed mild mitral regurgitation.", "The echocardiography showed no coronary impairment.", "We associated angiotensin converting enzyme inhibitors (Lisinopril).", "We associated Spironolactone.", "We associated Hydrochlorothiazide.", "Serial echocardiography showed resorption of the pericardial effusion.", "Serial echocardiography showed improvement of LV function.", "Serial echocardiography showed decreased serum levels of NT-proBNP (123.1 pg/mL).", "Serial echocardiography showed decreased serum levels of troponin (5.2 pg/mL).", "The patient was discharged on the 11th day of admission.", "The patient was discharged without any complaints.", "Most of the laboratory parameters were within normal ranges at discharge.", "D-dimer was not within normal ranges at discharge.", "We recommended continuation of anticoagulant therapy for another week.", "We recommended continuation of Lisinopril for the following 2 weeks.", "We recommended continuation of Spironolactone for the following 2 weeks.", "We recommended continuation of Hydrochlorothiazide for the following 2 weeks."], "index": 15, "original_id": "multiclinsum_test_723_en.txt", "split": "test", "summary_subclaims": ["The patient was a 2 years and 5-month-old boy.", "The patient was admitted for fever, abdominal pain, and diarrhea.", "The clinical exam at admission revealed influenced general status.", "The clinical exam at admission revealed bilateral palpebral edema.", "The clinical exam at admission revealed conjunctivitis.", "The clinical exam at admission revealed mucocutaneous signs of dehydration.", "The clinical exam at admission revealed abdominal tenderness at palpation.", "The laboratory tests showed lymphopenia.", "The laboratory tests showed thrombocytopenia.", "The laboratory tests showed anemia.", "The laboratory tests showed elevated C-reactive protein.", "The laboratory tests showed elevated erythrocyte sedimentation rate.", "The laboratory tests showed elevated ferritin levels.", "The laboratory tests showed hyponatremia.", "The laboratory tests showed hypokalemia.", "The laboratory tests showed hypertriglyceridemia.", "The laboratory tests showed elevated D-dimer.", "The laboratory tests showed increased troponin.", "The laboratory tests showed increased NT-proBNP.", "The RT-PCR test for SARS-CoV-2 infection was negative.", "The serology for SARS-CoV-2 was positive.", "The diagnosis of PIMS-TS was established.", "Intravenous immunoglobulin was initiated.", "Empirical antibiotic therapy was initiated.", "Anticoagulation therapy was initiated.", "Symptomatic drugs were initiated.", "The clinical course and laboratory parameters worsened.", "The 2nd echocardiography showed minimal pericardial effusion.", "The 2nd echocardiography showed slight dilation of the left cavities.", "The 2nd echocardiography showed dyskinesia of the inferior and septal basal segments of the left ventricle.", "The 2nd echocardiography showed left ventricular systolic dysfunction.", "Intravenous methylprednisolone was added.", "Angiotensin converting enzyme inhibitors were added.", "Spironolactone was added.", "Hydrochlorothiazide was added.", "The clinical evolution was outstandingly favorable."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 3.7-kg, 1-month-old male.", "He presented at day 24 of life with severe aortic stenosis and coarctation of the aorta.", "He was born at term following an uncomplicated pregnancy.", "On day 5 of life, he was noted to be jaundiced and have a murmur.", "His jaundice resolved, and he was discharged home with cardiac follow-up.", "He had progressive increase in his work of breathing.", "He was not gaining weight.", "An echocardiogram on day 24 of life showed a thickened and dysplastic bicuspid aortic valve with doming of the valve leaflets.", "The flow across the valve was measured on continuous wave doppler at 4 m/s.", "He was found to have a discrete juxta ductal coarctation of the aorta with continuous doppler flow of 2.5 m/s with diastolic tail.", "His ventricular function remained preserved.", "He was started on intravenous prostaglandin.", "Urgent surgery was scheduled.", "The best course of action was felt to be a hybrid approach with surgical end-to-end anastomosis of the aortic arch via a thoracotomy followed by surgical carotid cut down for AoVP.", "The patient was taken to the hybrid catheter laboratory theater.", "He underwent the surgical end-to-end anastomosis via the thoracotomy via the third intercostal space.", "The arch, patent ductus arteriosus, and descending aorta were dissected out.", "Clamps were applied to the arch and descending aorta.", "The coarctation segment was resected.", "The patent ductus arteriosus was ligated.", "An end to side anastomosis was performed between the aortic arch and the descending aorta.", "The pleura and chest were closed in layers.", "The patient was assessed and felt to be stable to proceed with the planned aortic balloon.", "A 5/0 purse string suture was applied to the right common carotid artery.", "A 4-Fr sheath was inserted in the right common carotid artery.", "Ascending aortic pressure was measured at 61/42 mmHg.", "The aortic valve annulus measured 7.5 mm.", "The pressure in the left ventricle was recorded at 110/13 mmHg.", "A peak to peak gradient of 49 mmHg was calculated.", "A 0.014 ChoICE PT extra support coronary wire was placed in the left ventricle.", "A NuMED Tyshak II 6 mm \u00d7 2 cm percutaneous transluminal valvuloplasty balloon catheter was delivered over the ChoICE wire to the aortic valve.", "The balloon was inflated to burst pressure of 4 atmospheres.", "A waist was seen within the balloon and dewaisting occurred.", "The balloon catheter was removed.", "The pressure was measured at 100/10 mmHg.", "Repeat angiogram at the aortic root did not demonstrate any significant aortic incompetence.", "A 7 mm \u00d7 2 cm NuMED Tyshak II percutaneous transluminal valvuloplasty balloon catheter was delivered over the coronary guidewire in position.", "The balloon was inflated to 4 atm.", "A waist was again seen and dewaisting occurred.", "The balloon catheter was removed.", "The pressure within the left ventricle was now 90/10 mmHg.", "The pullback peak to peak gradient between the left ventricle and ascending aorta measured 30 mmHg.", "The catheter and sheath were removed.", "The vessel was repaired by tightening the pursestring suture.", "The skin was closed in layers.", "An echocardiogram performed post procedure showed qualitatively normal ventricular function with no pericardial effusion.", "The arch was unobstructed with doppler flow velocity of 1.6 m/s.", "The aortic valve was bicuspid and obviously dysplastic.", "There was mild flow acceleration across the valve using continuous wave doppler of 3 m/s.", "There was a mean doppler gradient of 15 mmHg.", "There was no obvious aortic incompetency seen.", "The patient was transferred from the hybrid catheter laboratory to the pediatric intensive care unit.", "He remained cardiovascularly stable during his PICU admission.", "He was extubated but had to be reintubated within a few hours due to upper airway issues.", "He was successfully extubated on day 3 post procedure.", "He was transferred to the cardiac ward.", "His admission on the ward was uncomplicated.", "He was discharged on day 6 post intervention.", "At 4 months of age, he was reviewed in the outpatient clinic.", "He was clinically asymptomatic with steady growth.", "His echocardiogram demonstrated qualitatively normal ventricular function.", "The aortic valve stenosis was mild to moderate with flow of 3.7 m/s on continuous wave doppler.", "There was evidence of mild aortic incompetence.", "The aortic arch remained unobstructed with flow velocity of 1.4 m/s.", "His most recent follow-up was at 8 months of age.", "He remained asymptomatic and well with his weight increasing to 9 kg.", "His echocardiogram again demonstrated qualitatively normal ventricular function.", "The bicuspid aortic valve had flow of 3.2 m/s across the valve.", "There was mild aortic incompetence.", "The aortic arch remained unobstructed.", "There were no issues with his carotid artery access.", "There were no ongoing neurological issues."], "summary_subclaims": ["The patient is a 1-month-old baby.", "The baby presented with severe AS.", "The baby presented with CoA.", "The decision was made to perform a hybrid surgical procedure.", "The patient underwent a lateral thoracotomy for repair of the CoA.", "The patient underwent carotid cutdown for aortic balloon valvuloplasty."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 3.7-kg, 1-month-old male.", "He presented at day 24 of life with severe aortic stenosis and coarctation of the aorta.", "He was born at term following an uncomplicated pregnancy.", "On day 5 of life, he was noted to be jaundiced and have a murmur.", "His jaundice resolved, and he was discharged home with cardiac follow-up.", "He had progressive increase in his work of breathing.", "He was not gaining weight.", "An echocardiogram on day 24 of life showed a thickened and dysplastic bicuspid aortic valve with doming of the valve leaflets.", "The flow across the valve was measured on continuous wave doppler at 4 m/s.", "He was found to have a discrete juxta ductal coarctation of the aorta with continuous doppler flow of 2.5 m/s with diastolic tail.", "His ventricular function remained preserved.", "He was started on intravenous prostaglandin.", "Urgent surgery was scheduled.", "The best course of action was felt to be a hybrid approach with surgical end-to-end anastomosis of the aortic arch via a thoracotomy followed by surgical carotid cut down for AoVP.", "The patient was taken to the hybrid catheter laboratory theater.", "He underwent the surgical end-to-end anastomosis via the thoracotomy via the third intercostal space.", "The arch, patent ductus arteriosus, and descending aorta were dissected out.", "Clamps were applied to the arch and descending aorta.", "The coarctation segment was resected.", "The patent ductus arteriosus was ligated.", "An end to side anastomosis was performed between the aortic arch and the descending aorta.", "The pleura and chest were closed in layers.", "The patient was assessed and felt to be stable to proceed with the planned aortic balloon.", "A 5/0 purse string suture was applied to the right common carotid artery.", "A 4-Fr sheath was inserted in the right common carotid artery.", "Ascending aortic pressure was measured at 61/42 mmHg.", "The aortic valve annulus measured 7.5 mm.", "The pressure in the left ventricle was recorded at 110/13 mmHg.", "A peak to peak gradient of 49 mmHg was calculated.", "A 0.014 ChoICE PT extra support coronary wire was placed in the left ventricle.", "A NuMED Tyshak II 6 mm \u00d7 2 cm percutaneous transluminal valvuloplasty balloon catheter was delivered over the ChoICE wire to the aortic valve.", "The balloon was inflated to burst pressure of 4 atmospheres.", "A waist was seen within the balloon and dewaisting occurred.", "The balloon catheter was removed.", "The pressure was measured at 100/10 mmHg.", "Repeat angiogram at the aortic root did not demonstrate any significant aortic incompetence.", "A 7 mm \u00d7 2 cm NuMED Tyshak II percutaneous transluminal valvuloplasty balloon catheter was delivered over the coronary guidewire in position.", "The balloon was inflated to 4 atm.", "A waist was again seen and dewaisting occurred.", "The balloon catheter was removed.", "The pressure within the left ventricle was now 90/10 mmHg.", "The pullback peak to peak gradient between the left ventricle and ascending aorta measured 30 mmHg.", "The catheter and sheath were removed.", "The vessel was repaired by tightening the pursestring suture.", "The skin was closed in layers.", "An echocardiogram performed post procedure showed qualitatively normal ventricular function with no pericardial effusion.", "The arch was unobstructed with doppler flow velocity of 1.6 m/s.", "The aortic valve was bicuspid and obviously dysplastic.", "There was mild flow acceleration across the valve using continuous wave doppler of 3 m/s.", "There was a mean doppler gradient of 15 mmHg.", "There was no obvious aortic incompetency seen.", "The patient was transferred from the hybrid catheter laboratory to the pediatric intensive care unit.", "He remained cardiovascularly stable during his PICU admission.", "He was extubated but had to be reintubated within a few hours due to upper airway issues.", "He was successfully extubated on day 3 post procedure.", "He was transferred to the cardiac ward.", "His admission on the ward was uncomplicated.", "He was discharged on day 6 post intervention.", "At 4 months of age, he was reviewed in the outpatient clinic.", "He was clinically asymptomatic with steady growth.", "His echocardiogram demonstrated qualitatively normal ventricular function.", "The aortic valve stenosis was mild to moderate with flow of 3.7 m/s on continuous wave doppler.", "There was evidence of mild aortic incompetence.", "The aortic arch remained unobstructed with flow velocity of 1.4 m/s.", "His most recent follow-up was at 8 months of age.", "He remained asymptomatic and well with his weight increasing to 9 kg.", "His echocardiogram again demonstrated qualitatively normal ventricular function.", "The bicuspid aortic valve had flow of 3.2 m/s across the valve.", "There was mild aortic incompetence.", "The aortic arch remained unobstructed.", "There were no issues with his carotid artery access.", "There were no ongoing neurological issues."], "index": 19, "original_id": "multiclinsum_test_2724_en.txt", "split": "test", "summary_subclaims": ["The patient is a 1-month-old baby.", "The baby presented with severe AS.", "The baby presented with CoA.", "The decision was made to perform a hybrid surgical procedure.", "The patient underwent a lateral thoracotomy for repair of the CoA.", "The patient underwent carotid cutdown for aortic balloon valvuloplasty."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["An 84-year-old man was admitted to our hospital complaining of muscular weakness while rising up from a chair that led to a fall.", "He was admitted for further studying.", "His head CT and MRI did not report any abnormal structural findings.", "He reported a significant 10% weight loss in the past 6 months.", "The weight loss was associated with decreased appetite and diminished mobility.", "The weight loss was associated with progressive muscular weakness and difficulty rising from chair.", "The physical examination was remarkable for muscular weakness with 3/5 muscle strength in the lower extremities.", "The physical examination showed 4/5 muscle strength in the upper extremities.", "Muscle weakness was confined to the proximal muscles.", "Tendon reflexes were diminished.", "The tone examination revealed mild bilateral quadriceps hypotonia and atrophy.", "There were no other clinical findings on the physical examination.", "The patient reported a medical history of stage G4 chronic kidney disease.", "The patient reported a medical history of erythroid and megakaryocyte-predominant myelodysplastic syndrome.", "The patient reported a medical history of high blood pressure.", "The patient was receiving medication with azacytidine.", "The patient was receiving medication with diltiazem.", "The patient was receiving medication with darbepoetin.", "The patient did not smoke.", "The patient did not consume alcohol.", "The patient did not use illicit drugs.", "The family history was negative for neuromuscular diseases.", "During the present admission, laboratory investigation showed an elevated creatine kinase level of up to 78,924 U/L.", "The creatine kinase level was more than 50 times the normal reference range.", "Elevated serum creatinine was found (4.4 mg/dl).", "Mild hypocalcemia (7.2 mg/dl) was found.", "Mild hyponatremia (130 mg/dl) was found.", "Coprologic examination revealed positive testing for rotavirus.", "Antibody testing reported negative results for antinuclear antibodies (ANAs).", "Antibody testing reported negative results for anti-Jo1.", "Antibody testing reported negative results for anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR).", "Antibody testing reported negative results for anti-Mi-2.", "Antibody testing reported negative results for antiganglioside antibodies.", "The electromyography (EMG) of the upper and lower limbs showed myopathic changes in proximal muscle.", "The EMG showed lower limb predominance.", "The EMG showed short duration, low-amplitude polyphasic potential.", "The EMG showed no positive sharp waves.", "The EMG showed no spontaneous electrical activity.", "An FDG-PET/CT scan was performed searching for neoplasia.", "The FDG-PET/CT scan revealed increased FDG uptake in bilateral quadriceps.", "There was no posterior compartment muscle uptake.", "There was no increased metabolism in any other region of the body.", "An open biopsy of the left vastus lateralis muscle was performed.", "Light microscopy showed 50% myonecrosis.", "There were mild fiber atrophy and lymphocytic infiltrate with CD8+ predominance.", "There was perivascular involvement.", "There were no immune deposits in the skin microscopic examination.", "The diagnosis of PM was made.", "The patient started on intravenous hydration with medium saline solution/bicarbonate for rhabdomyolysis.", "The patient started on prednisone 0.5 mg/kg/day.", "The patient received intravenous immunoglobulin with a total dose of 2 g/kg distributed in 5 days.", "The patient received calcium supplementation.", "The patient continued azacytidine.", "Steroid-sparing drugs such as azathioprine or methotrexate were not considered.", "The renal function of the patient improved within 5 days.", "There was partial recovery of lower limb strength.", "The patient was discharged for external consultation follow-up.", "After 2 months from discharge, the patient had increased muscle strength.", "After 2 months from discharge, the patient had diminished CPK levels.", "The patient received low-dose prednisone as maintenance therapy."], "summary_subclaims": ["The patient is an 84-year-old male.", "The patient had difficulty rising from a chair.", "The patient had a fall.", "Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values.", "Electromyography showed myopathic changes.", "FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps.", "A biopsy revealed lymphocytic predominant infiltrates.", "A biopsy revealed myonecrosis.", "Prednisone was administered.", "Intravenous immunoglobulin was administered.", "Strength improved.", "The patient was discharged for further follow-up."]}, "extra_info": {"fulltext_subclaims": ["An 84-year-old man was admitted to our hospital complaining of muscular weakness while rising up from a chair that led to a fall.", "He was admitted for further studying.", "His head CT and MRI did not report any abnormal structural findings.", "He reported a significant 10% weight loss in the past 6 months.", "The weight loss was associated with decreased appetite and diminished mobility.", "The weight loss was associated with progressive muscular weakness and difficulty rising from chair.", "The physical examination was remarkable for muscular weakness with 3/5 muscle strength in the lower extremities.", "The physical examination showed 4/5 muscle strength in the upper extremities.", "Muscle weakness was confined to the proximal muscles.", "Tendon reflexes were diminished.", "The tone examination revealed mild bilateral quadriceps hypotonia and atrophy.", "There were no other clinical findings on the physical examination.", "The patient reported a medical history of stage G4 chronic kidney disease.", "The patient reported a medical history of erythroid and megakaryocyte-predominant myelodysplastic syndrome.", "The patient reported a medical history of high blood pressure.", "The patient was receiving medication with azacytidine.", "The patient was receiving medication with diltiazem.", "The patient was receiving medication with darbepoetin.", "The patient did not smoke.", "The patient did not consume alcohol.", "The patient did not use illicit drugs.", "The family history was negative for neuromuscular diseases.", "During the present admission, laboratory investigation showed an elevated creatine kinase level of up to 78,924 U/L.", "The creatine kinase level was more than 50 times the normal reference range.", "Elevated serum creatinine was found (4.4 mg/dl).", "Mild hypocalcemia (7.2 mg/dl) was found.", "Mild hyponatremia (130 mg/dl) was found.", "Coprologic examination revealed positive testing for rotavirus.", "Antibody testing reported negative results for antinuclear antibodies (ANAs).", "Antibody testing reported negative results for anti-Jo1.", "Antibody testing reported negative results for anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR).", "Antibody testing reported negative results for anti-Mi-2.", "Antibody testing reported negative results for antiganglioside antibodies.", "The electromyography (EMG) of the upper and lower limbs showed myopathic changes in proximal muscle.", "The EMG showed lower limb predominance.", "The EMG showed short duration, low-amplitude polyphasic potential.", "The EMG showed no positive sharp waves.", "The EMG showed no spontaneous electrical activity.", "An FDG-PET/CT scan was performed searching for neoplasia.", "The FDG-PET/CT scan revealed increased FDG uptake in bilateral quadriceps.", "There was no posterior compartment muscle uptake.", "There was no increased metabolism in any other region of the body.", "An open biopsy of the left vastus lateralis muscle was performed.", "Light microscopy showed 50% myonecrosis.", "There were mild fiber atrophy and lymphocytic infiltrate with CD8+ predominance.", "There was perivascular involvement.", "There were no immune deposits in the skin microscopic examination.", "The diagnosis of PM was made.", "The patient started on intravenous hydration with medium saline solution/bicarbonate for rhabdomyolysis.", "The patient started on prednisone 0.5 mg/kg/day.", "The patient received intravenous immunoglobulin with a total dose of 2 g/kg distributed in 5 days.", "The patient received calcium supplementation.", "The patient continued azacytidine.", "Steroid-sparing drugs such as azathioprine or methotrexate were not considered.", "The renal function of the patient improved within 5 days.", "There was partial recovery of lower limb strength.", "The patient was discharged for external consultation follow-up.", "After 2 months from discharge, the patient had increased muscle strength.", "After 2 months from discharge, the patient had diminished CPK levels.", "The patient received low-dose prednisone as maintenance therapy."], "index": 17, "original_id": "multiclinsum_test_2937_en.txt", "split": "test", "summary_subclaims": ["The patient is an 84-year-old male.", "The patient had difficulty rising from a chair.", "The patient had a fall.", "Laboratory results showed increased creatine kinase levels of more than 50 times the normal reference values.", "Electromyography showed myopathic changes.", "FDG-PET/CT scan showed increased FDG uptake in bilateral quadriceps.", "A biopsy revealed lymphocytic predominant infiltrates.", "A biopsy revealed myonecrosis.", "Prednisone was administered.", "Intravenous immunoglobulin was administered.", "Strength improved.", "The patient was discharged for further follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 33-year-old female.", "She presented with a polyp on top of a red plaque in the left side mons pubis for 1 year.", "The lesion was a round flaky red bulge.", "The plaque was slightly bulgy without pressing pain.", "The plaque was 2.2 \u00d7 1.8 \u00d7 0.5 cm.", "The polyp was 2.5 \u00d7 2 \u00d7 1.5 cm.", "The width of the pedicle was 1.4 cm.", "The lesion was covered with a thick yellow-white crust.", "There were no other systemic abnormalities.", "There was no palpable lymphadenopathy.", "Ultrasound B was applied to evaluate the superficial inguinal lymph nodes.", "She had no significant history of medicine, surgery, irritation, and trauma.", "Before the lesion appearance, the patient had no discomfort.", "She did not use other external medicines.", "Until nearly a month, she found that the lesion was prone to bleed after friction.", "The lesion was removed surgically.", "Histopathologic examination was performed.", "The possibility of skin tumor was considered through dermoscopy.", "The skin biopsy was made on December 31, 2019.", "The immunohistochemical reports were done on January 17, 2020.", "Dermoscopic images showed a dark red background.", "The dermoscopic images showed a thick yellow-and-white crust.", "The dermoscopic images showed spot-shaped and polymorphic vascular structures.", "The dermoscopic images showed white homogeneous structures.", "The dermoscopic images showed dark red clumps.", "No typical pigment structure was seen.", "The skin lesions were considered as the diagnosis of skin tumors using dermoscopy.", "The excisional biopsy was carried out.", "The specimen tissue was fixed in formalin.", "The histological examination showed the skin lesion at the left side of mons pubis was spindle-shaped.", "The lesion size was 2.2 \u00d7 1.8 \u00d7 0.5 cm.", "The polyps were lined by melanocytes with pale cytoplasm.", "The polyps showed atypical cells and heteromorphic nuclei.", "The cells had different sizes.", "Abnormal mitosis was 5\u20137 counts /10HPF.", "Each slide was reviewed by 3 different pathologists.", "The diagnosis was made as the melanocyte tumor.", "The immunohistochemistry studies revealed positive staining for S-100.", "The immunohistochemistry studies revealed positive staining for HMB-45.", "The immunohistochemistry studies revealed positive staining for Melan A.", "The immunohistochemistry studies revealed positive staining for Cyclin D1.", "CD-117 was focally immunoreactive.", "CD31 was stained negative.", "P16 was stained negative.", "PCK was stained negative.", "LCA was stained negative.", "The final histopathological diagnosis was melanocyte nevus malignancy, nodular malignant melanoma.", "The patient underwent a complete local excision.", "She recovered well recently.", "The patient was required to re-examined regularly after surgery.", "Recent follow-ups showed that she recovered well.", "There was no sign of recurrence till now."], "summary_subclaims": ["The patient is a 33-year-old female.", "The lesion was a solitary polypoid nodule without apparent pigmentation on her vulvar skin.", "Her medical history was unclear.", "No ulcer was seen in the lesion area.", "Dermatoscopy was indicated a possible tumorous change.", "The final diagnosis was nodular malignant melanoma (NM).", "The Breslow thickness was 9.5mm.", "The Clark level was 4."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 33-year-old female.", "She presented with a polyp on top of a red plaque in the left side mons pubis for 1 year.", "The lesion was a round flaky red bulge.", "The plaque was slightly bulgy without pressing pain.", "The plaque was 2.2 \u00d7 1.8 \u00d7 0.5 cm.", "The polyp was 2.5 \u00d7 2 \u00d7 1.5 cm.", "The width of the pedicle was 1.4 cm.", "The lesion was covered with a thick yellow-white crust.", "There were no other systemic abnormalities.", "There was no palpable lymphadenopathy.", "Ultrasound B was applied to evaluate the superficial inguinal lymph nodes.", "She had no significant history of medicine, surgery, irritation, and trauma.", "Before the lesion appearance, the patient had no discomfort.", "She did not use other external medicines.", "Until nearly a month, she found that the lesion was prone to bleed after friction.", "The lesion was removed surgically.", "Histopathologic examination was performed.", "The possibility of skin tumor was considered through dermoscopy.", "The skin biopsy was made on December 31, 2019.", "The immunohistochemical reports were done on January 17, 2020.", "Dermoscopic images showed a dark red background.", "The dermoscopic images showed a thick yellow-and-white crust.", "The dermoscopic images showed spot-shaped and polymorphic vascular structures.", "The dermoscopic images showed white homogeneous structures.", "The dermoscopic images showed dark red clumps.", "No typical pigment structure was seen.", "The skin lesions were considered as the diagnosis of skin tumors using dermoscopy.", "The excisional biopsy was carried out.", "The specimen tissue was fixed in formalin.", "The histological examination showed the skin lesion at the left side of mons pubis was spindle-shaped.", "The lesion size was 2.2 \u00d7 1.8 \u00d7 0.5 cm.", "The polyps were lined by melanocytes with pale cytoplasm.", "The polyps showed atypical cells and heteromorphic nuclei.", "The cells had different sizes.", "Abnormal mitosis was 5\u20137 counts /10HPF.", "Each slide was reviewed by 3 different pathologists.", "The diagnosis was made as the melanocyte tumor.", "The immunohistochemistry studies revealed positive staining for S-100.", "The immunohistochemistry studies revealed positive staining for HMB-45.", "The immunohistochemistry studies revealed positive staining for Melan A.", "The immunohistochemistry studies revealed positive staining for Cyclin D1.", "CD-117 was focally immunoreactive.", "CD31 was stained negative.", "P16 was stained negative.", "PCK was stained negative.", "LCA was stained negative.", "The final histopathological diagnosis was melanocyte nevus malignancy, nodular malignant melanoma.", "The patient underwent a complete local excision.", "She recovered well recently.", "The patient was required to re-examined regularly after surgery.", "Recent follow-ups showed that she recovered well.", "There was no sign of recurrence till now."], "index": 156, "original_id": "multiclinsum_test_1142_en.txt", "split": "test", "summary_subclaims": ["The patient is a 33-year-old female.", "The lesion was a solitary polypoid nodule without apparent pigmentation on her vulvar skin.", "Her medical history was unclear.", "No ulcer was seen in the lesion area.", "Dermatoscopy was indicated a possible tumorous change.", "The final diagnosis was nodular malignant melanoma (NM).", "The Breslow thickness was 9.5mm.", "The Clark level was 4."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 16-year-old Persian man.", "The patient's mother was diagnosed with aggressive MTC.", "The patient's mother had a mass in the thyroid gland and cervical lymphadenopathy for six years.", "The patient's mother underwent thyroidectomy a year earlier.", "The patient had no history of lymphadenopathy.", "The patient had no history of weight loss.", "The patient had no history of fever.", "The patient had no history of caf\u00e9 au lait spots.", "The patient had no history of ocular problems.", "The patient had no history of gastrointestinal problems.", "The patient had no history of thyroid nodule.", "The patient had no history of hoarseness.", "The patient had no history of dyspnea.", "The patient had no history of cough.", "On physical examination, the patient's face was symmetric.", "There was no sign of high arched palate.", "There was no sign of mandibular prognathism.", "There was no sign of flat nasal bridge.", "The patient had bumpy lips.", "The patient had several neuromas on his upper and lower eyelids, lips, and tongue.", "The neuromas were characteristic of MEN2B.", "The patient's thyroid gland was normal.", "The patient's abdomen was normal.", "There were no other remarkable findings in the physical examination.", "The patient had a normal height.", "There were no signs of marfanoid habitus.", "The patient had increased calcitonin levels.", "The patient had increased carcinoembryonic antigen (CEA) levels.", "Tests for RET proto-oncogene on exon 10, 11, and 16 were negative.", "The results of an ophthalmology examination showed several mucosal neuromas on inner eyelids and conjunctivae.", "The ophthalmology examination showed prominent perilimbal conjunctival blood vessels.", "The ophthalmology examination showed enlarged corneal nerves.", "The patient's intra-ocular pressure (IOP) was normal.", "The upper gastrointestinal and small bowel series were normal.", "Pheochromocytoma was ruled out based on the laboratory test results.", "The patient underwent a thyroidectomy.", "The results of pathological tests revealed a small (0.5cm) medullary thyroid carcinoma in the right lobe.", "The surgical margins were free of tumor.", "Post-operative evaluation included cervical ultrasound.", "Post-operative evaluation included cervical, thoracic, and abdominal computed tomography.", "The post-operative evaluations were normal.", "The patient's calcitonin and CEA levels were assessed periodically.", "All the family members had signed an informed consent.", "The family members provided the authors with an authorization to publish their information."], "summary_subclaims": ["The patient is a 16-year-old Persian man.", "The patient was diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B.", "The patient has medullary thyroid cancer.", "The patient has mucosal neuroma of the tongue.", "The patient has mucosal neuroma of the lips.", "The patient has mucosal neuroma of the inner eyelids.", "The patient had a positive family history of medullary thyroid cancer.", "The patient was of normal height.", "The patient had no signs of marfanoid habitus."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 16-year-old Persian man.", "The patient's mother was diagnosed with aggressive MTC.", "The patient's mother had a mass in the thyroid gland and cervical lymphadenopathy for six years.", "The patient's mother underwent thyroidectomy a year earlier.", "The patient had no history of lymphadenopathy.", "The patient had no history of weight loss.", "The patient had no history of fever.", "The patient had no history of caf\u00e9 au lait spots.", "The patient had no history of ocular problems.", "The patient had no history of gastrointestinal problems.", "The patient had no history of thyroid nodule.", "The patient had no history of hoarseness.", "The patient had no history of dyspnea.", "The patient had no history of cough.", "On physical examination, the patient's face was symmetric.", "There was no sign of high arched palate.", "There was no sign of mandibular prognathism.", "There was no sign of flat nasal bridge.", "The patient had bumpy lips.", "The patient had several neuromas on his upper and lower eyelids, lips, and tongue.", "The neuromas were characteristic of MEN2B.", "The patient's thyroid gland was normal.", "The patient's abdomen was normal.", "There were no other remarkable findings in the physical examination.", "The patient had a normal height.", "There were no signs of marfanoid habitus.", "The patient had increased calcitonin levels.", "The patient had increased carcinoembryonic antigen (CEA) levels.", "Tests for RET proto-oncogene on exon 10, 11, and 16 were negative.", "The results of an ophthalmology examination showed several mucosal neuromas on inner eyelids and conjunctivae.", "The ophthalmology examination showed prominent perilimbal conjunctival blood vessels.", "The ophthalmology examination showed enlarged corneal nerves.", "The patient's intra-ocular pressure (IOP) was normal.", "The upper gastrointestinal and small bowel series were normal.", "Pheochromocytoma was ruled out based on the laboratory test results.", "The patient underwent a thyroidectomy.", "The results of pathological tests revealed a small (0.5cm) medullary thyroid carcinoma in the right lobe.", "The surgical margins were free of tumor.", "Post-operative evaluation included cervical ultrasound.", "Post-operative evaluation included cervical, thoracic, and abdominal computed tomography.", "The post-operative evaluations were normal.", "The patient's calcitonin and CEA levels were assessed periodically.", "All the family members had signed an informed consent.", "The family members provided the authors with an authorization to publish their information."], "index": 159, "original_id": "multiclinsum_test_2043_en.txt", "split": "test", "summary_subclaims": ["The patient is a 16-year-old Persian man.", "The patient was diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B.", "The patient has medullary thyroid cancer.", "The patient has mucosal neuroma of the tongue.", "The patient has mucosal neuroma of the lips.", "The patient has mucosal neuroma of the inner eyelids.", "The patient had a positive family history of medullary thyroid cancer.", "The patient was of normal height.", "The patient had no signs of marfanoid habitus."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 39-year-old Chinese woman.", "She had delivered a second live full-term infant through an uncomplicated cesarean section in 2011.", "She had a miscarriage in 2010.", "She had a first cesarean section in 2005.", "In December 2014, she noticed a purple, nontender swelling appearing as an anterior abdominal wall mass around her cesarean scar.", "The mass was the size of a green bean.", "The mass was not accompanied by any abdominal pain.", "The mass was not accompanied by any abnormal vaginal bleeding.", "There were no notable findings in her past medical history.", "There were no notable findings in her family history.", "There were no notable findings in her psychosocial history.", "The abdominal wall mass had progressively enlarged.", "She had undergone tumor resection of the abdominal wall in June 2015.", "The resection might be interpreted as the abdominal wall endometriosis malignancy.", "She had visited a regional tertiary hospital for a consultation regarding the pathologic diagnosis of a CC.", "Her physical examination showed no abnormalities except for the scar from the local excision on the abdominal wall.", "The first excised specimen from the previous hospital was reviewed by our pathologists.", "The pathologists confirmed the characteristic of CC coexisting with minor ETT.", "Her Ki-67 proliferative index was approximately 50%.", "Laboratory analysis revealed normal serum levels of \u03b2-human chorionic gonadotropin (\u03b2-hCG; < 1.2 IU/L).", "Laboratory analysis revealed normal tumor markers, including CA 125, CEA, CA 19-9, CA 15-3, and \u03b1-fetoprotein.", "Positron emission tomography was performed.", "No residual tumor and suspicious malignant lesions were observed.", "Endometrial curettage was performed.", "The results of endometrial curettage revealed normal menstrual phase endometrium.", "The patient received two courses of chemotherapy with a regimen of etoposide and cisplatin (EP) over a 2-month period.", "During chemotherapy, her serum \u03b2-hCG levels remained negative (< 1.2 IU/L).", "A recurrent nodule was found on the same abdominal wall scar site in January 2017.", "The nodule was found approximately 17 months after the last chemotherapy.", "Her serum \u03b2-hCG had increased to 6.17 IU/L.", "Two oval hypoechoic masses were visualized by ultrasonography in the subcutaneous soft tissue of the lower abdomen wall scar.", "Chest CT and head MRI showed no abnormality.", "She underwent a second notable mass excision by ultrasound interventional localization.", "The nodule was in the fat layer next to the superficial fascia.", "Her serum \u03b2-hCG level was decreased to 3.4 IU/L on the second postoperative day.", "The result of pathological examination was initially in line with CC metastasis to the abdominal wall.", "The patient\u2019s Ki-67 index was 20%.", "The patient\u2019s pathological sections were sent to the Fudan University Obstetrics and Gynecology Hospital for further consultation.", "The finding was ETT.", "The patient was encouraged to maintain close follow-up.", "Her serum \u03b2-hCG level had gradually decreased.", "In the follow-up visits, the patient\u2019s serum \u03b2-hCG level was elevated to the highest level of 10.68 IU/L again 4 months later.", "A pelvic CT scan showed several nodules on the abdominal wall midline fascia.", "The largest nodule was approximately 21 \u00d7 15 mm in size.", "The nodules had clear boundaries.", "The nodules were less uniform in internal echoes.", "Test results for tumor markers such as CA 125, CA 19-9, CEA, and HE4 were negative.", "The results of routine blood sampling tests were normal.", "We suggested a third resection of the mass to the patient.", "She opted for a hysterectomy due to fear of malignancy and further relapse.", "She finally underwent exploratory laparotomy with removal of the abdominal wall lesion, subtotal hysterectomy, bilateral salpingectomy, left ovarian cyst resection, and right inguinal lymph node biopsy in July 2017.", "Intraoperative exploration revealed that the abdominal wall lesion was located on the anterior wall fascia.", "Histopathological observations suggested that hyperplasia of fatty fibrous tissue was visible with cancer infiltration and necrosis around the cancer tissue.", "The histopathological findings were consistent with trophoblastic tumor.", "The trophoblastic tumor was constituted primarily by major epidermoid trophoblastic tumors (approximately 90%).", "The trophoblastic tumor was constituted by CC components (approximately 10%).", "Immunohistochemistry showed \u03b2-hCG (focal positive).", "Immunohistochemistry showed inhibin-\u03b1 (epithelial trophoblast negative, CC positive).", "Immunohistochemistry showed p63 (epidermoid trophoblast positive, CC positive).", "There was no tumor involvement in other tissues, including uterine, left ovarian cyst, and the right inguinal lymph nodes.", "The diagnosis was ETT accompanying CC.", "The patient\u2019s postoperative recovery was uneventful.", "Two weeks after hysterectomy, her serum \u03b2-hCG level had returned to normal (low 1.2 IU/L).", "Two years later, there was no evidence of recurrence according to serum \u03b2-hCG and imaging studies."], "summary_subclaims": ["The patient was a 39-year-old Chinese woman.", "She had a history of two cesarean sections.", "She had a history of one miscarriage.", "She had a recurrent anterior abdominal wall mass around her cesarean scar.", "The mass was initially suspected of being choriocarcinoma of unknown origin.", "The patient had negative or mildly increased serum \u03b2-human chorionic gonadotropin at follow-up.", "She had no abnormal vaginal bleeding.", "She had no abdominal pain.", "She underwent local excision twice.", "She had two courses of chemotherapy with an etoposide and cisplatin regimen.", "She finally opted for exploratory laparotomy with abdominal wall lesion removal.", "She had a subtotal hysterectomy.", "She had bilateral salpingectomy.", "She had left ovarian cyst resection.", "The abdominal wall lesion was revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors.", "The abdominal wall lesion was revealed by microscopy and immunohistochemical staining to be 10% choriocarcinomas.", "The lesion was from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 39-year-old Chinese woman.", "She had delivered a second live full-term infant through an uncomplicated cesarean section in 2011.", "She had a miscarriage in 2010.", "She had a first cesarean section in 2005.", "In December 2014, she noticed a purple, nontender swelling appearing as an anterior abdominal wall mass around her cesarean scar.", "The mass was the size of a green bean.", "The mass was not accompanied by any abdominal pain.", "The mass was not accompanied by any abnormal vaginal bleeding.", "There were no notable findings in her past medical history.", "There were no notable findings in her family history.", "There were no notable findings in her psychosocial history.", "The abdominal wall mass had progressively enlarged.", "She had undergone tumor resection of the abdominal wall in June 2015.", "The resection might be interpreted as the abdominal wall endometriosis malignancy.", "She had visited a regional tertiary hospital for a consultation regarding the pathologic diagnosis of a CC.", "Her physical examination showed no abnormalities except for the scar from the local excision on the abdominal wall.", "The first excised specimen from the previous hospital was reviewed by our pathologists.", "The pathologists confirmed the characteristic of CC coexisting with minor ETT.", "Her Ki-67 proliferative index was approximately 50%.", "Laboratory analysis revealed normal serum levels of \u03b2-human chorionic gonadotropin (\u03b2-hCG; < 1.2 IU/L).", "Laboratory analysis revealed normal tumor markers, including CA 125, CEA, CA 19-9, CA 15-3, and \u03b1-fetoprotein.", "Positron emission tomography was performed.", "No residual tumor and suspicious malignant lesions were observed.", "Endometrial curettage was performed.", "The results of endometrial curettage revealed normal menstrual phase endometrium.", "The patient received two courses of chemotherapy with a regimen of etoposide and cisplatin (EP) over a 2-month period.", "During chemotherapy, her serum \u03b2-hCG levels remained negative (< 1.2 IU/L).", "A recurrent nodule was found on the same abdominal wall scar site in January 2017.", "The nodule was found approximately 17 months after the last chemotherapy.", "Her serum \u03b2-hCG had increased to 6.17 IU/L.", "Two oval hypoechoic masses were visualized by ultrasonography in the subcutaneous soft tissue of the lower abdomen wall scar.", "Chest CT and head MRI showed no abnormality.", "She underwent a second notable mass excision by ultrasound interventional localization.", "The nodule was in the fat layer next to the superficial fascia.", "Her serum \u03b2-hCG level was decreased to 3.4 IU/L on the second postoperative day.", "The result of pathological examination was initially in line with CC metastasis to the abdominal wall.", "The patient\u2019s Ki-67 index was 20%.", "The patient\u2019s pathological sections were sent to the Fudan University Obstetrics and Gynecology Hospital for further consultation.", "The finding was ETT.", "The patient was encouraged to maintain close follow-up.", "Her serum \u03b2-hCG level had gradually decreased.", "In the follow-up visits, the patient\u2019s serum \u03b2-hCG level was elevated to the highest level of 10.68 IU/L again 4 months later.", "A pelvic CT scan showed several nodules on the abdominal wall midline fascia.", "The largest nodule was approximately 21 \u00d7 15 mm in size.", "The nodules had clear boundaries.", "The nodules were less uniform in internal echoes.", "Test results for tumor markers such as CA 125, CA 19-9, CEA, and HE4 were negative.", "The results of routine blood sampling tests were normal.", "We suggested a third resection of the mass to the patient.", "She opted for a hysterectomy due to fear of malignancy and further relapse.", "She finally underwent exploratory laparotomy with removal of the abdominal wall lesion, subtotal hysterectomy, bilateral salpingectomy, left ovarian cyst resection, and right inguinal lymph node biopsy in July 2017.", "Intraoperative exploration revealed that the abdominal wall lesion was located on the anterior wall fascia.", "Histopathological observations suggested that hyperplasia of fatty fibrous tissue was visible with cancer infiltration and necrosis around the cancer tissue.", "The histopathological findings were consistent with trophoblastic tumor.", "The trophoblastic tumor was constituted primarily by major epidermoid trophoblastic tumors (approximately 90%).", "The trophoblastic tumor was constituted by CC components (approximately 10%).", "Immunohistochemistry showed \u03b2-hCG (focal positive).", "Immunohistochemistry showed inhibin-\u03b1 (epithelial trophoblast negative, CC positive).", "Immunohistochemistry showed p63 (epidermoid trophoblast positive, CC positive).", "There was no tumor involvement in other tissues, including uterine, left ovarian cyst, and the right inguinal lymph nodes.", "The diagnosis was ETT accompanying CC.", "The patient\u2019s postoperative recovery was uneventful.", "Two weeks after hysterectomy, her serum \u03b2-hCG level had returned to normal (low 1.2 IU/L).", "Two years later, there was no evidence of recurrence according to serum \u03b2-hCG and imaging studies."], "index": 166, "original_id": "multiclinsum_test_2114_en.txt", "split": "test", "summary_subclaims": ["The patient was a 39-year-old Chinese woman.", "She had a history of two cesarean sections.", "She had a history of one miscarriage.", "She had a recurrent anterior abdominal wall mass around her cesarean scar.", "The mass was initially suspected of being choriocarcinoma of unknown origin.", "The patient had negative or mildly increased serum \u03b2-human chorionic gonadotropin at follow-up.", "She had no abnormal vaginal bleeding.", "She had no abdominal pain.", "She underwent local excision twice.", "She had two courses of chemotherapy with an etoposide and cisplatin regimen.", "She finally opted for exploratory laparotomy with abdominal wall lesion removal.", "She had a subtotal hysterectomy.", "She had bilateral salpingectomy.", "She had left ovarian cyst resection.", "The abdominal wall lesion was revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors.", "The abdominal wall lesion was revealed by microscopy and immunohistochemical staining to be 10% choriocarcinomas.", "The lesion was from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was admitted for recurrent lower extremity edema for 9 mo, abdominal distension for 7 mo, and aggravation for half a month.", "A 53-year-old rural Chinese woman visited Dafang County People\u2019s Hospital.", "Symptoms began to appear nine months ago.", "Edema and abdominal distension of both lower extremities recurred.", "These symptoms gradually worsened during the previous two months.", "Initial liver function examination showed elevated alanine transaminase (ALT).", "Initial liver function examination showed elevated aspartate aminotransferase (AST).", "Initial liver function examination showed elevated total bilirubin (TBIL).", "Initial liver function examination showed elevated direct bilirubin (DBIL).", "Initial liver function examination showed decreased albumin/globulin (ALB/GLO) ratio.", "Examination of blood cells indicated decreased white blood cells (WBCs).", "Examination of blood cells indicated decreased red blood cells (RBCs).", "Examination of blood cells indicated decreased hemoglobin (HB).", "Examination of blood cells indicated decreased platelets (PLTs).", "Examination of coagulation function indicated an increased international normalized ratio (INR).", "Examination of coagulation function indicated prolonged prothrombin time (PT).", "Examination of coagulation function indicated prolonged activated partial thromboplastin time (APTT).", "Examination of coagulation function indicated decreased fibrinogen (FIB).", "An upper abdominal computed tomography (CT) showed liver cirrhosis.", "Examination of thyroid function showed an elevated level of thyroid stimulating hormone (TSH).", "Examination of thyroid function showed a decreased level of free triiodothyronine (FT3).", "The initial diagnosis was \u201cdecompensated stage of cirrhosis and subclinical hypothyroidism.\u201d", "She tested negative for hepatitis viruses.", "She tested negative for autoimmune hepatitis.", "The cause of cirrhosis was unknown.", "She was hospitalized twice for abdominal distension with yellow staining of the sclera.", "These symptoms resolved after administration of a liver protectant and a diuretic to reduce swelling.", "After discharge, she still reported repeated abdominal distension and discomfort.", "These symptoms gradually became worse from 2020 Oct 1.", "Since the initial presentation, her liver function indexes have fluctuated.", "Thyroid function tests indicated a decreasing level of triiodothyronine (T3).", "Thyroid function tests indicated an increasing level of TSH.", "This indicated progression from subclinical hypothyroidism to clinical hypothyroidism.", "She reported loss of vision 30 years ago.", "She had no history of long-term heavy drinking.", "She had no history of taking a Chinese medicine.", "She had no history of exposure to toxic substances.", "She had no history of surgery.", "She had no history of trauma.", "We designated the index patient as proband II-1.", "She had five siblings (3 sisters, 2 brothers).", "All five siblings had night blindness.", "One sister (II-4) was completely blind.", "Her parents had no night blindness or impaired vision.", "Her parents were first cousins.", "We performed serum biochemical examinations of the father (I-1) and all siblings.", "The mother (I-2) was too old to travel to our institution for testing.", "The AST level was elevated in all 7 individuals.", "Fasting blood glucose was decreased in the father and 4 siblings.", "Two siblings had elevated levels of high density lipoprotein cholesterol (HDL-C).", "One sibling had a low level of HDL-C.", "The T3 level was low in two siblings.", "The TSH level was high in three siblings.", "Some of the siblings also had elevated levels of TBIL.", "Some of the siblings also had elevated levels of apolipoprotein A-I (APOA1).", "CT examinations showed that neither the father (I-1) nor the mother (I-2) had cirrhosis.", "Sibling II-2 had cirrhosis.", "Siblings II-3, II-5, and II-6 did not have cirrhosis.", "Abdominal color ultrasound indicated that sibling II-4 had a fatty liver.", "A physical examination indicated she had a BMI of 22.22.", "There was evidence of chronic liver disease.", "There were visible spider nevi.", "There was palmar erythema.", "She had no vision in either eye.", "There were no K-F rings in the corneas.", "A cardiopulmonary examination showed no obvious abnormalities.", "Her abdomen was slightly distensible.", "Her abdomen was positive for shifting dullness.", "There was moderate pitting edema in both lower limbs.", "2020 Oct 14: Blood lipid analysis indicated an HDL of 1.42 mmol/L.", "2020 Oct 14: Hepatitis A virus, hepatitis B virus, and hepatitis C virus related tests were all negative.", "2021 Jan 17: All antibody tests for autoimmune liver diseases were negative.", "2021 Jul 16: Examination of ascites indicated the Rivalta test was negative.", "2021 Jul 16: Ascites WBC count was 50 \u00d7 106/L.", "2021 Jul 16: Ascites total protein (TP) was 5.50 g/L.", "2021 Jul 16: Ascites adenosine deaminase (ADA) was 3.4 U/L.", "2021 Jul 16: Ascites glucose (GLU) was 8.71 mmol/L.", "2021 Jul 16: Ascites lactate dehydrogenase (LDH) was 48.8 U/L.", "2020 Oct 15: Color Doppler ultrasonography of the thyroid showed bilateral thyroid cysts.", "2020 Oct 23: A plain CT scan of the upper abdomen with enhancement showed cirrhotic ascites with splenomegaly.", "We suggested more extensive examination of a liver biopsy to clarify the cause of cirrhosis.", "This was not possible because the patient did not consent.", "The index patient was one of 6 siblings.", "Sibling II-2 was similar (night blindness complicated with cirrhosis and hypothyroidism).", "Sibling II-5 was completely blind in both eyes.", "The other three siblings had obvious night blindness.", "We considered the possibility of GLD.", "We suggested molecular genetic analysis.", "After receiving informed consent, we collected peripheral blood samples for whole-exome sequencing.", "The results indicated the presence of the deletion/insertion mutation C.802-8_810delinsGC (homozygous) in the cytochrome P450 4V2 (CYP4V2) gene.", "The results indicated the presence of the transcoding mutation C.413dupA (heterozygous) in the dual oxidase activator 2 (DUOXA2) gene.", "The same CYP4V2 mutation was present in I-1, I-2, II-2, II-3, II-5, II-6.", "Patient II-4 did not receive genetic testing because he lived in Tianjin."], "summary_subclaims": ["The patient is a 53-year-old female from a rural area in China.", "She was hospitalized for lower limb edema, abdominal distension, cirrhosis, and hypothyroidism.", "Common causes of liver disease were excluded.", "The patient had night-blindness since age 23 that worsened to complete blindness.", "The patient's parents were first cousins.", "All 5 siblings had night blindness and impaired vision.", "One sister was completely blind.", "Another sister had night-blindness complicated with cirrhosis and subclinical hypothyroidism.", "Entire exome sequencing showed mutations in the CYP4V2 gene in the patient, parents, and siblings.", "The CYP4V2 mutations of the parents and two sisters were heterozygous.", "The CYP4V2 mutations of the other siblings were homozygous.", "Two siblings also had heterozygous DUOXA2 mutations."]}, "extra_info": {"fulltext_subclaims": ["The patient was admitted for recurrent lower extremity edema for 9 mo, abdominal distension for 7 mo, and aggravation for half a month.", "A 53-year-old rural Chinese woman visited Dafang County People\u2019s Hospital.", "Symptoms began to appear nine months ago.", "Edema and abdominal distension of both lower extremities recurred.", "These symptoms gradually worsened during the previous two months.", "Initial liver function examination showed elevated alanine transaminase (ALT).", "Initial liver function examination showed elevated aspartate aminotransferase (AST).", "Initial liver function examination showed elevated total bilirubin (TBIL).", "Initial liver function examination showed elevated direct bilirubin (DBIL).", "Initial liver function examination showed decreased albumin/globulin (ALB/GLO) ratio.", "Examination of blood cells indicated decreased white blood cells (WBCs).", "Examination of blood cells indicated decreased red blood cells (RBCs).", "Examination of blood cells indicated decreased hemoglobin (HB).", "Examination of blood cells indicated decreased platelets (PLTs).", "Examination of coagulation function indicated an increased international normalized ratio (INR).", "Examination of coagulation function indicated prolonged prothrombin time (PT).", "Examination of coagulation function indicated prolonged activated partial thromboplastin time (APTT).", "Examination of coagulation function indicated decreased fibrinogen (FIB).", "An upper abdominal computed tomography (CT) showed liver cirrhosis.", "Examination of thyroid function showed an elevated level of thyroid stimulating hormone (TSH).", "Examination of thyroid function showed a decreased level of free triiodothyronine (FT3).", "The initial diagnosis was \u201cdecompensated stage of cirrhosis and subclinical hypothyroidism.\u201d", "She tested negative for hepatitis viruses.", "She tested negative for autoimmune hepatitis.", "The cause of cirrhosis was unknown.", "She was hospitalized twice for abdominal distension with yellow staining of the sclera.", "These symptoms resolved after administration of a liver protectant and a diuretic to reduce swelling.", "After discharge, she still reported repeated abdominal distension and discomfort.", "These symptoms gradually became worse from 2020 Oct 1.", "Since the initial presentation, her liver function indexes have fluctuated.", "Thyroid function tests indicated a decreasing level of triiodothyronine (T3).", "Thyroid function tests indicated an increasing level of TSH.", "This indicated progression from subclinical hypothyroidism to clinical hypothyroidism.", "She reported loss of vision 30 years ago.", "She had no history of long-term heavy drinking.", "She had no history of taking a Chinese medicine.", "She had no history of exposure to toxic substances.", "She had no history of surgery.", "She had no history of trauma.", "We designated the index patient as proband II-1.", "She had five siblings (3 sisters, 2 brothers).", "All five siblings had night blindness.", "One sister (II-4) was completely blind.", "Her parents had no night blindness or impaired vision.", "Her parents were first cousins.", "We performed serum biochemical examinations of the father (I-1) and all siblings.", "The mother (I-2) was too old to travel to our institution for testing.", "The AST level was elevated in all 7 individuals.", "Fasting blood glucose was decreased in the father and 4 siblings.", "Two siblings had elevated levels of high density lipoprotein cholesterol (HDL-C).", "One sibling had a low level of HDL-C.", "The T3 level was low in two siblings.", "The TSH level was high in three siblings.", "Some of the siblings also had elevated levels of TBIL.", "Some of the siblings also had elevated levels of apolipoprotein A-I (APOA1).", "CT examinations showed that neither the father (I-1) nor the mother (I-2) had cirrhosis.", "Sibling II-2 had cirrhosis.", "Siblings II-3, II-5, and II-6 did not have cirrhosis.", "Abdominal color ultrasound indicated that sibling II-4 had a fatty liver.", "A physical examination indicated she had a BMI of 22.22.", "There was evidence of chronic liver disease.", "There were visible spider nevi.", "There was palmar erythema.", "She had no vision in either eye.", "There were no K-F rings in the corneas.", "A cardiopulmonary examination showed no obvious abnormalities.", "Her abdomen was slightly distensible.", "Her abdomen was positive for shifting dullness.", "There was moderate pitting edema in both lower limbs.", "2020 Oct 14: Blood lipid analysis indicated an HDL of 1.42 mmol/L.", "2020 Oct 14: Hepatitis A virus, hepatitis B virus, and hepatitis C virus related tests were all negative.", "2021 Jan 17: All antibody tests for autoimmune liver diseases were negative.", "2021 Jul 16: Examination of ascites indicated the Rivalta test was negative.", "2021 Jul 16: Ascites WBC count was 50 \u00d7 106/L.", "2021 Jul 16: Ascites total protein (TP) was 5.50 g/L.", "2021 Jul 16: Ascites adenosine deaminase (ADA) was 3.4 U/L.", "2021 Jul 16: Ascites glucose (GLU) was 8.71 mmol/L.", "2021 Jul 16: Ascites lactate dehydrogenase (LDH) was 48.8 U/L.", "2020 Oct 15: Color Doppler ultrasonography of the thyroid showed bilateral thyroid cysts.", "2020 Oct 23: A plain CT scan of the upper abdomen with enhancement showed cirrhotic ascites with splenomegaly.", "We suggested more extensive examination of a liver biopsy to clarify the cause of cirrhosis.", "This was not possible because the patient did not consent.", "The index patient was one of 6 siblings.", "Sibling II-2 was similar (night blindness complicated with cirrhosis and hypothyroidism).", "Sibling II-5 was completely blind in both eyes.", "The other three siblings had obvious night blindness.", "We considered the possibility of GLD.", "We suggested molecular genetic analysis.", "After receiving informed consent, we collected peripheral blood samples for whole-exome sequencing.", "The results indicated the presence of the deletion/insertion mutation C.802-8_810delinsGC (homozygous) in the cytochrome P450 4V2 (CYP4V2) gene.", "The results indicated the presence of the transcoding mutation C.413dupA (heterozygous) in the dual oxidase activator 2 (DUOXA2) gene.", "The same CYP4V2 mutation was present in I-1, I-2, II-2, II-3, II-5, II-6.", "Patient II-4 did not receive genetic testing because he lived in Tianjin."], "index": 160, "original_id": "multiclinsum_test_2430_en.txt", "split": "test", "summary_subclaims": ["The patient is a 53-year-old female from a rural area in China.", "She was hospitalized for lower limb edema, abdominal distension, cirrhosis, and hypothyroidism.", "Common causes of liver disease were excluded.", "The patient had night-blindness since age 23 that worsened to complete blindness.", "The patient's parents were first cousins.", "All 5 siblings had night blindness and impaired vision.", "One sister was completely blind.", "Another sister had night-blindness complicated with cirrhosis and subclinical hypothyroidism.", "Entire exome sequencing showed mutations in the CYP4V2 gene in the patient, parents, and siblings.", "The CYP4V2 mutations of the parents and two sisters were heterozygous.", "The CYP4V2 mutations of the other siblings were homozygous.", "Two siblings also had heterozygous DUOXA2 mutations."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 39-year-old woman visited our hospital complaining of worsened right low back pain and fever in 1 month before her first visit.", "She had an experience of pyelonephritis 10 years ago.", "Her initial laboratory data had no abnormal findings.", "Her urine test was clear.", "Her urine cytology was negative.", "Ultrasound imaging revealed right gross hydronephrosis.", "CECT also detected right gross hydronephrosis.", "The right ureter was unclear on CECT.", "CECT was reconstructed to 3D imaging with Osirix\u00ae.", "3D imaging found an aberrant blood vessel contacting with the right ureteropelvic junction.", "UPJO was preoperatively diagnosed due to the aberrant blood vessel.", "Tc-99m MAG3 renal scan confirmed that the right kidney exhibited obstructive pattern.", "The right kidney had poor diuretic response.", "The T1/2 of the right kidney was 21.07 min.", "The right kidney function was similarly preserved to the left kidney function.", "MAG3 clearance of the right kidney was 163.7 ml/min/1.73 m2.", "Surgical treatment was indicated because of the symptomatic disease.", "Preoperative RP showed that the right ureter shifted inward compared with the normal position.", "Preoperative RP suggested the coexistence of retrocaval ureter.", "RALP was conducted by a three-port transperitoneal approach.", "Port position was more medial than usual.", "The swollen right renal pelvis and the aberrant blood vessel were identified.", "The right ureter was peeled downward.", "The right ureter was confirmed to be positioned behind the IVC.", "The renal pelvis was dissected.", "The ureter was repositioned anterior to the IVC.", "The strictured ureteropelvic junction was removed.", "The ureter and the renal pelvis were spatulated.", "A 6-Fr double-J stent was inserted.", "The ureter and the renal pelvis were reanastomosed in a tension-free fashion.", "The anastomosis was sutured with interrupted 5-0 sutures.", "A 10-Fr BLAKE Silicon drain was put into the anastomosis place.", "Blood loss was uncountable.", "The operation time was 403 min.", "The robot console time was 301 min.", "The urethral catheter was removed 5 days after surgery.", "The drain was removed 6 days after surgery.", "No perioperative adverse events were found.", "The double-J stent was removed 2 months after surgery.", "No recurrence of the symptoms was observed.", "Her right hydronephrosis improved in 2 years after surgery."], "summary_subclaims": ["The patient is a 39-year-old woman.", "She visited the hospital complaining of worsened right low back pain and fever.", "Contrast-enhanced computed tomography diagnosed right hydronephrosis due to ureteropelvic junction obstruction.", "Retrograde pyelography before robot-assisted laparoscopic pyeloplasty revealed concomitant ipsilateral retrocaval ureter.", "Laparoscopically, ureteropelvic junction obstruction due to aberrant blood vessel and coexisting retrocaval ureter was confirmed.", "Transposition of the ureter from posterior to anterior of the inferior vena cava and following dismembered pyeloplasty was performed.", "Two years after surgery, her right hydronephrosis improved.", "She had no complain of any symptom two years after surgery."]}, "extra_info": {"fulltext_subclaims": ["A 39-year-old woman visited our hospital complaining of worsened right low back pain and fever in 1 month before her first visit.", "She had an experience of pyelonephritis 10 years ago.", "Her initial laboratory data had no abnormal findings.", "Her urine test was clear.", "Her urine cytology was negative.", "Ultrasound imaging revealed right gross hydronephrosis.", "CECT also detected right gross hydronephrosis.", "The right ureter was unclear on CECT.", "CECT was reconstructed to 3D imaging with Osirix\u00ae.", "3D imaging found an aberrant blood vessel contacting with the right ureteropelvic junction.", "UPJO was preoperatively diagnosed due to the aberrant blood vessel.", "Tc-99m MAG3 renal scan confirmed that the right kidney exhibited obstructive pattern.", "The right kidney had poor diuretic response.", "The T1/2 of the right kidney was 21.07 min.", "The right kidney function was similarly preserved to the left kidney function.", "MAG3 clearance of the right kidney was 163.7 ml/min/1.73 m2.", "Surgical treatment was indicated because of the symptomatic disease.", "Preoperative RP showed that the right ureter shifted inward compared with the normal position.", "Preoperative RP suggested the coexistence of retrocaval ureter.", "RALP was conducted by a three-port transperitoneal approach.", "Port position was more medial than usual.", "The swollen right renal pelvis and the aberrant blood vessel were identified.", "The right ureter was peeled downward.", "The right ureter was confirmed to be positioned behind the IVC.", "The renal pelvis was dissected.", "The ureter was repositioned anterior to the IVC.", "The strictured ureteropelvic junction was removed.", "The ureter and the renal pelvis were spatulated.", "A 6-Fr double-J stent was inserted.", "The ureter and the renal pelvis were reanastomosed in a tension-free fashion.", "The anastomosis was sutured with interrupted 5-0 sutures.", "A 10-Fr BLAKE Silicon drain was put into the anastomosis place.", "Blood loss was uncountable.", "The operation time was 403 min.", "The robot console time was 301 min.", "The urethral catheter was removed 5 days after surgery.", "The drain was removed 6 days after surgery.", "No perioperative adverse events were found.", "The double-J stent was removed 2 months after surgery.", "No recurrence of the symptoms was observed.", "Her right hydronephrosis improved in 2 years after surgery."], "index": 162, "original_id": "multiclinsum_test_1681_en.txt", "split": "test", "summary_subclaims": ["The patient is a 39-year-old woman.", "She visited the hospital complaining of worsened right low back pain and fever.", "Contrast-enhanced computed tomography diagnosed right hydronephrosis due to ureteropelvic junction obstruction.", "Retrograde pyelography before robot-assisted laparoscopic pyeloplasty revealed concomitant ipsilateral retrocaval ureter.", "Laparoscopically, ureteropelvic junction obstruction due to aberrant blood vessel and coexisting retrocaval ureter was confirmed.", "Transposition of the ureter from posterior to anterior of the inferior vena cava and following dismembered pyeloplasty was performed.", "Two years after surgery, her right hydronephrosis improved.", "She had no complain of any symptom two years after surgery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 62-year-old previously healthy Sri Lankan native male from Gampaha, in the Western Province of Sri Lanka.", "He presented with high fever associated with chills and rigors for 17 days.", "He also complained of malaise, myalgia and arthralgia for the same duration.", "He denied any urinary, respiratory or abdominal symptoms.", "He had obtained treatment from a local hospital for the illness with no clinical improvement.", "He had received co-amoxyclav, clarythromicin and paracetamol for 4 days.", "He had not been consuming any medication prior to the illness.", "He had not received any drug that would result in extrapyramidal features.", "Around the 5th day of the clinical illness he had developed intermittent resting tremor in his right arm and leg.", "By the time he presented to us he had stiffness and very frequent intermittent resting tremor.", "This resulted in difficulty to carry out normal work with the right hand.", "He also found it difficult to walk due to unusual stiffness and heaviness of the right leg.", "He found it difficult to smile with others and felt very distressed.", "He denied similar previous episodes.", "There was no associated hearing impairment, seizures, or altered level of consciousness.", "There were no symptoms to suggest involvement of cerebellar system or autonomic nervous system.", "There was no family history of movement disorders.", "He had been working in his garden 7 days prior to the onset of fever.", "Examination revealed intermittent high amplitude low frequency resting tremor in his right hand.", "He had a mask like face where he found difficult to smile or show his teeth.", "He also had increased muscle tone limited to the right side with normal tendon reflexes.", "The rest of the central nervous system was unremarkable.", "His blood pressure was 140/90 mmHg in both supine and standing positions.", "The respiratory system revealed few basal crackles.", "The abdominal examination was unremarkable except for a superficial crater like lesion suggestive of an eschar.", "He did not have lymphadenopathy or a rash.", "His full blood count was 13.4 \u00d7 109/L (Neutrophils 43 %, Lymphocytes 56 %).", "Erythrocyte sedimentation rate was 80 mm/1st h.", "He was positive for Immunofluoresence Assay (IFA)-IgM and IgG for O. tsutsugamushi on the 17th day of illness.", "The IFA-IgG titre using Orientia Karp antigen was 1:1024 which rose up to 1:16,384 after 2 weeks.", "His fever settled with oral doxycycline and azithromycin within 48 h.", "He demonstrated some improvement in his Parkinsonism features prior to discharge from hospital in 4 days.", "He visited for review 2 weeks after discharge.", "By this time he showed complete improvement and was happy with a smiling face."], "summary_subclaims": ["The patient is a 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka.", "He presented with high fever with malaise, myalgia and arthralgia for 17 days.", "On the 5th day of illness he developed intermittent resting tremor in his right arm and leg.", "He denied similar previous episodes.", "Clinical examination revealed a high amplitude low frequency resting tremor in his right hand.", "There was a mask-like face and increased muscle tone limited to the right side.", "The rest of the system examination was normal except for an eschar over the abdomen.", "Immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers.", "With oral doxycycline and azithromycin his fever settled within 48 h.", "A complete recovery of Parkinson's features was observed within 2 weeks."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 62-year-old previously healthy Sri Lankan native male from Gampaha, in the Western Province of Sri Lanka.", "He presented with high fever associated with chills and rigors for 17 days.", "He also complained of malaise, myalgia and arthralgia for the same duration.", "He denied any urinary, respiratory or abdominal symptoms.", "He had obtained treatment from a local hospital for the illness with no clinical improvement.", "He had received co-amoxyclav, clarythromicin and paracetamol for 4 days.", "He had not been consuming any medication prior to the illness.", "He had not received any drug that would result in extrapyramidal features.", "Around the 5th day of the clinical illness he had developed intermittent resting tremor in his right arm and leg.", "By the time he presented to us he had stiffness and very frequent intermittent resting tremor.", "This resulted in difficulty to carry out normal work with the right hand.", "He also found it difficult to walk due to unusual stiffness and heaviness of the right leg.", "He found it difficult to smile with others and felt very distressed.", "He denied similar previous episodes.", "There was no associated hearing impairment, seizures, or altered level of consciousness.", "There were no symptoms to suggest involvement of cerebellar system or autonomic nervous system.", "There was no family history of movement disorders.", "He had been working in his garden 7 days prior to the onset of fever.", "Examination revealed intermittent high amplitude low frequency resting tremor in his right hand.", "He had a mask like face where he found difficult to smile or show his teeth.", "He also had increased muscle tone limited to the right side with normal tendon reflexes.", "The rest of the central nervous system was unremarkable.", "His blood pressure was 140/90 mmHg in both supine and standing positions.", "The respiratory system revealed few basal crackles.", "The abdominal examination was unremarkable except for a superficial crater like lesion suggestive of an eschar.", "He did not have lymphadenopathy or a rash.", "His full blood count was 13.4 \u00d7 109/L (Neutrophils 43 %, Lymphocytes 56 %).", "Erythrocyte sedimentation rate was 80 mm/1st h.", "He was positive for Immunofluoresence Assay (IFA)-IgM and IgG for O. tsutsugamushi on the 17th day of illness.", "The IFA-IgG titre using Orientia Karp antigen was 1:1024 which rose up to 1:16,384 after 2 weeks.", "His fever settled with oral doxycycline and azithromycin within 48 h.", "He demonstrated some improvement in his Parkinsonism features prior to discharge from hospital in 4 days.", "He visited for review 2 weeks after discharge.", "By this time he showed complete improvement and was happy with a smiling face."], "index": 155, "original_id": "multiclinsum_test_146_en.txt", "split": "test", "summary_subclaims": ["The patient is a 62-year-old previously healthy Sri Lankan native male from the Western province of Sri Lanka.", "He presented with high fever with malaise, myalgia and arthralgia for 17 days.", "On the 5th day of illness he developed intermittent resting tremor in his right arm and leg.", "He denied similar previous episodes.", "Clinical examination revealed a high amplitude low frequency resting tremor in his right hand.", "There was a mask-like face and increased muscle tone limited to the right side.", "The rest of the system examination was normal except for an eschar over the abdomen.", "Immunofluorescence assay-IgM and IgG against Orientia tsutsugamushi Karp antigen were positive with rising titers.", "With oral doxycycline and azithromycin his fever settled within 48 h.", "A complete recovery of Parkinson's features was observed within 2 weeks."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 15-year-old boy.", "He was previously diagnosed with SRU.", "He presented with frequent bloody stool.", "He had chronic abdominal pain.", "He had constipation.", "He had mucoid discharge.", "Five years earlier, his symptoms began with intermittent vague abdominal pain.", "Five years earlier, his symptoms began with bloody stool.", "Progressive deterioration of symptoms included increased blood in the stool.", "Progressive deterioration of symptoms included new onset of mucoid discharge.", "Progressive deterioration of symptoms included new onset of constipation.", "He complained of straining during defecation.", "He complained of difficulty passing hard and narrowed stool.", "He complained of a sense of incomplete defecation.", "He had no previous history of surgery.", "He had no previous history of prescription medication.", "He had no previous history of any other medical condition.", "He experienced no diarrhea.", "He experienced no food intolerance.", "He experienced no significant weight loss.", "His family history was negative for gastrointestinal disorders.", "His family history was negative for malignancies.", "His family history was negative for IBD.", "His family history was negative for FAP.", "He had his first colonoscopy approximately four years prior.", "The first colonoscopy revealed a solitary ulcer in the rectum.", "The initial histologic examination revealed regenerative crypts in the lamina propria.", "The initial histologic examination revealed fibrosis.", "The initial histologic examination revealed smooth muscle proliferation.", "The initial histologic examination confirmed the diagnosis of SRU.", "A previous laboratory evaluation revealed a WBC of 8100 \u00d7 109 cells/liter.", "A previous laboratory evaluation revealed an Hb of 13.2 g/dL.", "A previous laboratory evaluation revealed an MCV of 79.8 FL.", "A previous laboratory evaluation revealed platelets of 251,000 \u00d7 1010/unit.", "A previous laboratory evaluation revealed an FBS of 85 mg/dL.", "A previous laboratory evaluation revealed a TSH of 3.49 mIU/liter.", "A previous laboratory evaluation revealed an AST of 12 units/liter.", "A previous laboratory evaluation revealed an ALT of 16 units/liter.", "A previous laboratory evaluation revealed an ALP of 391 units/liter.", "A previous laboratory evaluation revealed a ferritin of 22.2 mcg/liter.", "A previous stool exam was negative for occult blood.", "A previous stool exam was negative for ova of parasites.", "A previous stool exam was negative for protozoa cyst.", "On physical examination, his vital signs were stable.", "There were no abnormal findings in his head.", "There were no abnormal findings in his neck.", "There were no abnormal findings in his chest.", "There were no abnormal findings in his abdomen.", "A perineal examination revealed no skin tags.", "A perineal examination revealed no fissures.", "A perineal examination revealed no visible prolapse.", "A perineal examination revealed no other indications of child abuse.", "Multiple irregular mass-like lesions were detected during the digital rectal examination.", "We performed a colonoscopy.", "The colonoscopy revealed multiple diffuse polyposes ranging in shape and size from 5 to 15 mm.", "The polyposes extended from the rectum\u2019s middle section to the rectosigmoid junction.", "Multiple biopsies were taken and sent for histopathologic evaluation.", "The histopathologic evaluation revealed a polypoid structure with a cap of ulcerated granulation tissue.", "The histopathologic evaluation revealed inflammatory exudates on the surface.", "The histopathologic evaluation revealed tortuous non-dysplastic crypts.", "The histopathologic evaluation revealed mucin spillage in the inflamed stroma.", "The histopathologic evaluation revealed smooth muscle fibers.", "The histopathologic evaluation revealed congested vessels.", "The diagnosis of CP was confirmed based on these new findings.", "Total serum protein was 6.7 g/dL.", "Total serum albumin was 4.3 g/dL.", "Until histopathologic confirmation of CP is obtained, conservative measures such as a high-fiber diet are recommended.", "Until histopathologic confirmation of CP is obtained, the use of laxative agents is recommended.", "Until histopathologic confirmation of CP is obtained, avoidance of manual stool evacuation is recommended.", "After histopathologic confirmation, we decided to perform endoscopic mucosal resection (EMR).", "We resected as many polyps as possible during the first session.", "The patient underwent two additional colonoscopy sessions during the 3-month follow-up.", "The majority of the remaining polyps were removed using EMR.", "Complete eradication of polyps was not possible.", "The patient\u2019s symptoms improved.", "The rectal bleeding stopped.", "The abdominal pain subsided."], "summary_subclaims": ["The patient is a 15-year-old boy.", "The patient was previously diagnosed with SRU.", "The patient presented with rectal bleeding.", "The patient presented with mucoid discharge.", "The patient presented with abdominal pain.", "Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum.", "Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma.", "The histologic findings indicated that SRU had transformed into CP.", "The plan was to perform endoscopic mucosal resection of the lesions in multiple sessions."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 15-year-old boy.", "He was previously diagnosed with SRU.", "He presented with frequent bloody stool.", "He had chronic abdominal pain.", "He had constipation.", "He had mucoid discharge.", "Five years earlier, his symptoms began with intermittent vague abdominal pain.", "Five years earlier, his symptoms began with bloody stool.", "Progressive deterioration of symptoms included increased blood in the stool.", "Progressive deterioration of symptoms included new onset of mucoid discharge.", "Progressive deterioration of symptoms included new onset of constipation.", "He complained of straining during defecation.", "He complained of difficulty passing hard and narrowed stool.", "He complained of a sense of incomplete defecation.", "He had no previous history of surgery.", "He had no previous history of prescription medication.", "He had no previous history of any other medical condition.", "He experienced no diarrhea.", "He experienced no food intolerance.", "He experienced no significant weight loss.", "His family history was negative for gastrointestinal disorders.", "His family history was negative for malignancies.", "His family history was negative for IBD.", "His family history was negative for FAP.", "He had his first colonoscopy approximately four years prior.", "The first colonoscopy revealed a solitary ulcer in the rectum.", "The initial histologic examination revealed regenerative crypts in the lamina propria.", "The initial histologic examination revealed fibrosis.", "The initial histologic examination revealed smooth muscle proliferation.", "The initial histologic examination confirmed the diagnosis of SRU.", "A previous laboratory evaluation revealed a WBC of 8100 \u00d7 109 cells/liter.", "A previous laboratory evaluation revealed an Hb of 13.2 g/dL.", "A previous laboratory evaluation revealed an MCV of 79.8 FL.", "A previous laboratory evaluation revealed platelets of 251,000 \u00d7 1010/unit.", "A previous laboratory evaluation revealed an FBS of 85 mg/dL.", "A previous laboratory evaluation revealed a TSH of 3.49 mIU/liter.", "A previous laboratory evaluation revealed an AST of 12 units/liter.", "A previous laboratory evaluation revealed an ALT of 16 units/liter.", "A previous laboratory evaluation revealed an ALP of 391 units/liter.", "A previous laboratory evaluation revealed a ferritin of 22.2 mcg/liter.", "A previous stool exam was negative for occult blood.", "A previous stool exam was negative for ova of parasites.", "A previous stool exam was negative for protozoa cyst.", "On physical examination, his vital signs were stable.", "There were no abnormal findings in his head.", "There were no abnormal findings in his neck.", "There were no abnormal findings in his chest.", "There were no abnormal findings in his abdomen.", "A perineal examination revealed no skin tags.", "A perineal examination revealed no fissures.", "A perineal examination revealed no visible prolapse.", "A perineal examination revealed no other indications of child abuse.", "Multiple irregular mass-like lesions were detected during the digital rectal examination.", "We performed a colonoscopy.", "The colonoscopy revealed multiple diffuse polyposes ranging in shape and size from 5 to 15 mm.", "The polyposes extended from the rectum\u2019s middle section to the rectosigmoid junction.", "Multiple biopsies were taken and sent for histopathologic evaluation.", "The histopathologic evaluation revealed a polypoid structure with a cap of ulcerated granulation tissue.", "The histopathologic evaluation revealed inflammatory exudates on the surface.", "The histopathologic evaluation revealed tortuous non-dysplastic crypts.", "The histopathologic evaluation revealed mucin spillage in the inflamed stroma.", "The histopathologic evaluation revealed smooth muscle fibers.", "The histopathologic evaluation revealed congested vessels.", "The diagnosis of CP was confirmed based on these new findings.", "Total serum protein was 6.7 g/dL.", "Total serum albumin was 4.3 g/dL.", "Until histopathologic confirmation of CP is obtained, conservative measures such as a high-fiber diet are recommended.", "Until histopathologic confirmation of CP is obtained, the use of laxative agents is recommended.", "Until histopathologic confirmation of CP is obtained, avoidance of manual stool evacuation is recommended.", "After histopathologic confirmation, we decided to perform endoscopic mucosal resection (EMR).", "We resected as many polyps as possible during the first session.", "The patient underwent two additional colonoscopy sessions during the 3-month follow-up.", "The majority of the remaining polyps were removed using EMR.", "Complete eradication of polyps was not possible.", "The patient\u2019s symptoms improved.", "The rectal bleeding stopped.", "The abdominal pain subsided."], "index": 164, "original_id": "multiclinsum_test_2219_en.txt", "split": "test", "summary_subclaims": ["The patient is a 15-year-old boy.", "The patient was previously diagnosed with SRU.", "The patient presented with rectal bleeding.", "The patient presented with mucoid discharge.", "The patient presented with abdominal pain.", "Additional colonoscopy evaluation revealed multiple polyposes varying in size and shape limited to the rectum.", "Histologic examination revealed a characteristic cap of granulation tissue covering tortuous nondysplastic crypts in the inflamed stroma.", "The histologic findings indicated that SRU had transformed into CP.", "The plan was to perform endoscopic mucosal resection of the lesions in multiple sessions."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 71-year-old female.", "She had been undergoing oral treatment for diabetes with canagliflozin 100 mg/day, metformin 1,000 mg/day, and saxagliptin 5 mg/day.", "She noticed general malaise a month before her emergency department visit.", "Two weeks before her emergency department visit, her oral intake decreased because of reduced appetite.", "She continued oral medications at their initial dose.", "The day prior to her emergency department visit, her malaise worsened.", "She developed nausea and abdominal pain.", "A local doctor discovered notable metabolic acidosis (pH, 6.860; CO2, 8 mmHg; HCO3, \u22121.0 mEq/L; base excess measurement, below sensitivity).", "She was urgently transferred to Kurume University Hospital Advanced Emergency Medical Service Center.", "On admission, her body temperature was 35.0 \u00b0C.", "On admission, her pulse was 118/min.", "On admission, her respiratory rate was 28/min.", "On admission, her blood pressure was 111/75 mmHg.", "The findings on consultation included notable dryness inside the oral cavity.", "The findings on consultation included a cold sensation on distal regions of the limbs.", "Chest auscultation revealed no significant findings.", "There was mild tenderness in the lower abdominal region.", "Blood gases demonstrated notable metabolic acidosis (pH, 6.89; CO2, 11.4 mmHg; HCO3, 1.9 mEq/L; base excess, \u221231.3 mmol/L).", "Lactic acid was mildly elevated at 3.3 mmol/L.", "Blood sugar was mildly elevated at 259 mg/dL.", "Hyperkalemia was observed accompanying the acidosis.", "No significant kidney function impairment was observed.", "A diagnosis of lactic acidosis secondary to metformin was considered.", "The patient had not recently been exposed to a contrast agent.", "Lactate was only mildly elevated.", "Point-of-care urine testing showed strongly positive urinary ketones.", "Point-of-care urine testing showed strongly positive urinary glucose.", "Plasma 3-hydroxybutyric acid was markedly high (>10,000 \u03bcmol/L).", "DKA was suspected.", "An injection of 0.45% sodium chloride was given as an intravenous drip at 800 mL/h.", "Blood sugar dropped to 180 mg/dL after using two units of short-acting insulin.", "Insulin was not used continuously.", "An intravenous drip of glucose was started.", "Around 6 units/day of insulin were used as appropriate.", "Sodium bicarbonate was given as an intravenous drip.", "Continuous renal replacement therapy (CRRT) was started from day 2 after hospital admission.", "The acidosis improved because of CRRT over 3 days.", "Hyperketonemia reduced notably after a few days.", "Urinary sugar continued to rise.", "Osmotic diuresis set in with urinary glucose as the cause.", "Polyurea was observed.", "Fluid replacement was carried out using Ringer\u2019s solution.", "Urinary sugar turned negative on day 16 after admission.", "She was discharged on day 18 after admission."], "summary_subclaims": ["The patient was a 71-year-old female.", "She was being treated for type 2 diabetes.", "She was taking canagliflozin, metformin, and saxagliptin orally.", "She presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain.", "Her blood glucose was 259 mg/dL.", "There was notable ketoacidosis.", "The pH was 6.89.", "The CO2 was 11.4 mmHg.", "The HCO3 was 1.9 mEq/L.", "The base excess was -31.3 mmol/L.", "The 3-hydroxybutyric acid was > 10,000 \u03bcmol/L.", "The uncontrolled acidosis improved following 3 days of continuous renal replacement therapy.", "Elevated urinary glucose continued for more than 10 days.", "Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria.", "Urinary glucose turned negative on day 16.", "There was improvement in the patient's overall state.", "She was discharged on day 18."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 71-year-old female.", "She had been undergoing oral treatment for diabetes with canagliflozin 100 mg/day, metformin 1,000 mg/day, and saxagliptin 5 mg/day.", "She noticed general malaise a month before her emergency department visit.", "Two weeks before her emergency department visit, her oral intake decreased because of reduced appetite.", "She continued oral medications at their initial dose.", "The day prior to her emergency department visit, her malaise worsened.", "She developed nausea and abdominal pain.", "A local doctor discovered notable metabolic acidosis (pH, 6.860; CO2, 8 mmHg; HCO3, \u22121.0 mEq/L; base excess measurement, below sensitivity).", "She was urgently transferred to Kurume University Hospital Advanced Emergency Medical Service Center.", "On admission, her body temperature was 35.0 \u00b0C.", "On admission, her pulse was 118/min.", "On admission, her respiratory rate was 28/min.", "On admission, her blood pressure was 111/75 mmHg.", "The findings on consultation included notable dryness inside the oral cavity.", "The findings on consultation included a cold sensation on distal regions of the limbs.", "Chest auscultation revealed no significant findings.", "There was mild tenderness in the lower abdominal region.", "Blood gases demonstrated notable metabolic acidosis (pH, 6.89; CO2, 11.4 mmHg; HCO3, 1.9 mEq/L; base excess, \u221231.3 mmol/L).", "Lactic acid was mildly elevated at 3.3 mmol/L.", "Blood sugar was mildly elevated at 259 mg/dL.", "Hyperkalemia was observed accompanying the acidosis.", "No significant kidney function impairment was observed.", "A diagnosis of lactic acidosis secondary to metformin was considered.", "The patient had not recently been exposed to a contrast agent.", "Lactate was only mildly elevated.", "Point-of-care urine testing showed strongly positive urinary ketones.", "Point-of-care urine testing showed strongly positive urinary glucose.", "Plasma 3-hydroxybutyric acid was markedly high (>10,000 \u03bcmol/L).", "DKA was suspected.", "An injection of 0.45% sodium chloride was given as an intravenous drip at 800 mL/h.", "Blood sugar dropped to 180 mg/dL after using two units of short-acting insulin.", "Insulin was not used continuously.", "An intravenous drip of glucose was started.", "Around 6 units/day of insulin were used as appropriate.", "Sodium bicarbonate was given as an intravenous drip.", "Continuous renal replacement therapy (CRRT) was started from day 2 after hospital admission.", "The acidosis improved because of CRRT over 3 days.", "Hyperketonemia reduced notably after a few days.", "Urinary sugar continued to rise.", "Osmotic diuresis set in with urinary glucose as the cause.", "Polyurea was observed.", "Fluid replacement was carried out using Ringer\u2019s solution.", "Urinary sugar turned negative on day 16 after admission.", "She was discharged on day 18 after admission."], "index": 2, "original_id": "multiclinsum_test_99_en.txt", "split": "test", "summary_subclaims": ["The patient was a 71-year-old female.", "She was being treated for type 2 diabetes.", "She was taking canagliflozin, metformin, and saxagliptin orally.", "She presented to the ED for evaluation of reduced oral intake, malaise, nausea, and abdominal pain.", "Her blood glucose was 259 mg/dL.", "There was notable ketoacidosis.", "The pH was 6.89.", "The CO2 was 11.4 mmHg.", "The HCO3 was 1.9 mEq/L.", "The base excess was -31.3 mmol/L.", "The 3-hydroxybutyric acid was > 10,000 \u03bcmol/L.", "The uncontrolled acidosis improved following 3 days of continuous renal replacement therapy.", "Elevated urinary glucose continued for more than 10 days.", "Ringer's lactated fluid supplementation was continued for management of polyurea and glucosuria.", "Urinary glucose turned negative on day 16.", "There was improvement in the patient's overall state.", "She was discharged on day 18."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 47-year-old man.", "He had a severe trauma of the left hemithorax, left hypochondrium, and left flank three years before the current presentation.", "He was admitted to the Department of Gastroenterology.", "He had nausea, repeated vomiting, epigastric pain, and intermittent constipation for over a month.", "He had acid regurgitation and pyrosis.", "He had loss of appetite and significant weight loss in the past six months.", "Physical examination revealed a firm, palpable abdominal mass in the left hypochondrium and left flank.", "Laboratory tests showed a low iron serum level of 46 \u03bcg/dL.", "Laboratory tests showed leukocytosis.", "Upper endoscopy described a deformed stomach with an extrinsic compression especially on the antrum.", "The extrinsic compression made difficult the passage through the pylorus.", "There was no significant distention of the gastric body on insufflation.", "There was no mucosal abnormality.", "An abdominal ultrasound highlighted a heterogeneous mass with tissular and cystic components.", "The mass extended from the left hepatic lobe to the spleen\u2019s hilum.", "Contrast-enhanced ultrasonography pointed out that the tissular component of the tumor was enhanced in the arterial phase.", "The tissular component presented a wash-out phenomenon in the late phase.", "The cystic and necrotic components were unenhanced.", "A contrast-enhanced abdominal computed tomography was scheduled.", "The CT scan described a heterogeneous tumor of 17\u00d715\u00d714 cm containing numerous necrosis and cystic areas.", "The tumor originated in the fundus and greater curvature of the stomach.", "The tumor had extraluminal development.", "The tumor was causing a mass effect on the stomach, spleen, splenic vein, and enveloping the body and pancreatic tail.", "We suspected it was a GIST with necrotic areas.", "We proposed the patient for surgery due to tumor size and gastric outlet obstruction symptoms.", "A xypho-umbilical approach was chosen.", "The peritoneal cavity was opened.", "The giant tumor occupied most of the upper abdominal cavity with adherence to the gastric wall.", "After the gastro-colic ligament was sectioned, tumor appurtenance of the great gastric wall was confirmed.", "Infiltration of the tail of the pancreas and splenic pedicle was confirmed.", "No hepatic or peritoneal metastases were found.", "The rest of the abdominal organs seemed macroscopically normal.", "En bloc surgical removal of the tumor was decided, including adjacent lymph nodes, spleen, and pancreas tail.", "The pancreas tail was sectioned 5 cm proximal from the splenic pedicle.", "The tumor block included the greater curvature of the stomach.", "The greater curvature of the stomach was sealed with a linear stapler.", "The resected piece measured 23\u00d717\u00d710 cm.", "The tumor had 22\u00d710 cm with many cystic and necrotic areas.", "Tumor fragments were embedded in 10% formalin for 24 hours.", "Classical staining with Hematoxylin\u2013Eosin described similar characteristics of a mesenchymal tumor.", "The tumor was composed of spindle-shaped cells with a high mitotic rate, over 5 mitoses/50 high-power fields.", "The tumor had an 86% risk of progression (PT4Nx).", "A partially encapsulated tumor proliferation was noted in the thickness of the muscular tunic of the gastric wall.", "The tumor proliferation had a pseudonodular appearance composed of fusiform cells.", "The cells had hypertrophic nuclei with unevenly arranged chromatin and karyorrhexes.", "The cells were arranged in a fasciculate pattern.", "The tumor had myxoid, hemorrhage, and necrosis areas.", "Neoplastic proliferation invaded only the submucosa.", "The neoplastic proliferation did not affect the gastric mucosa.", "The neoplastic proliferation did not invade adjacent splenic or pancreatic parenchyma.", "The mitotic rate was high, >5 mitoses/50 HPFs.", "Free margins (R0) were noted.", "No evidence of perineural invasion was noted.", "No lymph node metastasis was noted.", "No peritoneal metastasis was noted.", "IHC staining revealed that tumor cells were strongly diffuse positive for CD117/c-kit.", "IHC staining revealed that tumor cells were strongly diffuse positive for CD34.", "IHC staining revealed that tumor cells were strongly diffuse positive for DOG1.", "SMA and neuron-specific enolase (NSE) were variable focal positives in tumor proliferation.", "The Ki67 proliferation rate was positive in more than 5% of the tumor cells in 50 HPFs.", "The S100 protein was negative.", "The patient was successfully discharged.", "The patient underwent oncology follow-up with Imatinib.", "There was no relapse a year after surgical resection."], "summary_subclaims": ["The patient was diagnosed with a giant gastric GIST.", "The tumor presented for intermittent gastric outlet obstruction symptoms.", "There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction.", "Tumor resection should be adapted to every patient's status.", "The surgical approach should be focused on en bloc extraction.", "The surgical approach should aim for preservation of invaded organs as much as possible."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 47-year-old man.", "He had a severe trauma of the left hemithorax, left hypochondrium, and left flank three years before the current presentation.", "He was admitted to the Department of Gastroenterology.", "He had nausea, repeated vomiting, epigastric pain, and intermittent constipation for over a month.", "He had acid regurgitation and pyrosis.", "He had loss of appetite and significant weight loss in the past six months.", "Physical examination revealed a firm, palpable abdominal mass in the left hypochondrium and left flank.", "Laboratory tests showed a low iron serum level of 46 \u03bcg/dL.", "Laboratory tests showed leukocytosis.", "Upper endoscopy described a deformed stomach with an extrinsic compression especially on the antrum.", "The extrinsic compression made difficult the passage through the pylorus.", "There was no significant distention of the gastric body on insufflation.", "There was no mucosal abnormality.", "An abdominal ultrasound highlighted a heterogeneous mass with tissular and cystic components.", "The mass extended from the left hepatic lobe to the spleen\u2019s hilum.", "Contrast-enhanced ultrasonography pointed out that the tissular component of the tumor was enhanced in the arterial phase.", "The tissular component presented a wash-out phenomenon in the late phase.", "The cystic and necrotic components were unenhanced.", "A contrast-enhanced abdominal computed tomography was scheduled.", "The CT scan described a heterogeneous tumor of 17\u00d715\u00d714 cm containing numerous necrosis and cystic areas.", "The tumor originated in the fundus and greater curvature of the stomach.", "The tumor had extraluminal development.", "The tumor was causing a mass effect on the stomach, spleen, splenic vein, and enveloping the body and pancreatic tail.", "We suspected it was a GIST with necrotic areas.", "We proposed the patient for surgery due to tumor size and gastric outlet obstruction symptoms.", "A xypho-umbilical approach was chosen.", "The peritoneal cavity was opened.", "The giant tumor occupied most of the upper abdominal cavity with adherence to the gastric wall.", "After the gastro-colic ligament was sectioned, tumor appurtenance of the great gastric wall was confirmed.", "Infiltration of the tail of the pancreas and splenic pedicle was confirmed.", "No hepatic or peritoneal metastases were found.", "The rest of the abdominal organs seemed macroscopically normal.", "En bloc surgical removal of the tumor was decided, including adjacent lymph nodes, spleen, and pancreas tail.", "The pancreas tail was sectioned 5 cm proximal from the splenic pedicle.", "The tumor block included the greater curvature of the stomach.", "The greater curvature of the stomach was sealed with a linear stapler.", "The resected piece measured 23\u00d717\u00d710 cm.", "The tumor had 22\u00d710 cm with many cystic and necrotic areas.", "Tumor fragments were embedded in 10% formalin for 24 hours.", "Classical staining with Hematoxylin\u2013Eosin described similar characteristics of a mesenchymal tumor.", "The tumor was composed of spindle-shaped cells with a high mitotic rate, over 5 mitoses/50 high-power fields.", "The tumor had an 86% risk of progression (PT4Nx).", "A partially encapsulated tumor proliferation was noted in the thickness of the muscular tunic of the gastric wall.", "The tumor proliferation had a pseudonodular appearance composed of fusiform cells.", "The cells had hypertrophic nuclei with unevenly arranged chromatin and karyorrhexes.", "The cells were arranged in a fasciculate pattern.", "The tumor had myxoid, hemorrhage, and necrosis areas.", "Neoplastic proliferation invaded only the submucosa.", "The neoplastic proliferation did not affect the gastric mucosa.", "The neoplastic proliferation did not invade adjacent splenic or pancreatic parenchyma.", "The mitotic rate was high, >5 mitoses/50 HPFs.", "Free margins (R0) were noted.", "No evidence of perineural invasion was noted.", "No lymph node metastasis was noted.", "No peritoneal metastasis was noted.", "IHC staining revealed that tumor cells were strongly diffuse positive for CD117/c-kit.", "IHC staining revealed that tumor cells were strongly diffuse positive for CD34.", "IHC staining revealed that tumor cells were strongly diffuse positive for DOG1.", "SMA and neuron-specific enolase (NSE) were variable focal positives in tumor proliferation.", "The Ki67 proliferation rate was positive in more than 5% of the tumor cells in 50 HPFs.", "The S100 protein was negative.", "The patient was successfully discharged.", "The patient underwent oncology follow-up with Imatinib.", "There was no relapse a year after surgical resection."], "index": 169, "original_id": "multiclinsum_test_1842_en.txt", "split": "test", "summary_subclaims": ["The patient was diagnosed with a giant gastric GIST.", "The tumor presented for intermittent gastric outlet obstruction symptoms.", "There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction.", "Tumor resection should be adapted to every patient's status.", "The surgical approach should be focused on en bloc extraction.", "The surgical approach should aim for preservation of invaded organs as much as possible."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 51-year-old Caucasian woman.", "She presented with spinal, pelvic, and sternal inflammatory pain lasting for many years.", "The symptoms had a strong negative impact on her quality of life.", "She did not present palmoplantar pustulosis.", "There was no context of fever.", "She had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome at the age of 40 years.", "She had received sulfasalazine and nonsteroidal anti-inflammatory drugs (NSAIDs) for many years with incomplete pain relief.", "She also had a history of cervical and lumbar arthrodesis.", "She had a history of hypertension.", "She had a history of thyroidectomy.", "Total spine and pelvis magnetic resonance imaging (MRI) showed a short tau inversion recovery (STIR) hypersignal on several thoracic vertebrae (T6, T7, T8, and T9).", "Total spine and pelvis MRI showed a short tau inversion recovery (STIR) hypersignal on the sternal part of the right clavicle.", "Bone marrow oedema was also found on the right iliac bone.", "The sacroiliac joints were preserved.", "Bone scintigraphy showed anterior chest wall involvement.", "Right sternoclavicular hyperostosis was found on computed tomography.", "The C-reactive protein (CRP) was found to be 89.2 mg/L.", "The reference range for CRP is 0\u20135 mg/L.", "Several blood tests performed earlier had already shown elevation of inflammation parameters.", "HLA B27 antigen was negative.", "The diagnosis of active SAPHO syndrome was confirmed.", "Conventional synthetic disease-modifying antirheumatic drug (csDMARD) as methotrexate was not considered.", "Methotrexate is more effective on peripheral arthritis.", "Methotrexate has not shown comparable activity in axial disease in patients with axial spondyloarthritis.", "Anti-tumour necrosis factor (TNF) drugs could not be prescribed because the criteria for reimbursement of these drugs in Belgium were not met.", "The criteria for reimbursement were not met in the absence of sacroiliitis.", "JAK-inhibitors were initiated.", "Tofacitinib 5 mg twice daily was initiated.", "The patient reported rapid and significant reduction of pain within weeks of starting the treatment.", "Blood tests performed one month after the onset of treatment showed a clear regression of inflammatory parameters.", "The CRP was 25.5 mg/L one month after the onset of treatment.", "The CRP was 14 mg/L after 4 months of treatment.", "The CRP was 9.9 mg/L after 10 months of treatment.", "Total spine and pelvis MRI performed after 3 months of treatment showed regression of the STIR hypersignal on the body of the thoracic vertebrae.", "The hypersignal of the right iliac bone disappeared after 3 months of treatment.", "The rheumatic evolution was favourable from a clinical, biological, and radiological point of view since the introduction of a JAK-inhibitor.", "The treatment had to be discontinued due to pulmonary embolism occurring after 8 months on tofacitinib.", "Spinal, pelvic, and chest (sternal and costal) pain reappeared after discontinuation of tofacitinib.", "Elevation of inflammatory parameters occurred after discontinuation of tofacitinib.", "Written informed consent was obtained from the patient for the publication of this report and its accompanying images."], "summary_subclaims": ["The patient was a 51-year-old Caucasian woman.", "She had SAPHO syndrome with mainly axial involvement.", "She had been treated with sulfasalazine and anti-inflammatory drugs for many years.", "The treatment with sulfasalazine and anti-inflammatory drugs was without any success.", "A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved.", "Imaging showed considerable regression of the vertebral and pelvic lesions.", "Tofacitinib had to be discontinued due to the occurrence of pulmonary embolism.", "Recurrence of bone pain and biologic inflammation was rapidly observed."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 51-year-old Caucasian woman.", "She presented with spinal, pelvic, and sternal inflammatory pain lasting for many years.", "The symptoms had a strong negative impact on her quality of life.", "She did not present palmoplantar pustulosis.", "There was no context of fever.", "She had been diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome at the age of 40 years.", "She had received sulfasalazine and nonsteroidal anti-inflammatory drugs (NSAIDs) for many years with incomplete pain relief.", "She also had a history of cervical and lumbar arthrodesis.", "She had a history of hypertension.", "She had a history of thyroidectomy.", "Total spine and pelvis magnetic resonance imaging (MRI) showed a short tau inversion recovery (STIR) hypersignal on several thoracic vertebrae (T6, T7, T8, and T9).", "Total spine and pelvis MRI showed a short tau inversion recovery (STIR) hypersignal on the sternal part of the right clavicle.", "Bone marrow oedema was also found on the right iliac bone.", "The sacroiliac joints were preserved.", "Bone scintigraphy showed anterior chest wall involvement.", "Right sternoclavicular hyperostosis was found on computed tomography.", "The C-reactive protein (CRP) was found to be 89.2 mg/L.", "The reference range for CRP is 0\u20135 mg/L.", "Several blood tests performed earlier had already shown elevation of inflammation parameters.", "HLA B27 antigen was negative.", "The diagnosis of active SAPHO syndrome was confirmed.", "Conventional synthetic disease-modifying antirheumatic drug (csDMARD) as methotrexate was not considered.", "Methotrexate is more effective on peripheral arthritis.", "Methotrexate has not shown comparable activity in axial disease in patients with axial spondyloarthritis.", "Anti-tumour necrosis factor (TNF) drugs could not be prescribed because the criteria for reimbursement of these drugs in Belgium were not met.", "The criteria for reimbursement were not met in the absence of sacroiliitis.", "JAK-inhibitors were initiated.", "Tofacitinib 5 mg twice daily was initiated.", "The patient reported rapid and significant reduction of pain within weeks of starting the treatment.", "Blood tests performed one month after the onset of treatment showed a clear regression of inflammatory parameters.", "The CRP was 25.5 mg/L one month after the onset of treatment.", "The CRP was 14 mg/L after 4 months of treatment.", "The CRP was 9.9 mg/L after 10 months of treatment.", "Total spine and pelvis MRI performed after 3 months of treatment showed regression of the STIR hypersignal on the body of the thoracic vertebrae.", "The hypersignal of the right iliac bone disappeared after 3 months of treatment.", "The rheumatic evolution was favourable from a clinical, biological, and radiological point of view since the introduction of a JAK-inhibitor.", "The treatment had to be discontinued due to pulmonary embolism occurring after 8 months on tofacitinib.", "Spinal, pelvic, and chest (sternal and costal) pain reappeared after discontinuation of tofacitinib.", "Elevation of inflammatory parameters occurred after discontinuation of tofacitinib.", "Written informed consent was obtained from the patient for the publication of this report and its accompanying images."], "index": 0, "original_id": "multiclinsum_test_787_en.txt", "split": "test", "summary_subclaims": ["The patient was a 51-year-old Caucasian woman.", "She had SAPHO syndrome with mainly axial involvement.", "She had been treated with sulfasalazine and anti-inflammatory drugs for many years.", "The treatment with sulfasalazine and anti-inflammatory drugs was without any success.", "A few weeks after starting treatment with tofacitinib, both clinical and biological parameters dramatically improved.", "Imaging showed considerable regression of the vertebral and pelvic lesions.", "Tofacitinib had to be discontinued due to the occurrence of pulmonary embolism.", "Recurrence of bone pain and biologic inflammation was rapidly observed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 65-year-old man was admitted in the emergency department for seizures.", "His medical history included diabetes mellitus.", "His medical history included arterial hypertension.", "His medical history included smoking.", "Four months before admission, a chest X-Ray performed because of a persistent cough revealed a lung mass.", "The lung biopsy yielded a squamous non-small-cell lung cancer.", "The lung biopsy showed 80% expression of PD-L1.", "Extended evaluation showed a unique hepatic metastasis.", "Following consultation with the institutional multidisciplinary team in charge of lung cancer, the patient was treated with intravenous pembrolizumab.", "Pembrolizumab was started 3 months before admission.", "Pembrolizumab was given as a single-drug regimen.", "Pembrolizumab was given at 200 mg every three weeks.", "The patient had no tolerability issues with pembrolizumab.", "The patient had no adherence issues with pembrolizumab.", "On admission, the patient was afebrile.", "Clinical examination was normal.", "Routine biochemical and hematology tests were normal.", "The electroencephalogram performed 12 h after seizures was normal.", "Brain CT scan found a focal hypodense lesion in the right frontal lobe.", "Brain MRI showed an intracranial round-shaped lesion with a maximal diameter of 18 mm.", "The lesion had low signal intensity on T1-weighted images.", "The lesion had intermediate signal intensity on T2-weighted images.", "The lesion was associated with perilesional edema.", "The lesion showed wall enhancement on T1-weighted gadolinium-enhanced images.", "The lesion was suggestive of brain abscess.", "Brain metastasis could not be ruled out.", "The patient was transferred to the neurosurgical department for a total removal of the lesion.", "The excision was performed with craniotomy.", "Per-operative macroscopic findings were also suggestive of brain abscess.", "Empirical antimicrobial therapy was started after surgery.", "Antimicrobial therapy included intravenous ceftriaxone.", "Antimicrobial therapy included metronidazole.", "Microscopic examination revealed numerous filamentous-branching Gram-positive rods.", "Cultures yielded Nocardia farcinica.", "Nocardia farcinica was identified by MALDI-TOF mass spectrometry.", "Antibiotic treatment was modified to meropenem 1 g every 8 h.", "Antibiotic treatment was modified to cotrimoxazole 1600 mg/400 mg every 8 h.", "Antibiotic treatment included folinic acid.", "Body-CT did not show any other localization of nocardiosis.", "The mass tumor had decreased by 80% after the sixth cycle of pembrolizumab.", "Drug susceptibility testing found a meropenem MIC of 32 mg/L.", "Drug susceptibility testing found a linezolid MIC of 4 mg/L.", "Drug susceptibility testing found a cotrimoxazole MIC of 0.5 mg/L.", "Meropenem was replaced by linezolid 600 mg every 12 h.", "Linezolid was given in combination with cotrimoxazole.", "Following the diagnosis, additional risk factors for cerebral nocardiosis were ruled out.", "After 2 months, the patient was asymptomatic, except for asthenia.", "Antibiotics were well tolerated.", "The patient did not receive additional dose of pembrolizumab.", "At 10 weeks of treatment, he developed thrombocytopenia due to linezolid.", "He died 3 months after the diagnosis of cerebral nocardiosis.", "His death was probably related to a major upper-gastrointestinal bleeding.", "The upper-gastrointestinal bleeding was probably related to a peptic ulcer disease.", "The upper-gastrointestinal bleeding was probably related to thrombocytopenia."], "summary_subclaims": ["This is the first clinical case of a cerebral nocardiosis revealed after seizure in a patient treated by pembrolizumab for a metastatic lung cancer.", "The patient was not receiving any additional immunosuppressive therapy.", "The patient had no risk factors for cerebral nocardiosis.", "A brain CT-scan did not reveal any lesion before pembrolizumab.", "The 3-month delay between the start of pembrolizumab and the diagnosis of cerebral nocardiosis suggests that the infection occurred prior to the CPI.", "The patient died during treatment for cerebral nocardiosis.", "The lung cancer tumor mass had decreased by 80% after the sixth cycle of pembrolizumab."]}, "extra_info": {"fulltext_subclaims": ["A 65-year-old man was admitted in the emergency department for seizures.", "His medical history included diabetes mellitus.", "His medical history included arterial hypertension.", "His medical history included smoking.", "Four months before admission, a chest X-Ray performed because of a persistent cough revealed a lung mass.", "The lung biopsy yielded a squamous non-small-cell lung cancer.", "The lung biopsy showed 80% expression of PD-L1.", "Extended evaluation showed a unique hepatic metastasis.", "Following consultation with the institutional multidisciplinary team in charge of lung cancer, the patient was treated with intravenous pembrolizumab.", "Pembrolizumab was started 3 months before admission.", "Pembrolizumab was given as a single-drug regimen.", "Pembrolizumab was given at 200 mg every three weeks.", "The patient had no tolerability issues with pembrolizumab.", "The patient had no adherence issues with pembrolizumab.", "On admission, the patient was afebrile.", "Clinical examination was normal.", "Routine biochemical and hematology tests were normal.", "The electroencephalogram performed 12 h after seizures was normal.", "Brain CT scan found a focal hypodense lesion in the right frontal lobe.", "Brain MRI showed an intracranial round-shaped lesion with a maximal diameter of 18 mm.", "The lesion had low signal intensity on T1-weighted images.", "The lesion had intermediate signal intensity on T2-weighted images.", "The lesion was associated with perilesional edema.", "The lesion showed wall enhancement on T1-weighted gadolinium-enhanced images.", "The lesion was suggestive of brain abscess.", "Brain metastasis could not be ruled out.", "The patient was transferred to the neurosurgical department for a total removal of the lesion.", "The excision was performed with craniotomy.", "Per-operative macroscopic findings were also suggestive of brain abscess.", "Empirical antimicrobial therapy was started after surgery.", "Antimicrobial therapy included intravenous ceftriaxone.", "Antimicrobial therapy included metronidazole.", "Microscopic examination revealed numerous filamentous-branching Gram-positive rods.", "Cultures yielded Nocardia farcinica.", "Nocardia farcinica was identified by MALDI-TOF mass spectrometry.", "Antibiotic treatment was modified to meropenem 1 g every 8 h.", "Antibiotic treatment was modified to cotrimoxazole 1600 mg/400 mg every 8 h.", "Antibiotic treatment included folinic acid.", "Body-CT did not show any other localization of nocardiosis.", "The mass tumor had decreased by 80% after the sixth cycle of pembrolizumab.", "Drug susceptibility testing found a meropenem MIC of 32 mg/L.", "Drug susceptibility testing found a linezolid MIC of 4 mg/L.", "Drug susceptibility testing found a cotrimoxazole MIC of 0.5 mg/L.", "Meropenem was replaced by linezolid 600 mg every 12 h.", "Linezolid was given in combination with cotrimoxazole.", "Following the diagnosis, additional risk factors for cerebral nocardiosis were ruled out.", "After 2 months, the patient was asymptomatic, except for asthenia.", "Antibiotics were well tolerated.", "The patient did not receive additional dose of pembrolizumab.", "At 10 weeks of treatment, he developed thrombocytopenia due to linezolid.", "He died 3 months after the diagnosis of cerebral nocardiosis.", "His death was probably related to a major upper-gastrointestinal bleeding.", "The upper-gastrointestinal bleeding was probably related to a peptic ulcer disease.", "The upper-gastrointestinal bleeding was probably related to thrombocytopenia."], "index": 157, "original_id": "multiclinsum_test_2333_en.txt", "split": "test", "summary_subclaims": ["This is the first clinical case of a cerebral nocardiosis revealed after seizure in a patient treated by pembrolizumab for a metastatic lung cancer.", "The patient was not receiving any additional immunosuppressive therapy.", "The patient had no risk factors for cerebral nocardiosis.", "A brain CT-scan did not reveal any lesion before pembrolizumab.", "The 3-month delay between the start of pembrolizumab and the diagnosis of cerebral nocardiosis suggests that the infection occurred prior to the CPI.", "The patient died during treatment for cerebral nocardiosis.", "The lung cancer tumor mass had decreased by 80% after the sixth cycle of pembrolizumab."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 52-year-old female.", "The patient has no comorbidities.", "The disease evolution has lasted two years.", "The patient has localized pain on the distal phalanx of the left thumb.", "The pain is rated as 9 on the visual analogue scale.", "The pain is of a burning type.", "The pain increases with movement.", "The pain increases with changes in temperature.", "Physical examination showed subungual pain.", "Physical examination showed mild volume increase.", "Physical examination showed palpation of a radial-sided tumour.", "Ultrasound reported a highly vascularised nodular lesion.", "The lesion is circumscribed, hypoechoic, and homogeneous.", "The lesion measures 3.00 \u00d7 2.10 mm.", "The lesion is located on the medial edge of the distal phalanx of the first finger.", "There is thickening of the synovial sheath.", "These findings are characteristic of glomus tumours.", "Surgical treatment was decided.", "The surgery required glasses with two-fold magnification.", "The surgery used regional block anaesthesia and ischaemia.", "The surgical approach was to the distal phalanx and transverse subungual.", "A white-yellowish tumour, well encapsulated, was visualised.", "The tumour measured 3 \u00d7 2 mm.", "Bone curettage was performed.", "Cauterisation of the vascular bed was performed.", "The wound was sutured with monofilament nylon 4/0.", "A piece was sent for histopathological study.", "The patient attended a two-week follow-up appointment.", "Surgical wound stitches were removed.", "The surgical wound showed adequate healing.", "The patient could mobilise the distal interphalangeal joint.", "The pain was rated as 1 point on the visual analogue scale.", "The histopathological study reported a glomus tumour."], "summary_subclaims": ["The patient is a 52-year-old female.", "The patient reported chronic, burning pain radiating to the distal phalanx of the thumb.", "The pain had been present for two years.", "There was no traumatic history.", "The pain limited her daily activities.", "Interphalangeal Doppler ultrasound was performed.", "Interphalangeal Doppler ultrasound is an excellent alternative due to its easy accessibility.", "A glomus tumor in the interphalangeal phalanx of the thumb was diagnosed.", "A H-approach was performed on the interphalangeal fold.", "Subungual dissection and resection of the tumoral piece were performed.", "The surgical wound was found to be healing adequately.", "The patient was able to mobilize the interphalangeal distal joint.", "The visual analogue scale (VAS) was 1 point.", "The anatomopathological evaluation reported the existence of a glomus tumor."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 52-year-old female.", "The patient has no comorbidities.", "The disease evolution has lasted two years.", "The patient has localized pain on the distal phalanx of the left thumb.", "The pain is rated as 9 on the visual analogue scale.", "The pain is of a burning type.", "The pain increases with movement.", "The pain increases with changes in temperature.", "Physical examination showed subungual pain.", "Physical examination showed mild volume increase.", "Physical examination showed palpation of a radial-sided tumour.", "Ultrasound reported a highly vascularised nodular lesion.", "The lesion is circumscribed, hypoechoic, and homogeneous.", "The lesion measures 3.00 \u00d7 2.10 mm.", "The lesion is located on the medial edge of the distal phalanx of the first finger.", "There is thickening of the synovial sheath.", "These findings are characteristic of glomus tumours.", "Surgical treatment was decided.", "The surgery required glasses with two-fold magnification.", "The surgery used regional block anaesthesia and ischaemia.", "The surgical approach was to the distal phalanx and transverse subungual.", "A white-yellowish tumour, well encapsulated, was visualised.", "The tumour measured 3 \u00d7 2 mm.", "Bone curettage was performed.", "Cauterisation of the vascular bed was performed.", "The wound was sutured with monofilament nylon 4/0.", "A piece was sent for histopathological study.", "The patient attended a two-week follow-up appointment.", "Surgical wound stitches were removed.", "The surgical wound showed adequate healing.", "The patient could mobilise the distal interphalangeal joint.", "The pain was rated as 1 point on the visual analogue scale.", "The histopathological study reported a glomus tumour."], "index": 158, "original_id": "multiclinsum_test_3249_en.txt", "split": "test", "summary_subclaims": ["The patient is a 52-year-old female.", "The patient reported chronic, burning pain radiating to the distal phalanx of the thumb.", "The pain had been present for two years.", "There was no traumatic history.", "The pain limited her daily activities.", "Interphalangeal Doppler ultrasound was performed.", "Interphalangeal Doppler ultrasound is an excellent alternative due to its easy accessibility.", "A glomus tumor in the interphalangeal phalanx of the thumb was diagnosed.", "A H-approach was performed on the interphalangeal fold.", "Subungual dissection and resection of the tumoral piece were performed.", "The surgical wound was found to be healing adequately.", "The patient was able to mobilize the interphalangeal distal joint.", "The visual analogue scale (VAS) was 1 point.", "The anatomopathological evaluation reported the existence of a glomus tumor."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 63-year-old man was referred to Modarres Hospital, Tehran.", "He had gradual onset of obscure generalized abdominal pain six hours before admission.", "His pain was located in the epigastric and periumbilical region.", "There was no radiation of pain to anywhere else.", "He had one episode of vomiting.", "There was moderate abdominal distension.", "There was periumbilical abdominal tenderness.", "There was no guarding.", "Initial blood tests showed white cell count (WBC) of 21.7 \u00d7 109/L.", "Initial blood tests showed neutrophils 84.2%.", "Initial blood tests showed hemoglobin (Hb) 15.2 g/dL.", "C reactive protein was +2.", "Amylase was 63 U/L.", "Abdominal x-ray was normal.", "Ultrasonography was normal.", "About five hours after resuscitation and appropriate fluid therapy, he has not felt better.", "Blood tests were deranged.", "WBC was 18.4\u00d7109/L.", "Neutrophils were 76.5%.", "Hb was 8.1 g/dL.", "Abdominopelvic CT-scan showed evidence of hematoma near the head of pancreas.", "Abdominopelvic CT-scan showed perihepatic and perisplenic fluid.", "BP fell to 95/55 mmHg.", "Pulse rose to 105/min.", "He was transferred to operating room emergently.", "Midline laparotomy was performed.", "Massive intraperitoneal hematoma was evacuated.", "Right medial visceral rotation, the Cattell-Braasch maneuver, was performed.", "Active bleeding in the base of IPDA was detected.", "IPDA was suture ligated at the base with 4/0 nonabsorbable stitch.", "Hemostasis was achieved.", "The post-operative period was uneventful.", "Oral fluids were started the day after the surgery.", "The patient was discharged from the hospital two days after the surgery.", "One week after discharge, he had a normal follow-up.", "There were no concerning problems one week after discharge."], "summary_subclaims": ["The patient is a 63-year-old man.", "The patient had idiopathic spontaneous intraperitoneal hemorrhage.", "The hemorrhage was caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenal artery."]}, "extra_info": {"fulltext_subclaims": ["A 63-year-old man was referred to Modarres Hospital, Tehran.", "He had gradual onset of obscure generalized abdominal pain six hours before admission.", "His pain was located in the epigastric and periumbilical region.", "There was no radiation of pain to anywhere else.", "He had one episode of vomiting.", "There was moderate abdominal distension.", "There was periumbilical abdominal tenderness.", "There was no guarding.", "Initial blood tests showed white cell count (WBC) of 21.7 \u00d7 109/L.", "Initial blood tests showed neutrophils 84.2%.", "Initial blood tests showed hemoglobin (Hb) 15.2 g/dL.", "C reactive protein was +2.", "Amylase was 63 U/L.", "Abdominal x-ray was normal.", "Ultrasonography was normal.", "About five hours after resuscitation and appropriate fluid therapy, he has not felt better.", "Blood tests were deranged.", "WBC was 18.4\u00d7109/L.", "Neutrophils were 76.5%.", "Hb was 8.1 g/dL.", "Abdominopelvic CT-scan showed evidence of hematoma near the head of pancreas.", "Abdominopelvic CT-scan showed perihepatic and perisplenic fluid.", "BP fell to 95/55 mmHg.", "Pulse rose to 105/min.", "He was transferred to operating room emergently.", "Midline laparotomy was performed.", "Massive intraperitoneal hematoma was evacuated.", "Right medial visceral rotation, the Cattell-Braasch maneuver, was performed.", "Active bleeding in the base of IPDA was detected.", "IPDA was suture ligated at the base with 4/0 nonabsorbable stitch.", "Hemostasis was achieved.", "The post-operative period was uneventful.", "Oral fluids were started the day after the surgery.", "The patient was discharged from the hospital two days after the surgery.", "One week after discharge, he had a normal follow-up.", "There were no concerning problems one week after discharge."], "index": 4, "original_id": "multiclinsum_test_45_en.txt", "split": "test", "summary_subclaims": ["The patient is a 63-year-old man.", "The patient had idiopathic spontaneous intraperitoneal hemorrhage.", "The hemorrhage was caused by spontaneous rupture of non-aneurysmal inferior pancreaticoduodenal artery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is an 86-year-old male.", "He had a previous history of hypertension.", "He had a previous history of coronary artery disease.", "He had shortness of breath.", "He was admitted to the hospital due to heart failure.", "He had undergone percutaneous coronary interventions in the circumflex artery in 2019.", "He had undergone percutaneous coronary interventions in the left anterior descending artery in 2020.", "The interventions were performed at another hospital.", "The patient was asymptomatic before admission.", "Blood pressure was 176/91 mmHg.", "Heart rate was 85 b.p.m.", "Bilateral leg oedema was observed.", "A systolic murmur was heard on auscultation.", "Chest X-ray revealed pleural effusion.", "Chest X-ray revealed congestion.", "Electrocardiogram was within normal range.", "Brain natriuretic peptide was 150.4 pg/mL.", "The normal range for brain natriuretic peptide is <100 pg/mL.", "STS was 10.8.", "EuroSCORE 2 was 9.4.", "Trans-thoracic echocardiogram revealed a left ventricular ejection fraction of 66%.", "Trans-thoracic echocardiogram revealed a left ventricular diastolic diameter of 41 mm.", "A calcified aortic valve was observed.", "The peak velocity of the aortic valve was 3.5 m/s.", "The mean aortic valve pressure gradient was 33 mmHg.", "The aortic valve area using the Doppler method was 0.78 cm2.", "The presence of a VSD can affect TTE-derived peak velocity and mean PG.", "Membranous VSD was observed in cardiac computed tomography.", "Double-chambered right ventricle was observed in cardiac computed tomography.", "Trans-oesophageal echocardiogram, CT, and catheter-based AVA were 0.6\u20130.7 cm2.", "The calcium score was 2150 AgU.", "Based on these findings, the patient was diagnosed with severe aortic stenosis.", "Cardiac CT showed the cardiac anatomy was suitable for TAV implantation.", "The annulus perimeter was 66.1 mm.", "The Valsalva diameter was 29.1 mm.", "The VSD orifice was located 3.5\u20137.3 mm from the aortic valve annulus.", "The VSD orifice diameter was 3.8 mm.", "A thin sub-aortic band was attached to the LV outflow tract.", "Coronary angiogram showed no significant stenosis.", "The catheter-based pressure gradient between LV apex and aorta was 27 mmHg.", "No pressure gradient was observed between LV apex and LVOT.", "Right heart catheterization showed normal wedge pressure of 17 mmHg.", "Right heart catheterization showed a slightly decreased cardiac index of 2.1 L/min/m2.", "Pulmonary hypertension with a mean pressure of 38 mmHg was observed.", "A pressure gradient of 50 mmHg between high-pressure and low-pressure chambers of the right ventricle was observed.", "The catheter-based Qp/Qs ratio was 1.9.", "Severe aortic stenosis in combination with left-to-right shunt due to VSD was diagnosed as the leading cause of heart failure.", "These findings fulfilled the indication for invasive treatment for aortic stenosis and VSD.", "Surgical aortic valve replacement, VSD closure, myectomy of the right ventricle, and sub-aortic band resection were discussed.", "The surgical team deemed the patient not a surgical candidate.", "The surgical team cited the patient\u2019s age as a reason not to perform surgery.", "The surgical team cited high risk of surgery as a reason not to perform surgery.", "The surgical team cited frailty as a reason not to perform surgery.", "A TAVI procedure with VSD orifice coverage using a valve skirt was planned.", "A 26-mm Evolut Pro Plus\u2122 valve was selected.", "The valve has a long skirt at the bottom, which could cover the VSD orifice completely.", "The valve was deployed 9 mm from the annulus level.", "The valve was deployed to cover the entire orifice of VSD with the valve skirt.", "The valve was deployed by watching TOE to confirm no structural damage.", "The valve did not interfere with mitral valve movement.", "No leak across the valve was observed by TOE.", "Complete coverage of the VSD orifice with the valve skirt was observed by TOE.", "The amount of left-to-right shunt decreased.", "The catheter-based Qp/Qs ratio decreased from 1.9 to 1.2.", "Trans-thoracic echocardiogram\u2013based aortic valve pressure gradient decreased from 33 to 2 mmHg.", "Post-procedural TOE revealed no leakage.", "Post-procedural TOE revealed a decrease in left-to-right shunt.", "Post-procedural ECG finding was unchanged.", "Post-procedural ECG showed sinus rhythm.", "Post-procedural ECG showed a PR interval of 194 ms.", "Post-procedural ECG showed a QRS duration of 70 ms.", "The patient was discharged from hospital 7 days after the procedure.", "The patient had not been admitted to hospital since discharge."], "summary_subclaims": ["The patient was an 86-year-old male.", "The patient was admitted to the hospital with congestive heart failure.", "The patient had low-flow low-gradient severe AS.", "The patient had a membranous VSD.", "The patient had a sub-aortic band.", "The patient had a double-chambered right ventricle.", "The patient was not deemed to be a surgical candidate.", "Surgical aortic valve replacement, VSD closure, sub-aortic band resection, and myectomy of RV would be considered as definitive treatment.", "TAVI was performed using a 26\u2005mm Evolut Pro Plus\u2122 self-expanding valve.", "VSD orifice closure was performed using the skirt part of the self-expanding valve.", "A VSD occluder is not approved and thus not available in our country.", "The mean aortic valve pressure gradient improved from 33 to 2\u2005mmHg.", "The shunt flow (Qp/Qs) decreased from 1.9 to 1.2.", "The patient\u2019s heart failure improved.", "The patient was discharged to home 7 days after the procedure.", "The patient remained well and had not been admitted to hospital since discharge."]}, "extra_info": {"fulltext_subclaims": ["The patient is an 86-year-old male.", "He had a previous history of hypertension.", "He had a previous history of coronary artery disease.", "He had shortness of breath.", "He was admitted to the hospital due to heart failure.", "He had undergone percutaneous coronary interventions in the circumflex artery in 2019.", "He had undergone percutaneous coronary interventions in the left anterior descending artery in 2020.", "The interventions were performed at another hospital.", "The patient was asymptomatic before admission.", "Blood pressure was 176/91 mmHg.", "Heart rate was 85 b.p.m.", "Bilateral leg oedema was observed.", "A systolic murmur was heard on auscultation.", "Chest X-ray revealed pleural effusion.", "Chest X-ray revealed congestion.", "Electrocardiogram was within normal range.", "Brain natriuretic peptide was 150.4 pg/mL.", "The normal range for brain natriuretic peptide is <100 pg/mL.", "STS was 10.8.", "EuroSCORE 2 was 9.4.", "Trans-thoracic echocardiogram revealed a left ventricular ejection fraction of 66%.", "Trans-thoracic echocardiogram revealed a left ventricular diastolic diameter of 41 mm.", "A calcified aortic valve was observed.", "The peak velocity of the aortic valve was 3.5 m/s.", "The mean aortic valve pressure gradient was 33 mmHg.", "The aortic valve area using the Doppler method was 0.78 cm2.", "The presence of a VSD can affect TTE-derived peak velocity and mean PG.", "Membranous VSD was observed in cardiac computed tomography.", "Double-chambered right ventricle was observed in cardiac computed tomography.", "Trans-oesophageal echocardiogram, CT, and catheter-based AVA were 0.6\u20130.7 cm2.", "The calcium score was 2150 AgU.", "Based on these findings, the patient was diagnosed with severe aortic stenosis.", "Cardiac CT showed the cardiac anatomy was suitable for TAV implantation.", "The annulus perimeter was 66.1 mm.", "The Valsalva diameter was 29.1 mm.", "The VSD orifice was located 3.5\u20137.3 mm from the aortic valve annulus.", "The VSD orifice diameter was 3.8 mm.", "A thin sub-aortic band was attached to the LV outflow tract.", "Coronary angiogram showed no significant stenosis.", "The catheter-based pressure gradient between LV apex and aorta was 27 mmHg.", "No pressure gradient was observed between LV apex and LVOT.", "Right heart catheterization showed normal wedge pressure of 17 mmHg.", "Right heart catheterization showed a slightly decreased cardiac index of 2.1 L/min/m2.", "Pulmonary hypertension with a mean pressure of 38 mmHg was observed.", "A pressure gradient of 50 mmHg between high-pressure and low-pressure chambers of the right ventricle was observed.", "The catheter-based Qp/Qs ratio was 1.9.", "Severe aortic stenosis in combination with left-to-right shunt due to VSD was diagnosed as the leading cause of heart failure.", "These findings fulfilled the indication for invasive treatment for aortic stenosis and VSD.", "Surgical aortic valve replacement, VSD closure, myectomy of the right ventricle, and sub-aortic band resection were discussed.", "The surgical team deemed the patient not a surgical candidate.", "The surgical team cited the patient\u2019s age as a reason not to perform surgery.", "The surgical team cited high risk of surgery as a reason not to perform surgery.", "The surgical team cited frailty as a reason not to perform surgery.", "A TAVI procedure with VSD orifice coverage using a valve skirt was planned.", "A 26-mm Evolut Pro Plus\u2122 valve was selected.", "The valve has a long skirt at the bottom, which could cover the VSD orifice completely.", "The valve was deployed 9 mm from the annulus level.", "The valve was deployed to cover the entire orifice of VSD with the valve skirt.", "The valve was deployed by watching TOE to confirm no structural damage.", "The valve did not interfere with mitral valve movement.", "No leak across the valve was observed by TOE.", "Complete coverage of the VSD orifice with the valve skirt was observed by TOE.", "The amount of left-to-right shunt decreased.", "The catheter-based Qp/Qs ratio decreased from 1.9 to 1.2.", "Trans-thoracic echocardiogram\u2013based aortic valve pressure gradient decreased from 33 to 2 mmHg.", "Post-procedural TOE revealed no leakage.", "Post-procedural TOE revealed a decrease in left-to-right shunt.", "Post-procedural ECG finding was unchanged.", "Post-procedural ECG showed sinus rhythm.", "Post-procedural ECG showed a PR interval of 194 ms.", "Post-procedural ECG showed a QRS duration of 70 ms.", "The patient was discharged from hospital 7 days after the procedure.", "The patient had not been admitted to hospital since discharge."], "index": 154, "original_id": "multiclinsum_test_3275_en.txt", "split": "test", "summary_subclaims": ["The patient was an 86-year-old male.", "The patient was admitted to the hospital with congestive heart failure.", "The patient had low-flow low-gradient severe AS.", "The patient had a membranous VSD.", "The patient had a sub-aortic band.", "The patient had a double-chambered right ventricle.", "The patient was not deemed to be a surgical candidate.", "Surgical aortic valve replacement, VSD closure, sub-aortic band resection, and myectomy of RV would be considered as definitive treatment.", "TAVI was performed using a 26\u2005mm Evolut Pro Plus\u2122 self-expanding valve.", "VSD orifice closure was performed using the skirt part of the self-expanding valve.", "A VSD occluder is not approved and thus not available in our country.", "The mean aortic valve pressure gradient improved from 33 to 2\u2005mmHg.", "The shunt flow (Qp/Qs) decreased from 1.9 to 1.2.", "The patient\u2019s heart failure improved.", "The patient was discharged to home 7 days after the procedure.", "The patient remained well and had not been admitted to hospital since discharge."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["It is a case report of a 13-year-old girl.", "She had swelling over her right hand for 5 months.", "The swelling was gradually progressive.", "The swelling was situated over the dorsum and medial aspect of the hand.", "There was no history of trauma.", "There was no lesion elsewhere in the body.", "There was no lesion in the family.", "There were no associated features such as pain, fever, or signs influencing general health.", "On examination, the swelling was firm in consistency.", "The swelling occupied the dorsal and inner side of the fifth metacarpal.", "Local temperature was not raised.", "The skin was mobile.", "There was no feature suggestive of inflammatory pathology.", "On deep palpation, the swelling was tender.", "The range of movement was restricted.", "Routine hematological examination was within normal limits.", "Radiology revealed an osteolytic fusiform expansible lesion involving the distal 2/3rd of the fifth metacarpal.", "The lesion involved the articular surface.", "The cortical was paper thin, breached, inflated, and without periosteal reaction.", "The tumor radiograph had a 'soap bubble' appearance.", "The provisional diagnosis was aneurysmal bone cyst and GCT.", "The chest X-ray was within normal limits.", "A core-cut biopsy was sent.", "The biopsy conferred the diagnosis of GCT.", "The technique used was free osteoarticular metatarsal transfer, described by Maini et al.", "A dorsal approach was used for the enbloc resection.", "The incision included the previous biopsy track.", "The fifth metatarsal was removed except the base.", "Partial resection of surrounding muscles was performed.", "The capsule and collateral ligament of the fifth metacarpophalangeal joint were left.", "The fourth metatarsal was harvested from the foot.", "The capsuloligamentous of the metatarsal was sutured to the counter capsuloligamentous structure at the recipient site.", "The metatarsal was fixed with the leftover base of the metacarpal by K-wires.", "A volar slab was applied.", "At the 14th post-operative day, the sutures were removed.", "Exercise was started gradually.", "Union at the junction occurred in 6 weeks.", "No obvious changes were noticed at the transferred metatarsal.", "Initially, the movements had both extension and flexion lag.", "Electric stimulation was given.", "At the end of 6 months of follow-up, the movements were painless and almost up to normal.", "Flexion was restricted terminally at the metacarpophalangeal joint.", "The patient was able to grasp any object.", "The patient had pretty good grip strength.", "After 2 years of follow-up, the procedure was fulfilling expectations.", "The procedure corroborates the reliability of this method.", "During the initial follow-up, the patient had mild-to-moderate pain over the foot while walking.", "The patient was unable to dorsiflex the fourth toe.", "She is now free from pain or any complaint such as deformity or difficulty in walking.", "There is still slight weakness of the fourth toe\u2019s dorsiflexor.", "She is happy and has no complaints."], "summary_subclaims": ["It is a case report of a 13-year-old girl.", "She had a history of swelling over her right hand for 5 months.", "X-ray revealed an osteolytic fusiform expansible lesion.", "The biopsy conferred the diagnosis of GCT.", "A dorsal approach was used for the enbloc resection of the fifth metacarpals (except at the base).", "Partial excision of the surrounding muscles was done.", "The capsule and collateral ligament of the fifth metacarpophalangeal joint were left.", "The fourth metatarsal was harvested from the foot along with its capsule and collateral ligament of the metatarsophalangeal joint.", "The harvested fourth metatarsal was sutured to the counter capsuloligamentous structure at the recipient site."]}, "extra_info": {"fulltext_subclaims": ["It is a case report of a 13-year-old girl.", "She had swelling over her right hand for 5 months.", "The swelling was gradually progressive.", "The swelling was situated over the dorsum and medial aspect of the hand.", "There was no history of trauma.", "There was no lesion elsewhere in the body.", "There was no lesion in the family.", "There were no associated features such as pain, fever, or signs influencing general health.", "On examination, the swelling was firm in consistency.", "The swelling occupied the dorsal and inner side of the fifth metacarpal.", "Local temperature was not raised.", "The skin was mobile.", "There was no feature suggestive of inflammatory pathology.", "On deep palpation, the swelling was tender.", "The range of movement was restricted.", "Routine hematological examination was within normal limits.", "Radiology revealed an osteolytic fusiform expansible lesion involving the distal 2/3rd of the fifth metacarpal.", "The lesion involved the articular surface.", "The cortical was paper thin, breached, inflated, and without periosteal reaction.", "The tumor radiograph had a 'soap bubble' appearance.", "The provisional diagnosis was aneurysmal bone cyst and GCT.", "The chest X-ray was within normal limits.", "A core-cut biopsy was sent.", "The biopsy conferred the diagnosis of GCT.", "The technique used was free osteoarticular metatarsal transfer, described by Maini et al.", "A dorsal approach was used for the enbloc resection.", "The incision included the previous biopsy track.", "The fifth metatarsal was removed except the base.", "Partial resection of surrounding muscles was performed.", "The capsule and collateral ligament of the fifth metacarpophalangeal joint were left.", "The fourth metatarsal was harvested from the foot.", "The capsuloligamentous of the metatarsal was sutured to the counter capsuloligamentous structure at the recipient site.", "The metatarsal was fixed with the leftover base of the metacarpal by K-wires.", "A volar slab was applied.", "At the 14th post-operative day, the sutures were removed.", "Exercise was started gradually.", "Union at the junction occurred in 6 weeks.", "No obvious changes were noticed at the transferred metatarsal.", "Initially, the movements had both extension and flexion lag.", "Electric stimulation was given.", "At the end of 6 months of follow-up, the movements were painless and almost up to normal.", "Flexion was restricted terminally at the metacarpophalangeal joint.", "The patient was able to grasp any object.", "The patient had pretty good grip strength.", "After 2 years of follow-up, the procedure was fulfilling expectations.", "The procedure corroborates the reliability of this method.", "During the initial follow-up, the patient had mild-to-moderate pain over the foot while walking.", "The patient was unable to dorsiflex the fourth toe.", "She is now free from pain or any complaint such as deformity or difficulty in walking.", "There is still slight weakness of the fourth toe\u2019s dorsiflexor.", "She is happy and has no complaints."], "index": 163, "original_id": "multiclinsum_test_2668_en.txt", "split": "test", "summary_subclaims": ["It is a case report of a 13-year-old girl.", "She had a history of swelling over her right hand for 5 months.", "X-ray revealed an osteolytic fusiform expansible lesion.", "The biopsy conferred the diagnosis of GCT.", "A dorsal approach was used for the enbloc resection of the fifth metacarpals (except at the base).", "Partial excision of the surrounding muscles was done.", "The capsule and collateral ligament of the fifth metacarpophalangeal joint were left.", "The fourth metatarsal was harvested from the foot along with its capsule and collateral ligament of the metatarsophalangeal joint.", "The harvested fourth metatarsal was sutured to the counter capsuloligamentous structure at the recipient site."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 72-year-old Caucasian woman.", "She had a history of childhood encephalitis with motor sequelae.", "She had a 10-year history of full-thickness rectal prolapse.", "The rectal prolapse had progressively worsened despite two surgical procedures.", "The first surgical procedure was anal encirclement 13 years before presentation.", "The second surgical procedure was an encirclement associated with stapler mucous prolapsectomy 6 years before presentation.", "She had severe fecal incontinence associated with repeated rectal bleeding for 2 years.", "The patient's Wexner incontinence score was 19.", "Anorectal manometry showed marked hypotonia of the anal canal at rest (20 mmHg).", "Anorectal manometry showed marked hypotonia of the anal canal during contraction (40 mmHg).", "Endorectal ultrasonographic examination revealed no documentable sphincter lesions.", "The muscle fibers appeared markedly thinned on endorectal ultrasonographic examination.", "Electromyographic recordings disclosed severe neurogenic damage to her external anal sphincter.", "The patient declined to undergo construction of a definitive colostomy.", "The operation proceeded in three steps.", "The full-thickness rectal wall was incised circumferentially at 2 cm from the pectinate line.", "The pouch of Douglas was opened.", "About 20 cm of bowel was prepared.", "The peritoneal fossa was reconstructed.", "A coloanal anastomosis was constructed with a 29 circular stapler.", "The operation proceeded with dynamic graciloplasty.", "The gracile muscle was mobilized down to its insertion on the tibial tuberosity.", "Electrical stimuli were delivered to identify the neurovascular peduncle.", "This step is crucial to identify the site for definitive intramuscular electrode implantation.", "The gracile muscle was tunnelled and wrapped around the sigmoid colon anastomosed to the residual rectum.", "The muscle tendon was fixed on the perineal skin.", "A subcutaneous pouch was created in the right iliac fossa to house the neurostimulator.", "The leads connecting the neurostimulator to the gracile muscle were tunnelled subcutaneously.", "A temporary transverse colostomy was constructed.", "The patient had an uneventful postoperative course.", "On day 7, the patient began regular leg gymnastics with a soft balloon placed between her knees.", "Neurostimulation delivered at low frequency began on day 20.", "Neurostimulation continued for about 2 months before the frequency was increased.", "In the sixth month, clinical examination showed a slight improvement in sphincter tone.", "In the sixth month, manometric evaluation showed pressure at 30 mmHg without electrical stimulation.", "In the sixth month, manometric evaluation showed pressure at 55 mmHg with electrical stimulation.", "One year after the operation, the colostomy was closed under manometric evaluation.", "One year after the operation, manometric evaluation showed pressure at 40 mmHg without electrical stimulation.", "One year after the operation, manometric evaluation showed pressure at 65 mmHg with electrical stimulation.", "Two years after the combined operation, no further recurrent rectal prolapse was visible.", "The patient was continent for solids (Wexner incontinence score 9).", "The patient could switch the pacemaker device on and off without help."], "summary_subclaims": ["The patient is a 72-year-old Caucasian woman.", "The patient had full-thickness rectal prolapse.", "The patient had fecal incontinence.", "The fecal incontinence was associated with full-thickness rectal prolapse.", "The fecal incontinence was from severe neuromuscular damage."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 72-year-old Caucasian woman.", "She had a history of childhood encephalitis with motor sequelae.", "She had a 10-year history of full-thickness rectal prolapse.", "The rectal prolapse had progressively worsened despite two surgical procedures.", "The first surgical procedure was anal encirclement 13 years before presentation.", "The second surgical procedure was an encirclement associated with stapler mucous prolapsectomy 6 years before presentation.", "She had severe fecal incontinence associated with repeated rectal bleeding for 2 years.", "The patient's Wexner incontinence score was 19.", "Anorectal manometry showed marked hypotonia of the anal canal at rest (20 mmHg).", "Anorectal manometry showed marked hypotonia of the anal canal during contraction (40 mmHg).", "Endorectal ultrasonographic examination revealed no documentable sphincter lesions.", "The muscle fibers appeared markedly thinned on endorectal ultrasonographic examination.", "Electromyographic recordings disclosed severe neurogenic damage to her external anal sphincter.", "The patient declined to undergo construction of a definitive colostomy.", "The operation proceeded in three steps.", "The full-thickness rectal wall was incised circumferentially at 2 cm from the pectinate line.", "The pouch of Douglas was opened.", "About 20 cm of bowel was prepared.", "The peritoneal fossa was reconstructed.", "A coloanal anastomosis was constructed with a 29 circular stapler.", "The operation proceeded with dynamic graciloplasty.", "The gracile muscle was mobilized down to its insertion on the tibial tuberosity.", "Electrical stimuli were delivered to identify the neurovascular peduncle.", "This step is crucial to identify the site for definitive intramuscular electrode implantation.", "The gracile muscle was tunnelled and wrapped around the sigmoid colon anastomosed to the residual rectum.", "The muscle tendon was fixed on the perineal skin.", "A subcutaneous pouch was created in the right iliac fossa to house the neurostimulator.", "The leads connecting the neurostimulator to the gracile muscle were tunnelled subcutaneously.", "A temporary transverse colostomy was constructed.", "The patient had an uneventful postoperative course.", "On day 7, the patient began regular leg gymnastics with a soft balloon placed between her knees.", "Neurostimulation delivered at low frequency began on day 20.", "Neurostimulation continued for about 2 months before the frequency was increased.", "In the sixth month, clinical examination showed a slight improvement in sphincter tone.", "In the sixth month, manometric evaluation showed pressure at 30 mmHg without electrical stimulation.", "In the sixth month, manometric evaluation showed pressure at 55 mmHg with electrical stimulation.", "One year after the operation, the colostomy was closed under manometric evaluation.", "One year after the operation, manometric evaluation showed pressure at 40 mmHg without electrical stimulation.", "One year after the operation, manometric evaluation showed pressure at 65 mmHg with electrical stimulation.", "Two years after the combined operation, no further recurrent rectal prolapse was visible.", "The patient was continent for solids (Wexner incontinence score 9).", "The patient could switch the pacemaker device on and off without help."], "index": 165, "original_id": "multiclinsum_test_2449_en.txt", "split": "test", "summary_subclaims": ["The patient is a 72-year-old Caucasian woman.", "The patient had full-thickness rectal prolapse.", "The patient had fecal incontinence.", "The fecal incontinence was associated with full-thickness rectal prolapse.", "The fecal incontinence was from severe neuromuscular damage."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 44-year-old pediatrician working in Faryab Province, Afghanistan.", "The patient presented with compressing chest pain and dizziness.", "The chest pain and dizziness occurred during a common cold or exertion.", "The patient had previously experienced the same symptoms during an upper respiratory infection and exertions.", "The patient had no history of heart disease.", "The patient had no history of smoking.", "The patient's blood pressure was 120/80 mm Hg.", "The patient's heart rate was 86 beats/minute.", "The patient's oxygen saturation was 97%.", "The patient's BMI was 30.4.", "The physical examination was unremarkable.", "The patient tested negative for COVID-19.", "The patient tested negative for HIV.", "The patient tested negative for HBV.", "The abdominal ultrasonography showed no abnormalities.", "The chest x-ray was normal.", "Serial electrocardiography was normal.", "Cardiac enzymes were normal.", "Echocardiography revealed grade 1 left ventricular diastolic dysfunction.", "Echocardiography showed normal structural and valves of the heart.", "The ejection fraction was 60\u201365%.", "Blood examinations did not indicate any abnormalities.", "Coronary angiography showed a mid-LAD myocardial bridge with systolic compression.", "The coronary angiography showed significant stenosis.", "The milking effect was identified.", "A calcium channel blocker, Diltiazem 60mg per day, was prescribed.", "The patient tolerated the medication well.", "The patient remained asymptomatic during two years of follow-up."], "summary_subclaims": ["The patient is a 44-year-old man from Faryab Province in Afghanistan.", "The patient presented with chest pain and dizziness.", "The patient was suffering a common cold at the time of presentation.", "The patient underwent coronary angiography.", "The coronary angiography showed a myocardial bridge at the middle portion of the left anterior descending artery.", "The myocardial bridge was associated with significant stenosis causing ischemia.", "The patient was treated with a calcium channel blocker as initial treatment.", "The patient tolerated the medication well.", "The patient remained asymptomatic during two years of follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 44-year-old pediatrician working in Faryab Province, Afghanistan.", "The patient presented with compressing chest pain and dizziness.", "The chest pain and dizziness occurred during a common cold or exertion.", "The patient had previously experienced the same symptoms during an upper respiratory infection and exertions.", "The patient had no history of heart disease.", "The patient had no history of smoking.", "The patient's blood pressure was 120/80 mm Hg.", "The patient's heart rate was 86 beats/minute.", "The patient's oxygen saturation was 97%.", "The patient's BMI was 30.4.", "The physical examination was unremarkable.", "The patient tested negative for COVID-19.", "The patient tested negative for HIV.", "The patient tested negative for HBV.", "The abdominal ultrasonography showed no abnormalities.", "The chest x-ray was normal.", "Serial electrocardiography was normal.", "Cardiac enzymes were normal.", "Echocardiography revealed grade 1 left ventricular diastolic dysfunction.", "Echocardiography showed normal structural and valves of the heart.", "The ejection fraction was 60\u201365%.", "Blood examinations did not indicate any abnormalities.", "Coronary angiography showed a mid-LAD myocardial bridge with systolic compression.", "The coronary angiography showed significant stenosis.", "The milking effect was identified.", "A calcium channel blocker, Diltiazem 60mg per day, was prescribed.", "The patient tolerated the medication well.", "The patient remained asymptomatic during two years of follow-up."], "index": 167, "original_id": "multiclinsum_test_3208_en.txt", "split": "test", "summary_subclaims": ["The patient is a 44-year-old man from Faryab Province in Afghanistan.", "The patient presented with chest pain and dizziness.", "The patient was suffering a common cold at the time of presentation.", "The patient underwent coronary angiography.", "The coronary angiography showed a myocardial bridge at the middle portion of the left anterior descending artery.", "The myocardial bridge was associated with significant stenosis causing ischemia.", "The patient was treated with a calcium channel blocker as initial treatment.", "The patient tolerated the medication well.", "The patient remained asymptomatic during two years of follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 2-year-old girl.", "She was born full-term.", "She had developed normally.", "She had no medical history of asthma.", "She had no medical history of pneumonia.", "She had no familial history of immunodeficiency.", "She had no brothers or sisters.", "She was admitted to the hospital due to 3 days of fever.", "She had 15 min of respiratory and cardiac arrest.", "The symptoms started on 10 November.", "She had a fever up to 39.8 \u00b0C.", "She had no chills.", "She had no rash.", "She had no convulsions.", "Ibuprofen was given orally.", "The body temperature decreased for 4 to 5 h.", "The body temperature climbed to 40.3 \u00b0C.", "Shortness of breath accompanied the fever.", "The body temperature did not decrease obviously after oral administration of ibuprofen.", "Wheezing caused by the retention of phlegm in the throat occurred.", "A single paroxysmal cough occurred.", "She occasionally coughed up a small amount of yellow phlegm.", "She had a slightly runny nose.", "She had no asthma.", "She had no breathing difficulty.", "She had no hemoptysis.", "She had lethargy.", "She had a poor appetite.", "She had no vomiting.", "She had no diarrhea.", "On 11 November, the patient still had a high fever.", "Her body temperature fluctuated around approximately 40 \u00b0C.", "The patient\u2019s body temperature did not obviously decrease after oral ibuprofen and acetaminophen alternately.", "Acute infection was considered from then on.", "The patient received an intravenous infusion of 0.14 g Zithromax.", "The patient received an intravenous infusion of 120 mg rographolide.", "The patient received aerosol inhalation of 2 mg budesonide.", "Her fever persisted.", "Her body temperature rose to a peak of 40 \u00b0C.", "On 12 November, the patient still had a persistent fever.", "She had wheezing due to the retention of phlegm in her throat.", "She had shortness of breath.", "She had a light cough.", "She had a drooping spirit.", "She had a rash on the torso and limbs.", "Her appetite was slightly improved.", "She had no vomiting.", "She had no convulsions.", "On 13 November, the patient had sudden respiratory and cardiac arrest 3 h before admission.", "She was immediately and continuously treated with cardiopulmonary resuscitation by physicians.", "She received intravenous injection of adrenaline (4 times).", "She was treated with trachea cannula and mechanical ventilation.", "Her heart beat recovered approximately 15 min later.", "The patient remained in a deep comatose state with no spontaneous breathing.", "The patient was transferred to our hospital.", "She immediately underwent electrocardiogram (ECG) monitoring.", "Bloody fluid was visible in the indwelling gastrointestinal decompression tube.", "The blood-gas analysis showed metabolic acidosis.", "The patient was treated with sodium bicarbonate to correct the acidosis.", "She was diagnosed with an acute CNS infection.", "She was diagnosed with brain hernia.", "After cardiopulmonary resuscitation, she was admitted to the pediatric intensive care unit (PICU).", "The head CT scan showed extensive brain swelling.", "The head CT scan showed decreased brain parenchymal density.", "The head CT scan showed narrowed cerebral ventricles and cisterns.", "These findings prompted a diagnosis of extensive brain edema and hernia.", "The chest posteroanterior radiograph showed fuzzy, coarse bilateral lung markings.", "The chest posteroanterior radiograph showed visible small patchy shadows in the right inferior lung.", "The chest posteroanterior radiograph showed a clear pulmonary hilus.", "These findings were diagnosed as pneumonia.", "Routine blood examination results suggested the presence of a bacterial infection.", "The patient was treated with vancomycin to control an infection.", "The patient was treated with meropenem to control an infection.", "After that, immunoglobulin (1 g/kg) was administered for immune support.", "The patient was still in a deep coma state.", "Light reflexes of both pupils were absent.", "The patient\u2019s spontaneous breathing was weak and irregular.", "She had no response to painful stimulation.", "Compared with earlier, her rash was reduced.", "The pulmonary lesions shown on the chest posteroanterior radiograph were slightly absorbed.", "Immunoglobulin (1 g/kg) was continuously administered to neutralize pathogens.", "On 15 November, transcranial Doppler ultrasound assessment showed that the patient\u2019s anterior and posterior cerebral circulation corresponded to the diagnostic criteria for brain death.", "On 17 November, various organ functions failed.", "The patient could not tolerate a spontaneous breathing test.", "Her guardian chose to quit treatment.", "The patient died.", "Viral antigen detection based on both an immunofluorescence assay and the Luminex xTAG respiratory viral panel assay was positive for RSV in the patient\u2019s nasopharyngeal aspirates.", "The nasopharyngeal aspirates were collected on 14 Nov.", "The viral antigen detection was negative for adenovirus.", "The viral antigen detection was negative for influenza A and B viruses.", "The viral antigen detection was negative for parainfluenza virus 1\u20134.", "The viral antigen detection was negative for human metapneumovirus.", "The viral antigen detection was negative for enteroviruses and rhinoviruses.", "The viral antigen detection was negative for human coronavirus HKU1, 229E, NL63 and OC43.", "The viral antigen detection was negative for human bocavirus.", "The patient\u2019s guardian refused to consent to lumbar puncture.", "Cerebrospinal fluid (CSF) was not available for the detection of CNS infection.", "The amounts of red blood cells (RBCs) continuously decreased after the onset of symptoms.", "The amounts of hemoglobin continuously decreased after the onset of symptoms.", "The amounts of platelets continuously decreased after the onset of symptoms.", "Extremely high levels of C-reactive protein from the third day suggested viral or bacterial infection.", "Bacterial cultures of blood specimens yielded negative results.", "The percentage of T lymphocytes was 46.6%.", "Helper T cells accounted for 29.6%.", "Suppressor T cells accounted for 13.2%.", "The ratio of CD4/CD8 was 2.2.", "The proportions of B lymphocytes were 45.6%.", "The proportions of NK cells were 3%.", "All these immunological indexes indicated dysfunction of the patient\u2019s immune system.", "Oral swab, nasopharyngeal aspirate, and serum specimens were collected on 14 Nov.", "The specimens were subjected to multiplex metagenomic analyses using an NGS platform.", "The nucleic acid library was constructed as previously described.", "The amplified nucleic acid libraries were analyzed using an Illumina HiSeq 4000 sequencer.", "The raw sequence reads were filtered using previously described criteria to obtain valid sequences.", "When bacteriophages, plant-origin sequences, and contamination from reagents were excluded, only human RSV was identified.", "At least one specific sequence from the oral swab was identified.", "At least one specific sequence from the nasopharyngeal aspirate was identified.", "No virus-related sequences were detected in the serum specimen.", "Large numbers of sequence reads related to bacteria were detected in the oral swab, nasopharyngeal aspirate, or/and serum specimens.", "Bacterial culture of the blood specimens yielded negative results.", "The complete length of the RSV genome was obtained using NGS methods and gap amplification.", "This RSV strain was subtyped as RSVB.", "It was found to cluster in the BA genotype.", "It had the signature 60-bp duplication in the G gene.", "The newly identified virus was named RSVB/BCH-Y/2016.", "The full genome sequence was deposited in GenBank under accession number KY924878.", "The phylogenetic analysis was conducted with representative sequences from nearly all RSVB subgroups.", "RSVB/BCH-Y/2016 belonged to BA9 subgroup.", "The G gene of this strain was most closely related to strain RSVB/GZ/13\u2013730.", "The G gene shared 98.82% homology with strain RSVB/GZ/13\u2013730.", "Strain RSVB/GZ/13\u2013730 was isolated from a child in Guangzhou, China, in 2013.", "For the six most important antigenic sites in the fusion protein, no mutation was found in RSVB/BCH-Y/2016."], "summary_subclaims": ["The child was born at full-term.", "The child developed normally up to the age of 2 years old.", "Cardiopulmonary arrest occurred within 3 days after the onset of symptoms.", "The symptoms included cough and high fever.", "Complete brain edema was prominent.", "Encephalopathy was developing.", "Viral antigen detection verified an RSV infection.", "Microbiome analyses of oral swab and nasopharyngeal aspirate specimens verified an RSV infection.", "Bacterial culture of blood specimens yielded negative results.", "The RSV strain detected in this patient was subtyped as RSVB9.", "No mutation was found in the six antigenic sites for targeted drugs or vaccines."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 2-year-old girl.", "She was born full-term.", "She had developed normally.", "She had no medical history of asthma.", "She had no medical history of pneumonia.", "She had no familial history of immunodeficiency.", "She had no brothers or sisters.", "She was admitted to the hospital due to 3 days of fever.", "She had 15 min of respiratory and cardiac arrest.", "The symptoms started on 10 November.", "She had a fever up to 39.8 \u00b0C.", "She had no chills.", "She had no rash.", "She had no convulsions.", "Ibuprofen was given orally.", "The body temperature decreased for 4 to 5 h.", "The body temperature climbed to 40.3 \u00b0C.", "Shortness of breath accompanied the fever.", "The body temperature did not decrease obviously after oral administration of ibuprofen.", "Wheezing caused by the retention of phlegm in the throat occurred.", "A single paroxysmal cough occurred.", "She occasionally coughed up a small amount of yellow phlegm.", "She had a slightly runny nose.", "She had no asthma.", "She had no breathing difficulty.", "She had no hemoptysis.", "She had lethargy.", "She had a poor appetite.", "She had no vomiting.", "She had no diarrhea.", "On 11 November, the patient still had a high fever.", "Her body temperature fluctuated around approximately 40 \u00b0C.", "The patient\u2019s body temperature did not obviously decrease after oral ibuprofen and acetaminophen alternately.", "Acute infection was considered from then on.", "The patient received an intravenous infusion of 0.14 g Zithromax.", "The patient received an intravenous infusion of 120 mg rographolide.", "The patient received aerosol inhalation of 2 mg budesonide.", "Her fever persisted.", "Her body temperature rose to a peak of 40 \u00b0C.", "On 12 November, the patient still had a persistent fever.", "She had wheezing due to the retention of phlegm in her throat.", "She had shortness of breath.", "She had a light cough.", "She had a drooping spirit.", "She had a rash on the torso and limbs.", "Her appetite was slightly improved.", "She had no vomiting.", "She had no convulsions.", "On 13 November, the patient had sudden respiratory and cardiac arrest 3 h before admission.", "She was immediately and continuously treated with cardiopulmonary resuscitation by physicians.", "She received intravenous injection of adrenaline (4 times).", "She was treated with trachea cannula and mechanical ventilation.", "Her heart beat recovered approximately 15 min later.", "The patient remained in a deep comatose state with no spontaneous breathing.", "The patient was transferred to our hospital.", "She immediately underwent electrocardiogram (ECG) monitoring.", "Bloody fluid was visible in the indwelling gastrointestinal decompression tube.", "The blood-gas analysis showed metabolic acidosis.", "The patient was treated with sodium bicarbonate to correct the acidosis.", "She was diagnosed with an acute CNS infection.", "She was diagnosed with brain hernia.", "After cardiopulmonary resuscitation, she was admitted to the pediatric intensive care unit (PICU).", "The head CT scan showed extensive brain swelling.", "The head CT scan showed decreased brain parenchymal density.", "The head CT scan showed narrowed cerebral ventricles and cisterns.", "These findings prompted a diagnosis of extensive brain edema and hernia.", "The chest posteroanterior radiograph showed fuzzy, coarse bilateral lung markings.", "The chest posteroanterior radiograph showed visible small patchy shadows in the right inferior lung.", "The chest posteroanterior radiograph showed a clear pulmonary hilus.", "These findings were diagnosed as pneumonia.", "Routine blood examination results suggested the presence of a bacterial infection.", "The patient was treated with vancomycin to control an infection.", "The patient was treated with meropenem to control an infection.", "After that, immunoglobulin (1 g/kg) was administered for immune support.", "The patient was still in a deep coma state.", "Light reflexes of both pupils were absent.", "The patient\u2019s spontaneous breathing was weak and irregular.", "She had no response to painful stimulation.", "Compared with earlier, her rash was reduced.", "The pulmonary lesions shown on the chest posteroanterior radiograph were slightly absorbed.", "Immunoglobulin (1 g/kg) was continuously administered to neutralize pathogens.", "On 15 November, transcranial Doppler ultrasound assessment showed that the patient\u2019s anterior and posterior cerebral circulation corresponded to the diagnostic criteria for brain death.", "On 17 November, various organ functions failed.", "The patient could not tolerate a spontaneous breathing test.", "Her guardian chose to quit treatment.", "The patient died.", "Viral antigen detection based on both an immunofluorescence assay and the Luminex xTAG respiratory viral panel assay was positive for RSV in the patient\u2019s nasopharyngeal aspirates.", "The nasopharyngeal aspirates were collected on 14 Nov.", "The viral antigen detection was negative for adenovirus.", "The viral antigen detection was negative for influenza A and B viruses.", "The viral antigen detection was negative for parainfluenza virus 1\u20134.", "The viral antigen detection was negative for human metapneumovirus.", "The viral antigen detection was negative for enteroviruses and rhinoviruses.", "The viral antigen detection was negative for human coronavirus HKU1, 229E, NL63 and OC43.", "The viral antigen detection was negative for human bocavirus.", "The patient\u2019s guardian refused to consent to lumbar puncture.", "Cerebrospinal fluid (CSF) was not available for the detection of CNS infection.", "The amounts of red blood cells (RBCs) continuously decreased after the onset of symptoms.", "The amounts of hemoglobin continuously decreased after the onset of symptoms.", "The amounts of platelets continuously decreased after the onset of symptoms.", "Extremely high levels of C-reactive protein from the third day suggested viral or bacterial infection.", "Bacterial cultures of blood specimens yielded negative results.", "The percentage of T lymphocytes was 46.6%.", "Helper T cells accounted for 29.6%.", "Suppressor T cells accounted for 13.2%.", "The ratio of CD4/CD8 was 2.2.", "The proportions of B lymphocytes were 45.6%.", "The proportions of NK cells were 3%.", "All these immunological indexes indicated dysfunction of the patient\u2019s immune system.", "Oral swab, nasopharyngeal aspirate, and serum specimens were collected on 14 Nov.", "The specimens were subjected to multiplex metagenomic analyses using an NGS platform.", "The nucleic acid library was constructed as previously described.", "The amplified nucleic acid libraries were analyzed using an Illumina HiSeq 4000 sequencer.", "The raw sequence reads were filtered using previously described criteria to obtain valid sequences.", "When bacteriophages, plant-origin sequences, and contamination from reagents were excluded, only human RSV was identified.", "At least one specific sequence from the oral swab was identified.", "At least one specific sequence from the nasopharyngeal aspirate was identified.", "No virus-related sequences were detected in the serum specimen.", "Large numbers of sequence reads related to bacteria were detected in the oral swab, nasopharyngeal aspirate, or/and serum specimens.", "Bacterial culture of the blood specimens yielded negative results.", "The complete length of the RSV genome was obtained using NGS methods and gap amplification.", "This RSV strain was subtyped as RSVB.", "It was found to cluster in the BA genotype.", "It had the signature 60-bp duplication in the G gene.", "The newly identified virus was named RSVB/BCH-Y/2016.", "The full genome sequence was deposited in GenBank under accession number KY924878.", "The phylogenetic analysis was conducted with representative sequences from nearly all RSVB subgroups.", "RSVB/BCH-Y/2016 belonged to BA9 subgroup.", "The G gene of this strain was most closely related to strain RSVB/GZ/13\u2013730.", "The G gene shared 98.82% homology with strain RSVB/GZ/13\u2013730.", "Strain RSVB/GZ/13\u2013730 was isolated from a child in Guangzhou, China, in 2013.", "For the six most important antigenic sites in the fusion protein, no mutation was found in RSVB/BCH-Y/2016."], "index": 161, "original_id": "multiclinsum_test_3147_en.txt", "split": "test", "summary_subclaims": ["The child was born at full-term.", "The child developed normally up to the age of 2 years old.", "Cardiopulmonary arrest occurred within 3 days after the onset of symptoms.", "The symptoms included cough and high fever.", "Complete brain edema was prominent.", "Encephalopathy was developing.", "Viral antigen detection verified an RSV infection.", "Microbiome analyses of oral swab and nasopharyngeal aspirate specimens verified an RSV infection.", "Bacterial culture of blood specimens yielded negative results.", "The RSV strain detected in this patient was subtyped as RSVB9.", "No mutation was found in the six antigenic sites for targeted drugs or vaccines."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 62-year-old male.", "The patient has hypertension.", "The patient has hyperlipidaemia.", "The patient presented with 7 days of dizziness.", "The patient presented with 7 days of fatigue.", "The patient presented with 7 days of nausea.", "The patient presented with 7 days of vomiting.", "The patient was transported to the emergency department.", "The patient was discharged home after initial evaluation.", "Approximately 4 days after discharge, emergency medical services were called after the patient experienced syncope.", "An ECG obtained en route reported anterior ST-segment elevations.", "Before arrival at the hospital, the patient developed ventricular fibrillation.", "Cardiac defibrillation was successful.", "Endotracheal intubation was performed.", "Upon arrival at the emergency department, ventricular fibrillation recurred.", "Resuscitative efforts restored sinus rhythm and spontaneous circulation.", "On arrival, the patient's heart rate was 77 b.p.m.", "On arrival, the patient had a regular rhythm.", "On arrival, the patient had hypotension (86 mmHg/48 mmHg).", "There were no appreciable murmurs.", "There was no lower extremity oedema.", "The extremities were cool to touch.", "The patient required mechanical ventilation with a rate of 28.", "The patient required mechanical ventilation with a tidal volume of 500 mL.", "The patient required mechanical ventilation with FiO2 100%.", "The patient required mechanical ventilation with positive end-expiratory pressure of 8 cmH2O.", "Breath sounds were present bilaterally.", "The subsequent ECG showed wide complex rhythm consistent with slow ventricular tachycardia.", "The subsequent ECG showed right bundle branch block morphology.", "The subsequent ECG showed left axis deviation.", "There was high suspicion for acute coronary syndrome.", "The patient received aspirin.", "The patient received ticagrelor.", "The patient received heparin.", "The patient was presumed to have an ST-segment elevation myocardial infarction.", "Epinephrine infusion was started due to bradycardia with hypotension.", "The patient was emergently taken to the catheterization lab.", "Coronary angiography did not reveal coronary stenosis.", "Right heart catheterization revealed elevated right-sided filling pressures.", "Right atrial pressure was 22 mmHg.", "Pulmonary artery pressure was 61/28 (39) mmHg.", "Pulmonary capillary wedge pressure was 15 mmHg.", "Fick cardiac index was 2.6 L/min/m2.", "A point-of-care echocardiogram was performed.", "The point-of-care echocardiogram demonstrated a dilated right ventricle.", "The point-of-care echocardiogram demonstrated severely reduced right ventricular function.", "There was concern for pulmonary embolism.", "Immediate pulmonary angiography was performed.", "Pulmonary angiography revealed large, bilateral pulmonary emboli.", "EkoSonic\u2122 endovascular thrombolysis catheters were advanced into both main pulmonary arteries.", "5 mg of tissue plasminogen activator was delivered through each catheter.", "2 mg/catheter/h of tissue plasminogen activator was delivered for 2 h.", "1 mg/catheter/h of tissue plasminogen activator was delivered for 16 h.", "Infusion was guided by fibrinogen monitoring.", "Upper and lower extremity Doppler ultrasounds showed no evidence of venous thrombosis.", "Formal transthoracic echocardiogram confirmed depressed right ventricular function.", "Computed tomography of the chest showed bilateral peripheral ground-glass opacities.", "Computed tomography of the chest showed wedge-shaped opacities in the right lung.", "The wedge-shaped opacities were thought to represent pulmonary infarctions.", "The patient was started on broad-spectrum antibiotics for pneumonia.", "A viral respiratory panel was negative.", "Tracheal aspirate culture was positive for methicillin-resistant Staphylococcus aureus.", "Repeat ECG showed sinus rhythm.", "Repeat ECG showed first-degree atrioventricular (AV) block.", "Repeat ECG showed left axis deviation.", "Repeat ECG showed incomplete right bundle branch block.", "Repeat ECG showed a prolonged QTc interval (498 ms).", "Over the following 4 days, the patient developed anaemia.", "CT of the chest, abdomen, and pelvis showed a mediastinal haematoma.", "CT of the chest, abdomen, and pelvis showed persistent ground-glass opacities.", "The patient was tested for SARS-CoV-2.", "The patient was found to be positive for SARS-CoV-2.", "The patient was transferred to a COVID-19-dedicated intensive care unit.", "The patient was placed under enhanced contact precautions.", "The patient received supportive care.", "The patient was extubated 4 days later.", "Following extubation, the patient did well.", "The patient was admitted to an inpatient rehabilitation facility.", "The patient was discharged home.", "The patient was prescribed lifelong apixaban 5 mg twice daily.", "At 1 month follow-up, the patient described mild exertional dyspnoea.", "Transthoracic echocardiogram at 1 month follow-up noted improvement of right ventricular dilation.", "Transthoracic echocardiogram at 1 month follow-up noted improvement of right ventricular systolic function."], "summary_subclaims": ["The patient was a 62-year-old male.", "He presented after experiencing syncope and cardiac arrest.", "There was concern for acute coronary syndrome.", "Coronary angiogram did not reveal significant coronary obstruction.", "A bedside echocardiogram was rapidly performed.", "The bedside echocardiogram was indicative of right ventricular strain.", "A pulmonary angiogram was performed.", "The pulmonary angiogram revealed massive pulmonary embolism.", "He successfully underwent catheter-directed thrombolysis.", "He was discharged home on lifelong anticoagulation."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 62-year-old male.", "The patient has hypertension.", "The patient has hyperlipidaemia.", "The patient presented with 7 days of dizziness.", "The patient presented with 7 days of fatigue.", "The patient presented with 7 days of nausea.", "The patient presented with 7 days of vomiting.", "The patient was transported to the emergency department.", "The patient was discharged home after initial evaluation.", "Approximately 4 days after discharge, emergency medical services were called after the patient experienced syncope.", "An ECG obtained en route reported anterior ST-segment elevations.", "Before arrival at the hospital, the patient developed ventricular fibrillation.", "Cardiac defibrillation was successful.", "Endotracheal intubation was performed.", "Upon arrival at the emergency department, ventricular fibrillation recurred.", "Resuscitative efforts restored sinus rhythm and spontaneous circulation.", "On arrival, the patient's heart rate was 77 b.p.m.", "On arrival, the patient had a regular rhythm.", "On arrival, the patient had hypotension (86 mmHg/48 mmHg).", "There were no appreciable murmurs.", "There was no lower extremity oedema.", "The extremities were cool to touch.", "The patient required mechanical ventilation with a rate of 28.", "The patient required mechanical ventilation with a tidal volume of 500 mL.", "The patient required mechanical ventilation with FiO2 100%.", "The patient required mechanical ventilation with positive end-expiratory pressure of 8 cmH2O.", "Breath sounds were present bilaterally.", "The subsequent ECG showed wide complex rhythm consistent with slow ventricular tachycardia.", "The subsequent ECG showed right bundle branch block morphology.", "The subsequent ECG showed left axis deviation.", "There was high suspicion for acute coronary syndrome.", "The patient received aspirin.", "The patient received ticagrelor.", "The patient received heparin.", "The patient was presumed to have an ST-segment elevation myocardial infarction.", "Epinephrine infusion was started due to bradycardia with hypotension.", "The patient was emergently taken to the catheterization lab.", "Coronary angiography did not reveal coronary stenosis.", "Right heart catheterization revealed elevated right-sided filling pressures.", "Right atrial pressure was 22 mmHg.", "Pulmonary artery pressure was 61/28 (39) mmHg.", "Pulmonary capillary wedge pressure was 15 mmHg.", "Fick cardiac index was 2.6 L/min/m2.", "A point-of-care echocardiogram was performed.", "The point-of-care echocardiogram demonstrated a dilated right ventricle.", "The point-of-care echocardiogram demonstrated severely reduced right ventricular function.", "There was concern for pulmonary embolism.", "Immediate pulmonary angiography was performed.", "Pulmonary angiography revealed large, bilateral pulmonary emboli.", "EkoSonic\u2122 endovascular thrombolysis catheters were advanced into both main pulmonary arteries.", "5 mg of tissue plasminogen activator was delivered through each catheter.", "2 mg/catheter/h of tissue plasminogen activator was delivered for 2 h.", "1 mg/catheter/h of tissue plasminogen activator was delivered for 16 h.", "Infusion was guided by fibrinogen monitoring.", "Upper and lower extremity Doppler ultrasounds showed no evidence of venous thrombosis.", "Formal transthoracic echocardiogram confirmed depressed right ventricular function.", "Computed tomography of the chest showed bilateral peripheral ground-glass opacities.", "Computed tomography of the chest showed wedge-shaped opacities in the right lung.", "The wedge-shaped opacities were thought to represent pulmonary infarctions.", "The patient was started on broad-spectrum antibiotics for pneumonia.", "A viral respiratory panel was negative.", "Tracheal aspirate culture was positive for methicillin-resistant Staphylococcus aureus.", "Repeat ECG showed sinus rhythm.", "Repeat ECG showed first-degree atrioventricular (AV) block.", "Repeat ECG showed left axis deviation.", "Repeat ECG showed incomplete right bundle branch block.", "Repeat ECG showed a prolonged QTc interval (498 ms).", "Over the following 4 days, the patient developed anaemia.", "CT of the chest, abdomen, and pelvis showed a mediastinal haematoma.", "CT of the chest, abdomen, and pelvis showed persistent ground-glass opacities.", "The patient was tested for SARS-CoV-2.", "The patient was found to be positive for SARS-CoV-2.", "The patient was transferred to a COVID-19-dedicated intensive care unit.", "The patient was placed under enhanced contact precautions.", "The patient received supportive care.", "The patient was extubated 4 days later.", "Following extubation, the patient did well.", "The patient was admitted to an inpatient rehabilitation facility.", "The patient was discharged home.", "The patient was prescribed lifelong apixaban 5 mg twice daily.", "At 1 month follow-up, the patient described mild exertional dyspnoea.", "Transthoracic echocardiogram at 1 month follow-up noted improvement of right ventricular dilation.", "Transthoracic echocardiogram at 1 month follow-up noted improvement of right ventricular systolic function."], "index": 168, "original_id": "multiclinsum_test_2976_en.txt", "split": "test", "summary_subclaims": ["The patient was a 62-year-old male.", "He presented after experiencing syncope and cardiac arrest.", "There was concern for acute coronary syndrome.", "Coronary angiogram did not reveal significant coronary obstruction.", "A bedside echocardiogram was rapidly performed.", "The bedside echocardiogram was indicative of right ventricular strain.", "A pulmonary angiogram was performed.", "The pulmonary angiogram revealed massive pulmonary embolism.", "He successfully underwent catheter-directed thrombolysis.", "He was discharged home on lifelong anticoagulation."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 29-year-old Asian female.", "She had previously been in good health.", "She presented with recurrent episodes of severe headache, nausea, and vomiting.", "She described the headache as 'pulling' downward.", "The headache was triggered by standing.", "The headache resolved when supine.", "She reported axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms.", "She denied immediate symptoms after the chiropractic manipulation.", "She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation.", "She had no known prior history of trauma.", "She had no known prior history of dural structural pathology.", "She had no known prior history of connective tissue disease.", "Physical exam was normal with no neurological deficits.", "Previous cervical MRI with and without contrast had been unremarkable.", "Cervical MRI at presentation revealed a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine.", "There was no mass effect on the thecal sac.", "There was no meningeal enhancement.", "There was no perineural cyst.", "There was no dural ectasia.", "There was no abnormal venous engorgement.", "The patient was managed conservatively with bed rest for 2 weeks.", "She made a complete spontaneous recovery.", "Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection.", "The patient is doing well presently."], "summary_subclaims": ["We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine.", "The patient is a 29-year-old female.", "The patient received manipulation one week prior to developing symptoms.", "The patient developed symptoms of severe orthostatic headache, nausea, and vomiting.", "Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection.", "Symptomatic onset corresponded with the recent cervical chiropractic adjustment.", "We present serial imaging correlating with her symptomatology.", "We review the pertinent literature on complications of chiropractic manipulation."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 29-year-old Asian female.", "She had previously been in good health.", "She presented with recurrent episodes of severe headache, nausea, and vomiting.", "She described the headache as 'pulling' downward.", "The headache was triggered by standing.", "The headache resolved when supine.", "She reported axial tension and rotatory manipulation of her neck one week prior to the onset of her symptoms.", "She denied immediate symptoms after the chiropractic manipulation.", "She experienced increasingly painful headaches over the 2 weeks following her chiropractic manipulation.", "She had no known prior history of trauma.", "She had no known prior history of dural structural pathology.", "She had no known prior history of connective tissue disease.", "Physical exam was normal with no neurological deficits.", "Previous cervical MRI with and without contrast had been unremarkable.", "Cervical MRI at presentation revealed a CSF-isodense ventral extradural fluid collection in the lower cervical spine and upper thoracic spine.", "There was no mass effect on the thecal sac.", "There was no meningeal enhancement.", "There was no perineural cyst.", "There was no dural ectasia.", "There was no abnormal venous engorgement.", "The patient was managed conservatively with bed rest for 2 weeks.", "She made a complete spontaneous recovery.", "Follow-up cervical MRI at 6 months demonstrated decreased size of ventral extradural fluid collection.", "The patient is doing well presently."], "index": 5, "original_id": "multiclinsum_test_2542_en.txt", "split": "test", "summary_subclaims": ["We present a case of subacute cervical cerebrospinal fluid (CSF) leak resulting from chiropractic manipulation of the cervical spine.", "The patient is a 29-year-old female.", "The patient received manipulation one week prior to developing symptoms.", "The patient developed symptoms of severe orthostatic headache, nausea, and vomiting.", "Magnetic resonance imaging (MRI) revealed a new C5-C6 ventral CSF collection.", "Symptomatic onset corresponded with the recent cervical chiropractic adjustment.", "We present serial imaging correlating with her symptomatology.", "We review the pertinent literature on complications of chiropractic manipulation."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was diagnosed with high-risk CD20+ common-type B-cell precursor acute lymphoblastic leukemia.", "The patient received two cycles of HyperCVAD.", "The patient consulted the National Cancer Institute for a relapse and five-day polyarthralgia.", "The patient was initiated into the protocol established in 2003 by the Adult Acute Lymphoblastic Leukemia Research Group (GRAALL-2003).", "The patient developed febrile neutropenia.", "The patient had cellulitis of the left hand without abscess.", "The patient had methicillin-sensitive Staphylococcus aureus bacteremia.", "Cefapime and oxacillin were administered.", "The bacteremia resolved.", "On day 21 of hospitalization, the patient presented lesions on the back of the left hand.", "The lesions on the back of the left hand were of the type erythematoedematosa plaque.", "The lesions on the back of the left hand had mild and fine desquamation on the surface.", "The lesions on the back of the left hand had central blood crust.", "The patient had lesions in the right scapular and infra-scapular region.", "The lesions in the right scapular and infra-scapular region were 3 mm non-follicular papules.", "The lesions in the right scapular and infra-scapular region were grouped.", "The lesions in the right scapular and infra-scapular region were some erythematous and others erythemoparous.", "The lesions were assessed by the Dermatology Service.", "A skin biopsy was taken for histopathological study.", "The results were inconclusive for the diagnosis of mycosis.", "No culture was done for fungi of the biopsy.", "An invasive fungal infection was suspected.", "Caspofungin was initiated.", "The chest and sinus computed tomography (CT) scans were negative for invasive aspergillosis.", "The serum galactomannan detection was negative for invasive aspergillosis.", "Despite antimicrobial and antifungal treatment, the patient did not show significant improvement.", "The patient persisted with a fever of up to 40 \u00b0C.", "The patient had 1 cm nodules, soft, depressible, painless and in the previous sites of venipuncture.", "The blood count showed a profound neutropenia (20 white blood cells per \u00b5l).", "The C reactive protein was 6.15 mg/dl.", "The control CT scan of the paranasal sinuses showed incipient chronic inflammatory changes in the right maxillary sinus.", "The abdomen scan documented hepatosplenomegaly.", "The three blood cultures and the urine culture from day 28 of hospitalization showed yeast-like structures.", "The yeast-like structures were not identified in the automated panel Yeast ID (BD Phoenix\u2122 100).", "Arthroconidia were observed by microscopy.", "Colonies compatible with Geotrichum spp. were documented.", "The diagnosis was confirmed by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry.", "Treatment with amphotericin B deoxycholate was given at a daily dose of 1 mg/kg for 14 days.", "400 mg/day of voriconazole was given for four weeks.", "Clinical symptoms resolved.", "The patient recovered from neutropenia on day 24 of the combined antifungal treatment.", "The patient was discharged on day 101 of hospitalisation due to clinical improvement."], "summary_subclaims": ["The patient is a 27-year-old male.", "The patient has relapsed acute lymphoblastic leukemia.", "The patient had five-day-old polyarthralgia.", "The patient had febrile neutropenia.", "The patient had cellulitis without abscesses.", "The patient had methicillin-resistant Staphylococcus aureus bacteremia.", "The patient received therapy with oxacillin and cefepime.", "The febrile neutropenia persisted.", "An invasive fungal infection was suspected.", "A new set of blood cultures was taken.", "Antifungal treatment was initiated.", "Arthroconidia were identified in the blood cultures.", "Matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp.", "Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B.", "Antifungal treatment was adjusted to four weeks of voriconazole.", "The patient was discharged after a prolonged stay."]}, "extra_info": {"fulltext_subclaims": ["The patient was diagnosed with high-risk CD20+ common-type B-cell precursor acute lymphoblastic leukemia.", "The patient received two cycles of HyperCVAD.", "The patient consulted the National Cancer Institute for a relapse and five-day polyarthralgia.", "The patient was initiated into the protocol established in 2003 by the Adult Acute Lymphoblastic Leukemia Research Group (GRAALL-2003).", "The patient developed febrile neutropenia.", "The patient had cellulitis of the left hand without abscess.", "The patient had methicillin-sensitive Staphylococcus aureus bacteremia.", "Cefapime and oxacillin were administered.", "The bacteremia resolved.", "On day 21 of hospitalization, the patient presented lesions on the back of the left hand.", "The lesions on the back of the left hand were of the type erythematoedematosa plaque.", "The lesions on the back of the left hand had mild and fine desquamation on the surface.", "The lesions on the back of the left hand had central blood crust.", "The patient had lesions in the right scapular and infra-scapular region.", "The lesions in the right scapular and infra-scapular region were 3 mm non-follicular papules.", "The lesions in the right scapular and infra-scapular region were grouped.", "The lesions in the right scapular and infra-scapular region were some erythematous and others erythemoparous.", "The lesions were assessed by the Dermatology Service.", "A skin biopsy was taken for histopathological study.", "The results were inconclusive for the diagnosis of mycosis.", "No culture was done for fungi of the biopsy.", "An invasive fungal infection was suspected.", "Caspofungin was initiated.", "The chest and sinus computed tomography (CT) scans were negative for invasive aspergillosis.", "The serum galactomannan detection was negative for invasive aspergillosis.", "Despite antimicrobial and antifungal treatment, the patient did not show significant improvement.", "The patient persisted with a fever of up to 40 \u00b0C.", "The patient had 1 cm nodules, soft, depressible, painless and in the previous sites of venipuncture.", "The blood count showed a profound neutropenia (20 white blood cells per \u00b5l).", "The C reactive protein was 6.15 mg/dl.", "The control CT scan of the paranasal sinuses showed incipient chronic inflammatory changes in the right maxillary sinus.", "The abdomen scan documented hepatosplenomegaly.", "The three blood cultures and the urine culture from day 28 of hospitalization showed yeast-like structures.", "The yeast-like structures were not identified in the automated panel Yeast ID (BD Phoenix\u2122 100).", "Arthroconidia were observed by microscopy.", "Colonies compatible with Geotrichum spp. were documented.", "The diagnosis was confirmed by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry.", "Treatment with amphotericin B deoxycholate was given at a daily dose of 1 mg/kg for 14 days.", "400 mg/day of voriconazole was given for four weeks.", "Clinical symptoms resolved.", "The patient recovered from neutropenia on day 24 of the combined antifungal treatment.", "The patient was discharged on day 101 of hospitalisation due to clinical improvement."], "index": 3, "original_id": "multiclinsum_test_3210_en.txt", "split": "test", "summary_subclaims": ["The patient is a 27-year-old male.", "The patient has relapsed acute lymphoblastic leukemia.", "The patient had five-day-old polyarthralgia.", "The patient had febrile neutropenia.", "The patient had cellulitis without abscesses.", "The patient had methicillin-resistant Staphylococcus aureus bacteremia.", "The patient received therapy with oxacillin and cefepime.", "The febrile neutropenia persisted.", "An invasive fungal infection was suspected.", "A new set of blood cultures was taken.", "Antifungal treatment was initiated.", "Arthroconidia were identified in the blood cultures.", "Matrix-assisted laser desorption ionization-mass spectrometry confirmed the presence of Geotrichum spp.", "Antifungal treatment was adjusted to 14 days of deoxycholate amphotericin B.", "Antifungal treatment was adjusted to four weeks of voriconazole.", "The patient was discharged after a prolonged stay."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 24-year-old Caucasian man.", "He had fever and upper quadrant abdominal pain over the previous 20 days.", "Before admission, ciprofloxacin and metronidazole, followed by cefixime had been prescribed.", "Six years prior, the patient had been diagnosed with PSC.", "Six years prior, the patient had been diagnosed with UC.", "Six years prior, the patient had been diagnosed with suspected retroperitoneal fibrosis.", "Six years prior, the patient had been diagnosed with bile sludge.", "Six years prior, the patient had been diagnosed with splenomegaly.", "At that time, ursodiol 300mg BID was prescribed.", "At that time, mesalamine 4g per day was prescribed.", "At that time, exploratory laparotomy and a biopsy of the perihepatic, retroperitoneal tissue were performed.", "The biopsy excluded malignancy.", "Over this six-year period, the patient presented with recurrent episodes of cholangitis.", "The serum level of aminotransferases remained substantially normal.", "There was a progressive worsening of cholestatic test results.", "There was a progressive liver enlargement along with fibrosis.", "Gamma glutamyl transpeptidase (GGT) increased from 141UI/L to 344UI/L.", "Alkaline phosphatase (ALP) increased from 847UI/L to 2534UI/L.", "Hepatic tissue stiffness, measured by FibroScan\u00ae, progressed from 12.6 to 17.3kPa.", "The patient was never treated with immunosuppressive therapy.", "The patient was never treated with corticosteroids.", "One month before admission, an upper endoscopy was performed.", "The upper endoscopy excluded esophageal varices.", "One week before admission, a magnetic resonance of his abdomen and bile ducts was performed.", "The magnetic resonance revealed further enlargement of the liver.", "The magnetic resonance revealed further enlargement of the spleen.", "The magnetic resonance revealed further enlargement of the tissue surrounding his hepatic hilum.", "The tissue surrounding his hepatic hilum caused a compression of his second duodenal tract.", "The tissue surrounding his hepatic hilum caused a wrapping of the splenic and hepatic arteries.", "Beading and narrowing of the intra-hepatic and common bile ducts were reported.", "A narrowing of the pancreatic duct was also reported.", "At admission, the patient had a fever of 38.8\u00b0C.", "Physical examination revealed tenderness of his epigastrium.", "Physical examination revealed tenderness of his right upper hypochondrium.", "Microbiological blood and urine investigations were negative for bacteria.", "A chest radiograph was normal.", "An abdominal sonography revealed an enlarged liver.", "An abdominal sonography revealed thickened choledocus.", "An abdominal sonography revealed dilatation of the intra-hepatic biliary tree.", "An abdominal sonography revealed splenomegaly.", "An abdominal sonography revealed lymphadenopathy of the hepatic hilus.", "A colonoscopy showed erythema of the colonic mucosa from the rectum to the cecum.", "Random biopsy showed focal atrophy of the colonic mucosa with edema.", "Random biopsy showed chronic inflammatory infiltrates.", "Specific investigations for CMV were not carried out.", "Imipenem 500mg IV four times daily was administered.", "Three days later, imipenem was substituted with tigecycline 50mg IV BID.", "Further blood and urine cultures for bacteria were negative.", "The erythrocyte sedimentation rate (ESR) remained high.", "The C-reactive protein level (C-RP) remained high.", "The white blood cell (WBC) count decreased.", "The neutrophil count decreased.", "The procalcitonin level was 0.38ng/ml.", "The fever persisted.", "The upper abdominal pain subsided slightly.", "Investigations for HIV were negative.", "Investigations for Toxoplasma gondii were negative.", "Investigations for CMV were negative.", "Investigations for measles were negative.", "Investigations for parotitis were negative.", "Investigations for hepatitis C virus (HCV) were negative.", "Results for varicella zoster virus indicated previous infection.", "Results for human herpes virus indicated previous infection.", "Results for Epstein Barr indicated previous infection.", "Results for rubella indicated previous infection.", "Results for parvo virus B19 indicated previous infection.", "CD4?+?T lymphocytes were 1055mm3 (20.3%).", "CD3?+?T lymphocytes were 3193mm3 (67%).", "Mycobacterium tuberculosis interferon gamma release assay showed negative results.", "Twelve days after admission, teicoplanin 400mg die was prescribed.", "Twelve days after admission, gentamicin 80mg TID was prescribed.", "Twelve days after admission, metronidazole 500mg TID was prescribed.", "Tigecycline was stopped.", "Two days later, DNA Cytomegalovirus was detected in the blood with \u2264253 copies/mL.", "Three days later, this value increased to 6189 copies/mL.", "Three days later, 1431 copies/mL were evidenced from a urine sample.", "CMV pp65-antigen was also positive.", "CMV serology indicated acute CMV infection.", "The patient\u2019s fever rose to 39.2\u00b0C.", "The patient\u2019s abdominal pain extended to the right lower abdominal quadrant.", "The patient\u2019s abdominal pain radiated to the right groin.", "The patient\u2019s abdominal pain radiated to the right testicle.", "Ultrasound suggested acute appendicitis.", "He underwent surgery.", "Histology showed inflammatory infiltrates, including lymphocytes and neutrophils.", "Histochemistry was positive for CMV early antigens.", "Real time reaction of the appendix tissue was positive.", "Shell vial culture of the appendix tissue was positive.", "Microbiological investigations for bacteria showed Peptococcus spp.", "Microbiological investigations for fungi showed Candida albicans.", "Teicoplanin, gentamicin and metronidazole were administered for a total of 12 days.", "Intravenous ganciclovir 5mg/kg twice was administered for 15 days.", "After discharge, oral valganciclovir 900mg BID was prescribed for 10 days.", "After this, the CMV nucleic acid in the blood and urine was negative.", "After this, ESR remained abnormally high.", "After this, cholestatic liver test results remained abnormally high."], "summary_subclaims": ["The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man.", "The patient also suffered from primary sclerosing cholangitis and ulcerative colitis.", "Diagnosis was based on clinical manifestations.", "Diagnosis was based on serology results.", "Diagnosis was based on microbiological findings.", "Diagnosis was based on histological findings.", "Treatment consisted of surgery.", "Treatment consisted of anti-Cytomegalovirus therapy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 24-year-old Caucasian man.", "He had fever and upper quadrant abdominal pain over the previous 20 days.", "Before admission, ciprofloxacin and metronidazole, followed by cefixime had been prescribed.", "Six years prior, the patient had been diagnosed with PSC.", "Six years prior, the patient had been diagnosed with UC.", "Six years prior, the patient had been diagnosed with suspected retroperitoneal fibrosis.", "Six years prior, the patient had been diagnosed with bile sludge.", "Six years prior, the patient had been diagnosed with splenomegaly.", "At that time, ursodiol 300mg BID was prescribed.", "At that time, mesalamine 4g per day was prescribed.", "At that time, exploratory laparotomy and a biopsy of the perihepatic, retroperitoneal tissue were performed.", "The biopsy excluded malignancy.", "Over this six-year period, the patient presented with recurrent episodes of cholangitis.", "The serum level of aminotransferases remained substantially normal.", "There was a progressive worsening of cholestatic test results.", "There was a progressive liver enlargement along with fibrosis.", "Gamma glutamyl transpeptidase (GGT) increased from 141UI/L to 344UI/L.", "Alkaline phosphatase (ALP) increased from 847UI/L to 2534UI/L.", "Hepatic tissue stiffness, measured by FibroScan\u00ae, progressed from 12.6 to 17.3kPa.", "The patient was never treated with immunosuppressive therapy.", "The patient was never treated with corticosteroids.", "One month before admission, an upper endoscopy was performed.", "The upper endoscopy excluded esophageal varices.", "One week before admission, a magnetic resonance of his abdomen and bile ducts was performed.", "The magnetic resonance revealed further enlargement of the liver.", "The magnetic resonance revealed further enlargement of the spleen.", "The magnetic resonance revealed further enlargement of the tissue surrounding his hepatic hilum.", "The tissue surrounding his hepatic hilum caused a compression of his second duodenal tract.", "The tissue surrounding his hepatic hilum caused a wrapping of the splenic and hepatic arteries.", "Beading and narrowing of the intra-hepatic and common bile ducts were reported.", "A narrowing of the pancreatic duct was also reported.", "At admission, the patient had a fever of 38.8\u00b0C.", "Physical examination revealed tenderness of his epigastrium.", "Physical examination revealed tenderness of his right upper hypochondrium.", "Microbiological blood and urine investigations were negative for bacteria.", "A chest radiograph was normal.", "An abdominal sonography revealed an enlarged liver.", "An abdominal sonography revealed thickened choledocus.", "An abdominal sonography revealed dilatation of the intra-hepatic biliary tree.", "An abdominal sonography revealed splenomegaly.", "An abdominal sonography revealed lymphadenopathy of the hepatic hilus.", "A colonoscopy showed erythema of the colonic mucosa from the rectum to the cecum.", "Random biopsy showed focal atrophy of the colonic mucosa with edema.", "Random biopsy showed chronic inflammatory infiltrates.", "Specific investigations for CMV were not carried out.", "Imipenem 500mg IV four times daily was administered.", "Three days later, imipenem was substituted with tigecycline 50mg IV BID.", "Further blood and urine cultures for bacteria were negative.", "The erythrocyte sedimentation rate (ESR) remained high.", "The C-reactive protein level (C-RP) remained high.", "The white blood cell (WBC) count decreased.", "The neutrophil count decreased.", "The procalcitonin level was 0.38ng/ml.", "The fever persisted.", "The upper abdominal pain subsided slightly.", "Investigations for HIV were negative.", "Investigations for Toxoplasma gondii were negative.", "Investigations for CMV were negative.", "Investigations for measles were negative.", "Investigations for parotitis were negative.", "Investigations for hepatitis C virus (HCV) were negative.", "Results for varicella zoster virus indicated previous infection.", "Results for human herpes virus indicated previous infection.", "Results for Epstein Barr indicated previous infection.", "Results for rubella indicated previous infection.", "Results for parvo virus B19 indicated previous infection.", "CD4?+?T lymphocytes were 1055mm3 (20.3%).", "CD3?+?T lymphocytes were 3193mm3 (67%).", "Mycobacterium tuberculosis interferon gamma release assay showed negative results.", "Twelve days after admission, teicoplanin 400mg die was prescribed.", "Twelve days after admission, gentamicin 80mg TID was prescribed.", "Twelve days after admission, metronidazole 500mg TID was prescribed.", "Tigecycline was stopped.", "Two days later, DNA Cytomegalovirus was detected in the blood with \u2264253 copies/mL.", "Three days later, this value increased to 6189 copies/mL.", "Three days later, 1431 copies/mL were evidenced from a urine sample.", "CMV pp65-antigen was also positive.", "CMV serology indicated acute CMV infection.", "The patient\u2019s fever rose to 39.2\u00b0C.", "The patient\u2019s abdominal pain extended to the right lower abdominal quadrant.", "The patient\u2019s abdominal pain radiated to the right groin.", "The patient\u2019s abdominal pain radiated to the right testicle.", "Ultrasound suggested acute appendicitis.", "He underwent surgery.", "Histology showed inflammatory infiltrates, including lymphocytes and neutrophils.", "Histochemistry was positive for CMV early antigens.", "Real time reaction of the appendix tissue was positive.", "Shell vial culture of the appendix tissue was positive.", "Microbiological investigations for bacteria showed Peptococcus spp.", "Microbiological investigations for fungi showed Candida albicans.", "Teicoplanin, gentamicin and metronidazole were administered for a total of 12 days.", "Intravenous ganciclovir 5mg/kg twice was administered for 15 days.", "After discharge, oral valganciclovir 900mg BID was prescribed for 10 days.", "After this, the CMV nucleic acid in the blood and urine was negative.", "After this, ESR remained abnormally high.", "After this, cholestatic liver test results remained abnormally high."], "index": 1, "original_id": "multiclinsum_test_2576_en.txt", "split": "test", "summary_subclaims": ["The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man.", "The patient also suffered from primary sclerosing cholangitis and ulcerative colitis.", "Diagnosis was based on clinical manifestations.", "Diagnosis was based on serology results.", "Diagnosis was based on microbiological findings.", "Diagnosis was based on histological findings.", "Treatment consisted of surgery.", "Treatment consisted of anti-Cytomegalovirus therapy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 34-year-old Han female.", "The patient had a slight limp without obvious inducement 7 or 8 years previously.", "Approximately 1 year prior to the presentation, she had given birth to a boy.", "She developed progressive walking instability approximately 1 year prior to the presentation.", "Five months prior to the evaluation, she started experiencing static tremors in her hands and head.", "She had difficulty speaking.", "She had occasional numbness in the limbs.", "She had a cough after drinking water.", "The tremor was significantly aggravated during movement.", "She reported headaches.", "She reported dizziness.", "She reported nausea.", "One year prior, she lacked appetite.", "She had lost more than 10 pounds.", "She had a history of cephalosporin allergy.", "She had undergone an appendectomy 20 years prior.", "She had a history of tobacco and alcohol use for 10 years.", "She had quit smoking 6 months ago.", "She had no relatives with similar symptoms.", "She had 27 teeth.", "Her sex hormone levels were normal.", "Her menstruation was normal.", "At the time of presentation, she had dysarthria.", "She had upbeating nystagmus.", "She had right gaze-evoked nystagmus.", "Her limb reflexes were absent.", "Her bilateral finger-nose test was unstable.", "She demonstrated instability on her calcaneus tibial test.", "She had a positive Romberg sign.", "She had bilateral Babinski and Chaddock's signs.", "The total score of the scale for the assessment and rating of ataxia was 24.", "The gait sub-score was 5.", "The stance sub-score was 4.", "The sitting sub-score was 2.", "The speech sub-score was 2.", "The finger chase sub-score was 2.", "The nose\u2013finger test sub-score was 2.", "The fast alternating hand movement sub-score was 3.", "The heel\u2013shin slide sub-score was 4.", "The Mini-Mental State Examination score was within the normal range.", "She failed to complete the Montreal Cognitive Scale due to tremors of the hands and head.", "The results for tumor markers were not significantly abnormal.", "The results for ceruloplasmin were not significantly abnormal.", "The results for immune-related autoantibodies were not significantly abnormal.", "The results for the five items of thyroid function were not significantly abnormal.", "The results for the three items of rheumatism were not significantly abnormal.", "The results for the five items of immunity were not significantly abnormal.", "The results for antinuclear antibody were not significantly abnormal.", "The results for anticardiolipin antibody were not significantly abnormal.", "The results for screening and confirmation of anti-neutrophil cytoplasmic antibody were not significantly abnormal.", "Lumbar puncture results showed no abnormalities.", "Brain MRI revealed speckled and small patchy abnormal signals bilaterally in the corona radiata.", "The lesions were hypointense on T1 images.", "The lesions were hyperintense on T2 and FLAIR images.", "There were no obvious abnormal signals on diffusion-weighted images.", "The radiological diagnosis was multiple white matter demyelinating lesions.", "Color Doppler ultrasonography of the gynecological, abdominal, cardiac, carotid, and intracranial arteries revealed no obvious abnormalities.", "The detection of hereditary disease genes revealed mutations in POLR3A.", "The genetic variant c.4044C > G is classified as PM2.", "The clinical significance of c.4044C > G remains unclear.", "The genetic variant c.1186-2A > G is classified as PVS1 and PM2.", "The genetic variant c.1186-2A > G has the potential to influence RNA splicing.", "The patient did not undergo genetic testing for her parents or son.", "Her condition was diagnosed as POLR3A-related leukodystrophy (HLD7).", "She was administered oral vitamin B12.", "She was administered injectable acetylglutamine.", "No other drugs were used during the hospital stay.", "The symptoms did not show significant improvement during the 1 month of follow-up.", "The symptoms appeared aggravated during the 1 month of follow-up.", "The patient required assistance to walk.", "The patient was unable to hold objects in her hands.", "After discharge, she was treated with vitamin B12.", "After discharge, she was treated with vitamin E.", "After discharge, she was treated with coenzyme Q.", "After discharge, she was treated with traditional Chinese medicine.", "The traditional Chinese medicine included Ganoderma lucidum.", "The traditional Chinese medicine included ginseng.", "The traditional Chinese medicine included Poria Cocos.", "As of recent follow-up (1 year after discharge), she is able to walk slowly alone.", "As of recent follow-up, she is able to climb stairs.", "As of recent follow-up, the degree of head and hand tremors has reduced significantly.", "As of recent follow-up, she is able to hold objects.", "As of recent follow-up, she is able to cook independently.", "As of recent follow-up, her speech is slower and more indistinct than before."], "summary_subclaims": ["The patient is a 34-year-old female.", "The patient presented with ataxia.", "MRI of the brain revealed demyelinating lesions in the white matter.", "Genetic testing identified the c.4044C > G variant in the POLR3A gene.", "Genetic testing identified the c.1186-2A > G variant in the POLR3A gene.", "The patient was diagnosed with hypomyelinating leukodystrophy type 7.", "The patient received neurotrophic and symptomatic supportive therapy.", "After 1 month of follow-up, there was no improvement in her symptoms."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 34-year-old Han female.", "The patient had a slight limp without obvious inducement 7 or 8 years previously.", "Approximately 1 year prior to the presentation, she had given birth to a boy.", "She developed progressive walking instability approximately 1 year prior to the presentation.", "Five months prior to the evaluation, she started experiencing static tremors in her hands and head.", "She had difficulty speaking.", "She had occasional numbness in the limbs.", "She had a cough after drinking water.", "The tremor was significantly aggravated during movement.", "She reported headaches.", "She reported dizziness.", "She reported nausea.", "One year prior, she lacked appetite.", "She had lost more than 10 pounds.", "She had a history of cephalosporin allergy.", "She had undergone an appendectomy 20 years prior.", "She had a history of tobacco and alcohol use for 10 years.", "She had quit smoking 6 months ago.", "She had no relatives with similar symptoms.", "She had 27 teeth.", "Her sex hormone levels were normal.", "Her menstruation was normal.", "At the time of presentation, she had dysarthria.", "She had upbeating nystagmus.", "She had right gaze-evoked nystagmus.", "Her limb reflexes were absent.", "Her bilateral finger-nose test was unstable.", "She demonstrated instability on her calcaneus tibial test.", "She had a positive Romberg sign.", "She had bilateral Babinski and Chaddock's signs.", "The total score of the scale for the assessment and rating of ataxia was 24.", "The gait sub-score was 5.", "The stance sub-score was 4.", "The sitting sub-score was 2.", "The speech sub-score was 2.", "The finger chase sub-score was 2.", "The nose\u2013finger test sub-score was 2.", "The fast alternating hand movement sub-score was 3.", "The heel\u2013shin slide sub-score was 4.", "The Mini-Mental State Examination score was within the normal range.", "She failed to complete the Montreal Cognitive Scale due to tremors of the hands and head.", "The results for tumor markers were not significantly abnormal.", "The results for ceruloplasmin were not significantly abnormal.", "The results for immune-related autoantibodies were not significantly abnormal.", "The results for the five items of thyroid function were not significantly abnormal.", "The results for the three items of rheumatism were not significantly abnormal.", "The results for the five items of immunity were not significantly abnormal.", "The results for antinuclear antibody were not significantly abnormal.", "The results for anticardiolipin antibody were not significantly abnormal.", "The results for screening and confirmation of anti-neutrophil cytoplasmic antibody were not significantly abnormal.", "Lumbar puncture results showed no abnormalities.", "Brain MRI revealed speckled and small patchy abnormal signals bilaterally in the corona radiata.", "The lesions were hypointense on T1 images.", "The lesions were hyperintense on T2 and FLAIR images.", "There were no obvious abnormal signals on diffusion-weighted images.", "The radiological diagnosis was multiple white matter demyelinating lesions.", "Color Doppler ultrasonography of the gynecological, abdominal, cardiac, carotid, and intracranial arteries revealed no obvious abnormalities.", "The detection of hereditary disease genes revealed mutations in POLR3A.", "The genetic variant c.4044C > G is classified as PM2.", "The clinical significance of c.4044C > G remains unclear.", "The genetic variant c.1186-2A > G is classified as PVS1 and PM2.", "The genetic variant c.1186-2A > G has the potential to influence RNA splicing.", "The patient did not undergo genetic testing for her parents or son.", "Her condition was diagnosed as POLR3A-related leukodystrophy (HLD7).", "She was administered oral vitamin B12.", "She was administered injectable acetylglutamine.", "No other drugs were used during the hospital stay.", "The symptoms did not show significant improvement during the 1 month of follow-up.", "The symptoms appeared aggravated during the 1 month of follow-up.", "The patient required assistance to walk.", "The patient was unable to hold objects in her hands.", "After discharge, she was treated with vitamin B12.", "After discharge, she was treated with vitamin E.", "After discharge, she was treated with coenzyme Q.", "After discharge, she was treated with traditional Chinese medicine.", "The traditional Chinese medicine included Ganoderma lucidum.", "The traditional Chinese medicine included ginseng.", "The traditional Chinese medicine included Poria Cocos.", "As of recent follow-up (1 year after discharge), she is able to walk slowly alone.", "As of recent follow-up, she is able to climb stairs.", "As of recent follow-up, the degree of head and hand tremors has reduced significantly.", "As of recent follow-up, she is able to hold objects.", "As of recent follow-up, she is able to cook independently.", "As of recent follow-up, her speech is slower and more indistinct than before."], "index": 134, "original_id": "multiclinsum_test_1579_en.txt", "split": "test", "summary_subclaims": ["The patient is a 34-year-old female.", "The patient presented with ataxia.", "MRI of the brain revealed demyelinating lesions in the white matter.", "Genetic testing identified the c.4044C > G variant in the POLR3A gene.", "Genetic testing identified the c.1186-2A > G variant in the POLR3A gene.", "The patient was diagnosed with hypomyelinating leukodystrophy type 7.", "The patient received neurotrophic and symptomatic supportive therapy.", "After 1 month of follow-up, there was no improvement in her symptoms."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 14-year-old boy attended a local hospital for ankylosing spondylitis.", "Chest radiography showed an enhanced circular-density shadow near the left mediastinum.", "The shadow intersected with the mediastinum at an obtuse angle.", "The base was close to the mediastinum.", "The outer edge was clear and smooth.", "The mass density was even.", "A benign lesion was considered.", "Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment.", "The patient had no previous symptoms.", "The patient had no major illness before.", "Mandatory spondylitis was discovered this time because of his left hip pain.", "The results of the physical examination were normal.", "Blood analysis and the blood biochemistries, as well as urine analysis, were all normal.", "Electrocardiogram and arterial blood gas were also normal.", "Enhanced chest CT suggested irregular soft tissue density above the left aortic arch.", "The mass had a clear boundary.", "The mass was about 5.5 cm \u00d7 3.2 cm \u00d7 2.8 cm in size."], "summary_subclaims": ["A 14-year-old boy attended a local hospital for ankylosing spondylitis.", "Chest radiography showed an enhanced circular-density shadow near the left mediastinum.", "The patient had no chest symptoms.", "The physical examination was normal.", "Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment.", "During surgery, a left pericardial defect was observed.", "The bronchogenic cyst was removed by thoracoscopic surgery.", "The pericardial defect remained untreated.", "A satisfactory outcome was achieved after the operation.", "The patient was diagnosed with a mediastinal tumor.", "The pathological diagnosis of the tumor was a bronchogenic cyst."]}, "extra_info": {"fulltext_subclaims": ["A 14-year-old boy attended a local hospital for ankylosing spondylitis.", "Chest radiography showed an enhanced circular-density shadow near the left mediastinum.", "The shadow intersected with the mediastinum at an obtuse angle.", "The base was close to the mediastinum.", "The outer edge was clear and smooth.", "The mass density was even.", "A benign lesion was considered.", "Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment.", "The patient had no previous symptoms.", "The patient had no major illness before.", "Mandatory spondylitis was discovered this time because of his left hip pain.", "The results of the physical examination were normal.", "Blood analysis and the blood biochemistries, as well as urine analysis, were all normal.", "Electrocardiogram and arterial blood gas were also normal.", "Enhanced chest CT suggested irregular soft tissue density above the left aortic arch.", "The mass had a clear boundary.", "The mass was about 5.5 cm \u00d7 3.2 cm \u00d7 2.8 cm in size."], "index": 136, "original_id": "multiclinsum_test_2394_en.txt", "split": "test", "summary_subclaims": ["A 14-year-old boy attended a local hospital for ankylosing spondylitis.", "Chest radiography showed an enhanced circular-density shadow near the left mediastinum.", "The patient had no chest symptoms.", "The physical examination was normal.", "Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment.", "During surgery, a left pericardial defect was observed.", "The bronchogenic cyst was removed by thoracoscopic surgery.", "The pericardial defect remained untreated.", "A satisfactory outcome was achieved after the operation.", "The patient was diagnosed with a mediastinal tumor.", "The pathological diagnosis of the tumor was a bronchogenic cyst."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 77-year-old lady.", "She presented with progressive left groin pain.", "The left groin pain is due to degenerative hip osteoarthritis.", "She had a previous knee arthrodesis on the left leg.", "The knee arthrodesis was a result of a traffic accident during childhood.", "There was a leg length discrepancy of 8.5 cm at the expense of the left leg.", "The leg length discrepancy was corrected by an orthopedic shoe.", "There was no Trendelenburg limp.", "Log roll and rotation with the hip in flexion (and knee in extension) were painful.", "Radiographs showed left hip osteoarthritis.", "Previous conservative treatment had become insufficient.", "A total hip arthroplasty (THA) was proposed.", "Radiographically, there was a normal anatomy of the hip joint.", "A direct anterior approach (DAA) THA was planned.", "A cemented stem was planned.", "A literature search on PubMed was performed.", "Search terms included: Knee arthrodesis; femoral anteversion; and arthroplasty hip.", "A case of a THA after knee arthrodesis using a posterolateral approach was found.", "A case series by Bourne et al. of 16 patients was found.", "No literature was found about the anterior approach in this specific case."], "summary_subclaims": ["This case report presents the case of a 77 year old female patient.", "The patient has degenerative hip disease.", "The patient has an ipsilateral arthrodesis of the knee.", "The patient was operated using the DAA.", "No complications were found.", "The patient had an excellent follow-up.", "The patient had a forgotten joint score of 93.75 at 1 year.", "The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy.", "Pre-operative templating on X-rays was used.", "Intraoperative fluoroscopy was used.", "The posterior femoral neck was used.", "Hip biomechanics could be restored."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 77-year-old lady.", "She presented with progressive left groin pain.", "The left groin pain is due to degenerative hip osteoarthritis.", "She had a previous knee arthrodesis on the left leg.", "The knee arthrodesis was a result of a traffic accident during childhood.", "There was a leg length discrepancy of 8.5 cm at the expense of the left leg.", "The leg length discrepancy was corrected by an orthopedic shoe.", "There was no Trendelenburg limp.", "Log roll and rotation with the hip in flexion (and knee in extension) were painful.", "Radiographs showed left hip osteoarthritis.", "Previous conservative treatment had become insufficient.", "A total hip arthroplasty (THA) was proposed.", "Radiographically, there was a normal anatomy of the hip joint.", "A direct anterior approach (DAA) THA was planned.", "A cemented stem was planned.", "A literature search on PubMed was performed.", "Search terms included: Knee arthrodesis; femoral anteversion; and arthroplasty hip.", "A case of a THA after knee arthrodesis using a posterolateral approach was found.", "A case series by Bourne et al. of 16 patients was found.", "No literature was found about the anterior approach in this specific case."], "index": 140, "original_id": "multiclinsum_test_2302_en.txt", "split": "test", "summary_subclaims": ["This case report presents the case of a 77 year old female patient.", "The patient has degenerative hip disease.", "The patient has an ipsilateral arthrodesis of the knee.", "The patient was operated using the DAA.", "No complications were found.", "The patient had an excellent follow-up.", "The patient had a forgotten joint score of 93.75 at 1 year.", "The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy.", "Pre-operative templating on X-rays was used.", "Intraoperative fluoroscopy was used.", "The posterior femoral neck was used.", "Hip biomechanics could be restored."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 56-year-old female.", "The patient has a body mass index of 22.5\u202fkg/m2.", "The patient has a previous clinical history of diffuse scleroderma.", "The patient has intestinal pneumonitis.", "The patient has mild pulmonary hypertension.", "The patient has secondary gastroesophageal reflux.", "The patient has severe esophageal motility disease.", "The patient is receiving immunosuppression, antihypertensive, proton pump inhibitor, and prokinetic management.", "The patient has a weak response to medical therapy.", "The patient is admitted for surgical management after a 1-year follow-up with cardiology, pneumology, and gastroenterology.", "The patient has a previous diagnosis of esophageal aperistalsis.", "The patient has dysphagia.", "The patient has poor response to medical therapy.", "Physical examination revealed no significant findings.", "The lung transplant surgical team determined the patient was not a candidate given the severity of the GERD.", "The medical committee decided an open total gastrectomy with roux-en-Y anastomosis prior to lung transplant.", "Follow-up one week later with esophagogram revealed normal esophageal morphology.", "Follow-up one week later with esophagogram revealed no stenosis.", "Follow-up one week later with esophagogram revealed adequate esophago-jejunal anastomosis diameter.", "Follow-up one week later with esophagogram revealed no extravasation of the contrast medium.", "Follow-up one week later with esophagogram revealed adequate transit of the medium to the small intestine.", "Follow-up one week later with esophagogram revealed no evidence of reflux of the medium.", "An upper gastrointestinal endoscopy is performed within a 3-month period.", "The upper gastrointestinal endoscopy revealed mild esophago-jejunal anastomosis stricture.", "The stricture resolved after three balloon dilations of 11\u202fmm, 15\u202fmm, and 18\u202fmm, respectively.", "The patient continues follow-up consults.", "The patient is asymptomatic according to the Gastroesophageal Reflux Disease Health Related Quality of Life (GERD-HRQL) instrument.", "The patient currently awaits lung transplant."], "summary_subclaims": ["The patient is a 56-year-old female.", "The patient has a previous history of intestinal pneumonitis.", "The patient has mild pulmonary hypertension.", "The patient has gastroesophageal reflux secondary to systemic scleroderma.", "A lung transplant was initially not a viable option due to persistent gastroesophageal reflux.", "An open gastrectomy with roux-en-Y anastomosis was performed.", "Follow-up one week later revealed normal anatomy.", "Follow-up one week later showed an adequate esophageal-jejunal anastomosis.", "Follow-up one week later showed adequate contrast medium transit via esophagogram.", "There was no evidence of contrast medium reflux.", "This led to the patient becoming a candidate for lung transplant."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 56-year-old female.", "The patient has a body mass index of 22.5\u202fkg/m2.", "The patient has a previous clinical history of diffuse scleroderma.", "The patient has intestinal pneumonitis.", "The patient has mild pulmonary hypertension.", "The patient has secondary gastroesophageal reflux.", "The patient has severe esophageal motility disease.", "The patient is receiving immunosuppression, antihypertensive, proton pump inhibitor, and prokinetic management.", "The patient has a weak response to medical therapy.", "The patient is admitted for surgical management after a 1-year follow-up with cardiology, pneumology, and gastroenterology.", "The patient has a previous diagnosis of esophageal aperistalsis.", "The patient has dysphagia.", "The patient has poor response to medical therapy.", "Physical examination revealed no significant findings.", "The lung transplant surgical team determined the patient was not a candidate given the severity of the GERD.", "The medical committee decided an open total gastrectomy with roux-en-Y anastomosis prior to lung transplant.", "Follow-up one week later with esophagogram revealed normal esophageal morphology.", "Follow-up one week later with esophagogram revealed no stenosis.", "Follow-up one week later with esophagogram revealed adequate esophago-jejunal anastomosis diameter.", "Follow-up one week later with esophagogram revealed no extravasation of the contrast medium.", "Follow-up one week later with esophagogram revealed adequate transit of the medium to the small intestine.", "Follow-up one week later with esophagogram revealed no evidence of reflux of the medium.", "An upper gastrointestinal endoscopy is performed within a 3-month period.", "The upper gastrointestinal endoscopy revealed mild esophago-jejunal anastomosis stricture.", "The stricture resolved after three balloon dilations of 11\u202fmm, 15\u202fmm, and 18\u202fmm, respectively.", "The patient continues follow-up consults.", "The patient is asymptomatic according to the Gastroesophageal Reflux Disease Health Related Quality of Life (GERD-HRQL) instrument.", "The patient currently awaits lung transplant."], "index": 138, "original_id": "multiclinsum_test_2494_en.txt", "split": "test", "summary_subclaims": ["The patient is a 56-year-old female.", "The patient has a previous history of intestinal pneumonitis.", "The patient has mild pulmonary hypertension.", "The patient has gastroesophageal reflux secondary to systemic scleroderma.", "A lung transplant was initially not a viable option due to persistent gastroesophageal reflux.", "An open gastrectomy with roux-en-Y anastomosis was performed.", "Follow-up one week later revealed normal anatomy.", "Follow-up one week later showed an adequate esophageal-jejunal anastomosis.", "Follow-up one week later showed adequate contrast medium transit via esophagogram.", "There was no evidence of contrast medium reflux.", "This led to the patient becoming a candidate for lung transplant."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 33-year-old man.", "He had a five-month history of bilateral radiating pain through the hips, legs and ankles.", "He reported numbness, paresthesia and mild weakness in one lateral lower extremity.", "A pin-prick sensation test showed bilateral patchy loss of sensation and vibration in the legs and feet.", "The patient did not report bowel or bladder problems.", "He did not exhibit hyper-reflexia.", "He was negative for Babinski\u2019s sign.", "MRI revealed a lesion extending from L3 to L5.", "T1-weighted MRI showed an intradural, extra-medullary, isointense mass behind the vertebral bodies of L3 to L5.", "The mass was eccentric to the left and showed homogenous enhancement with contrast.", "The vertebral body of L4 exhibited a compressed deformation.", "Gastroscopy, colonoscopy and computed tomography scans of the abdomen and the thorax identified no additional masses.", "A lumbar laminectomy of L3 to L5 was performed.", "The tumor was soft with a rich blood supply.", "The tumor closely adhered to the medulla spinalis.", "There were no signs of dural invasion.", "A total tumor resection was performed.", "Lower extremity pain resolved immediately following surgery.", "Lower limb strength began to improve within a few days.", "The patient reported symptoms of postoperative dysuria.", "Dysuria symptoms showed improvement after one week.", "During the two-year postoperative follow-up, the patient exhibited no clinical signs of tumor recurrence.", "During the two-year postoperative follow-up, the patient exhibited no MRI radiological signs of tumor recurrence or metastasis.", "Postoperative histopathology confirmed a completely resected solid tumor.", "The specimen was a fully encapsulated smooth soft-tissue mass.", "Standard hematoxylin and eosin staining revealed sheet-like proliferation of NET cells in a trabecular pattern.", "There were no visible mitoses or necrosis.", "The tumor was positive for synaptophysin.", "The tumor was positive for chromogranin (CgA).", "The tumor was positive for cytokeratin.", "The tumor was positive for CD56.", "The tumor was negative for S-100.", "The Ki-67 labeling index was 2%.", "These findings are consistent with the known cellular characteristics of a typical CT."], "summary_subclaims": ["The patient was a 33-year-old man.", "He had a five-month history of bilateral lower extremity pain.", "He had paresthesia.", "He had mild weakness in one lateral lower extremity.", "A lumbar laminectomy of L3 to L5 was performed.", "An en bloc resection of the tumor was performed.", "Postoperative histopathology and immunohistochemical analysis of the tumor were consistent with that of a carcinoid tumor.", "There were no clinical signs of tumor recurrence at the patient's two year postoperative follow-up.", "There were no radiological signs of tumor recurrence at the patient's two year postoperative follow-up.", "There were no clinical or radiological signs of metastasis at the patient's two year postoperative follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 33-year-old man.", "He had a five-month history of bilateral radiating pain through the hips, legs and ankles.", "He reported numbness, paresthesia and mild weakness in one lateral lower extremity.", "A pin-prick sensation test showed bilateral patchy loss of sensation and vibration in the legs and feet.", "The patient did not report bowel or bladder problems.", "He did not exhibit hyper-reflexia.", "He was negative for Babinski\u2019s sign.", "MRI revealed a lesion extending from L3 to L5.", "T1-weighted MRI showed an intradural, extra-medullary, isointense mass behind the vertebral bodies of L3 to L5.", "The mass was eccentric to the left and showed homogenous enhancement with contrast.", "The vertebral body of L4 exhibited a compressed deformation.", "Gastroscopy, colonoscopy and computed tomography scans of the abdomen and the thorax identified no additional masses.", "A lumbar laminectomy of L3 to L5 was performed.", "The tumor was soft with a rich blood supply.", "The tumor closely adhered to the medulla spinalis.", "There were no signs of dural invasion.", "A total tumor resection was performed.", "Lower extremity pain resolved immediately following surgery.", "Lower limb strength began to improve within a few days.", "The patient reported symptoms of postoperative dysuria.", "Dysuria symptoms showed improvement after one week.", "During the two-year postoperative follow-up, the patient exhibited no clinical signs of tumor recurrence.", "During the two-year postoperative follow-up, the patient exhibited no MRI radiological signs of tumor recurrence or metastasis.", "Postoperative histopathology confirmed a completely resected solid tumor.", "The specimen was a fully encapsulated smooth soft-tissue mass.", "Standard hematoxylin and eosin staining revealed sheet-like proliferation of NET cells in a trabecular pattern.", "There were no visible mitoses or necrosis.", "The tumor was positive for synaptophysin.", "The tumor was positive for chromogranin (CgA).", "The tumor was positive for cytokeratin.", "The tumor was positive for CD56.", "The tumor was negative for S-100.", "The Ki-67 labeling index was 2%.", "These findings are consistent with the known cellular characteristics of a typical CT."], "index": 142, "original_id": "multiclinsum_test_2169_en.txt", "split": "test", "summary_subclaims": ["The patient was a 33-year-old man.", "He had a five-month history of bilateral lower extremity pain.", "He had paresthesia.", "He had mild weakness in one lateral lower extremity.", "A lumbar laminectomy of L3 to L5 was performed.", "An en bloc resection of the tumor was performed.", "Postoperative histopathology and immunohistochemical analysis of the tumor were consistent with that of a carcinoid tumor.", "There were no clinical signs of tumor recurrence at the patient's two year postoperative follow-up.", "There were no radiological signs of tumor recurrence at the patient's two year postoperative follow-up.", "There were no clinical or radiological signs of metastasis at the patient's two year postoperative follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 24-year-old male.", "The patient recently arrived in Burhakaba town of Somalia from Sa\u2019ada in northwest of Yemen.", "The patient was referred to the hospital with a complaint of left upper hypochondrium mass.", "The patient had high grade fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months.", "The patient claimed he had experienced a similar clinical condition three months ago.", "Before reporting to the hospital, he had visited a local hospital in the region.", "At the local hospital, he was administered local symptomatic treatment of antipyretics, antibiotics, and transfused with 2 units of whole blood.", "After the treatment at the local hospital, he felt mild improvement.", "Two months later, his clinical signs recurred with loss of appetite, weight loss, and generalized weakness.", "On presentation at the hospital, the patient appeared ill, thin, febrile, and pale.", "Abdominal examination revealed splenomegaly.", "The other system examinations were normal.", "The initial laboratory investigation showed white blood cell count 1.03 x10^9/L.", "The initial laboratory investigation showed hemoglobin 6.6 g/dl.", "The initial laboratory investigation showed platelet 70x10^9/L.", "The initial laboratory investigation showed C-reactive protein 45.73 mg/L.", "The initial laboratory investigation showed aspartate transaminase 104.5 U/I.", "The initial laboratory investigation showed alanine transaminase 112.5 U/I.", "The initial laboratory investigation showed serum creatinine 1.4 mg/dl.", "The initial laboratory investigation showed serum urea 54.3 mg/dl.", "A rapid diagnostic test for plasmodium parasite antigen was conducted and was found to be positive.", "Abdominal ultrasound revealed enlargement of the liver (20cm).", "Abdominal ultrasound revealed enlargement of the spleen (30cm).", "The patient was admitted initially for treatment of malaria.", "The patient was given four doses of intravenous artesunate 120mg.", "The patient was transfused one unit of whole blood.", "On the third day of admission, no significant improvement was observed.", "Infectious disease tests such as human immunodeficiency virus, viral hepatitis, and Brucella serological tests were conducted and found to be negative.", "An anti-Leishmania antibody with ELISA was not detected.", "A peripheral blood smear showed only pancytopenia and no evidence of malaria parasite.", "A tru-cut biopsy of the spleen was performed.", "The histopathology examinations of the tru-cut biopsy revealed consistent features with visceral leishmaniasis.", "An urgent combination therapy of sodium stibogluconate 800mg/day with paromomycin 600mg/day for 17 days was given.", "After the fourth week of treatment, significant improvement was observed.", "At the end of the fifth week, the patient was fully recovered.", "The patient was discharged following normal results of another tru-cut biopsy of the spleen."], "summary_subclaims": ["The patient is a 24-year-old from an endemic region of Somalia.", "The patient had fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months.", "The patient received symptomatic treatment and a blood transfusion.", "The patient showed no improvement after initial treatment.", "Physical examination revealed fever, pallor, and hepatosplenomegaly.", "Laboratory tests showed pancytopenia.", "The rapid diagnostic test was positive for plasmodium parasite antigen.", "The patient received three days of anti-malarial treatment.", "The symptoms persisted despite anti-malarial treatment.", "Hepatosplenomegaly worsened after three days of anti-malarial treatment.", "Infectious disease tests ruled out HIV, viral hepatitis, Brucella, and Leishmania antibodies.", "Peripheral blood smear showed pancytopenia.", "Bone marrow aspiration revealed no evidence of infection or malignancy.", "A tru-cut biopsy of the spleen was performed.", "The spleen biopsy confirmed the diagnosis of visceral leishmaniasis.", "The patient received a combination therapy of sodium stibogluconate and paromomycin.", "The patient showed significant improvement after treatment.", "The patient was discharged after completing treatment.", "The spleen biopsy results were normal after treatment."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 24-year-old male.", "The patient recently arrived in Burhakaba town of Somalia from Sa\u2019ada in northwest of Yemen.", "The patient was referred to the hospital with a complaint of left upper hypochondrium mass.", "The patient had high grade fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months.", "The patient claimed he had experienced a similar clinical condition three months ago.", "Before reporting to the hospital, he had visited a local hospital in the region.", "At the local hospital, he was administered local symptomatic treatment of antipyretics, antibiotics, and transfused with 2 units of whole blood.", "After the treatment at the local hospital, he felt mild improvement.", "Two months later, his clinical signs recurred with loss of appetite, weight loss, and generalized weakness.", "On presentation at the hospital, the patient appeared ill, thin, febrile, and pale.", "Abdominal examination revealed splenomegaly.", "The other system examinations were normal.", "The initial laboratory investigation showed white blood cell count 1.03 x10^9/L.", "The initial laboratory investigation showed hemoglobin 6.6 g/dl.", "The initial laboratory investigation showed platelet 70x10^9/L.", "The initial laboratory investigation showed C-reactive protein 45.73 mg/L.", "The initial laboratory investigation showed aspartate transaminase 104.5 U/I.", "The initial laboratory investigation showed alanine transaminase 112.5 U/I.", "The initial laboratory investigation showed serum creatinine 1.4 mg/dl.", "The initial laboratory investigation showed serum urea 54.3 mg/dl.", "A rapid diagnostic test for plasmodium parasite antigen was conducted and was found to be positive.", "Abdominal ultrasound revealed enlargement of the liver (20cm).", "Abdominal ultrasound revealed enlargement of the spleen (30cm).", "The patient was admitted initially for treatment of malaria.", "The patient was given four doses of intravenous artesunate 120mg.", "The patient was transfused one unit of whole blood.", "On the third day of admission, no significant improvement was observed.", "Infectious disease tests such as human immunodeficiency virus, viral hepatitis, and Brucella serological tests were conducted and found to be negative.", "An anti-Leishmania antibody with ELISA was not detected.", "A peripheral blood smear showed only pancytopenia and no evidence of malaria parasite.", "A tru-cut biopsy of the spleen was performed.", "The histopathology examinations of the tru-cut biopsy revealed consistent features with visceral leishmaniasis.", "An urgent combination therapy of sodium stibogluconate 800mg/day with paromomycin 600mg/day for 17 days was given.", "After the fourth week of treatment, significant improvement was observed.", "At the end of the fifth week, the patient was fully recovered.", "The patient was discharged following normal results of another tru-cut biopsy of the spleen."], "index": 146, "original_id": "multiclinsum_test_292_en.txt", "split": "test", "summary_subclaims": ["The patient is a 24-year-old from an endemic region of Somalia.", "The patient had fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months.", "The patient received symptomatic treatment and a blood transfusion.", "The patient showed no improvement after initial treatment.", "Physical examination revealed fever, pallor, and hepatosplenomegaly.", "Laboratory tests showed pancytopenia.", "The rapid diagnostic test was positive for plasmodium parasite antigen.", "The patient received three days of anti-malarial treatment.", "The symptoms persisted despite anti-malarial treatment.", "Hepatosplenomegaly worsened after three days of anti-malarial treatment.", "Infectious disease tests ruled out HIV, viral hepatitis, Brucella, and Leishmania antibodies.", "Peripheral blood smear showed pancytopenia.", "Bone marrow aspiration revealed no evidence of infection or malignancy.", "A tru-cut biopsy of the spleen was performed.", "The spleen biopsy confirmed the diagnosis of visceral leishmaniasis.", "The patient received a combination therapy of sodium stibogluconate and paromomycin.", "The patient showed significant improvement after treatment.", "The patient was discharged after completing treatment.", "The spleen biopsy results were normal after treatment."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 65-year-old woman with persistent atrial fibrillation.", "She underwent mechanical aortic and mitral valve replacement in 1995 for rheumatic valvular disease.", "She required a redo surgery due to an extensive pannus with two biological prostheses in January 2020.", "She also required a single-chamber pacemaker.", "Her current medical therapy included oral anticoagulation (apixaban 5\u2005mg twice daily).", "She developed chronic anaemia due to active intestinal angiodysplasia.", "Her CHA\u2082DS\u2082-VASc score was 3.", "Her HAS-BLED score was 3.", "Investigations ruled out other causes of anaemia, including haemolytic anaemia.", "The patient presented with two biological prostheses (VHD) without active rheumatic valve disease.", "The patient may be a candidate for LAAc.", "Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus.", "The ridge diameter was 28\u2005mm.", "One centimetre inside the LAA, the maximum landing zone diameter was 22\u2005mm.", "The shape of the LAA was tortuous and difficult to assess.", "Pre-operative computed tomography (CT) revealed an unusual LAA morphology that was horn-like in shape.", "The LAA had an inferior implantation and a superior axis.", "The ostium was close to the mitral prosthesis ring.", "A first procedure was performed using a standard left femoral venous approach.", "The transseptal puncture was performed postero-inferiorly as recommended under TEE guidance.", "Despite multiple attempts, it was not possible to advance the sheath beyond the first centimetre of the ostium.", "The deployment of a 31\u2005mm Watchman FLX was attempted but was unsuccessful given the unsuitable sheath position.", "A 3D printing model was prepared using SLS laser sintering technology.", "Simulation was performed from inferior and superior access points.", "Excessive sheath kinking was demonstrated with an inferior approach.", "Successful deployment was feasible using a superior approach.", "Transseptal puncture (second procedure) was performed using a right jugular venous approach under TEE guidance.", "Apixaban was discontinued 72\u2005h before the procedure.", "2000 IU unfractionated heparin was administered after jugular puncture.", "A Swartz SL0 sheath and a BRK-1 XS Series transseptal needle were used.", "Safe access to the left atrium was achieved by advancing a 0.014 stiff coronary wire Iron Man through the BRK-1 XS needle.", "The sheath was advanced in the left atrium over the needle and Iron Man wire.", "The SL0 was exchanged for the single-curve 14Fr delivery sheath over an Amplatz Super Stiff guidewire.", "Deep and safe advancement of the delivery sheath was performed over a pigtail catheter and the Amplatz Super Stiff guidewire.", "Proper sheath alignment without kinking was obtained.", "Successful implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved.", "The position was as predicted during the simulation on the 3D-printed model.", "No complications occurred during the first or second procedures.", "Following the successful second procedure, the patient continued to receive apixaban (2.5\u2005mg twice daily) until the control CT scan at month 2.", "At the patient\u2019s 3-month follow-up visit, and after cessation of oral anticoagulation, an improvement in symptoms was seen with no need for additional transfusions.", "Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis as predicted by the simulation procedure.", "TEE follow-up confirmed there was no leakage around the device.", "After 9 months\u2019 follow-up, there was no need for further transfusions.", "The patient\u2019s pulmonary pressure and functional class had improved."], "summary_subclaims": ["The patient is a 65-year-old woman.", "The patient has persistent atrial fibrillation.", "The patient was referred for left atrial appendage closure (LAAc).", "Transesophageal echocardiography (TEE) revealed spontaneous contrast in the left atrial appendage (LAA).", "Transesophageal echocardiography (TEE) did not reveal formation of a thrombus.", "The left atrial appendage shape was tortuous.", "The left atrial appendage was difficult to assess.", "A first LAAc procedure was unsuccessful.", "The first LAAc procedure was unsuccessful given the unsuitable sheath position.", "A soft three-dimensional (3D) model printing was performed by laser sintering.", "The 3D model revealed excessive sheath kinking with an inferior approach.", "The 3D model suggested successful deployment would be feasible using a superior approach.", "A successful trans-jugular implantation of a Watchman FLX 31 device was achieved.", "The Watchman FLX 31 device was in stable position.", "There was no residual leakage after the device implantation.", "At 3-month follow-up, the patient's symptoms improved.", "Oral anticoagulation was ceased after the procedure.", "Imaging demonstrated complete LAA occlusion.", "Imaging demonstrated correct placement of the device along the LAA superior axis."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 65-year-old woman with persistent atrial fibrillation.", "She underwent mechanical aortic and mitral valve replacement in 1995 for rheumatic valvular disease.", "She required a redo surgery due to an extensive pannus with two biological prostheses in January 2020.", "She also required a single-chamber pacemaker.", "Her current medical therapy included oral anticoagulation (apixaban 5\u2005mg twice daily).", "She developed chronic anaemia due to active intestinal angiodysplasia.", "Her CHA\u2082DS\u2082-VASc score was 3.", "Her HAS-BLED score was 3.", "Investigations ruled out other causes of anaemia, including haemolytic anaemia.", "The patient presented with two biological prostheses (VHD) without active rheumatic valve disease.", "The patient may be a candidate for LAAc.", "Transesophageal echocardiography (TEE) revealed spontaneous contrast in the LAA without formation of a thrombus.", "The ridge diameter was 28\u2005mm.", "One centimetre inside the LAA, the maximum landing zone diameter was 22\u2005mm.", "The shape of the LAA was tortuous and difficult to assess.", "Pre-operative computed tomography (CT) revealed an unusual LAA morphology that was horn-like in shape.", "The LAA had an inferior implantation and a superior axis.", "The ostium was close to the mitral prosthesis ring.", "A first procedure was performed using a standard left femoral venous approach.", "The transseptal puncture was performed postero-inferiorly as recommended under TEE guidance.", "Despite multiple attempts, it was not possible to advance the sheath beyond the first centimetre of the ostium.", "The deployment of a 31\u2005mm Watchman FLX was attempted but was unsuccessful given the unsuitable sheath position.", "A 3D printing model was prepared using SLS laser sintering technology.", "Simulation was performed from inferior and superior access points.", "Excessive sheath kinking was demonstrated with an inferior approach.", "Successful deployment was feasible using a superior approach.", "Transseptal puncture (second procedure) was performed using a right jugular venous approach under TEE guidance.", "Apixaban was discontinued 72\u2005h before the procedure.", "2000 IU unfractionated heparin was administered after jugular puncture.", "A Swartz SL0 sheath and a BRK-1 XS Series transseptal needle were used.", "Safe access to the left atrium was achieved by advancing a 0.014 stiff coronary wire Iron Man through the BRK-1 XS needle.", "The sheath was advanced in the left atrium over the needle and Iron Man wire.", "The SL0 was exchanged for the single-curve 14Fr delivery sheath over an Amplatz Super Stiff guidewire.", "Deep and safe advancement of the delivery sheath was performed over a pigtail catheter and the Amplatz Super Stiff guidewire.", "Proper sheath alignment without kinking was obtained.", "Successful implantation of a Watchman FLX 31 device in stable position without residual leakage was achieved.", "The position was as predicted during the simulation on the 3D-printed model.", "No complications occurred during the first or second procedures.", "Following the successful second procedure, the patient continued to receive apixaban (2.5\u2005mg twice daily) until the control CT scan at month 2.", "At the patient\u2019s 3-month follow-up visit, and after cessation of oral anticoagulation, an improvement in symptoms was seen with no need for additional transfusions.", "Imaging demonstrated complete LAA occlusion and correct placement of the device along the LAA superior axis as predicted by the simulation procedure.", "TEE follow-up confirmed there was no leakage around the device.", "After 9 months\u2019 follow-up, there was no need for further transfusions.", "The patient\u2019s pulmonary pressure and functional class had improved."], "index": 145, "original_id": "multiclinsum_test_2065_en.txt", "split": "test", "summary_subclaims": ["The patient is a 65-year-old woman.", "The patient has persistent atrial fibrillation.", "The patient was referred for left atrial appendage closure (LAAc).", "Transesophageal echocardiography (TEE) revealed spontaneous contrast in the left atrial appendage (LAA).", "Transesophageal echocardiography (TEE) did not reveal formation of a thrombus.", "The left atrial appendage shape was tortuous.", "The left atrial appendage was difficult to assess.", "A first LAAc procedure was unsuccessful.", "The first LAAc procedure was unsuccessful given the unsuitable sheath position.", "A soft three-dimensional (3D) model printing was performed by laser sintering.", "The 3D model revealed excessive sheath kinking with an inferior approach.", "The 3D model suggested successful deployment would be feasible using a superior approach.", "A successful trans-jugular implantation of a Watchman FLX 31 device was achieved.", "The Watchman FLX 31 device was in stable position.", "There was no residual leakage after the device implantation.", "At 3-month follow-up, the patient's symptoms improved.", "Oral anticoagulation was ceased after the procedure.", "Imaging demonstrated complete LAA occlusion.", "Imaging demonstrated correct placement of the device along the LAA superior axis."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 33-year-old Chinese man.", "He had sustainable foamy urine for more than one year.", "He complained of intermittent hair loss.", "He had recurrence of oral ulcers.", "One year prior, he was hospitalized at a local hospital for the same reason.", "Routine urine tests indicated microscopic hematuria and proteinuria.", "He did not pay much attention.", "There was no further diagnosis or treatment.", "One month prior, his blood pressure rose to 145/91 mmHg.", "Microscopic hematuria and heavy proteinuria were again detected.", "The patient had no comorbidities.", "The patient's father had asymptomatic microscopic hematuria and proteinuria.", "The father's findings were detected in a routine physical examination approximately 2 years prior.", "The patient had a daughter and a son.", "The daughter had asymptomatic microscopic hematuria.", "The son had microscopic hematuria and proteinuria.", "The son had ever been diagnosed with chronic nephritis at a local hospital.", "The patient's systolic blood pressure was 141 mmHg.", "The patient's diastolic blood pressure was 90 mmHg.", "No obvious abnormality was detected during physical examination.", "No specific nervous system symptoms were recognized.", "No hearing impairments were detected.", "No symptoms were found in either eye.", "Microscopic hematuria and proteinuria were confirmed by urine tests.", "No obvious abnormality was detected by abdominal ultrasound.", "No obvious abnormality was detected by X-ray diagnosis.", "No obvious abnormality was detected by electrocardiographic examination.", "Heart echocardiography showed a small amount of pericardial effusion.", "A histopathology study of renal biopsy was performed.", "A total of 13 glomeruli were observed.", "One glomerulus was enlarged and lobulated.", "Para-aminosailcylic acid staining and Masson staining were positive.", "Mild mesangial matrix proliferation was observed.", "The basement membrane was thickened.", "Three glomerular fibroblastic crescents were observed.", "Pericystic fibrosis of glomeruli was observed.", "Deposition of erythrotropin under the endothelium of the capillary loop was detected.", "Electron microscopy revealed variable thickness of the glomerular basement membrane.", "Electron microscopy revealed reticulation of the glomerular basement membrane.", "Electron microscopy revealed irregular subepithelial protrusion of the lamina densa.", "Fine particles and electron-dense bodies were detected in the stratified basement membrane.", "Immunological staining for IgG, IgA, IgM, C3, C4, C1q, \u041a, and \u03bb was positive in four glomeruli.", "The signals were deposited in the vascular lumen and mesangial area in a granular or linear form.", "Three relatives had microscopic hematuria.", "A diagnosis of ATS was highly suspected.", "The patient and his children were recommended to undergo genetic testing.", "WES was performed.", "Genomic DNA was extracted from blood samples.", "The coverage of the target sequence was over 99.12%.", "The mean sequencing depth was approximately 147.", "A heterozygous substitution, NM_000091 c.2657-1G>A (p. V294fs), was found in intron 22 of the COL4A3 gene.", "The mutation was confirmed by Sanger sequencing.", "The mutation was excluded from the single nucleotide polymorphism database.", "The mutation was included in the ClinVar database.", "The mutation is located at an evolutionarily conserved splice site.", "The splicing mutation is thought to lead to the skipping of exon 23.", "The variant is classified as 'likely pathogenic' according to the American College of Medical Genetics and Genomics standards and guidelines."], "summary_subclaims": ["A Chinese family with ATS was recruited for the current study.", "Clinical characteristics of ATS patients were collected from medical records.", "Potential causative genes were explored by whole-exome sequencing.", "A heterozygous substitution in intron 22 of COL4A3 (NM_000091 c.2657-1G>A) was found in the patients.", "The heterozygous substitution in intron 22 of COL4A3 was further confirmed by quantitative polymerase chain reaction."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 33-year-old Chinese man.", "He had sustainable foamy urine for more than one year.", "He complained of intermittent hair loss.", "He had recurrence of oral ulcers.", "One year prior, he was hospitalized at a local hospital for the same reason.", "Routine urine tests indicated microscopic hematuria and proteinuria.", "He did not pay much attention.", "There was no further diagnosis or treatment.", "One month prior, his blood pressure rose to 145/91 mmHg.", "Microscopic hematuria and heavy proteinuria were again detected.", "The patient had no comorbidities.", "The patient's father had asymptomatic microscopic hematuria and proteinuria.", "The father's findings were detected in a routine physical examination approximately 2 years prior.", "The patient had a daughter and a son.", "The daughter had asymptomatic microscopic hematuria.", "The son had microscopic hematuria and proteinuria.", "The son had ever been diagnosed with chronic nephritis at a local hospital.", "The patient's systolic blood pressure was 141 mmHg.", "The patient's diastolic blood pressure was 90 mmHg.", "No obvious abnormality was detected during physical examination.", "No specific nervous system symptoms were recognized.", "No hearing impairments were detected.", "No symptoms were found in either eye.", "Microscopic hematuria and proteinuria were confirmed by urine tests.", "No obvious abnormality was detected by abdominal ultrasound.", "No obvious abnormality was detected by X-ray diagnosis.", "No obvious abnormality was detected by electrocardiographic examination.", "Heart echocardiography showed a small amount of pericardial effusion.", "A histopathology study of renal biopsy was performed.", "A total of 13 glomeruli were observed.", "One glomerulus was enlarged and lobulated.", "Para-aminosailcylic acid staining and Masson staining were positive.", "Mild mesangial matrix proliferation was observed.", "The basement membrane was thickened.", "Three glomerular fibroblastic crescents were observed.", "Pericystic fibrosis of glomeruli was observed.", "Deposition of erythrotropin under the endothelium of the capillary loop was detected.", "Electron microscopy revealed variable thickness of the glomerular basement membrane.", "Electron microscopy revealed reticulation of the glomerular basement membrane.", "Electron microscopy revealed irregular subepithelial protrusion of the lamina densa.", "Fine particles and electron-dense bodies were detected in the stratified basement membrane.", "Immunological staining for IgG, IgA, IgM, C3, C4, C1q, \u041a, and \u03bb was positive in four glomeruli.", "The signals were deposited in the vascular lumen and mesangial area in a granular or linear form.", "Three relatives had microscopic hematuria.", "A diagnosis of ATS was highly suspected.", "The patient and his children were recommended to undergo genetic testing.", "WES was performed.", "Genomic DNA was extracted from blood samples.", "The coverage of the target sequence was over 99.12%.", "The mean sequencing depth was approximately 147.", "A heterozygous substitution, NM_000091 c.2657-1G>A (p. V294fs), was found in intron 22 of the COL4A3 gene.", "The mutation was confirmed by Sanger sequencing.", "The mutation was excluded from the single nucleotide polymorphism database.", "The mutation was included in the ClinVar database.", "The mutation is located at an evolutionarily conserved splice site.", "The splicing mutation is thought to lead to the skipping of exon 23.", "The variant is classified as 'likely pathogenic' according to the American College of Medical Genetics and Genomics standards and guidelines."], "index": 132, "original_id": "multiclinsum_test_1061_en.txt", "split": "test", "summary_subclaims": ["A Chinese family with ATS was recruited for the current study.", "Clinical characteristics of ATS patients were collected from medical records.", "Potential causative genes were explored by whole-exome sequencing.", "A heterozygous substitution in intron 22 of COL4A3 (NM_000091 c.2657-1G>A) was found in the patients.", "The heterozygous substitution in intron 22 of COL4A3 was further confirmed by quantitative polymerase chain reaction."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 74-year-old male.", "He complained of blurred vision in both eyes because of senile cataract in October 2015.", "Visual acuities were 6/20 OD and 8/20 OS.", "Intraocular pressure was normal.", "Slit-lamp examination revealed mild cortical cataract OU.", "Fundus findings showed nothing of note.", "The initial ophthalmologist planned to perform cataract surgery for his right eye.", "He had a medical history of prostate hypertrophy.", "He had no history of dementia.", "Viscoelastic materials with high-level cohesion were injected into the anterior chamber to dilate the pupil due to miosis following hydrodissection OD.", "Severe thermal corneoscleral injury occurred soon after beginning the phacoemulsification.", "The wound was tightly sutured by pedunculated conjunctiva.", "Viscoelastic materials were injected again since the leakage was not suppressed.", "He was referred to our hospital the next day.", "Visual acuity was hand motion OD.", "Intraocular pressure was 3 mm Hg OD.", "There was marked corneal stromal opacity with intraocular fluid leakage.", "The scleral wound was found to be opening following conjunctival incision.", "Mobility of the sclera was markedly involved.", "It was impossible to conduct direct suture of the injured sclera.", "The patient underwent transplantation of a donor scleral graft using 10-0 nylon to the burn site.", "After the transplantation and confirmation of the absence of intraocular fluid leakage, the lens nucleus was extracted from the newly formed wound on the temporal side of the scald.", "Histologically, the injured sclera showed coagulation necrosis with eosinophilic materials.", "Attachment of the transplanted sclera was favorable.", "Intraocular pressure recovered to normal.", "Three months after the surgery, macular edema occurred due to intraocular inflammation caused by the remaining lens cortex.", "Anterior vitrectomy was conducted leading to the resolution of macular edema.", "An intraocular lens was eventually fixed in the ciliary sulcus 7 months later.", "The visual acuity improved to 2/20 OD with stable IOP and a reduced corneal opacity in October 2016."], "summary_subclaims": ["Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male.", "His medical history was prostate hypertrophy.", "Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD.", "There was heavy corneal stromal opacity with intraocular fluid leakage.", "The patient underwent transplantation of a donor scleral graft to the burn site.", "Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration.", "An intraocular lens was eventually fixed in the ciliary sulcus 7 months later.", "His visual acuity remains at 2/20 OD."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 74-year-old male.", "He complained of blurred vision in both eyes because of senile cataract in October 2015.", "Visual acuities were 6/20 OD and 8/20 OS.", "Intraocular pressure was normal.", "Slit-lamp examination revealed mild cortical cataract OU.", "Fundus findings showed nothing of note.", "The initial ophthalmologist planned to perform cataract surgery for his right eye.", "He had a medical history of prostate hypertrophy.", "He had no history of dementia.", "Viscoelastic materials with high-level cohesion were injected into the anterior chamber to dilate the pupil due to miosis following hydrodissection OD.", "Severe thermal corneoscleral injury occurred soon after beginning the phacoemulsification.", "The wound was tightly sutured by pedunculated conjunctiva.", "Viscoelastic materials were injected again since the leakage was not suppressed.", "He was referred to our hospital the next day.", "Visual acuity was hand motion OD.", "Intraocular pressure was 3 mm Hg OD.", "There was marked corneal stromal opacity with intraocular fluid leakage.", "The scleral wound was found to be opening following conjunctival incision.", "Mobility of the sclera was markedly involved.", "It was impossible to conduct direct suture of the injured sclera.", "The patient underwent transplantation of a donor scleral graft using 10-0 nylon to the burn site.", "After the transplantation and confirmation of the absence of intraocular fluid leakage, the lens nucleus was extracted from the newly formed wound on the temporal side of the scald.", "Histologically, the injured sclera showed coagulation necrosis with eosinophilic materials.", "Attachment of the transplanted sclera was favorable.", "Intraocular pressure recovered to normal.", "Three months after the surgery, macular edema occurred due to intraocular inflammation caused by the remaining lens cortex.", "Anterior vitrectomy was conducted leading to the resolution of macular edema.", "An intraocular lens was eventually fixed in the ciliary sulcus 7 months later.", "The visual acuity improved to 2/20 OD with stable IOP and a reduced corneal opacity in October 2016."], "index": 150, "original_id": "multiclinsum_test_1564_en.txt", "split": "test", "summary_subclaims": ["Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male.", "His medical history was prostate hypertrophy.", "Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD.", "There was heavy corneal stromal opacity with intraocular fluid leakage.", "The patient underwent transplantation of a donor scleral graft to the burn site.", "Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration.", "An intraocular lens was eventually fixed in the ciliary sulcus 7 months later.", "His visual acuity remains at 2/20 OD."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 23-year-old critically-ill male.", "He had a history of Burkitt\u2019s lymphoma.", "He had graft-versus-host disease requiring high-dose corticosteroids.", "He was admitted after 2 days of somnolence and confusion.", "He had evolving respiratory distress requiring endotracheal intubation.", "On admission, he would open eyes to painful stimuli.", "On admission, he continued to follow commands.", "Initial CT head showed a flame hemorrhage in the left gyrus rectus.", "The flame hemorrhage was suspicious for vascular origin.", "A hypodensity in the left thalamus was suspicious for an established infarction.", "An angiogram demonstrated six fusiform aneurysms.", "Three aneurysms were at the frontopolar branch of the left anterior cerebral artery.", "One aneurysm was at the orbitofrontal branch of the left anterior cerebral artery.", "One aneurysm was at the frontopolar branch of the right anterior cerebral artery.", "One aneurysm was at the anterior temporal artery of the left middle cerebral artery.", "Body imaging revealed cavitary lung lesions.", "The patient was started on broad spectrum antibiotics.", "The patient was started on antifungals.", "The patient was started on antiviral medications.", "The location of hemorrhage pointed to the left ACA branch aneurysms as the source.", "Surgery was chosen to allow for inspection of all lesions under direct vision.", "Surgery was chosen to obtain tissue for microbiological purposes.", "A bicoronal craniotomy, parent vessel sacrifice, and excision of the three aneurysms arising from the left ACA were performed on postbleed day 2.", "Intraoperatively, the aneurysms were friable, thin walled, and prone to bleeding.", "The right ACA aneurysms were managed conservatively.", "Microbiology confirmed angioinvasive S. apiospermum infection.", "Vericonazole, amphotericin B, and caspofunging were started empirically.", "Vericonazole, amphotericin B, and caspofunging were continued throughout the disease process.", "A CT scan on postbleed day 4 revealed new left frontal intracerebral hemorrhage.", "A CT scan on postbleed day 4 revealed intraventricular hemorrhage.", "An emergency external ventricular drain was placed.", "A follow-up angiogram revealed interval growth of the left orbitofrontal artery aneurysm.", "Endovascular parent vessel occlusion was recommended.", "Endovascular parent vessel occlusion was performed uneventfully.", "An interval angiogram on postbleed day 7 demonstrated three new fusiform aneurysms of the right ACA.", "An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left anterior choroidal artery.", "An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left posterior communicating artery.", "The interval angiogram on postbleed day 7 confirmed a stable appearing left anterior temporal artery aneurysm.", "A3\u2013A3 revascularization was attempted to avoid ACA sacrifice.", "A3\u2013A3 revascularization was unsuccessful.", "Parent vessel sacrifice had to be performed.", "An intraoperative angiogram demonstrated a new anterior communicating artery aneurysm.", "The ACOMA aneurysm was left untreated at the time of surgery.", "On further follow-up imaging, the ACOMA aneurysm continued to enlarge.", "The ACOMA aneurysm was treated with endovascular A1 occlusions on postbleed day 9.", "Surveillance imaging demonstrated interval growth of the previously identified left AChA aneurysm.", "The left AChA aneurysm was ultimately treated with parent vessel sacrifice.", "Surveillance imaging demonstrated interval growth of the previously identified left PCOMA aneurysm.", "The left PCOMA aneurysm was ultimately treated with parent vessel sacrifice.", "Despite multiple parent vessel sacrifices, the patient recovered neurologically.", "The patient continued to follow commands with upper extremities.", "The patient had severe paraparesis in the lower extremities.", "Follow-up MRI confirmed a thalamic infarct.", "The thalamic infarct was already seen on admission imaging.", "Follow-up MRI showed new, incomplete ACA territory infarctions.", "The infarctions were in keeping with previous surgeries and parent vessel sacrifice of the bilateral ACAs.", "The patient remained intubated and ventilated.", "The patient underwent a tracheostomy procedure.", "The patient had septic shock from multidrug resistant pseudomonas superinfection.", "The patient died 6 months after the hemorrhagic presentation."], "summary_subclaims": ["The patient was a 23-year-old with Burkitt's lymphoma and graft-versus-host disease.", "The patient was admitted with intracerebral hemorrhage.", "The patient had 12 anterior circulation aneurysms from disseminated Scedosporium infection.", "The patient died 6 months later from multiorgan failure.", "The notable feature of this case is the rapid angioinvasiveness of the infection.", "New aneurysms formed within days of clear angiographic imaging.", "There was an apparent lack of skull base osteomyelitis."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 23-year-old critically-ill male.", "He had a history of Burkitt\u2019s lymphoma.", "He had graft-versus-host disease requiring high-dose corticosteroids.", "He was admitted after 2 days of somnolence and confusion.", "He had evolving respiratory distress requiring endotracheal intubation.", "On admission, he would open eyes to painful stimuli.", "On admission, he continued to follow commands.", "Initial CT head showed a flame hemorrhage in the left gyrus rectus.", "The flame hemorrhage was suspicious for vascular origin.", "A hypodensity in the left thalamus was suspicious for an established infarction.", "An angiogram demonstrated six fusiform aneurysms.", "Three aneurysms were at the frontopolar branch of the left anterior cerebral artery.", "One aneurysm was at the orbitofrontal branch of the left anterior cerebral artery.", "One aneurysm was at the frontopolar branch of the right anterior cerebral artery.", "One aneurysm was at the anterior temporal artery of the left middle cerebral artery.", "Body imaging revealed cavitary lung lesions.", "The patient was started on broad spectrum antibiotics.", "The patient was started on antifungals.", "The patient was started on antiviral medications.", "The location of hemorrhage pointed to the left ACA branch aneurysms as the source.", "Surgery was chosen to allow for inspection of all lesions under direct vision.", "Surgery was chosen to obtain tissue for microbiological purposes.", "A bicoronal craniotomy, parent vessel sacrifice, and excision of the three aneurysms arising from the left ACA were performed on postbleed day 2.", "Intraoperatively, the aneurysms were friable, thin walled, and prone to bleeding.", "The right ACA aneurysms were managed conservatively.", "Microbiology confirmed angioinvasive S. apiospermum infection.", "Vericonazole, amphotericin B, and caspofunging were started empirically.", "Vericonazole, amphotericin B, and caspofunging were continued throughout the disease process.", "A CT scan on postbleed day 4 revealed new left frontal intracerebral hemorrhage.", "A CT scan on postbleed day 4 revealed intraventricular hemorrhage.", "An emergency external ventricular drain was placed.", "A follow-up angiogram revealed interval growth of the left orbitofrontal artery aneurysm.", "Endovascular parent vessel occlusion was recommended.", "Endovascular parent vessel occlusion was performed uneventfully.", "An interval angiogram on postbleed day 7 demonstrated three new fusiform aneurysms of the right ACA.", "An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left anterior choroidal artery.", "An interval angiogram on postbleed day 7 demonstrated a new aneurysm of the left posterior communicating artery.", "The interval angiogram on postbleed day 7 confirmed a stable appearing left anterior temporal artery aneurysm.", "A3\u2013A3 revascularization was attempted to avoid ACA sacrifice.", "A3\u2013A3 revascularization was unsuccessful.", "Parent vessel sacrifice had to be performed.", "An intraoperative angiogram demonstrated a new anterior communicating artery aneurysm.", "The ACOMA aneurysm was left untreated at the time of surgery.", "On further follow-up imaging, the ACOMA aneurysm continued to enlarge.", "The ACOMA aneurysm was treated with endovascular A1 occlusions on postbleed day 9.", "Surveillance imaging demonstrated interval growth of the previously identified left AChA aneurysm.", "The left AChA aneurysm was ultimately treated with parent vessel sacrifice.", "Surveillance imaging demonstrated interval growth of the previously identified left PCOMA aneurysm.", "The left PCOMA aneurysm was ultimately treated with parent vessel sacrifice.", "Despite multiple parent vessel sacrifices, the patient recovered neurologically.", "The patient continued to follow commands with upper extremities.", "The patient had severe paraparesis in the lower extremities.", "Follow-up MRI confirmed a thalamic infarct.", "The thalamic infarct was already seen on admission imaging.", "Follow-up MRI showed new, incomplete ACA territory infarctions.", "The infarctions were in keeping with previous surgeries and parent vessel sacrifice of the bilateral ACAs.", "The patient remained intubated and ventilated.", "The patient underwent a tracheostomy procedure.", "The patient had septic shock from multidrug resistant pseudomonas superinfection.", "The patient died 6 months after the hemorrhagic presentation."], "index": 152, "original_id": "multiclinsum_test_2127_en.txt", "split": "test", "summary_subclaims": ["The patient was a 23-year-old with Burkitt's lymphoma and graft-versus-host disease.", "The patient was admitted with intracerebral hemorrhage.", "The patient had 12 anterior circulation aneurysms from disseminated Scedosporium infection.", "The patient died 6 months later from multiorgan failure.", "The notable feature of this case is the rapid angioinvasiveness of the infection.", "New aneurysms formed within days of clear angiographic imaging.", "There was an apparent lack of skull base osteomyelitis."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 41-year-old Chinese man presented with palpable right breast lumps for 1 year.", "On physical examination, a large retroareolar hard nontender mass approximately 4.5 cm in size was palpated over the right breast.", "The mass was nonmobile and superficial but did not have any overlying skin findings.", "A smaller adjacent mobile and nontender lesion, approximately 3 cm, was palpated just medial to the first mass.", "Initial laboratory evaluation was normal for prolactin, estradiol, luteinizing and follicle-stimulating hormone levels.", "He had never previously been treated with radiation, according to his past medical history.", "Conventional mammography was performed on Flat III (Metaltronica Company, Rome, Italy).", "Mammography showed a subcutaneous oval mass with a smooth and sharp margin on his right breast.", "Another small oval mass with a less well-defined margin was seen adjacent to the main lesion.", "MR imaging was performed on a 1.5 T Signa Infinity TwinSpeed MR scanner (GE Company, Milwaukee, WI, USA).", "The examination comprised of routine T1- and T2-weighted fast spin echo (FSE) sequences in axial and sagittal planes.", "T1- and T2-weighted imaging fat-suppressed in axial and sagittal planes, respectively.", "On T1-weighted imaging, the lesions were predominantly hypointense to subcutaneous fat and mildly hyperintense to the pectoralis major muscle.", "On T2-weighted imaging, the lesions were of a higher signal than the subcutaneous fat.", "The larger lesion had a smooth contour and well defined borders on all sequences.", "On T2-weighted images, the larger lesion had a lower signal central region.", "Along the border of the larger lesion, there was a distinct rim of decrease in signal between the lesion and fat interface.", "The small lesion had a less poorly defined border on conventional T2 weighted images.", "On the fat-suppressed sequences, both lesions had better depiction for the margins and borders.", "There was a mild mass effect of the dominant lesion on the underlying pectoralis major muscle.", "The gross pathology of the specimens after surgery showed a yellowish tanned smooth surface mass measuring 4.5 cm \u00d7 3.0 cm \u00d7 2.0 cm.", "A smaller lesion with similar features measuring 2.5 cm \u00d7 2.0 cm \u00d7 1.0 cm was also found.", "Histologic specimens showed high cellularity monomorphic slender spindle cells arrayed in a storiform pattern.", "The spindle cells were aligned at right angles to small vessels and collagen fibers intermixed with scattered adipose tissue.", "The nuclei of the spindle cells were well differentiated with only rare mitotic figures.", "The larger mass had a fibrous envelope and plentiful collagen fibers in the central region.", "The smaller mass lacked the fibrous envelope.", "There was positive immunohistologic staining for vimentin and cluster of differentiation (CD) 34.", "There was negative immunohistologic staining for b-cell leukemia-lymphoma (Bcl-2), S-100 protein, smooth muscle actin (SMA), desmin and epithelial membrane antigen (EMA)."], "summary_subclaims": ["The patient is a 41-year-old Chinese man.", "The patient initially presented with a palpable lump.", "A mammogram showed two lesions in the right breast.", "One lesion had a well circumscribed border.", "The other lesion had an ill defined border.", "Conventional magnetic resonance imaging was performed.", "The well defined larger lesion showed mild central hypointensity.", "The smaller lesion had an irregular border.", "Both lesions were well characterized on the fat-suppressed sequences."]}, "extra_info": {"fulltext_subclaims": ["A 41-year-old Chinese man presented with palpable right breast lumps for 1 year.", "On physical examination, a large retroareolar hard nontender mass approximately 4.5 cm in size was palpated over the right breast.", "The mass was nonmobile and superficial but did not have any overlying skin findings.", "A smaller adjacent mobile and nontender lesion, approximately 3 cm, was palpated just medial to the first mass.", "Initial laboratory evaluation was normal for prolactin, estradiol, luteinizing and follicle-stimulating hormone levels.", "He had never previously been treated with radiation, according to his past medical history.", "Conventional mammography was performed on Flat III (Metaltronica Company, Rome, Italy).", "Mammography showed a subcutaneous oval mass with a smooth and sharp margin on his right breast.", "Another small oval mass with a less well-defined margin was seen adjacent to the main lesion.", "MR imaging was performed on a 1.5 T Signa Infinity TwinSpeed MR scanner (GE Company, Milwaukee, WI, USA).", "The examination comprised of routine T1- and T2-weighted fast spin echo (FSE) sequences in axial and sagittal planes.", "T1- and T2-weighted imaging fat-suppressed in axial and sagittal planes, respectively.", "On T1-weighted imaging, the lesions were predominantly hypointense to subcutaneous fat and mildly hyperintense to the pectoralis major muscle.", "On T2-weighted imaging, the lesions were of a higher signal than the subcutaneous fat.", "The larger lesion had a smooth contour and well defined borders on all sequences.", "On T2-weighted images, the larger lesion had a lower signal central region.", "Along the border of the larger lesion, there was a distinct rim of decrease in signal between the lesion and fat interface.", "The small lesion had a less poorly defined border on conventional T2 weighted images.", "On the fat-suppressed sequences, both lesions had better depiction for the margins and borders.", "There was a mild mass effect of the dominant lesion on the underlying pectoralis major muscle.", "The gross pathology of the specimens after surgery showed a yellowish tanned smooth surface mass measuring 4.5 cm \u00d7 3.0 cm \u00d7 2.0 cm.", "A smaller lesion with similar features measuring 2.5 cm \u00d7 2.0 cm \u00d7 1.0 cm was also found.", "Histologic specimens showed high cellularity monomorphic slender spindle cells arrayed in a storiform pattern.", "The spindle cells were aligned at right angles to small vessels and collagen fibers intermixed with scattered adipose tissue.", "The nuclei of the spindle cells were well differentiated with only rare mitotic figures.", "The larger mass had a fibrous envelope and plentiful collagen fibers in the central region.", "The smaller mass lacked the fibrous envelope.", "There was positive immunohistologic staining for vimentin and cluster of differentiation (CD) 34.", "There was negative immunohistologic staining for b-cell leukemia-lymphoma (Bcl-2), S-100 protein, smooth muscle actin (SMA), desmin and epithelial membrane antigen (EMA)."], "index": 135, "original_id": "multiclinsum_test_1990_en.txt", "split": "test", "summary_subclaims": ["The patient is a 41-year-old Chinese man.", "The patient initially presented with a palpable lump.", "A mammogram showed two lesions in the right breast.", "One lesion had a well circumscribed border.", "The other lesion had an ill defined border.", "Conventional magnetic resonance imaging was performed.", "The well defined larger lesion showed mild central hypointensity.", "The smaller lesion had an irregular border.", "Both lesions were well characterized on the fat-suppressed sequences."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 70-year-old male patient visited our clinic because of poor cognitive function and gait disturbance.", "He was diagnosed with encephalitis following scrub typhus 23 years ago.", "The patient complained of poor memory.", "He was initially admitted to a local hospital with a high fever and headache 23 years ago.", "He developed neurological symptoms as mental change, visual disturbance, and weakness, according to medical history.", "The first MRI was conducted 7-d after onset.", "The diagnosis of scrub typhus encephalitis was confirmed.", "No special previous medical history was reported.", "No special personal and family histories were found.", "Physical examination revealed narrow visual fields.", "He could read books and newspapers.", "His motor power on both extremities was intact without any pain.", "Fine movements of the left hand were poor.", "He could only manage to walk indoors because of sensory impairment.", "Handgrip strength (right/left, kg) was 32.3/31.3.", "Two-point discrimination test (right/left, mm) was 5/absence.", "Monofilament test (right/left, mm) was 3.22/absence.", "The patient had impaired cognition, with a mini-mental status examination score of 14.", "The patient had impaired cognition, with a Montreal cognitive assessment score of 10[-].", "We performed a computerized neuropsychological test.", "DTI data were acquired with a 3.0 T scanner Intera (Philips, Ltd., Best, The Netherlands) with a six-channel head coil and single-shot echo-planar imaging.", "For each of the 32 non-collinear diffusion-sensitizing gradients, we acquired 80 contiguous slices parallel to the anterior commissure-posterior commissure line.", "The imaging parameters were as follows: acquisition matrix = 112 \u00d7 112, field of view = 224 mm \u00d7 224 mm, TR/TE = 8973/80 ms, parallel imaging reduction factor (SENSE factor) = 2, EPI factor = 49, b = 1000 s/mm2, NEX = 2, and slice thickness = 2.0 mm (acquired voxel size = 2 mm \u00d7 2 mm \u00d7 2 mm).", "Analysis of the DTI data was performed using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FSL: ) based on the probabilistic tractography method.", "Head motion artifacts and image distortion due to eddy current were corrected by affine multiscale two-dimensional registration.", "The 7-d MRI onset showed small lesions in the left frontal and parietal lobes, and large lesions in the right superior parietal lobule and both occipital lobes.", "Compared with the 7-d MRI, the 23-year MRI findings indicated expanded lesions of encephalomalacia with marked dilation of both ventricles.", "Probabilistic DTT of the Papez circuit revealed that the left thalamocortical tract and right mammillothalamic tract could not be reconstructed.", "The anterior part of the fornix was found to be injured.", "Both CSTs were well preserved."], "summary_subclaims": ["The patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago.", "The patient had poor cognition.", "The Mini-Mental Status Examination score was 14.", "Handgrip strength was 32.3 kg on the right and 31.3 kg on the left.", "DTT revealed serious injuries of the left thalamocingulate tract.", "DTT revealed serious injuries of the right mammillothalamic tract in the Papez circuit.", "DTT showed a partial injury of the anterior part of the fornix."]}, "extra_info": {"fulltext_subclaims": ["A 70-year-old male patient visited our clinic because of poor cognitive function and gait disturbance.", "He was diagnosed with encephalitis following scrub typhus 23 years ago.", "The patient complained of poor memory.", "He was initially admitted to a local hospital with a high fever and headache 23 years ago.", "He developed neurological symptoms as mental change, visual disturbance, and weakness, according to medical history.", "The first MRI was conducted 7-d after onset.", "The diagnosis of scrub typhus encephalitis was confirmed.", "No special previous medical history was reported.", "No special personal and family histories were found.", "Physical examination revealed narrow visual fields.", "He could read books and newspapers.", "His motor power on both extremities was intact without any pain.", "Fine movements of the left hand were poor.", "He could only manage to walk indoors because of sensory impairment.", "Handgrip strength (right/left, kg) was 32.3/31.3.", "Two-point discrimination test (right/left, mm) was 5/absence.", "Monofilament test (right/left, mm) was 3.22/absence.", "The patient had impaired cognition, with a mini-mental status examination score of 14.", "The patient had impaired cognition, with a Montreal cognitive assessment score of 10[-].", "We performed a computerized neuropsychological test.", "DTI data were acquired with a 3.0 T scanner Intera (Philips, Ltd., Best, The Netherlands) with a six-channel head coil and single-shot echo-planar imaging.", "For each of the 32 non-collinear diffusion-sensitizing gradients, we acquired 80 contiguous slices parallel to the anterior commissure-posterior commissure line.", "The imaging parameters were as follows: acquisition matrix = 112 \u00d7 112, field of view = 224 mm \u00d7 224 mm, TR/TE = 8973/80 ms, parallel imaging reduction factor (SENSE factor) = 2, EPI factor = 49, b = 1000 s/mm2, NEX = 2, and slice thickness = 2.0 mm (acquired voxel size = 2 mm \u00d7 2 mm \u00d7 2 mm).", "Analysis of the DTI data was performed using the Oxford Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library (FSL: ) based on the probabilistic tractography method.", "Head motion artifacts and image distortion due to eddy current were corrected by affine multiscale two-dimensional registration.", "The 7-d MRI onset showed small lesions in the left frontal and parietal lobes, and large lesions in the right superior parietal lobule and both occipital lobes.", "Compared with the 7-d MRI, the 23-year MRI findings indicated expanded lesions of encephalomalacia with marked dilation of both ventricles.", "Probabilistic DTT of the Papez circuit revealed that the left thalamocortical tract and right mammillothalamic tract could not be reconstructed.", "The anterior part of the fornix was found to be injured.", "Both CSTs were well preserved."], "index": 148, "original_id": "multiclinsum_test_1723_en.txt", "split": "test", "summary_subclaims": ["The patient was affected by encephalitis caused by scrub typhus that occurred 23 years ago.", "The patient had poor cognition.", "The Mini-Mental Status Examination score was 14.", "Handgrip strength was 32.3 kg on the right and 31.3 kg on the left.", "DTT revealed serious injuries of the left thalamocingulate tract.", "DTT revealed serious injuries of the right mammillothalamic tract in the Papez circuit.", "DTT showed a partial injury of the anterior part of the fornix."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 74-year-old female.", "The patient presented with an abnormal shadow on chest computed tomography (CT) at a medical checkup.", "Chest CT showed a 17 mm \u00d7 8 mm ground-glass opacity with approximately 30% solid component in the right superior segment (S6).", "The patient had undergone radical treatment of right breast cancer staged at pT2N0M0 IIA.", "The patient had four cycles of postoperative adjuvant chemotherapy 11 years prior.", "A thoracoscopic right S6 segmentectomy was planned.", "We performed thoracoscopic surgery using two ports.", "We made a 2-cm incision in the 7th intercostal space of the right midaxillary line as the observation hole.", "We made a 4-cm incision in the 4th intercostal space of the right anterior axillary line as the operating hole.", "Pleural adhesions were observed throughout the thoracic cavity perioperatively.", "The horizontal and posterior oblique fissures were poorly developed.", "The intersegmental plane could not be distinguished.", "Digital palpation indicated that the nodule was located in a high position.", "The interlobar fissures were separated.", "The posterior segmental and superior segmental arteries were located following the pulmonary trunk arteries.", "The nodule was eventually found in the S2 of the right upper lobe.", "The recurrent and ascending arteries were dissociated and resected.", "The posterior segmental bronchus (B2) was exposed and transected.", "The intersegmental plane was divided along the inflation-deflation line using the endostaplers.", "Resection of the S2 of the right upper lobe was completed.", "The tumor was 3 cm away from the incisal margin.", "Intraoperative pathology analysis revealed minimally invasive adenocarcinoma (MIA).", "Hilar lymph node sampling was performed.", "On postoperative day 2, the right lung was completely redilated on CT.", "Postoperative pathological examination revealed MIA with negative surrounding lymph nodes.", "We reviewed lung CT images and performed three-dimensional (3D) reconstructions using Mimics Medical 21.0 software postoperatively.", "The B2 originated from the bronchus intermedius.", "The posterior segmental artery (A2) of the right upper lung lobe bifurcated into the A2a and A2b branching from the recurrent and ascending arteries, respectively.", "The right superior pulmonary vein had no central vein but a posterior intrasegmental vein (V2t) that travelled below the S2."], "summary_subclaims": ["We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung.", "Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe.", "Intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe.", "The bronchi of the posterior segment of the right lung opened into the bronchus intermedius.", "The procedure was completed uneventfully.", "Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 74-year-old female.", "The patient presented with an abnormal shadow on chest computed tomography (CT) at a medical checkup.", "Chest CT showed a 17 mm \u00d7 8 mm ground-glass opacity with approximately 30% solid component in the right superior segment (S6).", "The patient had undergone radical treatment of right breast cancer staged at pT2N0M0 IIA.", "The patient had four cycles of postoperative adjuvant chemotherapy 11 years prior.", "A thoracoscopic right S6 segmentectomy was planned.", "We performed thoracoscopic surgery using two ports.", "We made a 2-cm incision in the 7th intercostal space of the right midaxillary line as the observation hole.", "We made a 4-cm incision in the 4th intercostal space of the right anterior axillary line as the operating hole.", "Pleural adhesions were observed throughout the thoracic cavity perioperatively.", "The horizontal and posterior oblique fissures were poorly developed.", "The intersegmental plane could not be distinguished.", "Digital palpation indicated that the nodule was located in a high position.", "The interlobar fissures were separated.", "The posterior segmental and superior segmental arteries were located following the pulmonary trunk arteries.", "The nodule was eventually found in the S2 of the right upper lobe.", "The recurrent and ascending arteries were dissociated and resected.", "The posterior segmental bronchus (B2) was exposed and transected.", "The intersegmental plane was divided along the inflation-deflation line using the endostaplers.", "Resection of the S2 of the right upper lobe was completed.", "The tumor was 3 cm away from the incisal margin.", "Intraoperative pathology analysis revealed minimally invasive adenocarcinoma (MIA).", "Hilar lymph node sampling was performed.", "On postoperative day 2, the right lung was completely redilated on CT.", "Postoperative pathological examination revealed MIA with negative surrounding lymph nodes.", "We reviewed lung CT images and performed three-dimensional (3D) reconstructions using Mimics Medical 21.0 software postoperatively.", "The B2 originated from the bronchus intermedius.", "The posterior segmental artery (A2) of the right upper lung lobe bifurcated into the A2a and A2b branching from the recurrent and ascending arteries, respectively.", "The right superior pulmonary vein had no central vein but a posterior intrasegmental vein (V2t) that travelled below the S2."], "index": 141, "original_id": "multiclinsum_test_2891_en.txt", "split": "test", "summary_subclaims": ["We report a case of thoracoscopic resection of the posterior segment of the right upper lobe of the lung.", "Preoperatively, the nodule was believed to be located in the superior segment of the right lower lobe.", "Intraoperative exploration revealed that the nodule was located in the posterior segment of the right upper lobe.", "The bronchi of the posterior segment of the right lung opened into the bronchus intermedius.", "The procedure was completed uneventfully.", "Postoperative retrospective three-dimensional (3D) reconstruction of the lung CT images confirmed that the bronchi of the posterior segment of the right upper lobe originated from the bronchus intermedius."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 19-year-old male was admitted to the Department of Plastic, hand and reconstructive surgery.", "The patient had persistant dysaesthesia of the median nerve-supplied area.", "The patient had a soft tissue laceration of the palmar wrist.", "The injury occurred following a wakeboarding accident three days before admission.", "The patient was wakeboarding on the largest German artificial wakeboarding circled nylon cable system.", "The automatic nylon cable system stopped immediately due to an overlapping wire.", "The male wakeboarder dived in the lake and got struck in the loose nylon cable system with his trunk and the hand.", "The nylon cable system was activated by chance and he was pulled 1/4 of the radius of the lake with a speed of 40 km/h.", "The patient suffered a strangulation of his wrist with immediate numbness of the median-nerve supplied area of the left hand.", "The patient had a laceration of the palmar aspect of the wrist covering 0.5 \u00d7 5 cm tissue size.", "At admission in a rural hospital, the two-point discrimination was > 15 mm for the entire interdigital nerves N1\u2013N7 of the left hand.", "The ulnar nerve was found without any pathology.", "The patient could not perform a wrist flexion.", "Wrist extension was possible.", "The capillary refill was 1s for all five fingertips.", "No distinct pain in the snuff box area was evident on admission.", "The left elbow joint had full range of motion.", "Supination and pronation were limited due to persistent pain at the wrist level.", "The patient was transferred three days after the initial injury with persistent clinical lesion of the median nerve.", "Conventional x-ray of the hand and the wrist found regular articulation without an evident bony lesion.", "No disruption of the scapular-lunar ligament was noted.", "Computer tomography of the wrist and the hand proved regular bony structures.", "In the operating room, dorsal compartment pressure of the forearm was 19 mmHg.", "In the operating room, palmar compartment pressure of the flexor carpi ulnaris muscle was 16 mmHg.", "The median nerve, 72 hours after the initial strangulation injury, appeared with hyperaemia and moderate swelling.", "The median nerve had limited haematoma in the carpal tunnel.", "The palmar branch of the median nerve was surrounded by a significant haematoma.", "The haematoma surrounding the palmar branch of the median nerve was evacuated.", "The ulnar nerve was inspected and found without any significant signs of injury or haematoma.", "The laceration area was excised completely.", "The skin could be closed primarily without compression.", "One subcutaneous drainage was inserted.", "On postoperative day 1, the patient regained the sensory function of the hand following 72 hours of acute carpal tunnel syndrome with median nerve contusion.", "On postoperative day 1, the patient had remaining dysaesthesia of the thenar skin supplied by the palmar branch of the median nerve.", "On postoperative day 5, the patient was discharged home after an uneventful postoperative course.", "The patient complained of minor dysaesthesias in the thenar area.", "The patient was advised to recover for a total of four weeks before returning to sport."], "summary_subclaims": ["The palmar branch of the median nerve was surrounded by a significant haematoma.", "The palmar branch of the median nerve had strangulation damage.", "The palmar branch of the median nerve is more superficially located in contrast to the median nerve."]}, "extra_info": {"fulltext_subclaims": ["A 19-year-old male was admitted to the Department of Plastic, hand and reconstructive surgery.", "The patient had persistant dysaesthesia of the median nerve-supplied area.", "The patient had a soft tissue laceration of the palmar wrist.", "The injury occurred following a wakeboarding accident three days before admission.", "The patient was wakeboarding on the largest German artificial wakeboarding circled nylon cable system.", "The automatic nylon cable system stopped immediately due to an overlapping wire.", "The male wakeboarder dived in the lake and got struck in the loose nylon cable system with his trunk and the hand.", "The nylon cable system was activated by chance and he was pulled 1/4 of the radius of the lake with a speed of 40 km/h.", "The patient suffered a strangulation of his wrist with immediate numbness of the median-nerve supplied area of the left hand.", "The patient had a laceration of the palmar aspect of the wrist covering 0.5 \u00d7 5 cm tissue size.", "At admission in a rural hospital, the two-point discrimination was > 15 mm for the entire interdigital nerves N1\u2013N7 of the left hand.", "The ulnar nerve was found without any pathology.", "The patient could not perform a wrist flexion.", "Wrist extension was possible.", "The capillary refill was 1s for all five fingertips.", "No distinct pain in the snuff box area was evident on admission.", "The left elbow joint had full range of motion.", "Supination and pronation were limited due to persistent pain at the wrist level.", "The patient was transferred three days after the initial injury with persistent clinical lesion of the median nerve.", "Conventional x-ray of the hand and the wrist found regular articulation without an evident bony lesion.", "No disruption of the scapular-lunar ligament was noted.", "Computer tomography of the wrist and the hand proved regular bony structures.", "In the operating room, dorsal compartment pressure of the forearm was 19 mmHg.", "In the operating room, palmar compartment pressure of the flexor carpi ulnaris muscle was 16 mmHg.", "The median nerve, 72 hours after the initial strangulation injury, appeared with hyperaemia and moderate swelling.", "The median nerve had limited haematoma in the carpal tunnel.", "The palmar branch of the median nerve was surrounded by a significant haematoma.", "The haematoma surrounding the palmar branch of the median nerve was evacuated.", "The ulnar nerve was inspected and found without any significant signs of injury or haematoma.", "The laceration area was excised completely.", "The skin could be closed primarily without compression.", "One subcutaneous drainage was inserted.", "On postoperative day 1, the patient regained the sensory function of the hand following 72 hours of acute carpal tunnel syndrome with median nerve contusion.", "On postoperative day 1, the patient had remaining dysaesthesia of the thenar skin supplied by the palmar branch of the median nerve.", "On postoperative day 5, the patient was discharged home after an uneventful postoperative course.", "The patient complained of minor dysaesthesias in the thenar area.", "The patient was advised to recover for a total of four weeks before returning to sport."], "index": 137, "original_id": "multiclinsum_test_2648_en.txt", "split": "test", "summary_subclaims": ["The palmar branch of the median nerve was surrounded by a significant haematoma.", "The palmar branch of the median nerve had strangulation damage.", "The palmar branch of the median nerve is more superficially located in contrast to the median nerve."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye.", "The patient denied any previous history of ocular inflammation.", "The patient denied any previous history of trauma.", "The patient denied any previous history of surgery.", "The patient denied any previous history of use of topical or systemic medications.", "Snellen\u2019s visual acuity in the right eye was 0.05.", "Snellen\u2019s visual acuity in the right eye was corrected to 0.5 with \u22123.00 to 2.00 \u00d7 15.", "Snellen\u2019s visual acuity in the left eye was 0.5.", "Snellen\u2019s visual acuity in the left eye was corrected to 0.8 with plano \u22120.75 \u00d7 170.", "Intraocular pressure was 14 mm Hg in the right eye.", "Intraocular pressure was 14 mm Hg in the left eye.", "Slit-lamp examination of the right eye anterior segment showed clear cornea.", "Slit-lamp examination of the right eye anterior segment showed deep and quiet anterior chamber.", "Slit-lamp examination of the right eye anterior segment showed no iris transillumination defects.", "Crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.", "Dilation of the right eye pupil showed no pigment deposits in the peripheral capsule.", "Dilation of the right eye pupil showed no pigment deposits on the posterior lens capsule.", "Dilation of the right eye pupil showed no pigment deposits on the anterior hyaloid face.", "The examination of the left eye anterior segment was within normal limits before and after dilation.", "Gonioscopy revealed open angle with mild pigmentation and prominent iris processes of the right eye.", "Ophthalmic examination of the posterior segment was normal in both eyes.", "The patient was reassured and prescribed glasses.", "The patient was booked for regular follow-up.", "Following discussion with the patient, she opted to have transepithelial photorefractive keratectomy for the right eye myopic astigmatism.", "Transepithelial photorefractive keratectomy improved her unaided vision to 0.8.", "Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made."], "summary_subclaims": ["The patient is a 23-year-old female.", "The patient presented with mild blurring of vision in the right eye.", "The patient inquired about refractive surgery.", "The patient denied any previous history of ocular inflammation.", "The patient denied any previous history of ocular trauma.", "The patient denied any previous history of ocular surgery.", "The patient denied any use of topical or systemic medications.", "Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular.", "The right eye crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.", "Left eye examination was completely within normal limits.", "Ophthalmic examination of the posterior segment was normal in both eyes.", "A diagnosis of unilateral congenital lenticular pigmentation was made."]}, "extra_info": {"fulltext_subclaims": ["A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye.", "The patient denied any previous history of ocular inflammation.", "The patient denied any previous history of trauma.", "The patient denied any previous history of surgery.", "The patient denied any previous history of use of topical or systemic medications.", "Snellen\u2019s visual acuity in the right eye was 0.05.", "Snellen\u2019s visual acuity in the right eye was corrected to 0.5 with \u22123.00 to 2.00 \u00d7 15.", "Snellen\u2019s visual acuity in the left eye was 0.5.", "Snellen\u2019s visual acuity in the left eye was corrected to 0.8 with plano \u22120.75 \u00d7 170.", "Intraocular pressure was 14 mm Hg in the right eye.", "Intraocular pressure was 14 mm Hg in the left eye.", "Slit-lamp examination of the right eye anterior segment showed clear cornea.", "Slit-lamp examination of the right eye anterior segment showed deep and quiet anterior chamber.", "Slit-lamp examination of the right eye anterior segment showed no iris transillumination defects.", "Crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.", "Dilation of the right eye pupil showed no pigment deposits in the peripheral capsule.", "Dilation of the right eye pupil showed no pigment deposits on the posterior lens capsule.", "Dilation of the right eye pupil showed no pigment deposits on the anterior hyaloid face.", "The examination of the left eye anterior segment was within normal limits before and after dilation.", "Gonioscopy revealed open angle with mild pigmentation and prominent iris processes of the right eye.", "Ophthalmic examination of the posterior segment was normal in both eyes.", "The patient was reassured and prescribed glasses.", "The patient was booked for regular follow-up.", "Following discussion with the patient, she opted to have transepithelial photorefractive keratectomy for the right eye myopic astigmatism.", "Transepithelial photorefractive keratectomy improved her unaided vision to 0.8.", "Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made."], "index": 149, "original_id": "multiclinsum_test_2126_en.txt", "split": "test", "summary_subclaims": ["The patient is a 23-year-old female.", "The patient presented with mild blurring of vision in the right eye.", "The patient inquired about refractive surgery.", "The patient denied any previous history of ocular inflammation.", "The patient denied any previous history of ocular trauma.", "The patient denied any previous history of ocular surgery.", "The patient denied any use of topical or systemic medications.", "Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular.", "The right eye crystalline lens anterior capsular showed confluent pigment deposits stellate in shape over the pupillary axis.", "Left eye examination was completely within normal limits.", "Ophthalmic examination of the posterior segment was normal in both eyes.", "A diagnosis of unilateral congenital lenticular pigmentation was made."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 51-year-old Hispanic female.", "She has a history of hypothyroidism.", "She presented with acute onset chest pain for 1 day.", "The chest pain was pressure-like, retrosternal, and radiated to her left arm and shoulder.", "She did not have shortness of breath.", "She reported the chest pain occurred suddenly while sitting at rest.", "She had intermittent chest pain with exertion for the past 2 months.", "She had to stop exercise for relief.", "She minimized her physical activity.", "The chest pain on presentation was similar in nature to the chest pain she had previously.", "She did not have syncope.", "She did not have palpitations.", "She did not have lightheadedness.", "She did not have anxiety.", "She did not have diarrhea.", "She did not have weight loss.", "She did not have brittle hair.", "She sought medical care due to increased severity of pain.", "Two months prior to presentation, she was diagnosed with hypothyroidism.", "Her TSH was ~500 U/mL.", "She was given levothyroxine 137 mcg daily.", "The dose was reduced after labs indicated supranormal T3 and T4 levels.", "She had most recently been on levothyroxine 100 mcg daily.", "She was compliant with levothyroxine.", "She took omeprazole 20 mg daily.", "She did not use oral contraceptive pills.", "She had a negative fasting lipid panel ~1 year prior.", "She denied any other past medical or surgical history.", "She did not have allergies.", "She was a lifelong non-smoker.", "She did not consume alcohol.", "She did not use illicit drugs.", "On presentation, her vitals were normal.", "Her BMI was 27.3 kg/m2.", "The physical exam was significant for a woman who appeared in her stated age in mild distress due to chest pain.", "The electrocardiogram was consistent with normal sinus rhythm without any abnormalities.", "Troponins were elevated and trended upward from 0.080 to 0.120 to 0.222 ng/mL each 8 hours apart.", "TSH was nearly undetectable at <0.015 U/mL.", "T3 and T4 were not measured on presentation.", "Levothyroxine was stopped.", "Chest x-ray was unremarkable.", "Bedside 2D echocardiogram showed a normal left ventricle with EF of >60%.", "There were no regional wall motion abnormalities.", "The left atrium was mildly dilated.", "Right ventricular systolic pressure was 32 mm Hg.", "Non-ST elevation MI was diagnosed.", "The patient was given atorvastatin 80 mg.", "The patient was given a heparin drip.", "The patient was given clopidogrel 600 mg.", "The patient was given aspirin 324 mg.", "Sublingual nitroglycerin 0.4 mg was given.", "The chest pain improved from 10/10 to 6/10.", "Coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.", "There was no evidence of occlusion.", "A follow-up coronary computed tomography angiogram confirmed the anomalous RCA.", "The anomalous RCA took an inter-arterial course.", "The anomalous RCA originated from the coronary ostium.", "There was a slit-like deformity.", "There was at least 50% luminal stenosis.", "Troponins trended downward.", "Chest pain resolved.", "The patient was referred to a cardiothoracic surgeon for definitive surgical correction.", "The patient was discharged home with levothyroxine 50 mcg daily.", "The patient was discharged home with metoprolol 25 mg BID.", "The patient was advised against aggressive physical activity.", "Informed consent was obtained from the patient for publication of this case report and any accompanying images."], "summary_subclaims": ["The patient is a 51-year-old female.", "The patient has a history of hypothyroidism.", "The patient had acute onset chest pain for 1 day.", "The patient's electrocardiogram was normal.", "The patient had elevated troponins.", "The patient was diagnosed with acute coronary syndrome.", "The patient was on levothyroxine.", "The patient had a subnormal thyroid-stimulating hormone level.", "The subnormal thyroid-stimulating hormone level suggested hyperthyroidism.", "The echocardiogram was normal.", "The coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.", "The coronary angiogram showed no evidence of atherosclerosis.", "A coronary computed tomography angiogram was done.", "The coronary computed tomography angiogram confirmed the anomalous RCA.", "The coronary computed tomography angiogram showed a slit-like deformity of the coronary ostium.", "The coronary computed tomography angiogram showed at least 50% luminal stenosis.", "The patient was referred to a cardiothoracic surgeon.", "The patient was referred for potential coronary artery bypass graft."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 51-year-old Hispanic female.", "She has a history of hypothyroidism.", "She presented with acute onset chest pain for 1 day.", "The chest pain was pressure-like, retrosternal, and radiated to her left arm and shoulder.", "She did not have shortness of breath.", "She reported the chest pain occurred suddenly while sitting at rest.", "She had intermittent chest pain with exertion for the past 2 months.", "She had to stop exercise for relief.", "She minimized her physical activity.", "The chest pain on presentation was similar in nature to the chest pain she had previously.", "She did not have syncope.", "She did not have palpitations.", "She did not have lightheadedness.", "She did not have anxiety.", "She did not have diarrhea.", "She did not have weight loss.", "She did not have brittle hair.", "She sought medical care due to increased severity of pain.", "Two months prior to presentation, she was diagnosed with hypothyroidism.", "Her TSH was ~500 U/mL.", "She was given levothyroxine 137 mcg daily.", "The dose was reduced after labs indicated supranormal T3 and T4 levels.", "She had most recently been on levothyroxine 100 mcg daily.", "She was compliant with levothyroxine.", "She took omeprazole 20 mg daily.", "She did not use oral contraceptive pills.", "She had a negative fasting lipid panel ~1 year prior.", "She denied any other past medical or surgical history.", "She did not have allergies.", "She was a lifelong non-smoker.", "She did not consume alcohol.", "She did not use illicit drugs.", "On presentation, her vitals were normal.", "Her BMI was 27.3 kg/m2.", "The physical exam was significant for a woman who appeared in her stated age in mild distress due to chest pain.", "The electrocardiogram was consistent with normal sinus rhythm without any abnormalities.", "Troponins were elevated and trended upward from 0.080 to 0.120 to 0.222 ng/mL each 8 hours apart.", "TSH was nearly undetectable at <0.015 U/mL.", "T3 and T4 were not measured on presentation.", "Levothyroxine was stopped.", "Chest x-ray was unremarkable.", "Bedside 2D echocardiogram showed a normal left ventricle with EF of >60%.", "There were no regional wall motion abnormalities.", "The left atrium was mildly dilated.", "Right ventricular systolic pressure was 32 mm Hg.", "Non-ST elevation MI was diagnosed.", "The patient was given atorvastatin 80 mg.", "The patient was given a heparin drip.", "The patient was given clopidogrel 600 mg.", "The patient was given aspirin 324 mg.", "Sublingual nitroglycerin 0.4 mg was given.", "The chest pain improved from 10/10 to 6/10.", "Coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.", "There was no evidence of occlusion.", "A follow-up coronary computed tomography angiogram confirmed the anomalous RCA.", "The anomalous RCA took an inter-arterial course.", "The anomalous RCA originated from the coronary ostium.", "There was a slit-like deformity.", "There was at least 50% luminal stenosis.", "Troponins trended downward.", "Chest pain resolved.", "The patient was referred to a cardiothoracic surgeon for definitive surgical correction.", "The patient was discharged home with levothyroxine 50 mcg daily.", "The patient was discharged home with metoprolol 25 mg BID.", "The patient was advised against aggressive physical activity.", "Informed consent was obtained from the patient for publication of this case report and any accompanying images."], "index": 133, "original_id": "multiclinsum_test_2590_en.txt", "split": "test", "summary_subclaims": ["The patient is a 51-year-old female.", "The patient has a history of hypothyroidism.", "The patient had acute onset chest pain for 1 day.", "The patient's electrocardiogram was normal.", "The patient had elevated troponins.", "The patient was diagnosed with acute coronary syndrome.", "The patient was on levothyroxine.", "The patient had a subnormal thyroid-stimulating hormone level.", "The subnormal thyroid-stimulating hormone level suggested hyperthyroidism.", "The echocardiogram was normal.", "The coronary angiogram showed an anomalous RCA arising from the left coronary cusp of the sinus of Valsalva.", "The coronary angiogram showed no evidence of atherosclerosis.", "A coronary computed tomography angiogram was done.", "The coronary computed tomography angiogram confirmed the anomalous RCA.", "The coronary computed tomography angiogram showed a slit-like deformity of the coronary ostium.", "The coronary computed tomography angiogram showed at least 50% luminal stenosis.", "The patient was referred to a cardiothoracic surgeon.", "The patient was referred for potential coronary artery bypass graft."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 60-year-old white female.", "She was referred to the nephrology clinic for an unexplained rise in creatinine to 1.4 mg/dL.", "Her baseline creatinine was 0.9 mg/dL.", "She was diagnosed with POEMS syndrome approximately 1 year prior.", "Her serum protein electrophoresis around 2 years prior showed an m-spike of 1.0 g/dL.", "Immunofixation electrophoresis demonstrated the presence of monoclonal IgG with kappa light chain restriction.", "Complementary bone marrow biopsy indicated mildly increased plasma cells (5%-7%) with kappa light chain predominance.", "She was diagnosed with hypertension approximately 3 years before her referral.", "She was taking prednisone 20 mg daily, prescribed by her hematologist due to suspected vasculitis.", "She reported intermittent consumption of nonsteroidal anti-inflammatory drugs (approximately 500 mg weekly) over the past couple of years.", "At her first nephrology visit, her creatinine level was 1.4 mg/dL.", "She was diagnosed with chronic kidney disease stage 3B at the nephrology visit.", "Her estimated glomerular filtration rate was 43 mL/min/1.73 m2.", "Her creatinine increased to 1.8 mg/dL 1 week after her first nephrology visit.", "Urinalysis results showed nephritic range proteinuria, hematuria, and pyuria with moderate bacteriuria.", "Autoimmune and infectious markers were negative.", "Kidney ultrasound was unremarkable.", "The kidney biopsy showed diffuse and focal nodular mesangial expansion without hypercellularity.", "DNAJB9 immunohistochemical staining and immunofluorescent studies were negative.", "Electron microscopy showed mesangial matrix expansion with scattered embedded distinct curved fibrils ranging from 7 to 12 nm in diameter.", "The patient was diagnosed with immunotactoid glomerulopathy in the context of hypertension and passive smoking.", "Her blood pressure became uncontrolled after the kidney biopsy, reaching a peak of 183/93 mm\u2009Hg.", "A duplex kidney ultrasound revealed left renal artery stenosis.", "She was referred for appropriate management of renal artery stenosis.", "Her most recent serum protein electrophoresis showed an M-spike of 0.8 g/dL.", "Immunofixation electrophoresis confirmed the presence of monoclonal IgG with kappa light chain restriction.", "At her most recent nephrology visit, 12 months later, her blood pressure was 144/78 mm\u2009Hg."], "summary_subclaims": ["The patient is a 60-year-old white female.", "She has POEMS syndrome.", "She has newly diagnosed HTN.", "She was referred because of an elevated creatinine level.", "She denied being an active smoker.", "She reported long-term exposure to cigarette smoke.", "Further investigations revealed microscopic hematuria.", "Further investigations revealed nephritic range proteinuria.", "Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity.", "Staining for amyloid was negative.", "Staining for fibrillary glomerulonephritis was negative.", "Staining for immunoglobulins was negative.", "The diagnosis was ING."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 60-year-old white female.", "She was referred to the nephrology clinic for an unexplained rise in creatinine to 1.4 mg/dL.", "Her baseline creatinine was 0.9 mg/dL.", "She was diagnosed with POEMS syndrome approximately 1 year prior.", "Her serum protein electrophoresis around 2 years prior showed an m-spike of 1.0 g/dL.", "Immunofixation electrophoresis demonstrated the presence of monoclonal IgG with kappa light chain restriction.", "Complementary bone marrow biopsy indicated mildly increased plasma cells (5%-7%) with kappa light chain predominance.", "She was diagnosed with hypertension approximately 3 years before her referral.", "She was taking prednisone 20 mg daily, prescribed by her hematologist due to suspected vasculitis.", "She reported intermittent consumption of nonsteroidal anti-inflammatory drugs (approximately 500 mg weekly) over the past couple of years.", "At her first nephrology visit, her creatinine level was 1.4 mg/dL.", "She was diagnosed with chronic kidney disease stage 3B at the nephrology visit.", "Her estimated glomerular filtration rate was 43 mL/min/1.73 m2.", "Her creatinine increased to 1.8 mg/dL 1 week after her first nephrology visit.", "Urinalysis results showed nephritic range proteinuria, hematuria, and pyuria with moderate bacteriuria.", "Autoimmune and infectious markers were negative.", "Kidney ultrasound was unremarkable.", "The kidney biopsy showed diffuse and focal nodular mesangial expansion without hypercellularity.", "DNAJB9 immunohistochemical staining and immunofluorescent studies were negative.", "Electron microscopy showed mesangial matrix expansion with scattered embedded distinct curved fibrils ranging from 7 to 12 nm in diameter.", "The patient was diagnosed with immunotactoid glomerulopathy in the context of hypertension and passive smoking.", "Her blood pressure became uncontrolled after the kidney biopsy, reaching a peak of 183/93 mm\u2009Hg.", "A duplex kidney ultrasound revealed left renal artery stenosis.", "She was referred for appropriate management of renal artery stenosis.", "Her most recent serum protein electrophoresis showed an M-spike of 0.8 g/dL.", "Immunofixation electrophoresis confirmed the presence of monoclonal IgG with kappa light chain restriction.", "At her most recent nephrology visit, 12 months later, her blood pressure was 144/78 mm\u2009Hg."], "index": 147, "original_id": "multiclinsum_test_3054_en.txt", "split": "test", "summary_subclaims": ["The patient is a 60-year-old white female.", "She has POEMS syndrome.", "She has newly diagnosed HTN.", "She was referred because of an elevated creatinine level.", "She denied being an active smoker.", "She reported long-term exposure to cigarette smoke.", "Further investigations revealed microscopic hematuria.", "Further investigations revealed nephritic range proteinuria.", "Kidney biopsy revealed diffuse and focal nodular mesangial expansion without hypercellularity.", "Staining for amyloid was negative.", "Staining for fibrillary glomerulonephritis was negative.", "Staining for immunoglobulins was negative.", "The diagnosis was ING."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 4 years and 8-month-old Syrian Arabic girl.", "She is the sixth of seven siblings.", "She was born to healthy consanguineous parents.", "She had a birth weight of 4 kg.", "She followed normal psychomotor development.", "She had no remarkable illness until the age of 4 years and 2 months.", "Her parents noticed rapid weight gain starting at 4 years and 2 months.", "She gained about 1 kg every 10 to 15 days.", "She required six to seven big meals per day.", "She had decreased tears when crying.", "She had decreased nasal discharge.", "She had unfavorable body odor.", "She had decreased sweating.", "She had blue cold extremities.", "She had diarrhea alternated with constipation.", "She had polyuria.", "She had polydipsia.", "Two months after the onset of obesity, she had urinary incontinence during night sleep.", "She had mood alteration.", "She had anxiety episodes.", "She had rage attacks.", "She had nervousness.", "She had aggressive behavior.", "She had recurrent fatigue.", "She had social withdrawal.", "She had prolonged periods of sleep (12 hours continuously).", "She had difficulty staying awake during the day.", "She was admitted to Damascus Children Hospital at the age of 4.5 years.", "The family history was negative for similar presentations.", "An older sister of the patient had died at the age of 12 years with a diagnosis of acute myeloid leukemia.", "Her sister\u2019s malignancy was not accompanied by any of the signs or symptoms the patient had.", "On physical examination, general obesity was noticed.", "No dysmorphic features were observed.", "Her weight was 25 kg.", "Her body mass index (BMI) was equal to 20.1.", "Her bone age was slightly advanced and fitted 5 to 5.5 years old.", "Brain MRI showed no cortical atrophy.", "A homogenous mild enlargement of the pituitary gland was observed.", "Her endocrine function tests were normal.", "She was discharged with risperidone 1 mg orally per day.", "She was recommended to follow up at the out-patient psychiatric clinic after 3 months.", "After 3 months, she developed dyspnea that worsened with exertion and during sleep.", "She had continuous snoring.", "She had recurrent chest pain.", "She had two episodes of cyanosis and obstructive apnea.", "She was readmitted to the ICU.", "She was intubated 24 hours after admission.", "She was attached to a mechanical ventilator.", "Her blood gases were pH 7.27, PaCO2 79 mmHg, PaO2 38 mmHg, and oxygen saturation 79%.", "A chest CT scan demonstrated a 6 cm round mass filling most of her right lung.", "A complete resection was performed of a 10\u00d710 cm solid round mass.", "The mass was a mature ganglioneuroma.", "ROHAAD syndrome was considered as a diagnosis.", "Familial obesity was excluded.", "Prader\u2013Willi syndrome was excluded.", "A brain MRI revealed generalized cortical atrophy.", "A tracheostomy was performed.", "She had cardiorespiratory arrest.", "She died one week after the tracheostomy."], "summary_subclaims": ["The patient is a 4 years and 8-month-old Syrian Arabic girl.", "The patient had signs and symptoms of rapid-onset obesity with hypoventilation.", "The patient had hypothalamic dysfunction.", "The patient had autonomic dysregulation syndrome.", "The patient had a mature ganglioneuroma in her chest.", "The patient had homogenous mild enlargement of her pituitary gland.", "The patient had generalized cortical brain atrophy.", "The patient had seizures.", "Three months after her first marked symptoms were noted, she had a sudden progression of severe respiratory distress.", "The patient's severe respiratory distress ended with her death."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 4 years and 8-month-old Syrian Arabic girl.", "She is the sixth of seven siblings.", "She was born to healthy consanguineous parents.", "She had a birth weight of 4 kg.", "She followed normal psychomotor development.", "She had no remarkable illness until the age of 4 years and 2 months.", "Her parents noticed rapid weight gain starting at 4 years and 2 months.", "She gained about 1 kg every 10 to 15 days.", "She required six to seven big meals per day.", "She had decreased tears when crying.", "She had decreased nasal discharge.", "She had unfavorable body odor.", "She had decreased sweating.", "She had blue cold extremities.", "She had diarrhea alternated with constipation.", "She had polyuria.", "She had polydipsia.", "Two months after the onset of obesity, she had urinary incontinence during night sleep.", "She had mood alteration.", "She had anxiety episodes.", "She had rage attacks.", "She had nervousness.", "She had aggressive behavior.", "She had recurrent fatigue.", "She had social withdrawal.", "She had prolonged periods of sleep (12 hours continuously).", "She had difficulty staying awake during the day.", "She was admitted to Damascus Children Hospital at the age of 4.5 years.", "The family history was negative for similar presentations.", "An older sister of the patient had died at the age of 12 years with a diagnosis of acute myeloid leukemia.", "Her sister\u2019s malignancy was not accompanied by any of the signs or symptoms the patient had.", "On physical examination, general obesity was noticed.", "No dysmorphic features were observed.", "Her weight was 25 kg.", "Her body mass index (BMI) was equal to 20.1.", "Her bone age was slightly advanced and fitted 5 to 5.5 years old.", "Brain MRI showed no cortical atrophy.", "A homogenous mild enlargement of the pituitary gland was observed.", "Her endocrine function tests were normal.", "She was discharged with risperidone 1 mg orally per day.", "She was recommended to follow up at the out-patient psychiatric clinic after 3 months.", "After 3 months, she developed dyspnea that worsened with exertion and during sleep.", "She had continuous snoring.", "She had recurrent chest pain.", "She had two episodes of cyanosis and obstructive apnea.", "She was readmitted to the ICU.", "She was intubated 24 hours after admission.", "She was attached to a mechanical ventilator.", "Her blood gases were pH 7.27, PaCO2 79 mmHg, PaO2 38 mmHg, and oxygen saturation 79%.", "A chest CT scan demonstrated a 6 cm round mass filling most of her right lung.", "A complete resection was performed of a 10\u00d710 cm solid round mass.", "The mass was a mature ganglioneuroma.", "ROHAAD syndrome was considered as a diagnosis.", "Familial obesity was excluded.", "Prader\u2013Willi syndrome was excluded.", "A brain MRI revealed generalized cortical atrophy.", "A tracheostomy was performed.", "She had cardiorespiratory arrest.", "She died one week after the tracheostomy."], "index": 139, "original_id": "multiclinsum_test_2845_en.txt", "split": "test", "summary_subclaims": ["The patient is a 4 years and 8-month-old Syrian Arabic girl.", "The patient had signs and symptoms of rapid-onset obesity with hypoventilation.", "The patient had hypothalamic dysfunction.", "The patient had autonomic dysregulation syndrome.", "The patient had a mature ganglioneuroma in her chest.", "The patient had homogenous mild enlargement of her pituitary gland.", "The patient had generalized cortical brain atrophy.", "The patient had seizures.", "Three months after her first marked symptoms were noted, she had a sudden progression of severe respiratory distress.", "The patient's severe respiratory distress ended with her death."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 24-year-old right-hand dominant Hispanic female.", "She initially presented to an urgent care office in October 2021.", "She had a right small finger mass on the ulnar aspect of the proximal interphalangeal joint.", "The mass had been present for several months prior to presentation.", "She had no pertinent medical or surgical history.", "Her family history was positive for renal cell carcinoma and diabetes on her maternal side.", "The mass would grow and reduce in size, especially during her pregnancy.", "The urgent care provider attempted aspiration of the mass, which was unsuccessful.", "The mass was diagnosed as a likely ganglion cyst.", "The patient saw another local hand surgeon sometime after her urgent care visit.", "Plans to remove the mass were never executed.", "In March 2022, she presented with complaints of increasing pain and an open wound with bleeding.", "Plain radiographs demonstrated a soft tissue mass on the ulnar aspect of the small finger near the PIP joint.", "The patient underwent a surgical excisional biopsy of the mass on 3/15/22.", "The surgical pathology was reviewed by two independent pathologists.", "The pathology was consistent with low-grade leiomyosarcoma of the finger.", "A PET/CT scan in early April 2022 demonstrated a suspicious lymph node in the right axilla.", "The treating oncologist thought the lymph node was benign and likely reactive.", "The clinical and pathologic assessment was consistent with AJCC stage 1A disease.", "The patient was discussed at the tumor board of the treating hospital in early May 2022.", "It was agreed that she would likely get the most benefit from a ray amputation.", "The patient presented with a new complaint of another mass on the small finger.", "The exam and radiographs were consistent with another focus of leiomyosarcoma.", "On 6/15/22, the patient underwent successful right-hand minor finger ray amputation.", "The small finger ray was amputated to the level of the mid-metacarpal shaft.", "The surgical margins assessed by a pathologist were clear for any tumor.", "The biopsy results were again consistent with low-grade leiomyosarcoma.", "The patient's right hand showed no evidence of recurrence or residual tumor clinically.", "An MRI of the right hand obtained on 10/11/22 showed no local or systemic disease recurrence.", "The patient continued progressing well postoperatively.", "She initiated hand therapy approximately three weeks postoperatively.", "Most recent occupational therapy clinic notes indicated full function of the right-hand digits 1\u20134.", "She had comparable grip strength to the contralateral hand.", "She had no pain or other masses.", "Postoperatively, she commented on a prominent and ropy scar.", "She underwent aggressive therapy and massage.", "Continued oncologic surveillance and repeat MRI showed no local or systemic disease recurrence at nine months postoperatively."], "summary_subclaims": ["The patient was diagnosed with a primary leiomyosarcoma of the small finger.", "She underwent extensive oncologic workup.", "She underwent successful ray amputation.", "She remains disease free."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 24-year-old right-hand dominant Hispanic female.", "She initially presented to an urgent care office in October 2021.", "She had a right small finger mass on the ulnar aspect of the proximal interphalangeal joint.", "The mass had been present for several months prior to presentation.", "She had no pertinent medical or surgical history.", "Her family history was positive for renal cell carcinoma and diabetes on her maternal side.", "The mass would grow and reduce in size, especially during her pregnancy.", "The urgent care provider attempted aspiration of the mass, which was unsuccessful.", "The mass was diagnosed as a likely ganglion cyst.", "The patient saw another local hand surgeon sometime after her urgent care visit.", "Plans to remove the mass were never executed.", "In March 2022, she presented with complaints of increasing pain and an open wound with bleeding.", "Plain radiographs demonstrated a soft tissue mass on the ulnar aspect of the small finger near the PIP joint.", "The patient underwent a surgical excisional biopsy of the mass on 3/15/22.", "The surgical pathology was reviewed by two independent pathologists.", "The pathology was consistent with low-grade leiomyosarcoma of the finger.", "A PET/CT scan in early April 2022 demonstrated a suspicious lymph node in the right axilla.", "The treating oncologist thought the lymph node was benign and likely reactive.", "The clinical and pathologic assessment was consistent with AJCC stage 1A disease.", "The patient was discussed at the tumor board of the treating hospital in early May 2022.", "It was agreed that she would likely get the most benefit from a ray amputation.", "The patient presented with a new complaint of another mass on the small finger.", "The exam and radiographs were consistent with another focus of leiomyosarcoma.", "On 6/15/22, the patient underwent successful right-hand minor finger ray amputation.", "The small finger ray was amputated to the level of the mid-metacarpal shaft.", "The surgical margins assessed by a pathologist were clear for any tumor.", "The biopsy results were again consistent with low-grade leiomyosarcoma.", "The patient's right hand showed no evidence of recurrence or residual tumor clinically.", "An MRI of the right hand obtained on 10/11/22 showed no local or systemic disease recurrence.", "The patient continued progressing well postoperatively.", "She initiated hand therapy approximately three weeks postoperatively.", "Most recent occupational therapy clinic notes indicated full function of the right-hand digits 1\u20134.", "She had comparable grip strength to the contralateral hand.", "She had no pain or other masses.", "Postoperatively, she commented on a prominent and ropy scar.", "She underwent aggressive therapy and massage.", "Continued oncologic surveillance and repeat MRI showed no local or systemic disease recurrence at nine months postoperatively."], "index": 143, "original_id": "multiclinsum_test_2201_en.txt", "split": "test", "summary_subclaims": ["The patient was diagnosed with a primary leiomyosarcoma of the small finger.", "She underwent extensive oncologic workup.", "She underwent successful ray amputation.", "She remains disease free."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 70-year-old Japanese man.", "He had smoked 20 cigarettes a day for 47 years until 5 years ago.", "He was under treatment and follow-up for essential hypertension, dyslipidemia and chronic kidney disease.", "His blood pressure and lipid levels were well controlled with administration of 40\u2005mg of olmesartan medoxomil and 5\u2005mg of atorvastatin calcium hydrate.", "He tested positive for SARS-CoV-2 by the polymerase chain reaction (PCR) test three days after coming in extended contact with a colleague who was also diagnosed with SARS-CoV-2.", "He was urgently admitted to the hospital the day after symptom onset and confirmation of the diagnosis.", "At admission, his body temperature was 36.4\u2005\u00b0C.", "At admission, his blood pressure was 185/72\u2005mm Hg.", "At admission, his peripheral oxygen saturation on pulse oximetry was 97.0%.", "Laboratory findings showed lymphocyte depletion.", "Laboratory findings showed coagulation abnormalities.", "CT showed emphysematous changes in the lung field.", "Ground glass opacities with neither a crazy-paving pattern nor consolidation was found below the dorsal pleura of the upper right lobe.", "The total CT score was 1/25 points.", "It was considered to be typical findings of early mild COVID-19 pneumonia.", "Administration of favipiravir 3600\u2005mg daily was started from the evening of the same day.", "1\u2005L/min oxygen administration via a nasal cannula was also started the following day.", "Weakness and a decreased level of consciousness appeared from the early morning of Day 2.", "A neurologist ruled out stroke.", "Fav was discontinued on the evening of Day 2.", "His symptoms improved by the morning of Day 3.", "The frequency of administration of acetaminophen 500\u2005mg was increased from 0 to 3 times a day.", "His CRP level increased.", "His SpO2 decreased, requiring an increase in oxygen flow rate from 1 to 3\u2005L/min by nasal cannula.", "CT performed on Day 4 showed slight deterioration in the pneumonia.", "The total CT score on Day 4 was 2/25 points.", "200\u2005mg of remdesivir was administered on Day 4.", "100\u2005mg of remdesivir was administered daily from Day 5 until Day 10.", "On Day 7, blood gas data showed that the alveolar-arterial oxygen difference had increased to 122.1\u2005mm Hg.", "No pulmonary hypertension was observed on electrocardiogram or echocardiography.", "A tendency of increasing D-D levels was also observed.", "The combination of nafamostat mesylate 100\u2005mg daily by continuous intravenous infusion and dexamethasone 6\u2005mg daily was administered for four days from Day 7.", "The treatment was remarkably effective, resulting in fever reduction.", "The treatment resulted in a decrease in CRP and D-D levels.", "On Day 10, oxygen administration could be discontinued.", "On Day 10, his blood pressure control improved.", "By Day 13, the alveolar-arterial oxygen difference had improved to 33.2\u2005mm Hg without supplementary oxygen.", "CT on Day 13 showed a tendency for improvement in pneumonia.", "The total CT score on Day 13 was still 2/25 points.", "For blood pressure control during the course of his hospitalization, continuous intravenous infusion of pernidipine was performed for two days when oral intake was difficult due to the decreased consciousness level.", "From Day 4, olmesartan medoxomil 40\u2005mg and nifedipine 20\u2005mg were administered in combination.", "With the treatment of COVID-19, his blood pressure gradually stabilized.", "The dose of nifedipine was reduced from Day 14 to 10\u2005mg.", "Nifedipine was discontinued from Day 19.", "The patient was discharged on Day 21."], "summary_subclaims": ["The patient was a 70-year-old Japanese man.", "The patient had essential hypertension.", "The patient had dyslipidemia.", "The patient had chronic kidney disease.", "The patient had emphysema.", "The patient was hospitalized with the novel coronavirus disease.", "The patient had hypoxemia that was disproportionate to the severity of pneumonia indicated by CT.", "The patient had coagulation abnormalities.", "We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy or hypoxic pulmonary vasoconstriction.", "Early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone was successful."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 70-year-old Japanese man.", "He had smoked 20 cigarettes a day for 47 years until 5 years ago.", "He was under treatment and follow-up for essential hypertension, dyslipidemia and chronic kidney disease.", "His blood pressure and lipid levels were well controlled with administration of 40\u2005mg of olmesartan medoxomil and 5\u2005mg of atorvastatin calcium hydrate.", "He tested positive for SARS-CoV-2 by the polymerase chain reaction (PCR) test three days after coming in extended contact with a colleague who was also diagnosed with SARS-CoV-2.", "He was urgently admitted to the hospital the day after symptom onset and confirmation of the diagnosis.", "At admission, his body temperature was 36.4\u2005\u00b0C.", "At admission, his blood pressure was 185/72\u2005mm Hg.", "At admission, his peripheral oxygen saturation on pulse oximetry was 97.0%.", "Laboratory findings showed lymphocyte depletion.", "Laboratory findings showed coagulation abnormalities.", "CT showed emphysematous changes in the lung field.", "Ground glass opacities with neither a crazy-paving pattern nor consolidation was found below the dorsal pleura of the upper right lobe.", "The total CT score was 1/25 points.", "It was considered to be typical findings of early mild COVID-19 pneumonia.", "Administration of favipiravir 3600\u2005mg daily was started from the evening of the same day.", "1\u2005L/min oxygen administration via a nasal cannula was also started the following day.", "Weakness and a decreased level of consciousness appeared from the early morning of Day 2.", "A neurologist ruled out stroke.", "Fav was discontinued on the evening of Day 2.", "His symptoms improved by the morning of Day 3.", "The frequency of administration of acetaminophen 500\u2005mg was increased from 0 to 3 times a day.", "His CRP level increased.", "His SpO2 decreased, requiring an increase in oxygen flow rate from 1 to 3\u2005L/min by nasal cannula.", "CT performed on Day 4 showed slight deterioration in the pneumonia.", "The total CT score on Day 4 was 2/25 points.", "200\u2005mg of remdesivir was administered on Day 4.", "100\u2005mg of remdesivir was administered daily from Day 5 until Day 10.", "On Day 7, blood gas data showed that the alveolar-arterial oxygen difference had increased to 122.1\u2005mm Hg.", "No pulmonary hypertension was observed on electrocardiogram or echocardiography.", "A tendency of increasing D-D levels was also observed.", "The combination of nafamostat mesylate 100\u2005mg daily by continuous intravenous infusion and dexamethasone 6\u2005mg daily was administered for four days from Day 7.", "The treatment was remarkably effective, resulting in fever reduction.", "The treatment resulted in a decrease in CRP and D-D levels.", "On Day 10, oxygen administration could be discontinued.", "On Day 10, his blood pressure control improved.", "By Day 13, the alveolar-arterial oxygen difference had improved to 33.2\u2005mm Hg without supplementary oxygen.", "CT on Day 13 showed a tendency for improvement in pneumonia.", "The total CT score on Day 13 was still 2/25 points.", "For blood pressure control during the course of his hospitalization, continuous intravenous infusion of pernidipine was performed for two days when oral intake was difficult due to the decreased consciousness level.", "From Day 4, olmesartan medoxomil 40\u2005mg and nifedipine 20\u2005mg were administered in combination.", "With the treatment of COVID-19, his blood pressure gradually stabilized.", "The dose of nifedipine was reduced from Day 14 to 10\u2005mg.", "Nifedipine was discontinued from Day 19.", "The patient was discharged on Day 21."], "index": 144, "original_id": "multiclinsum_test_2467_en.txt", "split": "test", "summary_subclaims": ["The patient was a 70-year-old Japanese man.", "The patient had essential hypertension.", "The patient had dyslipidemia.", "The patient had chronic kidney disease.", "The patient had emphysema.", "The patient was hospitalized with the novel coronavirus disease.", "The patient had hypoxemia that was disproportionate to the severity of pneumonia indicated by CT.", "The patient had coagulation abnormalities.", "We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy or hypoxic pulmonary vasoconstriction.", "Early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone was successful."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 21-year-old female patient with abdominal pain, irregular menstrual cycles, hyperestrogenemia, and recurrence of an ovarian mass was transferred to our hospital in July 2020.", "Four months prior, the patient was referred to another hospital because of abdominal pain and irregular menstrual cycles.", "Ultrasonography revealed a large multilocular cystic mass in the abdominal cavity.", "The patient underwent single-port laparoscopic removal of the bilateral ovarian cysts.", "During surgery, the bilateral ovaries were enlarged in a multilocular mass with yellow fluid inside.", "Histopathology revealed multiple luteinized follicular cysts of the ovary.", "After one month of clinical treatment, the patient experienced abdominal pain again.", "Pelvic ultrasound indicated recurrence of enlarged ovaries with multiple large cysts.", "The upper edge of the ovarian mass reached 20 mm above the umbilicus.", "The thickness of the endometrium was 17.4 mm.", "Biochemical evaluation demonstrated normal serum levels of LH, FSH, progesterone, cortisol, Free T4, thyroid-stimulating hormone, parathyroid hormone, calcium, phosphate, and growth hormone.", "Biochemical evaluation demonstrated elevated levels of plasma CA125, estradiol, and prolactin.", "Brain magnetic resonance imaging revealed the presence of a pituitary macroadenoma (17 mm \u00d7 27 mm \u00d7 19 mm).", "Visual field examination after brain MRI revealed bitemporal hemianopsia.", "Ultrasound showed a 48 mm \u00d7 30 mm \u00d7 23 mm mass in the right breast.", "Histopathology revealed breast fibroadenoma.", "Ultrasound imaging revealed no abnormalities in the thyroid, adrenal, or parathyroid glands.", "The patient was treated with oral bromocriptine (2.5 mg) three times a day.", "The patient had no significant history of illness, medical history, drug allergy, transfusion, injury, pregnancy, or other complications.", "The patient had a smoking history for over four years.", "The patient had menarche at age 12 years.", "In the past year, the menstrual cycle of the patient had extended to 2\u20133 months.", "The patient was 167 cm tall, weighed 68 kg, and had a body mass index of 24.38 kg/m2.", "An ultrasonographic study of the pelvis revealed multicystic ovaries, similar to the typical signs of spontaneous ovarian hyperstimulation syndrome.", "Computed tomography confirmed a large cystic mass in the abdominopelvic cavity, with a range of 19.4 cm \u00d7 7.9 cm \u00d7 15.9 cm.", "A homogeneously enhancing 21 mm \u00d7 16 mm \u00d7 28 mm sellar mass was imaged by brain MRI."], "summary_subclaims": ["The patient was a 21-year-old female.", "The patient had abdominal pain.", "The patient had irregular menstruation.", "The patient had hyperestrogenemia.", "The patient had an ovarian mass.", "Brain MRI revealed a pituitary macroadenoma.", "Transsphenoidal surgery relieved her clinical symptoms.", "Before transsphenoidal surgery, plasma CA125 levels were elevated.", "Before transsphenoidal surgery, estradiol levels were elevated.", "Before transsphenoidal surgery, prolactin levels were maintained at normal levels.", "Before transsphenoidal surgery, luteinizing hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, follicle-stimulating hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, PROG levels were maintained at normal levels.", "Before transsphenoidal surgery, cortisol levels were maintained at normal levels.", "Before transsphenoidal surgery, FT4 levels were maintained at normal levels.", "Before transsphenoidal surgery, thyroid-stimulating hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, parathyroid hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, GH levels were maintained at normal levels.", "After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma.", "Pelvic ultrasound confirmed normal-sized ovaries.", "The menstrual cycle returned to regular.", "Hormones were maintained within a normal range.", "There was no evidence of tumor recurrence after two years of follow-up."]}, "extra_info": {"fulltext_subclaims": ["A 21-year-old female patient with abdominal pain, irregular menstrual cycles, hyperestrogenemia, and recurrence of an ovarian mass was transferred to our hospital in July 2020.", "Four months prior, the patient was referred to another hospital because of abdominal pain and irregular menstrual cycles.", "Ultrasonography revealed a large multilocular cystic mass in the abdominal cavity.", "The patient underwent single-port laparoscopic removal of the bilateral ovarian cysts.", "During surgery, the bilateral ovaries were enlarged in a multilocular mass with yellow fluid inside.", "Histopathology revealed multiple luteinized follicular cysts of the ovary.", "After one month of clinical treatment, the patient experienced abdominal pain again.", "Pelvic ultrasound indicated recurrence of enlarged ovaries with multiple large cysts.", "The upper edge of the ovarian mass reached 20 mm above the umbilicus.", "The thickness of the endometrium was 17.4 mm.", "Biochemical evaluation demonstrated normal serum levels of LH, FSH, progesterone, cortisol, Free T4, thyroid-stimulating hormone, parathyroid hormone, calcium, phosphate, and growth hormone.", "Biochemical evaluation demonstrated elevated levels of plasma CA125, estradiol, and prolactin.", "Brain magnetic resonance imaging revealed the presence of a pituitary macroadenoma (17 mm \u00d7 27 mm \u00d7 19 mm).", "Visual field examination after brain MRI revealed bitemporal hemianopsia.", "Ultrasound showed a 48 mm \u00d7 30 mm \u00d7 23 mm mass in the right breast.", "Histopathology revealed breast fibroadenoma.", "Ultrasound imaging revealed no abnormalities in the thyroid, adrenal, or parathyroid glands.", "The patient was treated with oral bromocriptine (2.5 mg) three times a day.", "The patient had no significant history of illness, medical history, drug allergy, transfusion, injury, pregnancy, or other complications.", "The patient had a smoking history for over four years.", "The patient had menarche at age 12 years.", "In the past year, the menstrual cycle of the patient had extended to 2\u20133 months.", "The patient was 167 cm tall, weighed 68 kg, and had a body mass index of 24.38 kg/m2.", "An ultrasonographic study of the pelvis revealed multicystic ovaries, similar to the typical signs of spontaneous ovarian hyperstimulation syndrome.", "Computed tomography confirmed a large cystic mass in the abdominopelvic cavity, with a range of 19.4 cm \u00d7 7.9 cm \u00d7 15.9 cm.", "A homogeneously enhancing 21 mm \u00d7 16 mm \u00d7 28 mm sellar mass was imaged by brain MRI."], "index": 151, "original_id": "multiclinsum_test_318_en.txt", "split": "test", "summary_subclaims": ["The patient was a 21-year-old female.", "The patient had abdominal pain.", "The patient had irregular menstruation.", "The patient had hyperestrogenemia.", "The patient had an ovarian mass.", "Brain MRI revealed a pituitary macroadenoma.", "Transsphenoidal surgery relieved her clinical symptoms.", "Before transsphenoidal surgery, plasma CA125 levels were elevated.", "Before transsphenoidal surgery, estradiol levels were elevated.", "Before transsphenoidal surgery, prolactin levels were maintained at normal levels.", "Before transsphenoidal surgery, luteinizing hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, follicle-stimulating hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, PROG levels were maintained at normal levels.", "Before transsphenoidal surgery, cortisol levels were maintained at normal levels.", "Before transsphenoidal surgery, FT4 levels were maintained at normal levels.", "Before transsphenoidal surgery, thyroid-stimulating hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, parathyroid hormone levels were maintained at normal levels.", "Before transsphenoidal surgery, GH levels were maintained at normal levels.", "After transsphenoidal surgery, the patient was diagnosed with a functioning gonadotroph adenoma.", "Pelvic ultrasound confirmed normal-sized ovaries.", "The menstrual cycle returned to regular.", "Hormones were maintained within a normal range.", "There was no evidence of tumor recurrence after two years of follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 58-year-old woman.", "She presented with palpitations and diarrhea that had started 1 day before admission.", "She reported 5 episodes of watery stools.", "The palpitations were of sudden onset and irregular.", "Her initial heart rate was 150 beats/min with an irregular rhythm.", "Subsequent examination showed her heart rate stabilized at 80 beats/min.", "The initial electrocardiogram revealed atrial fibrillation with a heart rate of 150 beats/min and a right bundle branch block.", "Spontaneous conversion to sinus rhythm was observed shortly after the initial electrocardiogram.", "Pathological Q waves were noted in leads V1 and V2.", "A bedside point-of-care ultrasound revealed a large, irregular, hyperechoic, spiculated mass within the left ventricle.", "The chest radiograph revealed calcification within the cardiac silhouette.", "Her medical history was significant for type 2 diabetes mellitus and hypertension.", "She admitted to irregular adherence to her prescribed treatments.", "She had 2 episodes of non\u2013ST-segment elevation myocardial infarction in 2019 and 2022.", "There was no evidence of infections, parasitic diseases, or sepsis in her medical history.", "The differential diagnoses for a left ventricular intraventricular mass include thrombus, primary or metastatic tumors, vegetations, intracardiac calcifications, and parasitic infections.", "A transthoracic echocardiogram demonstrated a preserved ejection fraction of 56%.", "Regional wall motion abnormalities were present, including akinesia in the anterior, lateral, and inferior walls.", "A hyperechoic, irregular mass measuring 3 \u00d7 5 cm was located in the apex and lateral wall of the left ventricle.", "Laboratory evaluations revealed normal renal function, electrolytes, and calcium-phosphorus metabolism.", "Coronary CT angiography showed a coronary calcium score of 0 Agatston units.", "Extensive, thick, and irregular subendocardial calcifications measuring 66 mm in length were identified in the inferior, lateral, and apical walls of the left ventricle.", "The characteristics of the mass were consistent with dystrophic myocardial calcification.", "Rehydration therapy was initiated.", "Antiarrhythmic therapy and anticoagulation were started.", "The calcification was considered an incidental finding.", "A plan for continued medical surveillance was established."], "summary_subclaims": ["The patient is a 58-year-old woman.", "She presented with palpitations.", "She presented with diarrhea.", "Atrial fibrillation was noted.", "Spontaneous conversion to sinus rhythm occurred.", "A left ventricular mass was identified on echocardiogram.", "Computed tomography confirmed the mass as dystrophic calcification.", "The calcification was linked to previous myocardial infarctions.", "The calcification was considered an incidental finding.", "There was no significant systolic dysfunction."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 58-year-old woman.", "She presented with palpitations and diarrhea that had started 1 day before admission.", "She reported 5 episodes of watery stools.", "The palpitations were of sudden onset and irregular.", "Her initial heart rate was 150 beats/min with an irregular rhythm.", "Subsequent examination showed her heart rate stabilized at 80 beats/min.", "The initial electrocardiogram revealed atrial fibrillation with a heart rate of 150 beats/min and a right bundle branch block.", "Spontaneous conversion to sinus rhythm was observed shortly after the initial electrocardiogram.", "Pathological Q waves were noted in leads V1 and V2.", "A bedside point-of-care ultrasound revealed a large, irregular, hyperechoic, spiculated mass within the left ventricle.", "The chest radiograph revealed calcification within the cardiac silhouette.", "Her medical history was significant for type 2 diabetes mellitus and hypertension.", "She admitted to irregular adherence to her prescribed treatments.", "She had 2 episodes of non\u2013ST-segment elevation myocardial infarction in 2019 and 2022.", "There was no evidence of infections, parasitic diseases, or sepsis in her medical history.", "The differential diagnoses for a left ventricular intraventricular mass include thrombus, primary or metastatic tumors, vegetations, intracardiac calcifications, and parasitic infections.", "A transthoracic echocardiogram demonstrated a preserved ejection fraction of 56%.", "Regional wall motion abnormalities were present, including akinesia in the anterior, lateral, and inferior walls.", "A hyperechoic, irregular mass measuring 3 \u00d7 5 cm was located in the apex and lateral wall of the left ventricle.", "Laboratory evaluations revealed normal renal function, electrolytes, and calcium-phosphorus metabolism.", "Coronary CT angiography showed a coronary calcium score of 0 Agatston units.", "Extensive, thick, and irregular subendocardial calcifications measuring 66 mm in length were identified in the inferior, lateral, and apical walls of the left ventricle.", "The characteristics of the mass were consistent with dystrophic myocardial calcification.", "Rehydration therapy was initiated.", "Antiarrhythmic therapy and anticoagulation were started.", "The calcification was considered an incidental finding.", "A plan for continued medical surveillance was established."], "index": 153, "original_id": "multiclinsum_test_3200_en.txt", "split": "test", "summary_subclaims": ["The patient is a 58-year-old woman.", "She presented with palpitations.", "She presented with diarrhea.", "Atrial fibrillation was noted.", "Spontaneous conversion to sinus rhythm occurred.", "A left ventricular mass was identified on echocardiogram.", "Computed tomography confirmed the mass as dystrophic calcification.", "The calcification was linked to previous myocardial infarctions.", "The calcification was considered an incidental finding.", "There was no significant systolic dysfunction."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 53-year-old homeless man.", "He was admitted to the hospital due to a right femoral neck fracture.", "His medical history included noninsulin-dependent diabetes mellitus.", "A physical examination performed at admission was unremarkable.", "There was no fever.", "There was no lymphadenopathy.", "There were no other neurological defects.", "Laboratory tests revealed white blood cells of 4330 cells/mL.", "Laboratory tests revealed hemoglobin of 9.2 g/dL.", "Laboratory tests revealed platelet count of 29,900 platelets/mL.", "C-reactive protein was negative.", "Only normochromic-normocytic anemia was present.", "He successfully underwent surgery for the femoral neck fracture.", "The surgery was performed by an orthopedic surgeon.", "He had an episode of generalized seizures during the postoperative course.", "Phenytoin was administered.", "After this episode of generalized seizures, he was referred to our department.", "A computed tomography (CT) examination of the head without contrast showed a high-density and extraaxial mass in the right parietal convexity.", "Peritumoral brain edema was clearly observed.", "Enhanced magnetic resonance imaging (MRI) revealed an extraaxial, dural-based, and homogeneously enhanced mass with clear borders.", "The mass was compatible with a meningioma en plaque.", "The mass was iso- to hypointense on fluid-attenuated inversion recovery and T2 imaging sequences.", "The mass was iso- to hyperintense on T1 imaging.", "It was strongly suspected that the patient had a meningioma en plaque.", "The mass was exposed with a right frontotemporal craniotomy.", "The tumor appeared to be a meningioma en plaque.", "The tumor was extraaxial, xanthochromic, firm, nonaspiratable, and had high vascularity.", "The tumor was dural based.", "The tumor was tightly adhered to the adjacent cerebral cortex.", "The tumor was permeated by many pial arteries and veins of the brain surface.", "It is very difficult to preserve these pial vessels during the total removal of a tumor.", "A frozen section of the lesion showed inflammatory cell infiltration.", "The inflammatory cell infiltration mainly consisted of lymphocytes and plasma cells.", "The presence of these cells was initially interpreted as some kind of hematologic disorder or inflammatory pseudotumor.", "Paraffin-embedded sections showed a hypercellular pattern with features of polymorphous and mixed inflammatory infiltrates.", "The infiltrates were composed mainly of histiocytes in a background of collagen fibers.", "Some histiocytes had foamy and eosinophilic cytoplasm.", "Some histiocytes were seen to engulf viable lymphocytes.", "This was thought to reflect emperipolesis (lymphophagocytosis).", "The histiocytes were immunopositive for S-100 protein and CD68.", "The histiocytes were negative for CD1\u03b1.", "All of these findings were consistent with extranodal RDD.", "The patient had incomplete left hemiparesis after surgery.", "A brain CT examination conducted without contrast revealed postoperative hemorrhage.", "A low-density lesion in the right frontal lobe was observed.", "The low-density lesion seemed to be due to the sacrificed pial arteries from the brain-tumor interface.", "His seizures completely ceased.", "A whole-body CT examination postoperatively was performed.", "Findings of lymphadenopathy or other extranodal involvements were not found.", "The patient has been free of seizures since the surgery.", "He recovered from his hemiparesis 6 months after the surgery."], "summary_subclaims": ["The patient was a 53-year-old man.", "The patient had an episode of generalized seizures.", "Imaging studies of the brain were compatible with a meningioma en plaque.", "The mass was exposed by a right frontotemporal craniotomy.", "The tumor was adhered tightly to the adjacent cerebral cortex.", "The tumor was permeated by pial arteries of the brain surface.", "The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor.", "The patient had incomplete left hemiparesis after the surgery.", "Brain computed tomography (CT) imaging revealed a postoperative hemorrhage.", "Brain computed tomography (CT) imaging revealed a low-density lesion in the right frontal lobe.", "The patient was postoperatively diagnosed with isolated central nervous system RDD."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 53-year-old homeless man.", "He was admitted to the hospital due to a right femoral neck fracture.", "His medical history included noninsulin-dependent diabetes mellitus.", "A physical examination performed at admission was unremarkable.", "There was no fever.", "There was no lymphadenopathy.", "There were no other neurological defects.", "Laboratory tests revealed white blood cells of 4330 cells/mL.", "Laboratory tests revealed hemoglobin of 9.2 g/dL.", "Laboratory tests revealed platelet count of 29,900 platelets/mL.", "C-reactive protein was negative.", "Only normochromic-normocytic anemia was present.", "He successfully underwent surgery for the femoral neck fracture.", "The surgery was performed by an orthopedic surgeon.", "He had an episode of generalized seizures during the postoperative course.", "Phenytoin was administered.", "After this episode of generalized seizures, he was referred to our department.", "A computed tomography (CT) examination of the head without contrast showed a high-density and extraaxial mass in the right parietal convexity.", "Peritumoral brain edema was clearly observed.", "Enhanced magnetic resonance imaging (MRI) revealed an extraaxial, dural-based, and homogeneously enhanced mass with clear borders.", "The mass was compatible with a meningioma en plaque.", "The mass was iso- to hypointense on fluid-attenuated inversion recovery and T2 imaging sequences.", "The mass was iso- to hyperintense on T1 imaging.", "It was strongly suspected that the patient had a meningioma en plaque.", "The mass was exposed with a right frontotemporal craniotomy.", "The tumor appeared to be a meningioma en plaque.", "The tumor was extraaxial, xanthochromic, firm, nonaspiratable, and had high vascularity.", "The tumor was dural based.", "The tumor was tightly adhered to the adjacent cerebral cortex.", "The tumor was permeated by many pial arteries and veins of the brain surface.", "It is very difficult to preserve these pial vessels during the total removal of a tumor.", "A frozen section of the lesion showed inflammatory cell infiltration.", "The inflammatory cell infiltration mainly consisted of lymphocytes and plasma cells.", "The presence of these cells was initially interpreted as some kind of hematologic disorder or inflammatory pseudotumor.", "Paraffin-embedded sections showed a hypercellular pattern with features of polymorphous and mixed inflammatory infiltrates.", "The infiltrates were composed mainly of histiocytes in a background of collagen fibers.", "Some histiocytes had foamy and eosinophilic cytoplasm.", "Some histiocytes were seen to engulf viable lymphocytes.", "This was thought to reflect emperipolesis (lymphophagocytosis).", "The histiocytes were immunopositive for S-100 protein and CD68.", "The histiocytes were negative for CD1\u03b1.", "All of these findings were consistent with extranodal RDD.", "The patient had incomplete left hemiparesis after surgery.", "A brain CT examination conducted without contrast revealed postoperative hemorrhage.", "A low-density lesion in the right frontal lobe was observed.", "The low-density lesion seemed to be due to the sacrificed pial arteries from the brain-tumor interface.", "His seizures completely ceased.", "A whole-body CT examination postoperatively was performed.", "Findings of lymphadenopathy or other extranodal involvements were not found.", "The patient has been free of seizures since the surgery.", "He recovered from his hemiparesis 6 months after the surgery."], "index": 125, "original_id": "multiclinsum_test_1592_en.txt", "split": "test", "summary_subclaims": ["The patient was a 53-year-old man.", "The patient had an episode of generalized seizures.", "Imaging studies of the brain were compatible with a meningioma en plaque.", "The mass was exposed by a right frontotemporal craniotomy.", "The tumor was adhered tightly to the adjacent cerebral cortex.", "The tumor was permeated by pial arteries of the brain surface.", "The sacrificing of these arteries was inevitable in order to achieve the total removal of the tumor.", "The patient had incomplete left hemiparesis after the surgery.", "Brain computed tomography (CT) imaging revealed a postoperative hemorrhage.", "Brain computed tomography (CT) imaging revealed a low-density lesion in the right frontal lobe.", "The patient was postoperatively diagnosed with isolated central nervous system RDD."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 93-year-old Middle Eastern male.", "The patient has no known food or drug allergies.", "The patient has hypothyroidism.", "The patient has hypertension.", "The patient has dyslipidemia.", "The patient was admitted to the hospital owing to fatigue and refractory hiccups lasting for 2 weeks.", "The patient had had hiccups intermittently for more than 2 years.", "The patient had tried several medications, including proton-pump inhibitors, chlorpromazine, and baclofen, with minimal relief of his symptoms.", "The patient's home medications include levothyroxine, amlodipine, and rosuvastatin.", "The patient denies dysphagia, odynophagia, food impaction, heartburn, vomiting, or weight loss.", "Physical examination was unremarkable.", "Laboratory studies were only pertinent for an elevated eosinophil count of 18%.", "Stool studies were negative for parasitic infection.", "Imaging with computed tomography of the chest and abdomen was unremarkable.", "An upper endoscopy was performed and was normal, without any endoscopic finding to suggest EoE.", "Biopsies from the mid- and distal esophagus revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.", "The diagnosis favored EoE.", "The patient was prescribed a proton-pump inhibitor twice daily in combination with baclofen.", "The symptoms of intractable hiccups recurred despite partial initial improvement.", "The decision was made to switch therapy to topical budesonide 2 mg twice daily 30 minutes before meals.", "The frequency of the hiccup episodes gradually decreased and resolved completely within a week.", "Repeat blood test showed a decrease in eosinophilic count to 10%.", "A repeat endoscopy was offered but declined by the patient."], "summary_subclaims": ["The patient is a 93-year-old Middle Eastern male.", "The patient had longstanding treatment-refractory hiccups.", "Computed tomography of the chest and abdomen was unremarkable.", "An upper endoscopy was normal.", "There were no endoscopic findings to suggest eosinophilic esophagitis.", "The patient had an elevated peripheral eosinophil count.", "Biopsies were taken from the mid- and distal esophagus.", "The biopsies revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.", "The diagnosis favored eosinophilic esophagitis.", "The hiccups resolved following the initiation of eosinophilic esophagitis treatment."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 93-year-old Middle Eastern male.", "The patient has no known food or drug allergies.", "The patient has hypothyroidism.", "The patient has hypertension.", "The patient has dyslipidemia.", "The patient was admitted to the hospital owing to fatigue and refractory hiccups lasting for 2 weeks.", "The patient had had hiccups intermittently for more than 2 years.", "The patient had tried several medications, including proton-pump inhibitors, chlorpromazine, and baclofen, with minimal relief of his symptoms.", "The patient's home medications include levothyroxine, amlodipine, and rosuvastatin.", "The patient denies dysphagia, odynophagia, food impaction, heartburn, vomiting, or weight loss.", "Physical examination was unremarkable.", "Laboratory studies were only pertinent for an elevated eosinophil count of 18%.", "Stool studies were negative for parasitic infection.", "Imaging with computed tomography of the chest and abdomen was unremarkable.", "An upper endoscopy was performed and was normal, without any endoscopic finding to suggest EoE.", "Biopsies from the mid- and distal esophagus revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.", "The diagnosis favored EoE.", "The patient was prescribed a proton-pump inhibitor twice daily in combination with baclofen.", "The symptoms of intractable hiccups recurred despite partial initial improvement.", "The decision was made to switch therapy to topical budesonide 2 mg twice daily 30 minutes before meals.", "The frequency of the hiccup episodes gradually decreased and resolved completely within a week.", "Repeat blood test showed a decrease in eosinophilic count to 10%.", "A repeat endoscopy was offered but declined by the patient."], "index": 114, "original_id": "multiclinsum_test_3338_en.txt", "split": "test", "summary_subclaims": ["The patient is a 93-year-old Middle Eastern male.", "The patient had longstanding treatment-refractory hiccups.", "Computed tomography of the chest and abdomen was unremarkable.", "An upper endoscopy was normal.", "There were no endoscopic findings to suggest eosinophilic esophagitis.", "The patient had an elevated peripheral eosinophil count.", "Biopsies were taken from the mid- and distal esophagus.", "The biopsies revealed eosinophilic infiltration in the range of 15 eosinophils per high-power field.", "The diagnosis favored eosinophilic esophagitis.", "The hiccups resolved following the initiation of eosinophilic esophagitis treatment."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 22-year-old man.", "He had leg tremor in standing position for the previous 8 months.", "The tremor was initially bilateral.", "Seven months after development, the tremor subsided in the left leg.", "The tremor persisted only in the right leg.", "No tremor was evident when the patient was walking, reclining, or in a non-weight-bearing position.", "He denied any falls.", "He had no unsteadiness.", "There were no other complaints.", "The patient had no significant medical history.", "The patient had no family history of tremor.", "On examination, he showed incessant quivering in his right leg while standing.", "The tremor disappeared when he was asked to walk, sit, lie down, or lean against the wall for support.", "There was no resting or postural tremor of upper limbs.", "Bilateral tendon reflexes were diminished.", "There was no plantar response.", "Auscultation over the right popliteal fossa while the patient was standing revealed the 'helicopter sign'.", "The 'helicopter sign' indicated orthostatic tremor.", "All other components of neurological examination were normal.", "Laboratory tests, including routine blood tests, blood biochemistry, vitamin B12, thyroid hormone, rheumatoid factor, antinuclear autoantibody, anti-cardiolipin antibody, and anti-neutrophil cytoplasmic antibody tests, were normal.", "Tests of the blood and cerebrospinal fluid samples for anti-paraneoplastic antibodies, autoimmune antibodies, and anti-ganglioside antibodies were all normal.", "Brain MRI revealed mild, asymmetrical, non-enhancing white matter lesions, mainly in the right frontal and posterior periventricular regions, on T2-weighted imaging.", "No abnormal signal was found in the spinal cord on MRI.", "Chest CT was normal except for a residual thymus gland.", "FDG-PET was performed, and no abnormal metabolism was identified.", "EEG was normal.", "EMG recorded from the right gastrocnemius revealed a 6\u20138 Hz tremor.", "The tremor was present when the patient was standing and disappeared when he was resting or walking.", "No abnormalities were found in the left leg.", "These features were consistent with slow orthostatic tremor.", "Blood tests showed a phenylalanine/tyrosine ratio of 2.06.", "Blood phenylalanine level was 140 \u03bcmol/L.", "There was no phenylalanine in the urine.", "Whole-exome sequencing with NGS technology confirmed the presence of a compound heterozygous mutation in c.158G > A and c.728G > A of the PAH gene.", "Pedigree verification showed that the compound heterozygous variants were inherited from the parents.", "The patient\u2019s final diagnosis was orthostatic tremor secondary to mild hyperphenylalaninemia.", "The patient had not received any relevant interventions prior to admission.", "Clonazepam (1 mg, qd) was tried.", "Carbamazepine (100 mg, qd) was tried.", "Trihexyphenidyl (2 mg, tid) was tried.", "There was no clinical response to these treatments.", "After discharge, the patient was treated with levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet.", "One month later, the tremor was markedly alleviated.", "Three months later, the tremor disappeared."], "summary_subclaims": ["The patient is a 22-year-old male.", "The patient was admitted for bilateral leg tremor while standing.", "Symptom onset was eight months prior to admission.", "One month before admission, the tremor disappeared in the left leg.", "The tremor persisted in the right leg.", "Electromyography recorded from the right gastrocnemius revealed a 6-8\u00a0Hz tremor.", "The tremor appeared when the patient was standing.", "The tremor disappeared when the patient was resting or walking.", "Blood screening showed a phenylalanine/tyrosine ratio of 2.06.", "Blood screening showed a phenylalanine level of 140\u00a0\u03bcmol/L.", "Urine metabolic screening was negative.", "Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G\u2009>\u2009A and c.728G\u2009>\u2009A, in the phenylalanine hydroxylase (PAH) gene.", "After three months of levodopa/benserazide tablets (250\u00a0mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 22-year-old man.", "He had leg tremor in standing position for the previous 8 months.", "The tremor was initially bilateral.", "Seven months after development, the tremor subsided in the left leg.", "The tremor persisted only in the right leg.", "No tremor was evident when the patient was walking, reclining, or in a non-weight-bearing position.", "He denied any falls.", "He had no unsteadiness.", "There were no other complaints.", "The patient had no significant medical history.", "The patient had no family history of tremor.", "On examination, he showed incessant quivering in his right leg while standing.", "The tremor disappeared when he was asked to walk, sit, lie down, or lean against the wall for support.", "There was no resting or postural tremor of upper limbs.", "Bilateral tendon reflexes were diminished.", "There was no plantar response.", "Auscultation over the right popliteal fossa while the patient was standing revealed the 'helicopter sign'.", "The 'helicopter sign' indicated orthostatic tremor.", "All other components of neurological examination were normal.", "Laboratory tests, including routine blood tests, blood biochemistry, vitamin B12, thyroid hormone, rheumatoid factor, antinuclear autoantibody, anti-cardiolipin antibody, and anti-neutrophil cytoplasmic antibody tests, were normal.", "Tests of the blood and cerebrospinal fluid samples for anti-paraneoplastic antibodies, autoimmune antibodies, and anti-ganglioside antibodies were all normal.", "Brain MRI revealed mild, asymmetrical, non-enhancing white matter lesions, mainly in the right frontal and posterior periventricular regions, on T2-weighted imaging.", "No abnormal signal was found in the spinal cord on MRI.", "Chest CT was normal except for a residual thymus gland.", "FDG-PET was performed, and no abnormal metabolism was identified.", "EEG was normal.", "EMG recorded from the right gastrocnemius revealed a 6\u20138 Hz tremor.", "The tremor was present when the patient was standing and disappeared when he was resting or walking.", "No abnormalities were found in the left leg.", "These features were consistent with slow orthostatic tremor.", "Blood tests showed a phenylalanine/tyrosine ratio of 2.06.", "Blood phenylalanine level was 140 \u03bcmol/L.", "There was no phenylalanine in the urine.", "Whole-exome sequencing with NGS technology confirmed the presence of a compound heterozygous mutation in c.158G > A and c.728G > A of the PAH gene.", "Pedigree verification showed that the compound heterozygous variants were inherited from the parents.", "The patient\u2019s final diagnosis was orthostatic tremor secondary to mild hyperphenylalaninemia.", "The patient had not received any relevant interventions prior to admission.", "Clonazepam (1 mg, qd) was tried.", "Carbamazepine (100 mg, qd) was tried.", "Trihexyphenidyl (2 mg, tid) was tried.", "There was no clinical response to these treatments.", "After discharge, the patient was treated with levodopa/benserazide tablets (250 mg, tid) and a low-phenylalanine diet.", "One month later, the tremor was markedly alleviated.", "Three months later, the tremor disappeared."], "index": 115, "original_id": "multiclinsum_test_1859_en.txt", "split": "test", "summary_subclaims": ["The patient is a 22-year-old male.", "The patient was admitted for bilateral leg tremor while standing.", "Symptom onset was eight months prior to admission.", "One month before admission, the tremor disappeared in the left leg.", "The tremor persisted in the right leg.", "Electromyography recorded from the right gastrocnemius revealed a 6-8\u00a0Hz tremor.", "The tremor appeared when the patient was standing.", "The tremor disappeared when the patient was resting or walking.", "Blood screening showed a phenylalanine/tyrosine ratio of 2.06.", "Blood screening showed a phenylalanine level of 140\u00a0\u03bcmol/L.", "Urine metabolic screening was negative.", "Whole-exome sequencing confirmed the presence of a compound heterozygous mutation, c.158G\u2009>\u2009A and c.728G\u2009>\u2009A, in the phenylalanine hydroxylase (PAH) gene.", "After three months of levodopa/benserazide tablets (250\u00a0mg, tid) and a low-phenylalanine diet treatment, the tremor disappeared."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 30-year-old woman.", "She is Caucasian.", "She presented with complaints of COVID-19.", "She developed symptoms after her husband returned from international travel.", "She initially had symptoms of an upper respiratory tract infection.", "She had nasal congestion.", "She had cough.", "She had fatigue.", "She had shortness of breath on ambulation.", "Ten days after her initial symptoms, she developed an urticarial rash on her abdomen, legs, and hands.", "The rash was transient.", "The rash reappeared twice before disappearing.", "The rash only lasted hours on each occasion.", "The patient has no past medical history.", "She takes no medications.", "She does not drink alcohol.", "She does not smoke cigarettes.", "She does not use drugs.", "She is married.", "She lives at home with her husband.", "She works as a wedding planner.", "She has no children.", "She has never been pregnant.", "She complained of tongue swelling on the tenth day after developing COVID-19.", "The swelling went away after 1 hour on its own.", "She then developed geographic tongue.", "Her tongue had the appearance of tongue papillae that were inflamed.", "Some papillae were flattened.", "Her tongue had a sensation of sensitivity in the areas interspersed between areas of regular mucosa.", "She had some mild loss of sense of taste.", "In the office, her blood pressure was 117/71 mmHg.", "Her heart rate was 90 beats per minute.", "Her temperature was 98.4 \u00b0F.", "Her respirations were 14 per minute.", "Her pulse oximetry was 100% on room air.", "On further examination, she had a geographic appearance to the tongue.", "Her abdomen and extremities showed no signs of rash at the time of the clinical examination.", "Her neurological examination showed intact motor and sensory strength.", "Her white blood cell count was 4100/\u03bcL.", "Her hemoglobin was 13.8 gm/dL.", "Her platelets were 248,000/\u03bcL.", "Her creatinine level was 0.79 mg/dL.", "Her aspartate transaminase level was 18 U/L.", "Her alanine transaminase level was 17 U/L.", "Her vitamin B12 level was 468 pg/mL.", "Her serum folate was 10.3 ng/mL.", "She was diagnosed as having COVID tongue.", "She was started on a mouthwash containing diphenhydramine-lidocaine-aluminum-magnesium-simethicone-nystatin.", "She was to swish and swallow 5 mL every 6 hours.", "She subsequently completed 30 days of the mouthwash.", "She achieved 90% improvement in the appearance of the geographic tongue.", "Over the next 6 months, she had multiple flares of tongue sensitivity.", "She had visually active tongue lesions about every 3 weeks.", "She was prescribed dexamethasone 0.5mg/5mL to be swished and spit four times daily for 10 days.", "She did not achieve complete resolution of her tongue lesions.", "Six months after developing COVID tongue, she underwent three treatments of photobiomodulation therapy (PBMT) to her tongue.", "There was an interval of 24 hours between each session.", "At a follow-up 2 months after the PBMT, she had no further flares.", "Her tongue lesions were healing.", "Her systemic rash never returned.", "She subsequently did well."], "summary_subclaims": ["The patient is a 30-year-old Caucasian woman.", "She tested positive for COVID-19 after developing nasal congestion and cough.", "Ten days after testing positive, she developed a systemic rash on her extremities and torso.", "She developed swelling of the tongue lasting 1 hour.", "She had oral lesions that resembled geographic tongue.", "She had an irritable sensation on her tongue.", "She had some mild loss of sense of taste.", "We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours.", "The patient used the mouth rinse therapy for 1 month.", "She experienced a 90% improvement in her oral lesions and tongue sensitivity.", "She had repeated flares every 3 weeks over a 6-month period.", "The steroid mouthwash achieved incomplete resolution.", "After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity.", "After three sessions of photobiomodulation therapy, the lesions healed."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 30-year-old woman.", "She is Caucasian.", "She presented with complaints of COVID-19.", "She developed symptoms after her husband returned from international travel.", "She initially had symptoms of an upper respiratory tract infection.", "She had nasal congestion.", "She had cough.", "She had fatigue.", "She had shortness of breath on ambulation.", "Ten days after her initial symptoms, she developed an urticarial rash on her abdomen, legs, and hands.", "The rash was transient.", "The rash reappeared twice before disappearing.", "The rash only lasted hours on each occasion.", "The patient has no past medical history.", "She takes no medications.", "She does not drink alcohol.", "She does not smoke cigarettes.", "She does not use drugs.", "She is married.", "She lives at home with her husband.", "She works as a wedding planner.", "She has no children.", "She has never been pregnant.", "She complained of tongue swelling on the tenth day after developing COVID-19.", "The swelling went away after 1 hour on its own.", "She then developed geographic tongue.", "Her tongue had the appearance of tongue papillae that were inflamed.", "Some papillae were flattened.", "Her tongue had a sensation of sensitivity in the areas interspersed between areas of regular mucosa.", "She had some mild loss of sense of taste.", "In the office, her blood pressure was 117/71 mmHg.", "Her heart rate was 90 beats per minute.", "Her temperature was 98.4 \u00b0F.", "Her respirations were 14 per minute.", "Her pulse oximetry was 100% on room air.", "On further examination, she had a geographic appearance to the tongue.", "Her abdomen and extremities showed no signs of rash at the time of the clinical examination.", "Her neurological examination showed intact motor and sensory strength.", "Her white blood cell count was 4100/\u03bcL.", "Her hemoglobin was 13.8 gm/dL.", "Her platelets were 248,000/\u03bcL.", "Her creatinine level was 0.79 mg/dL.", "Her aspartate transaminase level was 18 U/L.", "Her alanine transaminase level was 17 U/L.", "Her vitamin B12 level was 468 pg/mL.", "Her serum folate was 10.3 ng/mL.", "She was diagnosed as having COVID tongue.", "She was started on a mouthwash containing diphenhydramine-lidocaine-aluminum-magnesium-simethicone-nystatin.", "She was to swish and swallow 5 mL every 6 hours.", "She subsequently completed 30 days of the mouthwash.", "She achieved 90% improvement in the appearance of the geographic tongue.", "Over the next 6 months, she had multiple flares of tongue sensitivity.", "She had visually active tongue lesions about every 3 weeks.", "She was prescribed dexamethasone 0.5mg/5mL to be swished and spit four times daily for 10 days.", "She did not achieve complete resolution of her tongue lesions.", "Six months after developing COVID tongue, she underwent three treatments of photobiomodulation therapy (PBMT) to her tongue.", "There was an interval of 24 hours between each session.", "At a follow-up 2 months after the PBMT, she had no further flares.", "Her tongue lesions were healing.", "Her systemic rash never returned.", "She subsequently did well."], "index": 119, "original_id": "multiclinsum_test_778_en.txt", "split": "test", "summary_subclaims": ["The patient is a 30-year-old Caucasian woman.", "She tested positive for COVID-19 after developing nasal congestion and cough.", "Ten days after testing positive, she developed a systemic rash on her extremities and torso.", "She developed swelling of the tongue lasting 1 hour.", "She had oral lesions that resembled geographic tongue.", "She had an irritable sensation on her tongue.", "She had some mild loss of sense of taste.", "We opted for conservative therapy, including mouth rinses containing lidocaine to be used every 6 hours.", "The patient used the mouth rinse therapy for 1 month.", "She experienced a 90% improvement in her oral lesions and tongue sensitivity.", "She had repeated flares every 3 weeks over a 6-month period.", "The steroid mouthwash achieved incomplete resolution.", "After three sessions of photobiomodulation therapy, she had no further flares or tongue sensitivity.", "After three sessions of photobiomodulation therapy, the lesions healed."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 28-month-old girl.", "She was admitted due to repeated hematochezia for more than 3 months.", "She experienced hematochezia at the age of 25 months.", "The hematochezia was with small to moderate amounts of dark red or bright red paste-like stool.", "She had abdominal pain mainly around the umbilical area.", "The abdominal pain had no obvious relationship with eating.", "The abdominal pain was not accompanied by vomiting.", "The abdominal pain was not accompanied by diarrhea.", "The abdominal pain was not accompanied by fever.", "The abdominal pain was not accompanied by cough.", "Routine stool analysis showed red and white blood cells.", "The pathological culture was negative.", "The white blood cell count was 16.3 \u00d7 109/L.", "The hemoglobin concentration was 123 g/L.", "Abdominal ultrasound showed active intestinal peristalsis.", "Abdominal ultrasound showed multiple hypoechoic nodules around the umbilical area.", "Abdominal ultrasound showed enlarged mesenteric lymph nodes.", "Bacterial enteritis was suspected.", "The patient was treated with anti-infection and hemostatic drugs.", "The patient was fed with deeply hydrolyzed formula.", "The deeply hydrolyzed formula yielded poor therapeutic effects.", "The patient was transferred to our hospital.", "The patient was born to a healthy and non-consanguineous Chinese couple.", "The patient was delivered naturally.", "The patient was generally in good condition after delivery.", "The patient previously underwent a cervical lymph node abscess biopsy.", "No abnormalities in growth and development were observed.", "A small rash was observed on the neck.", "The white blood cell count was 11.70 \u00d7 109/L.", "The hemoglobin was 110 g/L.", "The platelet count was 38 \u00d7 109/L.", "The neutrophil percentage was 31%.", "The immunoglobulin G (IgG) was 16.7 g/L.", "The immunoglobulin M (IgM) was 1.66 g/L.", "The immunoglobulin E (IgE) was 74 IU/ML.", "The absolute count of B cells was 1688.52 cells/ul.", "The absolute count of T cells was 4833.95 cells/ul.", "The absolute count of NK cells was 877.12 cells/ul.", "The antiprotease 3 antibody (ELISA) was 64.5.", "The food allergen IgE for milk was 1.59 IU/ml.", "C-reactive protein, procalcitonin, blood gas analysis, biochemical indexes, coagulation index, autoimmune antibody, rheumatoid factor, and T-SPOT.TB test yielded no abnormal findings.", "No abnormality was found on chest and abdominal radiographs.", "An initial diagnosis of cow milk protein allergy and congenital immunodeficiency disease was established.", "A gastroscopy indicated erosive gastritis and erosive bulbar duodenitis.", "The histopathological results showed mild chronic inflammation.", "A colonoscopy indicated erosive colitis.", "The mucosa presented mild chronic inflammation.", "A large number of lymphocytes and eosinophils infiltrated in lamina propria.", "The maximum number of lymphocytes and eosinophils per high power field was 85.", "Crypt abscesses were found in the ascending and transverse colon.", "The DHR assay of the patient\u2019s granulocytes revealed almost absence of fluorescence upon granulocyte stimulation.", "The stimulation index (SI) was 5.82.", "The DHR assay of granulocytes from the patient\u2019s mother showed a SI of 277.05.", "The DHR assay of granulocytes from the patient\u2019s father showed a SI of 364.03.", "A heterozygous de novo mutation c.388 C > T (p.R130X) in CYBB gene was identified.", "The mutation was validated by Sanger sequencing.", "A diagnosis of very early onset inflammatory bowel disease (VEO-IBD) with neutrophil dysfunction caused by CYBB gene mutation was established.", "Hematopoietic stem cell transplantation (HSCT) was conducted using peripheral blood stem cells from the father.", "Mycophenolate Mofetil combined with Tacrolimus Capsules were used to prevent graft-versus-host disease (GVHD).", "Voriconazole was used against fungal infections.", "Two months after HSCT, bone marrow and peripheral blood chimerism rates were 100% complete donor type.", "The DHR assay of granulocytes from the patient at 8 weeks after HSCT showed abnormal histogram with the SI of 28.85.", "The DHR assay of granulocytes from the patient at 16 weeks after HSCT showed normal histogram with the SI of 408.90.", "Normal neutrophil function was restored.", "A repeat colonoscopy six months after HSCT showed complete intestinal mucosal healing.", "After 18 months of follow-up, there was no severe infection.", "After 18 months of follow-up, there was no acute or chronic GVHD-related manifestations."], "summary_subclaims": ["The patient is a 2-year-old girl.", "The patient had VEO-IBD associated with a monogenic mutation.", "The patient presented with gastrointestinal symptoms.", "The gastrointestinal symptoms included recurrent hematochezia.", "The gastrointestinal symptoms included abdominal pain.", "The symptoms had been present for more than 3 months.", "A gastroscopy revealed erosive gastritis.", "A gastroscopy revealed bulbar duodenitis.", "A colonoscopy indicated erosive colitis.", "Abnormal results were obtained from the dihydrohodamine (DHR) assay.", "Abnormal results were obtained from immunoglobulin testing.", "Whole-exome sequencing identified a heterozygous and de novo nonsense mutation (c.388\u00a0C\u2009>\u2009T; p.R130X) in the CYBB gene.", "The mutation led to deficiency of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2).", "NOX2 is encoded by CYBB.", "NOX2 is a critical component of phagocytes.", "HSCT was performed successfully.", "The DHR assay showed that normal neutrophil function was restored.", "Six months after HSCT, clinical remission was observed.", "A repeat colonoscopy revealed intestinal mucosal healing was attained."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 28-month-old girl.", "She was admitted due to repeated hematochezia for more than 3 months.", "She experienced hematochezia at the age of 25 months.", "The hematochezia was with small to moderate amounts of dark red or bright red paste-like stool.", "She had abdominal pain mainly around the umbilical area.", "The abdominal pain had no obvious relationship with eating.", "The abdominal pain was not accompanied by vomiting.", "The abdominal pain was not accompanied by diarrhea.", "The abdominal pain was not accompanied by fever.", "The abdominal pain was not accompanied by cough.", "Routine stool analysis showed red and white blood cells.", "The pathological culture was negative.", "The white blood cell count was 16.3 \u00d7 109/L.", "The hemoglobin concentration was 123 g/L.", "Abdominal ultrasound showed active intestinal peristalsis.", "Abdominal ultrasound showed multiple hypoechoic nodules around the umbilical area.", "Abdominal ultrasound showed enlarged mesenteric lymph nodes.", "Bacterial enteritis was suspected.", "The patient was treated with anti-infection and hemostatic drugs.", "The patient was fed with deeply hydrolyzed formula.", "The deeply hydrolyzed formula yielded poor therapeutic effects.", "The patient was transferred to our hospital.", "The patient was born to a healthy and non-consanguineous Chinese couple.", "The patient was delivered naturally.", "The patient was generally in good condition after delivery.", "The patient previously underwent a cervical lymph node abscess biopsy.", "No abnormalities in growth and development were observed.", "A small rash was observed on the neck.", "The white blood cell count was 11.70 \u00d7 109/L.", "The hemoglobin was 110 g/L.", "The platelet count was 38 \u00d7 109/L.", "The neutrophil percentage was 31%.", "The immunoglobulin G (IgG) was 16.7 g/L.", "The immunoglobulin M (IgM) was 1.66 g/L.", "The immunoglobulin E (IgE) was 74 IU/ML.", "The absolute count of B cells was 1688.52 cells/ul.", "The absolute count of T cells was 4833.95 cells/ul.", "The absolute count of NK cells was 877.12 cells/ul.", "The antiprotease 3 antibody (ELISA) was 64.5.", "The food allergen IgE for milk was 1.59 IU/ml.", "C-reactive protein, procalcitonin, blood gas analysis, biochemical indexes, coagulation index, autoimmune antibody, rheumatoid factor, and T-SPOT.TB test yielded no abnormal findings.", "No abnormality was found on chest and abdominal radiographs.", "An initial diagnosis of cow milk protein allergy and congenital immunodeficiency disease was established.", "A gastroscopy indicated erosive gastritis and erosive bulbar duodenitis.", "The histopathological results showed mild chronic inflammation.", "A colonoscopy indicated erosive colitis.", "The mucosa presented mild chronic inflammation.", "A large number of lymphocytes and eosinophils infiltrated in lamina propria.", "The maximum number of lymphocytes and eosinophils per high power field was 85.", "Crypt abscesses were found in the ascending and transverse colon.", "The DHR assay of the patient\u2019s granulocytes revealed almost absence of fluorescence upon granulocyte stimulation.", "The stimulation index (SI) was 5.82.", "The DHR assay of granulocytes from the patient\u2019s mother showed a SI of 277.05.", "The DHR assay of granulocytes from the patient\u2019s father showed a SI of 364.03.", "A heterozygous de novo mutation c.388 C > T (p.R130X) in CYBB gene was identified.", "The mutation was validated by Sanger sequencing.", "A diagnosis of very early onset inflammatory bowel disease (VEO-IBD) with neutrophil dysfunction caused by CYBB gene mutation was established.", "Hematopoietic stem cell transplantation (HSCT) was conducted using peripheral blood stem cells from the father.", "Mycophenolate Mofetil combined with Tacrolimus Capsules were used to prevent graft-versus-host disease (GVHD).", "Voriconazole was used against fungal infections.", "Two months after HSCT, bone marrow and peripheral blood chimerism rates were 100% complete donor type.", "The DHR assay of granulocytes from the patient at 8 weeks after HSCT showed abnormal histogram with the SI of 28.85.", "The DHR assay of granulocytes from the patient at 16 weeks after HSCT showed normal histogram with the SI of 408.90.", "Normal neutrophil function was restored.", "A repeat colonoscopy six months after HSCT showed complete intestinal mucosal healing.", "After 18 months of follow-up, there was no severe infection.", "After 18 months of follow-up, there was no acute or chronic GVHD-related manifestations."], "index": 121, "original_id": "multiclinsum_test_533_en.txt", "split": "test", "summary_subclaims": ["The patient is a 2-year-old girl.", "The patient had VEO-IBD associated with a monogenic mutation.", "The patient presented with gastrointestinal symptoms.", "The gastrointestinal symptoms included recurrent hematochezia.", "The gastrointestinal symptoms included abdominal pain.", "The symptoms had been present for more than 3 months.", "A gastroscopy revealed erosive gastritis.", "A gastroscopy revealed bulbar duodenitis.", "A colonoscopy indicated erosive colitis.", "Abnormal results were obtained from the dihydrohodamine (DHR) assay.", "Abnormal results were obtained from immunoglobulin testing.", "Whole-exome sequencing identified a heterozygous and de novo nonsense mutation (c.388\u00a0C\u2009>\u2009T; p.R130X) in the CYBB gene.", "The mutation led to deficiency of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 2 (NOX2).", "NOX2 is encoded by CYBB.", "NOX2 is a critical component of phagocytes.", "HSCT was performed successfully.", "The DHR assay showed that normal neutrophil function was restored.", "Six months after HSCT, clinical remission was observed.", "A repeat colonoscopy revealed intestinal mucosal healing was attained."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 32-year-old female.", "The patient has non-diabetic chronic kidney disease.", "The patient was on regular hemodialysis for 3 years.", "The patient's hemodialysis access was a right forearm arteriovenous fistula.", "The patient was admitted due to involuntary movement for 5 days.", "The patient had a resting tremor in the shoulder and neck 5 days prior to admission.", "The patient's vital signs were stable.", "The patient did not have a headache.", "The patient did not have fever.", "The patient did not have blurred vision.", "The patient did not have mental disorder.", "Myodynamic examination in both legs was normal.", "Deep tendon reflexes in both legs were normal.", "The Babinski reflexes were suspiciously positive.", "The patient had significant fluctuation of blood creatinine levels.", "The patient had altered hyperthyroidism.", "The patient's intact parathyroid hormone (iPTH) levels were almost 3200 pg/mL.", "The patient did not have a history of hypertension.", "The patient did not have diabetes mellitus.", "The patient did not have a respiratory tract infection.", "The patient did not have fever.", "The patient did not have stroke.", "The patient did not have liver disease.", "The patient did not have hypoxia.", "The patient did not have toxic fume exposure.", "Brain MRI showed symmetrical T2-weighted imaging hyperintense non-hemorrhagic lesions in bilateral basal ganglia.", "Brain MRI showed T2/fluid-attenuated inversion recovery hyperintense lesions in bilateral basal ganglia.", "Brain MRI showed corona radiata lesions with mild diffusion restriction.", "T1-weighted imaging was normal.", "Diffusion-weighted images were normal.", "Blood analysis showed urea nitrogen 25.80 mmol/L.", "Blood analysis showed serum creatinine 1206 \u03bcmol/L.", "Blood analysis showed uric acid 548 \u03bcmol/L.", "Blood analysis showed phosphorus 1.88 mmol/L.", "Blood analysis showed calcium 2.33 mmol/L.", "Blood analysis showed anion gap 23.9 mmol/L.", "Blood analysis showed iPTH 2487 pg/mL.", "The patient was diagnosed with UE as a symptom of bilateral basal ganglia lesions.", "The patient did not suffer from diabetes mellitus.", "The patient did not suffer from cerebrovascular events.", "The patient did not suffer from intoxication.", "The patient did not suffer from hyperlactacidemia.", "UE was possibly due to a combined effect of uremic toxins and hyperthyroidism.", "The patient was treated with high frequency and high flux dialysis.", "The patient received 4 h hemodiafiltration with APS 15 uc dialyzer.", "The patient received hemodiafiltration 4 times per week.", "The patient received hyperbaric oxygen therapy.", "The patient received 1 \u03bcg of calcitriol injection every 2 days.", "The patient received 2 mg of haloperidol orally twice per day.", "The patient received 2 mg of clonazepam orally twice per day.", "The patient received 2 mg of benzhexol orally twice per day.", "The symptoms reduced in frequency.", "The amplitude of involuntary movement decreased.", "Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2WI.", "Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2FLAIR.", "The signal in the bilateral basal ganglia on T2WI was significantly weaker compared to the initial MRI signal.", "The signal in the bilateral basal ganglia on T2FLAIR was significantly weaker compared to the initial MRI signal.", "About 1 month after admission, the patient achieved complete remission.", "About 1 month after admission, the patient had restoration of normal body movement.", "Upon discharge, blood test results showed urea nitrogen 10.48 mmol/L.", "Upon discharge, blood test results showed serum creatinine 641.5 \u03bcmol/L.", "Upon discharge, blood test results showed uric acid 435 \u03bcmol/L.", "Upon discharge, blood test results showed phosphorus 1.43 mmol/L.", "Upon discharge, blood test results showed calcium 2.30 mmol/L.", "Upon discharge, blood test results showed anion gap 15.9 mmol/L.", "Upon discharge, blood test results showed iPTH 1609 pg/mL.", "Upon follow-up, brain MRI showed an almost complete resolution of the lesions.", "Upon follow-up, brain MRI showed slightly hyperintense signal in the bilateral basal ganglia."], "summary_subclaims": ["The patient is a 32\u2009year-old woman.", "She has a history of non-diabetic hemodialysis for 3\u2009years.", "She suffered from severe involuntary movement.", "Brain magnetic resonance imaging showed symmetrical T2-weighted imaging (T2WI) and T2/fluid-attenuated inversion recovery (T2FLAIR) hyperintense nonhemorrhagic lesions in the bilateral basal ganglia.", "She was diagnosed with UE as syndrome of bilateral basal ganglia lesions.", "The diagnosis was due to a combined effect of uremic toxins and hyperthyroidism.", "She received treatment with high frequency and high flux dialysis.", "She received hyperbaric oxygen therapy.", "She had declining parathyroid hormone.", "The patient achieved complete remission with normal body movement.", "The patient was discharged."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 32-year-old female.", "The patient has non-diabetic chronic kidney disease.", "The patient was on regular hemodialysis for 3 years.", "The patient's hemodialysis access was a right forearm arteriovenous fistula.", "The patient was admitted due to involuntary movement for 5 days.", "The patient had a resting tremor in the shoulder and neck 5 days prior to admission.", "The patient's vital signs were stable.", "The patient did not have a headache.", "The patient did not have fever.", "The patient did not have blurred vision.", "The patient did not have mental disorder.", "Myodynamic examination in both legs was normal.", "Deep tendon reflexes in both legs were normal.", "The Babinski reflexes were suspiciously positive.", "The patient had significant fluctuation of blood creatinine levels.", "The patient had altered hyperthyroidism.", "The patient's intact parathyroid hormone (iPTH) levels were almost 3200 pg/mL.", "The patient did not have a history of hypertension.", "The patient did not have diabetes mellitus.", "The patient did not have a respiratory tract infection.", "The patient did not have fever.", "The patient did not have stroke.", "The patient did not have liver disease.", "The patient did not have hypoxia.", "The patient did not have toxic fume exposure.", "Brain MRI showed symmetrical T2-weighted imaging hyperintense non-hemorrhagic lesions in bilateral basal ganglia.", "Brain MRI showed T2/fluid-attenuated inversion recovery hyperintense lesions in bilateral basal ganglia.", "Brain MRI showed corona radiata lesions with mild diffusion restriction.", "T1-weighted imaging was normal.", "Diffusion-weighted images were normal.", "Blood analysis showed urea nitrogen 25.80 mmol/L.", "Blood analysis showed serum creatinine 1206 \u03bcmol/L.", "Blood analysis showed uric acid 548 \u03bcmol/L.", "Blood analysis showed phosphorus 1.88 mmol/L.", "Blood analysis showed calcium 2.33 mmol/L.", "Blood analysis showed anion gap 23.9 mmol/L.", "Blood analysis showed iPTH 2487 pg/mL.", "The patient was diagnosed with UE as a symptom of bilateral basal ganglia lesions.", "The patient did not suffer from diabetes mellitus.", "The patient did not suffer from cerebrovascular events.", "The patient did not suffer from intoxication.", "The patient did not suffer from hyperlactacidemia.", "UE was possibly due to a combined effect of uremic toxins and hyperthyroidism.", "The patient was treated with high frequency and high flux dialysis.", "The patient received 4 h hemodiafiltration with APS 15 uc dialyzer.", "The patient received hemodiafiltration 4 times per week.", "The patient received hyperbaric oxygen therapy.", "The patient received 1 \u03bcg of calcitriol injection every 2 days.", "The patient received 2 mg of haloperidol orally twice per day.", "The patient received 2 mg of clonazepam orally twice per day.", "The patient received 2 mg of benzhexol orally twice per day.", "The symptoms reduced in frequency.", "The amplitude of involuntary movement decreased.", "Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2WI.", "Fourteen days after admission, brain MRI showed high signal in the bilateral basal ganglia on T2FLAIR.", "The signal in the bilateral basal ganglia on T2WI was significantly weaker compared to the initial MRI signal.", "The signal in the bilateral basal ganglia on T2FLAIR was significantly weaker compared to the initial MRI signal.", "About 1 month after admission, the patient achieved complete remission.", "About 1 month after admission, the patient had restoration of normal body movement.", "Upon discharge, blood test results showed urea nitrogen 10.48 mmol/L.", "Upon discharge, blood test results showed serum creatinine 641.5 \u03bcmol/L.", "Upon discharge, blood test results showed uric acid 435 \u03bcmol/L.", "Upon discharge, blood test results showed phosphorus 1.43 mmol/L.", "Upon discharge, blood test results showed calcium 2.30 mmol/L.", "Upon discharge, blood test results showed anion gap 15.9 mmol/L.", "Upon discharge, blood test results showed iPTH 1609 pg/mL.", "Upon follow-up, brain MRI showed an almost complete resolution of the lesions.", "Upon follow-up, brain MRI showed slightly hyperintense signal in the bilateral basal ganglia."], "index": 129, "original_id": "multiclinsum_test_168_en.txt", "split": "test", "summary_subclaims": ["The patient is a 32\u2009year-old woman.", "She has a history of non-diabetic hemodialysis for 3\u2009years.", "She suffered from severe involuntary movement.", "Brain magnetic resonance imaging showed symmetrical T2-weighted imaging (T2WI) and T2/fluid-attenuated inversion recovery (T2FLAIR) hyperintense nonhemorrhagic lesions in the bilateral basal ganglia.", "She was diagnosed with UE as syndrome of bilateral basal ganglia lesions.", "The diagnosis was due to a combined effect of uremic toxins and hyperthyroidism.", "She received treatment with high frequency and high flux dialysis.", "She received hyperbaric oxygen therapy.", "She had declining parathyroid hormone.", "The patient achieved complete remission with normal body movement.", "The patient was discharged."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was admitted to our hospital four days ago.", "The patient had been diagnosed with xerostomia and xerophthalmia over 20 years.", "Emission Computed Tomography (ECT) examination revealed decreased functions of bilateral parotid and submandibular glands.", "A chest CT three years ago showed scattered, various-sized and roundish radiolucencies, striped or hazy opacities in both lungs and multiple small nodules in the right lung.", "Another chest CT one year later revealed new patchy opacities in the right lung and lingual lobe.", "The patient was admitted to our hospital one year and 4 months later due to recurrent cough, expectoration and low fever.", "The chest CT revealed multiple cysts with multiple patchy and nodular opacities in both lungs.", "Results of antinuclear antibody profiles and vasculitis series were: SSA (RO-52) positive (+), SSA antibody positive (+), ESR 87 mm/hr.", "Immunoglobulins were: IgA 4.29 g/L, IgG 20.3 g/L and IgM 0.68 g/L.", "Blood gas analysis: pH 7.39, pCO2 39.5 mmHg, pO2 68.4 mmHg and SaO2 93.1%.", "Pathological report on (right lung biopsy): Chronic inflammation of lung tissue with diffuse distribution of lymphocytes in focal areas.", "Diagnosis: lymphoma could not be excluded.", "Preliminary clinical diagnosis: (1) Sjogren's syndrome, lymphocytic interstitial pneumonia first consideration; (2) malignant lymphoma to be excluded; (3) pulmonary infection.", "The patient received anti-inflammatory treatment and was discharged after symptoms were improved.", "After discharge, the patient continued to experience constant cough, expectoration and fever even after repeated anti-inflammatory treatments.", "A left lung biopsy was performed 4 months later during her inpatient treatment in another hospital.", "The pathological report indicated chronic suppurative inflammation with massive necrosis and cellulitis.", "The patient\u2019s chest enhancement CT after this admission displayed obviously more patchy and nodular foci in both lungs compared to previous CT images.", "Some of the lesions were surrounded with ground glass shadows.", "The diagnosis was: malignant tumor to be excluded.", "Auxiliary routine blood examinations showed white blood cell count 21.8 \u00d7 109/L and absolute neutrophil count 21.14 \u00d7 109/L.", "Pathological results from our hospital (right lung biopsy) and another hospital showed small areas of proliferating inflammatory fibrous tissue and small numbers of heterotypic cells within the necrotic tissue.", "Malignancy could not be excluded.", "Immunohistochemistry showed: CD20 (+), Ki-67 (high-value-added activity), BCL-6 (+), CD21 (+).", "Based on history and pathological results, the final diagnosis was Sjogren's syndrome, malignant transformation of LIP into diffuse large B-cell lymphoma.", "Subsequently, chemotherapy with a reduced-dose regimen of rituximab and Chop (R-miniCHOP) was administered eight times.", "Following treatment, PET/CT showed complete remission of lymphoma.", "The patient was at high risk of recurrence and is under active follow-up."], "summary_subclaims": ["The patient is a 64-year-old female.", "The patient has Sjogren's syndrome.", "The medical record was reviewed.", "Clinical and pathological data were obtained.", "Chest CT images were obtained.", "Literature related to the transformation was reviewed.", "There were no specific clinical manifestations of LIP and its transformation into malignant lymphoma in the patient.", "The chest CT mainly displayed multiple cystic foci.", "The chest CT showed multiple nodules in both lungs.", "The chest CT showed ground-glass shadows in both lungs."]}, "extra_info": {"fulltext_subclaims": ["The patient was admitted to our hospital four days ago.", "The patient had been diagnosed with xerostomia and xerophthalmia over 20 years.", "Emission Computed Tomography (ECT) examination revealed decreased functions of bilateral parotid and submandibular glands.", "A chest CT three years ago showed scattered, various-sized and roundish radiolucencies, striped or hazy opacities in both lungs and multiple small nodules in the right lung.", "Another chest CT one year later revealed new patchy opacities in the right lung and lingual lobe.", "The patient was admitted to our hospital one year and 4 months later due to recurrent cough, expectoration and low fever.", "The chest CT revealed multiple cysts with multiple patchy and nodular opacities in both lungs.", "Results of antinuclear antibody profiles and vasculitis series were: SSA (RO-52) positive (+), SSA antibody positive (+), ESR 87 mm/hr.", "Immunoglobulins were: IgA 4.29 g/L, IgG 20.3 g/L and IgM 0.68 g/L.", "Blood gas analysis: pH 7.39, pCO2 39.5 mmHg, pO2 68.4 mmHg and SaO2 93.1%.", "Pathological report on (right lung biopsy): Chronic inflammation of lung tissue with diffuse distribution of lymphocytes in focal areas.", "Diagnosis: lymphoma could not be excluded.", "Preliminary clinical diagnosis: (1) Sjogren's syndrome, lymphocytic interstitial pneumonia first consideration; (2) malignant lymphoma to be excluded; (3) pulmonary infection.", "The patient received anti-inflammatory treatment and was discharged after symptoms were improved.", "After discharge, the patient continued to experience constant cough, expectoration and fever even after repeated anti-inflammatory treatments.", "A left lung biopsy was performed 4 months later during her inpatient treatment in another hospital.", "The pathological report indicated chronic suppurative inflammation with massive necrosis and cellulitis.", "The patient\u2019s chest enhancement CT after this admission displayed obviously more patchy and nodular foci in both lungs compared to previous CT images.", "Some of the lesions were surrounded with ground glass shadows.", "The diagnosis was: malignant tumor to be excluded.", "Auxiliary routine blood examinations showed white blood cell count 21.8 \u00d7 109/L and absolute neutrophil count 21.14 \u00d7 109/L.", "Pathological results from our hospital (right lung biopsy) and another hospital showed small areas of proliferating inflammatory fibrous tissue and small numbers of heterotypic cells within the necrotic tissue.", "Malignancy could not be excluded.", "Immunohistochemistry showed: CD20 (+), Ki-67 (high-value-added activity), BCL-6 (+), CD21 (+).", "Based on history and pathological results, the final diagnosis was Sjogren's syndrome, malignant transformation of LIP into diffuse large B-cell lymphoma.", "Subsequently, chemotherapy with a reduced-dose regimen of rituximab and Chop (R-miniCHOP) was administered eight times.", "Following treatment, PET/CT showed complete remission of lymphoma.", "The patient was at high risk of recurrence and is under active follow-up."], "index": 131, "original_id": "multiclinsum_test_2470_en.txt", "split": "test", "summary_subclaims": ["The patient is a 64-year-old female.", "The patient has Sjogren's syndrome.", "The medical record was reviewed.", "Clinical and pathological data were obtained.", "Chest CT images were obtained.", "Literature related to the transformation was reviewed.", "There were no specific clinical manifestations of LIP and its transformation into malignant lymphoma in the patient.", "The chest CT mainly displayed multiple cystic foci.", "The chest CT showed multiple nodules in both lungs.", "The chest CT showed ground-glass shadows in both lungs."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 21-year-old man.", "He visited a clinic with a chief complaint of right inguinal pain.", "Abdominal ultrasonography revealed a huge intra-abdominal mass.", "He was referred to the hospital for further examination.", "He had a history of autism spectrum disorder.", "He had a history of bronchial asthma.", "The abdomen was mildly distended and soft.", "The tumor was not palpable.", "Laboratory examinations showed no abnormalities in blood count.", "Laboratory examinations showed no elevation of tumor markers.", "Abdominopelvic CT showed a huge mass with a maximum diameter of 34 cm.", "MRI revealed an intra-abdominal tumor 34 \u00d7 15 \u00d7 8 cm.", "The tumor appeared to be in contact with the gastric body.", "A contrast-enhanced examination could not be performed due to the history of bronchial asthma.", "Endoscopic ultrasonography showed a heterogeneous hypoechoic internal cavity.", "EUS-FNA was not performed, given the risk of seeding.", "No definitive diagnosis or organ of origin was confirmed preoperatively.", "Surgery was performed under suspicion of gastrointestinal stromal tumor.", "Surgery was performed under suspicion of desmoid tumor.", "Surgery was performed under suspicion of mesenteric tumor.", "Laparotomy was performed through upper and lower median incisions.", "Intraoperative findings showed a giant tumor covered with a capsule.", "The tumor extended from the pelvis to the diaphragm.", "The tumor showed firm adhesions to the stomach.", "The tumor showed firm adhesions to the transverse colon.", "The tumor showed firm adhesions to the diaphragm.", "The omentum was adherent to the tumor.", "The tumor was partially resected en bloc with portions of the stomach.", "The tumor was partially resected en bloc with portions of the transverse colon.", "The tumor was partially resected en bloc with portions of the diaphragm.", "Primary anastomosis of the colon was performed.", "The diaphragm was closed after tumor resection.", "The tumor appeared to have been completely excised without rupture of the capsule.", "The excised specimen measured 38 \u00d7 21 \u00d7 8 cm.", "The excised specimen weighed 6400 g.", "Pathological examination revealed atypical cells with spindle-shaped nuclei.", "Immunostaining showed negative results for c-kit.", "Immunostaining showed negative results for CD34.", "Immunostaining showed negative results for desmin.", "Immunostaining showed negative results for S-100.", "Immunostaining showed positive results for \u03b2-catenin.", "The diagnosis was confirmed as a desmoid tumor.", "Pathological results for the surgical margins were negative.", "Determining the primary site of tumor origin was difficult.", "The patient was discharged 17 days after surgery.", "A CT scan conducted 12 months after surgery showed a nodule 3.0 cm in diameter near the suture line of the gastric body.", "The nodule's size remained unchanged on a subsequent CT scan taken 9 months later."], "summary_subclaims": ["The patient was a 21-year-old man.", "He was referred to the hospital for treatment.", "He had right inguinal pain.", "Abdominal magnetic resonance imaging showed an intra-abdominal mass.", "The mass measured 34 \u00d7 15 \u00d7 8 cm.", "The mass showed partial signal hyperintensity on T2-weighted imaging.", "The mass showed hypointensity on T1-weighted imaging.", "The mass extended from the left abdominal cavity to the pelvic region.", "No definitive diagnosis was obtained preoperatively.", "Surgery was performed under suspicion of gastrointestinal stromal tumor or other significant disease.", "A mass was identified firmly adherent to the transverse colon.", "The mass was identified firmly adherent to the gastric wall.", "The mass was identified firmly adherent to the diaphragm.", "The transverse colon, gastric wall, and diaphragm were partially resected.", "The excised specimen measured 38 \u00d7 21 \u00d7 8 cm.", "The excised specimen weighed 6400 g.", "Macroscopically, the tumor showed a smooth surface.", "Macroscopically, the tumor showed a homogeneous interior.", "Pathological examination revealed atypical cells with spindle-shaped nuclei.", "Pathological examination revealed collagen fiber hyperplasia in the stroma.", "Immunostaining was negative for c-kit.", "Immunostaining was negative for CD34.", "Immunostaining was negative for desmin.", "Immunostaining was negative for S-100.", "Immunostaining was positive for \u03b2-catenin.", "The diagnosis was confirmed as desmoid tumor.", "Fifteen months after surgery, a local recurrence with a diameter of 3.0 cm was identified.", "The patient remains under careful follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 21-year-old man.", "He visited a clinic with a chief complaint of right inguinal pain.", "Abdominal ultrasonography revealed a huge intra-abdominal mass.", "He was referred to the hospital for further examination.", "He had a history of autism spectrum disorder.", "He had a history of bronchial asthma.", "The abdomen was mildly distended and soft.", "The tumor was not palpable.", "Laboratory examinations showed no abnormalities in blood count.", "Laboratory examinations showed no elevation of tumor markers.", "Abdominopelvic CT showed a huge mass with a maximum diameter of 34 cm.", "MRI revealed an intra-abdominal tumor 34 \u00d7 15 \u00d7 8 cm.", "The tumor appeared to be in contact with the gastric body.", "A contrast-enhanced examination could not be performed due to the history of bronchial asthma.", "Endoscopic ultrasonography showed a heterogeneous hypoechoic internal cavity.", "EUS-FNA was not performed, given the risk of seeding.", "No definitive diagnosis or organ of origin was confirmed preoperatively.", "Surgery was performed under suspicion of gastrointestinal stromal tumor.", "Surgery was performed under suspicion of desmoid tumor.", "Surgery was performed under suspicion of mesenteric tumor.", "Laparotomy was performed through upper and lower median incisions.", "Intraoperative findings showed a giant tumor covered with a capsule.", "The tumor extended from the pelvis to the diaphragm.", "The tumor showed firm adhesions to the stomach.", "The tumor showed firm adhesions to the transverse colon.", "The tumor showed firm adhesions to the diaphragm.", "The omentum was adherent to the tumor.", "The tumor was partially resected en bloc with portions of the stomach.", "The tumor was partially resected en bloc with portions of the transverse colon.", "The tumor was partially resected en bloc with portions of the diaphragm.", "Primary anastomosis of the colon was performed.", "The diaphragm was closed after tumor resection.", "The tumor appeared to have been completely excised without rupture of the capsule.", "The excised specimen measured 38 \u00d7 21 \u00d7 8 cm.", "The excised specimen weighed 6400 g.", "Pathological examination revealed atypical cells with spindle-shaped nuclei.", "Immunostaining showed negative results for c-kit.", "Immunostaining showed negative results for CD34.", "Immunostaining showed negative results for desmin.", "Immunostaining showed negative results for S-100.", "Immunostaining showed positive results for \u03b2-catenin.", "The diagnosis was confirmed as a desmoid tumor.", "Pathological results for the surgical margins were negative.", "Determining the primary site of tumor origin was difficult.", "The patient was discharged 17 days after surgery.", "A CT scan conducted 12 months after surgery showed a nodule 3.0 cm in diameter near the suture line of the gastric body.", "The nodule's size remained unchanged on a subsequent CT scan taken 9 months later."], "index": 112, "original_id": "multiclinsum_test_3373_en.txt", "split": "test", "summary_subclaims": ["The patient was a 21-year-old man.", "He was referred to the hospital for treatment.", "He had right inguinal pain.", "Abdominal magnetic resonance imaging showed an intra-abdominal mass.", "The mass measured 34 \u00d7 15 \u00d7 8 cm.", "The mass showed partial signal hyperintensity on T2-weighted imaging.", "The mass showed hypointensity on T1-weighted imaging.", "The mass extended from the left abdominal cavity to the pelvic region.", "No definitive diagnosis was obtained preoperatively.", "Surgery was performed under suspicion of gastrointestinal stromal tumor or other significant disease.", "A mass was identified firmly adherent to the transverse colon.", "The mass was identified firmly adherent to the gastric wall.", "The mass was identified firmly adherent to the diaphragm.", "The transverse colon, gastric wall, and diaphragm were partially resected.", "The excised specimen measured 38 \u00d7 21 \u00d7 8 cm.", "The excised specimen weighed 6400 g.", "Macroscopically, the tumor showed a smooth surface.", "Macroscopically, the tumor showed a homogeneous interior.", "Pathological examination revealed atypical cells with spindle-shaped nuclei.", "Pathological examination revealed collagen fiber hyperplasia in the stroma.", "Immunostaining was negative for c-kit.", "Immunostaining was negative for CD34.", "Immunostaining was negative for desmin.", "Immunostaining was negative for S-100.", "Immunostaining was positive for \u03b2-catenin.", "The diagnosis was confirmed as desmoid tumor.", "Fifteen months after surgery, a local recurrence with a diameter of 3.0 cm was identified.", "The patient remains under careful follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 5-year-old girl initially presented to our department due to worsening pain in the left proximal thigh.", "Osteosarcoma was suspected radiographically.", "Open biopsy revealed a high-grade conventional osteosarcoma.", "The tumor was initially staged as IIB (T2b N0 M0).", "Neoadjuvant chemotherapy was commenced in accordance with the NECO-95J protocol.", "After three cycles of neoadjuvant chemotherapy, the pain was alleviated.", "The extra-osseous mass was dramatically reduced.", "Limb-salvage surgery was planned.", "The tumor had already invaded the epiphyseal plate and epiphysis of the left distal femur at initial presentation.", "Osteo-articular resection was thought necessary so as to obtain a negative surgical margin.", "At 6 years and 2 months old, distal femoral resection and temporary spacer insertion was performed.", "Both medial and lateral meniscuses were preserved.", "The spacer was hand-made, using an intramedullary nail of 7 mm in diameter and molded polymethylmethacrylate (PMMA).", "Because there were no commercially available molds fitting the distal femur of such a young child, we made the spacer by hand, imitating the original distal femur of the patient that had been just removed.", "After surgery, the left leg was externally fixed in a cast for 4 weeks.", "Partial weight bearing on the affected leg, supported by a hinged knee brace, was thereafter commenced.", "The spacer was dislocated at 7 months post-operatively.", "The spacer dislocation prevented the patient from bearing weight.", "Bone atrophy in the left leg was observed.", "At 7 years and 8 months old, secondary surgery was performed with the aim of enabling weight bearing on the affected leg.", "A custom-made ceramic spacer (Kyocera Corp., Japan) with a smooth straight stem of 8 mm in diameter had been ordered 3 months prior to the surgery.", "Intra-operatively, after the removal of the initial spacer, a 1-cm length of the distal edge of the residual femur was removed.", "The periosteum and reactive membrane around the molded PMMA was preserved.", "The junction between the residual femur and the ceramic spacer was fixed with PMMA.", "The junction was covered with the preserved periosteum and membrane.", "After surgery, the left leg was placed in a cast for 4 weeks.", "The patient re-started partial weight bearing using a hinged knee brace as with the first spacer.", "The bone atrophy in the left leg was gradually resolved.", "At 18 months after the second surgery, the cortexes of the femur and tibia had thickened sufficiently for expandable mega-prosthesis.", "Loosening of the stem and varus deformity was observed.", "A third surgical intervention was, therefore, planned.", "At 9 years and 7 months old, the second spacer was removed, and the knee joint was reconstructed using a custom-made growing femoral prosthesis (Stryker Corp., Germany) with a curved porous stem of 8.5 mm in diameter fixed to the residual femur with two screws.", "Intra-operatively, the PMMA around the junction was already loosened, and the stem was easily removed.", "The residual femur was carefully reamed, and the stem was inserted.", "Cancellous bone chips from the proximal tibial epiphysis were grafted around the bone-prosthesis junction and then wrapped with the preserved periosteum and pseudo-periosteum membrane.", "The proximal surface of the tibia was also replaced, but the growth plate was preserved.", "Immediately after surgery, range of motion (ROM) exercise was started.", "Six weeks after surgery, partial weight bearing was permitted.", "Ten months after the third surgery, the patient was able to walk unsupported.", "A radiograph showed further thickening of the cortex of the residual femur.", "At 10 years and 7 months old, the growing femoral prosthesis was extended by 1.1 cm.", "At the latest follow-up, at 11 years and 1 month old, the patient was 143 cm in height with a limb length discrepancy (LLD) of 5 cm.", "The patient was able to walk unsupported using a 2.5 cm shoe lift.", "The Musculoskeletal Tumor Society (MSTS) score was 24 out of 30 points.", "The muscle strength of quadriceps recovered to manual muscle test (MMT) level 3.", "Active straight leg raising became possible without extension lag.", "The ROM of the left knee was 0\u201390\u00b0.", "The patient was receiving a second extension of growing femoral prosthesis."], "summary_subclaims": ["The patient is a 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur.", "The patient underwent three cycles of neoadjuvant chemotherapy.", "Limb-salvage surgery was planned because femoral rotationplasty had been refused.", "At 6\u2009years and 2\u2009months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed.", "At 7\u2009years and 8\u2009months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic.", "The distal end of the residual femur was removed by 1\u2009cm.", "The periosteum and induced membrane around polymethylmethacrylate was preserved.", "A custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized.", "The bone-spacer junction was fixed with polymethylmethacrylate.", "The bone-spacer junction was covered with the preserved periosteum and induced membrane.", "After surgery, the bone atrophy improved.", "At 9\u2009years and 7\u2009months old, the second spacer was removed because it had loosened.", "The knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem.", "Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane.", "At 10\u2009years and 5\u2009months old, the patient was able to walk unsupported.", "A radiograph showed further thickening of the cortex of the residual femur without any stress shielding.", "The patient had 5\u2009cm of limb length discrepancy.", "The patient and her mother were satisfied with the function.", "The MSTS score was 24 out of 30 points.", "Repeated limb length extensions are planned."]}, "extra_info": {"fulltext_subclaims": ["A 5-year-old girl initially presented to our department due to worsening pain in the left proximal thigh.", "Osteosarcoma was suspected radiographically.", "Open biopsy revealed a high-grade conventional osteosarcoma.", "The tumor was initially staged as IIB (T2b N0 M0).", "Neoadjuvant chemotherapy was commenced in accordance with the NECO-95J protocol.", "After three cycles of neoadjuvant chemotherapy, the pain was alleviated.", "The extra-osseous mass was dramatically reduced.", "Limb-salvage surgery was planned.", "The tumor had already invaded the epiphyseal plate and epiphysis of the left distal femur at initial presentation.", "Osteo-articular resection was thought necessary so as to obtain a negative surgical margin.", "At 6 years and 2 months old, distal femoral resection and temporary spacer insertion was performed.", "Both medial and lateral meniscuses were preserved.", "The spacer was hand-made, using an intramedullary nail of 7 mm in diameter and molded polymethylmethacrylate (PMMA).", "Because there were no commercially available molds fitting the distal femur of such a young child, we made the spacer by hand, imitating the original distal femur of the patient that had been just removed.", "After surgery, the left leg was externally fixed in a cast for 4 weeks.", "Partial weight bearing on the affected leg, supported by a hinged knee brace, was thereafter commenced.", "The spacer was dislocated at 7 months post-operatively.", "The spacer dislocation prevented the patient from bearing weight.", "Bone atrophy in the left leg was observed.", "At 7 years and 8 months old, secondary surgery was performed with the aim of enabling weight bearing on the affected leg.", "A custom-made ceramic spacer (Kyocera Corp., Japan) with a smooth straight stem of 8 mm in diameter had been ordered 3 months prior to the surgery.", "Intra-operatively, after the removal of the initial spacer, a 1-cm length of the distal edge of the residual femur was removed.", "The periosteum and reactive membrane around the molded PMMA was preserved.", "The junction between the residual femur and the ceramic spacer was fixed with PMMA.", "The junction was covered with the preserved periosteum and membrane.", "After surgery, the left leg was placed in a cast for 4 weeks.", "The patient re-started partial weight bearing using a hinged knee brace as with the first spacer.", "The bone atrophy in the left leg was gradually resolved.", "At 18 months after the second surgery, the cortexes of the femur and tibia had thickened sufficiently for expandable mega-prosthesis.", "Loosening of the stem and varus deformity was observed.", "A third surgical intervention was, therefore, planned.", "At 9 years and 7 months old, the second spacer was removed, and the knee joint was reconstructed using a custom-made growing femoral prosthesis (Stryker Corp., Germany) with a curved porous stem of 8.5 mm in diameter fixed to the residual femur with two screws.", "Intra-operatively, the PMMA around the junction was already loosened, and the stem was easily removed.", "The residual femur was carefully reamed, and the stem was inserted.", "Cancellous bone chips from the proximal tibial epiphysis were grafted around the bone-prosthesis junction and then wrapped with the preserved periosteum and pseudo-periosteum membrane.", "The proximal surface of the tibia was also replaced, but the growth plate was preserved.", "Immediately after surgery, range of motion (ROM) exercise was started.", "Six weeks after surgery, partial weight bearing was permitted.", "Ten months after the third surgery, the patient was able to walk unsupported.", "A radiograph showed further thickening of the cortex of the residual femur.", "At 10 years and 7 months old, the growing femoral prosthesis was extended by 1.1 cm.", "At the latest follow-up, at 11 years and 1 month old, the patient was 143 cm in height with a limb length discrepancy (LLD) of 5 cm.", "The patient was able to walk unsupported using a 2.5 cm shoe lift.", "The Musculoskeletal Tumor Society (MSTS) score was 24 out of 30 points.", "The muscle strength of quadriceps recovered to manual muscle test (MMT) level 3.", "Active straight leg raising became possible without extension lag.", "The ROM of the left knee was 0\u201390\u00b0.", "The patient was receiving a second extension of growing femoral prosthesis."], "index": 117, "original_id": "multiclinsum_test_1775_en.txt", "split": "test", "summary_subclaims": ["The patient is a 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur.", "The patient underwent three cycles of neoadjuvant chemotherapy.", "Limb-salvage surgery was planned because femoral rotationplasty had been refused.", "At 6\u2009years and 2\u2009months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed.", "At 7\u2009years and 8\u2009months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic.", "The distal end of the residual femur was removed by 1\u2009cm.", "The periosteum and induced membrane around polymethylmethacrylate was preserved.", "A custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized.", "The bone-spacer junction was fixed with polymethylmethacrylate.", "The bone-spacer junction was covered with the preserved periosteum and induced membrane.", "After surgery, the bone atrophy improved.", "At 9\u2009years and 7\u2009months old, the second spacer was removed because it had loosened.", "The knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem.", "Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane.", "At 10\u2009years and 5\u2009months old, the patient was able to walk unsupported.", "A radiograph showed further thickening of the cortex of the residual femur without any stress shielding.", "The patient had 5\u2009cm of limb length discrepancy.", "The patient and her mother were satisfied with the function.", "The MSTS score was 24 out of 30 points.", "Repeated limb length extensions are planned."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 42-year-old female.", "She was seen in the emergency department with three days of severe abdominal pain.", "She had sepsis.", "Her medical history included menometrorrhagia due to uterine fibroids.", "She had a previous endometrial ablation in 2015.", "She used a contraceptive vaginal ring for three months prior to presentation.", "She used Provera for 2 days prior to presentation for persistent vaginal bleeding.", "Physical examination revealed a temperature of 39.2\u00b0C.", "Physical examination revealed a pulse of 132 beats/min.", "Physical exam showed tenderness throughout the lower abdomen with voluntary guarding.", "Laboratory data revealed a white blood cell count of 12,000/\u00b5L.", "Laboratory data revealed a hemoglobin of 7.8 gm/dL.", "Laboratory data revealed a hematocrit of 25.7%.", "Laboratory data revealed a sodium of 127 mmol/L.", "Laboratory data revealed a chloride of 96 mmol/L.", "Lactate was normal at 1.5 mmol/L.", "Initial CT scan showed uterine masses consistent with known fibroids.", "Initial CT scan showed minimal pelvic fluid.", "She was admitted to the medical service for sepsis.", "Gynecology was consulted for presumed pelvic inflammatory disease.", "She was started on empiric antibiotics for PID: ceftriaxone IV 1 g every 24 hours, azithromycin IV 500 mg every 24 hours, and metronidazole IV 500 mg every 8 hours.", "Blood, urine, and stool cultures were sent upon admission.", "All cultures were negative.", "Her pain continued to progress.", "Her white blood cell count rose to 20,000/\u00b5L.", "A repeat CT scan on hospital day four showed interval development of ascites.", "Surgical consultation was obtained.", "She was found to have an acute abdomen.", "She was taken for a diagnostic laparoscopy.", "Diagnostic laparoscopy revealed a dense fibrinous exudate and significant ascites in all four quadrants of the abdomen.", "Multiple peritoneal biopsies were taken.", "Peritoneal fluid was sent for gram stain, cultures, and cytology.", "Postoperatively, carcinoembryonic antigen (CEA) and CA-125 levels were obtained.", "CEA was within the normal range.", "CA-125 was mildly elevated at 56.8 U/mL.", "Her white blood cell count fluctuated between 15,000 and 25,000/\u00b5L.", "Peritoneal fluid gram stain did not reveal any bacteria.", "Cytology revealed rare mesothelial cells and abundant neutrophils.", "Cytology did not reveal malignant cells.", "Final pathology report stated the presence of benign fibromembranous tissue with severe acute inflammation and extensive necrosis.", "The final pathology report was consistent with 'severe necrotizing acute peritonitis.'", "Infectious disease was consulted.", "Group A Strep (GAS) peritonitis was suspected.", "Recommendations were made to continue ceftriaxone at 1 g IV every 24 hours in addition to one dose of clindamycin 600 mg IV.", "Azithromycin was added to ceftriaxone three days later (IV 500 mg every 24 hours).", "A streptolysin O antibody (ASO) titer was sent.", "The ASO titer was normal at 61 I U/mL.", "The ASO titer argued against GAS peritonitis.", "Ceftriaxone was stopped.", "Azithromycin was transitioned to oral 500 mg daily.", "She continued to have persistent abdominal pain and anorexia.", "A repeat CT scan obtained nine days after surgery showed peritoneal enhancement and several fluid collections.", "A diagnostic paracentesis was performed.", "Peritoneal fluid was sent to an outside institution for 16S ribosome analysis.", "Her abdominal pain and leukocytosis slowly improved.", "She continued to have severe anorexia and food aversion.", "On hospital day 23, she was discharged home on oral azithromycin.", "16S ribosome testing revealed Mycoplasma hominis RNA within the peritoneal fluid.", "Her outpatient antibiotic was changed to oral doxycycline 100 mg twice daily for three months.", "She was closely followed as an outpatient.", "She gradually demonstrated clinical improvement.", "She remains well ten months after hospitalization."], "summary_subclaims": ["The patient is a 42-year-old female.", "She has a history of uterine fibroids.", "She was admitted with abdominal pain.", "She had intraperitoneal fluid of unknown etiology.", "She was initially managed nonoperatively.", "She was empirically treated with broad spectrum antibiotics.", "Blood and urine cultures were unrevealing.", "Diagnostic laparoscopy revealed a dense fibrinous exudate covering the entire peritoneal cavity.", "Peritoneal fluid and biopsies were sent for cytology and culture.", "The peritoneal fluid was sent for 16\u2009s ribosomal analysis.", "Mycoplasma hominis RNA was discovered.", "Her antibiotics were narrowed.", "She eventually made a full recovery."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 42-year-old female.", "She was seen in the emergency department with three days of severe abdominal pain.", "She had sepsis.", "Her medical history included menometrorrhagia due to uterine fibroids.", "She had a previous endometrial ablation in 2015.", "She used a contraceptive vaginal ring for three months prior to presentation.", "She used Provera for 2 days prior to presentation for persistent vaginal bleeding.", "Physical examination revealed a temperature of 39.2\u00b0C.", "Physical examination revealed a pulse of 132 beats/min.", "Physical exam showed tenderness throughout the lower abdomen with voluntary guarding.", "Laboratory data revealed a white blood cell count of 12,000/\u00b5L.", "Laboratory data revealed a hemoglobin of 7.8 gm/dL.", "Laboratory data revealed a hematocrit of 25.7%.", "Laboratory data revealed a sodium of 127 mmol/L.", "Laboratory data revealed a chloride of 96 mmol/L.", "Lactate was normal at 1.5 mmol/L.", "Initial CT scan showed uterine masses consistent with known fibroids.", "Initial CT scan showed minimal pelvic fluid.", "She was admitted to the medical service for sepsis.", "Gynecology was consulted for presumed pelvic inflammatory disease.", "She was started on empiric antibiotics for PID: ceftriaxone IV 1 g every 24 hours, azithromycin IV 500 mg every 24 hours, and metronidazole IV 500 mg every 8 hours.", "Blood, urine, and stool cultures were sent upon admission.", "All cultures were negative.", "Her pain continued to progress.", "Her white blood cell count rose to 20,000/\u00b5L.", "A repeat CT scan on hospital day four showed interval development of ascites.", "Surgical consultation was obtained.", "She was found to have an acute abdomen.", "She was taken for a diagnostic laparoscopy.", "Diagnostic laparoscopy revealed a dense fibrinous exudate and significant ascites in all four quadrants of the abdomen.", "Multiple peritoneal biopsies were taken.", "Peritoneal fluid was sent for gram stain, cultures, and cytology.", "Postoperatively, carcinoembryonic antigen (CEA) and CA-125 levels were obtained.", "CEA was within the normal range.", "CA-125 was mildly elevated at 56.8 U/mL.", "Her white blood cell count fluctuated between 15,000 and 25,000/\u00b5L.", "Peritoneal fluid gram stain did not reveal any bacteria.", "Cytology revealed rare mesothelial cells and abundant neutrophils.", "Cytology did not reveal malignant cells.", "Final pathology report stated the presence of benign fibromembranous tissue with severe acute inflammation and extensive necrosis.", "The final pathology report was consistent with 'severe necrotizing acute peritonitis.'", "Infectious disease was consulted.", "Group A Strep (GAS) peritonitis was suspected.", "Recommendations were made to continue ceftriaxone at 1 g IV every 24 hours in addition to one dose of clindamycin 600 mg IV.", "Azithromycin was added to ceftriaxone three days later (IV 500 mg every 24 hours).", "A streptolysin O antibody (ASO) titer was sent.", "The ASO titer was normal at 61 I U/mL.", "The ASO titer argued against GAS peritonitis.", "Ceftriaxone was stopped.", "Azithromycin was transitioned to oral 500 mg daily.", "She continued to have persistent abdominal pain and anorexia.", "A repeat CT scan obtained nine days after surgery showed peritoneal enhancement and several fluid collections.", "A diagnostic paracentesis was performed.", "Peritoneal fluid was sent to an outside institution for 16S ribosome analysis.", "Her abdominal pain and leukocytosis slowly improved.", "She continued to have severe anorexia and food aversion.", "On hospital day 23, she was discharged home on oral azithromycin.", "16S ribosome testing revealed Mycoplasma hominis RNA within the peritoneal fluid.", "Her outpatient antibiotic was changed to oral doxycycline 100 mg twice daily for three months.", "She was closely followed as an outpatient.", "She gradually demonstrated clinical improvement.", "She remains well ten months after hospitalization."], "index": 127, "original_id": "multiclinsum_test_1099_en.txt", "split": "test", "summary_subclaims": ["The patient is a 42-year-old female.", "She has a history of uterine fibroids.", "She was admitted with abdominal pain.", "She had intraperitoneal fluid of unknown etiology.", "She was initially managed nonoperatively.", "She was empirically treated with broad spectrum antibiotics.", "Blood and urine cultures were unrevealing.", "Diagnostic laparoscopy revealed a dense fibrinous exudate covering the entire peritoneal cavity.", "Peritoneal fluid and biopsies were sent for cytology and culture.", "The peritoneal fluid was sent for 16\u2009s ribosomal analysis.", "Mycoplasma hominis RNA was discovered.", "Her antibiotics were narrowed.", "She eventually made a full recovery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 77-year-old male.", "He presented with sudden onset pain in his left hip and shoulder.", "The pain followed an episode of slip and fall at home 2 days ago.", "He had been taking treatment for hypertension for the past 15 years.", "Clinical examination revealed extensive bruising over the chest, left arm, forearm, and the medial aspect of the entire left thigh.", "Movements of the involved hip and shoulder joints were extremely painful and restricted.", "There was no distal neurovascular deficit in any of the involved limbs.", "Laboratory investigations revealed anemia (Hb 8.5 g/dl).", "Blood urea was 266 mg/dl.", "Serum creatinine was 3.46 mg/dl.", "Serum potassium was 5.73 mmol/L.", "Uric acid was 10.4 mg/dl.", "Coagulation profile was within normal limits.", "The fracture of the left inter-trochanteric femur was confirmed.", "An associated fracture of the left proximal humerus was confirmed.", "X-rays did not reveal any bony injury to the chest/thigh and forearm.", "The patient received intravenous fluids (normal saline).", "Blood urea decreased to 79 mg/dl.", "Serum creatinine decreased to 0.68 mg/dl.", "Creatinine phosphokinase (CPK) was 865 U/L.", "The patient underwent closed reduction and internal fixation with the proximal femoral nail for the inter-trochanteric femur fracture.", "The proximal humerus fracture was managed non-operatively.", "The patient was discharged after 7 days of hospitalization.", "At 3 months follow-up, he was able to walk with the help of crutches.", "There was still residual pain and stiffness in his left shoulder."], "summary_subclaims": ["The patient was a 77-year-old hypertensive male.", "He presented to the emergency following an episode of slip and fall at home.", "Radiological evaluation revealed fractures of the left inter-trochanteric femur and left proximal humerus.", "Laboratory investigations showed grossly deranged renal parameters.", "Serum creatinine phosphokinase levels were more than 5 times the baseline.", "A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made.", "Medical management included adequate intravenous fluid administration.", "Medical management included strict input-output monitoring.", "The patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail.", "The fracture of the proximal humerus was managed non-operatively with sling immobilization.", "The patient refused to give consent for a second surgery."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 77-year-old male.", "He presented with sudden onset pain in his left hip and shoulder.", "The pain followed an episode of slip and fall at home 2 days ago.", "He had been taking treatment for hypertension for the past 15 years.", "Clinical examination revealed extensive bruising over the chest, left arm, forearm, and the medial aspect of the entire left thigh.", "Movements of the involved hip and shoulder joints were extremely painful and restricted.", "There was no distal neurovascular deficit in any of the involved limbs.", "Laboratory investigations revealed anemia (Hb 8.5 g/dl).", "Blood urea was 266 mg/dl.", "Serum creatinine was 3.46 mg/dl.", "Serum potassium was 5.73 mmol/L.", "Uric acid was 10.4 mg/dl.", "Coagulation profile was within normal limits.", "The fracture of the left inter-trochanteric femur was confirmed.", "An associated fracture of the left proximal humerus was confirmed.", "X-rays did not reveal any bony injury to the chest/thigh and forearm.", "The patient received intravenous fluids (normal saline).", "Blood urea decreased to 79 mg/dl.", "Serum creatinine decreased to 0.68 mg/dl.", "Creatinine phosphokinase (CPK) was 865 U/L.", "The patient underwent closed reduction and internal fixation with the proximal femoral nail for the inter-trochanteric femur fracture.", "The proximal humerus fracture was managed non-operatively.", "The patient was discharged after 7 days of hospitalization.", "At 3 months follow-up, he was able to walk with the help of crutches.", "There was still residual pain and stiffness in his left shoulder."], "index": 110, "original_id": "multiclinsum_test_2243_en.txt", "split": "test", "summary_subclaims": ["The patient was a 77-year-old hypertensive male.", "He presented to the emergency following an episode of slip and fall at home.", "Radiological evaluation revealed fractures of the left inter-trochanteric femur and left proximal humerus.", "Laboratory investigations showed grossly deranged renal parameters.", "Serum creatinine phosphokinase levels were more than 5 times the baseline.", "A diagnosis of acute kidney injury secondary to traumatic rhabdomyolysis was made.", "Medical management included adequate intravenous fluid administration.", "Medical management included strict input-output monitoring.", "The patient underwent closed reduction and internal fixation of the inter-trochanteric femur fracture with a proximal femoral nail.", "The fracture of the proximal humerus was managed non-operatively with sling immobilization.", "The patient refused to give consent for a second surgery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 52-year-old White man.", "The patient presented with intermittent constipation.", "The patient had a history of a decrease in lymphocyte count two months prior.", "Initial computed tomography scans revealed stage T4 prostatic adenocarcinoma.", "The tumor had invasion into adjacent structures.", "The tumor had metastasis to regional lymph nodes (stage N1).", "The tumor had metastases to the liver, bone, and a distant lymph node (stage M1).", "A retroperitoneal lymph node was biopsied to confirm histology.", "The patient's prostate-specific antigen (PSA) level was 1291ng/mL.", "The patient started the antiandrogen bicalutamide (oral) shortly after confirmed diagnosis.", "A gonadotrophin-releasing hormone agonist, leuprorelin (depot injection), was subsequently initiated.", "The patient received treatment until PSA values began to rise \u224815 weeks later.", "The patient discontinued bicalutamide.", "Docetaxel (intravenous infusion; 4 cycles) plus prednisone (oral; continuous dosing) was administered as standard of care.", "Prednisone was continued for 1 week after the end of docetaxel treatment for symptom control.", "The patient discontinued docetaxel/prednisone due to radiographic disease progression and PSA progression.", "The patient immediately started on abiraterone as an androgen receptor targeting therapy.", "The patient received palliative radiation of the right femur and acetabula around the time abiraterone was initiated.", "After discontinuing abiraterone, the patient was enrolled in the TRITON2 study.", "Local genomic testing of an archival tissue biopsy (retroperitoneal lymph node metastasis, 90% tumor purity) was obtained at initial diagnosis.", "Local testing utilized the Oncomine\u2122 Comprehensive Assay v3.", "The local test indicated the presence of a BRCA1 T1399I (allelic fraction [AF], 19%) mutation.", "A deleterious or probably damaging ATM G1663C mutation was also detected.", "A damaging TP53 P191del mutation was also detected.", "An oncogenic, activating BRAF K601E mutation was also detected.", "No gene amplifications were detected.", "No gene fusions were detected.", "TRITON2 patients provided plasma samples for central genomic analysis prior to starting rucaparib.", "The patient\u2019s pre-rucaparib plasma sample was analyzed using the FoundationOne Liquid CDx assay.", "The FoundationOne Liquid CDx assay detected the same alterations as the Oncomine analysis of the archival tissue biopsy.", "The FoundationOne Liquid CDx assay also revealed the presence of a BRCA2 homozygous loss (whole gene, 26 of 26 exons).", "The patient started at the recommended dose of rucaparib, 600 mg twice daily.", "The dose was reduced to 500 mg twice daily due to nausea/fatigue.", "The patient ultimately received rucaparib for 32 weeks.", "At enrollment into TRITON2, the patient had >21 bone-associated lesions.", "The patient had multiple liver lesions.", "Treatment with rucaparib resulted in a confirmed partial response per modified Response Evaluation Criteria In Solid Tumors, version 1.1.", "The partial response lasted 13 weeks.", "The partial response was ongoing as of the last radiographic assessment before subsequent anti-cancer therapy.", "The rPFS was 29 weeks.", "There was no confirmed progression in bone.", "The patient had a confirmed PSA response (maximum decrease, 95%).", "The PSA response lasted 28 weeks from the first dose of rucaparib.", "The patient discontinued rucaparib treatment due to clinical disease progression after 32 weeks on study.", "The patient received carboplatin and cabazitaxel for 2 cycles.", "Subsequent scans indicated progressive disease in nontarget liver lesions two months later.", "The patient discontinued carboplatin/cabazitaxel.", "The patient did not receive any further anticancer therapies.", "The patient died \u224823 months after initial diagnosis due to progression of his disease."], "summary_subclaims": ["The patient had BRCA-mutated metastatic castration-resistant prostate cancer.", "The patient had a response to the PARP inhibitor rucaparib.", "The patient remained on rucaparib for 32 weeks.", "The duration of treatment with rucaparib was >2 times longer than the duration of each of his prior therapies.", "The patient's prior therapies included bicalutamide, docetaxel, and abiraterone.", "The patient enrolled in TRITON2 based on results of local genomic testing of an archival biopsy.", "Local genomic testing indicated the presence of a BRCA1 T1399I mutation.", "The allelic fraction of the BRCA1 T1399I mutation was 19%.", "Local testing also identified an ATM G1663C mutation.", "Local testing also identified a TP53 P191del mutation.", "Local testing also identified a BRAF K601E mutation.", "Analysis of a plasma sample obtained before starting rucaparib detected the same alterations as those in the archival biopsy.", "Analysis of the plasma sample also revealed the presence of a BRCA2 homozygous loss.", "The BRCA2 homozygous loss involved the whole gene, 26 of 26 exons.", "The plasma sample analysis also revealed several other alterations of unknown functional impact.", "We hypothesize the response of the patient's tumor to rucaparib was likely driven by DNA damage repair deficiency.", "The DNA damage repair deficiency was caused by homozygous loss of all BRCA2 exons.", "The patient discontinued rucaparib due to clinical disease progression.", "Following discontinuation from rucaparib, the patient received carboplatin and cabazitaxel.", "The patient received carboplatin and cabazitaxel for \u22483 weeks.", "The patient died due to progression of his disease."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 52-year-old White man.", "The patient presented with intermittent constipation.", "The patient had a history of a decrease in lymphocyte count two months prior.", "Initial computed tomography scans revealed stage T4 prostatic adenocarcinoma.", "The tumor had invasion into adjacent structures.", "The tumor had metastasis to regional lymph nodes (stage N1).", "The tumor had metastases to the liver, bone, and a distant lymph node (stage M1).", "A retroperitoneal lymph node was biopsied to confirm histology.", "The patient's prostate-specific antigen (PSA) level was 1291ng/mL.", "The patient started the antiandrogen bicalutamide (oral) shortly after confirmed diagnosis.", "A gonadotrophin-releasing hormone agonist, leuprorelin (depot injection), was subsequently initiated.", "The patient received treatment until PSA values began to rise \u224815 weeks later.", "The patient discontinued bicalutamide.", "Docetaxel (intravenous infusion; 4 cycles) plus prednisone (oral; continuous dosing) was administered as standard of care.", "Prednisone was continued for 1 week after the end of docetaxel treatment for symptom control.", "The patient discontinued docetaxel/prednisone due to radiographic disease progression and PSA progression.", "The patient immediately started on abiraterone as an androgen receptor targeting therapy.", "The patient received palliative radiation of the right femur and acetabula around the time abiraterone was initiated.", "After discontinuing abiraterone, the patient was enrolled in the TRITON2 study.", "Local genomic testing of an archival tissue biopsy (retroperitoneal lymph node metastasis, 90% tumor purity) was obtained at initial diagnosis.", "Local testing utilized the Oncomine\u2122 Comprehensive Assay v3.", "The local test indicated the presence of a BRCA1 T1399I (allelic fraction [AF], 19%) mutation.", "A deleterious or probably damaging ATM G1663C mutation was also detected.", "A damaging TP53 P191del mutation was also detected.", "An oncogenic, activating BRAF K601E mutation was also detected.", "No gene amplifications were detected.", "No gene fusions were detected.", "TRITON2 patients provided plasma samples for central genomic analysis prior to starting rucaparib.", "The patient\u2019s pre-rucaparib plasma sample was analyzed using the FoundationOne Liquid CDx assay.", "The FoundationOne Liquid CDx assay detected the same alterations as the Oncomine analysis of the archival tissue biopsy.", "The FoundationOne Liquid CDx assay also revealed the presence of a BRCA2 homozygous loss (whole gene, 26 of 26 exons).", "The patient started at the recommended dose of rucaparib, 600 mg twice daily.", "The dose was reduced to 500 mg twice daily due to nausea/fatigue.", "The patient ultimately received rucaparib for 32 weeks.", "At enrollment into TRITON2, the patient had >21 bone-associated lesions.", "The patient had multiple liver lesions.", "Treatment with rucaparib resulted in a confirmed partial response per modified Response Evaluation Criteria In Solid Tumors, version 1.1.", "The partial response lasted 13 weeks.", "The partial response was ongoing as of the last radiographic assessment before subsequent anti-cancer therapy.", "The rPFS was 29 weeks.", "There was no confirmed progression in bone.", "The patient had a confirmed PSA response (maximum decrease, 95%).", "The PSA response lasted 28 weeks from the first dose of rucaparib.", "The patient discontinued rucaparib treatment due to clinical disease progression after 32 weeks on study.", "The patient received carboplatin and cabazitaxel for 2 cycles.", "Subsequent scans indicated progressive disease in nontarget liver lesions two months later.", "The patient discontinued carboplatin/cabazitaxel.", "The patient did not receive any further anticancer therapies.", "The patient died \u224823 months after initial diagnosis due to progression of his disease."], "index": 118, "original_id": "multiclinsum_test_759_en.txt", "split": "test", "summary_subclaims": ["The patient had BRCA-mutated metastatic castration-resistant prostate cancer.", "The patient had a response to the PARP inhibitor rucaparib.", "The patient remained on rucaparib for 32 weeks.", "The duration of treatment with rucaparib was >2 times longer than the duration of each of his prior therapies.", "The patient's prior therapies included bicalutamide, docetaxel, and abiraterone.", "The patient enrolled in TRITON2 based on results of local genomic testing of an archival biopsy.", "Local genomic testing indicated the presence of a BRCA1 T1399I mutation.", "The allelic fraction of the BRCA1 T1399I mutation was 19%.", "Local testing also identified an ATM G1663C mutation.", "Local testing also identified a TP53 P191del mutation.", "Local testing also identified a BRAF K601E mutation.", "Analysis of a plasma sample obtained before starting rucaparib detected the same alterations as those in the archival biopsy.", "Analysis of the plasma sample also revealed the presence of a BRCA2 homozygous loss.", "The BRCA2 homozygous loss involved the whole gene, 26 of 26 exons.", "The plasma sample analysis also revealed several other alterations of unknown functional impact.", "We hypothesize the response of the patient's tumor to rucaparib was likely driven by DNA damage repair deficiency.", "The DNA damage repair deficiency was caused by homozygous loss of all BRCA2 exons.", "The patient discontinued rucaparib due to clinical disease progression.", "Following discontinuation from rucaparib, the patient received carboplatin and cabazitaxel.", "The patient received carboplatin and cabazitaxel for \u22483 weeks.", "The patient died due to progression of his disease."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 44-year-old black African man of Burkinab\u00e8 origin.", "He is a smoker with 10 packs a year.", "He has sickle-cell anaemia.", "He has been taking 5 mg of folic acid daily.", "He has no notion of tuberculosis infection.", "He was admitted to the rheumatology department for chronic inflammatory lower back pain.", "He had inflammatory left knee pain that had been going on for about seven months.", "He had a cough with phlegm.", "He had evening fever.", "He had moderate physical asthenia.", "He had anorexia.", "He had significant weight loss.", "On physical examination, clinical anaemia was observed that was not decompensated.", "A spinal syndrome was observed.", "Bilateral psoitis was observed.", "A soft, purulent swelling of 4x5 cm was observed in the sterno-clavicular joint.", "A monoarthritis was found in the knee.", "The knee puncture revealed a purulent, fluid liquid.", "The respiratory tract examination showed a condensation syndrome in the left pulmonary field.", "A purulent pleural effusion on the right was observed.", "A right inguinal lymphadenopathy with pus was observed.", "A biological inflammatory syndrome was observed.", "The microcytic hypochromic anaemia was 8.1 g/dl.", "The C reactive protein (CRP) was 98 mg/l.", "There was no hyperleucocytosis.", "The intradermal reaction (IDR) to the tuberculin was positive at 18 mm.", "The cytobacteriological examination did not find any germ.", "The GeneXpert MTB/RIF test did not find any germ.", "The search for acid-fast bacilli (AFB) in the pus from the different sites did not find any germ.", "The thoracic computed tomography showed a right sterno-clavicular arthrosis with anterior muscular and mediastinal extension.", "The thoracic computed tomography showed a pyothorax.", "The thoracic computed tomography showed a right lung abscess.", "The thoracic computed tomography showed a L3-L4 spondylodiscitis with calcifying abscesses of the psoas and paravertebral muscles.", "The standard radiography of the left knee showed signs in favour of arthritis.", "The diagnosis of tuberculosis with multifocal, pleuropulmonary and lymph node involvement was retained.", "The patient was put on rifampicin 600 mg daily.", "The patient was put on isoniazid 300 mg daily.", "The patient was put on pyrazinamide 2000 mg daily.", "The patient was put on ethambutol 1600 mg daily for two months.", "The same doses of rifampicin and isoniazid were continued for 10 months.", "The patient received thoracic drainage of the pyothorax in the operating theatre.", "The patient received a joint lavage of the left knee.", "The patient received a drainage of the cold abscess in the sterno-clavicular joint.", "Local care with antiseptic was applied to the fistula of the inguinal lymphadenopathy.", "Local care with antiseptic was applied to the cold abscess until complete healing.", "Folic acid treatment was continued in the context of sickle cell anaemia.", "The immediate evolution was marked by a clinical and biological improvement.", "The inflammatory syndrome disappeared.", "The fever reduced.", "The evolution at three months was characterised by an improvement of the psoitis.", "The evolution at three months was characterised by an improvement of the lower back pain.", "The weight gain estimated at 3 months was 5%."], "summary_subclaims": ["The patient is a 44-year-old African black patient of Burkinabe origin.", "The patient had chronic inflammatory low back pain.", "The patient had inflammatory right knee pain.", "The patient had a cough with phlegm.", "The symptomatology had been developing for seven months.", "The symptomatology was in a febrile context.", "The patient had a general deterioration in health.", "The examination showed oligoarthritis of the right sternoclavicular joint.", "The examination showed oligoarthritis of the left knee.", "The examination showed a pulmonary condensation syndrome.", "The examination showed pleural effusion.", "The examination showed a cold abscess at the level of the right sternoclavicular joint.", "The examination showed a fistulous and purulent right inguinal lymphadenopathy.", "The biology showed an inflammatory syndrome.", "The GeneXpert test was positive in the sputum.", "The GeneXpert test showed no resistance to rifampicin.", "The intradermal reaction to the tuberculin was positive.", "The thoracic tomodensitometry showed a right sternoclavicular osteoarthritis.", "The thoracic tomodensitometry showed a spondylodiscitis of the L3-L4 spine.", "The standard radiography of the left knee objectified signs in favour of arthritis.", "The diagnosis of tuberculosis with multifocal, pleuropulmonary and ganglionar bone involvement was retained.", "The patient was given usual analgesics.", "The patient was given antituberculous.", "The evolution was favourable."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 44-year-old black African man of Burkinab\u00e8 origin.", "He is a smoker with 10 packs a year.", "He has sickle-cell anaemia.", "He has been taking 5 mg of folic acid daily.", "He has no notion of tuberculosis infection.", "He was admitted to the rheumatology department for chronic inflammatory lower back pain.", "He had inflammatory left knee pain that had been going on for about seven months.", "He had a cough with phlegm.", "He had evening fever.", "He had moderate physical asthenia.", "He had anorexia.", "He had significant weight loss.", "On physical examination, clinical anaemia was observed that was not decompensated.", "A spinal syndrome was observed.", "Bilateral psoitis was observed.", "A soft, purulent swelling of 4x5 cm was observed in the sterno-clavicular joint.", "A monoarthritis was found in the knee.", "The knee puncture revealed a purulent, fluid liquid.", "The respiratory tract examination showed a condensation syndrome in the left pulmonary field.", "A purulent pleural effusion on the right was observed.", "A right inguinal lymphadenopathy with pus was observed.", "A biological inflammatory syndrome was observed.", "The microcytic hypochromic anaemia was 8.1 g/dl.", "The C reactive protein (CRP) was 98 mg/l.", "There was no hyperleucocytosis.", "The intradermal reaction (IDR) to the tuberculin was positive at 18 mm.", "The cytobacteriological examination did not find any germ.", "The GeneXpert MTB/RIF test did not find any germ.", "The search for acid-fast bacilli (AFB) in the pus from the different sites did not find any germ.", "The thoracic computed tomography showed a right sterno-clavicular arthrosis with anterior muscular and mediastinal extension.", "The thoracic computed tomography showed a pyothorax.", "The thoracic computed tomography showed a right lung abscess.", "The thoracic computed tomography showed a L3-L4 spondylodiscitis with calcifying abscesses of the psoas and paravertebral muscles.", "The standard radiography of the left knee showed signs in favour of arthritis.", "The diagnosis of tuberculosis with multifocal, pleuropulmonary and lymph node involvement was retained.", "The patient was put on rifampicin 600 mg daily.", "The patient was put on isoniazid 300 mg daily.", "The patient was put on pyrazinamide 2000 mg daily.", "The patient was put on ethambutol 1600 mg daily for two months.", "The same doses of rifampicin and isoniazid were continued for 10 months.", "The patient received thoracic drainage of the pyothorax in the operating theatre.", "The patient received a joint lavage of the left knee.", "The patient received a drainage of the cold abscess in the sterno-clavicular joint.", "Local care with antiseptic was applied to the fistula of the inguinal lymphadenopathy.", "Local care with antiseptic was applied to the cold abscess until complete healing.", "Folic acid treatment was continued in the context of sickle cell anaemia.", "The immediate evolution was marked by a clinical and biological improvement.", "The inflammatory syndrome disappeared.", "The fever reduced.", "The evolution at three months was characterised by an improvement of the psoitis.", "The evolution at three months was characterised by an improvement of the lower back pain.", "The weight gain estimated at 3 months was 5%."], "index": 111, "original_id": "multiclinsum_test_3332_en.txt", "split": "test", "summary_subclaims": ["The patient is a 44-year-old African black patient of Burkinabe origin.", "The patient had chronic inflammatory low back pain.", "The patient had inflammatory right knee pain.", "The patient had a cough with phlegm.", "The symptomatology had been developing for seven months.", "The symptomatology was in a febrile context.", "The patient had a general deterioration in health.", "The examination showed oligoarthritis of the right sternoclavicular joint.", "The examination showed oligoarthritis of the left knee.", "The examination showed a pulmonary condensation syndrome.", "The examination showed pleural effusion.", "The examination showed a cold abscess at the level of the right sternoclavicular joint.", "The examination showed a fistulous and purulent right inguinal lymphadenopathy.", "The biology showed an inflammatory syndrome.", "The GeneXpert test was positive in the sputum.", "The GeneXpert test showed no resistance to rifampicin.", "The intradermal reaction to the tuberculin was positive.", "The thoracic tomodensitometry showed a right sternoclavicular osteoarthritis.", "The thoracic tomodensitometry showed a spondylodiscitis of the L3-L4 spine.", "The standard radiography of the left knee objectified signs in favour of arthritis.", "The diagnosis of tuberculosis with multifocal, pleuropulmonary and ganglionar bone involvement was retained.", "The patient was given usual analgesics.", "The patient was given antituberculous.", "The evolution was favourable."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The infant was born at 27 weeks and four days.", "The infant was a preterm male.", "The infant's birth weight was 1135 grams.", "The pregnancy was a dichorionic diamniotic twin pregnancy.", "The mother experienced premature membrane rupture in the 27th week of pregnancy.", "The mother experienced contractions in the 27th week of pregnancy.", "The mother experienced bleeding in the 27th week of pregnancy.", "The mother was treated with antenatal steroids.", "Cesarean delivery was planned due to an arrested birth.", "The neonate was hypotonic at birth.", "The neonate was apneic at birth.", "The neonate required intubation one minute after birth.", "The intubation was due to respiratory failure.", "An uncuffed endotracheal tube was used.", "The APGAR score was 4 at one minute.", "The APGAR score was 6 at five minutes.", "The APGAR score was 7 at ten minutes.", "The neonate was transferred to the newborn intensive care unit.", "A diagnosis of respiratory distress syndrome was made.", "Treatment with endotracheal poractant alfa 200 mg/kg was initiated.", "Treatment with parenteral ampicillin-gentamicin was initiated.", "Treatment with caffeine citrate was initiated.", "Ventilation settings were arranged to assist control and volume guaranteed mode.", "The maximum inspiring pressure was 20 cm/H\u00b2O.", "The cranial ultrasound showed no abnormalities.", "On hospital day 3, the neonate was extubated to nasal intermittent positive pressure ventilation.", "On hospital day 3, the neonate required reintubation for recurrent respiratory failure.", "Antibiotics were escalated to vancomycin-meropenem due to clinical deterioration.", "On hospital day 5, the baby had worsening acute hypoxic respiratory failure.", "A chest x-ray revealed mediastinal pneumothorax.", "A follow-up x-ray one hour later showed accelerated pneumothorax on the left side.", "A follow-up x-ray one hour later showed mediastinal shift to the right.", "A thorax tube was placed through the left 5th intercostal space.", "Repeat x-rays showed an expanded lung on the left side.", "Repeat x-rays showed air bronchograms on the right.", "Ten hours later, the neonate had persistent acidosis.", "Ten hours later, the neonate had persistent hypoxia.", "An x-ray ten hours later displayed a repeat pneumothorax on the left side.", "The thorax tube was set to continuous suction.", "The thorax tube resulted in a reduction of pneumothorax on subsequent imaging.", "An echocardiogram revealed a 3 mm patent ductus arteriosus.", "The patent ductus arteriosus had mostly left to right two-way shunts.", "The echocardiogram showed pulmonary hypertension.", "The oxygen saturation levels were approximately 80%.", "The arm-leg saturation differences were higher than 15 mm Hg.", "These findings were suspicious for persistent fetal circulation.", "Pediatric cardiology advised against the closure of PDA.", "A new chest x-ray showed a collapsed left lung.", "A second chest tube was placed in the left hemithorax.", "A decision was made to perform a surgical intervention.", "A left posterolateral thoracotomy was performed.", "A 1 cm perforated area between the left bronchus and carina was found.", "The perforated area was repaired by using a pleural patch.", "Suturing with 6.0 prolene was performed.", "There was no visible bleeding or air leak at the end of the procedure.", "The anesthesiologist applied high-pressure air via the endotracheal tube.", "A chest tube was inserted.", "The thoracotomy incision was closed by layers.", "A post-procedure chest x-ray showed an expanded left lung.", "Three days later, the neonate experienced another episode of hypoxia.", "The hypoxia was found to be secondary to a repeat left-sided pneumothorax.", "A second thoracotomy was performed using the same technique as the prior surgery.", "An air leak emanated from the same area.", "The perforated area was repaired using a pleural patch.", "The left 5th intercostal muscle long peduncle was used.", "Fibrin glue and spongestan were used as anchorage on top of the patch.", "No leak was found with the use of maximal airway pressure.", "A PDA ligation operation was performed simultaneously during the procedure.", "There was no air leakage in the repeat x-ray.", "Both the first and second thorax tubes were removed on postoperative days 0 and 5, respectively.", "There were no signs of air buildup or pneumothorax on the following days.", "On the 161st day of admission, the patient was discharged home.", "The patient was discharged with a home-type ventilator.", "The patient was discharged with 30% oxygen support."], "summary_subclaims": ["The patient was a preterm newborn.", "The patient developed pneumomediastinum.", "The patient developed pneumothorax.", "The pneumothorax persisted despite placement of a thorax tube.", "A thoracotomy was performed to detect and treat the bronchial rupture."]}, "extra_info": {"fulltext_subclaims": ["The infant was born at 27 weeks and four days.", "The infant was a preterm male.", "The infant's birth weight was 1135 grams.", "The pregnancy was a dichorionic diamniotic twin pregnancy.", "The mother experienced premature membrane rupture in the 27th week of pregnancy.", "The mother experienced contractions in the 27th week of pregnancy.", "The mother experienced bleeding in the 27th week of pregnancy.", "The mother was treated with antenatal steroids.", "Cesarean delivery was planned due to an arrested birth.", "The neonate was hypotonic at birth.", "The neonate was apneic at birth.", "The neonate required intubation one minute after birth.", "The intubation was due to respiratory failure.", "An uncuffed endotracheal tube was used.", "The APGAR score was 4 at one minute.", "The APGAR score was 6 at five minutes.", "The APGAR score was 7 at ten minutes.", "The neonate was transferred to the newborn intensive care unit.", "A diagnosis of respiratory distress syndrome was made.", "Treatment with endotracheal poractant alfa 200 mg/kg was initiated.", "Treatment with parenteral ampicillin-gentamicin was initiated.", "Treatment with caffeine citrate was initiated.", "Ventilation settings were arranged to assist control and volume guaranteed mode.", "The maximum inspiring pressure was 20 cm/H\u00b2O.", "The cranial ultrasound showed no abnormalities.", "On hospital day 3, the neonate was extubated to nasal intermittent positive pressure ventilation.", "On hospital day 3, the neonate required reintubation for recurrent respiratory failure.", "Antibiotics were escalated to vancomycin-meropenem due to clinical deterioration.", "On hospital day 5, the baby had worsening acute hypoxic respiratory failure.", "A chest x-ray revealed mediastinal pneumothorax.", "A follow-up x-ray one hour later showed accelerated pneumothorax on the left side.", "A follow-up x-ray one hour later showed mediastinal shift to the right.", "A thorax tube was placed through the left 5th intercostal space.", "Repeat x-rays showed an expanded lung on the left side.", "Repeat x-rays showed air bronchograms on the right.", "Ten hours later, the neonate had persistent acidosis.", "Ten hours later, the neonate had persistent hypoxia.", "An x-ray ten hours later displayed a repeat pneumothorax on the left side.", "The thorax tube was set to continuous suction.", "The thorax tube resulted in a reduction of pneumothorax on subsequent imaging.", "An echocardiogram revealed a 3 mm patent ductus arteriosus.", "The patent ductus arteriosus had mostly left to right two-way shunts.", "The echocardiogram showed pulmonary hypertension.", "The oxygen saturation levels were approximately 80%.", "The arm-leg saturation differences were higher than 15 mm Hg.", "These findings were suspicious for persistent fetal circulation.", "Pediatric cardiology advised against the closure of PDA.", "A new chest x-ray showed a collapsed left lung.", "A second chest tube was placed in the left hemithorax.", "A decision was made to perform a surgical intervention.", "A left posterolateral thoracotomy was performed.", "A 1 cm perforated area between the left bronchus and carina was found.", "The perforated area was repaired by using a pleural patch.", "Suturing with 6.0 prolene was performed.", "There was no visible bleeding or air leak at the end of the procedure.", "The anesthesiologist applied high-pressure air via the endotracheal tube.", "A chest tube was inserted.", "The thoracotomy incision was closed by layers.", "A post-procedure chest x-ray showed an expanded left lung.", "Three days later, the neonate experienced another episode of hypoxia.", "The hypoxia was found to be secondary to a repeat left-sided pneumothorax.", "A second thoracotomy was performed using the same technique as the prior surgery.", "An air leak emanated from the same area.", "The perforated area was repaired using a pleural patch.", "The left 5th intercostal muscle long peduncle was used.", "Fibrin glue and spongestan were used as anchorage on top of the patch.", "No leak was found with the use of maximal airway pressure.", "A PDA ligation operation was performed simultaneously during the procedure.", "There was no air leakage in the repeat x-ray.", "Both the first and second thorax tubes were removed on postoperative days 0 and 5, respectively.", "There were no signs of air buildup or pneumothorax on the following days.", "On the 161st day of admission, the patient was discharged home.", "The patient was discharged with a home-type ventilator.", "The patient was discharged with 30% oxygen support."], "index": 116, "original_id": "multiclinsum_test_2176_en.txt", "split": "test", "summary_subclaims": ["The patient was a preterm newborn.", "The patient developed pneumomediastinum.", "The patient developed pneumothorax.", "The pneumothorax persisted despite placement of a thorax tube.", "A thoracotomy was performed to detect and treat the bronchial rupture."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 25-year-old gentleman.", "He presented with a complaint of recurrent pain and swelling on his right cheek of three-month duration.", "He visited a general practitioner each time.", "The condition was resolved with analgesic and antibiotics.", "His symptoms got worse.", "He attended the Oral Surgery Clinic for consultation.", "The patient is a fit and healthy young man.", "He has no relevant medical history.", "He has no known history of allergy.", "He had undergone bimaxillary orthognathic surgery one and a half years earlier.", "The surgical team informed him that there was a dislodged orthodontic appliance in his right cheek that must have occurred during the operation.", "The molar tube from the right maxillary second molar was found missing the next day after the surgery.", "Its presence was confirmed high up in the right maxillary-zygomatic buttress area shown in the postoperative X-ray image taken the next day.", "A series of further postoperative radiographs confirmed its location, lying outside the right maxillary antrum.", "No attempt was made to remove the appliance due to the pronounced postoperative facial oedema.", "The absence of signs and symptoms during further follow-up sessions confirmed the decision to leave it in-situ.", "On examination, there was no extraoral swelling noted.", "The mandible and maxilla seemed firm.", "There was a sinus with slight pus discharge on the upper right buccal sulcus region adjacent to the upper right first premolar.", "Tenderness was elicited upon palpation on the upper right vestibular region.", "A periapical view was taken with gutta-percha inserted into the sinus for foreign body localization.", "The radiograph revealed the gutta-percha pointed towards the site of titanium plate and screws used for rigid fixation.", "A cone beam CT was performed to provide a 3D detailed location of the appliance.", "The presence of the molar orthodontic tube foreign body reaction was suspected as the most probable cause of the recurrent right cheek pain and swelling.", "Exploration of the site was performed through the sulcular incision under general anesthesia.", "The dislodged molar tube was identified lying on the zygomatic bone just beneath the raised flap.", "It was removed by dividing some surrounding fibrous tissue strands.", "One titanium straight bone plate with four screws used for fixing the previous Le Fort I osteotomy site was inspected.", "A decision was made to remove them based on the fact that they are present in an infected area.", "The Le Fort I osteotomy site showed good healing with new bone formation.", "The patient had an uneventful recovery.", "The orthognathic surgical team who attended him previously was informed of his progress."], "summary_subclaims": ["A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery.", "A bonded molar orthodontic tube had dislodged into the wound during the operation.", "The clinical presentation initially mimics an odontogenic infection.", "Our investigations revealed that the abscess originated from the dislodged appliance.", "The abscess was drained.", "The wound site was explored.", "The molar tube and neighbouring rigid fixation plates and screws were removed.", "The patient recovered well following the procedure."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 25-year-old gentleman.", "He presented with a complaint of recurrent pain and swelling on his right cheek of three-month duration.", "He visited a general practitioner each time.", "The condition was resolved with analgesic and antibiotics.", "His symptoms got worse.", "He attended the Oral Surgery Clinic for consultation.", "The patient is a fit and healthy young man.", "He has no relevant medical history.", "He has no known history of allergy.", "He had undergone bimaxillary orthognathic surgery one and a half years earlier.", "The surgical team informed him that there was a dislodged orthodontic appliance in his right cheek that must have occurred during the operation.", "The molar tube from the right maxillary second molar was found missing the next day after the surgery.", "Its presence was confirmed high up in the right maxillary-zygomatic buttress area shown in the postoperative X-ray image taken the next day.", "A series of further postoperative radiographs confirmed its location, lying outside the right maxillary antrum.", "No attempt was made to remove the appliance due to the pronounced postoperative facial oedema.", "The absence of signs and symptoms during further follow-up sessions confirmed the decision to leave it in-situ.", "On examination, there was no extraoral swelling noted.", "The mandible and maxilla seemed firm.", "There was a sinus with slight pus discharge on the upper right buccal sulcus region adjacent to the upper right first premolar.", "Tenderness was elicited upon palpation on the upper right vestibular region.", "A periapical view was taken with gutta-percha inserted into the sinus for foreign body localization.", "The radiograph revealed the gutta-percha pointed towards the site of titanium plate and screws used for rigid fixation.", "A cone beam CT was performed to provide a 3D detailed location of the appliance.", "The presence of the molar orthodontic tube foreign body reaction was suspected as the most probable cause of the recurrent right cheek pain and swelling.", "Exploration of the site was performed through the sulcular incision under general anesthesia.", "The dislodged molar tube was identified lying on the zygomatic bone just beneath the raised flap.", "It was removed by dividing some surrounding fibrous tissue strands.", "One titanium straight bone plate with four screws used for fixing the previous Le Fort I osteotomy site was inspected.", "A decision was made to remove them based on the fact that they are present in an infected area.", "The Le Fort I osteotomy site showed good healing with new bone formation.", "The patient had an uneventful recovery.", "The orthognathic surgical team who attended him previously was informed of his progress."], "index": 113, "original_id": "multiclinsum_test_1305_en.txt", "split": "test", "summary_subclaims": ["A 25-year-old gentleman presented with recurrent upper right vestibular abscess three months following a bimaxillary orthognathic surgery.", "A bonded molar orthodontic tube had dislodged into the wound during the operation.", "The clinical presentation initially mimics an odontogenic infection.", "Our investigations revealed that the abscess originated from the dislodged appliance.", "The abscess was drained.", "The wound site was explored.", "The molar tube and neighbouring rigid fixation plates and screws were removed.", "The patient recovered well following the procedure."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction.", "The right radial access was chosen for the performance of percutaneous coronary intervention.", "After the introduction of 6 F sheath, there was difficulty in the advancement of 0.035 J wire.", "The 0.035 J wire was exchanged with a Terumo hydrophilic wire (0.035 \u00d7 180).", "The Terumo hydrophilic wire was advanced easily to the aortic root.", "Coronary angiography was done.", "Coronary angiography revealed tortuous coronary arteries without significant lesions.", "Radial arteriography before sheath removal revealed perforation.", "Protamine sulfate (1 mg per 100 USP units of heparin) was administered intravenously.", "The dose of heparin was 70 U/kg.", "APTT was monitored 15 min after the protamine dose.", "Prolonged balloon inflation 2.5/3.0 was performed.", "The perforation was not sealed.", "A 7-F-long vascular sheath was inserted to internally tamponade the vessel.", "The patient was sent to the coronary care unit for monitoring of the forearm hematoma and the distal pulses.", "Over the next 3 days, serial radial angiographies were done.", "Serial radial angiographies revealed the persistence of the perforation.", "After 4 days, angiography revealed multiple thrombi.", "Thrombus aspiration was done using Pronto V4 extraction catheter.", "The implantation of a covered stent was performed.", "The stent was dislodged, mostly secondary to under expansion.", "The stent was successfully snared.", "The perforation was sealed spontaneously.", "There were no signs of intra-arterial thrombi."], "summary_subclaims": ["A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction.", "The right radial access was chosen for the performance of percutaneous coronary intervention.", "After the introduction of 6\u2009F sheath, there was difficulty in the advancement of 0.035\u2009J wire.", "The 0.035\u2009J wire was exchanged with a Terumo hydrophilic wire.", "After the procedure and before sheath removal, radial arteriography was done.", "Radial arteriography revealed perforation.", "Protamine sulfate was administered.", "Prolonged balloon inflation was attempted.", "Prolonged balloon inflation failed to seal the perforation.", "A 7-F-long vascular sheath was inserted to internally tamponade the vessel.", "The patient was sent to the coronary care unit for monitoring.", "Over the next 3 days, serial radial angiographies were done.", "Serial radial angiographies revealed the persistence of the perforation.", "On the fourth day, angiography revealed multiple thrombi.", "Thrombus aspiration was done using Pronto V4 extraction catheter.", "Thrombus aspiration was followed by the deployment of a covered stent.", "The stent was dislodged.", "The dislodged stent was successfully snared.", "The perforation was sealed spontaneously.", "There were no signs of intra-arterial thrombi."]}, "extra_info": {"fulltext_subclaims": ["A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction.", "The right radial access was chosen for the performance of percutaneous coronary intervention.", "After the introduction of 6 F sheath, there was difficulty in the advancement of 0.035 J wire.", "The 0.035 J wire was exchanged with a Terumo hydrophilic wire (0.035 \u00d7 180).", "The Terumo hydrophilic wire was advanced easily to the aortic root.", "Coronary angiography was done.", "Coronary angiography revealed tortuous coronary arteries without significant lesions.", "Radial arteriography before sheath removal revealed perforation.", "Protamine sulfate (1 mg per 100 USP units of heparin) was administered intravenously.", "The dose of heparin was 70 U/kg.", "APTT was monitored 15 min after the protamine dose.", "Prolonged balloon inflation 2.5/3.0 was performed.", "The perforation was not sealed.", "A 7-F-long vascular sheath was inserted to internally tamponade the vessel.", "The patient was sent to the coronary care unit for monitoring of the forearm hematoma and the distal pulses.", "Over the next 3 days, serial radial angiographies were done.", "Serial radial angiographies revealed the persistence of the perforation.", "After 4 days, angiography revealed multiple thrombi.", "Thrombus aspiration was done using Pronto V4 extraction catheter.", "The implantation of a covered stent was performed.", "The stent was dislodged, mostly secondary to under expansion.", "The stent was successfully snared.", "The perforation was sealed spontaneously.", "There were no signs of intra-arterial thrombi."], "index": 120, "original_id": "multiclinsum_test_1116_en.txt", "split": "test", "summary_subclaims": ["A 91-year-old woman presented to our institution with ST-segment elevation myocardial infarction.", "The right radial access was chosen for the performance of percutaneous coronary intervention.", "After the introduction of 6\u2009F sheath, there was difficulty in the advancement of 0.035\u2009J wire.", "The 0.035\u2009J wire was exchanged with a Terumo hydrophilic wire.", "After the procedure and before sheath removal, radial arteriography was done.", "Radial arteriography revealed perforation.", "Protamine sulfate was administered.", "Prolonged balloon inflation was attempted.", "Prolonged balloon inflation failed to seal the perforation.", "A 7-F-long vascular sheath was inserted to internally tamponade the vessel.", "The patient was sent to the coronary care unit for monitoring.", "Over the next 3 days, serial radial angiographies were done.", "Serial radial angiographies revealed the persistence of the perforation.", "On the fourth day, angiography revealed multiple thrombi.", "Thrombus aspiration was done using Pronto V4 extraction catheter.", "Thrombus aspiration was followed by the deployment of a covered stent.", "The stent was dislodged.", "The dislodged stent was successfully snared.", "The perforation was sealed spontaneously.", "There were no signs of intra-arterial thrombi."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 16-year-old Ukrainian boy was admitted to the Department of Children\u2019s Infectious Diseases in Warsaw, Poland.", "The boy had jaundice lasting for four days.", "The boy had malaise.", "The boy had diarrhoea.", "The boy had vomiting.", "The boy had lived in Poland for 1.5 years.", "The boy was working (training) in the profession of a hairdresser.", "The boy had a tattoo made at home by his mother\u2019s partner six months earlier.", "The boy had a finger cut by hairdressing scissors six weeks before the admission.", "The patient confirmed that he had two secured heterosexual encounters during the last six months.", "In Ukraine, he had been vaccinated against tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, and rubella.", "He has not been vaccinated against hepatitis B.", "He negated any dietary errors.", "He had never had blood transfusion nor surgery.", "He was once hospitalized due to acute gastroenteritis in Ukraine.", "The physical examination revealed jaundice.", "The physical examination revealed hepatomegaly (2 cm below the rib arch).", "The physical examination revealed a tattoo on the right forearm.", "Laboratory tests showed a significantly elevated level of aminotransferases.", "Alanine aminotransferase (ALT) was 2439 IU/L.", "Aspartate aminotransferase (AST) was 1418 IU/L.", "Serological testing was positive for HBsAg.", "Serological testing was positive for anti-Hbc IgM antibodies.", "Serological testing was negative for hepatitis A and hepatitis C viruses.", "The HBV viral load was 5.82 copies/mL.", "HBV genotype A was confirmed.", "Acute hepatitis B was diagnosed.", "The patient was treated conservatively.", "There were no signs of hepatic failure.", "During observation, hepatic parameters were firstly elevated.", "After 14 days, hepatic parameters improved.", "The patient was discharged home with the recommendation to appear for follow-up examinations after six months.", "The patient did not appear for the visit.", "After 15 months, he wrote a message on Facebook to his practitioner asking if he had to report on a follow-up.", "A visit in the clinic was arranged for him.", "Hepatic parameters were normal.", "Testing towards the hepatitis B antigen was negative.", "Chronic HBV infection was excluded.", "The extended interview revealed a urinary tract infection a year before.", "The extended interview revealed unprotected sexual encounters of both homo and heterosexual relations.", "During physical examination, a small ulcer around his anus was found.", "Additional tests for HIV, syphilis, gonorrhoea, and chlamydia trachomatis were ordered.", "All tests were negative except for syphilis.", "Due to risky sexual behaviour, the patient was offered pre-exposure prophylaxis.", "The patient applied for further treatment of syphilis to the Clinic of Dermatology and Venereology in Warsaw."], "summary_subclaims": ["The patient is a 16-year-old Ukrainian boy.", "The patient had acute hepatitis B.", "The patient had not been previously vaccinated against hepatitis B.", "Possible sources of infection included a tattoo made at home.", "Possible sources of infection included a finger cut made with hairdresser scissors during work.", "Possible sources of infection included unprotected sexual encounters.", "The clinical course of the disease was typical with jaundice.", "The clinical course of the disease was typical with elevated aminotransferases levels.", "There was no liver failure.", "During the follow-up visit 16 months after the onset of the disease, chronic hepatitis B was excluded.", "An ulcer around his anus was found.", "Additional tests for sexually transmitted diseases were ordered.", "The tests were positive for syphilis.", "The extended interview revealed that the patient had several unprotected bisexual encounters.", "The patient's unprotected bisexual encounters may have indicated a potential source of infections including the hepatitis B virus."]}, "extra_info": {"fulltext_subclaims": ["A 16-year-old Ukrainian boy was admitted to the Department of Children\u2019s Infectious Diseases in Warsaw, Poland.", "The boy had jaundice lasting for four days.", "The boy had malaise.", "The boy had diarrhoea.", "The boy had vomiting.", "The boy had lived in Poland for 1.5 years.", "The boy was working (training) in the profession of a hairdresser.", "The boy had a tattoo made at home by his mother\u2019s partner six months earlier.", "The boy had a finger cut by hairdressing scissors six weeks before the admission.", "The patient confirmed that he had two secured heterosexual encounters during the last six months.", "In Ukraine, he had been vaccinated against tuberculosis, diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, and rubella.", "He has not been vaccinated against hepatitis B.", "He negated any dietary errors.", "He had never had blood transfusion nor surgery.", "He was once hospitalized due to acute gastroenteritis in Ukraine.", "The physical examination revealed jaundice.", "The physical examination revealed hepatomegaly (2 cm below the rib arch).", "The physical examination revealed a tattoo on the right forearm.", "Laboratory tests showed a significantly elevated level of aminotransferases.", "Alanine aminotransferase (ALT) was 2439 IU/L.", "Aspartate aminotransferase (AST) was 1418 IU/L.", "Serological testing was positive for HBsAg.", "Serological testing was positive for anti-Hbc IgM antibodies.", "Serological testing was negative for hepatitis A and hepatitis C viruses.", "The HBV viral load was 5.82 copies/mL.", "HBV genotype A was confirmed.", "Acute hepatitis B was diagnosed.", "The patient was treated conservatively.", "There were no signs of hepatic failure.", "During observation, hepatic parameters were firstly elevated.", "After 14 days, hepatic parameters improved.", "The patient was discharged home with the recommendation to appear for follow-up examinations after six months.", "The patient did not appear for the visit.", "After 15 months, he wrote a message on Facebook to his practitioner asking if he had to report on a follow-up.", "A visit in the clinic was arranged for him.", "Hepatic parameters were normal.", "Testing towards the hepatitis B antigen was negative.", "Chronic HBV infection was excluded.", "The extended interview revealed a urinary tract infection a year before.", "The extended interview revealed unprotected sexual encounters of both homo and heterosexual relations.", "During physical examination, a small ulcer around his anus was found.", "Additional tests for HIV, syphilis, gonorrhoea, and chlamydia trachomatis were ordered.", "All tests were negative except for syphilis.", "Due to risky sexual behaviour, the patient was offered pre-exposure prophylaxis.", "The patient applied for further treatment of syphilis to the Clinic of Dermatology and Venereology in Warsaw."], "index": 123, "original_id": "multiclinsum_test_3310_en.txt", "split": "test", "summary_subclaims": ["The patient is a 16-year-old Ukrainian boy.", "The patient had acute hepatitis B.", "The patient had not been previously vaccinated against hepatitis B.", "Possible sources of infection included a tattoo made at home.", "Possible sources of infection included a finger cut made with hairdresser scissors during work.", "Possible sources of infection included unprotected sexual encounters.", "The clinical course of the disease was typical with jaundice.", "The clinical course of the disease was typical with elevated aminotransferases levels.", "There was no liver failure.", "During the follow-up visit 16 months after the onset of the disease, chronic hepatitis B was excluded.", "An ulcer around his anus was found.", "Additional tests for sexually transmitted diseases were ordered.", "The tests were positive for syphilis.", "The extended interview revealed that the patient had several unprotected bisexual encounters.", "The patient's unprotected bisexual encounters may have indicated a potential source of infections including the hepatitis B virus."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 78-year-old male.", "The patient had 5 months of intermittent cervicalgia.", "The patient had several weeks of a progressive right hemiparesis, up to hemiplegia (0/5).", "The patient had brisk upper and lower extremity reflexes.", "The patient had bilateral Hoffmann\u2019s and Babinski signs.", "The patient had left hemisensory dysesthesias.", "The patient had urinary incontinence.", "The cervical spinal MRI revealed an intramedullary expansive lesion (10 mm\u00d715 mm) at C1\u2013C2.", "The lesion at C1\u2013C2 markedly enhanced with gadolinium.", "A total body CT scan was performed.", "The CT scan revealed a large mass (about 85 mm in size) involving the upper polar region and the middle third of the right kidney.", "The mass extended to the adrenal gland.", "The mass extended to the ipsilateral psoas muscle.", "A CT-guided fine-needle ago-biopsy established the diagnosis of an RCC.", "The C1\u2013C2 lesion was most likely an RCC metastasis.", "A C1\u2013C2 laminectomy was performed.", "Intraoperative neurophysiological monitoring was used.", "The lesion was macroscopically fully resected.", "Postoperatively, the patient had a slight motor improvement.", "The right hemiparesis improved to 2/5.", "The histological examination revealed large cells with marked anaplasia.", "Immunostaining was negative for cytokeratin.", "Immunostaining was negative for GFAP.", "Immunostaining was negative for S-100.", "Immunostaining was negative for HMB-45.", "Immunostaining was positive for intermediate vimentin filaments.", "The histological and immunostaining studies confirmed the diagnosis of an RCC.", "The 1-week postoperative cervical spine MRI showed postoperative changes.", "The 1-week postoperative MRI showed full lesion excision.", "The patient was discharged to a neuromotor rehabilitation center.", "The patient underwent chemotherapy and radiotherapy for RCC.", "Fourteen months later, the patient died due to metastatic RCC."], "summary_subclaims": ["The patient is a 78-year-old male.", "The patient had intermittent cervicalgia of 5 months duration.", "The patient had progressive severe right hemiparesis for a few weeks.", "The MRI revealed an intramedullary expansive lesion at the C1-C2 level.", "The lesion measured 10 mm\u00d715 mm.", "The lesion readily enhanced with contrast.", "The CT scan documented an 85 mm mass involving the right kidney.", "The mass extended to the ipsilateral adrenal gland.", "The mass posteriorly infiltrated the ipsilateral psoas muscle.", "The CT-guided fine-needle biopsy confirmed the diagnosis of an RCC.", "The RCC was Stage IV.", "The patient underwent total surgical removal of the C1-C2 intramedullary mass.", "After surgery, the patient exhibited a slight motor improvement.", "The right hemiparesis was 2/5 after surgery.", "The patient died after 14 months.", "The cause of death was global RCC tumor progression."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 78-year-old male.", "The patient had 5 months of intermittent cervicalgia.", "The patient had several weeks of a progressive right hemiparesis, up to hemiplegia (0/5).", "The patient had brisk upper and lower extremity reflexes.", "The patient had bilateral Hoffmann\u2019s and Babinski signs.", "The patient had left hemisensory dysesthesias.", "The patient had urinary incontinence.", "The cervical spinal MRI revealed an intramedullary expansive lesion (10 mm\u00d715 mm) at C1\u2013C2.", "The lesion at C1\u2013C2 markedly enhanced with gadolinium.", "A total body CT scan was performed.", "The CT scan revealed a large mass (about 85 mm in size) involving the upper polar region and the middle third of the right kidney.", "The mass extended to the adrenal gland.", "The mass extended to the ipsilateral psoas muscle.", "A CT-guided fine-needle ago-biopsy established the diagnosis of an RCC.", "The C1\u2013C2 lesion was most likely an RCC metastasis.", "A C1\u2013C2 laminectomy was performed.", "Intraoperative neurophysiological monitoring was used.", "The lesion was macroscopically fully resected.", "Postoperatively, the patient had a slight motor improvement.", "The right hemiparesis improved to 2/5.", "The histological examination revealed large cells with marked anaplasia.", "Immunostaining was negative for cytokeratin.", "Immunostaining was negative for GFAP.", "Immunostaining was negative for S-100.", "Immunostaining was negative for HMB-45.", "Immunostaining was positive for intermediate vimentin filaments.", "The histological and immunostaining studies confirmed the diagnosis of an RCC.", "The 1-week postoperative cervical spine MRI showed postoperative changes.", "The 1-week postoperative MRI showed full lesion excision.", "The patient was discharged to a neuromotor rehabilitation center.", "The patient underwent chemotherapy and radiotherapy for RCC.", "Fourteen months later, the patient died due to metastatic RCC."], "index": 122, "original_id": "multiclinsum_test_2110_en.txt", "split": "test", "summary_subclaims": ["The patient is a 78-year-old male.", "The patient had intermittent cervicalgia of 5 months duration.", "The patient had progressive severe right hemiparesis for a few weeks.", "The MRI revealed an intramedullary expansive lesion at the C1-C2 level.", "The lesion measured 10 mm\u00d715 mm.", "The lesion readily enhanced with contrast.", "The CT scan documented an 85 mm mass involving the right kidney.", "The mass extended to the ipsilateral adrenal gland.", "The mass posteriorly infiltrated the ipsilateral psoas muscle.", "The CT-guided fine-needle biopsy confirmed the diagnosis of an RCC.", "The RCC was Stage IV.", "The patient underwent total surgical removal of the C1-C2 intramedullary mass.", "After surgery, the patient exhibited a slight motor improvement.", "The right hemiparesis was 2/5 after surgery.", "The patient died after 14 months.", "The cause of death was global RCC tumor progression."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 63-year-old man.", "The patient is Caucasian.", "The patient has non-ischemic dilated cardiomyopathy.", "The patient did not drink alcohol.", "The patient did not smoke tobacco.", "The patient did not have diabetes.", "The patient had an implantable cardioverter defibrillator implanted.", "The patient was in New York Heart Association (NYHA) IV class.", "The patient had left bundle branch block (LBBB; QRS duration of 145\u2009ms).", "The patient was referred for CRT-D upgrade.", "The patient was awaiting cardiac transplantation.", "The patient was receiving optimal medical therapy.", "The patient was receiving b-Blockade.", "The patient was receiving loop-diuretic.", "The patient was receiving angiotensin-converting enzyme (ACE) inhibitor.", "The patient was receiving K-sparing agent.", "The patient was receiving ivabradine.", "Standard clinical imaging protocol revealed a dilated left ventricle.", "The end-systolic volume (ESV) was 380\u2009ml.", "The ejection fraction (EF) was 4.8% as measured by the modified Simpson\u2019s method.", "Severe functional mitral regurgitation (FMR) was assessed by qualitative estimation with two-dimensional color flow Doppler approach.", "The FMR showed a very large central jet.", "The FMR jet reached the posterior wall of the left atrium.", "The patient underwent the implant of a CRT-D device.", "A quadripolar left ventricular (LV) lead was placed in the posterolateral branch of the coronary sinus.", "The right ventricle (RV)-to-LV electrical delay was recorded at each of the four LV rings.", "The A1 unipolar vector was chosen for LV pacing.", "The greatest electrical delay was 80\u2009ms.", "At 13-day post-implant follow-up, the patient showed worsening heart failure (HF) symptoms.", "Only A2 unipolar LV vector configuration was suitable for simultaneous biventricular activation.", "The interventricular (VV) interval was 0\u2009ms.", "Echo-PIV was used during the acute study with contrast agent bubbles.", "Echo-PIV evaluated the orientation and relative magnitude of blood-induced intraventricular forces.", "Without pacing stimulation (CRT OFF), the intraventricular flow was dominated by rotation.", "The intraventricular forces were predominantly transverse.", "The mean angle \u03c6 was 55.6\u00b0.", "A first setting option (CRT ON, VV delay 0\u2009ms) changed the orientation of intraventricular forces.", "The angle \u03c6 was reduced to 45\u00b0.", "Increasing the delay (CRT ON, VV delay \u2212\u200930\u2009ms) improved the alignment.", "The angle \u03c6 was reduced to 40.3\u00b0.", "Sequential biventricular activation with delay \u2212\u200950\u2009ms provided the best alignment.", "The angle \u03c6 was 38.8\u00b0.", "No reduction of FMR by three-dimensional FVCD was observed.", "The data acquisition time for each three-dimensional color Doppler data set was approximately 5\u2009seconds.", "The analysis of average regurgitation volume took less than 3\u2009minutes.", "Automated anatomy detection of the LV endocardial border, mitral annulus (MA), LV outflow (LVOT), and placement of three-dimensional hemispheric flow sampling planes in the MA and LVOT was performed.", "The software of three-dimensional FVCD computed the flow volumes as the area under the curve of both the MA and LVOT flow in three cardiac cycles.", "FMR volume was calculated by subtracting LVOT stroke volume from MA stroke volume.", "At 6-month follow-up, the patient showed an improvement of NYHA class to III.", "The LV EF improved to 26.6%.", "The ESV was reduced to 288\u2009ml.", "Persistent improvement of diastolic function was obtained.", "A significant reduction of FMR (mean value regurgitant volume, 42.2\u2009ml) was estimated.", "The intraventricular forces estimated by echo-PIV were still partially dominated by the longitudinal path of pressure gradient.", "The mean angle \u03c6 was 43.1\u00b0."], "summary_subclaims": ["The patient is a 63-year-old man.", "The patient is Caucasian.", "The patient showed worsening heart failure symptoms a few days after an implant.", "The two technologies are used in combination during acute echocardiographic optimization of left pacing vector.", "The effect of the device\u2019s optimization is assessed at 6-month follow-up."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 63-year-old man.", "The patient is Caucasian.", "The patient has non-ischemic dilated cardiomyopathy.", "The patient did not drink alcohol.", "The patient did not smoke tobacco.", "The patient did not have diabetes.", "The patient had an implantable cardioverter defibrillator implanted.", "The patient was in New York Heart Association (NYHA) IV class.", "The patient had left bundle branch block (LBBB; QRS duration of 145\u2009ms).", "The patient was referred for CRT-D upgrade.", "The patient was awaiting cardiac transplantation.", "The patient was receiving optimal medical therapy.", "The patient was receiving b-Blockade.", "The patient was receiving loop-diuretic.", "The patient was receiving angiotensin-converting enzyme (ACE) inhibitor.", "The patient was receiving K-sparing agent.", "The patient was receiving ivabradine.", "Standard clinical imaging protocol revealed a dilated left ventricle.", "The end-systolic volume (ESV) was 380\u2009ml.", "The ejection fraction (EF) was 4.8% as measured by the modified Simpson\u2019s method.", "Severe functional mitral regurgitation (FMR) was assessed by qualitative estimation with two-dimensional color flow Doppler approach.", "The FMR showed a very large central jet.", "The FMR jet reached the posterior wall of the left atrium.", "The patient underwent the implant of a CRT-D device.", "A quadripolar left ventricular (LV) lead was placed in the posterolateral branch of the coronary sinus.", "The right ventricle (RV)-to-LV electrical delay was recorded at each of the four LV rings.", "The A1 unipolar vector was chosen for LV pacing.", "The greatest electrical delay was 80\u2009ms.", "At 13-day post-implant follow-up, the patient showed worsening heart failure (HF) symptoms.", "Only A2 unipolar LV vector configuration was suitable for simultaneous biventricular activation.", "The interventricular (VV) interval was 0\u2009ms.", "Echo-PIV was used during the acute study with contrast agent bubbles.", "Echo-PIV evaluated the orientation and relative magnitude of blood-induced intraventricular forces.", "Without pacing stimulation (CRT OFF), the intraventricular flow was dominated by rotation.", "The intraventricular forces were predominantly transverse.", "The mean angle \u03c6 was 55.6\u00b0.", "A first setting option (CRT ON, VV delay 0\u2009ms) changed the orientation of intraventricular forces.", "The angle \u03c6 was reduced to 45\u00b0.", "Increasing the delay (CRT ON, VV delay \u2212\u200930\u2009ms) improved the alignment.", "The angle \u03c6 was reduced to 40.3\u00b0.", "Sequential biventricular activation with delay \u2212\u200950\u2009ms provided the best alignment.", "The angle \u03c6 was 38.8\u00b0.", "No reduction of FMR by three-dimensional FVCD was observed.", "The data acquisition time for each three-dimensional color Doppler data set was approximately 5\u2009seconds.", "The analysis of average regurgitation volume took less than 3\u2009minutes.", "Automated anatomy detection of the LV endocardial border, mitral annulus (MA), LV outflow (LVOT), and placement of three-dimensional hemispheric flow sampling planes in the MA and LVOT was performed.", "The software of three-dimensional FVCD computed the flow volumes as the area under the curve of both the MA and LVOT flow in three cardiac cycles.", "FMR volume was calculated by subtracting LVOT stroke volume from MA stroke volume.", "At 6-month follow-up, the patient showed an improvement of NYHA class to III.", "The LV EF improved to 26.6%.", "The ESV was reduced to 288\u2009ml.", "Persistent improvement of diastolic function was obtained.", "A significant reduction of FMR (mean value regurgitant volume, 42.2\u2009ml) was estimated.", "The intraventricular forces estimated by echo-PIV were still partially dominated by the longitudinal path of pressure gradient.", "The mean angle \u03c6 was 43.1\u00b0."], "index": 126, "original_id": "multiclinsum_test_3317_en.txt", "split": "test", "summary_subclaims": ["The patient is a 63-year-old man.", "The patient is Caucasian.", "The patient showed worsening heart failure symptoms a few days after an implant.", "The two technologies are used in combination during acute echocardiographic optimization of left pacing vector.", "The effect of the device\u2019s optimization is assessed at 6-month follow-up."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 68-year-old man was admitted to our hospital with dyspnea and general fatigue in July 2018.", "He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy.", "The patient had a history of severe coronary heart disease.", "The patient had chronic kidney disease (CKD Stage II-III).", "During his last hospitalization in 2017, coronary angiography showed severe triple vessel coronary artery disease.", "He refused revascularization therapy.", "Holter revealed paroxysmal ventricular tachycardia and frequent ventricular premature beats.", "He received implantable cardioverter defibrillator (ICD) treatment.", "Aspirin, atorvastatin, furosemide, spironolactone, perindopril, and metoprolol were taken regularly at home.", "On the current admission, his blood pressure was 135/82 mmHg.", "On the current admission, his heart rate was 75 beats/min.", "A S3 and systolic murmur were identified.", "Inspiratory moist rales were found in the bilateral lung fields.", "Slight edema of both lower limbs was noted.", "Serum creatinine was 160 umol/L.", "Estimated glomerular filtration rate was 38 ml/min/1.73 m2.", "NT-proBNP was 25,000 pg/mL.", "Cardiac troponin was 0.11 ng/mL.", "Electrocardiogram revealed a sinus rhythm with a heart rate of 75 beats per minute.", "Chest X-ray showed cardiomegaly.", "Chest X-ray showed left small pleural effusion.", "Echocardiography demonstrated severe left ventricular enlargement.", "Left ventricular ejection fraction was 28%.", "The patient was diagnosed with acute decompensated heart failure caused by volume overload.", "Intravenous loop diuretics and nesiritide were administered.", "The patient was insensitive to intravenous diuretics.", "The patient's clinical symptoms did not improve significantly.", "Diuretic resistance could be considered.", "Low-dose TLV (7.5 mg qd) was performed on day 3.", "The administration of TLV dramatically relieved dyspnea.", "The administration of TLV increased urinary output.", "After 3 days of TLV treatment, the patient became delirious.", "His limbs shook uncontrollably.", "Serum sodium was 173 mmol/L.", "Severe hypernatremia was diagnosed.", "We suspected a high sensitivity to the side effect of TLV.", "We stopped the use of TLV.", "Gastric tube was inserted orally to increase the intake of fresh water.", "Serum sodium was restored to normal (135 mmol/L) on day 10.", "Serum creatinine was 104 umol/L.", "Estimated glomerular filtration rate was 62 ml/min/1.73 m2.", "NT-proBNP was 3280 pg/mL.", "The patient remained insensitive to intravenous diuretics.", "We tried again to use a lower dose of TLV (3.75 mg qd).", "Serum sodium rose again (162 mmol/L).", "We confirmed that hypernatremia was caused by TLV.", "After the suspension of TLV, his serum sodium decreased to 138 mmol/L.", "Psychiatric symptoms recovered.", "We had to give the patient a larger dose of intravenous loop diuresis.", "The patient was discharged on the 21st day after admission.", "After hospital discharge, the patient eventually died of cardiac arrest due to critically ill heart failure."], "summary_subclaims": ["A 68-year-old man was admitted to our hospital with dyspea and general fatigue.", "He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy.", "Low-dose TLV (7.5\u200amg qd) was performed.", "After the 3-day treatment using TLV, he became delirious and his limbs shook uncontrollably.", "High serum sodium 173 mmol/L was noted compared to the results of the first examination (137 mmol/L).", "After intensive rescue, serum sodium was restored to normal (135\u200amol/L).", "When the patient refused continuous renal replacement therapy (CRRT), we tried again to use a lower dose of TLV to improve diuretic resistance.", "Two days later, serum sodium rose again (162\u200amol/L).", "During the course of therapy, we did not strictly require the patient to control the fluid intake.", "No other medication could cause elevation of serum sodium.", "We suspected a high sensitivity to the side effect of TLV.", "Stop the use of TLV and encourage the patient to drink plenty of water.", "Gastric tube was inserted orally to increase the intake of fresh water.", "His serum sodium decreased gradually and his psychiatric symptom recovered.", "During this period, overall condition of the patient was stable.", "After being discharged from the hospital, the patient eventually died of cardiac arrest due to critically ill heart failure."]}, "extra_info": {"fulltext_subclaims": ["A 68-year-old man was admitted to our hospital with dyspnea and general fatigue in July 2018.", "He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy.", "The patient had a history of severe coronary heart disease.", "The patient had chronic kidney disease (CKD Stage II-III).", "During his last hospitalization in 2017, coronary angiography showed severe triple vessel coronary artery disease.", "He refused revascularization therapy.", "Holter revealed paroxysmal ventricular tachycardia and frequent ventricular premature beats.", "He received implantable cardioverter defibrillator (ICD) treatment.", "Aspirin, atorvastatin, furosemide, spironolactone, perindopril, and metoprolol were taken regularly at home.", "On the current admission, his blood pressure was 135/82 mmHg.", "On the current admission, his heart rate was 75 beats/min.", "A S3 and systolic murmur were identified.", "Inspiratory moist rales were found in the bilateral lung fields.", "Slight edema of both lower limbs was noted.", "Serum creatinine was 160 umol/L.", "Estimated glomerular filtration rate was 38 ml/min/1.73 m2.", "NT-proBNP was 25,000 pg/mL.", "Cardiac troponin was 0.11 ng/mL.", "Electrocardiogram revealed a sinus rhythm with a heart rate of 75 beats per minute.", "Chest X-ray showed cardiomegaly.", "Chest X-ray showed left small pleural effusion.", "Echocardiography demonstrated severe left ventricular enlargement.", "Left ventricular ejection fraction was 28%.", "The patient was diagnosed with acute decompensated heart failure caused by volume overload.", "Intravenous loop diuretics and nesiritide were administered.", "The patient was insensitive to intravenous diuretics.", "The patient's clinical symptoms did not improve significantly.", "Diuretic resistance could be considered.", "Low-dose TLV (7.5 mg qd) was performed on day 3.", "The administration of TLV dramatically relieved dyspnea.", "The administration of TLV increased urinary output.", "After 3 days of TLV treatment, the patient became delirious.", "His limbs shook uncontrollably.", "Serum sodium was 173 mmol/L.", "Severe hypernatremia was diagnosed.", "We suspected a high sensitivity to the side effect of TLV.", "We stopped the use of TLV.", "Gastric tube was inserted orally to increase the intake of fresh water.", "Serum sodium was restored to normal (135 mmol/L) on day 10.", "Serum creatinine was 104 umol/L.", "Estimated glomerular filtration rate was 62 ml/min/1.73 m2.", "NT-proBNP was 3280 pg/mL.", "The patient remained insensitive to intravenous diuretics.", "We tried again to use a lower dose of TLV (3.75 mg qd).", "Serum sodium rose again (162 mmol/L).", "We confirmed that hypernatremia was caused by TLV.", "After the suspension of TLV, his serum sodium decreased to 138 mmol/L.", "Psychiatric symptoms recovered.", "We had to give the patient a larger dose of intravenous loop diuresis.", "The patient was discharged on the 21st day after admission.", "After hospital discharge, the patient eventually died of cardiac arrest due to critically ill heart failure."], "index": 124, "original_id": "multiclinsum_test_3307_en.txt", "split": "test", "summary_subclaims": ["A 68-year-old man was admitted to our hospital with dyspea and general fatigue.", "He was diagnosed with acute decompensated heart failure due to ischemic cardiomyopathy.", "Low-dose TLV (7.5\u200amg qd) was performed.", "After the 3-day treatment using TLV, he became delirious and his limbs shook uncontrollably.", "High serum sodium 173 mmol/L was noted compared to the results of the first examination (137 mmol/L).", "After intensive rescue, serum sodium was restored to normal (135\u200amol/L).", "When the patient refused continuous renal replacement therapy (CRRT), we tried again to use a lower dose of TLV to improve diuretic resistance.", "Two days later, serum sodium rose again (162\u200amol/L).", "During the course of therapy, we did not strictly require the patient to control the fluid intake.", "No other medication could cause elevation of serum sodium.", "We suspected a high sensitivity to the side effect of TLV.", "Stop the use of TLV and encourage the patient to drink plenty of water.", "Gastric tube was inserted orally to increase the intake of fresh water.", "His serum sodium decreased gradually and his psychiatric symptom recovered.", "During this period, overall condition of the patient was stable.", "After being discharged from the hospital, the patient eventually died of cardiac arrest due to critically ill heart failure."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["An 84-year-old white male presented with a pale, ulcerated lesion (1.3 cm in diameter) on the middle of his lower lip.", "There was no associated lymphadenopathy.", "An excisional biopsy was performed.", "Histopathological and immunoistochemical features revealed a Merkel cell carcinoma.", "The excision was incomplete.", "The patient was scheduled for a wider excision in the following 2 months.", "The lesion recurred.", "The patient returned with a protruding white lesion of 1.1 cm in diameter.", "A wider excision, with an 8 mm margin, was performed.", "Histopathology confirmed the nature of MCC.", "The second excision was within healthy margins.", "Two months later, the patient was referred to the Department of Plastic Surgery.", "The patient had a protruding ulcerated lesion, 3 cm in diameter, on his lower lip.", "Multiple palpable lymph nodes in the submandibular and cervical area were present.", "The patient had been diagnosed with chronic lymphocytic leukemia 8 years earlier.", "The patient did not receive any treatment for CLL.", "A CT scan showed a soft tissue lobular mass, 3 cm in diameter, on the lower lip.", "The mass had a possible extension to the mandible.", "A W-excision (4 \u00d7 3.5 \u00d7 1 cm) of the lip lesion was performed.", "An open biopsy of one submandibular lymph node was performed.", "Histopathology confirmed recurrence of MCC.", "An undifferentiated small cell carcinoma with hyaluronated stroma was identified.", "The cells arranged in nodules or rosettes.", "The cells had dense nuclear chromatin, with mitoses and nuclear debris.", "Immunoistochemical procedures showed Neuron Specific Enolase (NSE) positivity.", "Antibodies for Epithelial Membrane Antigen (EMA) and Chromogranin were negative.", "The excision was described as complete.", "The submandibular lymph node was positive for malignancy.", "The lymph node was associated with the CLL (non Hodgkin's, B cell small lymphocytic lymphoma).", "There was no evidence of metastatic infiltration by MCC.", "This was confirmed immunoistochemically with the positive expression of CD5 and CD20 antibody.", "The expression of CD10 antibody and NSE was negative.", "Due to the age of the patient, chemotherapy was not considered.", "A month later, a new CT scan depicted a soft tissue mass consistent with recurrence of MCC.", "Multiple enlarged superficial and deep cervical lymph nodes were present.", "Fine needle aspiration of the submandibular swelling was performed.", "FNA confirmed MCC.", "The patient underwent one month of neck radiotherapy with Cobalt 60.", "A total dose of 4600cGy in 23 days was administered.", "A further boost of 600cGy in 2 days on the left submandibular area was administered.", "The treatment was successfully completed with full remission of the cervical lymphadenopathy.", "Two months following the radiotherapy, a new CT scan showed reduction and obscurrence of the pre-existing mass on the left mandibular area.", "The lymph nodes were smaller.", "The patient is on regular follow up.", "The CLL status is stable.", "There is no evidence of progression or further recurrence of MCC 9 months post-radiotherapy."], "summary_subclaims": ["The patient is an 84-year-old male.", "The patient had an aggressively recurrent form of MCC on the lower lip.", "The patient had an 8-year history of untreated CLL.", "During the recurrences of MCC, coexisting regional lymphadenopathy posed a problem in the differential diagnosis.", "Histopathology and immunoistochemistry showed submandibular lymphadenopathy coexisting with the second recurrence of MCC.", "The submandibular lymphadenopathy was due to B-cell small lymphocytic lymphoma.", "The subsequent recurrence of the skin tumor involved the superficial and deep cervical lymph nodes.", "Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies."]}, "extra_info": {"fulltext_subclaims": ["An 84-year-old white male presented with a pale, ulcerated lesion (1.3 cm in diameter) on the middle of his lower lip.", "There was no associated lymphadenopathy.", "An excisional biopsy was performed.", "Histopathological and immunoistochemical features revealed a Merkel cell carcinoma.", "The excision was incomplete.", "The patient was scheduled for a wider excision in the following 2 months.", "The lesion recurred.", "The patient returned with a protruding white lesion of 1.1 cm in diameter.", "A wider excision, with an 8 mm margin, was performed.", "Histopathology confirmed the nature of MCC.", "The second excision was within healthy margins.", "Two months later, the patient was referred to the Department of Plastic Surgery.", "The patient had a protruding ulcerated lesion, 3 cm in diameter, on his lower lip.", "Multiple palpable lymph nodes in the submandibular and cervical area were present.", "The patient had been diagnosed with chronic lymphocytic leukemia 8 years earlier.", "The patient did not receive any treatment for CLL.", "A CT scan showed a soft tissue lobular mass, 3 cm in diameter, on the lower lip.", "The mass had a possible extension to the mandible.", "A W-excision (4 \u00d7 3.5 \u00d7 1 cm) of the lip lesion was performed.", "An open biopsy of one submandibular lymph node was performed.", "Histopathology confirmed recurrence of MCC.", "An undifferentiated small cell carcinoma with hyaluronated stroma was identified.", "The cells arranged in nodules or rosettes.", "The cells had dense nuclear chromatin, with mitoses and nuclear debris.", "Immunoistochemical procedures showed Neuron Specific Enolase (NSE) positivity.", "Antibodies for Epithelial Membrane Antigen (EMA) and Chromogranin were negative.", "The excision was described as complete.", "The submandibular lymph node was positive for malignancy.", "The lymph node was associated with the CLL (non Hodgkin's, B cell small lymphocytic lymphoma).", "There was no evidence of metastatic infiltration by MCC.", "This was confirmed immunoistochemically with the positive expression of CD5 and CD20 antibody.", "The expression of CD10 antibody and NSE was negative.", "Due to the age of the patient, chemotherapy was not considered.", "A month later, a new CT scan depicted a soft tissue mass consistent with recurrence of MCC.", "Multiple enlarged superficial and deep cervical lymph nodes were present.", "Fine needle aspiration of the submandibular swelling was performed.", "FNA confirmed MCC.", "The patient underwent one month of neck radiotherapy with Cobalt 60.", "A total dose of 4600cGy in 23 days was administered.", "A further boost of 600cGy in 2 days on the left submandibular area was administered.", "The treatment was successfully completed with full remission of the cervical lymphadenopathy.", "Two months following the radiotherapy, a new CT scan showed reduction and obscurrence of the pre-existing mass on the left mandibular area.", "The lymph nodes were smaller.", "The patient is on regular follow up.", "The CLL status is stable.", "There is no evidence of progression or further recurrence of MCC 9 months post-radiotherapy."], "index": 128, "original_id": "multiclinsum_test_1953_en.txt", "split": "test", "summary_subclaims": ["The patient is an 84-year-old male.", "The patient had an aggressively recurrent form of MCC on the lower lip.", "The patient had an 8-year history of untreated CLL.", "During the recurrences of MCC, coexisting regional lymphadenopathy posed a problem in the differential diagnosis.", "Histopathology and immunoistochemistry showed submandibular lymphadenopathy coexisting with the second recurrence of MCC.", "The submandibular lymphadenopathy was due to B-cell small lymphocytic lymphoma.", "The subsequent recurrence of the skin tumor involved the superficial and deep cervical lymph nodes.", "Surgical excision followed by involved field radiation therapy has been proven effective for both malignancies."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical manifestations often emerging in the later stages of disease. Early intervention through biomarker monitoring, blood pressure control, and pharmacological management (e.g., RAS inhibitors) is critical to slow disease progression and preserve renal function.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 61-year-old White man.", "The patient is a non-smoker.", "The patient has a diagnosis of long-standing arterial hypertension of difficult control.", "The patient has severe heart failure with a left ventricular ejection fraction of 30%.", "The patient is receiving pharmacological treatment with carvedilol, ivabradine, and losartan.", "The patient has a history of stage IIIB chronic renal failure without dialysis therapy.", "A year before the current admission, he consulted for urinary symptoms.", "The urinary symptoms rapidly evolved to systemic compromise with fever, diaphoresis, low back pain, hypotension, dyspnea, and increased acute phase reactants.", "He required hospitalization in the intensive care unit for multidisciplinary treatment.", "The diagnosis was sepsis of urinary origin.", "Alterations in calcium behavior were detected.", "The alterations in calcium behavior were associated to the underlying renal disease.", "The alterations in calcium behavior were associated to a severe hyperparathyroidism secondary to a functional adenoma in the lower left parathyroid.", "The functional adenoma in the lower left parathyroid was treated with surgery.", "Surgery achieved control of symptoms and levels of calcium and phosphorus.", "Chest x-ray showed 2 lesions of tumor aspect with internal lytic areas in the fourth right and eighth left costal arches.", "The first lesion measured 25 \u00d7 21 mm with involvement of fourth right costal arch.", "The second lesion measured 77 \u00d7 54 mm in eighth left costal arch showing growth toward the left pleural cavity.", "Both lesions were suggestive of a tumor of chondral origin, enchondroma.", "It was not possible to rule out malignancy with the images.", "He was admitted in our institution for excisional biopsy.", "The physical examination revealed a thin patient with chronic disease.", "The physical examination revealed a deformity in the neck with anterior flexion pronounced by severe dorsal kyphoscoliosis.", "The physical examination revealed secondary asymmetry of the right ribcage, which was retracted with decreased intercostal spaces.", "He referred increased dyspnea with the activities of daily life, with NYHA functional class III.", "Blood pressure was 120/70 mm Hg.", "Heart rate was 100 beats per minute.", "Breathing frequency was 16 breaths per minute.", "There was no cyanosis.", "There was jugular engorgement at 90\u00b0.", "There were no neck masses.", "The heart was tachycardic and rhythmic with no murmurs or gallop.", "Breath sounds were decreased at both lung bases.", "The abdomen had no ascites or masses.", "The extremities had edema grade II.", "No identifiable lesions in the chest wall other than deformity by kyphoscoliosis were found.", "Blood work was unremarkable, except for mild anemia of normal volumes.", "Spirometry showed a moderate restrictive ventilatory pattern.", "There were no significant post-bronchodilator changes.", "Diffusing capacity of carbon monoxide was in normal limits (DLCO: 109%).", "The chronic kidney disease was stable.", "Thoracic computed tomography (CT) scan showed a heterogeneous rounded lytic lesion with sclerotic edges and growth toward the pulmonary cavity.", "The lesion was of expansive type, causing displacement of pulmonary parenchyma.", "The lesion measured approximately 77 \u00d7 54 mm and depended on the eighth left costal arch.", "It was very difficult to determine if the lung was surrounding the lesion or if the mass was infiltrating the parenchyma.", "In the fourth right costal arch, an image of similar characteristics, but smaller in size, was found, measuring 25 \u00d7 21 mm.", "A severe dorsal kyphoscoliosis was identified.", "No further studies were implemented.", "The decision was made to perform a surgical resection of the mass with the possibility of having to do a lobectomy.", "The patient was hospitalized in the intensive care unit for pre-surgical conditioning.", "A left ventricular ejection fraction of 30% was evidenced.", "A cycle of intravenous levosimendan was initiated.", "He received red blood cell transfusion.", "He underwent resection of the left costal mass by thoracoscopy.", "During the surgical procedure, only 1 hard lesion was found that involved the eighth rib and soft tissues of the seventh to ninth left ribs.", "The lesion did not infiltrate into the lung tissue or pleural cavity.", "Only partial resection of these 3 ribs was necessary.", "The right side was not intervened.", "In the immediate postsurgical period, the patient presented a difficult evolution.", "The patient had hemodynamic instability.", "The patient required vasoactive support with norepinephrine.", "The patient had prolonged mechanical ventilation.", "The patient needed a tracheostomy to assist a long-standing recovery process.", "Subsequently, it was possible to remove the vasoactive drugs.", "The invasive ventilatory support was removed.", "The tracheostomy was removed.", "The patient had complete physical and respiratory rehabilitation."], "summary_subclaims": ["The patient had a history of multiple diseases.", "Two tumor-like lesions with internal lytic areas were detected.", "One lesion was located in the fourth right costal arch.", "One lesion was located in the eighth left costal arc.", "Clinical manifestations were described.", "Radiological findings were described.", "Laboratory findings were described.", "Pathological results were described.", "The outcome was described."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 61-year-old White man.", "The patient is a non-smoker.", "The patient has a diagnosis of long-standing arterial hypertension of difficult control.", "The patient has severe heart failure with a left ventricular ejection fraction of 30%.", "The patient is receiving pharmacological treatment with carvedilol, ivabradine, and losartan.", "The patient has a history of stage IIIB chronic renal failure without dialysis therapy.", "A year before the current admission, he consulted for urinary symptoms.", "The urinary symptoms rapidly evolved to systemic compromise with fever, diaphoresis, low back pain, hypotension, dyspnea, and increased acute phase reactants.", "He required hospitalization in the intensive care unit for multidisciplinary treatment.", "The diagnosis was sepsis of urinary origin.", "Alterations in calcium behavior were detected.", "The alterations in calcium behavior were associated to the underlying renal disease.", "The alterations in calcium behavior were associated to a severe hyperparathyroidism secondary to a functional adenoma in the lower left parathyroid.", "The functional adenoma in the lower left parathyroid was treated with surgery.", "Surgery achieved control of symptoms and levels of calcium and phosphorus.", "Chest x-ray showed 2 lesions of tumor aspect with internal lytic areas in the fourth right and eighth left costal arches.", "The first lesion measured 25 \u00d7 21 mm with involvement of fourth right costal arch.", "The second lesion measured 77 \u00d7 54 mm in eighth left costal arch showing growth toward the left pleural cavity.", "Both lesions were suggestive of a tumor of chondral origin, enchondroma.", "It was not possible to rule out malignancy with the images.", "He was admitted in our institution for excisional biopsy.", "The physical examination revealed a thin patient with chronic disease.", "The physical examination revealed a deformity in the neck with anterior flexion pronounced by severe dorsal kyphoscoliosis.", "The physical examination revealed secondary asymmetry of the right ribcage, which was retracted with decreased intercostal spaces.", "He referred increased dyspnea with the activities of daily life, with NYHA functional class III.", "Blood pressure was 120/70 mm Hg.", "Heart rate was 100 beats per minute.", "Breathing frequency was 16 breaths per minute.", "There was no cyanosis.", "There was jugular engorgement at 90\u00b0.", "There were no neck masses.", "The heart was tachycardic and rhythmic with no murmurs or gallop.", "Breath sounds were decreased at both lung bases.", "The abdomen had no ascites or masses.", "The extremities had edema grade II.", "No identifiable lesions in the chest wall other than deformity by kyphoscoliosis were found.", "Blood work was unremarkable, except for mild anemia of normal volumes.", "Spirometry showed a moderate restrictive ventilatory pattern.", "There were no significant post-bronchodilator changes.", "Diffusing capacity of carbon monoxide was in normal limits (DLCO: 109%).", "The chronic kidney disease was stable.", "Thoracic computed tomography (CT) scan showed a heterogeneous rounded lytic lesion with sclerotic edges and growth toward the pulmonary cavity.", "The lesion was of expansive type, causing displacement of pulmonary parenchyma.", "The lesion measured approximately 77 \u00d7 54 mm and depended on the eighth left costal arch.", "It was very difficult to determine if the lung was surrounding the lesion or if the mass was infiltrating the parenchyma.", "In the fourth right costal arch, an image of similar characteristics, but smaller in size, was found, measuring 25 \u00d7 21 mm.", "A severe dorsal kyphoscoliosis was identified.", "No further studies were implemented.", "The decision was made to perform a surgical resection of the mass with the possibility of having to do a lobectomy.", "The patient was hospitalized in the intensive care unit for pre-surgical conditioning.", "A left ventricular ejection fraction of 30% was evidenced.", "A cycle of intravenous levosimendan was initiated.", "He received red blood cell transfusion.", "He underwent resection of the left costal mass by thoracoscopy.", "During the surgical procedure, only 1 hard lesion was found that involved the eighth rib and soft tissues of the seventh to ninth left ribs.", "The lesion did not infiltrate into the lung tissue or pleural cavity.", "Only partial resection of these 3 ribs was necessary.", "The right side was not intervened.", "In the immediate postsurgical period, the patient presented a difficult evolution.", "The patient had hemodynamic instability.", "The patient required vasoactive support with norepinephrine.", "The patient had prolonged mechanical ventilation.", "The patient needed a tracheostomy to assist a long-standing recovery process.", "Subsequently, it was possible to remove the vasoactive drugs.", "The invasive ventilatory support was removed.", "The tracheostomy was removed.", "The patient had complete physical and respiratory rehabilitation."], "index": 130, "original_id": "multiclinsum_test_2403_en.txt", "split": "test", "summary_subclaims": ["The patient had a history of multiple diseases.", "Two tumor-like lesions with internal lytic areas were detected.", "One lesion was located in the fourth right costal arch.", "One lesion was located in the eighth left costal arc.", "Clinical manifestations were described.", "Radiological findings were described.", "Laboratory findings were described.", "Pathological results were described.", "The outcome was described."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 56-year-old Caucasian male.", "He has a past medical history of hypertension.", "He has a past medical history of acute coronary syndrome.", "He has a past medical history of atrial fibrillation.", "He presented to the emergency department with acute epigastric pain.", "His complaints had started 2 weeks earlier.", "The pain had worsened 1 day prior to ED presentation.", "The pain was associated with nausea.", "The pain increased on inspiration.", "Defecation was normal.", "Micturition was normal.", "He was taking fenprocoumon.", "He was taking sotalol.", "He was taking antihypertensives.", "He was taking a statin.", "He was taking a proton-pump inhibitor.", "There was no history of trauma.", "Physical examination showed a pale man.", "Physical examination showed a sweating man.", "Physical examination showed an obese man.", "His blood pressure was 113/73 mmHg.", "His heart rate was 72 beats/min.", "His oxygen saturation was 95% on room air.", "His respiratory rate was 13 breaths/min.", "The abdomen was not distended.", "There were normal bowel sounds.", "He had epigastric tenderness.", "There was no muscular defence.", "There was no hepato-splenomegaly.", "His initial haemoglobin was 8.5 mmol/l.", "White blood cell count was 8.5 \u00d7 109/l.", "C-reactive protein was 26 mg/l.", "The international normalised ratio (INR) was 2.4.", "Abdominal ultrasound showed an inhomogeneous aspect of the spleen.", "Contrast-enhanced computed tomography (CT) imaging of the abdomen revealed splenic haemorrhage.", "Contrast-enhanced CT imaging showed subcapsular hematoma.", "An acute operation was deemed unnecessary.", "Oral anticoagulation was reversed with 10 mg vitamin K.", "The patient was admitted to the hospital for observation.", "The patient was discharged in good condition after 3 days."], "summary_subclaims": ["The patient is a 56-year-old male.", "The patient was on oral anticoagulation.", "The patient presented to the emergency department with epigastric pain.", "The patient had nausea.", "The patient had left upper quadrant tenderness.", "There was no history of trauma.", "Contrast-enhanced CT imaging revealed a large subcapsular haematoma of the spleen.", "Oral anticoagulation was antagonised with vitamin K.", "The patient was discharged in good condition after 3 days of clinical observation."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 56-year-old Caucasian male.", "He has a past medical history of hypertension.", "He has a past medical history of acute coronary syndrome.", "He has a past medical history of atrial fibrillation.", "He presented to the emergency department with acute epigastric pain.", "His complaints had started 2 weeks earlier.", "The pain had worsened 1 day prior to ED presentation.", "The pain was associated with nausea.", "The pain increased on inspiration.", "Defecation was normal.", "Micturition was normal.", "He was taking fenprocoumon.", "He was taking sotalol.", "He was taking antihypertensives.", "He was taking a statin.", "He was taking a proton-pump inhibitor.", "There was no history of trauma.", "Physical examination showed a pale man.", "Physical examination showed a sweating man.", "Physical examination showed an obese man.", "His blood pressure was 113/73 mmHg.", "His heart rate was 72 beats/min.", "His oxygen saturation was 95% on room air.", "His respiratory rate was 13 breaths/min.", "The abdomen was not distended.", "There were normal bowel sounds.", "He had epigastric tenderness.", "There was no muscular defence.", "There was no hepato-splenomegaly.", "His initial haemoglobin was 8.5 mmol/l.", "White blood cell count was 8.5 \u00d7 109/l.", "C-reactive protein was 26 mg/l.", "The international normalised ratio (INR) was 2.4.", "Abdominal ultrasound showed an inhomogeneous aspect of the spleen.", "Contrast-enhanced computed tomography (CT) imaging of the abdomen revealed splenic haemorrhage.", "Contrast-enhanced CT imaging showed subcapsular hematoma.", "An acute operation was deemed unnecessary.", "Oral anticoagulation was reversed with 10 mg vitamin K.", "The patient was admitted to the hospital for observation.", "The patient was discharged in good condition after 3 days."], "index": 92, "original_id": "multiclinsum_test_1095_en.txt", "split": "test", "summary_subclaims": ["The patient is a 56-year-old male.", "The patient was on oral anticoagulation.", "The patient presented to the emergency department with epigastric pain.", "The patient had nausea.", "The patient had left upper quadrant tenderness.", "There was no history of trauma.", "Contrast-enhanced CT imaging revealed a large subcapsular haematoma of the spleen.", "Oral anticoagulation was antagonised with vitamin K.", "The patient was discharged in good condition after 3 days of clinical observation."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 78-year-old Greek male.", "The patient was a smoker.", "The patient had a BMI of 25.7 kg/m2.", "The patient was classified as an ASA physical status grade III.", "The patient had osteoarthritis of the left hip.", "The patient was scheduled for an elective total hip replacement.", "The patient had hypertension.", "The patient had dyslipidemia.", "The patient had type II diabetes managed by oral metformin.", "The patient had a normal pre-operative echocardiography with an ejection fraction of 60%.", "The patient had no history of pulmonary disease.", "The patient had a total knee replacement in the past without complications.", "The patient's preoperative laboratory examination was within normal parameters.", "The patient was hemodynamically stable with blood pressure 137/67 mmHg, heart rate 77 bpm, and SpO2 99%.", "The anesthesia plan included combined lumbar epidural and spinal anesthesia.", "Standard monitoring including ECG, SpO2, and non-invasive blood pressure was commenced in the OR.", "An oxygen mask administering 6 lt/min was used throughout the procedure.", "The neuraxial spinal technique was performed by a second-year anesthesia trainee.", "The spinal block was performed at the L4-L5 intervertebral space using a midline approach.", "Local anesthesia with 5 ml of 2% lidocaine was used.", "An 18-Gauge Tuohy needle was used with a syringe filled with 8 ml of air.", "The epidural space was located after a single redirection of the needle.", "A needle-through-needle approach was used to locate the subarachnoid space.", "Cerebrospinal fluid flowed freely through the spinal needle.", "A mixture of 1.9 ml of ropivacaine 0.75% and 0.2 ml of fentanyl was introduced into the subarachnoid space.", "The epidural catheter was placed in the epidural space.", "The spinal block was confirmed using the temperature differentiation method.", "An arterial catheter was inserted in the radial artery.", "The patient was placed on the right lateral side with the left hip facing upwards.", "The patient received no intravenous anesthetic or analgesic medication.", "Approximately 2 hours after the spinal block, the patient's blood pressure dropped from 163/84 mmHg to 82/45 mmHg.", "The patient's heart rate decreased to 45 bpm.", "The patient felt dizziness.", "Sinus bradycardia was apparent on the ECG.", "The anesthesiologist administered 5 mg of ephedrine and 1 mg of phenylephrine.", "O2 administration was increased to 15 lt/min.", "Intravenous fluid administration was increased.", "There was no improvement in the patient's hemodynamic state.", "The patient's blood pressure dropped further to 55/35 mmHg.", "The patient became unresponsive.", "1 mg of adrenaline was given intravenously.", "This produced an immediate rise in blood pressure to 183/88 mmHg.", "Small 0.05 mg/ml boluses of nitroglycerin were administered.", "The patient's mental status returned to normal.", "A point of care echocardiogram demonstrated no new cardiac abnormalities.", "A CTPA was performed and was negative for pulmonary embolism.", "A chest and abdomen CT demonstrated air in the subcutaneous tissue, intermuscular space, spinal canal, and mediastinum.", "The patient was admitted to the PACU.", "The epidural catheter was removed.", "The patient was discharged home on the fifteenth postoperative day."], "summary_subclaims": ["A combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique.", "The patient was a 78-year-old Greek (Caucasian) male.", "The patient was undergoing a total hip replacement.", "The patient was hemodynamically stable throughout the operation.", "Two hours following epidural analgesia, the patient manifested a sudden drop in blood pressure and heart rate.", "The patient's drop in blood pressure and heart rate required the administration of adrenaline.", "A Computed Tomography scan demonstrated pneumomediastinum.", "A Computed Tomography scan demonstrated pneumorrachis.", "A Computed Tomography scan demonstrated paravertebral soft tissue emphysema.", "We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum.", "We believe that the movement of air stimulated the para-aortic ganglia.", "We believe that the stimulation caused parasympathetic stimulation.", "We believe that the parasympathetic stimulation caused hypotension and bradycardia."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 78-year-old Greek male.", "The patient was a smoker.", "The patient had a BMI of 25.7 kg/m2.", "The patient was classified as an ASA physical status grade III.", "The patient had osteoarthritis of the left hip.", "The patient was scheduled for an elective total hip replacement.", "The patient had hypertension.", "The patient had dyslipidemia.", "The patient had type II diabetes managed by oral metformin.", "The patient had a normal pre-operative echocardiography with an ejection fraction of 60%.", "The patient had no history of pulmonary disease.", "The patient had a total knee replacement in the past without complications.", "The patient's preoperative laboratory examination was within normal parameters.", "The patient was hemodynamically stable with blood pressure 137/67 mmHg, heart rate 77 bpm, and SpO2 99%.", "The anesthesia plan included combined lumbar epidural and spinal anesthesia.", "Standard monitoring including ECG, SpO2, and non-invasive blood pressure was commenced in the OR.", "An oxygen mask administering 6 lt/min was used throughout the procedure.", "The neuraxial spinal technique was performed by a second-year anesthesia trainee.", "The spinal block was performed at the L4-L5 intervertebral space using a midline approach.", "Local anesthesia with 5 ml of 2% lidocaine was used.", "An 18-Gauge Tuohy needle was used with a syringe filled with 8 ml of air.", "The epidural space was located after a single redirection of the needle.", "A needle-through-needle approach was used to locate the subarachnoid space.", "Cerebrospinal fluid flowed freely through the spinal needle.", "A mixture of 1.9 ml of ropivacaine 0.75% and 0.2 ml of fentanyl was introduced into the subarachnoid space.", "The epidural catheter was placed in the epidural space.", "The spinal block was confirmed using the temperature differentiation method.", "An arterial catheter was inserted in the radial artery.", "The patient was placed on the right lateral side with the left hip facing upwards.", "The patient received no intravenous anesthetic or analgesic medication.", "Approximately 2 hours after the spinal block, the patient's blood pressure dropped from 163/84 mmHg to 82/45 mmHg.", "The patient's heart rate decreased to 45 bpm.", "The patient felt dizziness.", "Sinus bradycardia was apparent on the ECG.", "The anesthesiologist administered 5 mg of ephedrine and 1 mg of phenylephrine.", "O2 administration was increased to 15 lt/min.", "Intravenous fluid administration was increased.", "There was no improvement in the patient's hemodynamic state.", "The patient's blood pressure dropped further to 55/35 mmHg.", "The patient became unresponsive.", "1 mg of adrenaline was given intravenously.", "This produced an immediate rise in blood pressure to 183/88 mmHg.", "Small 0.05 mg/ml boluses of nitroglycerin were administered.", "The patient's mental status returned to normal.", "A point of care echocardiogram demonstrated no new cardiac abnormalities.", "A CTPA was performed and was negative for pulmonary embolism.", "A chest and abdomen CT demonstrated air in the subcutaneous tissue, intermuscular space, spinal canal, and mediastinum.", "The patient was admitted to the PACU.", "The epidural catheter was removed.", "The patient was discharged home on the fifteenth postoperative day."], "index": 89, "original_id": "multiclinsum_test_2918_en.txt", "split": "test", "summary_subclaims": ["A combined lumbar epidural and spinal anesthesia was performed using the loss of resistance to air technique.", "The patient was a 78-year-old Greek (Caucasian) male.", "The patient was undergoing a total hip replacement.", "The patient was hemodynamically stable throughout the operation.", "Two hours following epidural analgesia, the patient manifested a sudden drop in blood pressure and heart rate.", "The patient's drop in blood pressure and heart rate required the administration of adrenaline.", "A Computed Tomography scan demonstrated pneumomediastinum.", "A Computed Tomography scan demonstrated pneumorrachis.", "A Computed Tomography scan demonstrated paravertebral soft tissue emphysema.", "We believe that injected air from the epidural space and surrounding tissues slowly moved towards the mediastinum.", "We believe that the movement of air stimulated the para-aortic ganglia.", "We believe that the stimulation caused parasympathetic stimulation.", "We believe that the parasympathetic stimulation caused hypotension and bradycardia."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was diagnosed with acquired aplastic anemia in December 2019.", "Cytogenetic studies showed 46XX karyotype.", "Chromosomal breakage study was normal.", "Paroxysmal nocturnal hemoglobinuria clone was absent.", "Clinical exome did not show any genetic mutation for inherited bone marrow failure syndrome.", "The patient had no matched sibling or matched unrelated donor.", "She received a haploidentical stem cell transplant in July 2020.", "The conditioning regimen included Rabbit ATG from Day-9 to Day-7.", "Fludarabine was given at 40 mg/m2 for 4 days (Day-6 to Day-3).", "Cyclophosphamide was given at 14.5 mg/kg for 2 days (Day-6 and Day-5).", "A single fraction TBI (400 cGy) was given on Day-1.", "On the day of transplantation, she received a peripheral blood stem cell graft from the father.", "The graft contained 10 million CD34+ cells/kg.", "The graft contained 2.41 \u00d7 108 CD3+ T cells/kg.", "Post-transplant Cyclophosphamide (50 mg/kg) was given on Day+3 and Day+4.", "Ciclosporin and Mycophenolate mofetil were started on Day+5 as GvHD prophylaxis.", "On Day+9, she developed high-grade fever with the onset of engraftment.", "Bone marrow showed haemophagocytosis.", "A diagnosis of Candida tropicalis-driven macrophage activation syndrome was established on Day+13.", "She was treated with caspofungin and posaconazole.", "She received intravenous immunoglobulin (1 g/kg for 5 days).", "She received intravenous Methylprednisolone (2 mg/kg).", "One dose of intravenous Alemtuzumab (0.1 mg/kg) was administered.", "The patient developed hypertension from Day+13.", "On Day+14, she had loose motions with abdominal pain.", "An ultrasound scan was suggestive of pan-colitis.", "Oral Budesonide was started for possible gut GvHD.", "The patient had neutrophil engraftment on Day+16.", "TA-TMA was suspected based on anemia, thrombocytopenia, hypertension, gastrointestinal bleeding, decreased serum albumin, and raised lactate dehydrogenase.", "Blood smear showed 1 fragmented RBC per high power field on Day+20.", "Urine protein:creatinine ratio was 0.47 on Day+20.", "Soluble C5b-9 assay is not available nationally.", "ADAMTS-13 activity was normal.", "The diagnosis of TA-TMA was confirmed based on the Overall-TMA criteria.", "Ciclosporin was discontinued.", "Inj Defibrotide was given from Day+21.", "There was no evidence of pathogenic variation in TMA-associated genes on clinical exome.", "Eculizumab was considered but not used due to cost.", "Narsoplimab was accessed through an expanded access program.", "Narsoplimab was commenced at a dose of 4 mg/kg twice a week on Day+30.", "Severe colitis with inflammatory thickening measuring 5.5 mm extending up to the caecum and base of the appendix was seen on ultrasound.", "She was started on a TNF-\u03b1 inhibitor (Etanercept).", "She developed pneumatosis coli after two doses of Etanercept.", "Etanercept was stopped.", "She continued to have significant intestinal bleeding.", "Narsoplimab was increased to thrice a week on Day+45.", "Her lactate dehydrogenase improved dramatically after starting Narsoplimab.", "Her haptoglobin normalized on Day+48.", "Her hypertension improved and antihypertensive requirement was reduced to a single medication from Day+59.", "Intestinal bleeding reduced from Day+50 and completely stopped on Day+82.", "Inj Methylprednisolone was tapered and stopped on Day+92.", "There were no schistocytes in the peripheral blood smear after Day+70.", "The patient received the last packed cell transfusion on Day+70.", "The patient received the last platelet transfusion on Day+77.", "Narsoplimab was reduced to twice a week on Day+109.", "Narsoplimab was reduced to once a week on Day+133.", "Narsoplimab was stopped on Day+195.", "The patient had CMV reactivation on Day+59 with CMV copy numbers of 16,500/ml.", "She received Inj Foscarnet for 2 weeks.", "CMV viremia resolved on Day+73.", "She had a herpes zoster skin infection on Day+111.", "The infection resolved with Acyclovir.", "The patient developed liver GvHD from Day+217.", "Tacrolimus was started from Day+217.", "Ruxolitinib was added from Day+237.", "She had severe reticulocytopenia secondary to parvovirus infection on Day+246.", "Parvovirus infection was managed with immunoglobulin infusion.", "She developed a second episode of TA-TMA.", "The second episode was manifested by circulating schistocytes, anemia, thrombocytopenia, low albumin, and an increase in lactate dehydrogenase and creatinine.", "Urine protein:creatinine ratio increased to 0.89.", "Tacrolimus was stopped.", "Steroids were started.", "Ruxolitinib was continued.", "Narsoplimab was started from Day+254.", "Narsoplimab was given twice a week for 3 weeks.", "Narsoplimab was escalated to thrice a week from Day+274.", "Narsoplimab was tapered to twice weekly from Day+290.", "Narsoplimab was stopped on Day+357.", "Liver GvHD resolved with steroids and Ruxolitinib.", "The patient is alive and well.", "The patient had no features of TA-TMA on the last follow-up of Day+650."], "summary_subclaims": ["The six-year-old girl underwent a human leucocyte antigen (HLA) haploidentical hematopoietic stem cell transplant using post-transplant Cyclophosphamide for severe aplastic anemia.", "In the second week of the transplant, the patient developed macrophage activation syndrome.", "The diagnosis of hepatosplenic candidiasis was made based on USG abdomen and blood fungal PCR.", "Candida-triggered macrophage activation syndrome responded to antifungals, steroids, intravenous immunoglobulin, and alemtuzumab.", "The patient developed hypertension in the 2nd week.", "The patient had high lactate dehydrogenase (1010\u2009U/L), schistocytes (5 per hpf), low haptoglobin (<\u20095\u2009mg/dl), thrombocytopenia, and anemia in the 3rd week.", "Ciclosporin was stopped.", "The patient was treated with 10\u2009days of defibrotide without response.", "The course was further complicated by the involvement of the gastrointestinal tract and kidneys.", "Narsoplimab was started in the 5th week of the transplant.", "A fall in lactate dehydrogenase was observed after starting Narsoplimab.", "The resolution of gastrointestinal symptoms, proteinuria, and recovery of cytopenia followed starting Narsoplimab.", "The second episode of TA-TMA occurred with parvoviraemia.", "The second episode of TA-TMA was successfully treated with Narsoplimab."]}, "extra_info": {"fulltext_subclaims": ["The patient was diagnosed with acquired aplastic anemia in December 2019.", "Cytogenetic studies showed 46XX karyotype.", "Chromosomal breakage study was normal.", "Paroxysmal nocturnal hemoglobinuria clone was absent.", "Clinical exome did not show any genetic mutation for inherited bone marrow failure syndrome.", "The patient had no matched sibling or matched unrelated donor.", "She received a haploidentical stem cell transplant in July 2020.", "The conditioning regimen included Rabbit ATG from Day-9 to Day-7.", "Fludarabine was given at 40 mg/m2 for 4 days (Day-6 to Day-3).", "Cyclophosphamide was given at 14.5 mg/kg for 2 days (Day-6 and Day-5).", "A single fraction TBI (400 cGy) was given on Day-1.", "On the day of transplantation, she received a peripheral blood stem cell graft from the father.", "The graft contained 10 million CD34+ cells/kg.", "The graft contained 2.41 \u00d7 108 CD3+ T cells/kg.", "Post-transplant Cyclophosphamide (50 mg/kg) was given on Day+3 and Day+4.", "Ciclosporin and Mycophenolate mofetil were started on Day+5 as GvHD prophylaxis.", "On Day+9, she developed high-grade fever with the onset of engraftment.", "Bone marrow showed haemophagocytosis.", "A diagnosis of Candida tropicalis-driven macrophage activation syndrome was established on Day+13.", "She was treated with caspofungin and posaconazole.", "She received intravenous immunoglobulin (1 g/kg for 5 days).", "She received intravenous Methylprednisolone (2 mg/kg).", "One dose of intravenous Alemtuzumab (0.1 mg/kg) was administered.", "The patient developed hypertension from Day+13.", "On Day+14, she had loose motions with abdominal pain.", "An ultrasound scan was suggestive of pan-colitis.", "Oral Budesonide was started for possible gut GvHD.", "The patient had neutrophil engraftment on Day+16.", "TA-TMA was suspected based on anemia, thrombocytopenia, hypertension, gastrointestinal bleeding, decreased serum albumin, and raised lactate dehydrogenase.", "Blood smear showed 1 fragmented RBC per high power field on Day+20.", "Urine protein:creatinine ratio was 0.47 on Day+20.", "Soluble C5b-9 assay is not available nationally.", "ADAMTS-13 activity was normal.", "The diagnosis of TA-TMA was confirmed based on the Overall-TMA criteria.", "Ciclosporin was discontinued.", "Inj Defibrotide was given from Day+21.", "There was no evidence of pathogenic variation in TMA-associated genes on clinical exome.", "Eculizumab was considered but not used due to cost.", "Narsoplimab was accessed through an expanded access program.", "Narsoplimab was commenced at a dose of 4 mg/kg twice a week on Day+30.", "Severe colitis with inflammatory thickening measuring 5.5 mm extending up to the caecum and base of the appendix was seen on ultrasound.", "She was started on a TNF-\u03b1 inhibitor (Etanercept).", "She developed pneumatosis coli after two doses of Etanercept.", "Etanercept was stopped.", "She continued to have significant intestinal bleeding.", "Narsoplimab was increased to thrice a week on Day+45.", "Her lactate dehydrogenase improved dramatically after starting Narsoplimab.", "Her haptoglobin normalized on Day+48.", "Her hypertension improved and antihypertensive requirement was reduced to a single medication from Day+59.", "Intestinal bleeding reduced from Day+50 and completely stopped on Day+82.", "Inj Methylprednisolone was tapered and stopped on Day+92.", "There were no schistocytes in the peripheral blood smear after Day+70.", "The patient received the last packed cell transfusion on Day+70.", "The patient received the last platelet transfusion on Day+77.", "Narsoplimab was reduced to twice a week on Day+109.", "Narsoplimab was reduced to once a week on Day+133.", "Narsoplimab was stopped on Day+195.", "The patient had CMV reactivation on Day+59 with CMV copy numbers of 16,500/ml.", "She received Inj Foscarnet for 2 weeks.", "CMV viremia resolved on Day+73.", "She had a herpes zoster skin infection on Day+111.", "The infection resolved with Acyclovir.", "The patient developed liver GvHD from Day+217.", "Tacrolimus was started from Day+217.", "Ruxolitinib was added from Day+237.", "She had severe reticulocytopenia secondary to parvovirus infection on Day+246.", "Parvovirus infection was managed with immunoglobulin infusion.", "She developed a second episode of TA-TMA.", "The second episode was manifested by circulating schistocytes, anemia, thrombocytopenia, low albumin, and an increase in lactate dehydrogenase and creatinine.", "Urine protein:creatinine ratio increased to 0.89.", "Tacrolimus was stopped.", "Steroids were started.", "Ruxolitinib was continued.", "Narsoplimab was started from Day+254.", "Narsoplimab was given twice a week for 3 weeks.", "Narsoplimab was escalated to thrice a week from Day+274.", "Narsoplimab was tapered to twice weekly from Day+290.", "Narsoplimab was stopped on Day+357.", "Liver GvHD resolved with steroids and Ruxolitinib.", "The patient is alive and well.", "The patient had no features of TA-TMA on the last follow-up of Day+650."], "index": 98, "original_id": "multiclinsum_test_2016_en.txt", "split": "test", "summary_subclaims": ["The six-year-old girl underwent a human leucocyte antigen (HLA) haploidentical hematopoietic stem cell transplant using post-transplant Cyclophosphamide for severe aplastic anemia.", "In the second week of the transplant, the patient developed macrophage activation syndrome.", "The diagnosis of hepatosplenic candidiasis was made based on USG abdomen and blood fungal PCR.", "Candida-triggered macrophage activation syndrome responded to antifungals, steroids, intravenous immunoglobulin, and alemtuzumab.", "The patient developed hypertension in the 2nd week.", "The patient had high lactate dehydrogenase (1010\u2009U/L), schistocytes (5 per hpf), low haptoglobin (<\u20095\u2009mg/dl), thrombocytopenia, and anemia in the 3rd week.", "Ciclosporin was stopped.", "The patient was treated with 10\u2009days of defibrotide without response.", "The course was further complicated by the involvement of the gastrointestinal tract and kidneys.", "Narsoplimab was started in the 5th week of the transplant.", "A fall in lactate dehydrogenase was observed after starting Narsoplimab.", "The resolution of gastrointestinal symptoms, proteinuria, and recovery of cytopenia followed starting Narsoplimab.", "The second episode of TA-TMA occurred with parvoviraemia.", "The second episode of TA-TMA was successfully treated with Narsoplimab."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 6-year-old girl presented to the pediatric emergency department with the chief complaints of vomiting blood and blood in stool.", "Her mother reported that she noticed the blood in her daughter\u2019s stool three days ago.", "The baby was delivered at 34 weeks gestation with cesarean section.", "The baby had intrauterine growth restriction (IUGR).", "The baby was hospitalized in a neonatal intensive care unit for 1 month.", "The baby was treated with laser photocoagulation due to the vision loss in the left eye.", "The cranial magnetic resonance imaging (MRI) was performed at the age of 6 months.", "The cranial MRI revealed diffuse symmetric calcifications.", "The cranial MRI showed changes suggesting hemorrhage.", "The cranial MRI showed dilated lateral ventricles.", "The cranial MRI showed septated cystic lesions in the area extending from the roof of the third ventricle to the lateral ventricle.", "The cranial MRI showed hemorrhage in the globe in the left orbit.", "The patient was diagnosed with Coats plus syndrome.", "The patient\u2019s weight and height were below the 3rd percentile.", "The patient\u2019s mid-upper arm circumference was <115 mm.", "The patient was ill-appearing.", "The patient\u2019s peak heart rate was 120/min.", "The patient\u2019s blood pressure was 70/40 mmHg.", "Leukocoria and glaucoma were detected in the left eye.", "The patient had hypotonia.", "The patient\u2019s muscle strength in bilateral lower and upper extremities was 3/5.", "The percussion over Traube\u2019s space produced dull sounds during the abdominal examination.", "The patient\u2019s hemoglobin (Hb) was 6.5 gr/dL.", "The patient\u2019s hematocrit (Hct) was 21%.", "The patient\u2019s thrombocyte count was 292000/mm3.", "The patient\u2019s white blood cell (WBC) count was 2010/mm3.", "The patient\u2019s international normalized ratio (INR) was 1.3.", "The patient\u2019s alanine aminotransferase (ALT) was 113 U/L.", "The patient\u2019s aspartate aminotransferase (AST) was 115 U/L.", "The patient\u2019s gamma-glutamyl transferase (GGT) was 245 U/L.", "The patient\u2019s albumin was 3.21 gr/dL.", "The metabolic studies did not show any abnormalities.", "The levels of viral markers, alpha 1 antitrypsin, alpha fetoprotein, ceruloplasmin, autoantibody, and tissue transglutaminase were normal.", "Abdominal ultrasonography showed linear echogenicity and heterogeneity in the liver.", "Abdominal doppler ultrasonography suggested portal hypertension.", "Upper and lower gastrointestinal endoscopy revealed folded vascular appearance reminiscent of esophageal varices.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the pyloric antrum, duodenum, and colon.", "A liver biopsy revealed portal fibrosis.", "The patient was initially received nothing-by-mouth diet.", "The patient was given intravenous (IV) proton pump inhibitors.", "The severe gastrointestinal bleeding of the patient was later stopped after receiving IV octreotide and erythrocyte transfusion.", "The patient was treated with propranolol, ursodeoxycholic acid, and anticonvulsant.", "The patient was followed in the pediatric gastroenterology, neurology, and eye clinics.", "The patient continued to have intermittent gastrointestinal system bleeding.", "The patient had severe malnutrition.", "The patient was admitted to the emergency department and hospitalized multiple times.", "The patient was treated with tranexamic acid when she had mild bleeding.", "The patient received IV octreotide when the bleeding was severe.", "The patient was admitted to the intensive care unit due to multi-organ failure secondary to severe gastrointestinal system bleeding.", "An emergency endoscopy could not be performed.", "The patient received IV octreotide and erythrocyte transfusion again.", "The patient\u2019s condition did not improve.", "The patient eventually died."], "summary_subclaims": ["The patient is a 6-year-old girl.", "The patient has Coats plus syndrome.", "The patient presented with vomiting blood.", "The patient presented with blood in stool.", "Upper and lower gastrointestinal endoscopy revealed esophageal varices.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the pyloric antrum.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the duodenum.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the colon.", "The patient received intravenous octreotide.", "The bleeding was stopped after receiving intravenous octreotide.", "The patient was followed in the pediatric gastroenterology clinic.", "The patient was followed in the pediatric neurology clinic.", "The patient was followed in the pediatric ophthalmology clinic.", "The patient was hospitalized and admitted to the intensive care unit.", "The patient continued to have intermittent gastrointestinal system bleeding.", "The patient eventually died due to severe gastrointestinal system bleeding."]}, "extra_info": {"fulltext_subclaims": ["A 6-year-old girl presented to the pediatric emergency department with the chief complaints of vomiting blood and blood in stool.", "Her mother reported that she noticed the blood in her daughter\u2019s stool three days ago.", "The baby was delivered at 34 weeks gestation with cesarean section.", "The baby had intrauterine growth restriction (IUGR).", "The baby was hospitalized in a neonatal intensive care unit for 1 month.", "The baby was treated with laser photocoagulation due to the vision loss in the left eye.", "The cranial magnetic resonance imaging (MRI) was performed at the age of 6 months.", "The cranial MRI revealed diffuse symmetric calcifications.", "The cranial MRI showed changes suggesting hemorrhage.", "The cranial MRI showed dilated lateral ventricles.", "The cranial MRI showed septated cystic lesions in the area extending from the roof of the third ventricle to the lateral ventricle.", "The cranial MRI showed hemorrhage in the globe in the left orbit.", "The patient was diagnosed with Coats plus syndrome.", "The patient\u2019s weight and height were below the 3rd percentile.", "The patient\u2019s mid-upper arm circumference was <115 mm.", "The patient was ill-appearing.", "The patient\u2019s peak heart rate was 120/min.", "The patient\u2019s blood pressure was 70/40 mmHg.", "Leukocoria and glaucoma were detected in the left eye.", "The patient had hypotonia.", "The patient\u2019s muscle strength in bilateral lower and upper extremities was 3/5.", "The percussion over Traube\u2019s space produced dull sounds during the abdominal examination.", "The patient\u2019s hemoglobin (Hb) was 6.5 gr/dL.", "The patient\u2019s hematocrit (Hct) was 21%.", "The patient\u2019s thrombocyte count was 292000/mm3.", "The patient\u2019s white blood cell (WBC) count was 2010/mm3.", "The patient\u2019s international normalized ratio (INR) was 1.3.", "The patient\u2019s alanine aminotransferase (ALT) was 113 U/L.", "The patient\u2019s aspartate aminotransferase (AST) was 115 U/L.", "The patient\u2019s gamma-glutamyl transferase (GGT) was 245 U/L.", "The patient\u2019s albumin was 3.21 gr/dL.", "The metabolic studies did not show any abnormalities.", "The levels of viral markers, alpha 1 antitrypsin, alpha fetoprotein, ceruloplasmin, autoantibody, and tissue transglutaminase were normal.", "Abdominal ultrasonography showed linear echogenicity and heterogeneity in the liver.", "Abdominal doppler ultrasonography suggested portal hypertension.", "Upper and lower gastrointestinal endoscopy revealed folded vascular appearance reminiscent of esophageal varices.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the pyloric antrum, duodenum, and colon.", "A liver biopsy revealed portal fibrosis.", "The patient was initially received nothing-by-mouth diet.", "The patient was given intravenous (IV) proton pump inhibitors.", "The severe gastrointestinal bleeding of the patient was later stopped after receiving IV octreotide and erythrocyte transfusion.", "The patient was treated with propranolol, ursodeoxycholic acid, and anticonvulsant.", "The patient was followed in the pediatric gastroenterology, neurology, and eye clinics.", "The patient continued to have intermittent gastrointestinal system bleeding.", "The patient had severe malnutrition.", "The patient was admitted to the emergency department and hospitalized multiple times.", "The patient was treated with tranexamic acid when she had mild bleeding.", "The patient received IV octreotide when the bleeding was severe.", "The patient was admitted to the intensive care unit due to multi-organ failure secondary to severe gastrointestinal system bleeding.", "An emergency endoscopy could not be performed.", "The patient received IV octreotide and erythrocyte transfusion again.", "The patient\u2019s condition did not improve.", "The patient eventually died."], "index": 90, "original_id": "multiclinsum_test_1957_en.txt", "split": "test", "summary_subclaims": ["The patient is a 6-year-old girl.", "The patient has Coats plus syndrome.", "The patient presented with vomiting blood.", "The patient presented with blood in stool.", "Upper and lower gastrointestinal endoscopy revealed esophageal varices.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the pyloric antrum.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the duodenum.", "Upper and lower gastrointestinal endoscopy revealed vascular telangiectasia in the colon.", "The patient received intravenous octreotide.", "The bleeding was stopped after receiving intravenous octreotide.", "The patient was followed in the pediatric gastroenterology clinic.", "The patient was followed in the pediatric neurology clinic.", "The patient was followed in the pediatric ophthalmology clinic.", "The patient was hospitalized and admitted to the intensive care unit.", "The patient continued to have intermittent gastrointestinal system bleeding.", "The patient eventually died due to severe gastrointestinal system bleeding."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 9 days-old male neonate weighing 3.60 kg was referred to the National Cardiac Center Harapan Kita Hospital.", "The neonate was ventilated because of severe metabolic and respiratory acidosis.", "The neonate had circulatory dynamics instability.", "The neonate had a history of respiratory distress.", "The neonate had cyanosis.", "The neonate had hyperbilirubinemia.", "The neonate had a severe infection.", "The perinatal history was unremarkable.", "The neonate was born at 40 weeks of gestation by normal labour.", "The neonate's birth weight was 3.85 kg.", "The neonate's oxygen saturation at birth was 90%.", "The neonate's APGAR score was 9/9.", "On the 6th day postpartum, the neonate presented with feeding difficulty.", "On the 6th day postpartum, the neonate had severe cyanosis.", "On the 6th day postpartum, the neonate had congestive heart failure.", "The neonate was ventilated at the emergency room with oxygen saturation 82%.", "The neonate was transferred to the center for possible surgical repair.", "The neonate's oxygen saturation was 75%.", "Differential oxygen saturation was noted between the upper and lower limbs.", "No apparent cardiac murmur was detected.", "The chest X-ray showed mild cardiomegaly.", "The chest X-ray showed congestion of the lungs.", "The chest X-ray showed pulmonary edema.", "The electrocardiogram showed normal rhythm.", "The electrocardiogram showed right axis deviation.", "The electrocardiogram showed mild right ventricular hypertrophy.", "The neonate was admitted to the pediatric cardiac intensive care unit.", "The neonate's oxygen saturation was between 40% and 70%.", "Two-dimensional echocardiography revealed an interrupted aortic arch type A.", "Two-dimensional echocardiography revealed an aortopulmonary window type II.", "Two-dimensional echocardiography revealed a restricted patent ductus arteriosus.", "Two-dimensional echocardiography revealed pulmonary hypertension.", "Two-dimensional echocardiography did not reveal a ventricular septal defect.", "A PGE1 infusion 10 nano was started.", "Diuretics were administered.", "The baby had severe infection.", "The baby had disseminated intravascular coagulation.", "The baby had leucocyte count 28.387.", "The baby had pro-calcitonine 11.", "The baby had D-dimer 4.800.", "The baby had several epileptic episodes.", "Brain sonography showed arachnoiditis.", "Brain sonography showed brain edema.", "Brain sonography showed no intracranial bleeding.", "Operation was deferred because of the risk of infection.", "Operation was deferred because of sepsis.", "Operation was deferred because of the good general condition.", "Operation was performed on the 20th day of life.", "A one-stage surgical correction was performed through a median sternotomy.", "The surgery was performed under profound hypothermia (26 \u00b0C).", "Before the administration of heparin, the entire ascending aorta and the arch vessels were mobilized.", "Before the administration of heparin, the pulmonary trunk and both branch were mobilized.", "The external anatomy confirmed an interrupted aortic arch type A.", "The external anatomy confirmed a large aortopulmonary window type II.", "The right pulmonary artery was recognized to originate from the posterolateral part of the ascending aorta.", "The right pulmonary artery was recognized to have connection with the common pulmonary artery.", "The ascending aorta gave three branches including the brachiocephalic artery.", "The ascending aorta gave three branches including the left common carotid artery.", "The ascending aorta gave three branches including the left subclavian artery.", "There was no evidence of descending aorta.", "The proximal part of the patent ductus arteriosus arose from the pulmonary artery trunk.", "The distal part of the patent ductus arteriosus became the descending aorta.", "The left pulmonary artery arose from the pulmonary artery trunk.", "Cardiopulmonary bypass was established by right hemicerebral perfusion.", "Cardiopulmonary bypass was established by bicaval drainage.", "Right hemicerebral perfusion was obtained via an expanded 4-0 mm polytetrafluoroethylene graft.", "The graft was sewn to the right brachiocephalic artery.", "The aortic cross clamp was applied.", "Cardioplegia was infused.", "The aortic arch vessels were clamped at the origin of the brachiocephalic artery.", "The aortic arch vessels were clamped at the origin of the left common carotid artery.", "The aortic arch vessels were clamped at the origin of the left subclavian artery.", "Snaring of both pulmonary arteries precluded overflooding the lungs.", "The pump flow was lowered to 10%.", "Ductal tissue was ligated near its pulmonary origin.", "Ductal tissue was resected until normal aortic tissue appeared.", "The ascending aorta was longitudinally incised.", "An extended end-to-side anastomosis of the descending aorta to the distal ascending aorta was performed.", "The anastomosis was performed with a continuous 7-0 polypropylene suture.", "After removal of the aortic cross-clamp, full flow bypass was resumed.", "The anastomosis was checked for bleeding.", "The anastomosis was checked for undue tension.", "The aortic cross-clamp was reapplied proximal to the aortic cannula.", "Cardioplegia was infused again.", "The aortopulmonary window repair was started.", "The ascending aorta was transversely incised distal to the aortopulmonary window.", "The aortopulmonary window was confirmed to be very large, 10 mm diameter.", "The right pulmonary artery originated from the ascending aorta.", "The left pulmonary artery arose from the pulmonary artery trunk in the normal fashion.", "The coronary arteries were normally positioned.", "The aortic cross clamp was removed and reapplied for right hemicerebral perfusion again.", "A 4-0 Gore-tex patch was used to close the aortopulmonary window.", "A 4-0 Gore-tex patch was used to separate the right pulmonary artery from the aortic origin.", "After rewarming, cardiopulmonary bypass was easily weaned.", "Total bypass time was 125 minutes.", "Cross clamp time was 71 minutes.", "One-third flow time was 66 minutes.", "Peritoneal dialysis was performed post operatively for 3 days.", "Peritoneal dialysis was switched with lasix intermittently.", "The postoperative recovery was uneventful.", "The neonate was extubated on the 7th day post operatively.", "No clinical signs of neurologic disturbances were observed.", "Cardiopulmonary function was satisfactory.", "Distal perfusion was satisfactory.", "Early postoperative echocardiography demonstrated an excellent early surgical result.", "Early postoperative echocardiography showed a minimal pressure gradient of 12 mmHg across the aortic reconstruction.", "Early postoperative echocardiography showed good left ventricular function.", "Early postoperative echocardiography showed no residual aortopulmonary window.", "In 2021, the patient was a 9 year old child.", "The patient was cheerful.", "The patient was growing actively.", "The patient had entered elementary school in grade 2.", "There were no abnormalities of the heart and lungs according to the patient's mother.", "The patient had cerebral palsy sequela.", "The cerebral palsy sequela was being treated by a pediatric neurologist."], "summary_subclaims": ["A 9 days-old male neonate weighing 3.85 kg was referred to our center.", "The neonate was ventilated with a history of respiratory distress and severe infection since birth.", "Admission was to the PCICU.", "A 2D echo showed an IAA type A associated with a huge APW type II and restrictive PDA.", "A PGE1 infusion was started.", "The baby experienced several epileptic episodes during the following days.", "Surgery was performed on the 20th day of life in 2011.", "A successful one-stage repair of the anomalies was performed.", "The repair included cutting of the PDA that arose from the PA trunk and distally became the descending aorta.", "An extended end-to-end anastomosis was used to conduct ascending aortic blood flow into the descending aorta.", "An intra-arterial baffle was used.", "A 4-0 Gore-Tex baffle was used to close the APW and separate the RPA from the aortic origin.", "The result was good, as the child recently grew up as a cheerful 9 year old.", "The child is growing actively and has entered elementary school in grade 2."]}, "extra_info": {"fulltext_subclaims": ["A 9 days-old male neonate weighing 3.60 kg was referred to the National Cardiac Center Harapan Kita Hospital.", "The neonate was ventilated because of severe metabolic and respiratory acidosis.", "The neonate had circulatory dynamics instability.", "The neonate had a history of respiratory distress.", "The neonate had cyanosis.", "The neonate had hyperbilirubinemia.", "The neonate had a severe infection.", "The perinatal history was unremarkable.", "The neonate was born at 40 weeks of gestation by normal labour.", "The neonate's birth weight was 3.85 kg.", "The neonate's oxygen saturation at birth was 90%.", "The neonate's APGAR score was 9/9.", "On the 6th day postpartum, the neonate presented with feeding difficulty.", "On the 6th day postpartum, the neonate had severe cyanosis.", "On the 6th day postpartum, the neonate had congestive heart failure.", "The neonate was ventilated at the emergency room with oxygen saturation 82%.", "The neonate was transferred to the center for possible surgical repair.", "The neonate's oxygen saturation was 75%.", "Differential oxygen saturation was noted between the upper and lower limbs.", "No apparent cardiac murmur was detected.", "The chest X-ray showed mild cardiomegaly.", "The chest X-ray showed congestion of the lungs.", "The chest X-ray showed pulmonary edema.", "The electrocardiogram showed normal rhythm.", "The electrocardiogram showed right axis deviation.", "The electrocardiogram showed mild right ventricular hypertrophy.", "The neonate was admitted to the pediatric cardiac intensive care unit.", "The neonate's oxygen saturation was between 40% and 70%.", "Two-dimensional echocardiography revealed an interrupted aortic arch type A.", "Two-dimensional echocardiography revealed an aortopulmonary window type II.", "Two-dimensional echocardiography revealed a restricted patent ductus arteriosus.", "Two-dimensional echocardiography revealed pulmonary hypertension.", "Two-dimensional echocardiography did not reveal a ventricular septal defect.", "A PGE1 infusion 10 nano was started.", "Diuretics were administered.", "The baby had severe infection.", "The baby had disseminated intravascular coagulation.", "The baby had leucocyte count 28.387.", "The baby had pro-calcitonine 11.", "The baby had D-dimer 4.800.", "The baby had several epileptic episodes.", "Brain sonography showed arachnoiditis.", "Brain sonography showed brain edema.", "Brain sonography showed no intracranial bleeding.", "Operation was deferred because of the risk of infection.", "Operation was deferred because of sepsis.", "Operation was deferred because of the good general condition.", "Operation was performed on the 20th day of life.", "A one-stage surgical correction was performed through a median sternotomy.", "The surgery was performed under profound hypothermia (26 \u00b0C).", "Before the administration of heparin, the entire ascending aorta and the arch vessels were mobilized.", "Before the administration of heparin, the pulmonary trunk and both branch were mobilized.", "The external anatomy confirmed an interrupted aortic arch type A.", "The external anatomy confirmed a large aortopulmonary window type II.", "The right pulmonary artery was recognized to originate from the posterolateral part of the ascending aorta.", "The right pulmonary artery was recognized to have connection with the common pulmonary artery.", "The ascending aorta gave three branches including the brachiocephalic artery.", "The ascending aorta gave three branches including the left common carotid artery.", "The ascending aorta gave three branches including the left subclavian artery.", "There was no evidence of descending aorta.", "The proximal part of the patent ductus arteriosus arose from the pulmonary artery trunk.", "The distal part of the patent ductus arteriosus became the descending aorta.", "The left pulmonary artery arose from the pulmonary artery trunk.", "Cardiopulmonary bypass was established by right hemicerebral perfusion.", "Cardiopulmonary bypass was established by bicaval drainage.", "Right hemicerebral perfusion was obtained via an expanded 4-0 mm polytetrafluoroethylene graft.", "The graft was sewn to the right brachiocephalic artery.", "The aortic cross clamp was applied.", "Cardioplegia was infused.", "The aortic arch vessels were clamped at the origin of the brachiocephalic artery.", "The aortic arch vessels were clamped at the origin of the left common carotid artery.", "The aortic arch vessels were clamped at the origin of the left subclavian artery.", "Snaring of both pulmonary arteries precluded overflooding the lungs.", "The pump flow was lowered to 10%.", "Ductal tissue was ligated near its pulmonary origin.", "Ductal tissue was resected until normal aortic tissue appeared.", "The ascending aorta was longitudinally incised.", "An extended end-to-side anastomosis of the descending aorta to the distal ascending aorta was performed.", "The anastomosis was performed with a continuous 7-0 polypropylene suture.", "After removal of the aortic cross-clamp, full flow bypass was resumed.", "The anastomosis was checked for bleeding.", "The anastomosis was checked for undue tension.", "The aortic cross-clamp was reapplied proximal to the aortic cannula.", "Cardioplegia was infused again.", "The aortopulmonary window repair was started.", "The ascending aorta was transversely incised distal to the aortopulmonary window.", "The aortopulmonary window was confirmed to be very large, 10 mm diameter.", "The right pulmonary artery originated from the ascending aorta.", "The left pulmonary artery arose from the pulmonary artery trunk in the normal fashion.", "The coronary arteries were normally positioned.", "The aortic cross clamp was removed and reapplied for right hemicerebral perfusion again.", "A 4-0 Gore-tex patch was used to close the aortopulmonary window.", "A 4-0 Gore-tex patch was used to separate the right pulmonary artery from the aortic origin.", "After rewarming, cardiopulmonary bypass was easily weaned.", "Total bypass time was 125 minutes.", "Cross clamp time was 71 minutes.", "One-third flow time was 66 minutes.", "Peritoneal dialysis was performed post operatively for 3 days.", "Peritoneal dialysis was switched with lasix intermittently.", "The postoperative recovery was uneventful.", "The neonate was extubated on the 7th day post operatively.", "No clinical signs of neurologic disturbances were observed.", "Cardiopulmonary function was satisfactory.", "Distal perfusion was satisfactory.", "Early postoperative echocardiography demonstrated an excellent early surgical result.", "Early postoperative echocardiography showed a minimal pressure gradient of 12 mmHg across the aortic reconstruction.", "Early postoperative echocardiography showed good left ventricular function.", "Early postoperative echocardiography showed no residual aortopulmonary window.", "In 2021, the patient was a 9 year old child.", "The patient was cheerful.", "The patient was growing actively.", "The patient had entered elementary school in grade 2.", "There were no abnormalities of the heart and lungs according to the patient's mother.", "The patient had cerebral palsy sequela.", "The cerebral palsy sequela was being treated by a pediatric neurologist."], "index": 102, "original_id": "multiclinsum_test_2375_en.txt", "split": "test", "summary_subclaims": ["A 9 days-old male neonate weighing 3.85 kg was referred to our center.", "The neonate was ventilated with a history of respiratory distress and severe infection since birth.", "Admission was to the PCICU.", "A 2D echo showed an IAA type A associated with a huge APW type II and restrictive PDA.", "A PGE1 infusion was started.", "The baby experienced several epileptic episodes during the following days.", "Surgery was performed on the 20th day of life in 2011.", "A successful one-stage repair of the anomalies was performed.", "The repair included cutting of the PDA that arose from the PA trunk and distally became the descending aorta.", "An extended end-to-end anastomosis was used to conduct ascending aortic blood flow into the descending aorta.", "An intra-arterial baffle was used.", "A 4-0 Gore-Tex baffle was used to close the APW and separate the RPA from the aortic origin.", "The result was good, as the child recently grew up as a cheerful 9 year old.", "The child is growing actively and has entered elementary school in grade 2."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 52-year-old man from Bangladesh.", "The patient has diabetes.", "The patient has hypertension.", "The patient had exertional angina Canadian Cardiovascular Society III.", "A stress myocardial scintigraphy was performed.", "The stress myocardial scintigraphy revealed deep hypoperfusion in the antero-apical, septo-apical, and lateral walls.", "The stress test showed electric positivity.", "The resting left ventricle ejection fraction was 61%.", "The patient's blood pressure was 127/85 mmHg.", "The patient's heart rate was 92 b.p.m.", "The patient's oxygen saturation was normal.", "No murmurs were detected.", "There were no signs of heart failure.", "The electrocardiogram showed a sinus rhythm.", "The electrocardiogram showed no significant repolarization abnormalities.", "A diagnostic coronary angiogram was performed.", "Left injection revealed a stenosis on a third significant diagonal branch.", "The LAD appeared to stop at its mid-segment without wrapping around the apex.", "The LAD did not present a stump that could suggest a chronic occlusion.", "The right coronary sinus injection revealed a dominant RCA free of stenosis.", "A vessel opening into the ostium of the RCA was noted.", "A non-selective injection into this artery identified an ostial-proximal stenosis.", "Percutaneous coronary intervention of the third diagonal was performed.", "A coronary CT scan was performed.", "The CT scan identified an artery whose course is compatible with a mid and distal LAD.", "This artery connects in the right coronary ostium.", "This artery joins the interventricular groove.", "This artery wraps around the apex of the heart.", "Angioplasty was performed on the AAOCA.", "A 6F IM guiding catheter was used.", "The guiding catheter was accessed through the right radial artery.", "A workhorse wire was positioned in the right posterolateral artery.", "A polymerjacket wire with a hydrophilic coating was used to navigate within the AAOCA.", "A distal injection through a microcatheter revealed a severe stenosis in the mid LAD.", "The distal lesion was treated with a drug-eluting stent 2.25 \u00d7 15 mm.", "The mid lesion was treated with a drug-eluting balloon 2.0 \u00d7 15 mm.", "The ostial-proximal segment was treated with a drug-eluting stent 2.5 \u00d7 15 mm.", "The final angiographic result was satisfactory.", "A contralateral injection confirmed the discontinuity of the AAOCA with the native LAD.", "The post-procedural course was uneventful.", "The patient was discharged the following day."], "summary_subclaims": ["The patient is a 52-year-old from Bangladesh.", "The patient has dual-origin LAD arising from both left and right sinus.", "The LAD has a pre-pulmonary course.", "The patient presented with exertional angina.", "The patient had documented myocardial ischaemia.", "Computed tomography (CT) scan confirmed the anatomical course of the AAOCA.", "Percutaneous coronary intervention was successfully performed.", "Tailored techniques were used to treat significant atherosclerotic lesions."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 52-year-old man from Bangladesh.", "The patient has diabetes.", "The patient has hypertension.", "The patient had exertional angina Canadian Cardiovascular Society III.", "A stress myocardial scintigraphy was performed.", "The stress myocardial scintigraphy revealed deep hypoperfusion in the antero-apical, septo-apical, and lateral walls.", "The stress test showed electric positivity.", "The resting left ventricle ejection fraction was 61%.", "The patient's blood pressure was 127/85 mmHg.", "The patient's heart rate was 92 b.p.m.", "The patient's oxygen saturation was normal.", "No murmurs were detected.", "There were no signs of heart failure.", "The electrocardiogram showed a sinus rhythm.", "The electrocardiogram showed no significant repolarization abnormalities.", "A diagnostic coronary angiogram was performed.", "Left injection revealed a stenosis on a third significant diagonal branch.", "The LAD appeared to stop at its mid-segment without wrapping around the apex.", "The LAD did not present a stump that could suggest a chronic occlusion.", "The right coronary sinus injection revealed a dominant RCA free of stenosis.", "A vessel opening into the ostium of the RCA was noted.", "A non-selective injection into this artery identified an ostial-proximal stenosis.", "Percutaneous coronary intervention of the third diagonal was performed.", "A coronary CT scan was performed.", "The CT scan identified an artery whose course is compatible with a mid and distal LAD.", "This artery connects in the right coronary ostium.", "This artery joins the interventricular groove.", "This artery wraps around the apex of the heart.", "Angioplasty was performed on the AAOCA.", "A 6F IM guiding catheter was used.", "The guiding catheter was accessed through the right radial artery.", "A workhorse wire was positioned in the right posterolateral artery.", "A polymerjacket wire with a hydrophilic coating was used to navigate within the AAOCA.", "A distal injection through a microcatheter revealed a severe stenosis in the mid LAD.", "The distal lesion was treated with a drug-eluting stent 2.25 \u00d7 15 mm.", "The mid lesion was treated with a drug-eluting balloon 2.0 \u00d7 15 mm.", "The ostial-proximal segment was treated with a drug-eluting stent 2.5 \u00d7 15 mm.", "The final angiographic result was satisfactory.", "A contralateral injection confirmed the discontinuity of the AAOCA with the native LAD.", "The post-procedural course was uneventful.", "The patient was discharged the following day."], "index": 100, "original_id": "multiclinsum_test_3124_en.txt", "split": "test", "summary_subclaims": ["The patient is a 52-year-old from Bangladesh.", "The patient has dual-origin LAD arising from both left and right sinus.", "The LAD has a pre-pulmonary course.", "The patient presented with exertional angina.", "The patient had documented myocardial ischaemia.", "Computed tomography (CT) scan confirmed the anatomical course of the AAOCA.", "Percutaneous coronary intervention was successfully performed.", "Tailored techniques were used to treat significant atherosclerotic lesions."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 35-year-old woman.", "She has chronic rheumatic heart disease.", "She has severe mitral stenosis with pulmonary hypertension.", "She had percutaneous balloon mitral valvotomy 6 weeks prior.", "A left atrial thrombus was detected after the procedure.", "She started warfarin 5 mg, po, daily for 4 weeks.", "She escalated to warfarin 7.5 mg, po, daily.", "She had a severe headache and repeated episodes of vomiting for 1 day.", "She had a history of nasal bleeding.", "She stopped warfarin 3 days prior.", "She had fever, malaise, and generalized weakness for 1 week.", "Vital signs were within normal limits.", "She had no pallor of conjunctivae.", "She had wet buccal mucosa.", "She had an accentuated P2 on cardiovascular examination.", "She had a mid-diastolic and pan-systolic murmur at the mitral area.", "No cranial nerve palsy was found.", "No motor or sensory deficit was found.", "Meningeal irritation signs were negative.", "Diagnoses included chronic rheumatic heart disease.", "Diagnoses included pyogenic meningitis.", "Diagnoses included subarachnoid hemorrhage.", "White blood cell count was 25,000/\u00b5L.", "Neutrophil count was 85%.", "Lymphocyte count was 10%.", "Hemoglobin was 12 gm/dl.", "Platelets were 350,000/\u00b5L.", "Prothrombin time was 35 sec.", "Partial thromboplastin time was 53 sec.", "INR was 2.5.", "A lumbar puncture was deferred due to higher INR.", "ECG showed P-mitrale.", "ECG showed right bundle branch block.", "ECG showed ST depression and inverted T wave at V1-V3.", "Trans-thoracic echocardiography revealed moderate mitral stenosis.", "Trans-thoracic echocardiography revealed mild mitral regurgitation.", "Trans-thoracic echocardiography revealed severe pulmonary hypertension.", "No vegetation or thrombus was seen.", "She was started on Ceftriaxone 2 gm, IV, twice daily.", "She was started on Vancomycin 1 gm, IV, twice daily.", "Warfarin was discontinued.", "She developed sudden onset, frequent tonic-clonic convulsive episodes.", "She had a Glasgow Coma Score of 8/15.", "Both eyes deviated to the left side.", "Pupils were mid-sized but poorly reactive to light.", "She withdrew to painful stimuli.", "A non-contrast brain CT scan revealed left-sided acute subdural hematoma.", "A non-contrast brain CT scan revealed ventricular bleeds.", "She was diagnosed with status epilepticus secondary to intracranial hemorrhage.", "She was initiated on diazepam, 10 mg IV.", "She was initiated on Phenytoin 1 gm IV bolus.", "She was given O2 via face mask.", "An NG-tube was inserted.", "A urinary catheter was placed.", "She was transferred to ICU.", "She was intubated.", "She was put on a mechanical ventilator.", "Fresh frozen plasma 4 units were given.", "Vitamin K, 10 mg IV once daily for 3 days, was given.", "IV ceftriaxone and vancomycin were continued.", "Mannitol (20%), 50 gm IV bolus, was given.", "Valproic acid, 400 mg po 3 times daily, was added.", "A craniotomy was performed.", "Repeat laboratory values showed WBC=34,000/\u00b5L.", "Repeat laboratory values showed hemoglobin=9 gm/dl.", "Repeat laboratory values showed platelets=550,000/\u00b5L.", "Repeat coagulation profiles showed PT=49.8 sec.", "Repeat coagulation profiles showed PTT=63.2 sec.", "Repeat coagulation profiles showed INR=4.38.", "She had paroxysms of increase in pulse rate.", "She had paroxysms of increase in blood pressure.", "She had paroxysms of increase in respiratory rate.", "She had paroxysms of increase in temperature.", "She had sweating.", "She had decerebrate posturing.", "She had episodes of autonomic surge.", "She had a CSF score of 11.", "She had a DLT score of 11.", "She had a PSH-AM score of 21.", "A probable diagnosis of PSH was made.", "She was started on morphine 2 mg, IV, as required.", "She was started on paracetamol 1 gm, po, as required.", "She was started on propranolol, 40 mg po 3 times a day.", "She was started on diazepam 5 mg, IV 3 times a day.", "She was started on gabapentin 150\u2013300 mg po 3 times a day.", "Her GCS started to improve on the second week of ICU admission.", "The frequency and severity of sympathetic storm declined.", "IV antibiotics were discontinued after 2 weeks of therapy.", "On the third week of admission, she developed asystole.", "She died of cardiac arrest.", "CPR was performed."], "summary_subclaims": ["The patient is a 35-year-old woman.", "She has echo-proven chronic rheumatic heart disease.", "She had percutaneous balloon mitral valvotomy 6 weeks previously.", "Left atrial thrombus was detected after the procedure.", "Anticoagulant (warfarin) was initiated.", "She presented with severe headache and repeated vomiting of 1 day duration.", "She had frequent seizure attacks with subsequent loss of consciousness on the third day of admission.", "CT-scan revealed acute subdural hematoma and ventricular bleeding.", "Diagnosis of status epilepticus secondary to intracranial hemorrhage due to warfarin toxicity was made.", "She was transferred to medical intensive care unit (ICU), intubated, and put on mechanical ventilator.", "Anti-epileptic drugs, antibiotics, vitamin K, and fresh frozen plasma were given.", "She developed paroxysms of hypertension, tachycardia, tachypnea, hyperpyrexia, diaphoresis, and decerebrate posturing after 7 days of neurological insult.", "She had normal inter-ictal EEG tracing during cyclic autonomic surge.", "CFS score was 11.", "DLT score was 10.", "PSH-AM score was 21.", "PSH-AM score suggested 'probable' diagnosis of PSH.", "Morphine, diazepam, propranolol, and gabapentin were given in combination to treat PSH.", "Severity of autonomic storm started to improve on the second week of ICU admission.", "On the third week of admission, her clinical condition deteriorated suddenly.", "She developed asystole and died of cardiac arrest despite cardiopulmonary resuscitation (CPR)."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 35-year-old woman.", "She has chronic rheumatic heart disease.", "She has severe mitral stenosis with pulmonary hypertension.", "She had percutaneous balloon mitral valvotomy 6 weeks prior.", "A left atrial thrombus was detected after the procedure.", "She started warfarin 5 mg, po, daily for 4 weeks.", "She escalated to warfarin 7.5 mg, po, daily.", "She had a severe headache and repeated episodes of vomiting for 1 day.", "She had a history of nasal bleeding.", "She stopped warfarin 3 days prior.", "She had fever, malaise, and generalized weakness for 1 week.", "Vital signs were within normal limits.", "She had no pallor of conjunctivae.", "She had wet buccal mucosa.", "She had an accentuated P2 on cardiovascular examination.", "She had a mid-diastolic and pan-systolic murmur at the mitral area.", "No cranial nerve palsy was found.", "No motor or sensory deficit was found.", "Meningeal irritation signs were negative.", "Diagnoses included chronic rheumatic heart disease.", "Diagnoses included pyogenic meningitis.", "Diagnoses included subarachnoid hemorrhage.", "White blood cell count was 25,000/\u00b5L.", "Neutrophil count was 85%.", "Lymphocyte count was 10%.", "Hemoglobin was 12 gm/dl.", "Platelets were 350,000/\u00b5L.", "Prothrombin time was 35 sec.", "Partial thromboplastin time was 53 sec.", "INR was 2.5.", "A lumbar puncture was deferred due to higher INR.", "ECG showed P-mitrale.", "ECG showed right bundle branch block.", "ECG showed ST depression and inverted T wave at V1-V3.", "Trans-thoracic echocardiography revealed moderate mitral stenosis.", "Trans-thoracic echocardiography revealed mild mitral regurgitation.", "Trans-thoracic echocardiography revealed severe pulmonary hypertension.", "No vegetation or thrombus was seen.", "She was started on Ceftriaxone 2 gm, IV, twice daily.", "She was started on Vancomycin 1 gm, IV, twice daily.", "Warfarin was discontinued.", "She developed sudden onset, frequent tonic-clonic convulsive episodes.", "She had a Glasgow Coma Score of 8/15.", "Both eyes deviated to the left side.", "Pupils were mid-sized but poorly reactive to light.", "She withdrew to painful stimuli.", "A non-contrast brain CT scan revealed left-sided acute subdural hematoma.", "A non-contrast brain CT scan revealed ventricular bleeds.", "She was diagnosed with status epilepticus secondary to intracranial hemorrhage.", "She was initiated on diazepam, 10 mg IV.", "She was initiated on Phenytoin 1 gm IV bolus.", "She was given O2 via face mask.", "An NG-tube was inserted.", "A urinary catheter was placed.", "She was transferred to ICU.", "She was intubated.", "She was put on a mechanical ventilator.", "Fresh frozen plasma 4 units were given.", "Vitamin K, 10 mg IV once daily for 3 days, was given.", "IV ceftriaxone and vancomycin were continued.", "Mannitol (20%), 50 gm IV bolus, was given.", "Valproic acid, 400 mg po 3 times daily, was added.", "A craniotomy was performed.", "Repeat laboratory values showed WBC=34,000/\u00b5L.", "Repeat laboratory values showed hemoglobin=9 gm/dl.", "Repeat laboratory values showed platelets=550,000/\u00b5L.", "Repeat coagulation profiles showed PT=49.8 sec.", "Repeat coagulation profiles showed PTT=63.2 sec.", "Repeat coagulation profiles showed INR=4.38.", "She had paroxysms of increase in pulse rate.", "She had paroxysms of increase in blood pressure.", "She had paroxysms of increase in respiratory rate.", "She had paroxysms of increase in temperature.", "She had sweating.", "She had decerebrate posturing.", "She had episodes of autonomic surge.", "She had a CSF score of 11.", "She had a DLT score of 11.", "She had a PSH-AM score of 21.", "A probable diagnosis of PSH was made.", "She was started on morphine 2 mg, IV, as required.", "She was started on paracetamol 1 gm, po, as required.", "She was started on propranolol, 40 mg po 3 times a day.", "She was started on diazepam 5 mg, IV 3 times a day.", "She was started on gabapentin 150\u2013300 mg po 3 times a day.", "Her GCS started to improve on the second week of ICU admission.", "The frequency and severity of sympathetic storm declined.", "IV antibiotics were discontinued after 2 weeks of therapy.", "On the third week of admission, she developed asystole.", "She died of cardiac arrest.", "CPR was performed."], "index": 96, "original_id": "multiclinsum_test_1504_en.txt", "split": "test", "summary_subclaims": ["The patient is a 35-year-old woman.", "She has echo-proven chronic rheumatic heart disease.", "She had percutaneous balloon mitral valvotomy 6 weeks previously.", "Left atrial thrombus was detected after the procedure.", "Anticoagulant (warfarin) was initiated.", "She presented with severe headache and repeated vomiting of 1 day duration.", "She had frequent seizure attacks with subsequent loss of consciousness on the third day of admission.", "CT-scan revealed acute subdural hematoma and ventricular bleeding.", "Diagnosis of status epilepticus secondary to intracranial hemorrhage due to warfarin toxicity was made.", "She was transferred to medical intensive care unit (ICU), intubated, and put on mechanical ventilator.", "Anti-epileptic drugs, antibiotics, vitamin K, and fresh frozen plasma were given.", "She developed paroxysms of hypertension, tachycardia, tachypnea, hyperpyrexia, diaphoresis, and decerebrate posturing after 7 days of neurological insult.", "She had normal inter-ictal EEG tracing during cyclic autonomic surge.", "CFS score was 11.", "DLT score was 10.", "PSH-AM score was 21.", "PSH-AM score suggested 'probable' diagnosis of PSH.", "Morphine, diazepam, propranolol, and gabapentin were given in combination to treat PSH.", "Severity of autonomic storm started to improve on the second week of ICU admission.", "On the third week of admission, her clinical condition deteriorated suddenly.", "She developed asystole and died of cardiac arrest despite cardiopulmonary resuscitation (CPR)."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 41-year-old male.", "He had progressive exertional dyspnea.", "He was transferred to our hospital because of LV thrombus found on transthoracic echocardiogram.", "Transthoracic echocardiogram showed global hypokinetic LV with an EF of 28%.", "A pedunculated apical thrombus measuring 1.75 \u00d7 1.68\u200acm was found.", "Coronary angiogram revealed no significant obstructive lesion.", "He was discharged and took warfarin 3.75\u200amg/day for AF and LV thrombus.", "He developed sudden onset of right-hand clumsiness and expressive aphasia after 1 month.", "Right eye blurred vision and drooling from the right mouth angle were noted.", "The prothrombin time and INR were in the supratherapeutic range (INR 7.64).", "His symptoms totally recovered within 1 day.", "Brain MRI showed multiple acute infarctions in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral central semiovale.", "The infarctions highly suggested embolic stroke.", "Transthoracic echocardiogram on the same day of stroke still revealed LV thrombus (1.27 \u00d7 0.90\u200acm).", "Warfarin was discontinued due to acute infarction under high INR.", "Edoxaban (60\u200amg/day) was started after INR decreased to less than 2.", "Follow-up echocardiography showed resolution of LV thrombus after 23 days of edoxaban.", "The patient tolerated edoxaban well.", "He did not have recurrent stroke in the following 6 months."], "summary_subclaims": ["The patient is a 41-year-old man.", "He presented with acute onset of right-hand clumsiness.", "He presented with aphasia.", "He had an international normalized ratio of 7.64.", "He was previously treated with warfarin for the LV thrombus.", "He was previously treated with warfarin for non-valvular AF.", "Brain MRI showed multiple acute infarction in the cortex of the bilateral frontal lobes.", "Brain MRI showed multiple acute infarction in the left parietal lobe.", "Brain MRI showed multiple acute infarction in the bilateral central semiovale.", "The infarctions highly suggested embolic stroke.", "The repeated transthoracic echocardiogram still revealed LV thrombus.", "The LV thrombus measured 1.27 \u00d7 0.90\u200acm.", "The LV thrombus failed to respond to warfarin therapy.", "Acute infarctions occurred under supratherapeutic range of INR.", "Warfarin was switched to edoxaban after INR decreased to less than 2.", "The edoxaban dose was 60\u200amg/day.", "The thrombus disappeared after receiving edoxaban for 23 days.", "No more recurrent stroke was noted for more than 6 months."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 41-year-old male.", "He had progressive exertional dyspnea.", "He was transferred to our hospital because of LV thrombus found on transthoracic echocardiogram.", "Transthoracic echocardiogram showed global hypokinetic LV with an EF of 28%.", "A pedunculated apical thrombus measuring 1.75 \u00d7 1.68\u200acm was found.", "Coronary angiogram revealed no significant obstructive lesion.", "He was discharged and took warfarin 3.75\u200amg/day for AF and LV thrombus.", "He developed sudden onset of right-hand clumsiness and expressive aphasia after 1 month.", "Right eye blurred vision and drooling from the right mouth angle were noted.", "The prothrombin time and INR were in the supratherapeutic range (INR 7.64).", "His symptoms totally recovered within 1 day.", "Brain MRI showed multiple acute infarctions in the cortex of the bilateral frontal lobes, left parietal lobe, and bilateral central semiovale.", "The infarctions highly suggested embolic stroke.", "Transthoracic echocardiogram on the same day of stroke still revealed LV thrombus (1.27 \u00d7 0.90\u200acm).", "Warfarin was discontinued due to acute infarction under high INR.", "Edoxaban (60\u200amg/day) was started after INR decreased to less than 2.", "Follow-up echocardiography showed resolution of LV thrombus after 23 days of edoxaban.", "The patient tolerated edoxaban well.", "He did not have recurrent stroke in the following 6 months."], "index": 94, "original_id": "multiclinsum_test_3113_en.txt", "split": "test", "summary_subclaims": ["The patient is a 41-year-old man.", "He presented with acute onset of right-hand clumsiness.", "He presented with aphasia.", "He had an international normalized ratio of 7.64.", "He was previously treated with warfarin for the LV thrombus.", "He was previously treated with warfarin for non-valvular AF.", "Brain MRI showed multiple acute infarction in the cortex of the bilateral frontal lobes.", "Brain MRI showed multiple acute infarction in the left parietal lobe.", "Brain MRI showed multiple acute infarction in the bilateral central semiovale.", "The infarctions highly suggested embolic stroke.", "The repeated transthoracic echocardiogram still revealed LV thrombus.", "The LV thrombus measured 1.27 \u00d7 0.90\u200acm.", "The LV thrombus failed to respond to warfarin therapy.", "Acute infarctions occurred under supratherapeutic range of INR.", "Warfarin was switched to edoxaban after INR decreased to less than 2.", "The edoxaban dose was 60\u200amg/day.", "The thrombus disappeared after receiving edoxaban for 23 days.", "No more recurrent stroke was noted for more than 6 months."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 73-year-old male.", "The patient was 174 cm tall and weighed 47 kg.", "The patient had an American Society of Anesthesiologists physical classification of 3.", "The patient was scheduled for elective left nephroureterectomy.", "A left calyx tumor was incidentally discovered during a routine medical examination.", "A biopsy performed 1 month ago during ureteroscopy suggested a urothelial carcinoma.", "The patient had a past medical history of intraductal papillary mucinous neoplasm of the liver that was surgically removed 6 years ago.", "Chest computed tomography (CT) revealed pulmonary thromboembolism in the left lower lobe.", "A lower extremity ultrasonogram showed no evidence of deep vein thrombosis.", "Arterial blood gas analysis and D-dimer were within the normal ranges.", "The patient was instructed to fast for 8 hours before undergoing general anesthesia.", "Premedication involved an intramuscular injection of glycopyrrolate (0.2 mg) and famotidine (20 mg).", "Noninvasive monitoring devices were placed on the patient, including a blood pressure cuff, electrocardiogram, a pulse oximeter, a bispectral index signal device, and a quantitative monitor for neuromuscular blockade.", "General anesthesia was induced using 80 mg propofol.", "Rocuronium (30 mg) was used for neuromuscular blockade after confirming no response to stimuli.", "Sevoflurane (1.7%) was used to maintain the appropriate anesthesia depth after intubation.", "An arterial line was inserted into the right radial artery.", "Right internal jugular vein central venous catheterization was planned.", "Real-time ultrasound-guided catheterization was initially planned.", "The hospital\u2019s portable ultrasonography device was in use in other operating rooms.", "A blind catheterization technique was used based on the patient\u2019s anatomical structure without ultrasound guidance.", "The patient was positioned in the Trendelenburg position with the head 15\u00b0 below the horizontal plane and tilted 40\u00b0 to the left.", "The Bermuda triangle was clearly identified.", "The carotid artery pulse was palpated at the superior angle of the triangle and followed to the center of the triangle.", "A 10 ml syringe connected to a 23-gauge finder needle was inserted perpendicularly to the surface while aspirating.", "The presence of dark venous blood was confirmed at a depth of 2.2 cm.", "No pulsation was observed after separating the finder needle from the syringe.", "An 18-gauge puncture needle connected to the syringe was inserted toward the nipple at a 75\u00b0 angle from the skin while targeting the finder needle tip.", "The aspiration of venous blood flow was confirmed.", "A guidewire was inserted to a depth of 20 cm from the skin through the puncture needle without any resistance felt during the procedure.", "The puncture needle was removed while leaving the guidewire in place.", "The practitioner and colleagues attempted to investigate the anatomy of the puncture site by utilizing ultrasonography to detect the previously inserted guidewire.", "The guidewire was found to be located in a vein as which we presumed the vessel based on its location that was lateral from the common carotid artery and collapsibility when pressure was applied using the probe.", "A larger vessel presumed to be a vein was located superiorly and more laterally than the identified vessel.", "Real-time ultrasound-guided guidewire insertion was performed at the same view in this vessel using another central venous catheter kit.", "Both guidewires were left in place while the probe was tilted to visualize their paths.", "It was confirmed that they were both descending toward the right brachiocephalic vein.", "The first guidewire was removed, and manual compression using sterile gauze was applied for over 5 min.", "No resistance was felt during the removal.", "The second guidewire was used to complete the central venous catheterization.", "Free regurgitation was observed at each port.", "The central venous pressure measured using the central venous catheter was 15 mmHg.", "The surgery was successful.", "The patient was transferred to the post-anesthesia care unit after extubation.", "A simple anterior-to-posterior chest X-ray taken immediately after the surgery confirmed that the catheter tip was located near the right atrium, following the superior vena cava.", "We reviewed the contrast-enhanced chest CT performed for preoperative evaluation and confirmed that the right internal jugular vein coursed laterally to the right common carotid artery on the axial view.", "A large vessel was also observed behind the common carotid artery and internal jugular vein.", "It was traced upward and downward, confirming that it enters into the transverse foramen at the level of the sixth cervical vertebra and drains into the right brachiocephalic vein.", "The same findings were observed in the coronary view.", "The radiologist indicated this vessel as the vertebral vein.", "After considering the ultrasonographic findings and the radiologist\u2019s official reading, we confirmed that the vein that we had initially punctured was indeed the right cervical vertebral vein.", "On the third day after surgery, the central venous catheter was removed.", "The patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms."], "summary_subclaims": ["The patient was a 73-year-old male.", "The patient was suspected to have a urothelial carcinoma.", "The patient was scheduled for elective left nephroureterectomy.", "During central venous catheterization, the anatomic landmark technique was used to target the internal jugular vein.", "A guidewire was inadvertently inserted into the suspected vertebral vein.", "The radiologist reviewed the preoperative enhanced computed tomography.", "The radiologist confirmed that the initially punctured vessel was the vertebral vein.", "The central venous catheter was removed on the third day after surgery.", "The patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 73-year-old male.", "The patient was 174 cm tall and weighed 47 kg.", "The patient had an American Society of Anesthesiologists physical classification of 3.", "The patient was scheduled for elective left nephroureterectomy.", "A left calyx tumor was incidentally discovered during a routine medical examination.", "A biopsy performed 1 month ago during ureteroscopy suggested a urothelial carcinoma.", "The patient had a past medical history of intraductal papillary mucinous neoplasm of the liver that was surgically removed 6 years ago.", "Chest computed tomography (CT) revealed pulmonary thromboembolism in the left lower lobe.", "A lower extremity ultrasonogram showed no evidence of deep vein thrombosis.", "Arterial blood gas analysis and D-dimer were within the normal ranges.", "The patient was instructed to fast for 8 hours before undergoing general anesthesia.", "Premedication involved an intramuscular injection of glycopyrrolate (0.2 mg) and famotidine (20 mg).", "Noninvasive monitoring devices were placed on the patient, including a blood pressure cuff, electrocardiogram, a pulse oximeter, a bispectral index signal device, and a quantitative monitor for neuromuscular blockade.", "General anesthesia was induced using 80 mg propofol.", "Rocuronium (30 mg) was used for neuromuscular blockade after confirming no response to stimuli.", "Sevoflurane (1.7%) was used to maintain the appropriate anesthesia depth after intubation.", "An arterial line was inserted into the right radial artery.", "Right internal jugular vein central venous catheterization was planned.", "Real-time ultrasound-guided catheterization was initially planned.", "The hospital\u2019s portable ultrasonography device was in use in other operating rooms.", "A blind catheterization technique was used based on the patient\u2019s anatomical structure without ultrasound guidance.", "The patient was positioned in the Trendelenburg position with the head 15\u00b0 below the horizontal plane and tilted 40\u00b0 to the left.", "The Bermuda triangle was clearly identified.", "The carotid artery pulse was palpated at the superior angle of the triangle and followed to the center of the triangle.", "A 10 ml syringe connected to a 23-gauge finder needle was inserted perpendicularly to the surface while aspirating.", "The presence of dark venous blood was confirmed at a depth of 2.2 cm.", "No pulsation was observed after separating the finder needle from the syringe.", "An 18-gauge puncture needle connected to the syringe was inserted toward the nipple at a 75\u00b0 angle from the skin while targeting the finder needle tip.", "The aspiration of venous blood flow was confirmed.", "A guidewire was inserted to a depth of 20 cm from the skin through the puncture needle without any resistance felt during the procedure.", "The puncture needle was removed while leaving the guidewire in place.", "The practitioner and colleagues attempted to investigate the anatomy of the puncture site by utilizing ultrasonography to detect the previously inserted guidewire.", "The guidewire was found to be located in a vein as which we presumed the vessel based on its location that was lateral from the common carotid artery and collapsibility when pressure was applied using the probe.", "A larger vessel presumed to be a vein was located superiorly and more laterally than the identified vessel.", "Real-time ultrasound-guided guidewire insertion was performed at the same view in this vessel using another central venous catheter kit.", "Both guidewires were left in place while the probe was tilted to visualize their paths.", "It was confirmed that they were both descending toward the right brachiocephalic vein.", "The first guidewire was removed, and manual compression using sterile gauze was applied for over 5 min.", "No resistance was felt during the removal.", "The second guidewire was used to complete the central venous catheterization.", "Free regurgitation was observed at each port.", "The central venous pressure measured using the central venous catheter was 15 mmHg.", "The surgery was successful.", "The patient was transferred to the post-anesthesia care unit after extubation.", "A simple anterior-to-posterior chest X-ray taken immediately after the surgery confirmed that the catheter tip was located near the right atrium, following the superior vena cava.", "We reviewed the contrast-enhanced chest CT performed for preoperative evaluation and confirmed that the right internal jugular vein coursed laterally to the right common carotid artery on the axial view.", "A large vessel was also observed behind the common carotid artery and internal jugular vein.", "It was traced upward and downward, confirming that it enters into the transverse foramen at the level of the sixth cervical vertebra and drains into the right brachiocephalic vein.", "The same findings were observed in the coronary view.", "The radiologist indicated this vessel as the vertebral vein.", "After considering the ultrasonographic findings and the radiologist\u2019s official reading, we confirmed that the vein that we had initially punctured was indeed the right cervical vertebral vein.", "On the third day after surgery, the central venous catheter was removed.", "The patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms."], "index": 88, "original_id": "multiclinsum_test_2805_en.txt", "split": "test", "summary_subclaims": ["The patient was a 73-year-old male.", "The patient was suspected to have a urothelial carcinoma.", "The patient was scheduled for elective left nephroureterectomy.", "During central venous catheterization, the anatomic landmark technique was used to target the internal jugular vein.", "A guidewire was inadvertently inserted into the suspected vertebral vein.", "The radiologist reviewed the preoperative enhanced computed tomography.", "The radiologist confirmed that the initially punctured vessel was the vertebral vein.", "The central venous catheter was removed on the third day after surgery.", "The patient did not exhibit any complications, such as bleeding, swelling, and neurological symptoms."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 10-year-old Kurdish boy.", "The patient presented with bone pain.", "The patient had fever associated with night sweats.", "The patient had shortness of breath.", "The patient had weight loss of 5kg/month.", "The patient had purple purpuric spots over the skin.", "The patient had bleeding from the nose.", "The patient\u2019s history dated back to 1 month before admission.", "On examination, we observed pallor.", "On examination, we observed cachexia.", "On examination, we observed dyspnea.", "On examination, we observed fever.", "On examination, we observed tachycardia.", "On examination, we observed tachypnea.", "On examination, we observed multiple petechiae and ecchymoses all over the skin.", "On examination, we observed dilated tortuous veins over the chest.", "The pulse rate was 120bpm.", "The respiratory rate was 23cycles/minute.", "The temperature was 39\u00b0C.", "The blood pressure was 90/45mmHg.", "We found multiple small cervical lymphadenopathies.", "We found mild splenomegaly 3cm below the left costal margin.", "The liver was tender 7cm below the right costal margin.", "The patient had gross abdominal distention.", "The initial blood counts were hemoglobin 64g/L.", "The initial blood counts were white blood cell count 34 \u00d7 109/L.", "The initial blood counts were platelets 25 \u00d7 109/L.", "The initial blood counts showed blasts 38%.", "The blasts were homogeneous with a high nuclear to cytoplasmic ratio.", "The blasts had inconspicuous nucleoli.", "The blasts had open chromatin.", "Some of the blasts were vacuolated.", "Platelets were markedly reduced.", "There was mediastinal widening visualized on a chest X-ray.", "MRI showed lumbosacral vertebrae with diffuse infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae.", "The MRI findings were suggestive of bony metastases predominantly osteolytic in nature.", "Bone marrow aspiration showed no fragments.", "Bone marrow aspiration showed few areas of necrosis.", "Bone marrow biopsy showed marked BMN.", "The first immunophenotyping was not conclusive.", "The second immunophenotyping was positive for CD3.", "The second immunophenotyping was positive for terminal deoxynucleotidyl transferase.", "The second immunophenotyping was negative for CD20.", "The second immunophenotyping was negative for CD79a.", "The second immunophenotyping was negative for CD10.", "After admission, the patient\u2019s condition deteriorated.", "The patient developed frank superior vena cava syndrome.", "The patient was treated with chemotherapy according to the ALL protocol.", "Complete remission was achieved on day 28.", "At the 24th week of chemotherapy, the patient\u2019s condition relapsed on treatment.", "The patient returned to the hospital with fever.", "The patient returned to the hospital with chest infection.", "The patient returned to the hospital with 60% blasts observed on peripheral blood film.", "The complete blood count revealed severe pancytopenia.", "Bone marrow aspiration was a dry tap.", "The bone marrow biopsy showed hypercellular marrow.", "The bone marrow biopsy showed extensive infiltration by mononuclear cells.", "The bone marrow biopsy showed disappearance of necrosis.", "Treatment was reinitiated according to the ALL protocol.", "The patient developed severe mucositis.", "The patient developed uncontrolled septicemia.", "The patient developed electrolyte imbalance.", "The patient eventually died.", "The bone marrow aspiration at the time of diagnosis was diluted.", "The slides showed artefact with a few necrotic cells.", "The biopsy was a 1.6cm piece of tissue.", "The biopsy consisted of a fragment of trabecular bone.", "The biopsy showed marked BMN.", "The result of immunohistochemistry was not interpretable for the first specimen.", "The result of immunohistochemistry for the second specimen was definitive as precursor T-cell ALL.", "During admission, the patient received intravenous fluid 3000ml/m2/day.", "During admission, the patient received allopurinol tablets 100mg/m2/dose.", "During admission, the patient received antibiotics.", "The patient\u2019s condition deteriorated.", "The patient developed progressive dyspnea.", "The patient developed chest tightness.", "The patient developed abdominal distention.", "The patient developed fever.", "The patient was near to developing frank features of superior vena cava syndrome.", "The patient developed bilateral lower-limb weakness.", "The straight leg raising test was positive bilaterally.", "MRI of the dorsolumbosacral spine showed diffuse focal infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae.", "The MRI showed altered hypointense T1-weighted signal intensity.", "The image was suggestive of bony metastasis that was predominantly osteolytic in nature.", "Incidental hepatosplenomegaly was observed.", "Incidental bilateral renal enlargement was observed.", "There was no pressure on the spinal cord.", "Dexamethasone intravenous infusion at 6mg/m2 was started.", "Seven days after admission, induction therapy with vincristine 1.5mg/m2 intravenous bolus was started on days 7, 14, 21 and 28.", "Dexamethasone 6mg/m2 was administered daily.", "Daunorubicin 25mg/m2 was given on days 1 and 7.", "Upon starting induction, the patient developed attacks of tonic-clonic contractions.", "Computed tomography of the brain without contrast was negative.", "Electrolyte measurements showed severe hypocalcemia.", "Correction of hypocalcemia stabilized the convulsions.", "On day 28, bone marrow aspiration indicated a few fragments.", "On day 28, megakaryocytes were seen.", "On day 28, erythroid and myeloid series were present with all stages of maturation.", "On day 28, the data indicated predominant neutrophils and histiocytes.", "On day 28, the cellular elements could not confirm an excess of blast cells.", "The bone marrow biopsy report showed 95% cellularity.", "The bone marrow biopsy showed predominant early-stage granulocytes.", "The bone marrow biopsy showed normal maturation stages of hematopoietic cells.", "The blasts constituted about 2% of total marrow nucleated cells.", "The myeloid to erythroid cell ratio was 8:1.", "After a 4-week induction period, complete remission was observed.", "Early consolidation chemotherapy was continued.", "At the 24th week of treatment, the patient returned with fever.", "At the 24th week of treatment, the patient returned with chest infection.", "At the 24th week of treatment, the patient returned with neutropenia.", "At the 24th week of treatment, the patient returned with thrombocytopenia.", "We found the presence of a few blasts in the peripheral blood film.", "The patient was not responding to supportive treatment that included antibiotics and antipyretics.", "Follow-up analysis of bone marrow aspiration showed excessive bone marrow infiltration by mononuclear cells.", "Follow-up analysis of bone marrow aspiration showed multiple inconspicuous nucleoli.", "Both erythroid and megakaryocytic precursors were suppressed in bone marrow aspiration.", "In the relapsed biopsy, no necrosis was observed.", "On the reinduction therapy date, we followed a bone marrow relapsed protocol.", "On the 14th day of treatment reinduction, the patient developed severe anemia.", "On the 14th day of treatment reinduction, the patient developed thrombocytopenia.", "On the 14th day of treatment reinduction, the patient developed neutropenia.", "The patient developed grade IV mucositis.", "The patient developed hypokalemia.", "The patient could not tolerate the complications.", "The patient developed septicemia.", "The patient developed sepsis.", "The patient\u2019s death was an inevitable outcome.", "The overall survival period was 26 weeks after first diagnosis."], "summary_subclaims": ["The patient is a 10-year-old Kurdish boy.", "He had generalized bone pain and fever of 1 month's duration.", "The fever was associated with sweating.", "The fever was associated with easy fatigability.", "The fever was associated with nose bleeding.", "The fever was associated with breathlessness.", "The fever was associated with severe weight loss.", "On examination, pallor was observed.", "On examination, tachypnea was observed.", "On examination, tachycardia was observed.", "On examination, low blood pressure was observed.", "On examination, fever was observed.", "On examination, petechial hemorrhage was observed.", "On examination, ecchymoses were observed.", "On examination, tortuous dilated veins over the chest and upper part of abdomen were observed.", "On examination, multiple small cervical lymph node enlargements were observed.", "On examination, a mildly enlarged spleen was observed.", "On examination, a palpable liver was observed.", "On examination, gross abdominal distention was observed.", "Blood analysis revealed pancytopenia.", "Blood analysis revealed elevated lactate dehydrogenase.", "Blood analysis revealed elevated erythrocyte sedimentation rate.", "Imaging results showed mediastinal widening on a planar chest X-ray.", "Imaging results showed diffuse focal infiltration of the axial bone marrow on magnetic resonance imaging of the lumbosacral vertebrae.", "Bone marrow aspiration and biopsy examination showed extensive bone marrow necrosis.", "Immunophenotyping analysis of the bone marrow biopsy confirmed T-cell acute lymphoblastic leukemia.", "CD3 markers were positive.", "Terminal deoxynucleotidyl transferase markers were positive.", "CD10 markers were negative.", "CD20 markers were negative.", "CD79a markers were negative."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 10-year-old Kurdish boy.", "The patient presented with bone pain.", "The patient had fever associated with night sweats.", "The patient had shortness of breath.", "The patient had weight loss of 5kg/month.", "The patient had purple purpuric spots over the skin.", "The patient had bleeding from the nose.", "The patient\u2019s history dated back to 1 month before admission.", "On examination, we observed pallor.", "On examination, we observed cachexia.", "On examination, we observed dyspnea.", "On examination, we observed fever.", "On examination, we observed tachycardia.", "On examination, we observed tachypnea.", "On examination, we observed multiple petechiae and ecchymoses all over the skin.", "On examination, we observed dilated tortuous veins over the chest.", "The pulse rate was 120bpm.", "The respiratory rate was 23cycles/minute.", "The temperature was 39\u00b0C.", "The blood pressure was 90/45mmHg.", "We found multiple small cervical lymphadenopathies.", "We found mild splenomegaly 3cm below the left costal margin.", "The liver was tender 7cm below the right costal margin.", "The patient had gross abdominal distention.", "The initial blood counts were hemoglobin 64g/L.", "The initial blood counts were white blood cell count 34 \u00d7 109/L.", "The initial blood counts were platelets 25 \u00d7 109/L.", "The initial blood counts showed blasts 38%.", "The blasts were homogeneous with a high nuclear to cytoplasmic ratio.", "The blasts had inconspicuous nucleoli.", "The blasts had open chromatin.", "Some of the blasts were vacuolated.", "Platelets were markedly reduced.", "There was mediastinal widening visualized on a chest X-ray.", "MRI showed lumbosacral vertebrae with diffuse infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae.", "The MRI findings were suggestive of bony metastases predominantly osteolytic in nature.", "Bone marrow aspiration showed no fragments.", "Bone marrow aspiration showed few areas of necrosis.", "Bone marrow biopsy showed marked BMN.", "The first immunophenotyping was not conclusive.", "The second immunophenotyping was positive for CD3.", "The second immunophenotyping was positive for terminal deoxynucleotidyl transferase.", "The second immunophenotyping was negative for CD20.", "The second immunophenotyping was negative for CD79a.", "The second immunophenotyping was negative for CD10.", "After admission, the patient\u2019s condition deteriorated.", "The patient developed frank superior vena cava syndrome.", "The patient was treated with chemotherapy according to the ALL protocol.", "Complete remission was achieved on day 28.", "At the 24th week of chemotherapy, the patient\u2019s condition relapsed on treatment.", "The patient returned to the hospital with fever.", "The patient returned to the hospital with chest infection.", "The patient returned to the hospital with 60% blasts observed on peripheral blood film.", "The complete blood count revealed severe pancytopenia.", "Bone marrow aspiration was a dry tap.", "The bone marrow biopsy showed hypercellular marrow.", "The bone marrow biopsy showed extensive infiltration by mononuclear cells.", "The bone marrow biopsy showed disappearance of necrosis.", "Treatment was reinitiated according to the ALL protocol.", "The patient developed severe mucositis.", "The patient developed uncontrolled septicemia.", "The patient developed electrolyte imbalance.", "The patient eventually died.", "The bone marrow aspiration at the time of diagnosis was diluted.", "The slides showed artefact with a few necrotic cells.", "The biopsy was a 1.6cm piece of tissue.", "The biopsy consisted of a fragment of trabecular bone.", "The biopsy showed marked BMN.", "The result of immunohistochemistry was not interpretable for the first specimen.", "The result of immunohistochemistry for the second specimen was definitive as precursor T-cell ALL.", "During admission, the patient received intravenous fluid 3000ml/m2/day.", "During admission, the patient received allopurinol tablets 100mg/m2/dose.", "During admission, the patient received antibiotics.", "The patient\u2019s condition deteriorated.", "The patient developed progressive dyspnea.", "The patient developed chest tightness.", "The patient developed abdominal distention.", "The patient developed fever.", "The patient was near to developing frank features of superior vena cava syndrome.", "The patient developed bilateral lower-limb weakness.", "The straight leg raising test was positive bilaterally.", "MRI of the dorsolumbosacral spine showed diffuse focal infiltration of the axial bone marrow of the lower dorsal and lumbar vertebrae.", "The MRI showed altered hypointense T1-weighted signal intensity.", "The image was suggestive of bony metastasis that was predominantly osteolytic in nature.", "Incidental hepatosplenomegaly was observed.", "Incidental bilateral renal enlargement was observed.", "There was no pressure on the spinal cord.", "Dexamethasone intravenous infusion at 6mg/m2 was started.", "Seven days after admission, induction therapy with vincristine 1.5mg/m2 intravenous bolus was started on days 7, 14, 21 and 28.", "Dexamethasone 6mg/m2 was administered daily.", "Daunorubicin 25mg/m2 was given on days 1 and 7.", "Upon starting induction, the patient developed attacks of tonic-clonic contractions.", "Computed tomography of the brain without contrast was negative.", "Electrolyte measurements showed severe hypocalcemia.", "Correction of hypocalcemia stabilized the convulsions.", "On day 28, bone marrow aspiration indicated a few fragments.", "On day 28, megakaryocytes were seen.", "On day 28, erythroid and myeloid series were present with all stages of maturation.", "On day 28, the data indicated predominant neutrophils and histiocytes.", "On day 28, the cellular elements could not confirm an excess of blast cells.", "The bone marrow biopsy report showed 95% cellularity.", "The bone marrow biopsy showed predominant early-stage granulocytes.", "The bone marrow biopsy showed normal maturation stages of hematopoietic cells.", "The blasts constituted about 2% of total marrow nucleated cells.", "The myeloid to erythroid cell ratio was 8:1.", "After a 4-week induction period, complete remission was observed.", "Early consolidation chemotherapy was continued.", "At the 24th week of treatment, the patient returned with fever.", "At the 24th week of treatment, the patient returned with chest infection.", "At the 24th week of treatment, the patient returned with neutropenia.", "At the 24th week of treatment, the patient returned with thrombocytopenia.", "We found the presence of a few blasts in the peripheral blood film.", "The patient was not responding to supportive treatment that included antibiotics and antipyretics.", "Follow-up analysis of bone marrow aspiration showed excessive bone marrow infiltration by mononuclear cells.", "Follow-up analysis of bone marrow aspiration showed multiple inconspicuous nucleoli.", "Both erythroid and megakaryocytic precursors were suppressed in bone marrow aspiration.", "In the relapsed biopsy, no necrosis was observed.", "On the reinduction therapy date, we followed a bone marrow relapsed protocol.", "On the 14th day of treatment reinduction, the patient developed severe anemia.", "On the 14th day of treatment reinduction, the patient developed thrombocytopenia.", "On the 14th day of treatment reinduction, the patient developed neutropenia.", "The patient developed grade IV mucositis.", "The patient developed hypokalemia.", "The patient could not tolerate the complications.", "The patient developed septicemia.", "The patient developed sepsis.", "The patient\u2019s death was an inevitable outcome.", "The overall survival period was 26 weeks after first diagnosis."], "index": 99, "original_id": "multiclinsum_test_1185_en.txt", "split": "test", "summary_subclaims": ["The patient is a 10-year-old Kurdish boy.", "He had generalized bone pain and fever of 1 month's duration.", "The fever was associated with sweating.", "The fever was associated with easy fatigability.", "The fever was associated with nose bleeding.", "The fever was associated with breathlessness.", "The fever was associated with severe weight loss.", "On examination, pallor was observed.", "On examination, tachypnea was observed.", "On examination, tachycardia was observed.", "On examination, low blood pressure was observed.", "On examination, fever was observed.", "On examination, petechial hemorrhage was observed.", "On examination, ecchymoses were observed.", "On examination, tortuous dilated veins over the chest and upper part of abdomen were observed.", "On examination, multiple small cervical lymph node enlargements were observed.", "On examination, a mildly enlarged spleen was observed.", "On examination, a palpable liver was observed.", "On examination, gross abdominal distention was observed.", "Blood analysis revealed pancytopenia.", "Blood analysis revealed elevated lactate dehydrogenase.", "Blood analysis revealed elevated erythrocyte sedimentation rate.", "Imaging results showed mediastinal widening on a planar chest X-ray.", "Imaging results showed diffuse focal infiltration of the axial bone marrow on magnetic resonance imaging of the lumbosacral vertebrae.", "Bone marrow aspiration and biopsy examination showed extensive bone marrow necrosis.", "Immunophenotyping analysis of the bone marrow biopsy confirmed T-cell acute lymphoblastic leukemia.", "CD3 markers were positive.", "Terminal deoxynucleotidyl transferase markers were positive.", "CD10 markers were negative.", "CD20 markers were negative.", "CD79a markers were negative."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission.", "The patient had nausea and vomiting in the morning.", "The patient had no history of seizures or decreased consciousness.", "The examination of neurological symptoms was completely normal.", "The patient's blood pressure was 130/85 mmHg.", "The patient's heart rate was 86/min.", "The patient's temperature was 37.3 \u00b0C.", "The patient had undergone tympano-mastoidectomy surgery and resection of the cholesteatoma 1 week earlier.", "A canalwall down mastoidectomy was performed due to right ear cholesteatoma.", "Microtrauma was inflicted in the dural plate during surgery.", "No significant cerebrospinal fluid leak occurred during the procedure.", "The Mount Fuji sign was found on the brain CT scan.", "No evidence of brain abscess or intracranial hemorrhage was found.", "The patient was immediately admitted to the intensive care unit.", "Initial treatments such as CBR, 30-degree head elevation, anti-fever therapy, analgesics, oxygen therapy, and phenytoin were prescribed.", "The patient did not undergo surgery due to a lack of neurological symptoms, decreased level of consciousness, or seizures.", "The patient was maintained under regular and continuous monitoring of vital and neurological signs.", "The patient\u2019s headache had completely resolved the day after admission.", "The patient was admitted to the ICU for 5 days.", "The patient was monitored for the volume of pneumocephalus every day with a CT scan.", "The patient's pneumocephalus was resolved completely at the end of 5 days.", "The patient was transferred to the ward.", "The patient was discharged after complete recovery."], "summary_subclaims": ["The patient was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission.", "The patient experienced nausea and vomiting in the morning.", "The patient had no history of seizures or decreased consciousness.", "Examination of neurological symptoms was completely normal.", "The patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously.", "The Mount Fuji sign was found on the brain CT scan.", "Treatments such as CBR, 30-degree head elevation, anti-fever, analgesics, oxygen therapy, and phenytoin were prescribed.", "At the end of 5 days, the patient's pneumocephalus was resolved completely."]}, "extra_info": {"fulltext_subclaims": ["A 56-year-old woman was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission.", "The patient had nausea and vomiting in the morning.", "The patient had no history of seizures or decreased consciousness.", "The examination of neurological symptoms was completely normal.", "The patient's blood pressure was 130/85 mmHg.", "The patient's heart rate was 86/min.", "The patient's temperature was 37.3 \u00b0C.", "The patient had undergone tympano-mastoidectomy surgery and resection of the cholesteatoma 1 week earlier.", "A canalwall down mastoidectomy was performed due to right ear cholesteatoma.", "Microtrauma was inflicted in the dural plate during surgery.", "No significant cerebrospinal fluid leak occurred during the procedure.", "The Mount Fuji sign was found on the brain CT scan.", "No evidence of brain abscess or intracranial hemorrhage was found.", "The patient was immediately admitted to the intensive care unit.", "Initial treatments such as CBR, 30-degree head elevation, anti-fever therapy, analgesics, oxygen therapy, and phenytoin were prescribed.", "The patient did not undergo surgery due to a lack of neurological symptoms, decreased level of consciousness, or seizures.", "The patient was maintained under regular and continuous monitoring of vital and neurological signs.", "The patient\u2019s headache had completely resolved the day after admission.", "The patient was admitted to the ICU for 5 days.", "The patient was monitored for the volume of pneumocephalus every day with a CT scan.", "The patient's pneumocephalus was resolved completely at the end of 5 days.", "The patient was transferred to the ward.", "The patient was discharged after complete recovery."], "index": 105, "original_id": "multiclinsum_test_520_en.txt", "split": "test", "summary_subclaims": ["The patient was referred to the emergency department due to a severe headache in the frontal area for 2 days before admission.", "The patient experienced nausea and vomiting in the morning.", "The patient had no history of seizures or decreased consciousness.", "Examination of neurological symptoms was completely normal.", "The patient had undergone tympanomastoidectomy surgery and resection of the cholesteatoma 1 week previously.", "The Mount Fuji sign was found on the brain CT scan.", "Treatments such as CBR, 30-degree head elevation, anti-fever, analgesics, oxygen therapy, and phenytoin were prescribed.", "At the end of 5 days, the patient's pneumocephalus was resolved completely."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 22-year-old male soldier.", "The patient received multifragmental combined with thoraco-abdominal injuries as a result of shelling from MLRS \u201cGrad\u201d.", "The entrance wound was detected in the region of 5\u20137 ribs between the anterior and the posterior right axillary lines.", "The patient received first medical aid immediately at the place of injury.", "The time taken between injury and evacuation was less than 60 min.", "The patient was transported to the Military Medical Hospital #66 at Pokrovsk.", "The patient was diagnosed with a penetrating thoracic wound.", "The blood loss was approximately 1500 ml.", "Thoracentesis was performed to eliminate the right hemopneumothorax.", "Laparocentesis was performed.", "A hemorrhagic content was received at the laparocentesis.", "Laparotomy was performed.", "Ruptures of the liver\u2019s parenchyma were detected.", "The entrance wound was detected only in the chest area.", "The exit wound was not identified neither in chest, nor in abdomen wall.", "A conclusion was made that damage of the liver was in result of \u201chydrodynamic shock\u201d.", "Minimal surgical treatment was applied.", "Suturing of liver ruptures was performed.", "Excision of necrotic tissues was performed.", "Suturing of gunshot wounds of limbs was performed.", "In an early post-operative period, a hemorrhage and bile were detected on drainage.", "Relaparotomy was performed.", "Liver damage within the area of gallbladder fossa was detected.", "Cholecystectomy was performed.", "A patch of omentum was used to fill the gap in injured S3\u20136 of liver.", "The patient was transported to the Mechnikov Regional Clinical Hospital in Dnipro.", "Antibacterial therapy was administrated.", "The patient was transported to the ICU at the National Military Medical Clinical Center of Ukraine in Kyiv.", "Drainage from the subhepatic area showed daily bile volume up to 300 ml.", "Endoscopic papillosphincterotomy was performed.", "Endoscopic retrograde cholecystopancreatography was performed.", "Stenting of the common bile duct was performed.", "A feeding tube was placed behind the Treitz ligament.", "Implementation of endoscopic decompression of the bile duct had resulted in gradual reduction of bile volume.", "A CT scan of the abdomen was performed.", "The liver demonstrated zones with ischemic lesions.", "A liver resection of the affected segment was planned.", "Intra-abdominal bleeding was diagnosed.", "Urgent laparotomy was performed.", "Erosion of the right hepatic artery was detected.", "Erosive defect was sutured.", "Stable hemostasis was achieved.", "Tissue softening and color changes of liver S5\u20136 parenchyma were detected.", "Anatomic resection of the liver S5\u20136 was performed.", "The patient was transferred to the surgery ward from ICU.", "The patient was diagnosed with multiple fragmental injuries of soft tissues of the skull, chest, abdomen, as well as extremities.", "The most serious soft tissue injury was detected at the right lower limb.", "The patient was discharged from hospital in good condition on the 49th day after receiving injuries."], "summary_subclaims": ["The patient was injured after the multiple launcher rocket system 'Grad' shelling.", "The patient was diagnosed with hydrodynamic liver rupture.", "Medical management with application of damage control (DC) tactic was used.", "The patient underwent relaparatomy.", "The patient underwent liver resection.", "The patient underwent endoscopic papillosphincterotomy.", "The patient underwent endoscopic retrograde cholecystopancreatography.", "Stenting of the common bile duct was performed.", "VAC-therapy was applied.", "Applied treatment modalities were effective.", "The patient was discharged on the 49th day after injury."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 22-year-old male soldier.", "The patient received multifragmental combined with thoraco-abdominal injuries as a result of shelling from MLRS \u201cGrad\u201d.", "The entrance wound was detected in the region of 5\u20137 ribs between the anterior and the posterior right axillary lines.", "The patient received first medical aid immediately at the place of injury.", "The time taken between injury and evacuation was less than 60 min.", "The patient was transported to the Military Medical Hospital #66 at Pokrovsk.", "The patient was diagnosed with a penetrating thoracic wound.", "The blood loss was approximately 1500 ml.", "Thoracentesis was performed to eliminate the right hemopneumothorax.", "Laparocentesis was performed.", "A hemorrhagic content was received at the laparocentesis.", "Laparotomy was performed.", "Ruptures of the liver\u2019s parenchyma were detected.", "The entrance wound was detected only in the chest area.", "The exit wound was not identified neither in chest, nor in abdomen wall.", "A conclusion was made that damage of the liver was in result of \u201chydrodynamic shock\u201d.", "Minimal surgical treatment was applied.", "Suturing of liver ruptures was performed.", "Excision of necrotic tissues was performed.", "Suturing of gunshot wounds of limbs was performed.", "In an early post-operative period, a hemorrhage and bile were detected on drainage.", "Relaparotomy was performed.", "Liver damage within the area of gallbladder fossa was detected.", "Cholecystectomy was performed.", "A patch of omentum was used to fill the gap in injured S3\u20136 of liver.", "The patient was transported to the Mechnikov Regional Clinical Hospital in Dnipro.", "Antibacterial therapy was administrated.", "The patient was transported to the ICU at the National Military Medical Clinical Center of Ukraine in Kyiv.", "Drainage from the subhepatic area showed daily bile volume up to 300 ml.", "Endoscopic papillosphincterotomy was performed.", "Endoscopic retrograde cholecystopancreatography was performed.", "Stenting of the common bile duct was performed.", "A feeding tube was placed behind the Treitz ligament.", "Implementation of endoscopic decompression of the bile duct had resulted in gradual reduction of bile volume.", "A CT scan of the abdomen was performed.", "The liver demonstrated zones with ischemic lesions.", "A liver resection of the affected segment was planned.", "Intra-abdominal bleeding was diagnosed.", "Urgent laparotomy was performed.", "Erosion of the right hepatic artery was detected.", "Erosive defect was sutured.", "Stable hemostasis was achieved.", "Tissue softening and color changes of liver S5\u20136 parenchyma were detected.", "Anatomic resection of the liver S5\u20136 was performed.", "The patient was transferred to the surgery ward from ICU.", "The patient was diagnosed with multiple fragmental injuries of soft tissues of the skull, chest, abdomen, as well as extremities.", "The most serious soft tissue injury was detected at the right lower limb.", "The patient was discharged from hospital in good condition on the 49th day after receiving injuries."], "index": 93, "original_id": "multiclinsum_test_2795_en.txt", "split": "test", "summary_subclaims": ["The patient was injured after the multiple launcher rocket system 'Grad' shelling.", "The patient was diagnosed with hydrodynamic liver rupture.", "Medical management with application of damage control (DC) tactic was used.", "The patient underwent relaparatomy.", "The patient underwent liver resection.", "The patient underwent endoscopic papillosphincterotomy.", "The patient underwent endoscopic retrograde cholecystopancreatography.", "Stenting of the common bile duct was performed.", "VAC-therapy was applied.", "Applied treatment modalities were effective.", "The patient was discharged on the 49th day after injury."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 69-year-old female.", "She had a painful lump in her left breast 3 months ago.", "She had bloody discharge from the left nipple four years ago.", "The patient decided not to follow-up despite recommendations for diagnostic procedure.", "On physical examination, an erythematous tender mass with hard consistency was detected around the nipple.", "Sonography showed a lobulated hypoechoic mass with microcystic areas measuring 20\u00d717 mm at 3 o'clock beside the areola.", "Mammography showed a hyperdense mass in the retroareolar site.", "The patient was admitted and underwent surgery.", "Intraoperative pathology consultation based on multiple frozen sections from the mass was performed.", "A left modified radical mastectomy and lymph node dissection were done.", "The specimen was received in formalin.", "On serial sectioning, there were tan-brown firm masses with multiple cystic areas.", "The surgical margins were free from tumoral cells.", "The nipple was retracted.", "Sections were taken and stained by hematoxylin and eosin.", "Microscopically, neoplastic tissue composed of dilated ducts filled by papillary projections, cribriform and fused glands was seen.", "The neoplastic tissue was lined by mild to moderate atypical cells with scattered mitoses.", "There was no distinct myoepathelial layer.", "The neoplastic tissue was mostly floating in mucinous lakes with invasion to surrounding stroma.", "Foci of ductal carcinoma in situ including cribriform, papillary, and micropapillary patterns were present in about 30% of the tumor bulk.", "All surgical margins were free of tumor.", "An in situ component with papillary features was seen in the nipple.", "Nearby skin-deep dermis was involved by tumor.", "All 16 lymph nodes showed reactive changes.", "There was no perineural invasion.", "There was no lymphovascular invasion.", "Immunohistochemistry profile showed positive estrogen and progesterone receptors.", "Immunohistochemistry profile showed negative for HER2.", "The patient was discharged with regular follow-up."], "summary_subclaims": ["The patient is a 69-year-old female.", "The patient had a painful mass in her left breast.", "Intraoperative pathology consult showed neoplastic tissue mostly floating in mucinous lakes.", "Invasion to surrounding stroma was seen.", "Immunohistochemistry profile showed positive estrogen receptors.", "Immunohistochemistry profile showed positive progesterone receptors.", "Immunohistochemistry profile showed negative for HER2."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 69-year-old female.", "She had a painful lump in her left breast 3 months ago.", "She had bloody discharge from the left nipple four years ago.", "The patient decided not to follow-up despite recommendations for diagnostic procedure.", "On physical examination, an erythematous tender mass with hard consistency was detected around the nipple.", "Sonography showed a lobulated hypoechoic mass with microcystic areas measuring 20\u00d717 mm at 3 o'clock beside the areola.", "Mammography showed a hyperdense mass in the retroareolar site.", "The patient was admitted and underwent surgery.", "Intraoperative pathology consultation based on multiple frozen sections from the mass was performed.", "A left modified radical mastectomy and lymph node dissection were done.", "The specimen was received in formalin.", "On serial sectioning, there were tan-brown firm masses with multiple cystic areas.", "The surgical margins were free from tumoral cells.", "The nipple was retracted.", "Sections were taken and stained by hematoxylin and eosin.", "Microscopically, neoplastic tissue composed of dilated ducts filled by papillary projections, cribriform and fused glands was seen.", "The neoplastic tissue was lined by mild to moderate atypical cells with scattered mitoses.", "There was no distinct myoepathelial layer.", "The neoplastic tissue was mostly floating in mucinous lakes with invasion to surrounding stroma.", "Foci of ductal carcinoma in situ including cribriform, papillary, and micropapillary patterns were present in about 30% of the tumor bulk.", "All surgical margins were free of tumor.", "An in situ component with papillary features was seen in the nipple.", "Nearby skin-deep dermis was involved by tumor.", "All 16 lymph nodes showed reactive changes.", "There was no perineural invasion.", "There was no lymphovascular invasion.", "Immunohistochemistry profile showed positive estrogen and progesterone receptors.", "Immunohistochemistry profile showed negative for HER2.", "The patient was discharged with regular follow-up."], "index": 106, "original_id": "multiclinsum_test_2138_en.txt", "split": "test", "summary_subclaims": ["The patient is a 69-year-old female.", "The patient had a painful mass in her left breast.", "Intraoperative pathology consult showed neoplastic tissue mostly floating in mucinous lakes.", "Invasion to surrounding stroma was seen.", "Immunohistochemistry profile showed positive estrogen receptors.", "Immunohistochemistry profile showed positive progesterone receptors.", "Immunohistochemistry profile showed negative for HER2."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 48-year-old caucasian male.", "He had an extensive psychiatric history of depression.", "He was admitted to the intensive care unit following intoxication of approximately 20 g venlafaxine, 450 mg zolpidem, and 250 mg propiomazine.", "His past history included intensive care hospitalization due to two suicidal attempts through pharmacological intoxication.", "On admission, he was awake but drowsy.", "His Glasgow Coma Scale (GCS) was 13 of 15.", "His electrocardiography (ECG) was normal with a sinus rhythm of 57 beats per minute.", "Laboratory findings were within normal range.", "Admission occurred approximately 2 hours after intake of the pills.", "Activated charcoal suspension was administered via a nasogastric tube upon arrival at the intensive care unit.", "The patient was stable during the first 5 hours at the intensive care unit.", "Seven hours post-intoxication, he experienced tonic\u2013clonic seizures.", "This was successfully treated with diazepam 10 mg intravenously.", "He was intubated and sedated with propofol and remifentanil.", "Vasopressor support with low-dose norepinephrine was initiated.", "Nine hours after ingestion, his circulation began to slowly fail.", "Increased doses of norepinephrine were required.", "The patient developed metabolic acidosis with lactate elevation.", "Fifteen hours after ingestion, the patient\u2019s blood pressure fell rapidly despite high doses of norepinephrine.", "Prompt echocardiography revealed prominent hypokinesia with akinesia from the mid-left ventricle to the apex, as in TTC.", "The left ventricle ejection fraction (EF) was 20%.", "The right ventricle was also affected with a tricuspid annular plane systolic excursion (TAPSE) measuring 10 mm.", "Dobutamine was added to norepinephrine.", "Only a few micrograms of dobutamine were infused prior to cardiac arrest.", "The patient suffered a cardiac arrest with an initial rhythm of asystole.", "Advanced cardiac life support was initiated according to national guidelines.", "The patient was given three doses of epinephrine 1 mg intravenously.", "After 5 minutes without return of spontaneous circulation, the ECMO center at a tertiary hospital was contacted.", "Fifteen minutes post cardiac arrest, the patient regained circulation temporarily for approximately 10 minutes.", "The patient\u2019s circulatory status and blood pressure were inadequate during these 10 minutes.", "High-dose epinephrine infusion (1.0 \u00b5g/kg/minute) was initiated.", "Manual CPR continued for another 30 minutes.", "The patient was transported by helicopter to a tertiary hospital using mechanical CPR (AutoPulse Resuscitation System) and ongoing epinephrine infusion.", "Transportation time was approximately 30 minutes.", "One hour 15 minutes after the cardiac arrest, the patient was delivered to the tertiary hospital for ECMO initiation.", "Upon arrival at the tertiary hospital, the patient had a sinus rhythm but very low cardiac output.", "Blood pressure was 55/45 mmHg without cardiac arrest.", "External compression was continued whilst ECMO system treatment was established.", "Short pauses were taken during specifically vulnerable periods of the cannulation procedure.", "Lactate peaked at 4.6 mmol/L.", "Two hours after the cardiac arrest, the patient was on ECMO.", "After ECMO initiation, treatment with sedation and circulatory drugs continued.", "Continuous renal replacement therapy (CRRT) was initiated.", "CRRT was initiated due to anuria and creatinine level of 265 \u00b5mol/L.", "Sedation was reinitiated using midazolam and morphine instead of propofol and remifentanil.", "The amount of epinephrine was significantly decreased during the initial hours of ECMO treatment.", "Norepinephrine and milrinone were used instead.", "Multiple plasma and red cell concentrate (RCC) transfusions were also required due to significant bleeding from the femoral artery catheter.", "The patient was successfully weaned after 32 hours of ECMO.", "Epinephrine infusion was terminated the same day.", "Milrinone continued until the following day.", "The patient was transported back to the primary hospital with decreasing doses of norepinephrine the day after ECMO termination.", "Three days after the cardiac arrest, his cardiac function was echodynamically restored with an EF of above 55%.", "Values of the cardiac biomarker NT-proBNP decreased from 8360 ng/L the day after the cardiac arrest to 1190 ng/L 36 days after the intoxication.", "He was ventilated for 8 days.", "He received CRRT for 3 weeks.", "Two days after extubation, the patient gradually regained consciousness.", "Thirty days after the intoxication, he had regained normal cardiac and cognitive function.", "He left the hospital for further psychiatric treatment.", "The patient\u2019s renal function was fully restored with normal creatinine level (82 \u00b5mol/L) 7 weeks after the intoxication.", "He was finally discharged in good health without his former prescribed psychiatric medications.", "Two years later, his cardiac and renal function were normal.", "His psychiatric medication was reinstated.", "The serum venlafaxine concentration 24 hours after ingestion was 12.6 mg/L.", "This laboratory result was not received until 1 week after ingestion."], "summary_subclaims": ["The patient is a 48-year-old caucasian male.", "The patient has an extensive psychiatric history.", "The patient ingested a high dose of venlafaxine.", "The serum venlafaxine concentration was 12.6 mg/L 24 hours after ingestion.", "Seven hours post-ingestion, the patient experienced tonic-clonic seizures.", "Eight hours post-ingestion, takotsubo cardiomyopathy was recognized.", "The patient had a cardiac arrest.", "The patient was resuscitated with prolonged cardiopulmonary resuscitation.", "Ongoing automatic external compressions were used during helicopter transportation.", "The patient was transported to a tertiary hospital for extracorporeal membrane oxygenation treatment.", "The cardiopulmonary resuscitation duration was 2 hours.", "The patient received 36 hours of extracorporeal membrane oxygenation.", "The patient spent a total of 30 days in the intensive care unit.", "The patient made a full recovery."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 48-year-old caucasian male.", "He had an extensive psychiatric history of depression.", "He was admitted to the intensive care unit following intoxication of approximately 20 g venlafaxine, 450 mg zolpidem, and 250 mg propiomazine.", "His past history included intensive care hospitalization due to two suicidal attempts through pharmacological intoxication.", "On admission, he was awake but drowsy.", "His Glasgow Coma Scale (GCS) was 13 of 15.", "His electrocardiography (ECG) was normal with a sinus rhythm of 57 beats per minute.", "Laboratory findings were within normal range.", "Admission occurred approximately 2 hours after intake of the pills.", "Activated charcoal suspension was administered via a nasogastric tube upon arrival at the intensive care unit.", "The patient was stable during the first 5 hours at the intensive care unit.", "Seven hours post-intoxication, he experienced tonic\u2013clonic seizures.", "This was successfully treated with diazepam 10 mg intravenously.", "He was intubated and sedated with propofol and remifentanil.", "Vasopressor support with low-dose norepinephrine was initiated.", "Nine hours after ingestion, his circulation began to slowly fail.", "Increased doses of norepinephrine were required.", "The patient developed metabolic acidosis with lactate elevation.", "Fifteen hours after ingestion, the patient\u2019s blood pressure fell rapidly despite high doses of norepinephrine.", "Prompt echocardiography revealed prominent hypokinesia with akinesia from the mid-left ventricle to the apex, as in TTC.", "The left ventricle ejection fraction (EF) was 20%.", "The right ventricle was also affected with a tricuspid annular plane systolic excursion (TAPSE) measuring 10 mm.", "Dobutamine was added to norepinephrine.", "Only a few micrograms of dobutamine were infused prior to cardiac arrest.", "The patient suffered a cardiac arrest with an initial rhythm of asystole.", "Advanced cardiac life support was initiated according to national guidelines.", "The patient was given three doses of epinephrine 1 mg intravenously.", "After 5 minutes without return of spontaneous circulation, the ECMO center at a tertiary hospital was contacted.", "Fifteen minutes post cardiac arrest, the patient regained circulation temporarily for approximately 10 minutes.", "The patient\u2019s circulatory status and blood pressure were inadequate during these 10 minutes.", "High-dose epinephrine infusion (1.0 \u00b5g/kg/minute) was initiated.", "Manual CPR continued for another 30 minutes.", "The patient was transported by helicopter to a tertiary hospital using mechanical CPR (AutoPulse Resuscitation System) and ongoing epinephrine infusion.", "Transportation time was approximately 30 minutes.", "One hour 15 minutes after the cardiac arrest, the patient was delivered to the tertiary hospital for ECMO initiation.", "Upon arrival at the tertiary hospital, the patient had a sinus rhythm but very low cardiac output.", "Blood pressure was 55/45 mmHg without cardiac arrest.", "External compression was continued whilst ECMO system treatment was established.", "Short pauses were taken during specifically vulnerable periods of the cannulation procedure.", "Lactate peaked at 4.6 mmol/L.", "Two hours after the cardiac arrest, the patient was on ECMO.", "After ECMO initiation, treatment with sedation and circulatory drugs continued.", "Continuous renal replacement therapy (CRRT) was initiated.", "CRRT was initiated due to anuria and creatinine level of 265 \u00b5mol/L.", "Sedation was reinitiated using midazolam and morphine instead of propofol and remifentanil.", "The amount of epinephrine was significantly decreased during the initial hours of ECMO treatment.", "Norepinephrine and milrinone were used instead.", "Multiple plasma and red cell concentrate (RCC) transfusions were also required due to significant bleeding from the femoral artery catheter.", "The patient was successfully weaned after 32 hours of ECMO.", "Epinephrine infusion was terminated the same day.", "Milrinone continued until the following day.", "The patient was transported back to the primary hospital with decreasing doses of norepinephrine the day after ECMO termination.", "Three days after the cardiac arrest, his cardiac function was echodynamically restored with an EF of above 55%.", "Values of the cardiac biomarker NT-proBNP decreased from 8360 ng/L the day after the cardiac arrest to 1190 ng/L 36 days after the intoxication.", "He was ventilated for 8 days.", "He received CRRT for 3 weeks.", "Two days after extubation, the patient gradually regained consciousness.", "Thirty days after the intoxication, he had regained normal cardiac and cognitive function.", "He left the hospital for further psychiatric treatment.", "The patient\u2019s renal function was fully restored with normal creatinine level (82 \u00b5mol/L) 7 weeks after the intoxication.", "He was finally discharged in good health without his former prescribed psychiatric medications.", "Two years later, his cardiac and renal function were normal.", "His psychiatric medication was reinstated.", "The serum venlafaxine concentration 24 hours after ingestion was 12.6 mg/L.", "This laboratory result was not received until 1 week after ingestion."], "index": 97, "original_id": "multiclinsum_test_985_en.txt", "split": "test", "summary_subclaims": ["The patient is a 48-year-old caucasian male.", "The patient has an extensive psychiatric history.", "The patient ingested a high dose of venlafaxine.", "The serum venlafaxine concentration was 12.6 mg/L 24 hours after ingestion.", "Seven hours post-ingestion, the patient experienced tonic-clonic seizures.", "Eight hours post-ingestion, takotsubo cardiomyopathy was recognized.", "The patient had a cardiac arrest.", "The patient was resuscitated with prolonged cardiopulmonary resuscitation.", "Ongoing automatic external compressions were used during helicopter transportation.", "The patient was transported to a tertiary hospital for extracorporeal membrane oxygenation treatment.", "The cardiopulmonary resuscitation duration was 2 hours.", "The patient received 36 hours of extracorporeal membrane oxygenation.", "The patient spent a total of 30 days in the intensive care unit.", "The patient made a full recovery."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 46-year-old male with end-stage renal disease of unknown cause.", "He had been on hemodialysis for 3 years.", "He underwent cadaveric renal transplantation 15 months ago.", "There was no other remarkable medical history except for 3 years of hypertension.", "The donor was after brain death.", "During harvesting of the donor\u2019s kidneys, a branch of right renal artery to renal superior polar was inadvertently cut off.", "The artery branch with a diameter 0.3 mm arose from the bifurcation of abdominal aorta and renal artery.", "The severed renal artery branch was anastomosed in situ with 7\u20130 prolene during the repair of the kidney.", "The cold ischemia time of the kidney was 5 min.", "The warm ischemia time of the kidney was 6 h.", "The right kidney of donor was transplanted in the right iliac fossa.", "The donor renal artery with a Carrel patch of donor aorta was anastomosed end-to-side to the recipient right external iliac artery with 6\u20130 prolene.", "The renal vein was anastomosed end-to-side to the recipient right external iliac vein with 5\u20130 prolene.", "The graft ureter was anastomosed to the urinary bladder of the recipient with a double J stent.", "Basiliximab was used as immunity induction on the day of surgery and the fourth day after transplantation.", "His immunosuppression regimen consisted of tacrolimus, mycophenolate sodium, and prednisolone.", "His immediate postoperative course was unremarkable.", "His blood pressure was controlled to 140\u2013156/90\u2013105 mmHg with nicardipine, spironolactone, and furosemide.", "The 24-h urine volume was between 1937 and 4100 ml.", "His renal function significantly improved, reaching a creatinine of 151 \u03bcmol/L on 11st day posttransplantation.", "From the 12nd day after transplantation, his blood pressure began to gradually increase to 170\u2013174/103\u2013109 mmHg.", "There was no positive presentation on clinical examination and ultrasonography.", "The level of creatinine and urine volume were also stable.", "Nicardipine was increased.", "It was still difficult to control his blood pressure even though three antihypertensive medications were administered.", "His blood pressure reached 190/120 mmHg on 20th day after transplantation.", "There was a decrease in 24-h urine volume with 1620\u20131725 ml.", "There was mild impairment of renal function with a creatinine of 194 \u03bcmol/L.", "A bruit became audible over the site of the transplanted kidney.", "Color Doppler ultrasonography indicated a decreased RI in intrarenal arteries.", "Color Doppler ultrasonography indicated increased blood flow of the transplant renal artery.", "The RI was 0.45.", "The peak systolic velocity was 305 cm/s.", "The velocity gradient between stenotic and prestenotic segment was more than 3:1.", "A vascular complication of TRAS was suspected.", "Diagnostic arteriography showed a 90% stenosis of transplant renal artery.", "The TRAS occurred in the distal site of the anastomosis instead of the anastomosis.", "We considered that the reconstructional renal artery branch stretched the trunk of renal artery, which resulted in the stenosis distal to the suture line.", "Renal artery angioplasty was undertaken through a retrograde ipsilateral femoral artery approach.", "Percutaneous transluminal stent implantation was performed.", "A bare stent (6 \u00d7 14 mm, Express Vascular SD) had to be chosen to avoid affecting the flow of the artery branch.", "After the bare stent was successfully deployed, a second angiographic evaluation verified the effectiveness of the intervention was obvious.", "After the interventional treatment, the renal function and urine volume recovered.", "His blood pressure was stably controlled to 121/80 mmHg with only two antihypertension medications (nifedipine and arotinolol).", "He was discharged on 28 day after transplantation with a creatinine of 108 \u03bcmol/L.", "The patient\u2019s renal function remains stable at clinical follow-up of 15 months."], "summary_subclaims": ["The patient is a 46-year-old male.", "The patient has end-stage renal disease of unknown cause.", "The patient received a cadaveric renal transplant one year ago.", "Three antihypertensive medications were administrated.", "His blood pressure increased to 190/120 mmHg 3 weeks posttransplantation.", "The level of creatinine increased to 194 \u03bcmol/L.", "Color Doppler ultrasonography indicated a decreased resistance index in intrarenal arteries.", "Color Doppler ultrasonography indicated increased blood flow of the transplant renal artery.", "A vascular complication of TRAS was suspected.", "Arteriography was performed.", "TRAS occurred in the distal site of the anastomosis instead of the anastomosis.", "Percutaneous transluminal bare stent implantation treatment was successfully performed.", "Satisfactory clinical efficacy with improvement in transplant renal function was achieved after the interventional treatment.", "Satisfactory clinical efficacy with improvement in renovascular hypertension was achieved after the interventional treatment."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 46-year-old male with end-stage renal disease of unknown cause.", "He had been on hemodialysis for 3 years.", "He underwent cadaveric renal transplantation 15 months ago.", "There was no other remarkable medical history except for 3 years of hypertension.", "The donor was after brain death.", "During harvesting of the donor\u2019s kidneys, a branch of right renal artery to renal superior polar was inadvertently cut off.", "The artery branch with a diameter 0.3 mm arose from the bifurcation of abdominal aorta and renal artery.", "The severed renal artery branch was anastomosed in situ with 7\u20130 prolene during the repair of the kidney.", "The cold ischemia time of the kidney was 5 min.", "The warm ischemia time of the kidney was 6 h.", "The right kidney of donor was transplanted in the right iliac fossa.", "The donor renal artery with a Carrel patch of donor aorta was anastomosed end-to-side to the recipient right external iliac artery with 6\u20130 prolene.", "The renal vein was anastomosed end-to-side to the recipient right external iliac vein with 5\u20130 prolene.", "The graft ureter was anastomosed to the urinary bladder of the recipient with a double J stent.", "Basiliximab was used as immunity induction on the day of surgery and the fourth day after transplantation.", "His immunosuppression regimen consisted of tacrolimus, mycophenolate sodium, and prednisolone.", "His immediate postoperative course was unremarkable.", "His blood pressure was controlled to 140\u2013156/90\u2013105 mmHg with nicardipine, spironolactone, and furosemide.", "The 24-h urine volume was between 1937 and 4100 ml.", "His renal function significantly improved, reaching a creatinine of 151 \u03bcmol/L on 11st day posttransplantation.", "From the 12nd day after transplantation, his blood pressure began to gradually increase to 170\u2013174/103\u2013109 mmHg.", "There was no positive presentation on clinical examination and ultrasonography.", "The level of creatinine and urine volume were also stable.", "Nicardipine was increased.", "It was still difficult to control his blood pressure even though three antihypertensive medications were administered.", "His blood pressure reached 190/120 mmHg on 20th day after transplantation.", "There was a decrease in 24-h urine volume with 1620\u20131725 ml.", "There was mild impairment of renal function with a creatinine of 194 \u03bcmol/L.", "A bruit became audible over the site of the transplanted kidney.", "Color Doppler ultrasonography indicated a decreased RI in intrarenal arteries.", "Color Doppler ultrasonography indicated increased blood flow of the transplant renal artery.", "The RI was 0.45.", "The peak systolic velocity was 305 cm/s.", "The velocity gradient between stenotic and prestenotic segment was more than 3:1.", "A vascular complication of TRAS was suspected.", "Diagnostic arteriography showed a 90% stenosis of transplant renal artery.", "The TRAS occurred in the distal site of the anastomosis instead of the anastomosis.", "We considered that the reconstructional renal artery branch stretched the trunk of renal artery, which resulted in the stenosis distal to the suture line.", "Renal artery angioplasty was undertaken through a retrograde ipsilateral femoral artery approach.", "Percutaneous transluminal stent implantation was performed.", "A bare stent (6 \u00d7 14 mm, Express Vascular SD) had to be chosen to avoid affecting the flow of the artery branch.", "After the bare stent was successfully deployed, a second angiographic evaluation verified the effectiveness of the intervention was obvious.", "After the interventional treatment, the renal function and urine volume recovered.", "His blood pressure was stably controlled to 121/80 mmHg with only two antihypertension medications (nifedipine and arotinolol).", "He was discharged on 28 day after transplantation with a creatinine of 108 \u03bcmol/L.", "The patient\u2019s renal function remains stable at clinical follow-up of 15 months."], "index": 101, "original_id": "multiclinsum_test_1302_en.txt", "split": "test", "summary_subclaims": ["The patient is a 46-year-old male.", "The patient has end-stage renal disease of unknown cause.", "The patient received a cadaveric renal transplant one year ago.", "Three antihypertensive medications were administrated.", "His blood pressure increased to 190/120 mmHg 3 weeks posttransplantation.", "The level of creatinine increased to 194 \u03bcmol/L.", "Color Doppler ultrasonography indicated a decreased resistance index in intrarenal arteries.", "Color Doppler ultrasonography indicated increased blood flow of the transplant renal artery.", "A vascular complication of TRAS was suspected.", "Arteriography was performed.", "TRAS occurred in the distal site of the anastomosis instead of the anastomosis.", "Percutaneous transluminal bare stent implantation treatment was successfully performed.", "Satisfactory clinical efficacy with improvement in transplant renal function was achieved after the interventional treatment.", "Satisfactory clinical efficacy with improvement in renovascular hypertension was achieved after the interventional treatment."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 59-year-old male.", "The patient had no history of smoking.", "The carcinoembryonic antigen level was 5.6 ng/mL.", "Chest computed tomography revealed a tumor with a maximum diameter of 13 mm in the left lower pulmonary lobe.", "The tumor was suspected to be left lower lobe lung cancer (cT1bN0M0 stage1A2).", "Three-dimensional CT was performed using the Fujifilm Synapse Vincent system.", "A displaced B1 + 2 was running behind the main pulmonary artery.", "An anomalous V1 + 2 joined the left inferior pulmonary vein.", "Hyperlobulation between S1 + 2 and S3 with a completely fused interlobar fissure between S1 + 2 and S6 was observed.", "The interlobar plane between S1 + 2 and S6 ran perpendicular to the cranio-caudal direction.", "Bronchoscopy revealed that three bronchi branched from the left main bronchus.", "VATS was planned for surgical diagnosis and treatment.", "Non-anatomical wedge resection of the lesion was performed.", "The patient was diagnosed with adenocarcinoma.", "Left lower lobectomy and systematic nodal dissection were performed.", "The major pitfalls were to avoid injuring the displaced B1 + 2 and to avoid cutting the anomalous V1 + 2.", "The inferior pulmonary vein was identified on the posterior side of the hilum.", "The anomalous V1 + 2 joined the inferior pulmonary vein.", "The distal branch of A8 was identified using the interlobar fissure.", "A6 and V1 + 2 ran near A6 and a branch of V1 + 2 ran between S1 + 2 and S6.", "The branch of V1 + 2 was used as a landmark when dividing the fissure between S1 + 2 and the inferior lobe.", "Forceps were passed from the anterior to posterior side between a branch of V1 + 2 and A6.", "The largely fused fissure between S1 + 2 and the inferior lobe was divided using a stapler.", "A6 and A9 + 10 were identified and divided.", "The inferior bronchus branched from the left main bronchus at the level of the branches of B3 + B4 + 5 and the displaced B1 + 2.", "The displaced B1 + 2 was located at a more proximal site than normal.", "The station 11 lymph nodes were identified.", "Forceps were passed from the anterior to posterior side along the station 11 lymph nodes.", "The incomplete fissure between S5 and inferior lobe was divided using the stapler.", "The inferior bronchus was divided, which completed the lobectomy ND2a-2 procedure.", "The operation time was 185 min.", "Intraoperative blood loss was 30 mL.", "The tumor was diagnosed as an invasive mucinous adenocarcinoma with a maximal diameter of 15 mm.", "The pathological stage was p-T1aN0M0 stage I A1.", "The patient was discharged from hospital 6 days after the surgery."], "summary_subclaims": ["The patient was a 59-year-old male.", "The patient had suspected lung cancer in the left lower lobe.", "The patient was scheduled to undergo surgery.", "Chest computed tomography revealed a displaced B1 + 2.", "Chest computed tomography showed hyperlobulation between S1 + 2 and S3.", "The interlobar fissure between S1 + 2 and S6 was completely fused.", "Three-dimensional computed tomography revealed an anomalous V1 + 2 joining the left inferior pulmonary vein.", "A branch of the V1 + 2 ran between S1 + 2 and S6.", "The operation was a left lower lobectomy via video-assisted thoracic surgery.", "The strategy was to preserve V1 + 2.", "The strategy included confirming the locations of B1 + 2 and B6 when dividing the fissure."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 59-year-old male.", "The patient had no history of smoking.", "The carcinoembryonic antigen level was 5.6 ng/mL.", "Chest computed tomography revealed a tumor with a maximum diameter of 13 mm in the left lower pulmonary lobe.", "The tumor was suspected to be left lower lobe lung cancer (cT1bN0M0 stage1A2).", "Three-dimensional CT was performed using the Fujifilm Synapse Vincent system.", "A displaced B1 + 2 was running behind the main pulmonary artery.", "An anomalous V1 + 2 joined the left inferior pulmonary vein.", "Hyperlobulation between S1 + 2 and S3 with a completely fused interlobar fissure between S1 + 2 and S6 was observed.", "The interlobar plane between S1 + 2 and S6 ran perpendicular to the cranio-caudal direction.", "Bronchoscopy revealed that three bronchi branched from the left main bronchus.", "VATS was planned for surgical diagnosis and treatment.", "Non-anatomical wedge resection of the lesion was performed.", "The patient was diagnosed with adenocarcinoma.", "Left lower lobectomy and systematic nodal dissection were performed.", "The major pitfalls were to avoid injuring the displaced B1 + 2 and to avoid cutting the anomalous V1 + 2.", "The inferior pulmonary vein was identified on the posterior side of the hilum.", "The anomalous V1 + 2 joined the inferior pulmonary vein.", "The distal branch of A8 was identified using the interlobar fissure.", "A6 and V1 + 2 ran near A6 and a branch of V1 + 2 ran between S1 + 2 and S6.", "The branch of V1 + 2 was used as a landmark when dividing the fissure between S1 + 2 and the inferior lobe.", "Forceps were passed from the anterior to posterior side between a branch of V1 + 2 and A6.", "The largely fused fissure between S1 + 2 and the inferior lobe was divided using a stapler.", "A6 and A9 + 10 were identified and divided.", "The inferior bronchus branched from the left main bronchus at the level of the branches of B3 + B4 + 5 and the displaced B1 + 2.", "The displaced B1 + 2 was located at a more proximal site than normal.", "The station 11 lymph nodes were identified.", "Forceps were passed from the anterior to posterior side along the station 11 lymph nodes.", "The incomplete fissure between S5 and inferior lobe was divided using the stapler.", "The inferior bronchus was divided, which completed the lobectomy ND2a-2 procedure.", "The operation time was 185 min.", "Intraoperative blood loss was 30 mL.", "The tumor was diagnosed as an invasive mucinous adenocarcinoma with a maximal diameter of 15 mm.", "The pathological stage was p-T1aN0M0 stage I A1.", "The patient was discharged from hospital 6 days after the surgery."], "index": 91, "original_id": "multiclinsum_test_2752_en.txt", "split": "test", "summary_subclaims": ["The patient was a 59-year-old male.", "The patient had suspected lung cancer in the left lower lobe.", "The patient was scheduled to undergo surgery.", "Chest computed tomography revealed a displaced B1 + 2.", "Chest computed tomography showed hyperlobulation between S1 + 2 and S3.", "The interlobar fissure between S1 + 2 and S6 was completely fused.", "Three-dimensional computed tomography revealed an anomalous V1 + 2 joining the left inferior pulmonary vein.", "A branch of the V1 + 2 ran between S1 + 2 and S6.", "The operation was a left lower lobectomy via video-assisted thoracic surgery.", "The strategy was to preserve V1 + 2.", "The strategy included confirming the locations of B1 + 2 and B6 when dividing the fissure."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by factors including glomerular filtration rate (GFR), proteinuria, and comorbidities such as diabetes and hypertension. Early intervention with pharmacological agents, dietary modifications, and blood pressure control is critical to slow disease progression and reduce cardiovascular risk.\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 63-year-old woman.", "She had recurrent upper abdominal fullness discomfort for almost 10 years.", "She experienced exacerbation of intermittent nausea, vomiting with chyme (5 mL), heartburn, acid regurgitation, and eructation for 6 months.", "No history of hypertension, diabetes mellitus, or coronary heart disease was noted.", "A 5 \u00d7 4 cm mass with a hard texture and poor mobility was observed in the upper abdomen.", "Routine blood and tumor marker test results were within normal range.", "Abdomen CT showed a 32 mm \u00d7 22 mm soft tissue mass shadow with homogeneous density in the descending duodenum.", "The mass was protruding into the duodenal lumen.", "Thickening of the adjacent intestinal wall was noted.", "Upper abdomen MRI revealed significant thickening of the wall of the duodenal bulb and descending duodenum.", "The wall thickness was 1.1 cm.", "The signals were slightly low in T1-weighted images.", "The signals were slightly high in T2-weighted images.", "Endoscopic ultrasonography showed a protrusion in the duodenal bulb of about 26 \u00d7 18 mm in size.", "The protrusion had a clear boundary, smooth surface, and irregular shape.", "The base of the protrusion was about 17 mm.", "Color signals abound were noted.", "Neoplasm resection of the duodenum was performed.", "A mass measuring about 25 \u00d7 30 \u00d7 10 mm was found in the descending duodenum.", "The mass was soft, brittle, and mobile.", "The mass had a clear boundary.", "The pathological result revealed multiple Brunner\u2019s glands with tubes, fibers, and smooth muscle diffuse distribution.", "No dysplasia was noted on the epithelium.", "It was diagnosed as Brunner\u2019s gland adenoma of the duodenum.", "The patient was discharged from the hospital a week after recovery.", "To date, no relapse has occurred."], "summary_subclaims": ["The patient is a 63-year-old woman.", "The patient had upper gastrointestinal obstruction for almost 10 years.", "The patient was pathologically diagnosed with large Brunner's gland adenoma of the duodenum.", "Postoperatively, no sign of recurrence has been noted until now."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 63-year-old woman.", "She had recurrent upper abdominal fullness discomfort for almost 10 years.", "She experienced exacerbation of intermittent nausea, vomiting with chyme (5 mL), heartburn, acid regurgitation, and eructation for 6 months.", "No history of hypertension, diabetes mellitus, or coronary heart disease was noted.", "A 5 \u00d7 4 cm mass with a hard texture and poor mobility was observed in the upper abdomen.", "Routine blood and tumor marker test results were within normal range.", "Abdomen CT showed a 32 mm \u00d7 22 mm soft tissue mass shadow with homogeneous density in the descending duodenum.", "The mass was protruding into the duodenal lumen.", "Thickening of the adjacent intestinal wall was noted.", "Upper abdomen MRI revealed significant thickening of the wall of the duodenal bulb and descending duodenum.", "The wall thickness was 1.1 cm.", "The signals were slightly low in T1-weighted images.", "The signals were slightly high in T2-weighted images.", "Endoscopic ultrasonography showed a protrusion in the duodenal bulb of about 26 \u00d7 18 mm in size.", "The protrusion had a clear boundary, smooth surface, and irregular shape.", "The base of the protrusion was about 17 mm.", "Color signals abound were noted.", "Neoplasm resection of the duodenum was performed.", "A mass measuring about 25 \u00d7 30 \u00d7 10 mm was found in the descending duodenum.", "The mass was soft, brittle, and mobile.", "The mass had a clear boundary.", "The pathological result revealed multiple Brunner\u2019s glands with tubes, fibers, and smooth muscle diffuse distribution.", "No dysplasia was noted on the epithelium.", "It was diagnosed as Brunner\u2019s gland adenoma of the duodenum.", "The patient was discharged from the hospital a week after recovery.", "To date, no relapse has occurred."], "index": 108, "original_id": "multiclinsum_test_2813_en.txt", "split": "test", "summary_subclaims": ["The patient is a 63-year-old woman.", "The patient had upper gastrointestinal obstruction for almost 10 years.", "The patient was pathologically diagnosed with large Brunner's gland adenoma of the duodenum.", "Postoperatively, no sign of recurrence has been noted until now."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 30-year-old male.", "He is from the city of Intuto.", "Intuto is located 172 km from the city of Iquitos.", "He has a history of untreated type 2 diabetes mellitus.", "He presented to the emergency department of the Regional Hospital of Loreto.", "He had convulsions.", "He had loss of consciousness.", "He had functional limitations.", "He had chills.", "He had headache.", "He had a feeling of heat.", "He had poor general condition.", "His blood pressure was 90/60 mmHg.", "His heart rate was 67/min.", "His respiratory rate was 20/min.", "His temperature was 36.5 \u00b0C.", "His oxygen saturation was 96%.", "His weight was 60 kg.", "His BMI was 19.6 m\u00b2.", "He had pallor ++/+++.", "He was prostrate.", "He had general malaise.", "He had coldness of extremities.", "He had sensory disorder.", "He had myalgia.", "He had arthralgia.", "The illness lasted 14 days.", "The illness began with convulsions of 1 to 2 minutes.", "The convulsions occurred 5 to 6 times a day.", "Two days before admission, he had loss of consciousness.", "Two days before admission, he had limited motor function.", "He was transferred to the nearest health center.", "At the health center, a thick and extended gout examination was performed.", "Plasmodium vivax trophozoites were observed.", "Treatment was initiated.", "The doctor decided to refer him to a health center of greater complexity.", "He went to the emergency department of the Regional Hospital of Loreto.", "He was hospitalized.", "He received intravenous artesunate 14.4 mg at admission.", "Intravenous artesunate was repeated at 12 and 24 h.", "Each dose was diluted with 5% dextrose in a volume of 5 to 10 ml.", "Each dose was administered as a 5 min bolus.", "Artesunate was continued at 24 mg orally until day 5.", "600 mg of clindamycin was infused over 20 to 30 min every 12 h for 5 days.", "Clindamycin was diluted in 50 ml of 0.9% sodium chloride.", "A packed red blood cell transfusion was performed.", "Primaquine was continued for 7 days.", "A new thick blood examination was performed.", "No parasite was observed in the thick blood examination.", "The laboratory examinations showed depression of the three series of blood cells.", "The peripheral sheet extension was typical granulocytes ++.", "The peripheral sheet extension showed atypical lymphocytes +.", "The erythrocyte series showed microcytosis.", "The erythrocyte series showed anisocytosis.", "The erythrocyte series showed basophilic punctate.", "The abdominal ultrasound showed splenomegaly.", "The abdominal ultrasound showed bilateral pleural effusion.", "A lumbar puncture was performed.", "Cerebrospinal fluid analysis was performed.", "The patient showed clinical improvement.", "The patient had a neurological sequela of monoparesia of the motor nerves in the lower left."], "summary_subclaims": ["The patient is an adult male.", "The patient has cerebral malaria by Plasmodium vivax.", "The patient starts with general discomfort and fever.", "The patient presents convulsions more than twice a day.", "The patient has loss of consciousness.", "The patient has motor functional limitation.", "A thick drop shows Plasmodium vivax trophozoites.", "A thick drop shows depression of the three blood series.", "The patient is given treatment with artesunate and clindamycin for five days.", "The patient receives a blood transfusion.", "The patient continues with primaquine for seven days.", "The patient shows clinical improvement.", "The patient has neurological sequelae in the left lower extremity."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 30-year-old male.", "He is from the city of Intuto.", "Intuto is located 172 km from the city of Iquitos.", "He has a history of untreated type 2 diabetes mellitus.", "He presented to the emergency department of the Regional Hospital of Loreto.", "He had convulsions.", "He had loss of consciousness.", "He had functional limitations.", "He had chills.", "He had headache.", "He had a feeling of heat.", "He had poor general condition.", "His blood pressure was 90/60 mmHg.", "His heart rate was 67/min.", "His respiratory rate was 20/min.", "His temperature was 36.5 \u00b0C.", "His oxygen saturation was 96%.", "His weight was 60 kg.", "His BMI was 19.6 m\u00b2.", "He had pallor ++/+++.", "He was prostrate.", "He had general malaise.", "He had coldness of extremities.", "He had sensory disorder.", "He had myalgia.", "He had arthralgia.", "The illness lasted 14 days.", "The illness began with convulsions of 1 to 2 minutes.", "The convulsions occurred 5 to 6 times a day.", "Two days before admission, he had loss of consciousness.", "Two days before admission, he had limited motor function.", "He was transferred to the nearest health center.", "At the health center, a thick and extended gout examination was performed.", "Plasmodium vivax trophozoites were observed.", "Treatment was initiated.", "The doctor decided to refer him to a health center of greater complexity.", "He went to the emergency department of the Regional Hospital of Loreto.", "He was hospitalized.", "He received intravenous artesunate 14.4 mg at admission.", "Intravenous artesunate was repeated at 12 and 24 h.", "Each dose was diluted with 5% dextrose in a volume of 5 to 10 ml.", "Each dose was administered as a 5 min bolus.", "Artesunate was continued at 24 mg orally until day 5.", "600 mg of clindamycin was infused over 20 to 30 min every 12 h for 5 days.", "Clindamycin was diluted in 50 ml of 0.9% sodium chloride.", "A packed red blood cell transfusion was performed.", "Primaquine was continued for 7 days.", "A new thick blood examination was performed.", "No parasite was observed in the thick blood examination.", "The laboratory examinations showed depression of the three series of blood cells.", "The peripheral sheet extension was typical granulocytes ++.", "The peripheral sheet extension showed atypical lymphocytes +.", "The erythrocyte series showed microcytosis.", "The erythrocyte series showed anisocytosis.", "The erythrocyte series showed basophilic punctate.", "The abdominal ultrasound showed splenomegaly.", "The abdominal ultrasound showed bilateral pleural effusion.", "A lumbar puncture was performed.", "Cerebrospinal fluid analysis was performed.", "The patient showed clinical improvement.", "The patient had a neurological sequela of monoparesia of the motor nerves in the lower left."], "index": 95, "original_id": "multiclinsum_test_3364_en.txt", "split": "test", "summary_subclaims": ["The patient is an adult male.", "The patient has cerebral malaria by Plasmodium vivax.", "The patient starts with general discomfort and fever.", "The patient presents convulsions more than twice a day.", "The patient has loss of consciousness.", "The patient has motor functional limitation.", "A thick drop shows Plasmodium vivax trophozoites.", "A thick drop shows depression of the three blood series.", "The patient is given treatment with artesunate and clindamycin for five days.", "The patient receives a blood transfusion.", "The patient continues with primaquine for seven days.", "The patient shows clinical improvement.", "The patient has neurological sequelae in the left lower extremity."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient was a 59-year-old morbidly obese, African-American female.", "She had a history of Stage IIIc recurrent endometrial carcinosarcoma with para-aortic and pelvic lymph node involvement.", "She had a 1-month history of numbness of the left vulva.", "She had worsening left lower extremity pain/numbness.", "She had episodic urinary incontinence.", "The thoracic/lumbar MR revealed a 1.4 \u00d7 1.8 cm enhancing intradural extramedullary mass inferior to the conus at the L1 and L4-L5 levels.", "There was abnormal enhancement of the left-sided intradural nerve roots.", "There were bilateral, perihilar lung metastases.", "The patient underwent a T12-L2 laminectomy for gross total resection of the L1 intradural/extramedullary mass.", "The main aim of surgery was to provide neurological symptomatic relief.", "Intraoperatively, diffuse carcinomatosis of the cauda equina was observed.", "A large lesion was located anteroinferior to the conus.", "The tumor appeared vascular and involved multiple, swollen, engorged nerve roots.", "Dissection ceased once intraoperative electromyographic monitoring showed significant changes.", "The permanent pathology showed a mesenchymal malignant Mullerian mixed tumor (carcinosarcoma) without an epithelial component.", "The postoperative MR revealed residual intradural extramedullary tumor.", "The pain and numbness improved in her left lower extremity.", "She returned to the hospital 2 weeks later complaining of increased lower extremity symptoms.", "She had the new onset of right-sided facial weakness, numbness, and blurry vision.", "Imaging of the brain and spinal cord revealed leptomeningeal spread of her disease.", "Imaging revealed hydrocephalus.", "Imaging revealed multiple, new intracranial metastases.", "Two months later, she succumbed to her metastatic disease."], "summary_subclaims": ["The patient is a 59-year-old female.", "The patient has a history of recurrent UCS.", "The patient had new onset of left lower extremity pain.", "The patient had new onset of numbness.", "The patient had episodic urinary incontinence.", "MR revealed an enhancing intradural extramedullary mass posterior to the L1 vertebral body.", "The patient underwent a focal decompressive laminectomy.", "The patient improved neurologically postoperatively.", "The patient succumbed to the leptomeningeal spread of her disease.", "The patient died within 2 postoperative months."]}, "extra_info": {"fulltext_subclaims": ["The patient was a 59-year-old morbidly obese, African-American female.", "She had a history of Stage IIIc recurrent endometrial carcinosarcoma with para-aortic and pelvic lymph node involvement.", "She had a 1-month history of numbness of the left vulva.", "She had worsening left lower extremity pain/numbness.", "She had episodic urinary incontinence.", "The thoracic/lumbar MR revealed a 1.4 \u00d7 1.8 cm enhancing intradural extramedullary mass inferior to the conus at the L1 and L4-L5 levels.", "There was abnormal enhancement of the left-sided intradural nerve roots.", "There were bilateral, perihilar lung metastases.", "The patient underwent a T12-L2 laminectomy for gross total resection of the L1 intradural/extramedullary mass.", "The main aim of surgery was to provide neurological symptomatic relief.", "Intraoperatively, diffuse carcinomatosis of the cauda equina was observed.", "A large lesion was located anteroinferior to the conus.", "The tumor appeared vascular and involved multiple, swollen, engorged nerve roots.", "Dissection ceased once intraoperative electromyographic monitoring showed significant changes.", "The permanent pathology showed a mesenchymal malignant Mullerian mixed tumor (carcinosarcoma) without an epithelial component.", "The postoperative MR revealed residual intradural extramedullary tumor.", "The pain and numbness improved in her left lower extremity.", "She returned to the hospital 2 weeks later complaining of increased lower extremity symptoms.", "She had the new onset of right-sided facial weakness, numbness, and blurry vision.", "Imaging of the brain and spinal cord revealed leptomeningeal spread of her disease.", "Imaging revealed hydrocephalus.", "Imaging revealed multiple, new intracranial metastases.", "Two months later, she succumbed to her metastatic disease."], "index": 103, "original_id": "multiclinsum_test_2588_en.txt", "split": "test", "summary_subclaims": ["The patient is a 59-year-old female.", "The patient has a history of recurrent UCS.", "The patient had new onset of left lower extremity pain.", "The patient had new onset of numbness.", "The patient had episodic urinary incontinence.", "MR revealed an enhancing intradural extramedullary mass posterior to the L1 vertebral body.", "The patient underwent a focal decompressive laminectomy.", "The patient improved neurologically postoperatively.", "The patient succumbed to the leptomeningeal spread of her disease.", "The patient died within 2 postoperative months."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 69-year-old Tunisian female.", "She has no family history of auto-immune disease.", "She had a history of hypertension.", "She was explored 4 years prior to admission for transient arthralgias and arthritis.", "She experienced photosensitivity, malar rash, and diffuse discoid lesions in her trunk and face.", "She reported weight loss of approximately 3 kg in the last three months.", "The physical examination showed synovitis of the wrists.", "The autoimmune profile confirmed a strong positivity of Antinuclear antibodies (ANA) with titre 1:400.", "The autoimmune profile showed anti-double-stranded DNA (anti-dsDNA) at 115 UI/ml.", "The autoimmune profile showed normal serum complements.", "The patient was non-reactive for anti-La antibodies.", "The patient was non-reactive for anti-cardiolipin antibodies.", "The patient was non-reactive for lupus anticoagulant.", "The patient was non-reactive for anti-SM antibodies.", "The patient was non-reactive for anti-RNP antibodies.", "The patient was non-reactive for anti-SCL-70 antibodies.", "The patient was non-reactive for anticentromere antibodies.", "The patient was non-reactive for rheumatoid factor.", "The patient was non-reactive for autoantibodies against citrullinated protein.", "The presence of 6 of 11 American College of Rheumatology criteria allowed the diagnosis of SLE.", "The patient was treated with Chloroquine (200 mg/day).", "The patient showed improvement of her general state of health.", "The patient showed weight gain.", "One year later, she developed liver dysfunction.", "Antimitochondrial antibodies (AMA) were positive (1:164).", "Antimitochondrial antibodies were positive with positive anti-E2 fraction.", "The antinuclear antibody was positive.", "The anti-dsDNA was positive.", "Serologic markers for hepatitis B and hepatitis C viruses were negative.", "Abdominal echo showed no fatty change of the liver.", "Abdominal echo showed no abnormality of the bile ducts.", "Microscopic examination reveals a focal florid duct lesion characterized by a portal lymphocytic infiltrate and epitheloid cells that are centred on interlobular ducts with evidence of destruction.", "These lesions are associated with a lymphocytic cholangitis and a portal inflammation containing conspicuous plasma cells and numerous lymphocytes.", "No granuloma was found in lobule.", "These findings led to a diagnosis of stage I PBC according to Scheuer\u2019s classification.", "Based on the hematology and liver-tissue results, she was diagnosed with asymptomatic PBC.", "Treatment with ursodeoxycholic acid (600 mg daily) was started.", "The transaminase levels normalized with one month.", "The patient has not complained liver dysfunction.", "She was followed up regularly with stable health."], "summary_subclaims": ["The patient is a 70-years-old woman.", "The patient was diagnosed with SLE at 69\u2009years.", "The patient was admitted for further examination of liver dysfunction.", "PBC was confirmed based on elevated serum levels of transaminase.", "PBC was confirmed based on high levels of antimitochondrial antibodies.", "PBC was confirmed following a liver biopsy.", "The oral administration of ursodeoxycholic acid stabilized the liver dysfunction."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 69-year-old Tunisian female.", "She has no family history of auto-immune disease.", "She had a history of hypertension.", "She was explored 4 years prior to admission for transient arthralgias and arthritis.", "She experienced photosensitivity, malar rash, and diffuse discoid lesions in her trunk and face.", "She reported weight loss of approximately 3 kg in the last three months.", "The physical examination showed synovitis of the wrists.", "The autoimmune profile confirmed a strong positivity of Antinuclear antibodies (ANA) with titre 1:400.", "The autoimmune profile showed anti-double-stranded DNA (anti-dsDNA) at 115 UI/ml.", "The autoimmune profile showed normal serum complements.", "The patient was non-reactive for anti-La antibodies.", "The patient was non-reactive for anti-cardiolipin antibodies.", "The patient was non-reactive for lupus anticoagulant.", "The patient was non-reactive for anti-SM antibodies.", "The patient was non-reactive for anti-RNP antibodies.", "The patient was non-reactive for anti-SCL-70 antibodies.", "The patient was non-reactive for anticentromere antibodies.", "The patient was non-reactive for rheumatoid factor.", "The patient was non-reactive for autoantibodies against citrullinated protein.", "The presence of 6 of 11 American College of Rheumatology criteria allowed the diagnosis of SLE.", "The patient was treated with Chloroquine (200 mg/day).", "The patient showed improvement of her general state of health.", "The patient showed weight gain.", "One year later, she developed liver dysfunction.", "Antimitochondrial antibodies (AMA) were positive (1:164).", "Antimitochondrial antibodies were positive with positive anti-E2 fraction.", "The antinuclear antibody was positive.", "The anti-dsDNA was positive.", "Serologic markers for hepatitis B and hepatitis C viruses were negative.", "Abdominal echo showed no fatty change of the liver.", "Abdominal echo showed no abnormality of the bile ducts.", "Microscopic examination reveals a focal florid duct lesion characterized by a portal lymphocytic infiltrate and epitheloid cells that are centred on interlobular ducts with evidence of destruction.", "These lesions are associated with a lymphocytic cholangitis and a portal inflammation containing conspicuous plasma cells and numerous lymphocytes.", "No granuloma was found in lobule.", "These findings led to a diagnosis of stage I PBC according to Scheuer\u2019s classification.", "Based on the hematology and liver-tissue results, she was diagnosed with asymptomatic PBC.", "Treatment with ursodeoxycholic acid (600 mg daily) was started.", "The transaminase levels normalized with one month.", "The patient has not complained liver dysfunction.", "She was followed up regularly with stable health."], "index": 109, "original_id": "multiclinsum_test_2272_en.txt", "split": "test", "summary_subclaims": ["The patient is a 70-years-old woman.", "The patient was diagnosed with SLE at 69\u2009years.", "The patient was admitted for further examination of liver dysfunction.", "PBC was confirmed based on elevated serum levels of transaminase.", "PBC was confirmed based on high levels of antimitochondrial antibodies.", "PBC was confirmed following a liver biopsy.", "The oral administration of ursodeoxycholic acid stabilized the liver dysfunction."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["A previously healthy 64-year-old male was admitted to the hospital with headache, fever and later imbalance, blurred vision and general slowness.", "Patient\u2019s neurological examination revealed nuchal rigidity and general clumsiness.", "Blood tests showed leukocytosis (11.90 \u00d7 109/l) and an increased C-reactive protein (47 mg/l).", "A computer tomography (CT) scan of the brain showed normal results.", "The cerebrospinal fluid (CSF) was clear but yellowish.", "The CSF had a slightly elevated count of erythrocytes (10 \u00d7 106/l).", "The CSF had high levels of leukocytes (940 \u00d7 106/l; 40% lymphocytes and 56% granulocytes).", "The CSF had elevated protein levels (1,696 mg/l).", "The CSF had hypoglycorrhachia (0.9 mmol/l).", "Bacterial cultures and CSF staining remained negative.", "Meningitis was suspected.", "The patient was treated with intravenous (IV) dexamethasone (10 mg four times a day).", "The patient was treated with ceftriaxone (4 g daily).", "The patient was treated with acyclovir (750 mg three times a day).", "Four days after admission, when his C-reactive protein had decreased to 10 mg/l, viral meningitis was considered the most probable cause.", "The treatment with ceftriaxone and dexamethasone was discontinued.", "The acyclovir treatment continued.", "Nine days after admission, the patient\u2019s general condition slowly deteriorated.", "The patient became increasingly somnolent.", "The patient was restarted on IV ceftriaxone (2 g daily, which was increased to 4 g daily one day later).", "The patient was treated with doxycycline (100 mg twice a day) due to the suspicion of borreliosis.", "Brain magnetic resonance imaging (MRI) was performed.", "The MRI revealed signs compatible with ventriculitis in the right lateral ventricle and the third ventricle.", "Eleven days after admission, the patient\u2019s consciousness rapidly declined.", "A new CT scan of the brain revealed hydrocephalus and a mild midline shift, attributed to the enlarged right lateral ventricle.", "An emergency ventriculostomy was performed.", "Cerebrospinal fluid obtained during the operation appeared clear but yellowish.", "Later debris was observed in the CSF collector bag.", "Doxycycline was discontinued.", "Due to the neurosurgeon\u2019s suspicion of a poor clinical response to ceftriaxone, it was switched to IV cefotaxime (2 g three times a day).", "The dosage of cefotaxime was increased to 2 g four times a day by an infection consultant two days later.", "No signs of renal dysfunction were detected.", "Serum creatinine levels remained within the normal range.", "The patient\u2019s condition rapidly improved after the ventriculostomy and antibiotic treatment.", "On the 21st day after admission, the ventriculostomy was closed.", "In the Gram staining of the CSF sample obtained from the ventriculostomy at the time of the operation, chains of gram-positive cocci were observed inside polymorphonuclear leukocytes.", "The bacteria\u2019s morphology resembled that of streptococci.", "Bacterial cultures of both CSF and blood remained negative.", "The sample, which displayed bacteria in the Gram staining, and another CSF sample taken one day later, were analyzed using in-house bacterial 16s ribosomal RNA gene amplification by polymerase chain reaction (PCR) with high sensitivity for both aerobic and anaerobic bacteria, followed by sequencing.", "The analysis of both samples tested positive for S. intermedius.", "No clinical signs of infective endocarditis were observed in further assessments.", "Echocardiography was not performed.", "The patient mentioned a history of chronic dental problems.", "An orthopantomography revealed advanced periodontal destruction in several teeth.", "Periapical abscesses were found in teeth 33 and 31.", "Maxillary teeth 15 and 16 were urgently extracted.", "Teeth 17, 23, 24, 31, 32, 33, and 43 were extracted.", "During the latter operation, prophylactic metronidazole (500 mg three times a day) was initiated for three days.", "The patient continued to improve and was discharged in good condition one month after admission, with only slight left-sided hemiparesis."], "summary_subclaims": ["The patient was a 64-year-old male.", "The patient was admitted to the hospital with a headache.", "The patient had fever.", "The patient later had imbalance.", "The patient had blurred vision.", "The patient had general slowness.", "Neurological examination revealed nuchal rigidity.", "Neurological examination revealed general clumsiness.", "Meningitis was suspected.", "The patient was treated with dexamethasone.", "The patient was treated with ceftriaxone.", "The patient was treated with acyclovir.", "A brain CT scan was normal.", "CSF Gram staining remained negative.", "Bacterial cultures remained negative.", "The antibacterial treatment was discontinued.", "Nine days after admission, the patient's condition deteriorated.", "The antibacterial treatment was restarted.", "A brain MRI revealed ventriculitis.", "A CT scan showed hydrocephalus.", "A ventriculostomy was performed.", "In CSF Gram staining, chains of gram-positive cocci were observed.", "Bacterial cultures remained negative.", "A bacterial PCR detected Streptococcus intermedius.", "An orthopantomography revealed advanced periodontal destruction in several teeth.", "An orthopantomography revealed periapical abscesses.", "The teeth with periapical abscesses were subsequently operated on.", "The patient was discharged in good condition after one month."]}, "extra_info": {"fulltext_subclaims": ["A previously healthy 64-year-old male was admitted to the hospital with headache, fever and later imbalance, blurred vision and general slowness.", "Patient\u2019s neurological examination revealed nuchal rigidity and general clumsiness.", "Blood tests showed leukocytosis (11.90 \u00d7 109/l) and an increased C-reactive protein (47 mg/l).", "A computer tomography (CT) scan of the brain showed normal results.", "The cerebrospinal fluid (CSF) was clear but yellowish.", "The CSF had a slightly elevated count of erythrocytes (10 \u00d7 106/l).", "The CSF had high levels of leukocytes (940 \u00d7 106/l; 40% lymphocytes and 56% granulocytes).", "The CSF had elevated protein levels (1,696 mg/l).", "The CSF had hypoglycorrhachia (0.9 mmol/l).", "Bacterial cultures and CSF staining remained negative.", "Meningitis was suspected.", "The patient was treated with intravenous (IV) dexamethasone (10 mg four times a day).", "The patient was treated with ceftriaxone (4 g daily).", "The patient was treated with acyclovir (750 mg three times a day).", "Four days after admission, when his C-reactive protein had decreased to 10 mg/l, viral meningitis was considered the most probable cause.", "The treatment with ceftriaxone and dexamethasone was discontinued.", "The acyclovir treatment continued.", "Nine days after admission, the patient\u2019s general condition slowly deteriorated.", "The patient became increasingly somnolent.", "The patient was restarted on IV ceftriaxone (2 g daily, which was increased to 4 g daily one day later).", "The patient was treated with doxycycline (100 mg twice a day) due to the suspicion of borreliosis.", "Brain magnetic resonance imaging (MRI) was performed.", "The MRI revealed signs compatible with ventriculitis in the right lateral ventricle and the third ventricle.", "Eleven days after admission, the patient\u2019s consciousness rapidly declined.", "A new CT scan of the brain revealed hydrocephalus and a mild midline shift, attributed to the enlarged right lateral ventricle.", "An emergency ventriculostomy was performed.", "Cerebrospinal fluid obtained during the operation appeared clear but yellowish.", "Later debris was observed in the CSF collector bag.", "Doxycycline was discontinued.", "Due to the neurosurgeon\u2019s suspicion of a poor clinical response to ceftriaxone, it was switched to IV cefotaxime (2 g three times a day).", "The dosage of cefotaxime was increased to 2 g four times a day by an infection consultant two days later.", "No signs of renal dysfunction were detected.", "Serum creatinine levels remained within the normal range.", "The patient\u2019s condition rapidly improved after the ventriculostomy and antibiotic treatment.", "On the 21st day after admission, the ventriculostomy was closed.", "In the Gram staining of the CSF sample obtained from the ventriculostomy at the time of the operation, chains of gram-positive cocci were observed inside polymorphonuclear leukocytes.", "The bacteria\u2019s morphology resembled that of streptococci.", "Bacterial cultures of both CSF and blood remained negative.", "The sample, which displayed bacteria in the Gram staining, and another CSF sample taken one day later, were analyzed using in-house bacterial 16s ribosomal RNA gene amplification by polymerase chain reaction (PCR) with high sensitivity for both aerobic and anaerobic bacteria, followed by sequencing.", "The analysis of both samples tested positive for S. intermedius.", "No clinical signs of infective endocarditis were observed in further assessments.", "Echocardiography was not performed.", "The patient mentioned a history of chronic dental problems.", "An orthopantomography revealed advanced periodontal destruction in several teeth.", "Periapical abscesses were found in teeth 33 and 31.", "Maxillary teeth 15 and 16 were urgently extracted.", "Teeth 17, 23, 24, 31, 32, 33, and 43 were extracted.", "During the latter operation, prophylactic metronidazole (500 mg three times a day) was initiated for three days.", "The patient continued to improve and was discharged in good condition one month after admission, with only slight left-sided hemiparesis."], "index": 107, "original_id": "multiclinsum_test_1344_en.txt", "split": "test", "summary_subclaims": ["The patient was a 64-year-old male.", "The patient was admitted to the hospital with a headache.", "The patient had fever.", "The patient later had imbalance.", "The patient had blurred vision.", "The patient had general slowness.", "Neurological examination revealed nuchal rigidity.", "Neurological examination revealed general clumsiness.", "Meningitis was suspected.", "The patient was treated with dexamethasone.", "The patient was treated with ceftriaxone.", "The patient was treated with acyclovir.", "A brain CT scan was normal.", "CSF Gram staining remained negative.", "Bacterial cultures remained negative.", "The antibacterial treatment was discontinued.", "Nine days after admission, the patient's condition deteriorated.", "The antibacterial treatment was restarted.", "A brain MRI revealed ventriculitis.", "A CT scan showed hydrocephalus.", "A ventriculostomy was performed.", "In CSF Gram staining, chains of gram-positive cocci were observed.", "Bacterial cultures remained negative.", "A bacterial PCR detected Streptococcus intermedius.", "An orthopantomography revealed advanced periodontal destruction in several teeth.", "An orthopantomography revealed periapical abscesses.", "The teeth with periapical abscesses were subsequently operated on.", "The patient was discharged in good condition after one month."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}
{"data_source": "multiclinsum", "solution_str": "{\n    \"low_health_literacy\": \"Your body needs to keep your blood clean and your organs working well. If your kidneys aren\u2019t doing their job, it\u2019s like having a leaky faucet \u2014 waste builds up, and you might feel tired or sick. You should talk to a doctor if you notice these signs so they can check your kidneys and help you feel better.\",\n    \"intermediate_health_literacy\": \"Kidney function is essential for filtering waste and excess fluids from the blood. When kidney function declines, toxins accumulate, leading to symptoms like fatigue, swelling, and high blood pressure. Early detection through regular screening is key to managing the condition and preventing complications. Lifestyle changes and medical monitoring can help maintain kidney health.\",\n    \"proficient_health_literacy\": \"The kidneys play a central role in maintaining homeostasis by filtering metabolic waste, excess ions, and fluid from the bloodstream via glomerular filtration, reabsorption, and secretion. Impaired renal function results in the accumulation of uremic toxins, dysregulation of electrolyte balance (e.g., potassium, phosphate), and fluid overload, which can lead to hypertension, metabolic acidosis, and progressive glomerulosclerosis. Chronic kidney disease (CKD) progression is influenced by underlying pathophysiological mechanisms including glomerular injury, tubular atrophy, and vascular remodeling, with clinical outcomes dependent on stage, comorbidities, and biomarker profiles such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR).\"\n}", "ground_truth": {"fulltext_subclaims": ["The patient is a 43-year-old nonsmoking and nondrinking white male.", "The patient had oral cancer on the left side of the tongue.", "A biopsy sample taken from the tumor revealed G2 keratinizing squamous cell carcinoma.", "A CT scan performed two months before the operation showed a primary tumor measuring 15 \u00d7 10 mm with peripheral contrast enhancement.", "The CT scan showed two suspected, probably metastatic lymph nodes on the left side of the neck in groups III and IV, size 17 \u00d7 14 mm and 26 \u00d7 16 mm, respectively.", "Distant metastases were ruled out on chest X-ray and abdominal ultrasound.", "Anamnesis proved previous lower extremity deep vein thrombosis.", "Doppler ultrasound ruled out active deep vein thrombosis.", "The surgical procedure included excision of the left half of the tongue, the floor of the mouth, and the sidewall of the throat.", "The surgical procedure included bilateral cervical lymph node dissection in groups I-V on the left side and I-III on the right side.", "The second part of the operation involved reconstruction using an anterolateral thigh flap.", "Reoperation was performed three days after surgery due to hemorrhage from the wound after lymphadenectomy.", "The final histopathology report revealed G2 keratinizing squamous cell carcinoma, stage IVa (pT3 pN2b, AJCC 8th edition).", "The histopathology report noted perineural invasion of small nerves.", "The histopathology report noted an unfavorable pattern of invasion with small islands (the worst pattern of invasion, 4).", "The histopathology report noted a closest margin below 1 mm.", "The histopathology report noted five metastatic lymph nodes (of 49 lymph nodes dissected) without extracapsular extension at levels II, IV, V on the left side.", "The novel prognostic histopathological grading system in oral squamous cell carcinoma based on tumor budding revealed G-2.", "102 budding foci were detected per 10 high-power fields.", "Two to four cell-sized nests or single-cell invasion was observed.", "A multidisciplinary case conference qualified the patient for postoperative radiochemotherapy.", "The patient refused systemic treatment.", "Radiotherapy alone was recommended.", "Five-point head, neck, and shoulder masks were employed for patient immobilization.", "A CT scan (3 mm slice thickness) without intravenous contrast was performed in the planning radiotherapy process.", "The dose prescription involved the bilateral lymph nodes I-V to a total dose of 50 Gy in 25 fractions.", "The dose prescription involved the left side neck in groups II-V to a total dose of 60 Gy in 30 fractions.", "The dose prescription involved the tumor bed with bilateral submandibular lymph nodes to a total dose of 66 Gy in 33 fractions.", "The VMAT technique was applied.", "In the first stage of treatment, three full arcs were used.", "In the second stage, three arcs lateralized to the left side of the neck were used.", "In the third stage, two frontal arcs were applied.", "Radiotherapy was performed by linear accelerators (Clinac 23EX; Varian Medical Systems, Palo Alto, CA, USA) with an energy of 6 MV and maximal dose rate of 600 MU/min.", "Two weeks after the beginning of radiotherapy, ultrasound of the neck was performed due to a suspected lump in group III on the right side.", "The ultrasound revealed a 16 \u00d7 9 mm lymph node.", "Fine-needle aspiration biopsy was performed, confirming metastasis of the squamous cell carcinoma.", "The multidisciplinary case conference urged the application of a single-fraction stereotactic radiosurgery (SRS) boost of 18 Gy to the metastatic lymph node.", "After 29 days of conventional treatment, a new 5-point mask, a new CT scan without contrast, and an MR scan with gadolinium intravenous contrast were performed in the planned stereotactic boost process.", "The GTVboost volume was 0.7 cm3.", "A 3 mm margin was added to the GTVboost to create a PTVboost volume of 3.1 cm3.", "A new treatment plan consisting of four arcs was prepared.", "Four 6 MV FFF (flattening filter-free) photon beams with a maximal dose rate of 1400 MU/min were utilized.", "The dose that fully covers target volume was selected as the prescribed isodose level.", "The minimum dose in the target volume was 100% of the prescribed dose.", "The maximum dose was 108.4%.", "The angle range of arcs was adapted to the boost localization and was limited to the right and front sides of the patient.", "The boost was delivered two days after the last fraction of conventional radiotherapy with the same linear accelerator.", "Overall treatment time totaled 50 days.", "During radiotherapy, oral mucositis and moist desquamation (grade 3, CTCAE v5.0) were observed in the irradiated area.", "Oral mucositis and moist desquamation subsided within three months of follow up.", "Staphylococcus aureus and Klebsiella oxytoca were identified from the throat culture in the sixth week of conventional treatment.", "Antibiotic therapy consistent with the antibiogram (clindamycin, amoxicillin/clavulanate potassium) was used.", "Blood tests showed grade 1 anemia after 24 fractions.", "Blood tests showed grade 1 leukopenia after 33 fractions.", "Blood tests normalized seven months after treatment.", "CT scans and laryngological examinations did not prove locoregional recurrence three, ten, and thirteen months after the end of radiotherapy.", "Chest X-ray and abdominal ultrasound did not detect any metastatic changes one year after treatment.", "Xerostomia G2 was the only symptom of late toxicity fifteen months after radiotherapy.", "At 17 months of follow-up, the patient reported coughing, suffocation, and bloody sputum.", "A CT scan revealed infiltration (64 \u00d7 65 \u00d7 100 mm) in the 3rd segment of the right lung, encompassing the hilum and central part of the mediastinum.", "Pathological examination after EUS-FNA proved squamous cell carcinoma with moderate PD-L1 membrane expression (< 50%).", "Acknowledgment of the tumor in the chest as lung cancer or metastatic disease due to oral cancer was difficult.", "The patient was qualified for palliative radiotherapy to a total dose of 30 Gy in 10 fractions (VMAT technique, single arc, gantry angle 30.0\u2013210.0 deg) for the tumor in the chest.", "Systemic treatment was contraindicated in terms of performance status\u2014ECOG 2.", "Three months later, multiple metastases in the mediastinum, right lung, spleen, and bones were detected by PET/CT.", "The most painful osteolitic lesion in the left ischium and femoral head was irradiated in one fraction to 8 Gy.", "Two-dimensional radiotherapy technique, two coaxial opposite beams from AP and PA directions were used.", "The patient died the next month."], "summary_subclaims": ["The patient underwent surgery.", "During adjuvant radiotherapy, a metastatic cervical lymph node was diagnosed based on fine-needle aspiration biopsy.", "A stereotactic radiosurgery boost of 1\u2009\u00d7\u200918\u00a0Gy was performed two days after the last fraction of conventional radiotherapy.", "The early and late tolerance of this treatment were positive.", "During the 18-month follow-up, locoregional recurrence was not detected.", "The patient died due to secondary malignancy."]}, "extra_info": {"fulltext_subclaims": ["The patient is a 43-year-old nonsmoking and nondrinking white male.", "The patient had oral cancer on the left side of the tongue.", "A biopsy sample taken from the tumor revealed G2 keratinizing squamous cell carcinoma.", "A CT scan performed two months before the operation showed a primary tumor measuring 15 \u00d7 10 mm with peripheral contrast enhancement.", "The CT scan showed two suspected, probably metastatic lymph nodes on the left side of the neck in groups III and IV, size 17 \u00d7 14 mm and 26 \u00d7 16 mm, respectively.", "Distant metastases were ruled out on chest X-ray and abdominal ultrasound.", "Anamnesis proved previous lower extremity deep vein thrombosis.", "Doppler ultrasound ruled out active deep vein thrombosis.", "The surgical procedure included excision of the left half of the tongue, the floor of the mouth, and the sidewall of the throat.", "The surgical procedure included bilateral cervical lymph node dissection in groups I-V on the left side and I-III on the right side.", "The second part of the operation involved reconstruction using an anterolateral thigh flap.", "Reoperation was performed three days after surgery due to hemorrhage from the wound after lymphadenectomy.", "The final histopathology report revealed G2 keratinizing squamous cell carcinoma, stage IVa (pT3 pN2b, AJCC 8th edition).", "The histopathology report noted perineural invasion of small nerves.", "The histopathology report noted an unfavorable pattern of invasion with small islands (the worst pattern of invasion, 4).", "The histopathology report noted a closest margin below 1 mm.", "The histopathology report noted five metastatic lymph nodes (of 49 lymph nodes dissected) without extracapsular extension at levels II, IV, V on the left side.", "The novel prognostic histopathological grading system in oral squamous cell carcinoma based on tumor budding revealed G-2.", "102 budding foci were detected per 10 high-power fields.", "Two to four cell-sized nests or single-cell invasion was observed.", "A multidisciplinary case conference qualified the patient for postoperative radiochemotherapy.", "The patient refused systemic treatment.", "Radiotherapy alone was recommended.", "Five-point head, neck, and shoulder masks were employed for patient immobilization.", "A CT scan (3 mm slice thickness) without intravenous contrast was performed in the planning radiotherapy process.", "The dose prescription involved the bilateral lymph nodes I-V to a total dose of 50 Gy in 25 fractions.", "The dose prescription involved the left side neck in groups II-V to a total dose of 60 Gy in 30 fractions.", "The dose prescription involved the tumor bed with bilateral submandibular lymph nodes to a total dose of 66 Gy in 33 fractions.", "The VMAT technique was applied.", "In the first stage of treatment, three full arcs were used.", "In the second stage, three arcs lateralized to the left side of the neck were used.", "In the third stage, two frontal arcs were applied.", "Radiotherapy was performed by linear accelerators (Clinac 23EX; Varian Medical Systems, Palo Alto, CA, USA) with an energy of 6 MV and maximal dose rate of 600 MU/min.", "Two weeks after the beginning of radiotherapy, ultrasound of the neck was performed due to a suspected lump in group III on the right side.", "The ultrasound revealed a 16 \u00d7 9 mm lymph node.", "Fine-needle aspiration biopsy was performed, confirming metastasis of the squamous cell carcinoma.", "The multidisciplinary case conference urged the application of a single-fraction stereotactic radiosurgery (SRS) boost of 18 Gy to the metastatic lymph node.", "After 29 days of conventional treatment, a new 5-point mask, a new CT scan without contrast, and an MR scan with gadolinium intravenous contrast were performed in the planned stereotactic boost process.", "The GTVboost volume was 0.7 cm3.", "A 3 mm margin was added to the GTVboost to create a PTVboost volume of 3.1 cm3.", "A new treatment plan consisting of four arcs was prepared.", "Four 6 MV FFF (flattening filter-free) photon beams with a maximal dose rate of 1400 MU/min were utilized.", "The dose that fully covers target volume was selected as the prescribed isodose level.", "The minimum dose in the target volume was 100% of the prescribed dose.", "The maximum dose was 108.4%.", "The angle range of arcs was adapted to the boost localization and was limited to the right and front sides of the patient.", "The boost was delivered two days after the last fraction of conventional radiotherapy with the same linear accelerator.", "Overall treatment time totaled 50 days.", "During radiotherapy, oral mucositis and moist desquamation (grade 3, CTCAE v5.0) were observed in the irradiated area.", "Oral mucositis and moist desquamation subsided within three months of follow up.", "Staphylococcus aureus and Klebsiella oxytoca were identified from the throat culture in the sixth week of conventional treatment.", "Antibiotic therapy consistent with the antibiogram (clindamycin, amoxicillin/clavulanate potassium) was used.", "Blood tests showed grade 1 anemia after 24 fractions.", "Blood tests showed grade 1 leukopenia after 33 fractions.", "Blood tests normalized seven months after treatment.", "CT scans and laryngological examinations did not prove locoregional recurrence three, ten, and thirteen months after the end of radiotherapy.", "Chest X-ray and abdominal ultrasound did not detect any metastatic changes one year after treatment.", "Xerostomia G2 was the only symptom of late toxicity fifteen months after radiotherapy.", "At 17 months of follow-up, the patient reported coughing, suffocation, and bloody sputum.", "A CT scan revealed infiltration (64 \u00d7 65 \u00d7 100 mm) in the 3rd segment of the right lung, encompassing the hilum and central part of the mediastinum.", "Pathological examination after EUS-FNA proved squamous cell carcinoma with moderate PD-L1 membrane expression (< 50%).", "Acknowledgment of the tumor in the chest as lung cancer or metastatic disease due to oral cancer was difficult.", "The patient was qualified for palliative radiotherapy to a total dose of 30 Gy in 10 fractions (VMAT technique, single arc, gantry angle 30.0\u2013210.0 deg) for the tumor in the chest.", "Systemic treatment was contraindicated in terms of performance status\u2014ECOG 2.", "Three months later, multiple metastases in the mediastinum, right lung, spleen, and bones were detected by PET/CT.", "The most painful osteolitic lesion in the left ischium and femoral head was irradiated in one fraction to 8 Gy.", "Two-dimensional radiotherapy technique, two coaxial opposite beams from AP and PA directions were used.", "The patient died the next month."], "index": 104, "original_id": "multiclinsum_test_2840_en.txt", "split": "test", "summary_subclaims": ["The patient underwent surgery.", "During adjuvant radiotherapy, a metastatic cervical lymph node was diagnosed based on fine-needle aspiration biopsy.", "A stereotactic radiosurgery boost of 1\u2009\u00d7\u200918\u00a0Gy was performed two days after the last fraction of conventional radiotherapy.", "The early and late tolerance of this treatment were positive.", "During the 18-month follow-up, locoregional recurrence was not detected.", "The patient died due to secondary malignancy."], "raw_prompt": [{"content": "**System Role:**\n\nYou are an expert medical editor and Health Literacy specialist. Your task is to transform complex medical text into three distinct versions based on the reader's health literacy level. You must maintain the source language of the input while adjusting the linguistic complexity. Use the provided Gold Summary as the factual anchor to ensure the simplified versions remain accurate and focused on the most important information.\n\n**User Prompt:**\n\nPlease process the following medical Source Text and its corresponding Gold Summary to generate three versions tailored to different health literacy levels.\n### Instructions for Each Level:\n\n1. Level: Low Health Literacy (High Readability)\n\nTarget: Individuals needing the simplest terms for immediate action.\n\nLinguistic Goal: Use \"living room\" language. Replace all medical jargon with functional descriptions (e.g., \"renal\" becomes \"kidney\").\n\nInformation Density: Focus strictly on the \"need-to-know\" info found in the Gold Summary.\n\nStrategy: High paraphrasing using analogies. One idea per sentence.\n\nFaithfulness: Must align perfectly with the Gold Summary.\n\n2. Level: Intermediate Health Literacy (Medium Readability)\n\nTarget: The general public (news-reading level).\n\nLinguistic Goal: Standard vocabulary. Common medical terms are okay, but technical \"doctor-speak\" must be simplified.\n\nInformation Density: Balanced. Use the Gold Summary as the lead, supplemented by necessary context from the Source Text.\n\nStrategy: Moderate paraphrasing. Remove minor technical details to avoid information overload.\n\nFaithfulness: Maintains the main narrative of the Gold Summary.\n\n3. Level: Proficient Health Literacy (Low Readability)\n\nTarget: Researchers, clinicians, or highly informed patients.\n\nLinguistic Goal: Technical and academic language. Prioritize clinical nuance and medical accuracy.\n\nInformation Density: High. Use the Full Source Text to include data, physiological mechanisms, and statistics.\n\nStrategy: Minimal paraphrasing. Retain all original technical terminology.\n\nFaithfulness: Adhere to the Source Text; you may add related subclaims that provide deeper scientific context.\n\n\nI will provide the following information:\n\n- Input Language: <<<SOURCE_LANGUAGE>>>\n- Gold Summary (the anchor reference summary): <<<GOLD_SUMMARY>>>\n- Source Text (detailed content): <<<FULL_TEXT>>>\n\n**Output Format (JSON only):**\n    {\n    \"low_health_literacy\": \"...\",\n    \"intermediate_health_literacy\": \"...\",\n    \"proficient_health_literacy\": \"...\"\n    }", "role": "user"}], "num_turns": "2", "rollout_reward_scores": {}}}