/ elements,
- strips all XML markup, and returns a clean, whitespace-normalised string.
-
- Args:
- xml_bytes: Raw XML bytes as returned by efetch.
-
- Returns:
- Plain-text string. Empty string if parsing fails.
- """
- try:
- root = etree.fromstring(xml_bytes)
- except etree.XMLSyntaxError as exc:
- logger.warning("XML parse error: %s", exc)
- return ""
-
- sections: List[str] = []
- # Pull , , and in document order.
- for tag in ("article-title", "abstract", "body"):
- for element in root.iter(tag):
- text = _iter_text(element).strip()
- if text:
- sections.append(text)
-
- plain = "\n\n".join(sections)
- # Collapse excessive whitespace.
- import re
- plain = re.sub(r" {2,}", " ", plain)
- plain = re.sub(r"\n{3,}", "\n\n", plain)
- return plain.strip()
-
-
-def _get_article_meta(xml_bytes: bytes) -> Dict[str, str]:
- """Extract title and journal name from parsed PMC XML for the manifest."""
- meta: Dict[str, str] = {"title": "", "journal": ""}
- try:
- root = etree.fromstring(xml_bytes)
- title_el = root.find(".//article-title")
- if title_el is not None:
- meta["title"] = (_iter_text(title_el) or "").strip()
- journal_el = root.find(".//journal-title")
- if journal_el is not None:
- meta["journal"] = (journal_el.text or "").strip()
- except Exception:
- pass
- return meta
-
-
-# ---------------------------------------------------------------------------
-# Main fetch loop
-# ---------------------------------------------------------------------------
-
-
-def fetch_subdomain(
- subdomain: str,
- term: str,
- n: int,
- output_dir: Path,
- email: str,
- delay: float,
-) -> List[Dict]:
- """
- Search for and download up to `n` PMC articles matching `term`.
-
- Args:
- subdomain: Label string used in the manifest.
- term: NCBI search query.
- n: Target number of documents.
- output_dir: Directory to write .txt files into.
- email: NCBI requester email.
- delay: Seconds to sleep between requests.
-
- Returns:
- List of manifest entry dicts for successfully fetched documents.
- """
- logger.info("Subdomain '%s': searching for %d docs …", subdomain, n)
- try:
- ids = esearch(term, n, email)
- except Exception as exc:
- logger.error("esearch failed for '%s': %s", subdomain, exc)
- return []
-
- logger.info(" Found %d IDs; fetching full text …", len(ids))
- entries: List[Dict] = []
-
- for pmc_id in ids:
- time.sleep(delay)
- try:
- xml_bytes = efetch_xml(pmc_id, email)
- plain = xml_to_plain_text(xml_bytes)
- except requests.HTTPError as exc:
- logger.warning("HTTP error for PMC%s: %s", pmc_id, exc)
- continue
- except Exception as exc:
- logger.warning("Failed PMC%s: %s", pmc_id, exc)
- continue
-
- if len(plain) < 200:
- logger.debug("PMC%s: text too short (%d chars), skipping.", pmc_id, len(plain))
- continue
-
- out_path = output_dir / f"PMC{pmc_id}.txt"
- out_path.write_text(plain, encoding="utf-8")
-
- meta = _get_article_meta(xml_bytes)
- entries.append(
- {
- "pmc_id": pmc_id,
- "subdomain": subdomain,
- "title": meta["title"],
- "journal": meta["journal"],
- "source_url": f"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC{pmc_id}/",
- "path": str(out_path),
- "char_count": len(plain),
- }
- )
- logger.info(" Saved PMC%s (%d chars)", pmc_id, len(plain))
-
- logger.info(" Subdomain '%s': %d documents saved.", subdomain, len(entries))
- return entries
-
-
-def main(email: str = DEFAULT_NCBI_EMAIL, docs_per_subdomain: int = DOCS_PER_SUBDOMAIN) -> None:
- """
- Entry point. Iterates over all three medical subdomains and writes results.
- """
- if email == "your_email@example.com":
- logger.warning(
- "Using placeholder email — set the NCBI_EMAIL env var or pass --email. "
- "NCBI may throttle requests without a valid email."
- )
-
- OUTPUT_DIR.mkdir(parents=True, exist_ok=True)
-
- delay = REQUEST_DELAY_WITH_KEY if NCBI_API_KEY else REQUEST_DELAY_NO_KEY
- manifest: List[Dict] = []
-
- for subdomain, term in SEARCH_TERMS.items():
- entries = fetch_subdomain(subdomain, term, docs_per_subdomain, OUTPUT_DIR, email, delay)
- manifest.extend(entries)
-
- manifest_path = OUTPUT_DIR / "manifest.json"
- manifest_path.write_text(json.dumps(manifest, indent=2), encoding="utf-8")
- logger.info(
- "Done. %d medical documents fetched. Manifest → %s",
- len(manifest),
- manifest_path,
- )
-
-
-# ---------------------------------------------------------------------------
-# CLI
-# ---------------------------------------------------------------------------
-
-if __name__ == "__main__":
- parser = argparse.ArgumentParser(
- description="Fetch PubMed Central OA articles for the MEXAR medical corpus."
- )
- parser.add_argument(
- "--email",
- default=DEFAULT_NCBI_EMAIL,
- help="Your email address (required by NCBI usage policy).",
- )
- parser.add_argument(
- "--docs-per-subdomain",
- type=int,
- default=DOCS_PER_SUBDOMAIN,
- help="Number of documents to fetch per subdomain (default: %(default)s).",
- )
- args = parser.parse_args()
- main(email=args.email, docs_per_subdomain=args.docs_per_subdomain)
+"""
+MEXAR - PubMed Central OA fetcher for the medical corpus.
+
+Pulls ~220 documents from PubMed Central Open Access across three medical
+subdomains (cardiology, oncology, internal medicine), parses the full-text XML
+into plain text, and writes one .txt file per document into
+test_data/medical_real/, along with a manifest.json for auditing.
+
+Usage:
+ python backend/scripts/fetch_pubmed.py
+
+Requirements:
+ pip install requests lxml
+
+Environment:
+ NCBI_EMAIL — your email address (required by NCBI usage policy)
+ NCBI_API_KEY — optional; raises rate limit from 3 req/sec to 10 req/sec
+
+Run this locally (not in a network-restricted sandbox).
+"""
+import argparse
+import json
+import logging
+import os
+import sys
+import time
+from pathlib import Path
+from typing import Dict, List, Optional
+
+import requests
+from dotenv import load_dotenv
+load_dotenv()
+
+try:
+ from lxml import etree
+except ImportError:
+ sys.exit(
+ "lxml is required — run: pip install lxml"
+ )
+
+# ---------------------------------------------------------------------------
+# Configuration
+# ---------------------------------------------------------------------------
+
+logging.basicConfig(
+ level=logging.INFO,
+ format="%(asctime)s [%(levelname)s] %(message)s",
+)
+logger = logging.getLogger(__name__)
+
+# NCBI email is mandatory per NCBI E-utilities usage policy.
+# Override with the NCBI_EMAIL environment variable or the --email CLI flag.
+DEFAULT_NCBI_EMAIL: str = os.getenv("NCBI_EMAIL", "your_email@example.com")
+NCBI_API_KEY: Optional[str] = os.getenv("NCBI_API_KEY") # optional; raises rate cap to 10/s
+
+REPO_ROOT = Path(__file__).resolve().parent.parent.parent
+OUTPUT_DIR = REPO_ROOT / "test_data" / "medical_real"
+
+# Three subdomains × 75 docs ≈ 220 total (some may fail or be empty).
+SEARCH_TERMS: Dict[str, str] = {
+ "cardiology": "cardiology AND open access[filter]",
+ "oncology": "oncology AND open access[filter]",
+ "internal_medicine": "internal medicine AND open access[filter]",
+}
+DOCS_PER_SUBDOMAIN: int = 75
+
+# NCBI rate limits: 3 req/sec without key, 10/sec with key.
+REQUEST_DELAY_NO_KEY: float = 0.35 # ≈ 2.9 req/sec — safe without key
+REQUEST_DELAY_WITH_KEY: float = 0.12 # ≈ 8.3 req/sec — safe with key
+
+NCBI_BASE = "https://eutils.ncbi.nlm.nih.gov/entrez/eutils"
+
+# ---------------------------------------------------------------------------
+# NCBI E-utilities helpers
+# ---------------------------------------------------------------------------
+
+
+def _ncbi_params(extra: dict, email: str) -> dict:
+ """Return base params dict merged with extra, including optional API key."""
+ params = {"email": email, **extra}
+ if NCBI_API_KEY:
+ params["api_key"] = NCBI_API_KEY
+ return params
+
+
+def esearch(term: str, retmax: int, email: str) -> List[str]:
+ """
+ Run an E-search against the PMC database and return a list of PMC IDs.
+
+ Args:
+ term: NCBI search query string.
+ retmax: Maximum number of IDs to retrieve.
+ email: Requester email (required by NCBI).
+
+ Returns:
+ List of PMC ID strings (numeric, without the 'PMC' prefix).
+ """
+ url = f"{NCBI_BASE}/esearch.fcgi"
+ params = _ncbi_params(
+ {"db": "pmc", "term": term, "retmax": retmax, "retmode": "json"},
+ email,
+ )
+ resp = requests.get(url, params=params, timeout=30)
+ resp.raise_for_status()
+ return resp.json()["esearchresult"]["idlist"]
+
+
+def efetch_xml(pmc_id: str, email: str) -> bytes:
+ """
+ Fetch the full-text XML for a single PMC article.
+
+ Args:
+ pmc_id: Numeric PMC ID string (without the 'PMC' prefix).
+ email: Requester email.
+
+ Returns:
+ Raw XML bytes from the PMC OA full-text endpoint.
+ """
+ url = f"{NCBI_BASE}/efetch.fcgi"
+ params = _ncbi_params(
+ {"db": "pmc", "id": pmc_id, "rettype": "full", "retmode": "xml"},
+ email,
+ )
+ resp = requests.get(url, params=params, timeout=60)
+ resp.raise_for_status()
+ return resp.content
+
+
+# ---------------------------------------------------------------------------
+# XML → plain-text extraction
+# ---------------------------------------------------------------------------
+
+# Tags in the JATS PMC XML that contain useful body text.
+_BODY_TAGS = {"abstract", "body", "sec", "p", "title"}
+
+
+def _iter_text(element) -> str:
+ """
+ Recursively collect all text inside an lxml element, with
+ paragraph-level whitespace to keep the output readable.
+ """
+ parts = []
+ if element.text:
+ parts.append(element.text.strip())
+ for child in element:
+ child_text = _iter_text(child)
+ if child_text:
+ # Add a blank line between sections/paragraphs.
+ sep = "\n\n" if child.tag in {"sec", "p", "title", "abstract"} else " "
+ parts.append(sep + child_text)
+ if child.tail:
+ parts.append(child.tail.strip())
+ return " ".join(p for p in parts if p)
+
+
+def xml_to_plain_text(xml_bytes: bytes) -> str:
+ """
+ Parse PMC full-text XML and extract human-readable plain text.
+
+ Pulls text from , , and nested / elements,
+ strips all XML markup, and returns a clean, whitespace-normalised string.
+
+ Args:
+ xml_bytes: Raw XML bytes as returned by efetch.
+
+ Returns:
+ Plain-text string. Empty string if parsing fails.
+ """
+ try:
+ root = etree.fromstring(xml_bytes)
+ except etree.XMLSyntaxError as exc:
+ logger.warning("XML parse error: %s", exc)
+ return ""
+
+ sections: List[str] = []
+ # Pull , , and in document order.
+ for tag in ("article-title", "abstract", "body"):
+ for element in root.iter(tag):
+ text = _iter_text(element).strip()
+ if text:
+ sections.append(text)
+
+ plain = "\n\n".join(sections)
+ # Collapse excessive whitespace.
+ import re
+ plain = re.sub(r" {2,}", " ", plain)
+ plain = re.sub(r"\n{3,}", "\n\n", plain)
+ return plain.strip()
+
+
+def _get_article_meta(xml_bytes: bytes) -> Dict[str, str]:
+ """Extract title and journal name from parsed PMC XML for the manifest."""
+ meta: Dict[str, str] = {"title": "", "journal": ""}
+ try:
+ root = etree.fromstring(xml_bytes)
+ title_el = root.find(".//article-title")
+ if title_el is not None:
+ meta["title"] = (_iter_text(title_el) or "").strip()
+ journal_el = root.find(".//journal-title")
+ if journal_el is not None:
+ meta["journal"] = (journal_el.text or "").strip()
+ except Exception:
+ pass
+ return meta
+
+
+# ---------------------------------------------------------------------------
+# Main fetch loop
+# ---------------------------------------------------------------------------
+
+
+def fetch_subdomain(
+ subdomain: str,
+ term: str,
+ n: int,
+ output_dir: Path,
+ email: str,
+ delay: float,
+) -> List[Dict]:
+ """
+ Search for and download up to `n` PMC articles matching `term`.
+
+ Args:
+ subdomain: Label string used in the manifest.
+ term: NCBI search query.
+ n: Target number of documents.
+ output_dir: Directory to write .txt files into.
+ email: NCBI requester email.
+ delay: Seconds to sleep between requests.
+
+ Returns:
+ List of manifest entry dicts for successfully fetched documents.
+ """
+ logger.info("Subdomain '%s': searching for %d docs …", subdomain, n)
+ try:
+ ids = esearch(term, n, email)
+ except Exception as exc:
+ logger.error("esearch failed for '%s': %s", subdomain, exc)
+ return []
+
+ logger.info(" Found %d IDs; fetching full text …", len(ids))
+ entries: List[Dict] = []
+
+ for pmc_id in ids:
+ time.sleep(delay)
+ try:
+ xml_bytes = efetch_xml(pmc_id, email)
+ plain = xml_to_plain_text(xml_bytes)
+ except requests.HTTPError as exc:
+ logger.warning("HTTP error for PMC%s: %s", pmc_id, exc)
+ continue
+ except Exception as exc:
+ logger.warning("Failed PMC%s: %s", pmc_id, exc)
+ continue
+
+ if len(plain) < 200:
+ logger.debug("PMC%s: text too short (%d chars), skipping.", pmc_id, len(plain))
+ continue
+
+ out_path = output_dir / f"PMC{pmc_id}.txt"
+ out_path.write_text(plain, encoding="utf-8")
+
+ meta = _get_article_meta(xml_bytes)
+ entries.append(
+ {
+ "pmc_id": pmc_id,
+ "subdomain": subdomain,
+ "title": meta["title"],
+ "journal": meta["journal"],
+ "source_url": f"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC{pmc_id}/",
+ "path": str(out_path),
+ "char_count": len(plain),
+ }
+ )
+ logger.info(" Saved PMC%s (%d chars)", pmc_id, len(plain))
+
+ logger.info(" Subdomain '%s': %d documents saved.", subdomain, len(entries))
+ return entries
+
+
+def main(email: str = DEFAULT_NCBI_EMAIL, docs_per_subdomain: int = DOCS_PER_SUBDOMAIN) -> None:
+ """
+ Entry point. Iterates over all three medical subdomains and writes results.
+ """
+ if email == "your_email@example.com":
+ logger.warning(
+ "Using placeholder email — set the NCBI_EMAIL env var or pass --email. "
+ "NCBI may throttle requests without a valid email."
+ )
+
+ OUTPUT_DIR.mkdir(parents=True, exist_ok=True)
+
+ delay = REQUEST_DELAY_WITH_KEY if NCBI_API_KEY else REQUEST_DELAY_NO_KEY
+ manifest: List[Dict] = []
+
+ for subdomain, term in SEARCH_TERMS.items():
+ entries = fetch_subdomain(subdomain, term, docs_per_subdomain, OUTPUT_DIR, email, delay)
+ manifest.extend(entries)
+
+ manifest_path = OUTPUT_DIR / "manifest.json"
+ manifest_path.write_text(json.dumps(manifest, indent=2), encoding="utf-8")
+ logger.info(
+ "Done. %d medical documents fetched. Manifest → %s",
+ len(manifest),
+ manifest_path,
+ )
+
+
+# ---------------------------------------------------------------------------
+# CLI
+# ---------------------------------------------------------------------------
+
+if __name__ == "__main__":
+ parser = argparse.ArgumentParser(
+ description="Fetch PubMed Central OA articles for the MEXAR medical corpus."
+ )
+ parser.add_argument(
+ "--email",
+ default=DEFAULT_NCBI_EMAIL,
+ help="Your email address (required by NCBI usage policy).",
+ )
+ parser.add_argument(
+ "--docs-per-subdomain",
+ type=int,
+ default=DOCS_PER_SUBDOMAIN,
+ help="Number of documents to fetch per subdomain (default: %(default)s).",
+ )
+ args = parser.parse_args()
+ main(email=args.email, docs_per_subdomain=args.docs_per_subdomain)
diff --git a/backend/scripts/fetch_secedgar.py b/backend/scripts/fetch_secedgar.py
index 922418a60c58a6968fd7a62d285fc41db21e5a07..b93b890dce0b6002b7e1782b7697c1c50bcd5e9c 100644
--- a/backend/scripts/fetch_secedgar.py
+++ b/backend/scripts/fetch_secedgar.py
@@ -1,467 +1,470 @@
-"""
-MEXAR - SEC EDGAR fetcher for the financial corpus.
-
-Fetches ~130 10-K filing sections (MD&A, Risk Factors) from SEC EDGAR using
-the full-text search API, follows through to the actual EDGAR filing documents,
-extracts the relevant section text, and saves one .txt file per document plus
-a manifest.json.
-
-Usage:
- python backend/scripts/fetch_secedgar.py
-
-Requirements:
- pip install requests beautifulsoup4 lxml
-
-SEC Fair Access Policy:
- Every request MUST include a descriptive User-Agent header in the format:
- "FirstName LastName email@example.com"
- without this, SEC will block your IP.
-
- Override with the SEC_USER_AGENT environment variable.
-
-Run this locally (not in a network-restricted sandbox).
-"""
-import argparse
-import json
-import logging
-import os
-import re
-import sys
-import time
-from pathlib import Path
-from typing import Dict, List, Optional, Tuple
-from urllib.parse import urljoin
-
-import requests
-
-try:
- from bs4 import BeautifulSoup
-except ImportError:
- sys.exit("beautifulsoup4 is required — run: pip install beautifulsoup4 lxml")
-
-# ---------------------------------------------------------------------------
-# Configuration
-# ---------------------------------------------------------------------------
-
-logging.basicConfig(
- level=logging.INFO,
- format="%(asctime)s [%(levelname)s] %(message)s",
-)
-logger = logging.getLogger(__name__)
-
-# SEC requires a descriptive User-Agent on every request.
-# Format: "Name Email" — use yours or set SEC_USER_AGENT env var.
-_DEFAULT_USER_AGENT = "Devrajsinh Gohil djgohil2012@gmail.com"
-USER_AGENT: str = os.getenv("SEC_USER_AGENT", _DEFAULT_USER_AGENT)
-
-HEADERS: Dict[str, str] = {
- "User-Agent": USER_AGENT,
- "Accept-Encoding": "gzip, deflate",
- "Host": "efts.sec.gov",
-}
-EDGAR_HEADERS: Dict[str, str] = {
- "User-Agent": USER_AGENT,
- "Accept-Encoding": "gzip, deflate",
-}
-
-OUTPUT_DIR = Path("test_data/financial_real")
-
-# Search terms and per-term document targets (~130 total).
-SEARCH_CONFIG: List[Tuple[str, str, int]] = [
- ("risk_factors", "risk factors", 45),
- ("management_discussion", "management discussion and analysis", 45),
- ("accounting_standards", "GAAP IFRS accounting standards", 40),
-]
-
-# Maximum characters per saved document — keep consistent with medical/legal sizes.
-MAX_CHARS: int = 15_000
-
-# Be polite to SEC servers.
-REQUEST_DELAY: float = 0.25 # seconds
-
-# EDGAR full-text search endpoint.
-EFTS_URL = "https://efts.sec.gov/LATEST/search-index"
-EDGAR_ARCHIVES = "https://www.sec.gov/Archives/edgar/data"
-
-# ---------------------------------------------------------------------------
-# SEC EDGAR API helpers
-# ---------------------------------------------------------------------------
-
-
-def _get(url: str, params: dict = None, extra_headers: dict = None) -> requests.Response:
- """GET with SEC-compliant headers and error handling."""
- h = {**EDGAR_HEADERS}
- if extra_headers:
- h.update(extra_headers)
- resp = requests.get(url, headers=h, params=params or {}, timeout=30)
- resp.raise_for_status()
- return resp
-
-
-def full_text_search(query: str, count: int) -> List[dict]:
- """
- Query the SEC EDGAR full-text search API for 10-K filings.
-
- The EFTS search endpoint returns hit metadata only — not the filing body.
- Each hit contains the accession number and CIK needed to locate the filing
- document in EDGAR archives.
-
- Args:
- query: Search phrase (e.g. "risk factors").
- count: Maximum number of hits to return.
-
- Returns:
- List of _source dicts from the EFTS hits array.
- """
- # EFTS search uses query-string encoding.
- params = {
- "q": f'"{query}"',
- "forms": "10-K",
- "dateRange": "custom",
- "startdt": "2020-01-01",
- "enddt": "2024-12-31",
- }
- try:
- resp = _get(
- EFTS_URL,
- params=params,
- extra_headers={"Host": "efts.sec.gov"},
- )
- except Exception as exc:
- logger.error("EFTS search failed for '%s': %s", query, exc)
- return []
-
- data = resp.json()
- hits = data.get("hits", {}).get("hits", [])
- logger.info(" EFTS returned %d hits for '%s'", len(hits), query)
- return [h.get("_source", {}) for h in hits[:count]]
-
-
-# ---------------------------------------------------------------------------
-# Filing document text extraction
-# ---------------------------------------------------------------------------
-
-def _accession_to_path(accession: str) -> str:
- """Convert '0001234567-23-012345' → '000123456723012345'."""
- return accession.replace("-", "")
-
-
-def _get_filing_index(cik: str, accession: str) -> Optional[dict]:
- """
- Fetch the filing index JSON from EDGAR to find the primary document URL.
-
- Returns the parsed index data dict, or None on failure.
- """
- cik_int = str(int(cik)) if cik.isdigit() else cik
- acc_path = _accession_to_path(accession)
- url = (
- f"https://data.sec.gov/submissions/CIK{cik_int.zfill(10)}.json"
- )
- # Use the filing index endpoint instead.
- index_url = (
- f"https://www.sec.gov/cgi-bin/browse-edgar"
- f"?action=getcompany&CIK={cik_int}&type=10-K&dateb=&owner=include&count=1&search_text="
- )
- # Directly hit the accession-number based index.
- direct_url = (
- f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/{accession}-index.json"
- )
- try:
- resp = _get(direct_url)
- return resp.json()
- except Exception:
- pass
- # Fallback: try the .htm index.
- try:
- htm_url = (
- f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/{accession}-index.htm"
- )
- resp = _get(htm_url)
- # Parse the index page for the primary document link.
- soup = BeautifulSoup(resp.text, "lxml")
- return {"_html": resp.text, "_base": f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/"}
- except Exception as exc:
- logger.debug("Filing index fetch failed for %s/%s: %s", cik, accession, exc)
- return None
-
-
-def _find_primary_document_url(cik: str, accession: str, index_data: dict) -> Optional[str]:
- """
- Given filing index data, return the URL of the primary 10-K HTML document.
- """
- acc_path = _accession_to_path(accession)
- base = f"https://www.sec.gov/Archives/edgar/data/{cik}/{acc_path}/"
-
- # JSON index format (modern filings).
- if "documents" in index_data:
- for doc in index_data.get("documents", []):
- doc_type = doc.get("type", "").upper()
- if doc_type in ("10-K", "10-K/A"):
- filename = doc.get("filename") or doc.get("documentName", "")
- if filename:
- return base + filename
-
- # HTML index fallback.
- if "_html" in index_data:
- soup = BeautifulSoup(index_data["_html"], "lxml")
- for row in soup.find_all("tr"):
- cells = row.find_all("td")
- if len(cells) >= 3:
- doc_type = cells[3].get_text(strip=True) if len(cells) > 3 else ""
- if "10-K" in doc_type:
- link = cells[2].find("a")
- if link and link.get("href"):
- href = link["href"]
- if href.startswith("/"):
- return "https://www.sec.gov" + href
- return href
- # If no 10-K row found, grab any .htm link from the table.
- for link in soup.select("table a[href]"):
- href = link["href"]
- if href.endswith(".htm") or href.endswith(".html"):
- if href.startswith("/"):
- return "https://www.sec.gov" + href
- return href
-
- return None
-
-
-def _extract_section(html: str, section: str) -> str:
- """
- Extract a named section (e.g. 'risk factors', 'management discussion')
- from a 10-K HTML document.
-
- Strategy:
- 1. Parse with BeautifulSoup.
- 2. Find the first heading element (, , , ,
) whose
- text closely matches the section name.
- 3. Collect all subsequent paragraph text until the next major heading.
-
- Falls back to returning the first 15,000 chars of the full body text if
- no matching section heading is found.
- """
- soup = BeautifulSoup(html, "lxml")
-
- # Remove script/style noise.
- for tag in soup(["script", "style", "meta", "link"]):
- tag.decompose()
-
- section_lower = section.lower()
- # Headings to search in.
- heading_candidates = soup.find_all(
- ["b", "strong", "h1", "h2", "h3", "h4", "p"],
- )
-
- section_start = None
- for el in heading_candidates:
- text = el.get_text(" ", strip=True).lower()
- if section_lower in text and len(text) < 200:
- section_start = el
- break
-
- if section_start is None:
- # No section heading found — return the full text (truncated).
- full_text = soup.get_text(" ", strip=True)
- return re.sub(r" {2,}", " ", full_text)
-
- # Collect text from siblings/following elements until next major heading.
- parts: List[str] = []
- total = 0
- for sibling in section_start.find_all_next():
- tag_name = sibling.name or ""
- text = sibling.get_text(" ", strip=True)
- if not text:
- continue
-
- # Stop at the next major heading that looks like a different section.
- if tag_name in ("h1", "h2", "h3"):
- break
- if tag_name in ("b", "strong", "p") and len(text) < 200:
- text_lower = text.lower()
- # Check for common 10-K section heading patterns.
- if re.match(r"(item\s+\d|part\s+[iv]+)", text_lower):
- break
-
- parts.append(text)
- total += len(text)
- if total >= MAX_CHARS:
- break
-
- extracted = " ".join(parts)
- extracted = re.sub(r" {2,}", " ", extracted)
- return extracted.strip()
-
-
-def fetch_and_extract(source: dict, query_label: str) -> Tuple[str, str, int]:
- """
- Follow through from an EFTS hit's metadata to the actual filing text.
-
- Args:
- source: _source dict from an EFTS hit.
- query_label: Human-readable label for the search term (used for
- section extraction hints).
-
- Returns:
- (text, filing_url, char_count) — text is empty string on failure.
- """
- cik_list = source.get("ciks", [])
- cik = str(cik_list[0]) if cik_list else source.get("cik", "")
- accession = source.get("adsh", "")
-
- if not cik or not accession:
- return "", "", 0
-
- acc_path = _accession_to_path(accession)
- filing_url = f"https://www.sec.gov/Archives/edgar/data/{cik}/{acc_path}/"
-
- time.sleep(REQUEST_DELAY)
-
- # Step 1: Get filing index to find the primary document.
- index_data = _get_filing_index(cik, accession)
- if not index_data:
- logger.debug("No index for %s / %s", cik, accession)
- return "", filing_url, 0
-
- doc_url = _find_primary_document_url(cik, acc_path, index_data)
- if not doc_url:
- logger.debug("Could not locate primary doc for %s / %s", cik, accession)
- return "", filing_url, 0
-
- time.sleep(REQUEST_DELAY)
-
- # Step 2: Fetch the 10-K document.
- try:
- resp = _get(doc_url)
- html = resp.text
- except Exception as exc:
- logger.debug("Failed to fetch filing document %s: %s", doc_url, exc)
- return "", filing_url, 0
-
- # Step 3: Extract the relevant section.
- section_hint = query_label.replace("_", " ")
- text = _extract_section(html, section_hint)
- if len(text) > MAX_CHARS:
- text = text[:MAX_CHARS]
-
- return text, doc_url, len(text)
-
-
-# ---------------------------------------------------------------------------
-# Main fetch loop
-# ---------------------------------------------------------------------------
-
-
-def fetch_term(
- label: str,
- query: str,
- n: int,
- output_dir: Path,
-) -> List[Dict]:
- """
- Search EDGAR for `n` filings matching `query`, extract section text, save.
-
- Args:
- label: Short label for the search term (used in filename + manifest).
- query: EDGAR full-text search phrase.
- n: Target document count.
- output_dir: Directory to write .txt files into.
-
- Returns:
- List of manifest entry dicts.
- """
- logger.info("Term '%s': searching EDGAR for %d docs …", label, n)
- sources = full_text_search(query, n)
-
- entries: List[Dict] = []
- seen = set()
-
- for source in sources:
- cik_list = source.get("ciks", [])
- cik = str(cik_list[0]) if cik_list else source.get("cik", "")
- accession = source.get("adsh", "")
-
- if not cik or not accession:
- continue
-
- doc_key = f"{cik}_{accession}"
- if doc_key in seen:
- continue
- seen.add(doc_key)
-
- text, doc_url, char_count = fetch_and_extract(source, label)
- if char_count < 200:
- logger.debug("Skipping %s — insufficient text (%d chars).", doc_key, char_count)
- continue
-
- out_path = output_dir / f"{doc_key}.txt"
- out_path.write_text(text, encoding="utf-8")
-
- company_names = source.get("display_names", [])
- company = company_names[0] if company_names else source.get("entity_name", "")
-
- entries.append(
- {
- "cik": cik,
- "accession": accession,
- "company": company,
- "term": label,
- "filing_date": source.get("period_of_report", ""),
- "source_url": doc_url,
- "path": str(out_path),
- "char_count": char_count,
- }
- )
- logger.info(" Saved %s (%d chars)", doc_key, char_count)
-
- logger.info(" Term '%s': %d documents saved.", label, len(entries))
- return entries
-
-
-def main() -> None:
- """Entry point."""
- if USER_AGENT == _DEFAULT_USER_AGENT:
- logger.warning(
- "Using default User-Agent '%s'. "
- "Set the SEC_USER_AGENT env var to 'YourName your@email.com' "
- "to comply with SEC fair access policy.",
- USER_AGENT,
- )
-
- OUTPUT_DIR.mkdir(parents=True, exist_ok=True)
- manifest: List[Dict] = []
-
- for label, query, target_n in SEARCH_CONFIG:
- entries = fetch_term(label, query, target_n, OUTPUT_DIR)
- manifest.extend(entries)
-
- manifest_path = OUTPUT_DIR / "manifest.json"
- manifest_path.write_text(json.dumps(manifest, indent=2), encoding="utf-8")
- logger.info(
- "Done. %d financial documents fetched. Manifest → %s",
- len(manifest),
- manifest_path,
- )
-
-
-# ---------------------------------------------------------------------------
-# CLI
-# ---------------------------------------------------------------------------
-
-if __name__ == "__main__":
- parser = argparse.ArgumentParser(
- description="Fetch SEC EDGAR 10-K sections for the MEXAR financial corpus."
- )
- parser.add_argument(
- "--user-agent",
- default=None,
- help=(
- "SEC-compliant User-Agent string ('FirstName LastName email@example.com'). "
- "Overrides the SEC_USER_AGENT environment variable."
- ),
- )
- args = parser.parse_args()
- if args.user_agent:
- USER_AGENT = args.user_agent
- HEADERS["User-Agent"] = USER_AGENT
- EDGAR_HEADERS["User-Agent"] = USER_AGENT
- main()
+"""
+MEXAR - SEC EDGAR fetcher for the financial corpus.
+
+Fetches ~130 10-K filing sections (MD&A, Risk Factors) from SEC EDGAR using
+the full-text search API, follows through to the actual EDGAR filing documents,
+extracts the relevant section text, and saves one .txt file per document plus
+a manifest.json.
+
+Usage:
+ python backend/scripts/fetch_secedgar.py
+
+Requirements:
+ pip install requests beautifulsoup4 lxml
+
+SEC Fair Access Policy:
+ Every request MUST include a descriptive User-Agent header in the format:
+ "FirstName LastName email@example.com"
+ without this, SEC will block your IP.
+
+ Override with the SEC_USER_AGENT environment variable.
+
+Run this locally (not in a network-restricted sandbox).
+"""
+import argparse
+import json
+import logging
+import os
+import re
+import sys
+import time
+from pathlib import Path
+from typing import Dict, List, Optional, Tuple
+from urllib.parse import urljoin
+
+import requests
+from dotenv import load_dotenv
+load_dotenv()
+
+try:
+ from bs4 import BeautifulSoup
+except ImportError:
+ sys.exit("beautifulsoup4 is required — run: pip install beautifulsoup4 lxml")
+
+# ---------------------------------------------------------------------------
+# Configuration
+# ---------------------------------------------------------------------------
+
+logging.basicConfig(
+ level=logging.INFO,
+ format="%(asctime)s [%(levelname)s] %(message)s",
+)
+logger = logging.getLogger(__name__)
+
+# SEC requires a descriptive User-Agent on every request.
+# Format: "Name Email" — use yours or set SEC_USER_AGENT env var.
+_DEFAULT_USER_AGENT = "Devrajsinh Gohil djgohil2012@gmail.com"
+USER_AGENT: str = os.getenv("SEC_USER_AGENT", _DEFAULT_USER_AGENT)
+
+HEADERS: Dict[str, str] = {
+ "User-Agent": USER_AGENT,
+ "Accept-Encoding": "gzip, deflate",
+ "Host": "efts.sec.gov",
+}
+EDGAR_HEADERS: Dict[str, str] = {
+ "User-Agent": USER_AGENT,
+ "Accept-Encoding": "gzip, deflate",
+}
+
+REPO_ROOT = Path(__file__).resolve().parent.parent.parent
+OUTPUT_DIR = REPO_ROOT / "test_data" / "financial_real"
+
+# Search terms and per-term document targets (~130 total).
+SEARCH_CONFIG: List[Tuple[str, str, int]] = [
+ ("risk_factors", "risk factors", 45),
+ ("management_discussion", "management discussion and analysis", 45),
+ ("accounting_standards", "GAAP IFRS accounting standards", 40),
+]
+
+# Maximum characters per saved document — keep consistent with medical/legal sizes.
+MAX_CHARS: int = 15_000
+
+# Be polite to SEC servers.
+REQUEST_DELAY: float = 0.25 # seconds
+
+# EDGAR full-text search endpoint.
+EFTS_URL = "https://efts.sec.gov/LATEST/search-index"
+EDGAR_ARCHIVES = "https://www.sec.gov/Archives/edgar/data"
+
+# ---------------------------------------------------------------------------
+# SEC EDGAR API helpers
+# ---------------------------------------------------------------------------
+
+
+def _get(url: str, params: dict = None, extra_headers: dict = None) -> requests.Response:
+ """GET with SEC-compliant headers and error handling."""
+ h = {**EDGAR_HEADERS}
+ if extra_headers:
+ h.update(extra_headers)
+ resp = requests.get(url, headers=h, params=params or {}, timeout=30)
+ resp.raise_for_status()
+ return resp
+
+
+def full_text_search(query: str, count: int) -> List[dict]:
+ """
+ Query the SEC EDGAR full-text search API for 10-K filings.
+
+ The EFTS search endpoint returns hit metadata only — not the filing body.
+ Each hit contains the accession number and CIK needed to locate the filing
+ document in EDGAR archives.
+
+ Args:
+ query: Search phrase (e.g. "risk factors").
+ count: Maximum number of hits to return.
+
+ Returns:
+ List of _source dicts from the EFTS hits array.
+ """
+ # EFTS search uses query-string encoding.
+ params = {
+ "q": f'"{query}"',
+ "forms": "10-K",
+ "dateRange": "custom",
+ "startdt": "2020-01-01",
+ "enddt": "2024-12-31",
+ }
+ try:
+ resp = _get(
+ EFTS_URL,
+ params=params,
+ extra_headers={"Host": "efts.sec.gov"},
+ )
+ except Exception as exc:
+ logger.error("EFTS search failed for '%s': %s", query, exc)
+ return []
+
+ data = resp.json()
+ hits = data.get("hits", {}).get("hits", [])
+ logger.info(" EFTS returned %d hits for '%s'", len(hits), query)
+ return [h.get("_source", {}) for h in hits[:count]]
+
+
+# ---------------------------------------------------------------------------
+# Filing document text extraction
+# ---------------------------------------------------------------------------
+
+def _accession_to_path(accession: str) -> str:
+ """Convert '0001234567-23-012345' → '000123456723012345'."""
+ return accession.replace("-", "")
+
+
+def _get_filing_index(cik: str, accession: str) -> Optional[dict]:
+ """
+ Fetch the filing index JSON from EDGAR to find the primary document URL.
+
+ Returns the parsed index data dict, or None on failure.
+ """
+ cik_int = str(int(cik)) if cik.isdigit() else cik
+ acc_path = _accession_to_path(accession)
+ url = (
+ f"https://data.sec.gov/submissions/CIK{cik_int.zfill(10)}.json"
+ )
+ # Use the filing index endpoint instead.
+ index_url = (
+ f"https://www.sec.gov/cgi-bin/browse-edgar"
+ f"?action=getcompany&CIK={cik_int}&type=10-K&dateb=&owner=include&count=1&search_text="
+ )
+ # Directly hit the accession-number based index.
+ direct_url = (
+ f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/{accession}-index.json"
+ )
+ try:
+ resp = _get(direct_url)
+ return resp.json()
+ except Exception:
+ pass
+ # Fallback: try the .htm index.
+ try:
+ htm_url = (
+ f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/{accession}-index.htm"
+ )
+ resp = _get(htm_url)
+ # Parse the index page for the primary document link.
+ soup = BeautifulSoup(resp.text, "lxml")
+ return {"_html": resp.text, "_base": f"https://www.sec.gov/Archives/edgar/data/{cik_int}/{acc_path}/"}
+ except Exception as exc:
+ logger.debug("Filing index fetch failed for %s/%s: %s", cik, accession, exc)
+ return None
+
+
+def _find_primary_document_url(cik: str, accession: str, index_data: dict) -> Optional[str]:
+ """
+ Given filing index data, return the URL of the primary 10-K HTML document.
+ """
+ acc_path = _accession_to_path(accession)
+ base = f"https://www.sec.gov/Archives/edgar/data/{cik}/{acc_path}/"
+
+ # JSON index format (modern filings).
+ if "documents" in index_data:
+ for doc in index_data.get("documents", []):
+ doc_type = doc.get("type", "").upper()
+ if doc_type in ("10-K", "10-K/A"):
+ filename = doc.get("filename") or doc.get("documentName", "")
+ if filename:
+ return base + filename
+
+ # HTML index fallback.
+ if "_html" in index_data:
+ soup = BeautifulSoup(index_data["_html"], "lxml")
+ for row in soup.find_all("tr"):
+ cells = row.find_all("td")
+ if len(cells) >= 3:
+ doc_type = cells[3].get_text(strip=True) if len(cells) > 3 else ""
+ if "10-K" in doc_type:
+ link = cells[2].find("a")
+ if link and link.get("href"):
+ href = link["href"]
+ if href.startswith("/"):
+ return "https://www.sec.gov" + href
+ return href
+ # If no 10-K row found, grab any .htm link from the table.
+ for link in soup.select("table a[href]"):
+ href = link["href"]
+ if href.endswith(".htm") or href.endswith(".html"):
+ if href.startswith("/"):
+ return "https://www.sec.gov" + href
+ return href
+
+ return None
+
+
+def _extract_section(html: str, section: str) -> str:
+ """
+ Extract a named section (e.g. 'risk factors', 'management discussion')
+ from a 10-K HTML document.
+
+ Strategy:
+ 1. Parse with BeautifulSoup.
+ 2. Find the first heading element (, , , ,
) whose
+ text closely matches the section name.
+ 3. Collect all subsequent paragraph text until the next major heading.
+
+ Falls back to returning the first 15,000 chars of the full body text if
+ no matching section heading is found.
+ """
+ soup = BeautifulSoup(html, "lxml")
+
+ # Remove script/style noise.
+ for tag in soup(["script", "style", "meta", "link"]):
+ tag.decompose()
+
+ section_lower = section.lower()
+ # Headings to search in.
+ heading_candidates = soup.find_all(
+ ["b", "strong", "h1", "h2", "h3", "h4", "p"],
+ )
+
+ section_start = None
+ for el in heading_candidates:
+ text = el.get_text(" ", strip=True).lower()
+ if section_lower in text and len(text) < 200:
+ section_start = el
+ break
+
+ if section_start is None:
+ # No section heading found — return the full text (truncated).
+ full_text = soup.get_text(" ", strip=True)
+ return re.sub(r" {2,}", " ", full_text)
+
+ # Collect text from siblings/following elements until next major heading.
+ parts: List[str] = []
+ total = 0
+ for sibling in section_start.find_all_next():
+ tag_name = sibling.name or ""
+ text = sibling.get_text(" ", strip=True)
+ if not text:
+ continue
+
+ # Stop at the next major heading that looks like a different section.
+ if tag_name in ("h1", "h2", "h3"):
+ break
+ if tag_name in ("b", "strong", "p") and len(text) < 200:
+ text_lower = text.lower()
+ # Check for common 10-K section heading patterns.
+ if re.match(r"(item\s+\d|part\s+[iv]+)", text_lower):
+ break
+
+ parts.append(text)
+ total += len(text)
+ if total >= MAX_CHARS:
+ break
+
+ extracted = " ".join(parts)
+ extracted = re.sub(r" {2,}", " ", extracted)
+ return extracted.strip()
+
+
+def fetch_and_extract(source: dict, query_label: str) -> Tuple[str, str, int]:
+ """
+ Follow through from an EFTS hit's metadata to the actual filing text.
+
+ Args:
+ source: _source dict from an EFTS hit.
+ query_label: Human-readable label for the search term (used for
+ section extraction hints).
+
+ Returns:
+ (text, filing_url, char_count) — text is empty string on failure.
+ """
+ cik_list = source.get("ciks", [])
+ cik = str(cik_list[0]) if cik_list else source.get("cik", "")
+ accession = source.get("adsh", "")
+
+ if not cik or not accession:
+ return "", "", 0
+
+ acc_path = _accession_to_path(accession)
+ filing_url = f"https://www.sec.gov/Archives/edgar/data/{cik}/{acc_path}/"
+
+ time.sleep(REQUEST_DELAY)
+
+ # Step 1: Get filing index to find the primary document.
+ index_data = _get_filing_index(cik, accession)
+ if not index_data:
+ logger.debug("No index for %s / %s", cik, accession)
+ return "", filing_url, 0
+
+ doc_url = _find_primary_document_url(cik, acc_path, index_data)
+ if not doc_url:
+ logger.debug("Could not locate primary doc for %s / %s", cik, accession)
+ return "", filing_url, 0
+
+ time.sleep(REQUEST_DELAY)
+
+ # Step 2: Fetch the 10-K document.
+ try:
+ resp = _get(doc_url)
+ html = resp.text
+ except Exception as exc:
+ logger.debug("Failed to fetch filing document %s: %s", doc_url, exc)
+ return "", filing_url, 0
+
+ # Step 3: Extract the relevant section.
+ section_hint = query_label.replace("_", " ")
+ text = _extract_section(html, section_hint)
+ if len(text) > MAX_CHARS:
+ text = text[:MAX_CHARS]
+
+ return text, doc_url, len(text)
+
+
+# ---------------------------------------------------------------------------
+# Main fetch loop
+# ---------------------------------------------------------------------------
+
+
+def fetch_term(
+ label: str,
+ query: str,
+ n: int,
+ output_dir: Path,
+) -> List[Dict]:
+ """
+ Search EDGAR for `n` filings matching `query`, extract section text, save.
+
+ Args:
+ label: Short label for the search term (used in filename + manifest).
+ query: EDGAR full-text search phrase.
+ n: Target document count.
+ output_dir: Directory to write .txt files into.
+
+ Returns:
+ List of manifest entry dicts.
+ """
+ logger.info("Term '%s': searching EDGAR for %d docs …", label, n)
+ sources = full_text_search(query, n)
+
+ entries: List[Dict] = []
+ seen = set()
+
+ for source in sources:
+ cik_list = source.get("ciks", [])
+ cik = str(cik_list[0]) if cik_list else source.get("cik", "")
+ accession = source.get("adsh", "")
+
+ if not cik or not accession:
+ continue
+
+ doc_key = f"{cik}_{accession}"
+ if doc_key in seen:
+ continue
+ seen.add(doc_key)
+
+ text, doc_url, char_count = fetch_and_extract(source, label)
+ if char_count < 200:
+ logger.debug("Skipping %s — insufficient text (%d chars).", doc_key, char_count)
+ continue
+
+ out_path = output_dir / f"{doc_key}.txt"
+ out_path.write_text(text, encoding="utf-8")
+
+ company_names = source.get("display_names", [])
+ company = company_names[0] if company_names else source.get("entity_name", "")
+
+ entries.append(
+ {
+ "cik": cik,
+ "accession": accession,
+ "company": company,
+ "term": label,
+ "filing_date": source.get("period_of_report", ""),
+ "source_url": doc_url,
+ "path": str(out_path),
+ "char_count": char_count,
+ }
+ )
+ logger.info(" Saved %s (%d chars)", doc_key, char_count)
+
+ logger.info(" Term '%s': %d documents saved.", label, len(entries))
+ return entries
+
+
+def main() -> None:
+ """Entry point."""
+ if USER_AGENT == _DEFAULT_USER_AGENT:
+ logger.warning(
+ "Using default User-Agent '%s'. "
+ "Set the SEC_USER_AGENT env var to 'YourName your@email.com' "
+ "to comply with SEC fair access policy.",
+ USER_AGENT,
+ )
+
+ OUTPUT_DIR.mkdir(parents=True, exist_ok=True)
+ manifest: List[Dict] = []
+
+ for label, query, target_n in SEARCH_CONFIG:
+ entries = fetch_term(label, query, target_n, OUTPUT_DIR)
+ manifest.extend(entries)
+
+ manifest_path = OUTPUT_DIR / "manifest.json"
+ manifest_path.write_text(json.dumps(manifest, indent=2), encoding="utf-8")
+ logger.info(
+ "Done. %d financial documents fetched. Manifest → %s",
+ len(manifest),
+ manifest_path,
+ )
+
+
+# ---------------------------------------------------------------------------
+# CLI
+# ---------------------------------------------------------------------------
+
+if __name__ == "__main__":
+ parser = argparse.ArgumentParser(
+ description="Fetch SEC EDGAR 10-K sections for the MEXAR financial corpus."
+ )
+ parser.add_argument(
+ "--user-agent",
+ default=None,
+ help=(
+ "SEC-compliant User-Agent string ('FirstName LastName email@example.com'). "
+ "Overrides the SEC_USER_AGENT environment variable."
+ ),
+ )
+ args = parser.parse_args()
+ if args.user_agent:
+ USER_AGENT = args.user_agent
+ HEADERS["User-Agent"] = USER_AGENT
+ EDGAR_HEADERS["User-Agent"] = USER_AGENT
+ main()
diff --git a/backend/scripts/recompile_agents_from_real_data.py b/backend/scripts/recompile_agents_from_real_data.py
new file mode 100644
index 0000000000000000000000000000000000000000..3fb414201d6b1f9f2588d2614fe04a35cc156b8c
--- /dev/null
+++ b/backend/scripts/recompile_agents_from_real_data.py
@@ -0,0 +1,92 @@
+"""
+MEXAR - Bulk Recompile Domain Agents from Real Data.
+Reads real text documents from test_data/medical_real/, test_data/legal_real/, and test_data/financial_real/
+and compiles knowledge into SQLite database and FastEmbed vector store for medical_agent, legal_agent, and financial_agent.
+"""
+import os
+import sys
+import glob
+import logging
+from pathlib import Path
+
+sys.path.append(os.path.dirname(os.path.dirname(os.path.abspath(__file__))))
+
+from modules.knowledge_compiler import create_knowledge_compiler
+from modules.prompt_analyzer import create_prompt_analyzer
+from core.database import Base, engine as db_engine
+
+logging.basicConfig(level=logging.INFO, format="%(asctime)s [%(levelname)s] %(message)s")
+logger = logging.getLogger(__name__)
+
+REPO_ROOT = Path(__file__).resolve().parent.parent.parent
+
+
+def recompile_domain_agent(domain_key: str, agent_name: str, system_prompt: str):
+ data_dir = REPO_ROOT / "test_data" / f"{domain_key}_real"
+ txt_files = list(data_dir.glob("*.txt"))
+
+ if not txt_files:
+ logger.warning(f"No .txt files found in {data_dir} for domain '{domain_key}'")
+ return
+
+ logger.info(f"Recompiling '{agent_name}' from {len(txt_files)} documents in {data_dir}...")
+
+ parsed_data = []
+ for fpath in sorted(txt_files):
+ try:
+ content = fpath.read_text(encoding="utf-8")
+ parsed_data.append({
+ "file_name": fpath.name,
+ "source": fpath.name,
+ "text": content,
+ "content": content,
+ "format": "txt"
+ })
+ except Exception as e:
+ logger.error(f"Error reading {fpath}: {e}")
+
+ analyzer = create_prompt_analyzer()
+ prompt_analysis = analyzer.analyze_prompt(system_prompt)
+ prompt_analysis["domain"] = domain_key
+
+ compiler = create_knowledge_compiler()
+ res = compiler.compile(
+ agent_name=agent_name,
+ parsed_data=parsed_data,
+ system_prompt=system_prompt,
+ prompt_analysis=prompt_analysis
+ )
+
+ logger.info(
+ f"Recompiled '{agent_name}': signature terms={len(res.get('domain_signature', []))}, "
+ f"processed {len(parsed_data)} files successfully."
+ )
+
+
+def main():
+ Base.metadata.create_all(bind=db_engine)
+
+ agents_config = [
+ (
+ "medical",
+ "medical_agent",
+ "You are an expert medical AI assistant specialized in cardiology, oncology, and internal medicine."
+ ),
+ (
+ "legal",
+ "legal_agent",
+ "You are an expert legal AI assistant specialized in contract law, intellectual property, and corporate governance."
+ ),
+ (
+ "financial",
+ "financial_agent",
+ "You are an expert financial AI assistant specialized in SEC EDGAR 10-K filings, MD&A, and risk factor analysis."
+ )
+ ]
+
+ for domain_key, agent_name, system_prompt in agents_config:
+ recompile_domain_agent(domain_key, agent_name, system_prompt)
+
+
+if __name__ == "__main__":
+ main()
diff --git a/backend/utils/faithfulness.py b/backend/utils/faithfulness.py
index da68ddc8a4db7336332d74bf90f838666ba52b06..96fb67e145070293737a3aa6a8d38e9b76ef8c66 100644
--- a/backend/utils/faithfulness.py
+++ b/backend/utils/faithfulness.py
@@ -1,366 +1,374 @@
-"""
-MEXAR - Faithfulness Scoring Module
-Measures how well the LLM answer is grounded in the retrieved context.
-"""
-import json
-import logging
-from typing import List, Dict
-from dataclasses import dataclass
-
-logger = logging.getLogger(__name__)
-
-
-@dataclass
-class FaithfulnessResult:
- """Result of faithfulness evaluation."""
- score: float # 0-1 score
- total_claims: int
- supported_claims: int
- unsupported_claims: List[str]
-
-
-class FaithfulnessScorer:
- """
- Evaluates how faithful (grounded) an LLM answer is to the context.
-
- Process:
- 1. Extract factual claims from the answer
- 2. Check each claim against the retrieved context
- 3. Calculate percentage of supported claims
-
- High faithfulness = answer is well-grounded, low hallucination risk
- """
-
- def __init__(self, groq_client=None):
- """
- Initialize scorer.
-
- Args:
- groq_client: Groq client for LLM calls
- """
- self._client = groq_client
-
- @property
- def client(self):
- """Lazy load Groq client."""
- if self._client is None:
- from utils.groq_client import get_groq_client
- self._client = get_groq_client()
- return self._client
-
- def score(self, answer: str, context: str) -> FaithfulnessResult:
- """
- Score how well answer is grounded in context.
-
- Args:
- answer: LLM generated answer
- context: Retrieved context used to generate answer
-
- Returns:
- FaithfulnessResult with score and details
- """
- if not answer or not context:
- return FaithfulnessResult(
- score=1.0,
- total_claims=0,
- supported_claims=0,
- unsupported_claims=[]
- )
-
- # Step 1: Extract claims from answer
- claims = self._extract_claims(answer)
-
- if not claims:
- return FaithfulnessResult(
- score=1.0,
- total_claims=0,
- supported_claims=0,
- unsupported_claims=[]
- )
-
- # Step 2: Check each claim against context
- supported = 0
- unsupported = []
-
- for claim in claims:
- if self._is_supported(claim, context):
- supported += 1
- else:
- unsupported.append(claim)
-
- # Step 3: Calculate score
- score = supported / len(claims)
-
- logger.info(f"Faithfulness: {supported}/{len(claims)} claims supported ({score*100:.0f}%)")
-
- return FaithfulnessResult(
- score=round(score, 3),
- total_claims=len(claims),
- supported_claims=supported,
- unsupported_claims=unsupported[:5] # Limit to 5 for display
- )
-
- def _extract_claims(self, answer: str) -> List[str]:
- """
- Extract factual claims from the answer.
-
- Uses LLM to identify distinct factual statements.
- """
- try:
- prompt = f"""Extract individual factual claims from this answer.
-A claim is a specific statement that can be verified as true or false.
-Return ONLY a JSON array of strings, no explanation.
-
-Answer: "{answer[:2000]}"
-
-Example output: ["Claim 1", "Claim 2", "Claim 3"]"""
-
- response = self.client.analyze_with_system_prompt(
- system_prompt="You extract factual claims. Return only valid JSON array.",
- user_message=prompt,
- model="fast",
- json_mode=True
- )
-
- # Parse response
- claims = json.loads(response)
-
- # Handle both list and dict responses
- if isinstance(claims, list):
- return [str(c) for c in claims if c]
- elif isinstance(claims, dict):
- return [str(c) for c in claims.get("claims", claims.get("statements", [])) if c]
-
- return []
-
- except json.JSONDecodeError as e:
- logger.warning(f"Failed to parse claims JSON: {e}")
- # Fallback: split by sentences
- return self._fallback_extract_claims(answer)
- except Exception as e:
- logger.warning(f"Claim extraction failed: {e}")
- return self._fallback_extract_claims(answer)
-
- def _fallback_extract_claims(self, answer: str) -> List[str]:
- """Fallback claim extraction by splitting sentences."""
- import re
- sentences = re.split(r'(?<=[.!?])\s+', answer)
- # Filter to substantive sentences
- return [s.strip() for s in sentences if len(s.strip()) > 20][:10]
-
- def _is_supported(self, claim: str, context: str) -> bool:
- """
- Check if a claim is supported by the context.
-
- Uses LLM to evaluate if the context contains evidence for the claim.
- """
- try:
- prompt = f"""Is this claim supported by the context? Answer only YES or NO.
-
-Claim: "{claim}"
-
-Context (first 4000 chars):
-"{context[:4000]}"
-
-Answer YES if the context contains information that supports this claim.
-Answer NO if the claim cannot be verified from the context or contradicts it."""
-
- response = self.client.analyze_with_system_prompt(
- system_prompt="You verify claims. Answer only YES or NO.",
- user_message=prompt,
- model="fast"
- )
-
- return "YES" in response.upper()
-
- except Exception as e:
- logger.warning(f"Support check failed: {e}")
- # Optimistic fallback - assume supported if check fails
- return True
-
- def quick_score(self, answer: str, context: str) -> float:
- """
- Quick faithfulness estimate without LLM calls.
- Uses text overlap as a proxy for grounding.
-
- Args:
- answer: LLM answer
- context: Retrieved context
-
- Returns:
- Estimated faithfulness score (0-1)
- """
- if not answer or not context:
- return 0.5
-
- # Get significant words from answer
- answer_words = set(w.lower() for w in answer.split() if len(w) > 4)
- context_lower = context.lower()
-
- if not answer_words:
- return 0.5
-
- # Check how many answer words appear in context
- found = sum(1 for w in answer_words if w in context_lower)
- overlap = found / len(answer_words)
-
- # Scale to reasonable range
- return min(1.0, overlap * 1.5)
-
-
-def create_faithfulness_scorer() -> FaithfulnessScorer:
- """Factory function to create FaithfulnessScorer."""
- return FaithfulnessScorer()
-
-
-class DebertaNLIScorer:
- """
- Primary faithfulness verifier per Section III-C.
-
- Uses cross-encoder/nli-deberta-v3-large (DeBERTa-v3-large fine-tuned on MNLI)
- to break the circular LLM-judges-LLM evaluation pattern.
-
- Implements:
- - Eq. 6: per-claim, per-document max entailment probability
- - Eq. 7: faithfulness score = fraction of claims exceeding TAU_ENT
-
- score() receives individual retrieved chunk texts (NOT concatenated), so the
- per-document max in Eq. 6 is meaningful.
- """
-
- TAU_ENT = 0.7 # Entailment probability threshold (Eq. 7)
-
- def __init__(self):
- self._model = None
- self._entailment_idx: int = 1 # Verified at load time from id2label
-
- @property
- def model(self):
- """Lazy-load CrossEncoder to avoid slow startup when not needed."""
- if self._model is None:
- from sentence_transformers import CrossEncoder
- logger.info("Loading cross-encoder/nli-deberta-v3-large for faithfulness scoring...")
- self._model = CrossEncoder("cross-encoder/nli-deberta-v3-large")
-
- # CRITICAL: verify the actual label order from the model's config,
- # NLI checkpoints do NOT always use the same label ordering.
- # Do not hardcode entailment_idx=1 without confirming here.
- try:
- id2label = self._model.model.config.id2label
- logger.info(f"DeBERTa NLI id2label: {id2label}")
- # Find the index whose label contains 'entail' (case-insensitive)
- for idx, label in id2label.items():
- if "entail" in label.lower():
- self._entailment_idx = int(idx)
- break
- logger.info(
- f"DeBERTa-v3 NLI loaded. "
- f"Confirmed entailment_idx={self._entailment_idx} "
- f"(label='{id2label.get(self._entailment_idx, 'unknown')}')"
- )
- except Exception as e:
- logger.warning(
- f"Could not read id2label from DeBERTa config ({e}). "
- f"Defaulting entailment_idx=1. Verify this is correct for this checkpoint."
- )
- return self._model
-
- def score(self, answer: str, context_documents: List[str]) -> FaithfulnessResult:
- """
- Score faithfulness of an answer against a list of individual retrieved chunks.
-
- Args:
- answer: LLM-generated answer text.
- context_documents: List of individual chunk texts (NOT concatenated).
- Per-document max in Eq. 6 requires individual documents.
-
- Returns:
- FaithfulnessResult with per-sentence entailment-based score.
- """
- import re
- import numpy as np
-
- if not answer or not context_documents:
- return FaithfulnessResult(
- score=1.0, total_claims=0, supported_claims=0, unsupported_claims=[]
- )
-
- # Split answer into sentences (Eq. 6 operates per-claim / per-sentence)
- sentences = [
- s.strip()
- for s in re.split(r'(?<=[.!?])\s+', answer)
- if len(s.strip()) > 15
- ][:10] # cap at 10 sentences for latency
-
- if not sentences:
- return FaithfulnessResult(
- score=1.0, total_claims=0, supported_claims=0, unsupported_claims=[]
- )
-
- supported = 0
- unsupported_sentences = []
-
- try:
- for sentence in sentences:
- # Build (premise=doc, hypothesis=sentence) pairs for all docs
- pairs = [(doc[:2000], sentence) for doc in context_documents]
-
- # predict() returns raw logits shape: (n_docs, n_labels)
- raw_scores = self.model.predict(pairs)
-
- # Apply softmax to get probabilities
- probs = self._softmax(raw_scores)
-
- # Eq. 6: max entailment probability across all retrieved documents
- max_entailment = float(np.max(probs[:, self._entailment_idx]))
-
- if max_entailment > self.TAU_ENT:
- supported += 1
- else:
- unsupported_sentences.append(sentence)
-
- except Exception as e:
- logger.error(f"DebertaNLIScorer inference failed: {e}")
- return FaithfulnessResult(
- score=0.5,
- total_claims=len(sentences),
- supported_claims=0,
- unsupported_claims=sentences[:5],
- )
-
- # Eq. 7: faithfulness = fraction of supported claims
- score = supported / len(sentences)
- logger.info(
- f"DeBERTa NLI Faithfulness: {supported}/{len(sentences)} sentences "
- f"supported (score={score:.3f}, TAU_ENT={self.TAU_ENT})"
- )
-
- return FaithfulnessResult(
- score=round(score, 3),
- total_claims=len(sentences),
- supported_claims=supported,
- unsupported_claims=unsupported_sentences[:5],
- )
-
- @staticmethod
- def _softmax(x):
- """Numerically stable softmax over last axis."""
- import numpy as np
- e_x = np.exp(x - np.max(x, axis=-1, keepdims=True))
- return e_x / e_x.sum(axis=-1, keepdims=True)
-
-
-class FActScoreCompat:
- """
- Simulates the FActScore (Min et al., ACL 2023) evaluation.
- Breaks answer into atomic facts, verifies each fact against context independently.
- This acts as a wrapper around FaithfulnessScorer to explicitly mark it for FActScore baseline comparisons.
- """
- def __init__(self, groq_client=None):
- self._scorer = FaithfulnessScorer(groq_client=groq_client)
-
- def score(self, answer: str, context: str) -> FaithfulnessResult:
- result = self._scorer.score(answer, context)
- logger.info(f"FActScore: {result.score * 100:.1f}% ({result.supported_claims}/{result.total_claims} facts)")
- return result
-
+"""
+MEXAR - Faithfulness Scoring Module
+Measures how well the LLM answer is grounded in the retrieved context.
+"""
+import json
+import logging
+from typing import List, Dict
+from dataclasses import dataclass
+
+logger = logging.getLogger(__name__)
+
+
+@dataclass
+class FaithfulnessResult:
+ """Result of faithfulness evaluation."""
+ score: float # 0-1 score
+ total_claims: int
+ supported_claims: int
+ unsupported_claims: List[str]
+
+
+class FaithfulnessScorer:
+ """
+ Evaluates how faithful (grounded) an LLM answer is to the context.
+
+ Process:
+ 1. Extract factual claims from the answer
+ 2. Check each claim against the retrieved context
+ 3. Calculate percentage of supported claims
+
+ High faithfulness = answer is well-grounded, low hallucination risk
+ """
+
+ def __init__(self, groq_client=None):
+ """
+ Initialize scorer.
+
+ Args:
+ groq_client: Groq client for LLM calls
+ """
+ self._client = groq_client
+
+ @property
+ def client(self):
+ """Lazy load Groq client."""
+ if self._client is None:
+ from utils.groq_client import get_groq_client
+ self._client = get_groq_client()
+ return self._client
+
+ def score(self, answer: str, context: str) -> FaithfulnessResult:
+ """
+ Score how well answer is grounded in context.
+
+ Args:
+ answer: LLM generated answer
+ context: Retrieved context used to generate answer
+
+ Returns:
+ FaithfulnessResult with score and details
+ """
+ if not answer or not context:
+ return FaithfulnessResult(
+ score=1.0,
+ total_claims=0,
+ supported_claims=0,
+ unsupported_claims=[]
+ )
+
+ # Step 1: Extract claims from answer
+ claims = self._extract_claims(answer)
+
+ if not claims:
+ return FaithfulnessResult(
+ score=1.0,
+ total_claims=0,
+ supported_claims=0,
+ unsupported_claims=[]
+ )
+
+ # Step 2: Check each claim against context
+ supported = 0
+ unsupported = []
+
+ for claim in claims:
+ if self._is_supported(claim, context):
+ supported += 1
+ else:
+ unsupported.append(claim)
+
+ # Step 3: Calculate score
+ score = supported / len(claims)
+
+ logger.info(f"Faithfulness: {supported}/{len(claims)} claims supported ({score*100:.0f}%)")
+
+ return FaithfulnessResult(
+ score=round(score, 3),
+ total_claims=len(claims),
+ supported_claims=supported,
+ unsupported_claims=unsupported[:5] # Limit to 5 for display
+ )
+
+ def _extract_claims(self, answer: str) -> List[str]:
+ """
+ Extract factual claims from the answer.
+
+ Uses LLM to identify distinct factual statements.
+ """
+ try:
+ prompt = f"""Extract individual factual claims from this answer.
+A claim is a specific statement that can be verified as true or false.
+Return ONLY a JSON array of strings, no explanation.
+
+Answer: "{answer[:2000]}"
+
+Example output: ["Claim 1", "Claim 2", "Claim 3"]"""
+
+ response = self.client.analyze_with_system_prompt(
+ system_prompt="You extract factual claims. Return only valid JSON array.",
+ user_message=prompt,
+ model="fast",
+ json_mode=True
+ )
+
+ # Parse response
+ claims = json.loads(response)
+
+ # Handle both list and dict responses
+ if isinstance(claims, list):
+ return [str(c) for c in claims if c]
+ elif isinstance(claims, dict):
+ return [str(c) for c in claims.get("claims", claims.get("statements", [])) if c]
+
+ return []
+
+ except json.JSONDecodeError as e:
+ logger.warning(f"Failed to parse claims JSON: {e}")
+ # Fallback: split by sentences
+ return self._fallback_extract_claims(answer)
+ except Exception as e:
+ logger.warning(f"Claim extraction failed: {e}")
+ return self._fallback_extract_claims(answer)
+
+ def _fallback_extract_claims(self, answer: str) -> List[str]:
+ """Fallback claim extraction by splitting sentences."""
+ import re
+ sentences = re.split(r'(?<=[.!?])\s+', answer)
+ # Filter to substantive sentences
+ return [s.strip() for s in sentences if len(s.strip()) > 20][:10]
+
+ def _is_supported(self, claim: str, context: str) -> bool:
+ """
+ Check if a claim is supported by the context.
+
+ Uses LLM to evaluate if the context contains evidence for the claim.
+ """
+ try:
+ prompt = f"""Is this claim supported by the context? Answer only YES or NO.
+
+Claim: "{claim}"
+
+Context (first 4000 chars):
+"{context[:4000]}"
+
+Answer YES if the context contains information that supports this claim.
+Answer NO if the claim cannot be verified from the context or contradicts it."""
+
+ response = self.client.analyze_with_system_prompt(
+ system_prompt="You verify claims. Answer only YES or NO.",
+ user_message=prompt,
+ model="fast"
+ )
+
+ return "YES" in response.upper()
+
+ except Exception as e:
+ logger.warning(f"Support check failed: {e}")
+ # Optimistic fallback - assume supported if check fails
+ return True
+
+ def quick_score(self, answer: str, context: str) -> float:
+ """
+ Quick faithfulness estimate without LLM calls.
+ Uses text overlap as a proxy for grounding.
+
+ Args:
+ answer: LLM answer
+ context: Retrieved context
+
+ Returns:
+ Estimated faithfulness score (0-1)
+ """
+ if not answer or not context:
+ return 0.5
+
+ # Get significant words from answer
+ answer_words = set(w.lower() for w in answer.split() if len(w) > 4)
+ context_lower = context.lower()
+
+ if not answer_words:
+ return 0.5
+
+ # Check how many answer words appear in context
+ found = sum(1 for w in answer_words if w in context_lower)
+ overlap = found / len(answer_words)
+
+ # Scale to reasonable range
+ return min(1.0, overlap * 1.5)
+
+
+def create_faithfulness_scorer() -> FaithfulnessScorer:
+ """Factory function to create FaithfulnessScorer."""
+ return FaithfulnessScorer()
+
+
+class DebertaNLIScorer:
+ """
+ Primary faithfulness verifier per Section III-C.
+
+ Uses cross-encoder/nli-deberta-v3-large (DeBERTa-v3-large fine-tuned on MNLI)
+ to break the circular LLM-judges-LLM evaluation pattern.
+
+ Implements:
+ - Eq. 6: per-claim, per-document max entailment probability
+ - Eq. 7: faithfulness score = fraction of claims exceeding TAU_ENT
+
+ score() receives individual retrieved chunk texts (NOT concatenated), so the
+ per-document max in Eq. 6 is meaningful.
+ """
+
+ TAU_ENT = 0.7 # Entailment probability threshold (Eq. 7)
+
+ def __init__(self):
+ self._model = None
+ self._entailment_idx: int = 1 # Verified at load time from id2label
+
+ @property
+ def model(self):
+ """Lazy-load CrossEncoder to avoid slow startup when not needed."""
+ if self._model is None:
+ from sentence_transformers import CrossEncoder
+ logger.info("Loading cross-encoder/nli-deberta-v3-large for faithfulness scoring...")
+ self._model = CrossEncoder("cross-encoder/nli-deberta-v3-large")
+
+ # CRITICAL: verify the actual label order from the model's config,
+ # NLI checkpoints do NOT always use the same label ordering.
+ # Do not hardcode entailment_idx=1 without confirming here.
+ try:
+ id2label = self._model.model.config.id2label
+ logger.info(f"DeBERTa NLI id2label: {id2label}")
+ # Find the index whose label contains 'entail' (case-insensitive)
+ for idx, label in id2label.items():
+ if "entail" in label.lower():
+ self._entailment_idx = int(idx)
+ break
+ logger.info(
+ f"DeBERTa-v3 NLI loaded. "
+ f"Confirmed entailment_idx={self._entailment_idx} "
+ f"(label='{id2label.get(self._entailment_idx, 'unknown')}')"
+ )
+ except Exception as e:
+ logger.warning(
+ f"Could not read id2label from DeBERTa config ({e}). "
+ f"Defaulting entailment_idx=1. Verify this is correct for this checkpoint."
+ )
+ return self._model
+
+ def score(self, answer: str, context_documents: List[str]) -> FaithfulnessResult:
+ """
+ Score faithfulness of an answer against a list of individual retrieved chunks.
+
+ Args:
+ answer: LLM-generated answer text.
+ context_documents: List of individual chunk texts (NOT concatenated).
+ Per-document max in Eq. 6 requires individual documents.
+
+ Returns:
+ FaithfulnessResult with per-sentence entailment-based score.
+ """
+ import re
+ import numpy as np
+
+ if not answer or not context_documents:
+ return FaithfulnessResult(
+ score=1.0, total_claims=0, supported_claims=0, unsupported_claims=[]
+ )
+
+ # Split answer into sentences (Eq. 6 operates per-claim / per-sentence)
+ sentences = [
+ s.strip()
+ for s in re.split(r'(?<=[.!?])\s+', answer)
+ if len(s.strip()) > 15
+ ][:3] # cap at top 3 key sentences for fast CPU NLI verification
+
+ if not sentences:
+ return FaithfulnessResult(
+ score=1.0, total_claims=0, supported_claims=0, unsupported_claims=[]
+ )
+
+ supported = 0
+ unsupported_sentences = []
+
+ try:
+ # Limit context documents to top 3 retrieved chunks
+ top_docs = context_documents[:3]
+
+ # Batch all (doc, sentence) pairs across sentences into a single predict call
+ all_pairs = []
+ for sentence in sentences:
+ for doc in top_docs:
+ all_pairs.append((doc[:400], sentence[:200]))
+
+ import torch
+ with torch.inference_mode():
+ raw_scores = self.model.predict(all_pairs, batch_size=32)
+ probs = self._softmax(raw_scores)
+
+ n_docs = len(top_docs)
+ probs = probs.reshape(len(sentences), n_docs, -1)
+
+ for i, sentence in enumerate(sentences):
+ # Eq. 6: max entailment probability across all retrieved documents
+ max_entailment = float(np.max(probs[i, :, self._entailment_idx]))
+
+ if max_entailment > self.TAU_ENT:
+ supported += 1
+ else:
+ unsupported_sentences.append(sentence)
+
+ except Exception as e:
+ logger.error(f"DebertaNLIScorer inference failed: {e}")
+ return FaithfulnessResult(
+ score=0.5,
+ total_claims=len(sentences),
+ supported_claims=0,
+ unsupported_claims=sentences[:5],
+ )
+
+ # Eq. 7: faithfulness = fraction of supported claims
+ score = supported / len(sentences)
+ logger.info(
+ f"DeBERTa NLI Faithfulness: {supported}/{len(sentences)} sentences "
+ f"supported (score={score:.3f}, TAU_ENT={self.TAU_ENT})"
+ )
+
+ return FaithfulnessResult(
+ score=round(score, 3),
+ total_claims=len(sentences),
+ supported_claims=supported,
+ unsupported_claims=unsupported_sentences[:5],
+ )
+
+ @staticmethod
+ def _softmax(x):
+ """Numerically stable softmax over last axis."""
+ import numpy as np
+ e_x = np.exp(x - np.max(x, axis=-1, keepdims=True))
+ return e_x / e_x.sum(axis=-1, keepdims=True)
+
+
+class FActScoreCompat:
+ """
+ Simulates the FActScore (Min et al., ACL 2023) evaluation.
+ Breaks answer into atomic facts, verifies each fact against context independently.
+ This acts as a wrapper around FaithfulnessScorer to explicitly mark it for FActScore baseline comparisons.
+ """
+ def __init__(self, groq_client=None):
+ self._scorer = FaithfulnessScorer(groq_client=groq_client)
+
+ def score(self, answer: str, context: str) -> FaithfulnessResult:
+ result = self._scorer.score(answer, context)
+ logger.info(f"FActScore: {result.score * 100:.1f}% ({result.supported_claims}/{result.total_claims} facts)")
+ return result
+
diff --git a/backend/utils/groq_client.py b/backend/utils/groq_client.py
index ab5ad7ffc6e9c66b5b0e119cb4707df451a7657d..24ca1c67ccad07da75b756ca2d5cd10af021086a 100644
--- a/backend/utils/groq_client.py
+++ b/backend/utils/groq_client.py
@@ -1,308 +1,327 @@
-"""
-MEXAR Core Engine - Groq API Client Wrapper
-Provides a unified interface for all Groq API interactions.
-"""
-
-import os
-import base64
-from typing import Optional, List, Dict, Any
-from groq import Groq
-from dotenv import load_dotenv
-
-# Load environment variables (.env) from root/backend
-load_dotenv()
-
-
-class GroqClient:
- """
- Unified Groq API client for MEXAR.
- Handles LLM, Whisper (audio), and Vision (image) capabilities.
- """
-
- def __init__(self, api_key: Optional[str] = None):
- """
- Initialize Groq client with API key.
-
- Args:
- api_key: Groq API key. If not provided, reads from GROQ_API_KEY env var.
- """
- self.api_key = api_key or os.getenv("GROQ_API_KEY")
- if not self.api_key:
- raise ValueError("GROQ_API_KEY not found in environment variables")
-
- self.client = Groq(api_key=self.api_key)
-
- from core.config import settings
-
- # Model configurations based on LLM_BACKBONE and environment settings
- backbone = getattr(settings, "LLM_BACKBONE", "openai/gpt-oss-120b").lower()
- active_model = getattr(settings, "GROQ_MODEL", os.getenv("GROQ_MODEL", "openai/gpt-oss-120b"))
-
- if backbone == "mixtral":
- self.models = {
- "chat": "mixtral-8x7b-32768",
- "advanced": "mixtral-8x7b-32768",
- "fast": "mixtral-8x7b-32768",
- "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
- "whisper": "whisper-large-v3"
- }
- elif backbone == "gemma":
- self.models = {
- "chat": "gemma2-9b-it",
- "advanced": "gemma2-9b-it",
- "fast": "gemma2-9b-it",
- "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
- "whisper": "whisper-large-v3"
- }
- elif backbone == "llama3":
- self.models = {
- "chat": "llama-3.1-8b-instant",
- "advanced": "llama-3.3-70b-versatile",
- "fast": "llama-3.1-8b-instant",
- "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
- "whisper": "whisper-large-v3"
- }
- else:
- self.models = {
- "chat": active_model, # Primary LLM (openai/gpt-oss-120b)
- "advanced": active_model, # Advanced reasoning
- "fast": active_model, # Fast responses
- "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
- "whisper": "whisper-large-v3"
- }
-
- def chat_completion(
- self,
- messages: List[Dict[str, str]],
- model: str = "chat",
- temperature: float = 0.7,
- max_tokens: int = 4096,
- json_mode: bool = False
- ) -> str:
- """
- Send a chat completion request.
-
- Args:
- messages: List of message dicts with 'role' and 'content'
- model: Model key from self.models
- temperature: Sampling temperature (0-2)
- max_tokens: Maximum tokens in response
- json_mode: If True, force JSON output
-
- Returns:
- Generated text response
- """
- model_name = self.models.get(model, model)
-
- kwargs = {
- "model": model_name,
- "messages": messages,
- "temperature": temperature,
- "max_tokens": max_tokens
- }
-
- if json_mode:
- kwargs["response_format"] = {"type": "json_object"}
-
- response = self.client.chat.completions.create(**kwargs)
- return response.choices[0].message.content
-
- def analyze_with_system_prompt(
- self,
- system_prompt: str,
- user_message: str,
- model: str = "chat",
- json_mode: bool = False
- ) -> str:
- """
- Convenience method for system + user message pattern.
-
- Args:
- system_prompt: System instructions
- user_message: User query
- model: Model to use
- json_mode: If True, force JSON output
-
- Returns:
- Generated response
- """
- messages = [
- {"role": "system", "content": system_prompt},
- {"role": "user", "content": user_message}
- ]
- return self.chat_completion(messages, model=model, json_mode=json_mode)
-
- def transcribe_audio(self, audio_path: str, language: str = "en") -> str:
- """
- Transcribe audio file using Whisper via direct HTTP request.
-
- Args:
- audio_path: Path to audio file
- language: Language code (e.g., 'en', 'es')
-
- Returns:
- Transcribed text
- """
- import requests
- from pathlib import Path
-
- url = "https://api.groq.com/openai/v1/audio/transcriptions"
-
- headers = {
- "Authorization": f"Bearer {self.api_key}"
- }
-
- audio_file_path = Path(audio_path)
-
- # Determine the correct mime type
- ext = audio_file_path.suffix.lower()
- mime_types = {
- ".mp3": "audio/mpeg",
- ".wav": "audio/wav",
- ".m4a": "audio/mp4",
- ".ogg": "audio/ogg",
- ".flac": "audio/flac",
- ".webm": "audio/webm"
- }
- mime_type = mime_types.get(ext, "audio/mpeg")
-
- with open(audio_path, "rb") as audio_file:
- files = {
- "file": (audio_file_path.name, audio_file, mime_type)
- }
- data = {
- "model": "whisper-large-v3-turbo",
- "language": language
- }
-
- response = requests.post(url, headers=headers, files=files, data=data, timeout=60)
-
- if response.status_code == 200:
- result = response.json()
- return result.get("text", "")
- else:
- raise Exception(f"Groq Whisper API error: {response.status_code} - {response.text}")
-
- def describe_image(
- self,
- image_path: str,
- prompt: str = "Describe this image in detail.",
- max_tokens: int = 1024
- ) -> str:
- """
- Describe an image using Vision model.
-
- Args:
- image_path: Path to image file
- prompt: Question about the image
- max_tokens: Maximum response tokens
-
- Returns:
- Image description
- """
- import logging
- logger = logging.getLogger(__name__)
-
- logger.info(f"[GROQ VISION] Starting image analysis for: {image_path}")
- logger.info(f"[GROQ VISION] Prompt: {prompt[:100]}...")
-
- # Verify file exists
- if not os.path.exists(image_path):
- raise FileNotFoundError(f"Image file does not exist: {image_path}")
-
- # Get file size
- file_size = os.path.getsize(image_path)
- logger.info(f"[GROQ VISION] Image file size: {file_size} bytes")
-
- # Read and encode image
- with open(image_path, "rb") as img_file:
- image_bytes = img_file.read()
- image_data = base64.b64encode(image_bytes).decode("utf-8")
-
- logger.info(f"[GROQ VISION] Image encoded to base64, length: {len(image_data)} chars")
-
- # Detect image type from extension
- ext = os.path.splitext(image_path)[1].lower()
- mime_types = {
- ".jpg": "image/jpeg",
- ".jpeg": "image/jpeg",
- ".png": "image/png",
- ".gif": "image/gif",
- ".webp": "image/webp"
- }
- mime_type = mime_types.get(ext, "image/jpeg")
- logger.info(f"[GROQ VISION] Detected MIME type: {mime_type}")
-
- messages = [
- {
- "role": "user",
- "content": [
- {"type": "text", "text": prompt},
- {
- "type": "image_url",
- "image_url": {
- "url": f"data:{mime_type};base64,{image_data}"
- }
- }
- ]
- }
- ]
-
- logger.info(f"[GROQ VISION] Calling Groq API with model: {self.models['vision']}")
-
- try:
- response = self.client.chat.completions.create(
- model=self.models["vision"],
- messages=messages,
- max_tokens=max_tokens,
- temperature=0.7
- )
-
- result = response.choices[0].message.content
- logger.info(f"[GROQ VISION] Success! Response length: {len(result)} chars")
- logger.info(f"[GROQ VISION] Response preview: {result[:200]}...")
-
- return result
-
- except Exception as e:
- logger.error(f"[GROQ VISION] API call failed: {type(e).__name__}: {str(e)}")
- raise
-
- def extract_json(self, text: str, schema_description: str) -> Dict[str, Any]:
- """
- Extract structured JSON from text.
-
- Args:
- text: Input text to analyze
- schema_description: Description of expected JSON structure
-
- Returns:
- Parsed JSON dictionary
- """
- import json
-
- system_prompt = f"""You are a JSON extraction assistant.
-Extract structured data from the given text and return ONLY valid JSON.
-Expected structure: {schema_description}
-Do not include any explanation, only the JSON object."""
-
- response = self.analyze_with_system_prompt(
- system_prompt=system_prompt,
- user_message=text,
- model="fast",
- json_mode=True
- )
-
- return json.loads(response)
-
-
-# Singleton instance for easy importing
-_client_instance: Optional[GroqClient] = None
-
-
-def get_groq_client() -> GroqClient:
- """Get or create the singleton Groq client instance."""
- global _client_instance
- if _client_instance is None:
- _client_instance = GroqClient()
- return _client_instance
+"""
+MEXAR Core Engine - Groq API Client Wrapper
+Provides a unified interface for all Groq API interactions.
+"""
+
+import os
+import base64
+from typing import Optional, List, Dict, Any
+from groq import Groq
+from dotenv import load_dotenv
+
+# Load environment variables (.env) from root/backend
+load_dotenv()
+
+
+class GroqClient:
+ """
+ Unified Groq API client for MEXAR.
+ Handles LLM, Whisper (audio), and Vision (image) capabilities.
+ """
+
+ def __init__(self, api_key: Optional[str] = None):
+ """
+ Initialize Groq client with API key.
+
+ Args:
+ api_key: Groq API key. If not provided, reads from GROQ_API_KEY env var.
+ """
+ self.api_key = api_key or os.getenv("GROQ_API_KEY")
+ if not self.api_key:
+ raise ValueError("GROQ_API_KEY not found in environment variables")
+
+ self.client = Groq(api_key=self.api_key)
+
+ from core.config import settings
+
+ # Model configurations based on LLM_BACKBONE and environment settings
+ backbone = getattr(settings, "LLM_BACKBONE", "openai/gpt-oss-120b").lower()
+ active_model = getattr(settings, "GROQ_MODEL", os.getenv("GROQ_MODEL", "openai/gpt-oss-120b"))
+
+ if backbone == "mixtral":
+ self.models = {
+ "chat": "mixtral-8x7b-32768",
+ "advanced": "mixtral-8x7b-32768",
+ "fast": "mixtral-8x7b-32768",
+ "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
+ "whisper": "whisper-large-v3"
+ }
+ elif backbone == "gemma":
+ self.models = {
+ "chat": "gemma2-9b-it",
+ "advanced": "gemma2-9b-it",
+ "fast": "gemma2-9b-it",
+ "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
+ "whisper": "whisper-large-v3"
+ }
+ elif backbone == "llama3":
+ self.models = {
+ "chat": "llama-3.1-8b-instant",
+ "advanced": "llama-3.3-70b-versatile",
+ "fast": "llama-3.1-8b-instant",
+ "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
+ "whisper": "whisper-large-v3"
+ }
+ else:
+ self.models = {
+ "chat": active_model, # Primary LLM (openai/gpt-oss-120b)
+ "advanced": active_model, # Advanced reasoning
+ "fast": active_model, # Fast responses
+ "vision": "meta-llama/llama-4-scout-17b-16e-instruct",
+ "whisper": "whisper-large-v3"
+ }
+
+ def chat_completion(
+ self,
+ messages: List[Dict[str, str]],
+ model: str = "chat",
+ temperature: float = 0.7,
+ max_tokens: int = 4096,
+ json_mode: bool = False
+ ) -> str:
+ """
+ Send a chat completion request.
+
+ Args:
+ messages: List of message dicts with 'role' and 'content'
+ model: Model key from self.models
+ temperature: Sampling temperature (0-2)
+ max_tokens: Maximum tokens in response
+ json_mode: If True, force JSON output
+
+ Returns:
+ Generated text response
+ """
+ model_name = self.models.get(model, model)
+
+ kwargs = {
+ "model": model_name,
+ "messages": messages,
+ "temperature": temperature,
+ "max_tokens": max_tokens
+ }
+
+ if json_mode:
+ kwargs["response_format"] = {"type": "json_object"}
+
+ fallback_candidates = ["llama-3.3-70b-versatile", "llama-3.1-8b-instant", "mixtral-8x7b-32768", "gemma2-9b-it"]
+ try:
+ response = self.client.chat.completions.create(**kwargs)
+ return response.choices[0].message.content
+ except Exception as e:
+ err_str = str(e).lower()
+ if any(k in err_str for k in ["rate limit", "429", "decommissioned", "400", "quota", "tpd"]):
+ import logging
+ import time
+ for fallback in fallback_candidates:
+ if fallback == kwargs.get("model"):
+ continue
+ try:
+ logging.getLogger(__name__).warning(f"Groq API error on model '{kwargs['model']}': {e}. Falling back to '{fallback}'...")
+ kwargs["model"] = fallback
+ response = self.client.chat.completions.create(**kwargs)
+ return response.choices[0].message.content
+ except Exception as fb_err:
+ time.sleep(2)
+ continue
+ raise e
+
+ def analyze_with_system_prompt(
+ self,
+ system_prompt: str,
+ user_message: str,
+ model: str = "chat",
+ json_mode: bool = False
+ ) -> str:
+ """
+ Convenience method for system + user message pattern.
+
+ Args:
+ system_prompt: System instructions
+ user_message: User query
+ model: Model to use
+ json_mode: If True, force JSON output
+
+ Returns:
+ Generated response
+ """
+ messages = [
+ {"role": "system", "content": system_prompt},
+ {"role": "user", "content": user_message}
+ ]
+ return self.chat_completion(messages, model=model, json_mode=json_mode)
+
+ def transcribe_audio(self, audio_path: str, language: str = "en") -> str:
+ """
+ Transcribe audio file using Whisper via direct HTTP request.
+
+ Args:
+ audio_path: Path to audio file
+ language: Language code (e.g., 'en', 'es')
+
+ Returns:
+ Transcribed text
+ """
+ import requests
+ from pathlib import Path
+
+ url = "https://api.groq.com/openai/v1/audio/transcriptions"
+
+ headers = {
+ "Authorization": f"Bearer {self.api_key}"
+ }
+
+ audio_file_path = Path(audio_path)
+
+ # Determine the correct mime type
+ ext = audio_file_path.suffix.lower()
+ mime_types = {
+ ".mp3": "audio/mpeg",
+ ".wav": "audio/wav",
+ ".m4a": "audio/mp4",
+ ".ogg": "audio/ogg",
+ ".flac": "audio/flac",
+ ".webm": "audio/webm"
+ }
+ mime_type = mime_types.get(ext, "audio/mpeg")
+
+ with open(audio_path, "rb") as audio_file:
+ files = {
+ "file": (audio_file_path.name, audio_file, mime_type)
+ }
+ data = {
+ "model": "whisper-large-v3-turbo",
+ "language": language
+ }
+
+ response = requests.post(url, headers=headers, files=files, data=data, timeout=60)
+
+ if response.status_code == 200:
+ result = response.json()
+ return result.get("text", "")
+ else:
+ raise Exception(f"Groq Whisper API error: {response.status_code} - {response.text}")
+
+ def describe_image(
+ self,
+ image_path: str,
+ prompt: str = "Describe this image in detail.",
+ max_tokens: int = 1024
+ ) -> str:
+ """
+ Describe an image using Vision model.
+
+ Args:
+ image_path: Path to image file
+ prompt: Question about the image
+ max_tokens: Maximum response tokens
+
+ Returns:
+ Image description
+ """
+ import logging
+ logger = logging.getLogger(__name__)
+
+ logger.info(f"[GROQ VISION] Starting image analysis for: {image_path}")
+ logger.info(f"[GROQ VISION] Prompt: {prompt[:100]}...")
+
+ # Verify file exists
+ if not os.path.exists(image_path):
+ raise FileNotFoundError(f"Image file does not exist: {image_path}")
+
+ # Get file size
+ file_size = os.path.getsize(image_path)
+ logger.info(f"[GROQ VISION] Image file size: {file_size} bytes")
+
+ # Read and encode image
+ with open(image_path, "rb") as img_file:
+ image_bytes = img_file.read()
+ image_data = base64.b64encode(image_bytes).decode("utf-8")
+
+ logger.info(f"[GROQ VISION] Image encoded to base64, length: {len(image_data)} chars")
+
+ # Detect image type from extension
+ ext = os.path.splitext(image_path)[1].lower()
+ mime_types = {
+ ".jpg": "image/jpeg",
+ ".jpeg": "image/jpeg",
+ ".png": "image/png",
+ ".gif": "image/gif",
+ ".webp": "image/webp"
+ }
+ mime_type = mime_types.get(ext, "image/jpeg")
+ logger.info(f"[GROQ VISION] Detected MIME type: {mime_type}")
+
+ messages = [
+ {
+ "role": "user",
+ "content": [
+ {"type": "text", "text": prompt},
+ {
+ "type": "image_url",
+ "image_url": {
+ "url": f"data:{mime_type};base64,{image_data}"
+ }
+ }
+ ]
+ }
+ ]
+
+ logger.info(f"[GROQ VISION] Calling Groq API with model: {self.models['vision']}")
+
+ try:
+ response = self.client.chat.completions.create(
+ model=self.models["vision"],
+ messages=messages,
+ max_tokens=max_tokens,
+ temperature=0.7
+ )
+
+ result = response.choices[0].message.content
+ logger.info(f"[GROQ VISION] Success! Response length: {len(result)} chars")
+ logger.info(f"[GROQ VISION] Response preview: {result[:200]}...")
+
+ return result
+
+ except Exception as e:
+ logger.error(f"[GROQ VISION] API call failed: {type(e).__name__}: {str(e)}")
+ raise
+
+ def extract_json(self, text: str, schema_description: str) -> Dict[str, Any]:
+ """
+ Extract structured JSON from text.
+
+ Args:
+ text: Input text to analyze
+ schema_description: Description of expected JSON structure
+
+ Returns:
+ Parsed JSON dictionary
+ """
+ import json
+
+ system_prompt = f"""You are a JSON extraction assistant.
+Extract structured data from the given text and return ONLY valid JSON.
+Expected structure: {schema_description}
+Do not include any explanation, only the JSON object."""
+
+ response = self.analyze_with_system_prompt(
+ system_prompt=system_prompt,
+ user_message=text,
+ model="fast",
+ json_mode=True
+ )
+
+ return json.loads(response)
+
+
+# Singleton instance for easy importing
+_client_instance: Optional[GroqClient] = None
+
+
+def get_groq_client() -> GroqClient:
+ """Get or create the singleton Groq client instance."""
+ global _client_instance
+ if _client_instance is None:
+ _client_instance = GroqClient()
+ return _client_instance
diff --git a/data/agents/financial_agent/context.txt b/data/agents/financial_agent/context.txt
new file mode 100644
index 0000000000000000000000000000000000000000..01be18e5e9eac667923ebfad0fdb8cd778584d0b
--- /dev/null
+++ b/data/agents/financial_agent/context.txt
@@ -0,0 +1,1182 @@
+
+============================================================
+SOURCE: 0000320575_0000320575-20-000008.txt (TXT)
+============================================================
+
+10-K/A 1 form10-ka2019.htm 10-K/A Document UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 FORM 10-K/A Amendment No. 1 (Mark one) ý ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2019 or o TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 Commission File Number: 1-8182 PIONEER ENERGY SERVICES CORP. (Exact name of registrant as specified in its charter) _____________________________________________ TEXAS 74-2088619 (State or other jurisdiction of incorporation or organization) (I.R.S. Employer Identification Number) 1250 N.E. Loop 410, Suite 1000 San Antonio, Texas 78209 (Address of principal executive offices) (Zip Code) Registrant’s telephone number, including area code: (855) 884-0575 Securities registered pursuant to Section 12(b) of the Act Title of each class Trading Symbol(s) Name of each exchange on which registered Securities registered pursuant to Section 12(g) of the Act: Common Stock, $0.10 par value Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ¨ No þ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ¨ No þ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes þ No ¨ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes þ No ¨ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer o Accelerated filer o Non-accelerated filer þ Smaller reporting company þ Emerging growth company o If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨ Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ¨ No þ The aggregate market value of the registrant’s common stock held by non-affiliates of the registrant as of the last business day of the registrant’s most recently completed second fiscal quarter (based on the closing sales price on the New York Stock Exchange (NYSE) on June 30, 2019 ) was approximately $19.0 million . As of March 31, 2020 , there were 79,579,571 shares of common stock, par value $0.10 per share, of the registrant issued and outstanding. EXPLANATORY NOTE This Amendment No. 1 on Form 10-K/A (this "Amendment") amends the Annual Report on Form 10-K of Pioneer Energy Services Corp. ("Pioneer," "Company," "we," "us," and "our") for the year ended December 31, 2019 that was originally filed with the U.S. Securities and Exchange Commission ("SEC") on March 6, 2020 (the "Original Filing"). The purpose of this Amendment is to (i) supplement the risk factors set forth in Item 1A of Part I of the Original Filing and (ii) provide the information required by Items 10, 11, 12, 13, and 14 of Part III of the Original Filing, which information was previously omitted from the Original Filing in reliance on General Instruction G(3) to Form 10-K. The supplemental risk factors set forth in this Amendment should be read in conjunction with the other risk factors set forth in the Original Filing, and Part III of the Original Filing is hereby amended and restated in its entirety. Capitalized terms not otherwise defined in Part III of this Amendment shall have the same meanings assigned to such terms in Parts I and II of the Original Filing. In addition, as required by Rule 12b-15 under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), currently dated certifications by our principal executive officer and principal financial officer are filed as exhibits to this Amendment under Item 15 of Part IV hereof. Except as described above, this Amendment does not amend or otherwise update any other information in the Original Filing. Accordingly, this Amendment should be read in conjunction with the Original Filing and with our filings with the SEC subsequent to the Original Filing. As previously disclosed, on March 1, 2020 , Pioneer and certain of its affiliates (together with Pioneer, the "Pioneer RSA Parties"), filed voluntary petitions for reorganization under chapter 11 of title 11 of the United States Code (the "Bankruptcy Code") in the United States Bankruptcy Court for the Southern District of Texas (the "Bankruptcy Court"). The Chapter 11 proceedings are being jointly administered under the caption In re Pioneer Energy Services Corp. et al (the "Chapter 11 Cases"). For the duration of the Chapter 11 Cases, our operations and our ability to develop and execute our business plan are subject to risks and uncertainties associated with the Chapter 11 Cases as described in "Item 1A. Risk Factors" in Part I of the Original Filing and this Amendment. As a result of these risks and uncertainties, our assets, liabilities, shareholders' equity, officers and/or directors could be significantly different following the conclusion of the Chapter 11 Cases, and the description of our operations, properties, and capital plans included in the Original Filing may not accurately reflect our operations, properties, and capital plans following the Chapter 11 Cases. 1 TABLE OF CONTENTS Page PART I Item 1A. Risk Factors 3 PART III Item 10. Directors, Executive Officers and Corporate Governance 5 Item 11. Executive Compensation 10 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Shareholder Matters 20 Item 13. Certain Relationships and Related Transactions, and Director Independence 22 Item 14. Principal Accounting Fees and Services 23 PART IV Item 15. Exhibits, Financial Statement Schedules 24 Signatures 25 2 PART I ITEM 1A. RISK FACTORS Except as discussed below, there has been no material change in our risk factors as previously disclosed in Item 1A – “Risk Factors” of the Original Filing. The risk factors set forth in this Amendment should be read in conjunction with the other risk factors set forth in the Original Filing. The following two risk factors in Part I, Item 1A of the Original Filing are amended and restated in their entirety as follows: • We derive all our revenues from companies in the oil and gas exploration and production industry, a historically cyclical industry with levels of activity that are significantly affected by the levels and volatility of oil and gas prices. As a provider of contract land drilling services and oil and gas production services, our business depends on the level of exploration and production activity in the geographic markets where we operate. The oil and gas exploration and production industry is a historically cyclical industry characterized by significant changes in the levels of exploration and development activities. Oil and gas prices, and market expectations of potential changes in those prices, significantly affect the levels of those activities. Oil and gas prices have been volatile historically and, we believe, will likely continue in the future. Oil prices have experienced declines in March 2020 and could decline further. Worldwide political, economic, and military events, as well as natural disasters and pandemics (including the recent coronavirus (COVID-19) outbreak), have contributed to oil and gas price volatility historically, and are likely to continue to do so in the future. Many factors beyond our control affect oil and gas prices, including: • the worldwide supply and demand for oil and gas; • the cost of exploring for, producing and delivering oil and gas; • the discovery rate of new oil and gas reserves; • the rate of decline of existing and new oil and gas reserves; • available pipeline and other oil and gas transportation capacity; • the levels of oil and gas storage; • the ability of oil and gas exploration and production companies to raise capital; • economic conditions in the United States and elsewhere; • actions by the Organization of Petroleum Exporting Countries (OPEC) and Russia; • political instability in oil and gas producing regions; • governmental regulations, both domestic and foreign; • domestic and foreign tax policy; • weather conditions in the United States and elsewhere; • the pace adopted by foreign governments for the exploration, development and production of their national reserves, or their investments in oil and gas reserves located in other countries; and • the price of foreign imports of oil and gas. Additionally, the above factors can also be affected by technological advances affecting energy consumption and the supply and demand within the market for renewable energy resources. • Oil and natural gas prices, and market expectations of potential changes in these prices, significantly impact the level of worldwide drilling and production services activities. Oil and natural gas prices, and market expectations of potential changes in these prices, significantly impact the level of worldwide drilling and production services activities. Reduced demand for oil and natural gas generally results in lower prices for these commodities and often impacts the economics of planned drilling projects and ongoing production projects, resulting in the curtailment, reduction, delay or postponement of such projects for an indeterminate period of time. When drilling and production activity and spending declines, both dayrates and utilization historically decline as well. In late 2014, oil prices worldwide began to drop significantly and as a result, our clients significantly reduced both their operating and capital expenditures during 2015 and 2016, which adversely affected our business. In 2017 and 2018, our clients modestly increased their spending as compared to 2016 levels, and our business trended upward as a result. However, in late 2018, oil prices again began to decline and despite some improvement in early 2019, have since languished without significant improvement in 2019 and early 2020. Since January 2020, the coronavirus (COVID-19) outbreak and fear of further spread of the coronavirus have caused disruptions in international economies and international financial and oil markets, including a decline in the price of oil. The economic 3 downturn caused by the coronavirus outbreak has weakened demand for oil, and after OPEC and a group of oil producing nations led by Russia failed on March 6, 2020 to agree on oil production cuts, Saudi Arabia announced that it would cut oil prices and increase production, leading to a sharp further decline in oil trading prices. Following these developments, WTI crude oil prices fell to $20 per barrel at the end of March 2020. We cannot anticipate whether or when this dispute will be resolved and production returned to normalized levels. The coronavirus and responses of oil producers to the lower demand for oil and lower oil prices are rapidly evolving situations. Oil and gas exploration and production companies have announced reductions to previously planned capital spending programs for 2020, thereby reducing demand for our services. Sustained low or worsening oil prices could have an adverse effect on our financial condition, results of operations, and cash flow. Additionally, because our business depends on the level of spending by our clients, we are also affected by our clients’ ability to access the capital markets. After several consecutive years without significant improvement in commodity prices, many exploration and production companies have limited their spending to a level which can be supported by net operating cash flows alone, as access to the capital markets through debt or equity financings has become more challenging in our industry. This challenge has increased recently due to the major stock market and bond market indices experiencing substantial declines, with such declines intensifying, and elevated levels of volatility, in 2020. If the reduction in the overall level of exploration and development activities, whether resulting from changes in oil and gas prices or otherwise, continues or worsens, it could adversely affect us further by negatively impacting: • our revenues, cash flows and profitability; • the fair market value of our drilling and production services fleets; • our ability to maintain or increase its borrowing capacity; • our ability to obtain additional capital to finance our business or make acquisitions, and the cost of that capital; • the collectability of our receivables; • our ability to adequately maintain our equipment, or bring it back into service; and • our ability to retain skilled operations personnel. The following risk factor supplements those above and those set forth in the Original Filing. • The rapid spread of a contagious illness, including the recent spread of COVID-19, or fear of such an event, could adversely affect our business, operations, and financial condition. Our business could be adversely affected by a widespread outbreak of contagious disease, including the recent outbreak of respiratory illness caused by a novel coronavirus (COVID-19). Since January 2020, the coronavirus outbreak and fear of further spread of the coronavirus have caused significant disruptions in international economies and international financial and oil markets, including a substantial decline in the price of oil. Our customers responded to the outbreak by announcing reductions to their capital programs, resulting in a reduction in demand for our services. As the coronavirus outbreak is still evolving, much of its international and domestic impact remains unknown. The coronavirus outbreak has led to quarantines of entire countries and smaller localities, cancellation of events and travel, prohibitions on entry imposed by many countries, government-mandated and voluntary business and school shutdowns, supply chain interruptions, and overall economic and financial market instability. Further spread of the coronavirus could cause additional quarantines, reduction in business activity, labor shortages and other operational
+
+============================================================
+SOURCE: 0001041588_0001041588-20-000001.txt (TXT)
+============================================================
+
+10-K 1 accr12311910K.txt January 2nd, 2020
+
+
+
+PERIOD and DOCUMENT: 10KSB for the FULL YEAR 12/31/2019
+COMPANY CONFIRMED NAME: ACCESS-POWER, INC.
+CENTRAL INDEX KEY: 0001041588
+FORM TYPE: 10KSB
+SEC FILE NUMBER: 333-65069
+BUSINESS ADDRESS:
+STREET 1: 17164 DUNE VIEW DRIVE
+STREET 2: APT 106
+CITY: GRAND HAVEN
+STATE: MI
+ZIP: 49417
+
+
+
+Respectfully submitted to the,
+
+
+UNITED STATES SECURITIES AND EXCHANGE COMMISSION
+WASHINGTON, D.C. 20549
+The Division of Corporation Finance,
+100 F Street NE, Washington, D.C. 20549
+
+FORM 10-KSB
+
+/X/ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED
+DECEMBER 31, 2019.
+
+TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
+OF THE SECURITIES EXCHANGE ACT OF 1934
+FOR THE TRANSITION PERIOD FROM ______ TO _____
+
+
+COMMISSION FILE NUMBER: 333-65069
+
+
+ACCESS-POWER, INC.
+[Exact name of Registrant as
+specified in its charter]
+
+
+*** FLORIDA ***
+
+Domicile State or other jurisdiction of
+incorporation or organization
+http://www.sunbiz.org
+
+*** MICHIGAN ***
+
+State of Operations
+https://cofs.lara.state.mi.us/SearchApi/Search/Search
+
+
+
+59-3420985
+(I.R.S. Employer
+Identification No.)
+
+
+17164 DUNE VIEW DRIVE
+APT 106
+GRAND HAVEN, MI 49417
+
+or
+
+PO BOX 598
+Grand Haven, MI 49417
+
+(Address of principal executive offices)
+
+REGISTRANTS TELEPHONE NUMBER, INCLUDING AREA CODE: 616-312-5390
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: NONE
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT:
+COMMON STOCK, $0.001 PAR VALUE - 500,000,000 shares authorized.
+
+
+Indicate by check mark if the registrant is a well-known
+seasoned issuer, as defined in Rule 405 of the Securities
+Act. Yes No X
+
+Indicate by check mark if the registrant is not required to file
+reports pursuant to Section 13 or Section 15(d) of the Act.
+Yes No X
+
+The Company has had discussions with the SEC regarding a FRAUD
+FORM 15 that was filed by previous management in 2007. We believe
+that we have a fiduciary responsibility to report transaprent
+information to our Shareholders.
+
+We were victims of toxic death spiral debentures from 1998 to
+2008. PLEASE FORGIVE OUR PAST. The past it the past, and
+we wish to move forward with a plan to become fully
+current with the SEC. We are trying the best we can within the
+Spirit of the Law.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+Indicate by check mark whether the registrant (1) has
+filed all reports required to be filed be Section 13 or 15(d)
+of the Securities Exchange Act of 1934 during the preceding 12
+months (or for such shorter period that the registrant was
+required to file such reports), and (2) has been subject
+to such filing requirements for the past 90 days. Yes X No
+
+Indicate by check mark whether the registrant has submitted
+electronically and posted on its corporate Web site, if any,
+every Interactive Data File required to be submitted and
+posted pursuant to Rule 405 of Regulation S-T (232.405 of
+this chapter) during the preceding 12 months (or for such
+shorter period that the registrant was required to submit
+and post such files). Yes X No
+
+Indicate by check mark if disclosure of delinquent filers
+pursuant to Item 405 of Regulation S-K (Section 229.405
+of this chapter) is not contained herein, and will not be
+contained, to the best of registrants knowledge, in definitive
+proxy or information statements incorporated by reference in
+Part III of this Form 10-K or any amendment to this Form 10-K.
+
+Indicate by check mark whether the registrant is a large a
+ccelerated filer, an accelerated filer, a non-accelerated
+filer, smaller reporting company, or an emerging growth
+company. See the definitions of large accelerated filer,
+accelerated filer, smaller reporting company, and
+emerging growth company in Rule 12b-2 of the Exchange Act.
+
+Large accelerated filer NO Accelerated filer NO
+Non-accelerated filer NO (Do not check if a smaller
+reporting company)
+
+Smaller reporting company YES
+Emerging growth company YES
+
+If an emerging growth company, indicate by check mark if
+the registrant has elected not to use the extended
+transition period for complying with any new or revised
+financial accounting standards provided pursuant to
+ection 13(a) of the Exchange Act.
+
+Indicate by check mark whether the registrant is a shell
+company (as defined in Rule 12b-2 of the Exchange Act).
+Yes No X
+
+The aggregate market value of the voting common stock held by non-affils.
+of the registrant (assuming officers and directors are affiliates) was
+approximately $1,017,140.59 as of 12/3119, computed on the basis of
+the closing price on such date.
+
+As of January 2nd, 2020, there were 244,144,121 shares of the
+registrant's
+Common Stock outstanding. PATRICK J JENSEN, Director of Access-Power, Inc.
+has 131,128,500 Restricted Shares. 113,015,621 + 131,128,500 =
+244,144,121
+total shares available of Access-Power, Inc. common stock.
+
+
+*****WE ONLY HAVE COMMON STOCK*****
+
+*****WE DO NOT HAVE CONVERTIBLE NOTES or WARRANTS*****
+
+
+THE TOTAL MARKET CAPITALIZATION AS OF THE CLOSE OF BUSINESS
+January 2nd, 2020 IS 2,197,297.09 BASED ON A CLOSING PRICE OF
+$.009 PER SHARE.
+
+
+___________________________________________________________________________
+
+
+
+**** CURRENT UPDATE ****
+
+Our comeback journey continues. We are very excited about our future.
+
+We filed our first tax return in 18 years. We hired H&R Block of Muskegon
+to look over and supervise and review all of our financial bank records
+and statements for 2018 and 2019. We believe in 100% Transparency. We are
+making very good informed decisions. H&R BLOCK engagement--->
+
+This occured on November 5, 2019 - our date of engagement with HR&BLOCK
+
+In November of 2019 , we have started an application with the State of
+Michigan to obtain a MicroMarijuana business. We only plan to operate
+our futuristic plan of delivering Marijuana Plants by Drones via a
+service called Clones by Drones TM. This process could take
+2-3 years to implement. The application was started at:
+
+https://aca3.accela.com/MIMM/Login.aspx
+
+The Company believes it has the right to commence operations with a
+pending license application. ACCR has a very super cool business model
+that will defy conventional logic---> LOGISTICs are simple.
+
+We expect to get the licenses, zoning requirements, and permits
+necessary to operate our BUSINESS PLAN. WE HAVE A SALES BUSINESS PLAN.
+ACCR has a business plan that represents my DREAMs in life. I will
+not hurt my Shareholders. Everyone is welcome, and ACCR is grateful
+and thankful. We are not sellers of our common stock. PERIOD.
+
+Access-Power, Inc. has a big task ahead of itself. We have many
+obstancles to grow our 20' x 20' Master Mother Grow and Cloning Rooms. We
+would expect to be fully operational with inventory in 3 months of
+beginning construction. We do not have Clones by Drones operational yet
+to accept Visa/Martercard or Pay/Pal payments. We expect to turn on
+our eCommerce website sometime in 2020 or possibly 2021. Probably in
+2020. We believe in only MEDICAL MARIJUANA, and will not offer at the
+moment any products to people that do not possess a valid Medical
+Marijuana Card issued by any State. There are dispensaries here in
+Michigan that accept patients from out of State. We plan to
+mirror the growth's of the Dispensaries. We plan to grow around
+the dispensaries, and offer our cool and futuristic service
+by Drones. Access-Power, Inc. has in its business plan a way to
+logistically deliver in a very cost effective way.
+
+BACK to our engagement with H&R Block on November 5, 2019.
+
+We realize that this is not a PCAOB firm, PLEASE...
+however, this is all the Company can afford. Within the spirit of the
+law, we are filing these documents to report transparency to our
+Shareholders. We have spoken to the SEC regarding this requirement, and
+it is the Companies intention to hire a PCAOB firm in 2020 or in 2021.
+We have to start somewhere and again it is our goal to fully hire a PCAOB
+accountant in the year 2020 or 2021. We have communicated our 2 year
+plan with the SEC. We have a very transparent relationship
+with many divisions of FINRA. The Company has great contacts at
+OTC Markets. The Company also has a trusting relationship that is
+very open with the SEC.
+
+Access-Power, Inc. was the victim of toxic convertible death spiral
+debentures from inception through 2008. I purchased common stock
+during this time, and slowly became a 10% stock holder over the years.
+The Florida Law which allowed us to fire all previous crooked Directors
+is Chap 607.0702 of the 2012 Florida Senate Law.
+
+The Company has survived a short attack, and the Company will attempt
+to hire an attorney in 2020 to represent us.
+
+ON DECEMBER 13, 2019, ACCESS-POWER, INC. eFILED ITS FIRST STATE AND
+FEDERAL TAX RETURN IN OVER 18 YEARS. THE eFILE WAS ACCEPTED BY ALL
+PARTIES ON DECEMBER 19, 2019. ACCESS-POWER, INC. PLANS TO CONTINUE TO
+WORK WITH OUR TEMPORARY AUDITOR THROUGHOUT 2020. WE ARE STRIVING TO BE
+A VERY TRANSPARENT AND CURRENT REPORTING ENTITY. THERE ARE ONLY
+98,144,246 SHARES IN OUR PUBLIC FLOAT. THIS IS FIXED, AND THERE IS NO
+DILUTION, I REPEAT....NO DILUTION IN THE COMPANY COMMON SHARES
+THROUGHOUT 2020 AND 2021. AGAIN, THE SUPPLY OF STOCK IS FIXED.
+
+We are a micro-cap business with very struggling revenues at
+the moment, and we are developing the first eCommerce website to deliver
+Marijuana, Marijuana plants, and other Marijuana products such as Edibles
+by Drones. We are going through a rough economic business cycle.
+We applied for a Trademark SERVICE MARK on November 13, 2019.
+
+We will succeed. This may take a few years to develop. At the present
+time, I am still waiting for our Companies previously announced
+$50,000.00 donation. This may take another 6-9 months.
+
+There are many entities that do not want ACCR to comeback.
+
+As of the close of business January 1st 2020, our commomn stock
+structure is as follows:
+
+Authorized Common Stock: 500,000,000 shares
+Outstanding Common Stock: 244,144,121 shares
+Estimated Float: Substanstially less than 98,244,146 shares
+Restricted Common Stock: 145,769,975 shares
+
+https://www.otcmarkets.com/stock/ACCR/profile
+
+We have public profiles at:
+
+https://www.linkedin.com/in/patrick-j-jensen-564946b4
+https://www.twitter.com/AccessOtc
+https://www.twitter.com/AccrOtc
+https://brokercheck.finra.org/individual/summary/1952963
+
+OUR CORPORATE WEBSITEs ARE:
+
+http://www.myaccess-power.com
+http://www.clonesbydrones.com
+http://www.mycbdpets.com
+http://www.nyumarijuana.com
+
+Access-Power, Inc.'s contact is pjensen@myaccess-power.com.
+
+We applied for a Trademark for Clones By Drones TM. The service
+will be very futuristic, and will be the first of its kind.
+
+Access-Power, Inc. is in good standing and has a very good relationship
+with our Transfer Agent, Standard Transfer & Co.
+Our Transfer Agent is SEC registered, and except for one
+change in ownership in 2007, is our original transfer agent dating
+back to 1996. Our transfer agent is SEC registered and has a profile at:
+
+https://www.sec.gov/divisions/marketreg/mrtransfer.shtml
+https://www.otcmarkets.com/learn/service-providers/2433?t=6
+
+https://standardtransferco.com
+
+Standard Transfer & Co.
+440 East 400 South Suite 200, Salt Lake City, Utah 84111
+Phone (801) 571-8844 Fax: (801) 328-4058
+
+Our ticker symbol ACCR and further information may be found at:
+
+https://www.sec.gov/cgi-bin/browse-edgar?CIK=accr
+
+State the aggregate market value of the voting stock held by
+non-affiliates
+computed by reference to the price at which the stock was sold,
+or the average
+bid and asked prices of such stock as of a specified date
+within the past 60
+days: $1,130,156.21
+
+At January 1st 2020, there were issued and outstanding 244,144,121
+shares of Common Stock, and Patrick J. Jensen owns 131,128,500 shares
+or 53.7090
+percent of all the Common Stock. I am willing to give up Control and
+ a
+percentage of the Company, for an Equity Partner in our Company.
+All
+131,128,500 are currently restricted and held in book entry form at the
+Transfer Agent. I am actively looking for a MERGER DEAL.
+
+There are currently a total of 98,244,146 shares registered in our
+float.
+Management continues to believe that there is a massive short position
+in our Company stock that was accumulated from 1999 to 2008, and we
+estimate
+this short position to be massive. As Director of this Company, I
+want to
+apologize to my Shareholders for previously stating that our estimated
+float
+was between 5,000,000 and 10,000,000. Although I firmly believe the
+float
+in our Company stock is substantially lower than the official
+98,244,146 shares
+reported to OTC Markets.
+
+We care about our Shareholders dearly, and our top priority is investor
+protection. There is NO DILUTION IN THE COMMON STOCK OF ACCR.
+
+
+ PART I
+
+
+ITEM 1. DESCRIPTION OF BUSINESS
+
+Access-Power, Inc, is a for profit business looking for a
+MERGER CANDIDATE.
+We currently pay bills through a Work at Home business. Our monthly
+fixed expenses are previosuly documented in an 8K at $2,350.00. We
+operate a part time work at home business. The company subcontracts
+through a big call center, and provides sales and customer service
+to big Fortune 500 companies. In 2019, we operated via Hunter Vunter,
+our subsidiary through www.liveops.com. We ended the relationship
+with LiveOps on May 1st 2019. As a result, Hunter Venture was
+officially dissolved.
+
+The Company struggled from May 1, 2019 to October 18, 2019. We had no
+income during this period, and our operational expenses were paid for
+by myself, Patrick J. Jensen as a donation to the Company. I personally
+paid out of my own pocket all the expenses during this dark time.
+
+On October 2, 2019---> I dreamed of getting off the greys. ACCR is a
+DREAM right now...This is how builders work.
+
+On October 18, 2019, we acquired Grand Haven MM LLC, and this entity
+is our subsidiary now. This is an operating entity very similar
+to Hunter Venture. The entity is registered in the State of Michigan
+here:
+
+https://cofs.lara.state.mi.us/CorpWeb/CorpSearch/CorpSummary.aspx?
+ID=802220565
+
+Grand Haven MM now operates a part time work at home program through
+another national call center very similar and much bigger in size
+than our previour contracter. We provide work at home sales and
+customer services subcontracted on a part time basis. I am a builder.
+I am building a Clone Delivery Service for Marijuana Plants .... in
+West Michigan.
+
+The Company also operates 2 eCommerce websites at the present time.
+
+http://www.clonesbydrones.com
+http://www.mycbdpets.com
+
+We continue to strive to build up our revenues. We want to succeed
+and we will comeback to a higher reporting standard. On October 18,
+2019 we were upgraded in trading tier from the dark grey market
+to the PINK NO INFORMATION market. We have no intention of going
+back to the grey market, as the Company currently trades on an
+"unsolicited basis" in the PINK NO INFORMATION tier at OTC
+Markets. There are so many unknowns, however I have a visi
+
+============================================================
+SOURCE: 0001041588_0001041588-21-000001.txt (TXT)
+============================================================
+
+10-K 1 accr12312010k.txt January 4th, 2021
+
+
+
+
+
+This form is filled out within all the SPIRITs of the SEC Laws of '33 and '34.
+
+
+
+
+ACCESS-POWER & CO., INC.
+OTC TICKER: ACCR
+We were violent victims of toxic death spiral convertible "floorless"
+debentures from 1998 to 2008, and then through March 2012.
+
+
+PERIOD and DOCUMENT: 10KSB for the FULL YEAR 12/31/2020
+COMPANY CONFIRMED NAME: ACCESS-POWER & Co., INC.
+CENTRAL INDEX KEY: 0001041588
+FORM TYPE: 10KSB
+
+SEC FILE NUMBER: 333-65069
+
+
+
+
+
+
+BUSINESS ADDRESS:
+STREET 1: PO BOX 598
+
+CITY: GRAND HAVEN
+STATE: MI
+ZIP: 49417
+
+
+
+
+
+
+
+
+
+Respectfully submitted to the,
+
+
+UNITED STATES SECURITIES AND EXCHANGE COMMISSION
+WASHINGTON, D.C. 20549
+The Division of Corporation Finance, Section 11
+100 F Street NE, Washington, D.C. 20549
+
+
+
+
+
+
+FORM 10-K
+
+/X/ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED
+DECEMBER 31, 2020.
+
+TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
+OF THE SECURITIES EXCHANGE ACT OF 1934
+FOR THE TRANSITION PERIOD FROM ______ TO _____
+
+
+COMMISSION FILE NUMBER: 333-65069
+
+
+ACCESS-POWER & CO., INC.
+[Exact name of Registrant as
+specified in its charter]
+
+
+*** FLORIDA ***
+
+Domicile State or other jurisdiction of
+incorporation or organization
+http://www.sunbiz.org
+
+*** MICHIGAN ***
+
+State of Operations
+https://cofs.lara.state.mi.us/SearchApi/Search/Search
+
+
+
+59-3420985
+(I.R.S. Employer
+Identification No.)
+
+
+PO BOX 598
+GRAND HAVEN, MI 49417
+616-312-5390
+Email: pjensen@myaccess-power.com
+
+
+(Address of principal executive offices)
+
+REGISTRANTS TELEPHONE NUMBER, INCLUDING AREA CODE: 616-312-5390
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: NONE
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT:
+COMMON STOCK, $0.001 PAR VALUE - 300,000,000 shares authorized fully diluted.
+
+
+
+
+Indicate by check mark if the registrant is a well-known
+seasoned issuer, as defined in Rule 405 of the Securities
+Act. Yes No X
+
+Indicate by check mark if the registrant is not required to file
+reports pursuant to Section 13 or Section 15(d) of the Act.
+Yes No X
+
+
+Indicate by check mark whether the registrant (1) has
+filed all reports required to be filed be Section 13 or 15(d)
+of the Securities Exchange Act of 1934 during the preceding 12
+months (or for such shorter period that the registrant was
+required to file such reports), and (2) has been subject
+to such filing requirements for the past 90 days. Yes X No
+
+Indicate by check mark whether the registrant has submitted
+electronically and posted on its corporate Web site, if any,
+every Interactive Data File required to be submitted and
+posted pursuant to Rule 405 of Regulation S-T (232.405 of
+this chapter) during the preceding 12 months (or for such
+shorter period that the registrant was required to submit
+and post such files). Yes X No
+
+Indicate by check mark if disclosure of delinquent filers
+pursuant to Item 405 of Regulation S-K (Section 229.405
+of this chapter) is not contained herein, and will not be
+contained, to the best of registrants knowledge, in definitive
+proxy or information statements incorporated by reference in
+Part III of this Form 10-K or any amendment to this Form 10-K.
+
+Indicate by check mark whether the registrant is a large a
+ccelerated filer, an accelerated filer, a non-accelerated
+filer, smaller reporting company, or an emerging growth
+company. See the definitions of large accelerated filer,
+accelerated filer, smaller reporting company, and
+emerging growth company in Rule 12b-2 of the Exchange Act.
+
+Large accelerated filer NO Accelerated filer NO
+Non-accelerated filer NO (Do not check if a smaller
+reporting company)
+
+Smaller reporting company YES
+Emerging growth company YES
+
+If an emerging growth company, indicate by check mark if
+the registrant has elected not to use the extended
+transition period for complying with any new or revised
+financial accounting standards provided pursuant to
+ection 13(a) of the Exchange Act.
+
+Indicate by check mark whether the registrant is a shell
+company (as defined in Rule 12b-2 of the Exchange Act).
+Yes No X
+
+
+ALL COMMON SHARES REFLECT A FULLY DILUTED BASIS.
+
+
+
+State the aggregate market value of the voting stock held by
+non-affiliates computed by reference to the price at which the stock was
+sold, or the average bid and asked prices of such stock as of a
+specified date within the past 60 days:
+
+PATRICK restricted shares: 186 ,984,379 shares
+PERCENT OF SHARES HELD BY NON AFFILIATES= 37.6719%
+SHARES HELD BY EVERYONE ELSE : 113,015,621 and of this amount,
+we certify a DTCC FLOAT SINCE MARCH 1, 2012: 98,376,146 common shares
+
+
+
+The aggregate market value of the voting common stock held by non-affils.
+of the registrant (assuming officers and directors are affiliates) was
+approximately $ 395,554.67 as of 12/31/2020, computed on the fully diluted
+basis of and the closing price on such date of $.0035, and so...
+
+113,015,621 held by non-affiliates + 131,128,500 shares acquired by our
+Director plus 55,855,879 issued to our Director in 2020 = 300,000,000
+common shares verified by our SEC Registrered same Transfer Agent
+dating back to May 1997. Our Director's FORM 4 filings are found here:
+
+https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001557361
+
+
+As of December 31st, 2020, there were 300,000,000 shares of the registrant's
+Common Stock outstanding. PATRICK J JENSEN, Director of Access-Power & CO.,
+Inc. has a total of 186,984,379 Restricted Shares of these shares.
+
+
+
+
+THE TOTAL MARKET CAPITALIZATION AS OF THE CLOSE OF BUSINESS
+January 4th , 2021 is $1,050,000.00 BASED ON A CLOSING PRICE OF
+$.0035 PER SHARE on 12/31/2020, and total outstanding issued
+common stock equalling 300,000,000 shares.
+
+At January 4th , 2021, there were issued and outstanding 300,000,000
+shares of Common Stock fully diluted, and Patrick J. Jensen owns
+186,984,379 shares or 62.3281 percent of all the Common Stock.
+
+In 2020, the Company during the course of 2020 experienced a market
+capitalization HIGH of over $3,000,000.00.
+
+All 186,984,379 are currently all restricted and held in book entry form at our
+Transfer Agent.
+
+
+
+
+THE SEC COMMISSION CONFIRMED OUR FORM RW ON 12/21/2020.
+
+
+
+
+
+______________________________________________________________
+
+
+
+
+
+My Dear Shareholders, OTC Markets Directors, colleagues at FINRA, and to the
+Esteemed Commissioners of the SEC, and of course, to my Chiefs at Section 11
+at the SEC,
+
+CURRENT UPDATE...as of January 4th, 2021.
+
+Our Director is called many names on message boards...and today, in 2021 we
+bow our heads to all decision makers at OTC Markets in our quest to
+re-apply to the PINK CURRENT INFO tier status.
+This is a reapplication to occur on January 24th, 2021.
+
+
+*****WE ONLY HAVE COMMON STOCK IN OUR CAPITAL STRUCTURE****
+
+*****WE DO NOT HAVE CONVERTIBLE NOTES or WARRANTS*****
+
+****WE HAVE ZERO LONG TERM DEBT********
+
+*****ACCR DOES NOT BELIEVE IN PROMOTION*********
+
+It is very expensive to hire a PCAOB registered firm/accountant/attorneys
+for our
+micro-cap operations. However, we will succeed in capturing all of the
+requirements
+of all the SEC Rules of '33 and '34, as best as we can.
+
+We are fully aware of the FINAL RULE imposed by the SEC, by September
+21st, 2021 to require movement of all PINK NO INFORMATION
+tier companies to the grey market today called the EXPERT MARKET.
+
+We are pleading with all the Directors at OTC Markets to please be fair to our
+Company. We will re-apply with OTC Markets on January 24, 2021 to become
+PINK CURRENT INFORMATION tier again, as we once were in 2008.
+The only reason why there is a RED STOP SIGN is because of a discussed
+CRIMINAL FORM 15 filed by our previous inept managers in 2007.
+We charge our past managers naked short sold our
+shares into the ground. Their intent was to carve all the equity
+off the bone, and then to file the CRIMINAL FORM 15 in 2007
+as their criminal strategy.
+
+We provide full disclosure to our
+Market Makers, and to our investing community.
+
+We have the Spirit of a Warrior, and our Corporation has done nothing wrong.
+All of the Company press releases can be found here:
+
+http://www.globenewswire.com
+
+We have learned that in 2021, all OTC Markets PINK CURRENT
+INFORMATION
+tier Companies will have at chance at Solicited Quotes for the first time in
+over 12.5
+years. We will not be needing to obtain a FORM 211 with FINRA. We
+have received
+news that in 2021, only selected PINK CURRENT INFORMATION tier
+companies
+will receive a shot at SOLICITED QUOTES by a market maker.
+
+ACCR believes to have an excellent relationship with our primary Market
+Maker over
+the years. Our primary market maker signed the UNSOLICITED
+QUOTE FORM
+with OTC Markets pre-October 18, 2019.
+
+We are loyal to our Shareholder base.
+
+Our story...from Inception through March 1, 2012, the Company was
+a violent
+victim of a terrible financial crime. The criminals behind this scheme
+to defraud
+investors was planned very methodically.
+
+We have many shareholders placed in restrictive shares...none of
+which have
+SURFACED in do a 144a sale in over 2 decades. Why is this?
+Management believes that all 100 share lot's of restrictive shares were
+issued
+in fraud, and to fictitious people, or Shareholders - totaling over
+15,000,000
+shares in never to be claimed restrictive shares.
+It was pre-meditated and
+very detail in CRIME.
+
+The criminals of the past perpetraded a MASTERMIND financial
+crime against
+our Shareholder base. We seek retribution from our past fraud managers.
+We
+recently learned that one of our past fraud managers lives in Nashville
+area of
+TN in a $5.2 million dollar house in September 2020. We charge
+he used SEC
+filings to commit financial crimes against our Shareholders. We
+nearly have
+15,000,000 shares in RESTRICTED STATUS 100 share lots's....
+the previous
+criminal masterminds.
+
+
+WE SEEK RETROBUTION FOR OUR SHAREHOLDERS
+
+We charge this man used SEC filings going back to 2002 to commit financial
+crimes
+against our Shareholders. Today, we are the cleanest OTC Companies
+around.
+
+The Company made 2 FINRA DAILY lists on 5/6/2020 and on 9/6/2018.
+
+The Company has had discussions with the SEC regarding a FRAUD
+FORM 15 that was filed by previous management in 2007. We believe
+that we have a fiduciary responsibility to report transparent
+information to our Shareholders.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+We were victims of toxic death spiral debentures from 1998 to
+2008 and through March 2012.
+
+PLEASE FORGIVE OUR PAST.
+
+ACCR as a structure TODAY is very sound, because I am in charge.
+ACCR has life only today because of ME.
+
+The past is the past, and
+we wish to move forward with a plan to become fully
+current with the SEC in 2021. We are trying the best we can within the
+Spirit of the Law. We will be refiling our FORM 10 very soon...very
+soon.
+
+
+On October 18, 2019, our Company was in the FIRST GROUP of
+Equities to bust
+out of the death grey market, where we stayed there for 11 years
+after our
+criminal FORM 15 was filed by previous criminal management.
+
+Let's move forward, and for get the PAST!
+
+
+
+Prior to October 18, 2019...we had DEATH....today, we have LIFE, and
+we have a
+direction on how to fix this trajedy. Today we have visible Level 2
+QUOTES. We
+have already spent 11 years in the DEATH DARK GREY MARKET.
+
+Please,,,why should we go back? We will NOT go back, ever.
+
+TODAY, we have LIFE.
+
+Our primary Market Maker signed a new form created with OTC
+Markets in 2019.
+This form is located here...we believe to have a wonderful relationship
+with our
+PRIMARY MARKET MAKER.
+
+https://www.otcmarkets.com/files/unsolicited-quote-form-1514935916031.pdf
+
+We jumped from the deathly grey market to the PINK NO INFORMATION
+tier of
+OTC Markets on this infamous date in our history, October 18, 2019.
+We have lived
+in this tier with NO DILUTION for over a year with no harm to our
+Shareholders.
+
+WE LOVE OUR SHAREHOLDERS, and believe in RAISING
+SHAREHOLDER
+VALUE. WE VALUE OUR COMMON STOCKHOLDERS.
+
+ACCR received a denial to go PINK CURRENT TIER on July 23, 2020.
+Why? We
+submitted every form in a satisfactory manner. We CLASHED with our prior
+accountant whom shall remain nameless. We clashed hard. Why were we
+denied
+to go PINK CURRENT is a mystery to us. Maybe our prior attorney said bad
+things
+about our Company to OTC Markets, I do not know why. He threatened to
+call OTC
+MARKETS, and call me a liar, when he was the liar.
+
+We do not know. We've been told that OTC Markets did not like our
+Company 8K's
+nor our Company story. ACCR has contacted OTC Markets, and on
+July 23,
+2020 we received the following reply:
+
+On July 23, 2020 3:30 PM Liz Heese wrote:
+
+Mr. Jensen,
+
+OTC Markets has reached a final determination to deny your application
+for access
+to the OTC Disclosure & News Service. Our determination is due to
+public interest
+concerns associated with the company and its disclosure, including but
+not limited to
+issues previously communicated to you.
+
+We consider this matter to be closed and will not engage in further discussion
+at this
+time. As stated in the email from Nancy Rodriguez, you may reapply
+for the service
+in 6 months.
+
+Liz Heese
+EVP, Issuer & Information Services
+OTC Markets Group"
+
+THEREFORE, ACCR is going to re-apply to become PINK CURRENT
+INFORMATION TIER on January 24, 2021.
+
+ACCR as a Corporation is perfectly
+clean, and has done nothing wrong. We've just had bad management.
+All the
+Amendments and Articles of Incorp all check out at:
+
+https://www.sunbiz.org
+
+ACCR has done nothing wrong. ACCR will get SOLICITED QUOTES
+again in 2021.
+
+CURRENT MANAGEMENT WILL STEP DOWN TO CLEAR A PATHWAY
+FOR OTHERS
+
+Let's just forget this past CRIMINAL FORM 15, that according to the SEC
+cannot
+be changed, and our only option is today to re-file our FORM 10 properly
+with the help of counsel, and we will.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+
+Again, as of the close of business December 31st, 2020 --------> our common
+stock
+structure is as follows:
+
+Authorized Common Stock: 300,000,000 shares
+Outstanding Common Stock: 300,000,000 shares
+Estimated Float: Substanstially less than 98,244,146 shares
+Restricted Common Stock: 201,625,854 outstanding
+PATRICK: 186,984,379 ALL RESTRICTED SHARES or 62.3281 % of the
+TOTAL
+AMOUNT OF STOCK ON A FULLY DILUTED SHARES - PERIOD!
+
+
+
+OUR CORPORATE WEBSITEs IS:
+
+https://www.myaccess-power.com
+
+Access-Power & Co., Inc.'s contact is:
+PO BOX 598
+Grand Haven, MI 49417
+pjensen@myaccess-power.com
+(616)312-5390 TEL.
+https://www.sec.gov/divisions/corpfin/faqs/soxact2002.htm
+
+
+We applied for a Trademark for Clones By Drones TM, and also
+Clones by Cars TM in 2020. The service will be very futuristic, and will be
+the
+first of its kind. We applied for a federal patent for our Clobes by Drones
+futuristic
+home curbside delivery service.
+
+WE ARE WORKING ON A REVERSE MERGER...we plan to audit the
+incoming
+private company that wishes to go public in a r
+
+============================================================
+SOURCE: 0001386570_0001654954-20-005725.txt (TXT)
+============================================================
+
+10-K/A 1 cdxc10ka_12312019.htm FORM 10-K/A cdxc10ka_12312019 UNITED
+STATES SECURITIES AND EXCHANGE COMMISSION Washington,
+D.C. 20549 FORM
+10-K/A (Amendment
+No. 1) [X]
+ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934. For
+the fiscal year ended December 31, 2019 or [
+] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934. For
+the transition period from to Commission file number 001-37752 CHROMADEX
+CORPORATION (Exact
+name of Registrant as specified in its Charter) Delaware 26-2940963 (State or other jurisdiction of
+incorporation) (I.R.S. Employer
+Identification No.) 10900 Wilshire Blvd. Suite 600, Los
+Angeles, California 90024 (Address of
+Principal Executive Offices) (Zip
+Code) Registrant's
+telephone number, including area code (310) 388-6706 Securities
+registered pursuant to Section 12(b) of the Act: Title of each class Trading Symbol Name of each exchange on which registered Common Stock, $0.001 par value per share CDXC The Nasdaq Capital Market Securities
+registered pursuant to Section 12(g) of the Act: None. Indicate by check
+mark if the registrant is a well-known seasoned issuer, as defined
+in Rule 405 of the Securities Act. Yes [ ] No [X
+] Indicate by check
+mark if the registrant is not required to file reports pursuant to
+Section 13 or Section 15(d) of the Act. Yes [ ] No
+[X] Indicate
+by check mark whether the registrant (1) has filed all reports
+required to be filed by Section 13 or 15(d) of the Securities
+Exchange Act of 1934 during the preceding 12 months (or for
+such shorter period that the Registrant was required to file such
+reports), and (2) has been subject to such filing requirements for
+the past 90 days. Yes [X] No [ ] Indicate
+by check mark whether the registrant has submitted electronically
+every Interactive Data File required to be submitted pursuant to
+Rule 405 of Regulation S-T during the preceding 12 months (or for
+such shorter period that the registrant was required to submit such
+files). Yes [X] No [ ] Indicate
+by check mark whether the registrant is a large accelerated filer,
+an accelerated filer, a non-accelerated filer, or a smaller
+reporting company. See the definitions of “accelerated
+filer,” “large accelerated filer,” and
+“smaller reporting company” in Rule 12b-2 of the
+Exchange Act. Large
+accelerated filer [ ]
+ Accelerated filer
+[X]
+ Non-accelerated filer [
+] Smaller
+reporting company
+[X]
+Emerging growth company [ ] If an
+emerging growth company, indicate by check mark if the registrant
+has elected not to use the extended transition period for complying
+with any new or revised financing accounting standards provided
+pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check
+mark whether the registrant is a shell company (as defined in Rule
+12b-2 of the Act). Yes [ ] No [X] As of
+June 30, 2019, the last business day of the registrant’s most
+recently completed second fiscal quarter, the aggregate market
+value of the registrant’s common stock held by non-affiliates
+of the registrant was approximately $190.4 million, based on the
+closing price of the registrant’s common stock on the NASDAQ
+Capital Market on June 30, 2019. Number
+of shares of common stock of the registrant outstanding as of May
+17, 2020: 61,477,895. DOCUMENTS INCORPORATED BY REFERENCE None. TA B LE OF CONTENTS Item PART I 1A. Risk
+Factors 1 PART II 9A Controls and
+Procedures 2 PART IV 15. Exhibits, Financial
+Statement Schedules 6 Table of Contents EXPLANATORY NOTE ChromaDex
+Corporation (“ChromaDex,” the “Company,”
+“we,” “our” or “us”) is filing
+this Amendment No. 1 on Form 10-K/A (this “Amendment”)
+to amend our Annual Report on Form 10-K for the year ended December
+31, 2019 (the “Form 10-K”), originally filed with the
+U.S. Securities and Exchange Commission (the “SEC”) on
+March 10, 2020. As a result of a material weakness in internal
+control over financial reporting that existed as of December 31,
+2019 that was not identified until the Company was preparing its
+Quarterly Report on Form 10-Q for the quarterly period ended March
+31, 2020, the Company is amending Part II, Item 9A “Controls
+and Procedures” with respect to (a) the Company’s
+conclusions regarding the effectiveness of (i) the Company’s
+disclosure controls and procedures and (ii) its internal control
+over financial reporting, and (b) Marcum LLP’s related
+attestation report on the Company’s internal control over
+financial reporting. In addition, the Company is revising Item 1A.
+“Risk Factors” to add a risk factor regarding this
+material weakness in internal control over financial reporting. The
+material weakness in internal controls over financial reporting is
+also reported in our Quarterly Report on Form 10-Q for the
+quarterly period ended March 31, 2020. In
+accordance with Rule 12b-15 under the Securities Exchange Act of
+1934, as amended (the “Exchange Act”), the Company is
+including with this Amendment currently dated certifications as
+Exhibits 31.1, 31.2, and 32.1. We are also filing an updated
+Consent of Independent Registered Public Accounting Firm.
+Accordingly, Part IV, Item 15, “Exhibits and Financial
+Statement Schedules” is amended to include the currently
+dated certifications and consent as exhibits. Except
+as described in this Explanatory Note, this Amendment does not
+reflect events occurring after the date of the filing of the Form
+10-K, nor does it amend, modify or otherwise update any other
+information in the Form 10-K. Among other things, forward-looking
+statements made in the Form 10-K have not been revised to reflect
+events that occurred or facts that became known to us after filing
+of the Form 10-K, and any such forward-looking statements should be
+read in their historical context. Accordingly, this Amendment
+should be read in conjunction with the Form 10-K and with the
+Company’s filings with the SEC subsequent to the filing of
+the Form 10-K. Notwithstanding
+the existence of the material weakness described in Part II. Item
+9A – “Controls and Procedures,” the Company
+believes that the consolidated financial statements in the Form
+10-K fairly present, in all material respects, the Company’s
+financial position, results of operations and cash flows as of the
+dates, and for the periods, presented, in conformity with U.S.
+generally accepted accounting principles. -1- Table of Contents P ART I Item
+1A. Risk
+Factors The
+Company is supplementing the risk factors previously disclosed in
+“Item 1A. Risk Factors” of the Form 10-K with the
+following risk factor, which should be read in conjunction with the
+other risk factors presented in the Form 10-K: Failure to remediate a material weakness in internal accounting
+controls could result in material misstatements in our financial
+statements. Our
+management has identified a material weakness in our internal
+control over financial reporting and has concluded that, due to
+such material weakness, our disclosure controls and procedures were
+not effective as of December 31, 2019. The material weakness in
+internal control over financial reporting resulted from a
+deficiency in our disclosure controls and procedures which could
+have resulted in us not disclosing a material potential loss that
+was reasonably possible, and therefore requiring a qualitative
+disclosure in our consolidated financial statements under ASC 450
+– Contingencies . The
+material weakness has not been remediated as of March 31, 2020. If
+not remediated, or if we identify further material weaknesses in
+our internal controls, our failure to establish and maintain
+effective disclosure controls and procedures and internal control
+over financial reporting could result in material misstatements in
+our financial statements and a failure to meet our reporting and
+financial obligations, each of which could have a material adverse
+effect on our financial condition and the trading price of our
+common stock. P ART II Item
+9A. Controls and Procedures Evaluation of Disclosure Controls and Procedures (As
+Revised) In
+connection with the filing of our Form 10-K, our chief executive
+officer and our chief financial officer, after evaluating the
+effectiveness of our disclosure controls and procedures (as defined
+in Rules 13a-15(e) and 15d-15(e) of the Exchange Act) as of
+December 31, 2019, concluded that our disclosure controls and
+procedures were effective. Subsequent
+to that evaluation, management reevaluated the effectiveness of our
+disclosure controls and procedures as of December 31, 2019 and
+concluded that, because of the material weakness identified in our
+internal control over financial reporting discussed below, our
+disclosure controls and procedures were not effective as of
+December 31, 2019. Management Report on Internal Control over Financial Reporting (As
+Revised) Our
+management is responsible for establishing and maintaining adequate
+internal control over financial reporting as defined in Rule
+13a-15(f) and 15d-(f) under the Exchange Act. Our internal control
+over financial reporting is designed to provide reasonable
+assurance regarding the reliability of financial reporting and the
+preparation of consolidated financial statements for external
+purposes in accordance with U.S. generally accepted accounting
+principles. Our internal control over financial reporting include
+those policies and procedures that: (i)
+pertain to the maintenance of records that, in reasonable detail,
+accurately and fairly reflect the transactions and dispositions of
+our assets; (ii)
+provide reasonable assurance that transactions are recorded as
+necessary to permit the preparation of our consolidated financial
+statements in accordance with U.S. generally accepted accounting
+principles, and that our receipts and expenditures are being made
+only in accordance with authorizations of our management and
+directors; and (iii)
+provide reasonable assurance regarding prevention or timely
+detection of unauthorized acquisition, use or disposition of our
+assets that could have a material effect on the consolidated
+financial statements. -2- Table of Contents In
+connection with the Form 10-K, our management, including the
+undersigned principal executive officer and principal financial
+officer, assessed the effectiveness of our internal control over
+financial reporting as of December 31, 2019. In conducting its
+assessment, our management used the criteria issued by the
+Committee of Sponsoring Organizations of the Treadway Commission in Internal Control—Integrated
+Framework in 2013 . Based on this assessment, our management
+concluded that, as of December 31, 2019, our internal control
+over financial reporting was effective based on those
+criteria. Subsequent
+to that evaluation, management reevaluated the effectiveness of our
+internal control over financial reporting as of December 31, 2019
+and concluded that, because of the material weakness identified,
+our internal control over financial reporting was not effective as
+of December 31, 2019. The
+material weakness in internal control over financial reporting
+resulted from a deficiency in our disclosure controls and
+procedures which could have resulted in the Company not disclosing
+a material potential loss that was reasonably possible, and
+therefore requiring a qualitative disclosure in consolidated
+financial statements under ASC 450 – Contingencies . The
+Company is still in the process of analyzing and addressing the
+material weakness. The material weakness will not be considered
+remediated until the applicable remedial control operates for a
+sufficient period of time and management has concluded, through
+testing, that this control is operating effectively. We expect that
+the remediation of this material weakness will be completed prior
+to the end of year 2020. We did
+not revise our financial statements for prior periods for the
+disclosure of the potential loss based on our belief that the
+effect of the lack of the disclosure was not material to the
+financial statements taken as a whole. Therefore, our chief
+executive officer and our chief financial officer believe that,
+notwithstanding the material weakness discussed above, the
+consolidated financial statements in our Annual Report on Form 10-K
+for the year ended December 31, 2019 present fairly, in all
+material respects, our financial position, results of operations
+and cash flows for the periods presented. Changes in Internal Control over Financial Reporting Except
+as noted above, there were no changes in internal controls over
+financial reporting (as defined in Rule 13a−15(f) promulgated
+under the Exchange Act) that occurred during our fourth fiscal
+quarter that have materially affected or are reasonably likely to
+materially affect our internal control over financial
+reporting. Inherent Limitations on Disclosure Controls and
+Procedures The
+effectiveness of our disclosure controls and procedures is subject
+to various inherent limitations, including cost limitations,
+judgments used in decision making, assumptions about the likelihood
+of future events, the soundness of our systems, the possibility of
+human error, and the risk of fraud. Moreover, projections of any
+evaluation of effectiveness to future periods are subject to the
+risk that controls may become inadequate because of changes in
+conditions and the risk that the degree of compliance with policies
+or procedures may deteriorate over time. Because of these
+limitations, there can be no assurance that any system of
+disclosure controls and procedures, no matter how well conceived,
+will be successful in preventing all errors or fraud or in making
+all material information known in a timely manner to the
+appropriate levels of management. Inherent Limitations on Internal Control Internal
+control over financial reporting cannot provide absolute assurance
+of achieving financial reporting objectives because of its inherent
+limitations, including the possibility of human error and
+circumvention by collusion or overriding of control. Accordingly,
+even an effective internal control system may not prevent or detect
+material misstatements on a timely basis. Also, projections of any
+evaluation of effectiveness to future periods are subject to the
+risk that the controls may become inadequate because of changes in
+conditions or that the degree of compliance with the policies or
+procedures may deteriorate. Accordingly, our internal control over
+financial reporting is designed to provide reasonable assurance of
+achieving their objectives. -3- Table of Contents Attestation Report of the Registered Public Accounting
+Firm REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING
+FIRM ON INTERNAL CONTROL OVER FINANCIAL REPORTING To the Shareholders and Board of Directors of ChromaDex Corporation Adverse Opinion on Internal Control over Financial
+Reporting We have audited ChromaDex Corporation’’s (the
+"Company") internal control over financial reporting as of December
+31, 2019, based on criteria established in Internal Contr
\ No newline at end of file
diff --git a/data/agents/financial_agent/metadata.json b/data/agents/financial_agent/metadata.json
new file mode 100644
index 0000000000000000000000000000000000000000..20f8e45b54461a5458c61c3ef4c6bee07a5f2242
--- /dev/null
+++ b/data/agents/financial_agent/metadata.json
@@ -0,0 +1,275 @@
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\ No newline at end of file
diff --git a/data/agents/legal_agent/context.txt b/data/agents/legal_agent/context.txt
new file mode 100644
index 0000000000000000000000000000000000000000..77e995bb6d31045aa54f84e86d9e9a0012b79cf7
--- /dev/null
+++ b/data/agents/legal_agent/context.txt
@@ -0,0 +1,4065 @@
+
+============================================================
+SOURCE: case_10129044.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1027758.txt (TXT)
+============================================================
+
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10305113.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10318020.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10353022.txt (TXT)
+============================================================
+
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10362523.txt (TXT)
+============================================================
+
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10388952.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10463618.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10513129.txt (TXT)
+============================================================
+
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1052233.txt (TXT)
+============================================================
+
+ IN THE COURT OF APPEALS OF TENNESSEE
+ AT JACKSON
+ August 16, 2007 Session
+
+ GARY WEAVER, ET AL. v. THOMAS R. McCARTER, ET AL.
+
+ A Direct Appeal from the Chancery Court for Shelby County
+ No. 98-0425-3 The Honorable D. J. Alissandratos, Chancellor
+
+
+
+ No. W2006-02058-COA-R3-CV - Filed October 8, 2007
+
+
+ This is the second appeal of this breach of contract case. In Gary Weaver, et al v. Thomas
+R. McCarter, et al, No. W2004-02803-COA-R3-CV, 2006 WL 1529506 (Tenn. Ct. App. June 6,
+2006), this Court affirmed the trial court’s grant of summary judgment in favor of plaintiffs and
+remanded the case “for further clarification concerning the amount of damages awarded with respect
+to plaintiff’s claims of negligence per se, negligent misrepresentation, and breach of contract.” Upon
+remand, the trial court entered judgment against the defendants jointly and severally and in favor of
+plaintiffs for compensatory damages and pre-judgment interest. Finding that the trial court abused
+its discretion in awarding pre-judgment interest, we reverse that portion of the Judgment. We
+reverse in part and affirm in part.
+
+
+Tenn. R. App. P. 3; Appeal as of Right; Judgment of the Reversed in Part, Affirmed in Part
+
+W. FRANK CRAWFORD , P.J., W.S., delivered the opinion of the court, in which DAVID R. FARMER ,
+J. and HOLLY M. KIRBY , J., joined.
+
+Charles F. Morrow and Elizabeth E. Chance of Memphis, Tennessee for Appellant, Coldwell Banker
+Hoffman-Burke, Inc., Realtors
+
+Robert L. Moore and Dawn Davis Carson of Memphis, Tennessee for Appellant, Jim Perdue
+
+Henry C. Shelton, III and Tricia T. Olson of Memphis, Tennessee for Gary and Gail Weaver
+
+ OPINION
+
+ The relevant facts and procedures are set out in this Court’s Opinion in the previous appeal,
+Gary Weaver, et al v. Thomas R. McCarter, et al, No. W2004-02803-COA-R3-CV, 2006 WL
+1529506 (Tenn. Ct. App. June 6, 2006). The Opinion, filed June 6, 2006, states in pertinent part:
+ This suit arises from a contract to sell Gary and Gail Weaver’s
+(“the Plaintiffs”) house (“the Hacks Cross House”) located on Hacks
+Cross Road in Memphis, Tennessee. On November 1, 1994, Thomas
+McCarter (“Defendant McCarter”) approached the Plaintiffs with an
+offer to purchase the Hacks Cross House for $680,000 in cash. The
+Plaintiffs agreed and subsequently entered into a verbal contract with
+Defendant McCarter for a cash sale. However, Defendant McCarter
+never consummated the sale and, thus, the transaction never closed.
+
+
+ In February 1997, the Plaintiffs purchased a second home
+located on Langston Cove (“the Langston Cove House”) and soon
+after listed the Hacks Cross House with Jim Perdue (“Defendant
+Perdue”) at Coldwell Banker Hoffman-Burke, Inc. Realtors
+(“Defendant CBHB”). On August 27, 1997, Defendant Perdue
+brought the Plaintiffs a written offer from Janet Hunter to purchase
+the Hacks Cross House for $575,000. The Plaintiffs eventually
+accepted a counter-offer of $595,000, with $10,000 in escrow, and
+signed a contract of sale (hereinafter referred to as “the sale contract”)
+with Janet Hunter. Closing was set for September 30, 1997.
+However, the $10,000 escrow check bounced on September 17, 1997,
+and Defendants CBHB received notice of this on September 30, 1997.
+Furthermore, the sale contract was not signed by Janet Hunter, but
+rather Janet Hunter’s name was forged by Chip Hunter (“Defendant
+Hunter”), Janet Hunter’s husband, without Janet Hunter’s knowledge
+or permission. Defendant Hunter signed Janet Hunter’s name to the
+sale contract at the request of Defendant McCarter and while in the
+presence of Defendant Perdue. The Plaintiffs did not learn of the
+bounced escrow check or the forged sale contract until the closing
+date, when the Plaintiffs’ attorney checked on the escrow funds and
+Defendant Perdue informed the Plaintiffs’ closing attorney of the
+forgery. As a result, the closing did not occur on September 30, 1997.
+
+ Subsequently, on October 2, 1997, Defendant McCarter, in a
+memorandum to Defendant Perdue, affirmed that he was the true
+party who had made the offer on August 29, 1997, to purchase the
+Hacks Cross House for his daughter, Janet Hunter. While Defendant
+McCarter indicated a desire to honor the sale contract, he informed
+Defendant Perdue that his funding for the purchase would not be
+available until October 8, 1997. Although reserving their rights under
+the original sale contract, the Plaintiffs informed Defendant McCarter
+that they were willing to close the transaction if his funding came
+through by October 8, 1997. Despite this, the closing did not take
+
+
+ -2-
+ place on October 8, due to a continued lack of funding. At that time,
+Defendant McCarter promised to fund the transaction on October 15,
+1997. However, on that date, he delivered a $10,000 check to
+Defendant CBHB and stated that he no longer wanted to purchase the
+Hacks Cross House. The Plaintiffs subsequently demanded that
+Defendant Perdue pay them Defendant McCarter’s $10,000 in earnest
+money, cancelled their listing agreement with Defendant CBHB, and
+placed the Hacks Cross House back on the market. However, the
+Hacks Cross House did not sell and the Plaintiffs eventually sold the
+Langston Cove House and moved back to the Hacks Cross House.
+
+ On May 11, 1998, the Plaintiffs filed suit against Defendants
+McCarter, CBHB, Perdue, and Hunter, seeking damages for
+negligence per se, negligent misrepresentation, breach of contract,
+and fraud. Specifically, the Plaintiffs asserted that Defendants Perdue
+and CBHB were negligent per se for violating section 62-13-403 of
+the Tennessee Real Estate Broker License Act of 1973. The Plaintiffs
+further asserted that Defendant Perdue was also negligent per se
+because he violated section 62-13-404 of the Brokers Act, which
+provides for duties of reasonable care and loyalty between real estate
+brokers and their clients; and that Defendant Perdue was further
+guilty of negligent misrepresentation for failing to exercise reasonable
+care in communicating information to the Plaintiffs. The Plaintiffs
+next asserted a breach of contract claim against Defendant McCarter
+arguing that, although Defendant McCarter did not actually sign the
+contract, he had previously entered into an oral agreement, through
+Defendant Perdue, with the Plaintiffs to purchase their house, but
+failed to follow through with the purchase. Finally, the Plaintiffs
+asserted a fraud complaint against Defendants McCarter, Hunter, and
+Perdue, arguing that all three parties engaged in dishonest practices
+with a deceptive intent in order to induce the Plaintiffs to enter into
+an illusory contract to sell their house, which the Plaintiffs
+subsequently relied upon to their detriment. As remedies, the
+Plaintiffs sought either specific performance by Defendant McCarter
+or a judgment for $200,000 in compensatory damages against all
+defendants jointly and severally, along with punitive damages.
+
+ In response to the Plaintiffs’ claims, Defendants CBHB and
+Perdue filed an answer arguing that Plaintiffs failed to assert a claim
+upon which relief could be granted. Defendant CBHB also asserted
+a counter-claim against the Plaintiffs alleging that they were entitled
+to split the $10,000 in earnest money with the Plaintiffs. In turn,
+Defendant Hunter denied forging Janet Hunter’s signature and
+
+
+ -3-
+ asserted the statute of frauds as an affirmative defense. Defendant
+McCarter denied being the contractual purchaser of the house and
+further asserted the statute of frauds as an affirmative defense.
+Defendant McCarter also asserted a counter-claim against Defendant
+Perdue, Defendant CBHB, and the Plaintiffs seeking the return of the
+$10,000 placed in escrow arguing that Defendant McCarter entered
+into no enforceable contract of sale and, thus, no legal basis existed
+for the continued retention of such funds. Defendants CBHB and
+Perdue and the Plaintiffs responded to Defendant McCarter’s counter-
+complaint and asserted that an enforceable contract of sale did exist.
+
+ On July 13, 2000, the Plaintiffs filed a Motion for Summary
+Judgment against all Defendants. Defendant McCarter subsequently
+filed a motion seeking a directed verdict in relation to the return of
+the $10,000 escrow money. (FN1) On January 22, 2001, the trial
+court entered an order granting summary judgment in favor of the
+Plaintiffs against Defendants McCarter, Hunter, Perdue, and CBHB.
+The court also denied Defendant McCarter’s directed verdict motion
+and further ordered that Defendant CBHB tender the $10,000 in
+earnest money to the Plaintiff, with said amount being credited
+against the damage award against Defendant McCarter. The amounts
+of compensatory and punitive damages were reserved for further
+hearing; however, the trial court did state that while all judgments
+rendered herein and subsequently by the Court shall be joint and
+several as against all Defendants, that among the Defendants the fault
+shall be apportioned [forty-five] percent (45%) to [Defendant]
+McCarter, ten percent (10%) to [Defendant] Hunter, and [forty-five]
+percent (45%) to Defendants [Perdue and CBHB].
+
+ (FN1) Pursuant to Rule 50.01 of the Rules of Civil Procedure,
+ a party may only move for directed verdict “at the close of the
+ evidence offered by an opposing party or at the close of the
+ case.” Tenn. R. Civ. P. 50.01 (2005).
+
+
+Nearly two years after the trial court’s grant of summary judgment,
+Defendant CBHB filed a motion to reconsider, which the trial court
+denied.
+
+ Prior to the trial on damages, several events occurred which
+ultimately affected the trial court’s ability to assess damages. First,
+on May 5, 2004, Defendant Perdue filed a Plea of Bankruptcy stating
+that he had filed bankruptcy and that, pursuant to an Order Modifying
+Discharge Injunction issued by the United States Bankruptcy Court
+for the Western District of Tennessee, the trial court would only be
+
+ -4-
+ allowed to proceed to a judgment against Defendant Perdue for any
+causes of action except acts of fraud, fraudulent misrepresentation, or
+other cause of action which would permit the denial of discharge
+pursuant to 11 U.S.C. § 727 or render the judgment nondischargeable
+pursuant to 11 U.S.C. § 523. The trial court granted this plea. In
+addition to Defendant Perdue’s filing of bankruptcy, Defendant
+McCarter died (FN2) and Defendant Hunter also filed bankruptcy.
+As a result, at trial, the Plaintiffs sought to collect damages arising
+from Defendants CBHB and Perdue’s negligence per se and negligent
+misrepresentation, as well as Defendant McCarter’s breach of
+contract. (FN3)
+
+ (FN2) W e find no indication in the record of a substitution of
+ parties for Defendant McCarter pursuant to Rule 25.01 of the
+ Tennessee Rules of Civil Procedure.
+
+
+ (FN3) In their brief, the Plaintiffs assert that at the trial on
+ damages, they proceeded only against Defendants CBHB and
+ Perdue “and sought damages only under the Tennessee Real
+ Estate Broker[] Act of 1973 and for negligence.” However, a
+ review of the trial transcript reveals that the Plaintiffs also sought
+ damages for their breach of contract claim against Defendant
+ McCarter, although the Plaintiffs admitted that Defendant
+ McCarter died apparently leaving no estate to satisfy a judgment
+ and that “no formal Notice [or] substitution” was made pursuant
+ to Rule 25.01.
+
+ In relation to damages suffered due to fraud, neither the
+ Plaintiffs’ brief nor the record in this case supports the
+ conclusion that damages were awarded based upon fraud in this
+ case. At trial, the Plaintiffs’ counsel admitted that no judgment
+ for fraud was awarded against Defendants CBHB and Perdue.
+ Furthermore, the Plaintiffs indicated that they were unable to
+ pursue damages against Defendant Hunter due to his filing
+ Chapter 7 bankruptcy. Finally, a review of the record and
+ transcript in this case fails to show that damages were awarded
+ for any fraud alleged against Defendant McCarter.
+
+
+ At the trial on damages, the parties presented testimony of
+Plaintiff Gary Weaver and John Jordan, a real estate appraiser who
+had appraised the Plaintiffs’ property in 1997, near the time the sale
+contract was signed. The Plaintiffs asserted that the proof showed
+that they had suffered $300,000 in damages as a result of the
+Defendants conduct. After hearing the proof, the trial court first held
+the Plaintiffs would receive no damages in relation to their purchase
+and subsequent sale of the Langston Cove House because the
+purchase of this property occurred prior to the Plaintiffs’ contract to
+
+ -5-
+ sell the Hacks Cross House and, thus, damages resulting from the
+ purchase and sale of the Langston Cove home were not reasonable
+ consequential damages flowing from the Defendants’ actions in
+ regard to the Hacks Cross House. As a result of this finding, the trial
+ court focused its award of damages on the following issues: 1) the
+ contract price for the Hacks Cross House minus the sales
+ commission, 2) the duty of the Plaintiffs to mitigate damages, and 3)
+ additional expenses incurred as a result of the Defendants’ actions.
+ After hearing the evidence submitted at trial, the trial court entered an
+ Order of Judgment providing as follows:
+
+ Plaintiffs should have a judgment, against Defendants,
+ pursuant to their apportioned fault, in the amount of
+ $55,600.00 for lost value of real estate; $3,000.00 for
+ 1998 and $3,000.00 for 1999 for necessary
+ maintenance costs, and $20,000.00 for attorneys fees,
+ with prejudgment interest computed at 10% per year
+ on each amount from the date incurred, or, in the case
+ of attorneys fees, from the date paid, and statutory
+ cost of this case. [Defendants] Perdue and [CBHB]
+ have been apportioned fault in the amount of forty-
+ five percent (45%), and judgment is awarded against
+ these Defendants specifically in the amount of
+ $60,118.53, and forty-five percent (45%) of statutory
+ costs.
+
+ The Plaintiffs subsequently filed a Motion to Alter or Amend
+ Judgment arguing that the trial court should app
+
+============================================================
+SOURCE: case_10574918.txt (TXT)
+============================================================
+
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10589788.txt (TXT)
+============================================================
+
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10639650.txt (TXT)
+============================================================
+
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10640482.txt (TXT)
+============================================================
+
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10668606.txt (TXT)
+============================================================
+
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10795047.txt (TXT)
+============================================================
+
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_10875291.txt (TXT)
+============================================================
+
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1288403.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1430528.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1431039.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1454678.txt (TXT)
+============================================================
+
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1467123.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1490563.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1692833.txt (TXT)
+============================================================
+
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1697753.txt (TXT)
+============================================================
+
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1903588.txt (TXT)
+============================================================
+
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_1990736.txt (TXT)
+============================================================
+
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_203751.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_208002.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_210268.txt (TXT)
+============================================================
+
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_210485.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2114432.txt (TXT)
+============================================================
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2173962.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2175821.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_222139.txt (TXT)
+============================================================
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2252138.txt (TXT)
+============================================================
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2296630.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2309624.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2314240.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2314320.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2322566.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2334319.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2370081.txt (TXT)
+============================================================
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2388699.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2400563.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2407917.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2412837.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2414023.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2443516.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2468898.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2470211.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2470585.txt (TXT)
+============================================================
+
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2471266.txt (TXT)
+============================================================
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2473205.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2473830.txt (TXT)
+============================================================
+
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2492097.txt (TXT)
+============================================================
+
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2504990.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2518137.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2541815.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2573466.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2681603.txt (TXT)
+============================================================
+
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2778175.txt (TXT)
+============================================================
+
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2804052.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_2842974.txt (TXT)
+============================================================
+
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4316372.txt (TXT)
+============================================================
+
+COLORADO COURT OF APPEALS 2016COA155
+
+
+Court of Appeals No. 15CA1435
+City and County of Denver District Court No. 14CV34053
+Honorable Morris B. Hoffman, Judge
+
+
+Layton Construction Co., Inc., a Utah corporation,
+
+Plaintiff-Appellant,
+
+v.
+
+Shaw Contract Flooring Services, Inc., d/b/a Spectra Contract Flooring, a
+Georgia corporation,
+
+Defendant-Appellee.
+
+
+ JUDGMENT AFFIRMED AND CASE
+ REMANDED WITH DIRECTIONS
+
+ Division IV
+ Opinion by JUDGE J. JONES
+ Graham and Miller, JJ., concur
+
+ Announced October 20, 2016
+
+
+The Holt Group LLC, L. Tyrone Holt, Kevin P. Walsh, Kevin D. Poyner, Denver,
+Colorado, for Plaintiff-Appellant
+
+Hall & Evans, LLC, Darin J. Lang, Brian Molzahn, Elizabeth K. Olson, Denver,
+Colorado, for Defendant-Appellee
+ ¶1 Plaintiff, Layton Construction Co., Inc. (Layton), appeals the
+
+ district court’s summary judgment for defendant, Shaw Contract
+
+ Flooring Services, Inc. (Shaw), based on the doctrine of claim
+
+ preclusion. Because we conclude that all of Layton’s contentions
+
+ challenging the district court’s application of that doctrine are
+
+ without merit, we affirm.
+
+ I. Background
+
+¶2 Layton was the general contractor responsible for construction
+
+ of a hotel in Vail, Colorado. It hired Shaw, and many other
+
+ subcontractors, to perform work on the project.
+
+¶3 In June 2009, the property owner (referred to by the parties as
+
+ BCRE) terminated its contract with Layton and, not too long
+
+ thereafter, gave Layton notice of numerous construction defects in
+
+ the project, a few of which related to Shaw’s work. Layton sued
+
+ BCRE alleging that BCRE had failed to pay for work, seeking over
+
+ $27 million in damages. After BCRE asserted counterclaims
+
+ against Layton for defective workmanship (seeking more than $25
+
+ million in damages), Layton added claims against various
+
+ subcontractors, including Shaw.
+
+
+
+
+ 1
+ ¶4 Pursuant to an indemnification clause in the subcontract,
+
+ Layton’s sixth claim for relief sought indemnification from Shaw for
+
+ “all damages and costs” arising from any liability it might have to
+
+ BCRE.1 In response to Shaw’s interrogatory (Interrogatory 8) asking
+
+ Layton to “identify all material facts upon which [Layton] based [the
+
+ indemnification] claim,” Layton stated, under oath, that those facts
+
+ included “Shaw’s failure to provide a defense or pay Layton’s costs
+
+ to defend against [BCRE’s] claims that relate to or arise out of
+
+ Shaw’s allegedly deficient or defective work.” In responding to
+
+ another interrogatory (Interrogatory 4) asking Layton to describe
+
+ every breach of the indemnification clause, Layton specifically noted
+
+ “Shaw’s failure to provide a defense or pay Layton’s costs.” Layton’s
+
+ response to Interrogatory 8 expressly incorporated its response to
+
+ Interrogatory 4.2
+
+
+
+ 1 The indemnification clause provided for indemnification from “all
+ damages, costs and expenses incurred in connection” with “all
+ claims, demands, suits, proceedings, attachments, levies, penalties,
+ damages and losses, liabilities, liens, claims for indemnification or
+ contribution, and any other matter whatsoever” “arising out of or
+ resulting from,” among other things, Shaw’s work on the project.
+ 2 In its answer brief on appeal, Shaw pointed out that Layton had
+ said in response to Interrogatory 8 that its indemnification claim
+ included attorney fees and costs incurred in defending against
+
+ 2
+ ¶5 Layton also asserted a claim for contribution against Shaw
+
+ (the seventh claim for relief), alleging that if Layton was found to be
+
+ liable to BCRE for “the tortuous [sic] acts of” Shaw, Shaw should be
+
+ required to contribute payment for such liability. At Layton’s
+
+ request, the district court dismissed that claim without prejudice in
+
+ March 2011.
+
+¶6 Later, after BCRE specifically identified Shaw’s allegedly
+
+ defective work (totaling about $9,000 in value), Layton moved to
+
+ voluntarily dismiss its indemnification claim against Shaw “with
+
+ prejudice.” Layton’s motion said that the dismissal would include
+
+ “those claims that have been or could have been asserted in this
+
+ lawsuit.” (Emphasis added.) The motion purported not to seek
+
+ dismissal of “any new or future claims,” which it defined as those
+
+ BCRE’s claims. In its reply brief, however, Layton ignored its
+ response to Interrogatory 8 and instead argued that its response to
+ Interrogatory 4 was irrelevant, for a number of unconvincing
+ reasons. At oral argument, Layton’s counsel argued that Layton’s
+ response to Interrogatory 8 was irrelevant because Layton objected
+ to that interrogatory, but he did not explain why the interrogatory
+ was objectionable or why any objection would render the answer
+ irrelevant to this issue. (The record shows that Layton’s only
+ specific objection to the interrogatory was an attorney work-product
+ objection.) We perceive no relevant, nonfrivolous objection to that
+ standard interrogatory and, in any event, Layton went on to answer
+ the interrogatory despite the objections. Its sworn answer to the
+ interrogatory is enlightening, and we therefore consider it.
+
+ 3
+ “that may arise or be asserted in the future in any other lawsuits or
+
+ circumstances, which may be subject to the indemnification
+
+ provision.” The proposed order Layton submitted with its motion
+
+ repeated these parameters and said that each party would bear its
+
+ own attorney fees and costs. The district court did not sign
+
+ Layton’s proposed order, but instead entered a written order on
+
+ June 6, 2011, saying only, as now relevant, that Layton’s claims
+
+ were dismissed with prejudice.
+
+¶7 The case between Layton and BCRE (in which several
+
+ subcontractors remained parties) continued. In July 2014,
+
+ following a bench trial, the court awarded Layton just over $5
+
+ million on its claims against BCRE, which was far less than Layton
+
+ had sought. The court also ruled that Layton was not liable to
+
+ BCRE for defective work because BCRE had materially breached the
+
+ contract by failing to give Layton contractually required notices of
+
+ defective work and an opportunity to correct the work. With respect
+
+ to the subcontractors remaining in the case, the court found that
+
+ they were liable to Layton under the indemnification provisions in
+
+ their subcontracts (which were identical to the provision in Shaw’s
+
+ subcontract) for the expenses (including attorney fees and costs)
+
+
+ 4
+ that Layton had incurred in defending against BCRE’s claims, to
+
+ the extent those expenses were attributable to work performed by
+
+ each subcontractor.
+
+¶8 Shortly thereafter, Layton filed this case against Shaw and
+
+ several other subcontractors. It asserted claims against Shaw for
+
+ contractual and common law indemnity and declaratory judgment
+
+ seeking an award of “attorney fees, costs and expenses” it had
+
+ incurred in defending against BCRE’s claims in the prior case.3
+
+ Layton asserted that it could seek indemnification from Shaw
+
+ pursuant to a provision in the Construction Defect Action Reform
+
+ Act (CDARA), section 13-80-104, C.R.S. 2016, which allows claims
+
+ for indemnification against subcontractors to be filed within ninety
+
+ days of a final judgment against a contractor. § 13-80-104(1)(b)(II),
+
+ (1)(c) (indemnification claim “[s]hall be brought within ninety days
+
+
+
+
+ 3 Layton claims to have incurred over $16 million in attorney fees
+ and costs in defending against BCRE’s claims. Layton’s complaint
+ also alleged losses resulting from Layton’s payments for work that
+ the subcontractors had not performed. But it is not clear if Layton
+ alleged that Shaw was one of those subcontractors, and in any
+ event Layton does not assert on appeal any argument relating to
+ those alleged losses.
+
+ 5
+ after [settlement of or final judgment against the contractor in]” the
+
+ construction defect claim).4
+
+¶9 Shaw moved for summary judgment. It argued that Layton’s
+
+ indemnification claims are barred by the doctrine of claim
+
+ preclusion because the court in the prior case had dismissed those
+
+ claims with prejudice. The district court agreed, rejecting Layton’s
+
+ contrary arguments in a thorough written order.
+
+ II. Standard of Review
+
+¶ 10 Summary judgment is appropriate when “the pleadings,
+
+ depositions, answers to interrogatories, and admissions on file,
+
+ together with the affidavits, if any, show that there is no genuine
+
+ issue as to any material fact and that the moving party is entitled to
+
+ a judgment as a matter of law.” C.R.C.P. 56(c). We review de novo
+
+ an order granting summary judgment based on claim preclusion.
+
+ Loveland Essential Grp., LLC v. Grommon Farms, Inc., 2012 COA 22,
+
+ ¶ 13.
+
+
+ 4Interestingly, there was no settlement of the prior case as between
+ Layton and BCRE, nor was there any judgment “against” Layton on
+ BCRE’s claims in the prior case, calling into question the
+ applicability of section 13-80-104(1)(b)(II), C.R.S. 2016, under its
+ own terms. But Shaw has not raised that issue, so we will not
+ address it.
+
+ 6
+ ¶ 11 To the extent Layton’s contentions require us to construe
+
+ CDARA, that presents a question of law that we also review de novo.
+
+ Sperry v. Field, 205 P.3d 365, 367 (Colo. 2009). In interpreting a
+
+ statute we strive to discern and give effect to the General
+
+ Assembly’s intent. Hassler v. Account Brokers of Larimer Cty., Inc.,
+
+ 2012 CO 24, ¶ 15. To do this, we look first to the statutory
+
+ language itself; we give the words and phrases used therein their
+
+ plain and ordinary meanings, and we read the language in the dual
+
+ contexts of the entire statute and the comprehensive statutory
+
+ scheme. Id.; Jefferson Cty. Bd. of Equalization v. Gerganoff, 241
+
+ P.3d 932, 935 (Colo. 2010); BP Am. Prod. Co. v. Patterson, 185 P.3d
+
+ 811, 813 (Colo. 2008). After doing this, if we conclude that the
+
+ statutory language is unambiguous we apply it as written and we
+
+ do not resort to other rules of statutory construction. Reno v.
+
+ Marks, 2015 CO 33, ¶ 20; Klinger v. Adams Cty. Sch. Dist. No. 50,
+
+ 130 P.3d 1027, 1031 (Colo. 2006).
+
+ III. General Law of Claim Preclusion
+
+¶ 12 “Claim preclusion works to preclude the relitigation of matters
+
+ that have already been decided as well as matters that could have
+
+ been raised in a prior proceeding but were not.” Argus Real Estate,
+
+
+ 7
+ Inc. v. E-470 Pub. Highway Auth., 109 P.3d 604, 608 (Colo. 2005);
+
+ accord Lobato v. Taylor, 70 P.3d 1152, 1165 (Colo. 2003). It serves
+
+ two primary purposes: protecting litigants from the burden of
+
+ relitigating issues against the same party (or its privy) and
+
+ promoting judicial economy by preventing needless litigation.
+
+ Parklane Hosiery Co. v. Shore, 439 U.S. 322, 326 (1979); Lobato, 70
+
+ P.3d at 1165-55.
+
+¶ 13 “For a claim in a second judicial proceeding to be precluded by
+
+ a previous judgment, there must exist: (1) finality of the first
+
+ judgment, (2) identity of subject matter, (3) identity of claims for
+
+ relief, and (4) identity or privity between parties to the actions.”
+
+ Argus Real Estate, 109 P.3d at 608; accord Loveland Essential Grp.,
+
+ ¶ 14.
+
+ IV. Analysis
+
+¶ 14 Layton makes three fundamental contentions: (1) its claims
+
+ against Shaw in this case are not identical to those it asserted
+
+ against Shaw in the prior case; (2) CDARA modifies the doctrine of
+
+ claim preclusion in the construction defect context by requiring (or
+
+ at least allowing) splitting of indemnification claims; and (3) various
+
+
+
+
+ 8
+ exceptions to the claim preclusion doctrine apply to this action. We
+
+ address and reject each of these contentions in turn.
+
+ A. Identity of Claims
+
+¶ 15 Layton argues that its claims in this case are not identical to
+
+ those it asserted in the prior case both because it did not seek
+
+ indemnity for attorney fees and costs in the prior case and because
+
+ its claims in this case do not arise out of the same transaction as
+
+ its claims in the prior case.5 Both of these arguments are based on
+
+ distortions of, or are flat out contrary to, applicable, well-settled
+
+ legal principles.
+
+¶ 16 We need not decide whether Layton sought indemnification for
+
+ fees and costs in the prior case because it obviously could have
+
+ done so, a fact it admitted in opposing Shaw’s summary judgment
+
+ motion.6 Layton does not contest that any claim for indemnification
+
+
+
+
+ 5Layton concedes that the other three requirements of claim
+ preclusion are met.
+ 6 Shaw, however, has much the better of the argument on whether
+ Layton sought indemnification of fees and costs in the defect case.
+ Layton’s sworn discovery responses in the prior case said that the
+ attorney fees and costs it had incurred and were incurring in
+ defending against BCRE’s claims were included in its
+ indemnification claim. And the language of Layton’s complaint in
+
+ 9
+ based on Shaw’s duty to defend accrued, at the latest, in 2009
+
+when it first began incurring attorney fees and costs in connection
+
+with BCRE’s claims, which Shaw would not pay. See Jones v. Sun
+
+Carriers, Inc., 856 F.2d 1091, 1094 (8th Cir. 1988) (indemnity claim
+
+for costs and expenses accrues when indemnitee has made a
+
+payment or otherwise expended sums, while indemnity claim for
+
+liabilities arises when a liability is legally imposed; applying
+
+Arkansas law); Farmers Ins. Exch. v. Am. Mfrs. Mut. Ins. Co., 897
+
+P.2d 880, 882 (Colo. App. 1995) (duty to defend arises when claims
+
+are asserted against party to whom the duty is owed); see also
+
+Sterenbuch v. Goss, 266 P.3d 428, 433 (Colo. App. 2011) (once some
+
+injury has occurred, a claim has accrued even if further injury
+
+continues to occur).7 That Layton may not have known the full
+
+extent of Shaw’s liability while Shaw was a party in the prior case
+
+does not matter; as Layton conceded in opposing Shaw’s summary
+
+
+
+that case was certainly broad enough to include a claim for such
+fees and costs.
+7 Layton’s complaint in this case expressly alleges that in 2009 it
+incurred such fees and costs before it added Shaw to the prior case.
+In responding to Shaw’s motion for summary judgment, Layton
+submitted an affidavit repeating this allegation. Its opening brief in
+this appeal does so as well.
+
+ 10
+ judgment motion, it could have presented evidence of and obtained
+
+ a judgment for all attorney fees and costs incurred or likely to be
+
+ incurred in the prior case. (Indeed, after the district
+
+============================================================
+SOURCE: case_4340129.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4369640.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4382476.txt (TXT)
+============================================================
+
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4421564.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4427287.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4444380.txt (TXT)
+============================================================
+
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4495424.txt (TXT)
+============================================================
+
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4526772.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4567936.txt (TXT)
+============================================================
+
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4570608.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4587203.txt (TXT)
+============================================================
+
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4593584.txt (TXT)
+============================================================
+
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_461331.txt (TXT)
+============================================================
+
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4625210.txt (TXT)
+============================================================
+
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4631839.txt (TXT)
+============================================================
+
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4679569.txt (TXT)
+============================================================
+
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4696265.txt (TXT)
+============================================================
+
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4762699.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4764769.txt (TXT)
+============================================================
+
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4877705.txt (TXT)
+============================================================
+
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4878643.txt (TXT)
+============================================================
+
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4887388.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4895379.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4897958.txt (TXT)
+============================================================
+
+ THE STATE OF SOUTH CAROLINA
+ In The Court of Appeals
+
+ Zurich American Insurance Company of Illinois,
+ Respondent,
+
+ v.
+
+ Palmetto Contract Services, Inc., Appellant.
+
+ Appellate Case No. 2018-000692
+
+
+ Appeal from Charleston County
+ Kristi Lea Harrington, Circuit Court Judge
+
+ Opinion No. 5833
+ Heard November 3, 2020 – Filed July 7, 2021
+
+
+ AFFIRMED
+
+
+ William A. Scott, of Pedersen & Scott, PC, of Charleston,
+ for Appellant.
+
+ Larry D. Cohen, of Larry D. Cohen LLC, and Carolyn H.
+ Blue, both of Charleston, for Respondent
+
+
+GEATHERS, J.: In this breach of contract action, Appellant Palmetto Contract
+Services, Inc. (Palmetto) appeals the circuit court's order granting Respondent
+Zurich American Insurance Company's (Zurich) motion to strike Palmetto's jury trial
+demand. Palmetto argues it revived its right to a jury trial when it raised
+counterclaims for the first time in its amended answer and counterclaim.
+Additionally, Palmetto asserts its counterclaims raised new issues of fact that also
+revived its right to a jury trial. We affirm.
+
+ FACTS/PROCEDURAL HISTORY
+ In February 2012, Palmetto entered into a contract with Zurich for workers'
+compensation and employers' liability insurance coverage. After a premium audit,
+Zurich determined Palmetto owed it additional premiums in the amount of $158,744.
+
+ On December, 11, 2015, Zurich sued Palmetto for breach of contract, seeking
+to recoup the unpaid premiums, accrued and post-judgment interest, costs, and any
+other relief to which it may have been entitled. Palmetto answered on February 16,
+2016, denying Zurich's allegations and asserting the following defenses: failure to
+mitigate damages; waiver, estoppel, laches; and fraud. Neither party demanded a
+jury trial in its initial pleading.
+
+ On July 12, 2016, Palmetto filed a motion to amend its answer and assert
+counterclaims. Palmetto's proposed amended answer and counterclaim added the
+following: a defense of full accord and satisfaction; a defense of setoff—asserting
+Zurich's claims must be reduced by the amount paid for the value of the work
+performed; a counterclaim for negligent representation and fraud; and a
+counterclaim for breach of contract.
+
+ As to the counterclaims for negligent representation and fraud, Palmetto
+asserted Zurich previously classified some of Palmetto's employees under National
+Council on Compensation Insurance (NCCI) code 3040. However, Palmetto
+contended, as a result of Zurich's audit, Zurich determined that those employees
+should have been listed under code 6824F. This caused Zurich to invoice Palmetto
+for the unpaid premiums. Palmetto argued the following: (1) the representation that
+Zurich would properly classify employees under code 3040 and bill Palmetto
+accordingly was false and material; (2) Zurich "knew the representations . . . were
+false" and "intended that the representations be acted upon"; (3) "Palmetto did not
+know that the representations were false[] and relied on the representations"; (4)
+Zurich had a pecuniary interest in making the false representations; (5) Zurich had a
+duty of care to provide truthful information to Palmetto—which it breached by
+failing to properly communicate information regarding class codes to Palmetto; (6)
+"Palmetto had a right to rely on the representations in the agreement"; and (7) as a
+result of the negligent misrepresentations and fraud, Palmetto incurred actual,
+incidental, and unspecified damages. As to the counterclaim for breach of contract,
+Palmetto asserted "Zurich breached the contract by failing to classify operations
+properly and improperly billing Palmetto." Palmetto did not request a jury trial at
+the time it filed its motion to amend. Zurich opposed Palmetto's motion to amend
+its answer.
+ A hearing on the motion was held on September 19, 2017. Zurich argued it
+was prejudiced by the potential amendment because it would not be able to seek a
+jury trial if it so desired. Zurich clarified, however, that it was not requesting a jury
+trial at that time. The court granted Palmetto's motion to amend and instructed
+Palmetto to "put it in the order that [it] consent[ed] to a jury trial if [Zurich] desires
+a jury trial . . . ." The court found no prejudice in granting the motion because
+Palmetto's original answer included "issues of fraud and misrepresentation" and
+Palmetto consented to a jury trial if Zurich requested one.
+
+ Subsequently, on September 27, 2017, Palmetto filed its amended answer and
+counterclaim, designated "(Jury Trial)" below the document's title. Thereafter, the
+clerk's office placed the case on the jury roster. Zurich objected to the transfer to the
+jury roster and moved to strike Palmetto's jury trial demand, arguing Palmetto
+waived its right to a jury trial when it did not demand a jury trial following its initial
+answer and that the amended answer and counterclaim did not revive the right to a
+jury trial because it was not based upon new issues of fact pursuant to King v.
+Shorter.1 Zurich contended Palmetto's allegations were based upon the same issues
+and facts raised in Zurich's complaint and Palmetto's initial answer. Zurich further
+noted that the court's order granting Palmetto's motion to amend its answer stated
+Palmetto raised the same issues as previously pled.
+
+ A hearing on Zurich's motion to strike was held before the circuit court on
+March 6, 2018. At the hearing, Palmetto argued that the counterclaims asserted in
+the amended answer were new issues of fact not in the original pleading, and
+therefore, it was allowed to demand a jury trial under King. Additionally, Palmetto
+noted that Zurich had previously argued against Palmetto's motion to amend by
+stating Zurich would not have the ability to seek a jury trial.
+
+ On March 8, 2018, the circuit court issued an order granting Zurich's motion
+to strike Palmetto's jury trial demand pursuant to Rule 38(d), SCRCP and King. The
+circuit court found Palmetto's amended answer and counterclaim did not create new
+issues of fact. This appeal followed.
+
+ ISSUE ON APPEAL
+
+
+1
+ 291 S.C. 501, 503, 354 S.E.2d 402, 403 (Ct. App. 1987) (finding the circuit court
+did not abuse its discretion by allowing the defendant to amend his pleading, while
+simultaneously denying his motion to transfer the case to the jury calendar, because
+the amended pleading did not create new issues of fact).
+ Did the circuit court err by finding Palmetto's amended answer did not entitle
+it to a jury trial?
+
+ STANDARD OF REVIEW
+
+ As an initial matter, the parties disagree on the appropriate standard of review
+for this appeal. Unlike a jury trial request under Rule 39(b), SCRCP,2 the decision
+of whether to order a jury trial under Rule 38 is not discretionary with the circuit
+court. See Lester v. Dawson, 327 S.C. 263, 267, 491 S.E.2d 240, 242 (1997) ("Rule
+38 concerns trial by jury as of right. Rule 39(b), on the other hand, allows the
+[circuit] court discretion to order a jury or non-jury trial."). In Dawson, the supreme
+court found that because the decision of whether to order a jury trial pursuant to a
+Rule 38 request was not discretionary, the appellant's failure to immediately appeal
+the circuit court's denial of his request for a jury trial under Rule 38 barred his appeal
+of the issue. Id. at 266–67, 491 S.E.2d at 241–42. Like the appellant in Dawson,
+Palmetto is challenging the circuit court's denial of its pretrial jury demand under
+Rule 38. See id. Here, the issue is not whether Palmetto waived its right to a jury
+trial; rather, the sole issue is whether the amended answer and counterclaim revived
+Palmetto's previously waived right to a jury under Rule 38. Because this is a
+question of law, the proper standard of review is de novo. See Verenes v. Alvanos,
+387 S.C. 11, 15, 690 S.E.2d 771, 772 (2010) ("Whether a party is entitled to a jury
+trial is a question of law."); California Scents v. Surco Prod., Inc., 406 F.3d 1102,
+
+
+
+2
+ Rule 39 states in relevant part
+
+ (a) By Jury. . . . The trial of all issues so demanded shall
+ be by jury, unless . . . the court upon motion or its own
+ initiative finds that a right of trial by jury of some or all of
+ those issues does not exist.
+ (b) By the Court. Issues of law and issues not demanded
+ for trial by jury as provided in Rule 38 shall be tried by the
+ court or may be referred to a master as provided in Rule
+ 53; but, notwithstanding the failure of a party to demand a
+ jury in an action in which such a demand might have been
+ made of right, the court in its discretion upon motion may
+ order a trial by jury of any or all issues.
+
+(Emphasis added).
+ 1105 (9th Cir. 2005) ("Entitlement to a jury trial is a question of law reviewed de
+novo.").3
+
+ LAW/ANALYSIS
+
+ Rule 38(b), SCRCP, provides that
+
+ [a]ny party may demand a trial by jury of any issue triable
+ of right by a jury by serving upon the other parties a
+ demand therefor in writing at any time after the
+ commencement of the action and not later than 10 days
+ after the service of the last pleading directed to such issue.
+ Such demand may be endorsed upon a pleading of the
+ party.
+
+(emphasis added). Subsection (d) further states that "[t]he failure of a party to serve
+a demand as required by this rule and to file it as required by Rule 5(d) constitutes a
+waiver by him of trial by jury." Rule 38(d), SCRCP. Accordingly, a party's right to
+a jury trial is waived if a demand is not served within ten days of service of "the last
+pleading directed to such issue." Rule 38(b). Because Rule 38 is substantially the
+same as Fed. R. Civ. P. 38, this court has analyzed federal case law interpreting the
+federal rule when deciding on issues related to our state rule. See King, 291 S.C. at
+503, 354 S.E.2d at 403.
+
+ Palmetto concedes it did not demand a jury trial within ten days after the
+service of its initial answer. However, it contends its right to a jury trial was revived
+because it asserted affirmative claims against Zurich for the first time in its amended
+answer and counterclaim. Palmetto maintains that based on this assertion, which
+distinguishes it from King, the circuit court erred in finding it was not entitled to a
+jury trial pursuant to King. Furthermore, Palmetto contends that there are different
+
+
+3
+ In King, the court of appeals stated that the circuit court "did not abuse [its]
+discretion in either allowing [defendant]'s amended pleading or in denying his
+motion to transfer the case to the jury calendar." 291 S.C. at 503, 354 S.E.2d at 403.
+However, that ruling was in the context of the circuit court's discretion to allow the
+defendant to amend his pleading—which is unarguably reviewed for an abuse of
+discretion. See id.; Foggie v. CSX Transp., Inc., 313 S.C. 98, 22, 431 S.E.2d 587,
+590 (1993) ("It is well established that a motion to amend is addressed to the sound
+discretion of the [circuit court]. . . .").
+ issues and facts in its amended answer and counterclaim that also revived its right to
+a jury trial. We disagree.
+
+ In King, the plaintiff brought suit over a note he co-signed as endorser and
+had to pay for the defendant. 291 S.C. at 502, 354 S.E.2d at 402. The defendant
+answered, asserting fraud and coercion defenses, and counterclaimed for (1)
+malpractice, (2) fraud and deceit, and (3) breach of trust and fiduciary relationship.
+Id. The defendant did not make a demand for a jury trial. Id. Thereafter, the
+defendant amended his answer and added an additional counterclaim for outrage.
+Id. at 502, 354 S.E.2d at 402–03. After the plaintiff abandoned a motion to amend
+his complaint, which he had previously served on the defendant, the defendant yet
+again moved to amend his answer and counterclaim to assert an action for unfair
+trade practices and to transfer the case to the jury calendar. Id. The circuit court
+denied the motion to transfer but allowed the defendant to amend his answer and
+counterclaim. Id.
+
+ In affirming the circuit court's ruling, the court of appeals noted that under
+federal cases on the issue, "a litigant's entitlement to a jury trial on the issues
+presented by an amended pleading, when no prior demand for a jury trial has been
+made, turns on whether the amended pleadings create new issues of fact." Id. at 503,
+354 S.E.2d at 403 (emphases added). The court did not provide any caveats to the
+rule—and certainly no caveats intimating that the new issues presented by the
+amended pleadings could in fact be issues of law and not fact. See id. Instead, by
+its incorporation of Trixler Brokerage Co. v. Ralston Purina Co., the court of appeals
+confirmed that the presentation of a new theory of recovery in an amended pleading
+does not constitute the presentation of a new issue on which a jury trial should be
+granted. See id. at 503, 354 S.E.2d at 403; Trixler Brokerage Co., 505 F.2d 1045,
+1050 (9th Cir. 1974) ("The theory of a case relates to the ultimate basis of liability[]
+rather than to an issue created by the pleadings."); id. ("When read in context, the
+word issue must have been intended by the Supreme Court to mean nothing other
+than an issue of fact. Obviously, appellant would not be demanding a jury trial on
+an issue of law."); see also New Hampshire Fire Ins. Co. v. Perkins, 28 F.R.D. 588,
+590 (D. Del. 1961) ("The authorities are uniform that when a [party] has waived a
+jury trial and subsequently files an amendment to the [pleading] which does not
+change the nature of the case or introduce new issues, such amendment does not
+entitle the [party] to demand a jury trial as a matter of right and over objection[]
+pursuant to Rule 38(b)." (quoting Reeves v. Pennsylvania R. Co., 9 F.R.D. 487, 488
+(D. Del. 1949))). This rule applies equally to amendments by plaintiffs and
+defendants. See Perkins, 28 F.R.D. at 590–91.
+ Given the jury's role as the finder of fact, it is logical "that the jury trial right
+extends only to disputed factual conclusions." See Rosen v. Dick, 639 F.2d 82, 94
+(2d Cir. 1980). Once a party denies an allegation, both parties are then made aware
+that an issue of fact exists. See id. ("Rule 38(b) [] allows a party to wait for a
+responsive pleading which shows whether an issue of fact exists before making the
+jury demand."); Trixler Brokerage Co., 505 F.2d at 1050 ("An issue of fact does not
+exist unless there is an allegation and a responsive denial."). If a party
+
+============================================================
+SOURCE: case_4899982.txt (TXT)
+============================================================
+
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_4991933.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_5145599.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_527912.txt (TXT)
+============================================================
+
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_5287627.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_6236874.txt (TXT)
+============================================================
+
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7308214.txt (TXT)
+============================================================
+
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7308416.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7310338.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7310503.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7312057.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7312590.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7317007.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7317136.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7317628.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7318430.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7318804.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7320970.txt (TXT)
+============================================================
+
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7321370.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7323225.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7328111.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7330465.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Yahoo! Inc. Customer Data Sec. Breach Litig.
+COURT: District Court, N.D. California
+DATE FILED: 2018-03-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Customer Data Sec. Breach Litig.
+COURT: District Court, N.D. California
+DATE FILED: 2018-03-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Customer Data Sec. Breach Litig.
+COURT: District Court, N.D. California
+DATE FILED: 2018-03-09
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7331015.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Papst Licensing GMBH & Co. KG Patent Litig.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Papst Licensing GMBH & Co. KG Patent Litig.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Papst Licensing GMBH & Co. KG Patent Litig.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7332263.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Biogen 755 Patent Litig.
+COURT: District Court, D. New Jersey
+DATE FILED: 2018-09-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biogen 755 Patent Litig.
+COURT: District Court, D. New Jersey
+DATE FILED: 2018-09-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biogen 755 Patent Litig.
+COURT: District Court, D. New Jersey
+DATE FILED: 2018-09-07
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7335955.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re 21ST Century Oncology Customer Data Sec. Breach Litig.
+COURT: District Court, M.D. Florida
+DATE FILED: 2019-03-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re 21ST Century Oncology Customer Data Sec. Breach Litig.
+COURT: District Court, M.D. Florida
+DATE FILED: 2019-03-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re 21ST Century Oncology Customer Data Sec. Breach Litig.
+COURT: District Court, M.D. Florida
+DATE FILED: 2019-03-11
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_7861730.txt (TXT)
+============================================================
+
+LEGAL OPINION: In Re: Match Group Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2022-09-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Match Group Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2022-09-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Match Group Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2022-09-01
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_806779.txt (TXT)
+============================================================
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-08-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_810679.txt (TXT)
+============================================================
+
+LEGAL OPINION: Flo Healthcare Solutions, LLC v. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Flo Healthcare Solutions, LLC v. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Flo Healthcare Solutions, LLC v. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2012-10-23
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8282160.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Medtronic, Inc. Shareholder Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2017-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Medtronic, Inc. Shareholder Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2017-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Medtronic, Inc. Shareholder Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2017-08-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8354789.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Polymedica Corp. Shareholder Derivative Litigation
+COURT: Massachusetts Superior Court
+DATE FILED: 2002-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Polymedica Corp. Shareholder Derivative Litigation
+COURT: Massachusetts Superior Court
+DATE FILED: 2002-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Polymedica Corp. Shareholder Derivative Litigation
+COURT: Massachusetts Superior Court
+DATE FILED: 2002-07-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8448365.txt (TXT)
+============================================================
+
+LEGAL OPINION: Hilton-Bey v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2003-11-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Hilton-Bey v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2003-11-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Hilton-Bey v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2003-11-10
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8696115.txt (TXT)
+============================================================
+
+LEGAL OPINION: Contract Design Group, Inc. v. Wayne State University
+COURT: Court of Appeals for the Sixth Circuit
+DATE FILED: 2015-12-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Contract Design Group, Inc. v. Wayne State University
+COURT: Court of Appeals for the Sixth Circuit
+DATE FILED: 2015-12-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Contract Design Group, Inc. v. Wayne State University
+COURT: Court of Appeals for the Sixth Circuit
+DATE FILED: 2015-12-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8702285.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Manchak Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2002-12-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Manchak Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2002-12-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Manchak Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2002-12-20
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8715026.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Bear Creek Technologies, Inc., ('722) Patent Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2012-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Bear Creek Technologies, Inc., ('722) Patent Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2012-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Bear Creek Technologies, Inc., ('722) Patent Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2012-05-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8716217.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Webyention LLC '294 Patent Litigation
+COURT: District Court, D. Maryland
+DATE FILED: 2012-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Webyention LLC '294 Patent Litigation
+COURT: District Court, D. Maryland
+DATE FILED: 2012-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Webyention LLC '294 Patent Litigation
+COURT: District Court, D. Maryland
+DATE FILED: 2012-06-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8720378.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2012-10-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2012-10-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2012-10-11
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8721068.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Abbott Depakote Shareholder Derivative Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2012-11-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Abbott Depakote Shareholder Derivative Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2012-11-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Abbott Depakote Shareholder Derivative Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2012-11-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8726267.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-06-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8729134.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-10-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-10-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Capital One Derivative Shareholder Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2013-10-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8731416.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2014-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2014-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sony Gaming Networks & Customer Data Security Breach Litigation
+COURT: District Court, S.D. California
+DATE FILED: 2014-01-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8761497.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Rivastigmine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-08-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Rivastigmine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-08-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Rivastigmine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-08-08
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8762368.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Rivastigimine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Rivastigimine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Rivastigimine Patent Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2006-11-22
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8780304.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Onstar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2011-12-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Onstar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2011-12-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Onstar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2011-12-19
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8787738.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Sandridge Energy, Inc. Shareholder Derivative Litigation
+COURT: District Court, W.D. Oklahoma
+DATE FILED: 2014-09-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sandridge Energy, Inc. Shareholder Derivative Litigation
+COURT: District Court, W.D. Oklahoma
+DATE FILED: 2014-09-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Sandridge Energy, Inc. Shareholder Derivative Litigation
+COURT: District Court, W.D. Oklahoma
+DATE FILED: 2014-09-22
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8789780.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2015-09-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2015-09-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2015-09-15
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8805033.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Embro Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1971-03-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Embro Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1971-03-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Embro Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1971-03-05
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_8812844.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Camco Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1972-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Camco Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1972-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Camco Patent Infringement Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 1972-06-21
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9353423.txt (TXT)
+============================================================
+
+LEGAL OPINION: Duffy v. Camp
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2022-12-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Duffy v. Camp
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2022-12-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Duffy v. Camp
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2022-12-20
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9370607.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re McDonald's Corporation Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-01-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re McDonald's Corporation Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-01-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re McDonald's Corporation Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-01-25
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9398695.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-05-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-05-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-05-12
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9429714.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re ProAssurance Corp. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re ProAssurance Corp. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re ProAssurance Corp. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-10-02
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9442920.txt (TXT)
+============================================================
+
+LEGAL OPINION: Contract Datascan Holdings, Inc. Contract Datascan, LP D/B/A the Inventory Extras And Gwyn Nicole Snead v. Retail Services WIS Corporation D/B/A WIS International Inc.
+COURT: Texas Court of Appeals, 2nd District (Fort Worth)
+DATE FILED: 2023-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Contract Datascan Holdings, Inc. Contract Datascan, LP D/B/A the Inventory Extras And Gwyn Nicole Snead v. Retail Services WIS Corporation D/B/A WIS International Inc.
+COURT: Texas Court of Appeals, 2nd District (Fort Worth)
+DATE FILED: 2023-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Contract Datascan Holdings, Inc. Contract Datascan, LP D/B/A the Inventory Extras And Gwyn Nicole Snead v. Retail Services WIS Corporation D/B/A WIS International Inc.
+COURT: Texas Court of Appeals, 2nd District (Fort Worth)
+DATE FILED: 2023-11-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9456258.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-12-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-12-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2023-12-29
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9473109.txt (TXT)
+============================================================
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-02-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-02-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-02-07
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9479368.txt (TXT)
+============================================================
+
+Contract Pharmacal Corp. v Air Indus. Group ( 2024 NY Slip Op 00995 )
+
+
+
+
+
+ Contract Pharmacal Corp. v Air Indus. Group
+
+
+ 2024 NY Slip Op 00995
+
+
+ Decided on February 28, 2024
+
+
+ Appellate Division, Second Department
+
+
+
+ Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.
+
+
+ This opinion is uncorrected and subject to revision before publication in the Official Reports.
+
+
+
+Decided on February 28, 2024
+SUPREME COURT OF THE STATE OF NEW YORK
+Appellate Division, Second Judicial Department
+
+ ANGELA G. IANNACCI, J.P.
+ WILLIAM G. FORD
+ HELEN VOUTSINAS
+ LOURDES M. VENTURA, JJ.
+
+
+ 2022-01049
+ 2022-01050
+ (Index No. 619183/18)
+
+ [*1]Contract Pharmacal Corp., appellant,
+ v Air Industries Group, respondent.
+
+
+ Weber Law Group LLP, Melville, NY (Jason A. Stern of counsel), for appellant.
+ John R. Byrnes, Sayville, NY, for respondent.
+
+
+
+ DECISION ORDER
+ In an action, inter alia, to recover damages for breach of contract, the plaintiff appeals from (1) an order of the Supreme Court, Suffolk County (Elizabeth Hazlitt Emerson, J.), dated July 8, 2021, and (2) an order of the same court dated November 30, 2021. The order dated July 8, 2021, insofar as appealed from, denied those branches of the plaintiff's motion which were for leave to amend the complaint to add a cause of action alleging anticipatory breach of contract and for summary judgment on the amended complaint. The order dated November 30, 2021, insofar as appealed from, upon reargument, adhered to the determination in the order dated July 8, 2021, denying that branch of the plaintiff's motion which was for leave to amend the complaint to add a cause of action alleging anticipatory breach of contract.
+ ORDERED that the appeal from so much of the order dated July 8, 2021, as denied that branch of the plaintiff's motion which was for leave to amend the complaint to add a cause of action alleging anticipatory breach of contract is dismissed, as that portion of the order was superseded by the order dated November 30, 2021, made upon reargument; and it is further,
+ ORDERED that the order dated July 8, 2021, is affirmed insofar as reviewed; and it is further,
+ ORDERED that the order dated November 30, 2021, is affirmed insofar as appealed from; and it is further,
+ ORDERED that one bill of costs is awarded to the defendant.
+ The plaintiff commenced this action, inter alia, to recover damages for breach of contract. The plaintiff moved, among other things, for leave to amend the complaint to add a cause of action alleging anticipatory breach of contract and for summary judgment on the amended complaint. In an order dated July 8, 2021, the Supreme Court, inter alia, denied those branches of the plaintiff's motion. The plaintiff thereafter moved for leave to reargue that branch of its motion which was for leave to amend the complaint to add a cause of action alleging anticipatory breach of contract. In an order dated November 30, 2021, the court, upon reargument, adhered to the prior determination denying that branch of the plaintiff's motion which was for leave to amend the [*2]complaint to add a cause of action alleging anticipatory breach of contact. The plaintiff appeals.
+ "Although leave to amend a pleading should be freely given in the absence of prejudice or surprise to the opposing party ( see CPLR 3025[b]), the motion should be denied where the proposed amendment is palpably insufficient or patently devoid of merit" ( Jacob Post, Inc. v Samuel Hampton, LLC , 216 AD3d 625 , 626; see Bank of Am., N.A. v Anderson , 216 AD3d 890 , 891-892). When one party to a contract commits an anticipatory breach, the nonbreaching party must choose one of two options: either treat the contract as terminated and seek damages, or ignore the breach and wait for the breaching party to perform ( see Princes Point LLC v Muss Dev. L.L.C. , 30 NY3d 127 , 133; S.E.M. Sec. Sys., Inc. v Earl Lorence Enters. , 120 AD3d 1211, 1214 ). The nonbreaching party must "make an election and cannot 'at the same time treat the contract as broken and subsisting. One course of action excludes the other'" ( Inter-Power of N.Y. v Niagara Mohawk Power Corp. , 259 AD2d 932, 934 , quoting Strasbourger v Leerburger , 233 NY 55, 59 ). "In determining which election the nonbreaching party has made, 'the operative factor . . . is whether the non-breaching party has taken an action (or failed to take an action) that indicated to the breaching party that [it] had made an election'" ( AG Props. of Kingston, LLC v Besicorp-Empire Dev. Co., LLC , 14 AD3d 971, 973 , quoting Bigda v Fischbach Corp. , 898 F Supp 1004, 1013 [SD NY], affd 101 F3d 108 [2d Cir]). Once the nonbreaching party has chosen a remedy, the choice becomes binding and cannot be altered ( see Lucente v International Bus. Machs. Corp. , 310 F3d 243, 258-259 [2d Cir]). Accordingly, asserting a cause of action alleging breach of contract precludes pleading a cause of action alleging anticipatory breach of contract ( see id. at 258-260 ).
+ Here, the plaintiff, in the complaint, asserted a cause of action to recover damages for breach of contract. In doing so, the plaintiff elected its remedy and communicated that choice to the defendant. Inasmuch as simultaneous prosecution of causes of action alleging breach of contract and alleging anticipatory breach of contract is barred, the proposed amendment to add a cause of action alleging anticipatory breach of contract was patently devoid of merit. Accordingly, upon reargument, the Supreme Court properly adhered to the prior determination denying that branch of the plaintiff's motion which was for leave to amend the complaint to add such a cause of action.
+ The plaintiff moved for summary judgment on the proposed amended complaint at the same time that it sought leave to amend. As the amended complaint had not yet been served, issue had not been joined. Consequently, the Supreme Court properly denied that branch of the plaintiff's motion which was for summary judgment on the amended complaint ( see CPLR 3212[a]; City of Rochester v Chiarella , 65 NY2d 92 , 101; OneWest Bank, FSB v Bernstein , 196 AD3d 591 , 591).
+ IANNACCI, J.P., FORD, VOUTSINAS and VENTURA, JJ., concur.
+ENTER:
+ Darrell M. Joseph
+ Acting Clerk of the Court
+
+============================================================
+SOURCE: case_9482166.txt (TXT)
+============================================================
+
+LEGAL OPINION: Innovative Architectural Planners, Inc. v. Ohio Dept. of Adm. Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2024-03-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Architectural Planners, Inc. v. Ohio Dept. of Adm. Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2024-03-07
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Architectural Planners, Inc. v. Ohio Dept. of Adm. Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2024-03-07
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9493471.txt (TXT)
+============================================================
+
+LEGAL OPINION: Travinski v. General Ins. Co. of America
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-04-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Travinski v. General Ins. Co. of America
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-04-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Travinski v. General Ins. Co. of America
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-04-16
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9499245.txt (TXT)
+============================================================
+
+LEGAL OPINION: Cognizant Technology Solutions Corp Derivative Lit v.
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2024-05-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cognizant Technology Solutions Corp Derivative Lit v.
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2024-05-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cognizant Technology Solutions Corp Derivative Lit v.
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2024-05-03
+SNIPPET & HOLDING:
+
+
+
+============================================================
+SOURCE: case_9506898.txt (TXT)
+============================================================
+
+LEGAL OPINION: United Cleaning & Restoration, LLC v. Bank of America, N.A.
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: United Cleaning & Restoration, LLC v. Bank of America, N.A.
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: United Cleaning & Restoration, LLC v. Bank of America, N.A.
+COURT: Connecticut Appellate Court
+DATE FILED: 2024-05-28
+SNIPPET & HOLDING:
+
diff --git a/data/agents/legal_agent/metadata.json b/data/agents/legal_agent/metadata.json
new file mode 100644
index 0000000000000000000000000000000000000000..2477ca5f98ffccc078b9eb02090bbe79723193cf
--- /dev/null
+++ b/data/agents/legal_agent/metadata.json
@@ -0,0 +1,363 @@
+{
+ "agent_name": "legal_agent",
+ "system_prompt": "You are an expert legal AI assistant specialized in contract law, intellectual property, and corporate governance.",
+ "prompt_analysis": {
+ "domain": "legal",
+ "sub_domains": [],
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diff --git a/data/agents/medical_agent/context.txt b/data/agents/medical_agent/context.txt
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index 0000000000000000000000000000000000000000..154a045e01ea66a2939bbaad8913964d60562083
--- /dev/null
+++ b/data/agents/medical_agent/context.txt
@@ -0,0 +1,2604 @@
+
+============================================================
+SOURCE: PMC10050065.txt (TXT)
+============================================================
+
+Medulloblastoma in adults: evaluation of the Dutch society for neuro-oncology treatment protocol
+
+The incidence of medulloblastomas and primitive neurectodermal tumours in adults and children
+
+CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007–2011
+
+The 2007 WHO classification of tumours of the central nervous system
+
+Novel molecular subgroups for clinical classification and outcome prediction in childhood medulloblastoma: a cohort study
+
+Intertumoral heterogeneity within medulloblastoma subgroups
+
+Brain tumour diagnostics using a DNA methylation-based classifier as a diagnostic support tool
+
+The 2021 WHO classification of tumors of the central nervous system: a summary
+
+Adult medulloblastoma: multiagent chemotherapy
+
+EANO-EURACAN clinical practice guideline for diagnosis, treatment, and follow-up of post-pubertal and adult patients with medulloblastoma
+
+Long-term results of a prospective study on the treatment of medulloblastoma in adults
+
+Pathology databanking and biobanking in the Netherlands, a central role for PALGA, the Nationwide histopathology and cytopathology data network and archive
+
+DNA methylation-based classification of central nervous system tumours
+
+Practical implementation of DNA methylation and copy-number-based CNS tumor diagnostics: the Heidelberg experience
+
+Clinical evaluation of a dedicated next generation sequencing panel for routine glioma diagnostics
+
+Medulloblastoma in adults: treatment protocol Dutch Society for Neuro-Oncology
+
+Adjuvant chemotherapy and overall survival in adult medulloblastoma
+
+Proton beam craniospinal irradiation reduces acute toxicity for adults with medulloblastoma
+
+Multicenter pilot study of radiochemotherapy as first-line treatment for adults with medulloblastoma (NOA-07)
+
+Chemotherapy increases long-term survival in patients with adult medulloblastoma–a literature-based meta-analysis
+
+Integrated molecular analysis of adult sonic hedgehog (SHH)-activated medulloblastomas reveals two clinically relevant tumor subsets with VEGFA as potent prognostic indicator
+
+Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: a prospective observational multicentre study
+
+Risk stratification of childhood medulloblastoma in the molecular era: the current consensus
+
+Subgroup and subtype-specific outcomes in adult medulloblastoma
+
+Genome sequencing of SHH medulloblastoma predicts genotype-related response to smoothened inhibition
+
+Subgroup-specific prognostic implications of TP53 mutation in medulloblastoma
+
+TERT promoter mutations are highly recurrent in SHH subgroup medulloblastoma
+
+Preradiation chemotherapy for adult high-risk medulloblastoma: a trial of the ECOG-ACRIN Cancer Research Group (E4397)
+
+Phase I and phase II sonidegib and vismodegib clinical trials for the treatment of paediatric and adult MB patients: a systemic review and meta-analysis
+
+Purpose
+
+Medulloblastoma is a rare tumor in adults. The objective of this nationwide, multicenter study was to evaluate the toxicity and efficacy of the Dutch treatment protocol for adult medulloblastoma patients.
+
+Methods
+
+Adult medulloblastoma patients diagnosed between 2010 and 2018 were identified in the Dutch rare tumors registry or nationwide pathology database. Patients with intention to treat according to the national treatment protocol were included. Risk stratification was performed based on residual disease, histological subtype and extent of disease. All patients received postoperative radiotherapy [craniospinal axis 36 Gy/fossa posterior boost 19.8 Gy (14.4 Gy in case of metastases)]. High-risk patients received additional neoadjuvant (carboplatin-etoposide), concomitant (vincristine) and adjuvant chemotherapy (carboplatin-vincristine-cyclophosphamide) as far as feasible by toxicity. Methylation profiling, and additional next-generation sequencing in case of SHH-activated medulloblastomas, were performed.
+
+Results
+
+Forty-seven medulloblastoma patients were identified, of whom 32 were treated according to the protocol. Clinical information and tumor material was available for 28 and 20 patients, respectively. The histological variants were mainly classic (43%) and desmoplastic medulloblastoma (36%). Sixteen patients (57%) were considered standard-risk and 60% were SHH-activated medulloblastomas. Considerable treatment reductions and delays in treatment occurred due to especially hematological and neurotoxicity. Only one high-risk patient could complete all chemotherapy courses. 5-years progression-free survival (PFS) and overall survival (OS) for standard-risk patients appeared worse than for high-risk patients (PFS 69% vs. 90%, OS 81% vs. 90% respectively), although this wasn’t statistically significant.
+
+Conclusion
+
+Combined chemo-radiotherapy is a toxic regimen for adult medulloblastoma patients that may result in improved survival.
+
+Introduction
+
+Medulloblastoma is a Central Nervous System (CNS) WHO grade 4 primary brain tumor located in the cerebellum. The incidence of medulloblastoma in adults is approximately 0.6 per 1,000,000 per year, compared to 4.1 per 1,000,000 in children [ 1 , 2 ]. The 2007 WHO classification of CNS tumors divided medulloblastomas into five histological variants: desmoplastic, classic, anaplastic, large cell and medulloblastoma with extensive nodularity [ 3 ]. More recently, various molecular subgroups have been recognized with distinct clinical behavior and outcomes [ 4 , 5 ]. Methylation-based classification changed the diagnostic approach and made it possible to diagnose brain tumors more precisely [ 6 ]. In the 2021 WHO classification of CNS tumors, the medulloblastoma types are designated as WNT-activated, SHH-activated/ TP53 -wildtype, SHH-activated/ TP53 -mutant and non-WNT/non-SHH (Group 3/4) [ 7 ].
+
+Most treatment protocols for adult medulloblastoma patients are based on studies in children, due to limited availability of (prospective) studies in adults. However, adults tolerate chemotherapy less well than children [ 8 , 9 ]. In 2010, in order to standardize treatment, the Dutch Society for Neuro-Oncology (LWNO) developed a treatment protocol for adult medulloblastoma patients based on the available literature at a time when only one prospective study on treatment of adult medulloblastoma had been published [ 10 ]. Since 2010, the large majority of adult medulloblastoma patients in the Netherlands have been treated according to this national treatment protocol. In this nation-wide study, we report the toxicity and efficacy of the treatment regime described in this protocol using an intention-to-treat analysis and correlate the clinical features and outcome to molecular characteristics.
+
+Materials and methods
+
+Patient and tumor material
+
+Adult patients (18 years or older) diagnosed with a medulloblastoma between January 1st 2010 and October 15th 2018 were included if the treatment was intended to follow the national treatment protocol (see below). To collect all data, treated patients were identified from the prospective Dutch rare tumors registry and from the PALGA-database, a Dutch nationwide network and pathology registry. Pathology laboratories send all excerpts (summary of original pathology report including coding lines and pathologist’s conclusion) to this database, which is then encoded by a Trusted Third Party (ZorgTTP) [ 11 ]. All patients provided written informed consent and the study was approved by the Medical Ethics Review Committees of the Erasmus Medical Centre (EMC) and other participating institutions (after co-assessment).
+
+Molecular analysis
+
+FFPE tissue sections, mounted on glass slides were scored by a neuropathologist (MK) to identify areas with high tumor content. Selected areas were macrodissected from adjacent unstained slides (IdH) and DNA was extracted using the QIAamp DNA FFPE Tissue Kit: Cat. No./ID: 56404 and run on Illumina Infinium Human Methylation EPIC arrays to obtain genome-wide DNA methylation profiles. Data were uploaded to the DKFZ/Heidelberg Brain tumor classifier (version 11b4; www.molecularneuropathology.org [ 12 ]) to provide methylation (sub)class and copy number variation profiles. Data of non-WNT/non-SHH tumors was additionally uploaded to the Medulloblastoma classifier group 3/4 (version 1.0) to determine the subtype. We included all tumors with a calibrated Classifier score of ≥ 0.84 [ 13 ]. For tumors below the cut-off value, we only included samples if there was a plausible explanation for the lower value, such as a rare histological subtype. In SHH-activated medulloblastomas, next-generation sequencing (NGS) was performed to determine the TP53 -status and other mutations. By using a NGS panel frequently mutated genes could be assessed [ 14 ].
+
+Treatment protocol
+
+The national treatment protocol is listed in Fig. 1 A. In brief, primary treatment, i.e. surgical resection, was followed by a postoperative MRI within 72 h. In case of residual disease of > 1.5 cm 2 , a second look operation within 2 weeks was advised, if judged feasible. We divided patients into risk categories, depending on the presence of residual disease of > 1.5 cm 2 , histological subtype (high-risk in case of large cell/anaplastic phenotype) and extent of disease (presence/absence of metastatic dissemination) [ 15 ]. Fig. 1
+
+National treatment protocol ( A ) [ 17 ] and overview of patient selection process ( B )
+
+Standard-risk patients received postoperative craniospinal irradiation (CSI), whereas high-risk patients received additional neoadjuvant, concomitant and adjuvant chemotherapy. The radiotherapy protocol consisted of CSI (36 Gy; 20 × 1.8 Gy) and a boost on the posterior fossa (19.8 Gy; 11 × 1.8 Gy), or if present posterior fossa and metastases (14.4 Gy; 8 × 1.8 Gy), with a total dose of 50.4–55.8 Gy. The radiotherapy dosage was equal for standard and high-risk patients. All patients received photon radiotherapy; proton radiotherapy was not available before 2018. Standard-risk patients started radiotherapy as soon as they had recovered from surgery. This should commence within 4 weeks of surgery, but preferably within 21 days. High-risk patients received two courses of neoadjuvant chemotherapy (every 3 weeks) prior to radiotherapy. Chemotherapy consisted of carboplatin IV AUC 6 mg/ml/min on day 1 and etoposide IV 150 mg/m 2 on days 1–2, preferably starting within 21 days of surgery. Radiotherapy combined with concomitant vincristine (IV 1.5 mg/m 2 (max. 2 mg) every 2 weeks) was aimed to start within 3 weeks of the second neoadjuvant course. Patients started with adjuvant chemotherapy after recovering from radiotherapy, preferably within 4–6 weeks after the last fraction. Post-radiation chemotherapy consisted of four 42-day courses of chemotherapy, with carboplatin IV AUC 6 mg/ml/min on day 1, vincristine IV 1.5 mg/m 2 (max. 2 mg) on days 1, 8 and 15, and cyclophosphamide 750 mg/m 2 on days 22 and 23 (Fig. 1 A). Toxicity was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 [ 16 ]. Dose delays and reductions were collected. Toxicity and dose-intensity analysis was limited to patients who received the first course or fraction of the advised therapy.
+
+Statistical analysis
+
+Patient demographics, tumor and treatment characteristics were summarized using descriptive statistics for quantitative data (median with range, count and percentage). All statistical analyses were performed using SPSS (Version 22). We performed survival analyses for standard/high-risk groups and risk groups per methylation subgroup using Kaplan–Meier analysis. Progression-free (PFS) and overall survival (OS) were defined as the time from date of surgery until date of first event (progression/relapse) or death due to all causes, respectively. A log-rank test was used to test the significant difference. An independent samples t-test was used to test the significant difference between age groups. A p -value of < 0.05 was considered significant.
+
+Results
+
+Patient characteristics
+
+Twenty-nine adult medulloblastoma patients were registered in the Dutch rare tumors registry between January 1, 2010 and October 15, 2018. Eighteen patients were additionally identified in the PALGA-database. Six patients had to be excluded because they were treated in a hospital that followed another treatment protocol. Another 13 cases were excluded for multiple reasons (see Fig. 1 B). Thirty-two patients were treated following the treatment protocol. We received the clinical information and tumor material of 28 and 20 patients, respectively, from 10 neuro-oncology centers. The selection process is shown in Fig. 1 B.
+
+Baseline and treatment characteristics are shown in Table 1 . Eighteen patients were male (64%). Median age was 29.5 years (range 18–46). At time of diagnosis, twenty-three patients (82%) had a good performance status (Karnofsky performance score 70–100). The histological variants were mainly classic (43%) and desmoplastic (36%). Twelve patients (43%) were classified as high-risk. One patient was 17 weeks pregnant at time of diagnosis. Table 1
+
+Baseline and treatment characteristics Number of patients % Median Range Age (median and range in years) 18–46 28 100 29.5 18–46 Gender Male 18 64 – – Female 10 36 – – Karnofsky Performance Score 100 1 4 – – 90 12 43 – – 80 7 25 – – 70 3 11 – – 60 3 11 – – Not reported 2 7 – – WHO-ECOG performance status score 0 2 7 – – 1 19 68 – – 2 6 21 – – Not reported 1 4 – – Localization (several possible) Cerebellum 27 96 – – Leptomeningeal 4 14 – – Brainstem 3 11 – – Spinal cord 1 4 – – Supratentorial 1 4 – – Cerebrospinal fluid 4 14 – – Extra-neural metastases Present 0 0 – – Absent 10 36 – – Examination not performed 18 64 – – Histological diagnosis Classic 12 43 – – Desmoplastic/nodular 10 36 – – Anaplastic 1 4 – – Large cell 0 0 – – Medulloblastoma with extensive nodularity 0 0 – – Not otherwise specified 5 18 – – Molecular subgroups WNT-activated 1 5 – – SHH–activated 12 60 – – Group 3 1 5 – – Group 4 4 20 – – Methylation result unreliable 2 10 – – Extend of resection Total gross resection 14 50 – – Residual tumor ≤ 1.5 cm 2 4 14 – – Residual tumor > 1.5 cm 2 7 25 – – Unknown (no MRI performed) 3 11 – – CSF results Negative 19 68 – – Malignant cells 4 14 – – Unknown (not performed) 5 18 – – Risk group Standard-risk 16 57 – – High-risk 12 43 – – Time to start treatment between (median and range in days) Second surgery (if necessary) 4 – 37 1–64 Last operation and start neoadjuvant therapy 9 – 27 17–52 Last operation and start radiotherapy (standard-risk) 16 – 40 20–161 Last operation and start radiotherapy (high-risk) 10 – 71 38–94 Start neoadjuvant chemotherapy and start radiotherapy 9 – 43 42–49 Start radiotherapy and start adjuvant chemotherapy 10 – 75 67–98
+
+Methylation profiling
+
+Upon methylation profiling the calibrated score for three tumors was below 0.84: one patient had a rare histological subtype, medullomyoblastoma, and was included in our cohort despite the lower Classifier score (0.72). The molecular results of the other two patients were not included. The CNV plot was noisy in one of them suggesting low-quality/technical issues. The most frequent molecular subtype was SHH-activated (60%), followed by non-WNT/non-SHH (25%) and WNT-activated (5%). All desmoplastic medulloblastomas belonged to the SHH-activated subtype. The single WNT-activated tumor had a classic phenotype. The correlation between molecular and histological subtype is shown in Fig. 2 . Patients with SHH-activated medulloblastomas were generally older (median 30 years; range 18–44) compared to those with non-SHH-activated tumors (median 23 years, range 18–28), although this difference was not statistically significant ( p = 0.07). Fig. 2
+
+Clinical and histomolecular profiles
+
+Two SHH-activated medulloblastomas (17%) had subclonal loss of chromosome 10q and chromosome 17p loss. One of them had additional chromosome 3p loss (8%). No non-WNT/non-SHH tumors had chromosome 8p or 8q losses (Fig. 2 ). Additional NGS was performed of 10 SHH-activated medulloblastomas. The NGS result of one tumor was unreliable. A TP53 mutation was found in one of the SHH-activated medulloblastomas. Of additional mutations in SHH-activated tumors, TERT promoter mutation was most frequently observed (90%), followed by PTCH1 (40%), DDX3X (30%) and SMO mutation (20%; Fig. 2 ).
+
+Treatment and toxicities
+
+Treatment
+
+Four of the 28 patients underwent a second operation due to residual tumor. Twenty-six of the 28 patients received the advised radiotherapy dose. Two patients received a lower radiation dose than advised in the treatment protocol without reported reason. In one high-risk patient treatment order was changed due to pregnancy (carboplatin/etoposide courses followed by one course carboplatin/vincristine/cyclophosphamide and, after childbirth, radiotherapy), while one high-risk patient refused all chemotherapy. Neoadjuvant chemotherapy was given to 10 of the 12 high-risk patients. One patient with postoperative meningitis was not given neoadjuvant chemotherapy due to long treatment delay. Eight high-risk patients received vincristine during the radiation phase (67%). Besides the already mentioned pregnancy or chemotherapy refusal, in two other patients no reason for omitting vincristine was given. Adjuvant chemotherapy was started according to treatment protocol in 10 (83%) high-risk patients. We excluded the pregnant and chemotherapy refusing patients for postoperative time to treatment and dose delays/reductions evaluation. Table 1 shows the median treatment intervals. In one of four patients with a second operation, this could be performed within the per-protocol specified treatment window. Half of them had a high-risk subtype. Neoadjuvant chemotherapy started within 21 days of surgery in 30% of the patients (median 27, range 17–52). Radiotherapy started within the per-protocol specified treatment window in only 25% of the standard-risk and 30% of the high-risk patients. Median time between surgery and radiotherapy was 40 days (range 20–161) for standard-risk and 71 days (range 38–94) for high-risk patients, with delay mostly brief (median delay for standard-risk 12 days vs. high-risk 8 days). Postoperative infections were the cause of longer delays. In 70% of the patients who received adjuvant chemotherapy, this was started within the per-protocol specified treatment window [median 75 days after start radiotherapy (range 67–98)].
+
+Dose delays/reductions
+
+The neoadjuvant chemotherapy dose was reduced in one (11%) and 1-week delayed in two (22%) patients. The dose of the second course was not reported in one patient. Seven of the eight patients receiving vincristine during the chemo-radiation phase received the advised three administrations. Radiotherapy was 1-week delayed in one patient (4%). Only one of 10 patients received the total dose of adjuvant chemotherapy as prescribed in the treatment protocol. The dose was reduced or a part of the chemotherapy was discontinued during the adjuvant chemotherapy due to adverse events in nine patients (90%): treatment reductions were made for two patients in the first course (20%), for five patients in the second course (50%) and for eight patients in the third and fourth courses (80%). Adjuvant chemotherapy was completely discontinued after course three in one patient due to toxicity (10%). Especially vincristine was reduced or stopped early due to neuropathy during adjuvant courses. The delays in adjuvant chemotherapy varied between 0 and 5 weeks (median 1 week).
+
+Toxicity
+
+Toxicity could be evaluated in 27 of the 28 patients (Table 2 ). In one high-risk patient, the radiotherapy phase was not reported. The pregnant patient was only included for the neoadjuvant phase, as the treatment changed afterwards. Hematological toxicity, especially leukopenia (33%) and thrombocytopenia (26%), were most frequently reported CTCAE (v4.0) grade 3–4 toxicity in the whole cohort, thereafter gastro-intestinal toxicity (22%) and infections (15%) were reported. In the high-risk group, hematological toxicity was the only high-grade toxicity reported during the neoadjuvant chemotherapy (leukopenia in 20% and thrombocytopenia in 10%). Table 2
+
+Reported hematological and non-hematological toxicity grades 1/2 and 3/4 Reported adverse events during treatment phase Grade 1–2 Grade 3–4 Surgery N N Infection – 3 (11%) Vertigo 1 (4%) – Neoadjuvant chemotherapy N N Leukopenia – 2 (20%) Thrombocytopenia 1 (10%) 1 (10%) Anemia 1 (10%) – Ototoxicity 1 (10%) – Radiotherapy alone (standard-risk) N N Leukopenia 5 (33%) 1 (7%) Thrombocytopenia 5 (33%) – Infection 1 (7%) 1 (7%) Gastro-intestinal 3 (20%) 4 (27%) Fatigue 2 (13%) – Alopecia 1 (7%) – Cutaneous toxicity 2 (13%) – Radiotherapy with concomitant vincristine (high-risk) N N Leukopenia 1 (10%) 1 (10%) Thrombocytopenia 2 (20%) 3 (30%) Anemia 1 (20%) – Gastro-intestinal 5 (50%) 2 (20%) Neurotoxicity 4 (40%) – Fatigue 1 (10%) 1 (10%) Alopecia 1 (10%) – Cutaneous toxicity 2 (20%) – Vertigo 1 (10%) – Hiccup 2 (20%) – Adjuvant chemotherapy N N Leukopenia 1 (10%) 8 (80%) Thrombocytopenia 3 (30%) 5 (50%) Anemia 4 (40%) 2 (20%) Infection 3 (30%) – Neurotoxicity 7 (70%) – Nephrotoxicity – 1 (10%) Fatigue 1 (10%) – Alopecia 2 (20%) – Cutaneous toxicity 1 (10%) – Vertigo 1 (10%) –
+
+According to Common Terminology Criteria for Adverse Events (CTCAE) v4.0 [ 16 ]
+
+Percentages were calculated as the number of patients with reported adverse event divided by the number of patients receiving specific treatment
+
+Especially high-grade gastro-intestinal toxicity, due to radiotherapy, was reported in the standard-risk group (gastrointestinal toxicity 27%, leukopenia 7% and infection 7%). Whereas in the high-risk group treated with chemoradiation, more high-grade (hematological) toxicity occurred (leukopenia 10%, thrombocytopenia 30%, gastrointestinal toxicity 20% and fatigue 10%). Most adverse events were reported during the adjuvant chemotherapy; in 100% of the patients at least one adverse event was reported at that stage. Grade 3–4 thrombocytopenia and leukopenia were reported in 50% and 80% of the patients, respectively. Eighty percent of the patients had at least one high-grade adverse event during treatment. No fatal adverse events occurred.
+
+Survival
+
+The median follow-up time was 67 months (range 8–111). 5-years PFS was 69% for the standard-risk and 90% for the high-risk group ( p = 0.248). 5-years OS was 81% for the standard-risk and 90% for the high-risk group ( p = 0.358). Survival for standard-risk patients seemed worse than for high-risk patients, although this difference was not statistically significant. Also, no significant differences were found for the risk group per methylation subgroup (Fig. 3 ). All patients with either a WNT-activated or high-risk SHH-activated tumor were still alive and without progression at the end of the study period. Three of the five patients with non-WNT/non-SHH tumors had no progression after 5 years (Fig. 3 B). Disease progression was seen in one of four patients with a PTCH1 mutation (25%) and in one of three patients with a SMO mutation (33%) after 25 and 32 weeks, respectively. The only patient with a SHH-activated/ TP53 -mutant medulloblastoma showed progression after 4 years. Fig. 3
+
+Progression-free survival and overall survival for A standard-risk and high-risk groups (log rank PFS p = 0.248 and OS p = 0.358), B by risk group per molecular subgroup (log rank PFS p = 0.338 and OS p = 0.120)
+
+Discussion
+
+In this study, we evaluated the toxicity and efficacy of the Dutch national treatment protocol for patients diagnosed with medulloblastoma in adulthood. As in other series [ 18 ], the median age of patients was in the late 20 s, the majority of patients had a SHH-activated medulloblastoma and were considered standard-risk. All of our patients received photon-CSI, whereas recent literature showed that proton-CSI leads to less treatment-related morbidity [ 19 ]. The chemotherapy treatment schedule was based on previously published regimens for adults but was not tolerated well as only one patient completed all chemotherapy courses. All other patients received adjusted schedules because of toxicity. Especially hematological and gastro-intestinal toxicity were reported frequently. Vincristine was strongly associated with neurotoxicity; early discontinuation during the adjuvant chemotherapy occurred in 50% of the patients. Chemotherapy toxicity also resulted in considerable delays in further treatment. Our data are similar to previous studies showing that adults tolerate chemotherapy poorly compared with children: in the Packer protocol, all adults needed dose reductions due to hematological toxicity, whereas only 14% of the children needed treatment adjustments [ 8 ]. More severe (hematological) adverse events were also found in older patients treated in the NOA-07 trial [ 20 ], in which all patients were treated with chemotherapy and photon-CSI.
+
+Despite the observed delays in especially radiotherapy in our cohort, survival rates were comparable to published rates. The difference in PFS favoring high-risk patients, a known poor prognostic factor, is intriguing and may be explained by the effects of chemotherapy [ 18 , 21 ]. The poor tolerance of chemotherapy suggests that our treatment protocol requires adjustments to make it feasible for more patients; the chemotherapy administration may be of greater importance than meeting our per-protocol specified deadlines. Moreover, the difference in survival between the standard-risk and high-risk patients was not significant and PFS and OS were similar to those found by Brandes et al., on which our treatment schedule was based [ 10 ]. Studies with (intention to) chemo-radiotherapy for all patients observed 57–68% PFS and 70–89% OS during a follow-up period of 3–5 years [ 20 , 22 , 23 ], also comparable with our findings.
+
+We compared survival between methylation subclasses and found no significant differences. Although this may have been the result of the small number of patients, other series also have failed to identify differences in survival between these categories in adults, as opposed to children[ 24 , 25 ]. The majority of patients in our cohort had a SHH-subtype (60%). Further molecular stratification of these tumors revealed a high prevalence of TERT promoter, DDX3X , PTCH1 and SMO mutations and low prevalence of TP53 mutations, which is in line with previous literature [ 25 , 26 ]. Previous studies showed that TP53 mutations are associated with unfavorable outcome [ 25 – 27 ], though the only patient in our cohort showed progression only after 4 years. TERT promoter mutations are reported to be associated with a favorable outcome in patients of SHH-activated tumors but a poor outcome in patients with Group 4 tumors [ 28 ]. Conflicting data exist regarding prognostic value of PTCH1 and SMO mutations [ 22 , 25 ]. The majority of patients with PTCH1 or SMO mutations in our cohort survived without progression.
+
+Beside mutations, previous studies in adult patients with SHH-activated tumors have shown that chromosome 3p, 10q or 17p losses were correlated with decreased survival. In contrast, patients with chromosome 8 loss in Group 4 tumors had improved outcomes [ 22 , 25 ]. In our cohort, the patients with subclonal chromosome 10q loss, chromosome 3p and/or 17p losses survived during the follow-up period. There was no chromosome 8 loss in Group 4 medulloblastomas in our series. Of note, the treatment regimen of our study wasn’t based on molecular stratification.
+
+The strength of our study is the nationwide multicenter consecutive series of patients treated in a uniform manner. Limitations are the relatively low patient numbers and lack of a uniform and standardized registration of adverse events. No significant results were found regarding prognostication of medulloblastoma subgroups. WNT-activated and non-WNT/non-SHH-activated medulloblastomas are underrepresented in adults; this makes prognostication research in these subgroups challenging. However, we showed that toxicity of neoadjuvant chemotherapy led to delay in radiotherapy initiation in more than 2/3 of patients but that nevertheless survival was comparable to that in other series. Moreover, the similar survival shows that chemotherapy is an important modality to consider in medulloblastoma patients [ 9 , 21 ]. Moots et al. found disease progression in two adult medulloblastoma patients during neo-adjuvant chemotherapy [ 29 ]. The Dutch treatment protocol was amended recently for standard-risk patients to radiotherapy combined with concomitant and adjuvant chemotherapy [ 30 ]. Also, proton-CSI is now used, which leads to less bone marrow depression and therefore allows for more dose-intense adjuvant chemotherapy administration [ 19 ]. Some of the frequent mutations, such as those activating the SHH pathway, hold promise for more tailored treatment. SMO inhibitors, as selective antagonist of this pathway, will be investigated in a prospective trial [ 31 ]. Further molecular characterization and discovering new targetable mutations can be appealing steps towards more personalized treatment. For the development of robust risk stratification, international collaboration is required because of the rarity of the medulloblastoma in adults.
+
+============================================================
+SOURCE: PMC10523176.txt (TXT)
+============================================================
+
+Assessment of Acute Side Effects Among 3D-Concurrent Radiotherapy With Cisplatin-Treated Head and Neck Cancer Patients
+
+Nasopharyngeal carcinoma: the next challenges
+
+Global epidemiology of head and neck cancers: a continuing challenge
+
+Epidemiologic trends in head and neck cancer and aids in diagnosis
+
+Head and neck cancers in developing countries
+
+Risk factors of lung, head and neck, esophageal, and kidney and urinary tract carcinomas after liver transplantation: the effect of smoking withdrawal
+
+Epidemiology of cancer from the oral cavity and oropharynx
+
+Can intensity-modulated-radiotherapy reduce toxicity in head and neck squamous cell carcinoma
+
+Head and neck cancer: changing epidemiology, diagnosis, and treatment
+
+High-dose cisplatin concurrent to conventionally delivered radiotherapy is associated with unacceptable toxicity in unresectable, non-metastatic stage IV head and neck squamous cell carcinoma
+
+Head and neck cancer in primary care: presenting symptoms and the effect of delayed diagnosis of cancer cases
+
+Weekly low‐dose versus three‐weekly high‐dose cisplatin for concurrent chemoradiation in locoregionally advanced non‐nasopharyngeal head and neck cancer: a systematic review and meta‐analysis of aggregate data
+
+Chemotherapy- and radiotherapy-induced mucositis in head and neck cancer patients: new trends in pathophysiology, prevention and treatment
+
+Disease control and functional outcome in three modern combined organ preserving regimens for locally advanced squamous cell carcinoma of the head and neck (SCCHN)
+
+Frequency of mucositis among head and neck cancer patients receiving three-dimensional (3D) radiotherapy
+
+Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers
+
+Comparison of four cisplatin-based radiochemotherapy regimens for nonmetastatic stage III/IV squamous cell carcinoma of the head and neck
+
+Introduction: Three-dimensional conformal radiation therapy has become one of the basic components of multidisciplinary treatment for head and neck cancer. Generally, patients with squamous-cell carcinoma of the head and neck receive cisplatin-based chemoradiation.
+
+Aims: In the current project, the goal was to assess 3D-CRT with cisplatin-induced acute side effects (dermatitis plus xerostomia) among head and neck cancer patients.
+
+Methodology: This descriptive case series was held at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, with an enrollment of 106 head and neck cancer patients following the hospital’s ethical approval. All patients received 3D-CRT with concurrent cisplatin chemotherapy according to the oncology treatment protocol at the Institute of Nuclear Medicine and Oncology. The evaluation of enrolled patients was done during treatment at a weekly interval and at one-month post-radiation. Stage 3 patients (17.9%) received chemo-radiation therapy with 40 mg/m 2 cisplatin once weekly for seven weeks. All patients received 70 grays in 35 fractions with two grays per fraction over the course of seven weeks following a standard protocol. All enrolled cases had biopsy-proven squamous cell carcinoma of the head and neck. IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. analyzed the data. Chi-square and Fisher's exact tests were applied, while a p-value ≤ 0.05 was taken as statistically significant.
+
+Results: All patients developed acute skin changes (dermatitis plus xerostomia) as a side effect of radiation therapy, with cisplatin having different grades during treatment until seven weeks. However, these changes improved and became less severe in terms of grade after one month of post-treatment among all patients.
+
+Conclusion: It was concluded that 3D-CRT was associated with dermatitis and xerostomia during and immediately after follow-up, even though the treatment response was good. However, clinical signs and symptoms improved, indicating that radiation therapy is a relatively safe treatment modality among cancer patients. Moreover, 40 mg/m 2 cisplatin once weekly for seven weeks resulted in better loco-regional control and survival among advanced-stage head and neck cancer patients as a part of treatment. Although, higher doses of cisplatin (100 mg/m 2 ) every three weeks have more harmful acute side effects and delay treatment for patients due to poor compliance.
+
+Introduction
+
+Head and neck cancer impacted lives badly, both physically and mentally. Unfortunately, the oral cavity, nasopharynx, or hypopharynx are common targets for disease, as revealed by a literature review. It may involve the tongue, posterior and lateral pharynx, mucosa of the oral cavity, and pharynx [ 1 ]. Among all cancer types, squamous cell carcinomas constitute the majority (90%) of the cases globally. Today’s one of the health problems is head and neck cancer (HNC) globally. Its management is a challenge for the health community. Head and neck cancer (HNC) radiation oncologists (ROs) help in curing patients through a multi-disciplinary approach to reduce toxic effects [ 2 ]. Head and neck cancers have a high mortality rate and cause almost 300,000 deaths each year, as estimated by one previous survey globally. These cancers are aggressive malignancies with an annual incidence of more than 550,000 cases in Asia, according to one study [ 3 ]. Unfortunately, this disease is gender biased, affecting males more in comparison to females, with ratios ranging from 2:1 to 4:1 [ 4 , 5 ].
+
+Patients with early-stage disease usually have vague signs and symptoms. They depend on the primary site involved in disease [ 6 ]. Patients have non-healing ulcers with pain if the oral cavity is involved, whereas oropharynx involvement is present as a sore throat, chronic dysphagia, and otalgia. By contrast, patients usually have a neck mass with supraglottic tumors due to the advancement of the disease [ 6 ].
+
+In developing countries and Asia, the predisposing factors include alcohol, tobacco consumption, and betel nut chewing, which contribute towards its development [ 7 ]. Alcohol and tobacco consumption have a synergistic effect as carcinogens when combined. Furthermore, women have adopted the male pattern of alcohol and tobacco consumption in recent years. Other risk factors that contributed to the development of oral cavity cancers include genetic susceptibility, viral infections, radiotherapy, and poor oral hygiene. Treatment failure occurs because of poor compliance with treatment, treatment side effects, and traditional medicines involving herbal and hakeem systems [ 8 , 9 ].
+
+The purpose of concurrent radiotherapy is to kill tumor cells maximally. Although 3D-CRT is linked with several side effects like dermatitis and xerostomia among patients. In light of the increasing burden of head and neck cancer and the difficulty in treating this disease due to the various side effects of 3D-CRT, we planned the current study to assess 3D-CRT with cisplatin-induced changes in skin physiology (Dermatitis and Xerostomia) among cancer patients. This study helped us identify the acute side effects of 3D-CRT in terms of dermatitis and xerostomia among the local Pakistani population. This study added information to the existing literature review so we could make a proper strategy regarding the side effects of radiation therapy. Once side effects are managed and addressed properly for cancer patients, adequate treatment will decrease the burden of this disease. A proper treatment strategy will improve treatment compliance among patients.
+
+Materials and methods
+
+This descriptive case series was held at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, following the hospital’s ethical approval. Patients (n = 106) received concurrent 3D-radiotherapy with cisplatin according to the current treatment protocol [ 10 ]. Patients who were reluctant and had a second malignancy or pregnancy were excluded. Written informed consent was obtained from each patient. All patients were given radiotherapy or chemo-radiotherapy as per clinician advice and hospital protocol. All patients were evaluated at pre-radiation time, at weekly intervals during treatment, and at 11 weeks from the first radiation fraction. In the present study, 82.1% of patients (stages 1 and 2) received only radiation therapy, while stage 3 patients (17.9%) received chemo-radiation therapy with 40 mg/m2 cisplatin once weekly for seven weeks [ 11 ]. All patients received 70 grays in 35 fractions with two grays per fraction over the course of seven weeks following a standard protocol. All enrolled cases had biopsy-proven squamous cell carcinoma of the head and neck.
+
+A non-probability, consecutive sampling technique was used. Both male and female patients, ages 25 to 75, were enrolled in stage I-III of head and neck cancer with ECOG status 1 and 2. All baseline parameters were enrolled in a performance at the time of enrollment. Strict monitoring was done for patients with acute side effects.
+
+After initial work-up, staging was done to evaluate the extent of disease by using the American Joint Commission on Cancer's (AJCC) TMN staging system. Universally, staging systems for cancers include the TNM classification system based on anatomical information. At the time of diagnosis or after surgery, tumor size or location (T), regional lymph node involvement (N), and distant metastases (M) are the indicators for disease metastasis as well as its prognosis. Important points regarding TNM staging are: A) The T staging for head and neck cancers differs according to the primary site. B) The N staging is common for all subsites except the nasopharynx. C) The M staging is common to all sites (Table 1 ). Table 1
+
+TNM staging for all subsites except nasopharynx
+
+LN= Lymph nodes Classification Characteristics T 1 Tumor ≤ 12 cm in greatest dimensions T 2 Tumor > 2cm but < 4cm in greatest dimensions T 3 Tumor > 4cm in greatest dimensions T 4 Tumor invades adjacent structures N 0 No regional LN N 1 Single ipsilateral LN ≤ 3cm N 2a Single ipsilateral LN,3-6 cm N 2b Multiple ipsilateral LN, none >6cm N 2c Bilateral or contralateral LN, none >6cm N 3 Any LN, none >6cm M 0 No distant metastasis M 1 Distant metastasis
+
+After RT or accidental exposures, acute changes after RT treatment in cancerous patients appear within 90 days. Generalized erythema usually appears within hours after RT but vanishes within days. The second phase of severe erythema appears within two weeks after dosing without any epidermal changes due to cytokines (Table 2 ). Table 2
+
+Criteria for grading dermatitis by WHO Adverse Events Grades 1 2 3 4 Dermatitis Faint erythema or dry desquamation Moderate erythema, edema, desquamation confined to skin folds Desquamation ≥ 1.5cm not confined to skin folds, pitting edema Skin necrosis or ulceration.
+
+There are mainly three main salivary glands (parotid, sublingual, and submandibular) surrounding the mouth, which secrete their secretions into the mouth via ducts. These three primary glands secrete around 90% of total salivary secretions. As a result of 3D-CRT, the patient's saliva becomes thick and tenacious. However, if RT continues, mucous cells, as well as the quantity of saliva, will decrease (Table 3 ). Table 3
+
+Criteria for grading Xerostomia by WHO Adverse Effect Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Xerostomia None Slight dryness of mouth, good response on stimulation Moderate dryness of mouth, poor response on stimulation Complete dryness of mouth, no response on stimulation Fibrosis Death
+
+IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. analyzed the data. Chi-square and Fisher's exact tests were applied, while a p-value ≤ 0.05 was taken as statistically significant. Mean± SD presented quantitative parameters. Frequencies and percentages represented qualitative parameters like gender, cancer stage, and ECOG status (performance scale) of patients.
+
+Results
+
+Baseline parameters (age and dose of radiation) were noted at the time of enrollment in terms of mean± SD (Table 4 ). Table 4
+
+Baseline quantitative parameters Mean ± SD Minimum Maximum Age (years) 57.8 ± 8.3 39 70 Total radiation dose (Grays) 62.8 ± 7.4 30 70
+
+The distribution of qualitative parameters among head and neck cancer patients (Table 5 ). Table 5
+
+Distribution of participants with respect to qualitative parameters Variable Category Frequency Percentage (%) Gender Male 44 41.5 Female 62 58.5 Cancer Stage 1 41 38.7 Stage 2 46 43.4 Stage 3 19 17.9 ECOG Poor 67 63.2 Good 39 36.8 Oral hygiene Poor 26 24.5 Average 28 26.4 Good 52 49.1
+
+An improvement in grades of dermatitis appeared among all patients post-treatment (Table 6 ). Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Toxicity criteria were also used in accordance with WHO criteria. Table 6
+
+Distribution of patients during and after treatment into different grades of dermatitis Week Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 1 st 98 (92.5%) 8 (7.5%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 nd 67 (63.2%) 39 (36.8%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 3 rd 8 (7.5%) 90 (84.5%) 8 (7.5%) 0 (0%) 0 (0%) 0 (0%) 4 th 0 (0%) 67 (63.2%) 31 (29.2%) 8 (7.5%) 0 (0%) 0 (0%) 5 th 0 (0%) 14 (13.2%) 84 (79.2%) 8 (7.5%) 0 (0%) 0 (0%) 6 th 0 (0%) 0 (0%) 51 (48.1%) 47 (44.3%) 8 (7.5%) 0 (0%) 7 th 0 (0%) 6 (5.7%) 8 (7.5%) 84 (79.2%) 8 (7.5%) 0 (0%) 11 th 0 (0%) 14 (13.2%) 53 (50%) 39 (36.8%) 0 (0%) 0 (0%)
+
+There is an insignificant difference among different dermatitis grades based on gender at different weeks of treatment (Table 7 ). Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Toxicity criteria were also used in accordance with WHO criteria. Table 7
+
+Different dermatitis grades on the basis of gender Week Gender Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 p-value 1 st Male 40(90.9%) 4(9.1%) Nil Nil Nil Nil 0.716 Female 58(93.5%) 4(6.5%) Nil Nil Nil Nil 4 th Male 0 (0%) 26(59.1%) 14(31.8%) 4(9.1%) 0 (0%) 0 (0%) 0.775 Female 0 (0%) 41(66.1%) 17(27.4%) 4(6.5%) 0 (0%) 0 (0%) 7 th Male 0 (0%) 1(2.3%) 4(9.1%) 35(79.5%) 4(9.1%) 0 (0%) 0.625 Female 0 (0%) 5(8.1%) 4(6.5%) 49(79.0%) 4(6.5%) 0 (0%) 11 th Male 0 (0%) 5(11.4%) 21(47.7%) 18(40.9%) 0 (0%) 0 (0%) 0.734 Female 0 (0%) 9(14.5%) 32(51.6%) 21(33.9%) 0 (0%) 0 (0%)
+
+At the seventh week of treatment, xerostomia of grade 4 was observed in 57 (53.8%) patients and improved afterwards (Table 8 ). Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) Toxicity criteria were also used in accordance with WHO criteria. Table 8
+
+Distribution of patients according to different grades of xerostomia Week Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 1 st 78 (73.6%) 28 (26.4%) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 2 nd 78 (73.6%) 21 (19.8%) 7 (6.6%) 0 (0%) 0 (0%) 0 (0%) 3 rd 49 (46.2%) 29 (27.4%) 28 (26.4%) 0 (0%) 0 (0%) 0 (0%) 4 th 10 (9.4%) 68 (64.2%) 18 (17%) 10 (9.4%) 0 (0%) 0 (0%) 5 th 0 (0%) 29 (27.4%) 49 (46.2%) 18 (17%) 10 (9.4%) 0 (0%) 6 th 0 (0%) 10 (9.4%) 39 (36.8%) 30 (28.3%) 27 (25.5%) 0 (0%) 7 th 0 (0%) 0 (0%) 29 (27.4%) 20 (18.9%) 57 (53.8%) 0 (0%) 11 th 0 (0%) 0 (0%) 69 (65.1%) 37 (34.9%) 0 (0%) 0 (0%)
+
+There was an insignificant difference among different xerostomia grades on the basis of gender at different weeks of treatment (Table 9 ). Table 9
+
+Different xerostomia grades on the basis of gender Week Gender Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 p-value 1 st Male 33 (75.0%) 11 (25.0) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 0.781 Female 45 (72.6) 17 (27.4) 0 (0%) 0 (0%) 0 (0%) 0 (0%) 4 th Male 4 (9.1%) 65.9%) 8 (18.2%) 3 (6.8%) 0 (0%) 0 (0%) 0.924 Female 6 (9.7%) 39 (62.9%) 10 (16.1%) 7 (11.3%) 0 (0%) 0 (0%) 7 th Male 0 (0%) 0 (0%) 13 (29.5%) 7 (15.9%) 24 (54.5%) 0 (0%) 0.783 Female 0 (0%) 0 (0%) 16 (25.8%) 13 (21.0%) 33 (53.2%) 0 (0%) 11 th Male 0 (0%) 0 (0%) 28 (63.6%) 16 (36.4%) 0 (0%) 0 (0%) 0.791 Female 0 (0%) 0 (0%) 41 (66.1%) 21 (33.9%) 0 (0%) 0 (0%)
+
+Discussion
+
+Unfortunately, the high prevalence of head and neck cancer among our population has affected our pupils badly, both mentally and physically. However, Pakistan being a developing country with limited human resources, this health issue remained untouched in our setups. Thus, we examined the safety of concurrent 3D-RT in non-metastatic cancer patients enrolled in our clinical setup at the Institute of Nuclear Medicine and Oncology [ 12 ]. Causes of therapeutic failure for both chemotherapy and radiation therapy are false beliefs about drugs being prescribed in oncology centers and parallel treatment systems, e.g., traditional medicines, that drift them away from taking treatment for the desired duration [ 8 , 9 ]. Thus, this attitude increases the burden of disease in society. Moreover, they have to face severe acute as well as chronic toxicities related to their treatment. Patients developed other acute side effects with radiation therapy, like mucositis, ulcers, dysphagia, and diarrhea.
+
+In the current project, there was an increase in grades of dermatitis among patients with treatments, as results depicted that at the fourth week of treatment, 98 (92.5%) patients had mild dermatitis (grades 1 and 2). At the seventh week of treatment, severe dermatitis (grade 4) was observed in 58 (7%) patients. However, a decline in grades of dermatitis post-treatment among all patients was observed, as shown in Table 6 . Previous studies held on head and neck cancer treatment with chemo-radiotherapy fully supported our results and findings that acute side effects develop during treatment but improve post-radiation if followed regularly and properly [ 13 ].
+
+In terms of xerostomia, after the fourth week of treatment, grade 3 was observed in 10 (9.4%) patients, whereas mild xerostomia (grades 1 and 2) was observed in 86 (81%) patients, respectively. At the seventh week of treatment, severe xerostomia of grade 4 was observed in 57 (53.8%) patients. Post-treatment, a decline in grades of xerostomia among patients was observed, as given in Table 8 . Our findings were similar to the results of previous studies that showed a decline in acute side effects after one month of radiation therapy [ 14 , 15 ].
+
+Cisplatin-based regimens are very often used for the radiotherapy of squamous head and neck cancer patients, particularly regimens including cisplatin alone. Almost 17.9% of patients (stage 3) received chemoradiation with cisplatin at a dose of 40 mg/m2 once weekly for seven weeks throughout the treatment period. No mortality was noted in the current study, and good local and regional control was seen. Similarly, in the past, a study compared two different doses of cisplatin (the lower dose of 20 mg/m2/day and the higher dose of 25 mg/m2/day) five days per week for four weeks. They concluded that a lower dose was well tolerated and had a better response among cancer patients. Thus, their findings supported our results that cisplatin at a lower dose is much more effective for a longer period of treatment than at a higher dose [ 16 ].
+
+Tumor response was assessed four weeks after treatment completion by means of CT scans. Cisplatin was administered concurrently on a weekly basis as a one-hour intravenous infusion of 40 mg/m2. All patients received vigorous hydration and anti-emetic therapy before cisplatin. Our work was in line with previous research on head and neck cancer patients receiving RT [ 11 ].
+
+Abundant studies had reported acute side effects of RT in head and neck cancer patients, but few studies had scrutinized whether they affected cancer treatment responses. In the current project, we assessed acute side effects and clinical signs and symptoms during and immediately after follow-up after four weeks of complete treatment. It was a rare study in the sense that it evaluated acute side effects related to chemo-radiotherapy and treatment response clinically in head and neck cancer patients. This study helped to evaluate the reasons for the increasing burden of head and neck cancer cases in the Pakistani population despite the treatment given. In the present study, patients showed clinical improvement in terms of signs and symptoms, and no deaths were reported both during and after treatment.
+
+Limitations
+
+A small sample size with a limited time frame, financial constraints, and limited human resources added to our limitations. However, more studies with a large sample size and long-term follow-up are recommended to see chronic side effects as well. This study helped us design a protocol for proper management of these side effects in order to reduce the illness, as it added useful insight into the disease.
+
+Conclusions
+
+It was concluded that 3D-radiation therapy was associated with the development of acute side effects like dermatitis and xerostomia during and immediately after follow-up, although the treatment response was good. Moreover, 40 mg/m2 cisplatin once weekly for seven weeks resulted in better loco-regional control and treatment response among cancer patients with no delay in treatment due to its harmful side effects. Results supported our conclusion, as no mortality was reported during treatment or in the follow-up period, and grades of toxicity improved during the follow-up period. However, patients improved clinically in their signs and symptoms. Thus, a low dose (40 mg/m2) of cisplatin once weekly rather than a higher dose (100 mg/m2) should be given to cancer patients requiring cisplatin in our clinical settings in order to avoid poor compliance due to side effects.
+
+============================================================
+SOURCE: PMC13391250.txt (TXT)
+============================================================
+
+Empirically constrained order parameter dynamics in cardiovascular criticality: a synergetic Langevin framework for arrhythmic transitions with cross-cohort parameter estimation and Kramers escape-time validation
+
+Deceleration capacity of heart rate as a predictor of mortality after myocardial infarction: cohort study
+
+Microvolt T-wave alternans and the risk of death or sustained ventricular arrhythmias in patients with left ventricular dysfunction
+
+Noise in the nervous system
+
+The free-energy principle
+
+Controlling cardiac chaos
+
+Fractal dynamics in physiology: alterations with disease and aging
+
+Singularities and groups in bifurcation theory
+
+Reaction-rate theory: fifty years after Kramers
+
+Time domain measurements of heart rate variability
+
+Elements of applied bifurcation theory
+
+Criticality in intracellular calcium signaling in cardiac myocytes
+
+Heterogeneous dynamical pathways preceding ventricular arrhythmia
+
+Quantification of scaling exponents in nonstationary heartbeat time series
+
+Early-warning signals for critical transitions
+
+Heart-rate turbulence after ventricular premature beats as a predictor of mortality after acute myocardial infarction
+
+Power-law properties of nocturnal arrhythmia avalanches
+
+Nonlinear dynamics and chaos
+
+Avalanches in cardiology
+
+Bifurcation and chaos in a model of cardiac early afterdepolarizations
+
+Background
+
+This companion empirical study established fundamental heterogeneity in pre-arrhythmic dynamical pathways across nine PhysioNet cohorts (N > 1,500 records): 93%–98% of events do not follow the canonical suppress-to-late-rise trajectory, Phase V (scaling manifold collapse, R 2 < 0.93) is absent in healthy subjects and increases monotonically with disease severity, and healthy dynamics are predominantly supercritical (CHI = 2 (α 1 − α 2 ) = +0.334). Although these empirical markers characterize the dynamical state, they lacked formal theoretical grounding. The present study addresses this gap by constructing and validating a minimal stochastic dynamical model of cardiovascular criticality.
+
+Methods
+
+A coupled Langevin system, grounded in Haken’s synergetic order-parameter formalism, is reduced to dψ/dt = A (R 2 )ψ − Bψ + ε(ψ)η(t) via adiabatic elimination. Parameters estimated by Fokker–Planck KL-divergence minimization, cross-cohort regression, and Kramers calibration. Euler–Maruyama and Heun/Stratonovich simulations (N = 50,000; SEED = 42) provide large-noise ground-truth benchmarks.
+
+Results
+
+Rc = 0.991, a 0 = 20.5, D = 0.06 ± 0.02. A five-condition P_self benchmark (Kramers additive/EM sim/Kramers multiplicative/Heun sim/empirical: 0.42|0.49|0.65|0.50|0.70 for Suppress; 0.50|0.41|0.63|0.43|0.58 for Late-rise) establishes that multiplicative Kramers overestimates simulation in the large-noise regime, quantifying the boundary conditions of Kramers-based approximations. Individual-level estimation (78 patients and 135 mr records) yields ICC = 0.37–0.41, demonstrating real between-patient heterogeneity with dominant within-patient non-stationarity. This ICC range is comparable to that of published values for DFA α 1 (ICC ≈0.40–0.60; Penttilä et al., 2001; Aubert et al., 2003) and reflects the expected property of a dynamical rather than trait marker: CHI measures the current phase of the regulatory system, which varies within individuals across states, activity levels, and time of day. Low ICC is, therefore, not a limitation of CHI as a dynamic biomarker but a consequence of measuring a quantity that changes with the physiological context—analogous to blood pressure ICC being lower than body height ICC. High test–retest reliability would indicate that CHI is insensitive to physiological dynamics, which would contradict its role as an order parameter. CHI follows Student’s-t (ν = 12.4; ΔAIC = 74.4 vs. Gaussian). Cross-cohort validation supports P1 (Spearman ρ = 0.867, p = 0.001, N = 10; extended to N = 13 with nsrdb and Fantasia external cohorts, ρ = 0.989; p < 0.0001) and P3 (β = 1.255 [BCa 95%CI: 0.69–2.89], permutation p = 0.014, directionally consistent with pitchfork prediction; exploratory at N = 6). Within-patient temporal prediction (N = 78; 7,555 rolling windows; Cox model) yields HR_CHI = 0.61 (p < 0.001) and HR_PV = 2.31 (p = 0.001); temporal receiver operating characteristic (ROC) area under the curve (AUC) increases from 0.71 to 0.86 as VT/VF onset approaches; Harrell’s C = 0.78 with CHI trend ΔCHI included.
+
+Conclusion
+
+This study provides the first formal dynamical framework for the ECSoC empirical markers, deriving the pitchfork bifurcation structure of cardiovascular criticality from the first principles approach and validating it against cross-cohort data and stochastic simulations. The model is structurally validated across analytical, simulation, and empirical domains, with quantitative constraints in the large-noise regime delineating the boundary conditions for Kramers-based approximations. Six falsifiable predictions (P1–P6) define the roadmap for prospective quantitative validation.
+
+1
+
+Introduction
+
+ 1.1
+
+The gap between description and dynamics
+
+A companion empirical study ( Okabe, 2026 ) established three findings across nine PhysioNet cohorts (N > 1,500 records): (i) 93%–98% of arrhythmic events do not follow the canonical Suppress→Late-rise trajectory; (ii) Phase V (R 2 < 0.93) is absent in 0/124 healthy subjects and increases monotonically with disease severity; and (iii) healthy dynamics are predominantly supercritical (mean CHI = +0.334). These findings are empirically robust but theoretically incomplete. The present paper derives a minimal Langevin system, estimates all parameters from cross-cohort data, validates against the empirical Markov matrix, and generates six falsifiable predictions ( Okabe, 2026 ; Hänggi et al., 1990 ).
+
+Within the framework of synergetics, complex physiological systems near instability are governed by few order parameters that enslave fast microscopic degrees of freedom. The present study explicitly identifies CHI-derived ψ as such an order parameter and demonstrates that cardiovascular arrhythmic transitions can be described as noise-driven bifurcations in a reduced low-dimensional manifold. This identification positions ECSoC within Haken’s general program: the macroscopic phenomenology of arrhythmic collapse emerges from the slaving of autonomic and ionic degrees of freedom to the single collective variable ψ(t) = CHI(t), without invoking detailed mechanistic models of ion-channel kinetics or sympathovagal circuitry.
+
+ 1.2
+
+Synergetics and adiabatic elimination
+
+This work is dedicated to the memory of Hermann Haken (1927–2024), whose foundational contributions to Synergetics provide the theoretical framework that we have employed throughout. Synergetics ( Haken, 1983a ; Haken, 1983b ) provides the theoretical framework. Haken’s formalism identifies three canonical roles in any self-organizing system near a critical point: (i) a control parameter that drives the system through the transition; (ii) an order parameter whose symmetry-breaking captures the macroscopic state; and (iii) slaved variables whose fast relaxation allows adiabatic elimination. The identification of the ECSoC order parameter begins from a physiological, not mathematical, observation. The cardiac autonomic regulatory system operates across two competing timescales: short-range regulation (sympathovagal beat-to-beat modulation; 4–16 beats, ≈3–12 s) and long-range regulation (hormonal, baroreflex, and circadian mechanisms; 16–64 beats, ≈12–50 s). In healthy systems, these two regulatory timescales are balanced. Disease progression disrupts this balance—not by eliminating one timescale but by shifting the dominance from one to the other. The natural collective coordinate capturing this competition is the signed difference between short-range and long-range fractal regulation: ψ ∝ (short-range dominance) − (long-range dominance). Its empirical projection in DFA exponent space is CHI = 2 (α 1 − α 2 ), ( Peng et al., 1995 ) where α 1 quantifies short-range scaling (4–16 beats) and α 2 quantifies long-range scaling (16–64 beats). This derivation rests on conditions whose epistemic status must be distinguished carefully. C1 (ℤ 2 sign-change at the transition) and C2 (monotonic slaving to the control parameter) follow necessarily from the mathematical structure of the pitchfork normal form dψ/dt = Aψ − Bψ 3 and from Haken’s adiabatic elimination principle, respectively—they are theoretically determined before any physiological candidate is considered, and any quantity that fails either condition is structurally disqualified as an order parameter of a ℤ 2 symmetric bifurcation ( Kuznetsov, 2004 ; Haken, 1983a ; Haken, 1983b ). The ℤ 2 symmetry requirement in C1 is not an ad hoc constraint imposed to favor CHI. Pitchfork-type bifurcation structure has been independently demonstrated in cardiac electrophysiology across multiple scales: at the cellular level, Garfinkel et al. (1992) established that ouabain-induced ventricular arrhythmias in rabbit ventricle are governed by deterministic chaos consistent with period-doubling bifurcation from periodic beating, and Tran et al. (2009) , Independently, Nivala et al. (2012) demonstrated criticality in intracellular calcium signalling in cardiac myocytes, providing further multi-scale evidence for bifurcation dynamics showed that early afterdepolarization dynamics follow a pitchfork-type bifurcation, in which two symmetric fixed points emerge as a control parameter crosses a critical threshold. At the autonomic and whole-heart scale, Goldberger et al. (2002) additional evidence for power-law and avalanche dynamics in cardiac systems has been reported by Subramanyan (2021) and Shahrbabaki et al. (2025) demonstrated that DFA scaling exponents systematically deviate from the healthy 1/f regime in a directionally asymmetric manner with disease and aging—a signature consistent with the breaking of a symmetric critical state. These independent lines of evidence support the theoretical prediction that the relevant collective mode at the HRV timescale should inherit ℤ 2 symmetry as CHI does by construction through its antisymmetric dependence on α 1 and α 2 . C3 (informational sufficiency beyond any single constituent) is an additional empirical discriminability requirement: it narrows the candidate class within the space of DFA-compute quantities by excluding simple relabeling of existing measurements, but it is not independently derivable from the normal-form mathematics alone. The signed difference ψ ∝ (short-range dominance) − (long-range dominance) is the unique scalar derivable from dual-band DFA that satisfies C1 and C2 by construction and C3 empirically. The systematic comparison of alternative candidates in Section 6.6.1 confirms this conclusion; it is not required for C1 and C2 but provides empirical support for C3. The resulting stochastic model is employed as a symmetry-constrained pitchfork-like normal-form approximation—the minimal model consistent with the empirically observed ℤ 2 sign-change at the supercritical–subcritical transition—not as a model derived from the first principles approach of cardiac electrophysiology. Quantitative deviations from the symmetric normal form are expected and are accommodated by an imperfect extension ( Section 2.1.1 ). Biologically, this scale-competition framing maps naturally onto the known hierarchical structure of cardiac autonomic control: vagal efferent activity dominates short-range RR interval correlations, while sympathetic tone, baroreflex gain, and circadian mechanisms contribute substantially to longer-range organization—making α 1 − α 2 an interpretable measure of autonomic tier balance rather than an abstract mathematical construct. CHI does not represent a single molecular pathway, ion channel, or autonomic circuit. It is a macroscopic collective coordinate that coarse-grains multiple electrophysiological degrees of freedom—including action potential duration restitution, calcium handling dynamics, gap–junction coupling, and regional sympathetic tone—into a single scalar quantity that encodes which regulatory timescale dominates the scaling structure of the heartbeat series. This is precisely the role of an order parameter in Haken’s slaving principle: macroscopic phenomenology emerges from the enslavement of fast microscopic variables to the collective mode ψ, without requiring a mechanistic model of any individual substrate. In ECSoC, the three canonical Haken roles are filled as follows. R 2 (t)—the coefficient of determination of the DFA log–log fit—serves as an empirical control-parameter proxy: it drives the system through the bifurcation in the model but is itself a DFA fit-quality statistic affected by recording length, preprocessing, and scale selection and does not causally control cardiovascular dynamics in the mechanistic sense. The order parameter ψ(t) is identified with CHI = 2 (α 1 − α 2 ), which is the signed difference between short- and long-range DFA exponents. Biologically, CHI measures the signed deviation between short-range (α 1 ; scales 4–16 beats, ≈3–12 s) and long-range (α 2 ; scales 16–64 beats, ≈12–50 s) fractal regulation of heart rate variability. Positive CHI (α 1 > α 2 ) reflects the dominance of short-range autonomic modulation—the supercritical regime associated with active sympathovagal flexibility. Negative CHI (α 1 < α 2 ) reflects the dominance of long-range correlations—the subcritical regime associated with rigid, low-variability dynamics characteristic of advanced structural heart disease. At CHI ≈0, the two regulatory timescales are balanced, corresponding to operation near the critical manifold. CHI, thus, serves as an empirical measure of the balance between short- and long-range cardiac autonomic regulation, without invoking detailed ion–channel kinetics or sympathovagal circuitry. The fast slaved variable φ(t) represents the autonomic modulation field whose relaxation timescale satisfies the prerequisite of scale-separation for adiabatic elimination.
+
+The control parameter coupling A (R 2 ) = a 0 (R 2 − Rc) is the empirical realization of Haken’s concept of a linearly varying control parameter driving the system through bifurcation; R 2 is used here as an empirical proxy for the underlying physiological control variable. Cross-cohort regression ( Section 3.2 ) yields a 0 = 20.5 and Rc = 0.991. The gap [0.93, 0.991] constitutes a critical precursor window and forms the basis of predictions P1 and P5 ( Section 5 ). All symbols used throughout this study are defined in Table 1 . TABLE 1
+
+Notation. All symbols used in the stochastic dynamical model and associated analyses. Normalized units are dimensionless quantities scaled to the physiological RR-interval timescale. Symbol Definition Units/Notes ψ(t) Order parameter = CHI(t) Dimensionless CHI 2 (α 1 − α 2 ); signed DFA exponent contrast Dimensionless α 1 DFA scaling exponent, short-range (scales 4–16 beats) Dimensionless α 2 DFA scaling exponent, long-range (scales 16–64 beats) Dimensionless R 2 Coefficient of determination of DFA log-log fit; empirical control-parameter proxy Dimensionless ∈ [0,1] Rc Critical R 2 threshold; A (R 2 ) = 0 at R 2 = Rc = 0.991 Dimensionless A (R 2 ) Linear (bifurcation) coefficient; A (R 2 ) = a 0 (R 2 − Rc) s -1 (normalized) a 0 Sensitivity coefficient; estimated a 0 = 20.5 s -1 (normalized) B Cubic (restoring) coefficient; B > 0 s -1 (normalized) h Tilt parameter; ℤ 2 symmetry-breaking term (h = 0: symmetric pitchfork) Dimensionless D Noise intensity; D = ε 2 (ψ)/2 in the additive case s -1 (normalized) ε(ψ) State-dependent noise amplitude; ε(ψ) = ε 0 exp (−κψ 2 ) Dimensionless ε 0 Baseline noise amplitude; D ≈ ε 0 2 /2 ≈ 0.06 Dimensionless κ Multiplicative noise decay parameter Dimensionless η(t) White noise; ⟨η(t)⟩ = 0, ⟨η(t)η(t′)⟩ = δ(t−t′) s -1 / 2 W(t) Standard Wiener process; η(t)dt = dW(t) — φ(t) Slow autonomic modulation field (adiabatically eliminated) Dimensionless λ Decay rate of φ; λ ≫ |A| (adiabatic elimination condition) s -1 (normalized) V(ψ) Effective potential; V(ψ) = −Aψ 2 /2 + Bψ 4 /4 Dimensionless Phase V State defined by R 2 < 0.93; marker of B → 0 degeneracy Threshold: R 2 < 0.93
+
+ 2
+
+The minimal dynamical model
+
+ 2.1
+
+Coupled equations
+
+ d ψ / dt = a R 2 ψ − b ψ 3 + c φ + ε ψ η t (1) d φ / dt = − λ φ + k ψ (2)
+
+Under the slaving condition λ ≫ a, adiabatic elimination ( Equation 1 ) yields the one-dimensional reduction dψ/dt = A (R 2 )ψ − Bψ 3 + ε(ψ)η(t) with A (R 2 ) = a 0 (R 2 − Rc) + ck/λ. The numerical constraint λ ≫ |a| required for adiabatic elimination is satisfied by the empirical estimate: |A| ≤ a 0 |R 2 − Rc| ≤ 20.5 × 0.07 ≈ 1.4 (maximum across cohorts), while autonomic modulation timescales imply λ ∼ 10–50 (in normalized units), giving λ/|a| ∼ 7–35.
+
+The pitchfork normal form dψ/dt = Aψ − Bψ 3 is not assumed but derived from a symmetry requirement: at the critical point R 2 = Rc, the cardiovascular control system is invariant under ψ → −ψ—that is, neither supercritical nor subcritical dynamics is structurally preferred at criticality. This ℤ 2 symmetry condition motivates and supports the odd-polynomial normal form to third-order form ( Kuznetsov, 2004 ): even-order terms would break the symmetry and produce an asymmetric bifurcation that is inconsistent with the empirical CHI distribution ( Section 6.3.3 ), making the symmetric pitchfork the minimal consistent choice rather than a uniquely derived result. The identification ψ(t) = CHI(t) is, therefore, not a post hoc fitting choice but a consequence of the structural symmetry of the reduced system.
+
+ 2.1.1
+
+Imperfect (tilted) pitchfork extension
+
+The symmetric pitchfork requires exact ℤ 2 invariance. Physiological systems, however, may carry intrinsic asymmetries—developmental, pharmacological, or autonomic—that break this symmetry without destroying the bifurcation structure. The minimal extension that accommodates broken ℤ 2 symmetry is the tilted (imperfect) pitchfork, obtained by adding a linear symmetry-breaking term h to the normal form: V ψ = ψ 4 / 4 − A ψ 2 / 2 − h ψ (3) d ψ / dt = − dV / d ψ = A ψ − ψ 3 + h (4) Here, h is the tilt parameter, encoding the degree and direction of ℤ 2 symmetry breaking. When h = 0, the symmetric pitchfork is recovered. When h ≠ 0, the double-well potential is tilted: one well is deepened and the other is elevated, biasing the system toward a preferred attractor without eliminating the bifurcation structure itself ( Golubitsky and Schaeffer, 1985 ; Strogatz, 2015 ). The equilibrium condition dV/dψ = 0 yields h = ψ 3 − Aψ, which permits point-wise estimation of h from observed (ψ, A) pairs without additional free parameters.
+
+Three physiological sources of h are identified. First, pharmacological asymmetry: drug action that preferentially activates one branch of the bifurcation (e.g., antiarrhythmic agents that stabilize the supercritical well or proarrhythmic agents that deepen the subcritical well) introduces a drug-specific h ≠ 0. Second, autonomic imbalance: persistent sympathovagal imbalance tilts the effective potential by biasing the φ field in Equation 2 , which after adiabatic elimination contributes a residual term h_eff = ck⟨φ⟩/λ. Third, ageing-related remodeling: progressive loss of autonomic reserves introduces a slow drift in h over years, providing a developmental complement to the acute bifurcation dynamics.
+
+The sign of h encodes the direction of symmetry breaking: h > 0 biases the system toward positive ψ (the supercritical, protective attractor), while h < 0 biases toward negative ψ (the subcritical, proarrhythmic attractor). The magnitude |h| quantifies the degree of asymmetry: a small |h| preserves approximate ℤ 2 symmetry and near-symmetric bifurcation structure; a large |h| eliminates the local potential barrier and creates a single-attractor landscape with no bifurcation. The critical condition for bifurcation persistence under tilt is |h| < h_c = (2/3√3) A^(3/2), the fold catastrophe boundary ( Kuznetsov, 2004 ). Below this boundary, the tilted double-well structure is preserved and the ECSoC phase classification remains valid with quantitative corrections to the fixed-point positions.
+
+For completeness, the most general imperfect pitchfork extension—including a quadratic term Cψ 2 that accounts for potential asymmetry in the curvature of the two wells—takes the following form: dψ = [h + A (R 2 )ψ + Cψ 2 − Bψ 3 ]dt + ε(ψ)dW(t). The quadratic term Cψ 2 introduces a further ℤ 2 -breaking correction beyond the tilt h; its magnitude quantifies asymmetry in the curvature of the potential wells rather than merely their depth. In the population analysis of this study, C is set to 0 (consistent with the near-symmetric empirical CHI distributions observed across cohorts); individual-level C estimation is designated for Paper 3. Critically, imperfect pitchfork dynamics predict that the critical slowing down signal (AR (1) → 1) should be asymmetric across attractor branches: the branch toward which h tilts the potential exhibits a stronger temporal autocorrelation (deeper well and slower escape) relative to the disfavored branch. This constitutes a testable prediction distinguishing the imperfect from the symmetric pitchfork: P7 (see Section 5 ). The symmetric pitchfork model employed in the main analysis is, therefore, understood as the h = 0 limiting case of Equation 4 , appropriate when ℤ 2 symmetry holds to leading order across the patient population. Individual patient trajectories, pharmacological perturbations, and cross-domain applications may require non-zero h for quantitative accuracy. In this sense, h functions as a supplementary symmetry parameter that complements the established three-layer hierarchy (CHI as the order parameter, R 2 as the control parameter, and Phase V as the bifurcation indicator): its sign and magnitude characterize the direction and degree of ℤ 2 breaking without altering the structural roles of the primary ECSoC metrics.
+
+ 2.1.2
+
+Stochastic interpretation and noise convention
+
+The reduced one-dimensional equation is written as a stochastic differential equation (SDE) in the following canonical form ( Equation 5 ): d ψ = A R 2 ψ − B ψ 3 dt + ε ψ dW t (5)
+
+where W(t) is a standard Wiener process satisfying ⟨dW(t)⟩ = 0 and ⟨dW(t) 2 ⟩ = dt. The noise term η(t) used in the body of the text is related to W(t) by η(t) dt = dW(t) so that η(t) is a Gaussian white noise process with ⟨η(t)⟩ = 0 and ⟨η(t)η(t’)⟩ = δ(t − t’). The noise intensity D entering the Fokker–Planck equation is related to the amplitude function ε(ψ) by D = ε 2 (ψ)/2 in the additive case.
+
+ 2.1.2.1
+
+Stochastic convention
+
+All simulations use the Stratonovich convention, which is physically motivated by the fact that the noise ε(ψ) arises from fast physiological fluctuations with a finite (though short) correlation time—the standard setting in which Stratonovich calculus applies ( Gardiner, 2009 ). Euler–Maruyama (EM) integration approximates the additive SDE (ε(ψ) = ε 0 = const) by the standard forward-Euler discretization: ψ(t + Δt) = ψ(t) + [Aψ − Bψ 3 ]Δt + ε 0 √Δt · ξ(t), where ξ(t) ∼ N (0,1) i.i.d. The Heun method implements the Stratonovich predictor–corrector scheme for the multiplicative SDE (ε(ψ) = ε 0 exp (−κψ 2 )): the predictor step applies EM, and the corrector step averages the drift and diffusion evaluated at the current and predicted states ( Kloeden and Platen, 1992 ). EM and Heun agree to first order in Δt; the discrepancy between their P_self estimates quantifies the Stratonovich correction due to multiplicative noise.
+
+ 2.1.2.2
+
+Additive vs. multiplicative noise and pitchfork symmetry
+
+In the additive case, ε(ψ) = ε 0 is constant and the Fokker–Planck stationary density ( Risken, 1989 ) is p_st(ψ) ∝ exp (−V(ψ)/D), with D = ε 0 2 /2. In the multiplicative (Stratonovich) case, ε(ψ) = ε 0 exp (−κψ 2 ) and the effective potential becomes V_eff(ψ) = V(ψ) + Dκψ 2 , deepening both wells symmetrically. Crucially, because ε(ψ) is an even function of ψ (i.e., ε(ψ) = ε(−ψ)), the multiplicative noise term does not break ℤ 2 symmetry: it shifts R_c to R_c_eff = R_c + 2Dκ/a 0 but preserves the symmetric double-well structure. This ensures that the imperfect pitchfork extension remains mathematically well-posed in the presence of multiplicative noise.
+
+ 2.1.2.3
+
+Kramers escape time
+
+For the additive SDE, the mean first-passage time (MFPT) from one potential well to the other is given by the Kramers Formula 3 : τ_K = (2π/√|V″(ψ_max)|) · (1/√|V″(ψ_min)|) · exp (ΔV/D), where ΔV = V (ψ_max) − V (ψ_min) is the barrier height. For the multiplicative SDE under Stratonovich convention, the Kramers formula is applied to V_eff(ψ) in place of V(ψ), yielding the multiplicative Kramers estimate. The self-transition probability P_self used in Table 2 is computed as P_self = Δt/(Δt + τ_K), where Δt is the sliding window duration (16 s). Section 3.3 and Figure 3 demonstrate that multiplicative Kramers analytical predictions overestimate P_self relative to Heun simulation in the large-noise regime (ΔV/D ≈ 0.1), establishing the boundary conditions of Kramers-based approximations used throughout this study. TABLE 2
+
+A five-condition P_self comparison. N_SIM = 50,000; SEED = 42; WINDOW = 16 s. Method Role Suppress Late-rise Kramers additive (analytical) Lower bound—small-noise limit 0.42 0.50 Euler–Maruyama simulation Additive ground truth 0.49 0.41 Kramers multiplicative (analytical) Upper bound—Stratonovich V_eff 0.65 0.63 Heun/Stratonovich simulation Multiplicative ground truth 0.50 0.43 Empirical (Okabe 2026 [9] Markov) Observed target 0.70 0.58
+
+ 2.2
+
+ECSoC phases as fixed-point regimes Phase Condition Fixed points/Attractor Empirical cohort I A>0, R 2 high ±√(A/B) stable—double well NSR Healthy (CHI = +0.334, R 2 = 0.997) II A≈0 ψ* = 0 marginal—flat potential CHF2 NYHA1-3 (CHI = −0.030) III A>0, φ↑ ψ* = +√(A/B)—stable (+) Late-rise substrate (rare; 2%–7%) IV A<0 ψ* = 0 only—single well SVTDB suppress majority (62%) V b→0 Attractor lost—bifurcation MVEDB 90.9%, BIDMC 53.3%
+
+ 2.2.1
+
+Distinction between phase V and the canonical pitchfork bifurcation
+
+Two structurally distinct mechanisms must be carefully separated. The canonical pitchfork bifurcation occurs when the linear coefficient A (R 2 ) crosses 0: as R 2 falls toward Rc = 0.991, A transitions from positive to negative, the double-well potential collapses to a single well, and the stable fixed points ψ* = ±√(A/B) merge at the origin. This is an A-crossing event and governs Phases I–IV. Phase V, by contrast, is defined operationally as R 2 < 0.93 and corresponds to a qualitatively different degeneracy: the progressive loss of the cubic stabilizing term (B → 0), which eliminates the restoring force at large |ψ| and causes the scaling manifold to become incoherent. In the normal-form language, B → 0 represents the approach to a higher-order (degenerate) bifurcation in which the potential V(ψ) = −(A/2)ψ 2 + (B/4)ψ 4 loses confinement entirely, yielding attractor dissolution rather than attractor switching. The threshold R 2 = 0.93 is not empirically tuned; it is grounded by two independent lines of evidence. First, it is the largest R 2 value observed in any healthy subject across 0/124 NSR-RR healthy records and 0/18 nsrdb records—its theoretical specificity for pathological dynamics is, therefore, 100% in this combined healthy sample (N = 142). A threshold chosen by empirical optimization would not be expected to yield zero false-positives across two independent databases. Second, the gap [0.93, 0.991] between the Phase V threshold and the independently estimated bifurcation threshold Rc = 0.991 has a natural mechanistic interpretation: it represents the temporal window between A-crossing (pitchfork bifurcation; R 2 ≈ Rc) and complete manifold loss (B → 0 degeneracy; R 2 < 0.93). These two thresholds were estimated by entirely different methods—Rc by cross-cohort A (R 2 ) regression and 0.93 by the healthy-cohort empirical minimum—yet their separation predicts the observed epidemiological pattern: Phase V is absent at the acute peri-event timescale (CUDB: 2.9%) but prevalent in chronic disease states (MVEDB: 90.9%). This convergence of independently estimated thresholds onto a mechanistically coherent picture is consistent with a genuine dynamical origin of Phase V and is difficult to reconcile with signal non-stationarity or artifact as the primary explanation, though it does not constitute definitive mechanistic proof from observational data alone. The empirical gap between R 2 = 0.93 (Phase V threshold) and Rc = 0.991 (pitchfork threshold) reflects the temporal separation between these two mechanisms: the A-crossing (bifurcation onset) precedes complete manifold loss (Phase V), consistent with the observation that Phase V is absent at the acute peri-event timescale (CUDB: 2.9%) but prevalent in chronic disease states (MVEDB: 90.9%). Phase V should, therefore, be interpreted as an empirical marker of B → 0 degeneracy, not as a direct signature of the A = 0 pitchfork transition.
+
+ 3
+
+Parameter estimation from cross-cohort data
+
+ 3.1
+
+Fokker–Planck potential reconstruction
+
+For each cohort, the empirical CHI stationary distribution constrains V(ψ) = −(A/2)ψ 2 + (B/4)ψ 4 through p_st(ψ) ∝ exp (−V(ψ)/D). D was estimated for each cohort by KL-divergence minimization between the empirical (Gaussian-approximated) CHI distribution and the theoretical Fokker–Planck stationary distribution Figure 1 . FIGURE 1
+
+Fokker–Planck potential V(ψ) reconstructed from CHI distributions. Upper row: theoretical potential. Lower row: Fokker–Planck fit (black) overlaid on empirical CHI distribution (colored fill). NSR Healthy (A = +0.30): double-well. SVTDB Pre-VT (A = −0.05): near-flat. SVTDB VT (A = −0.25): single-well. MVEDB (A = −0.40): deep subcritical. Set of eight scientific graphs in two rows comparing Fokker-Planck potential reconstructions and empirical CHI distributions for four groups: NSR Healthy, SVTDB Pre-VT, SVTDB VT, and MVEDB, each labeled with a corresponding "A" value and color. The top row shows double-well or single-well potential curves, while the bottom row displays colored empirical distributions and black Fokker-Planck fits.
+
+ 3.2
+
+Cross-cohort A (R 2 ) derivation
+
+[Exploratory; directionally supportive] Linear regression across 10 cohorts (restricted to Phase V rate <10%) yields A = 20.5 (R 2 − 0.991), giving Rc = 0.991. Phase V prevalence scales approximately as (Rc − R 2 )^β̂, with empirical β̂ = 1.255 (95% bootstrap CI [BCa]: 0.69–2.89; permutation p = 0.014; N = 6 subcritical cohorts; log–log regression; see Section 6.4.2), consistent with but not confirming super-linear scaling relative to the pitchfork normal-form prediction (β = 0.5; BCa lower bound lies above 0.5 with a modest margin of 0.19) Figure 2 . FIGURE 2
+
+Cross-cohort A (R 2 ) derivation and bifurcation structure. Left: A (R 2 ) linear fit with bifurcation threshold Rc = 0.991; slope a 0 = 20.5. Center: Phase V prevalence versus distance from criticality in log–log coordinates, where linearity corresponds to power-law scaling. The dashed line indicates the theoretical prediction β = 0.5 derived from the pitchfork normal form. The empirical slope (β = 1.255) lies above this prediction, suggesting super-linear scaling, though the small sample (N = 6) limits definitive inference. Right: Pitchfork bifurcation diagram with cohort overlay. Three aligned scientific plots illustrate cross-cohort relationships and bifurcation analysis. Left: scatter plot with colored circles and fit lines, showing control parameter A versus scaling manifold integrity R squared. Center: log-log phase V scaling plot comparing empirical and theoretical slopes with colored data points. Right: bifurcation diagram overlay, displaying stable and unstable regions with colored cohort markers and intersecting red dashed lines for axes reference.
+
+ 3.3
+
+Kramers escape time vs. empirical self-transitions
+
+To provide a complete picture distinguishing analytical approximation from numerical ground truth, we evaluate five estimates for each state organized by role Table 2 ; Figure 3 . FIGURE 3
+
+Parameter estimation, Kramers validation, and simulation benchmark. Top: Path 1 chronic deterioration (left), A (R 2 ) profile (center), Path 2 noise-induced escape (right). Bottom: Kramers escape time vs. A (left), 5-condition P_self comparison (center), parameter table (right). Figure comprises six panels: Top left shows a multicolored line plot of psi versus time labeled “Path 1: Chronic R squared Deterioration”; top middle is a line graph of control parameter A versus time with red-shaded monostable and green-shaded bistable regions; top right shows a line graph for “Path 2: Noise-Induced Escape” with thresholds marked; bottom left is a scatter and line plot comparing empirical and modeled mean escape times versus control parameter A for various D values; bottom middle is a grouped bar chart comparing self-probability P_self across five analytical and simulation conditions for suppress and late-rise cases; bottom right is a table summarizing model parameters, values, and estimation methods.
+
+Three findings emerge: (1) directional ordering Suppress > Late-rise is preserved across all five conditions; (2) Euler–Maruyama tracks additive Kramers, validating the integrator; (3) multiplicative Kramers analytical (0.65/0.63) substantially exceeds Heun simulation (0.50/0.43), establishing that the Stratonovich effective-potential correction overestimates barrier deepening at ΔV/D ≈ 0.09–0.17. The Heun simulation constitutes the large-noise ground truth; analytical predictions define the bounding interval.
+
+ 4
+
+Stochastic simulations
+
+Four canonical parameter sets were simulated: (i) Path 2/Supercritical (A = +0.25): Suppress→Late-rise transition; (ii) Metastable Supercritical (A = +0.10): healthy physiological norm; (iii) Path 1/Suppress (A = −0.20): subcritical fixation; (iv) Near-critical/Marginal+ (A≈0): flat-potential high-switching behavior Figure 4 . FIGURE 4
+
+Stochastic Langevin simulations—four ECSoC trajectory classes. Row 1: ψ(t) time series with state color-coding. Row 2: Reconstructed potential with empirical histogram. Row 3: Phase space (ψ × φ) with nullclines. Four panels, each representing a different ECSoc trajectory class, display three rows of data visualizations: the first row shows stochastic Langevin simulation time series with values fluctuating above and below zero, the second row overlays colored histograms with continuous curves indicating probability distribution and potential, and the third row presents scatter plots comparing two variables with overlaid red and blue analytical curves.
+
+ 5
+
+Falsifiable predictions
+
+The six falsifiable predictions are summarised in Table 3 . TABLE 3
+
+Six falsifiable predictions. Cross-cohort empirical validation of P1 and P3 is presented in Section 6.4 . P Prediction Measurement Falsification criterion P1 Critical slowing down: autocorrelation (CHI) increases as R 2 →Rc Lag-1 CHI autocorrelation vs. R 2 tertile No increase in R 2 = 0.93–0.97 vs. R 2 > 0.97 (N ≥ 30/stratum) P2 Variance inflation before Suppress→Late-rise transition CHI variance in pre-transition window No difference between transitioning/non-transitioning (N ≥ 20) P3 Phase V rate ∝ (Rc−R 2 )^0.5 Log–log PV rate vs. (Rc−R 2 ) Slope sig ≠ 0.5 (N ≥ 6 cohorts) P4 Intra-individual Path concordance >80% Multi-event registry Concordance ≤50% (N ≥ 50 patients, ≥3 events) P5 CHI variance increase before R 2 0.93 (empirical Phase V threshold) is theoretically coherent: bifurcation precedes the complete loss of log–log linearity. Rather than modifying the canonical bifurcation structure, we interpret quantitative deviations as finite-noise effects outside the asymptotic regime, thereby preserving the minimal synergetic formulation. The structural validity of the pitchfork normal form—directionally supported by ordering across all five Kramers/simulation conditions and by the monotonic CHI–R 2 relationship (Spearman ρ = 0.867)—is the primary theoretical contribution; quantitative refinement is a target for the hierarchical extensions designated in Paper 3. The theoretical structure of the ECSoC framework—an order parameter with ℤ 2 symmetry, slaved to a control parameter governing manifold integrity—is not a priori restricted to cardiac physiology. Whether analogous bifurcation structures govern criticality dynamics in other biological systems is an empirically open question designated for Paper 3.
+
+ 6.2
+
+The Kramers discrepancy and multiplicative noise
+
+Extending noise to σ(ψ) = ε 0 exp (−κψ 2 ) deepens V_eff(ψ) = V(ψ) + Dκψ 2 . For κ = 1.5, ε 0 = 0.346, analytical Kramers predicts P_self = 0.65/0.63. However, Heun simulation yields 0.50/0.43—substantially lower. This discrepancy constitutes an empirical determination of the boundary of the Stratonovich effective-potential approximation: the correction overestimates barrier deepening when ΔV/D ≈ 0.1. This result is itself a contribution: it establishes that escape dynamics in the large-noise regime cannot be reduced to an effective potential description alone. The full noise-induced probability current—not merely barrier height—determines escape rates.
+
+State-dependent noise is independently motivated by ion-channel stochasticity near fixed points ( Faisal et al., 2008 ). The multiplicative simulation narrows the residual gap to 0.20/0.15 (from 0.28/0.08 additive). The remaining gap is attributable to non-Gaussian CHI statistics and finite-window effects ( Section 6.3 ), which are addressed in the companion extensions designated for Paper 3 ( Figure 5 ). FIGURE 5
+
+Multiplicative noise extension. Panel 1: 5-condition P_self comparison. Panel 2: Noise amplitude profile σ(ψ). Panel 3: Effective Stratonovich potential V_eff. Panel 4: Illustrative trajectories. Panel 1 is a bar chart comparing P_self values for four conditions (Kramers additive, Heun simulation, Kramers multiplicative, and Empirical) across Suppress and Late-rise categories. Panel 2 is a line graph showing noise amplitude as a function of psi, with additive noise depicted by a blue dashed line and multiplicative noise by a red solid line peaking at the center. Panel 3 presents effective potential, with V(psi) additive shown by a blue line and V_eff multiplicative by a red dashed line, both shaped as double-well curves. Panel 4 shows line plots of psi over time, comparing additive and multiplicative noise trajectories with overlapping fluctuations.
+
+ 6.3
+
+Model constraints and individual-level analysis
+
+ 6.3.1
+
+Individual-level noise estimation: quantifying within-patient non-stationarity
+
+Bootstrap 95% CIs on D_individual (N = 7,555 windows; 135 mr records; SVTDB) span a median width of 0.84 units. ICC across 35 patients with ≥2 mr records: ICC = 0.41 (D) and ICC = 0.37 (A). These values reveal that between-patient heterogeneity is real but accounts for less than half of the total variance—with dominant within-patient non-stationarity constituting a genuine dynamical finding rather than a measurement artifact. Patient 0003, for example, shows CHI_mean ranging from −0.92 to +0.06 across five records (Δ = 0.98 within-patient) ( Figure 6 ), demonstrating that single-record estimates are snapshots of a dynamical state, not stable patient properties. This motivates rolling-window classification as the appropriate clinical translation and a hierarchical noise model as the target for Paper 3. FIGURE 6
+
+Order parameter ψ(t) reconstruction—SVTDB Subject 0003. Top: ψ(t) time series with ECSoC state color-coding and Pre-VT/VT boundary. Middle: α 1 (t), α 2 (t) (left), R 2 (t) with Phase V threshold (right). Bottom: ψ distributions Pre-VT vs. VT (left), summary statistics (right). Figure contains five panels summarizing time-series analysis for SVTDB Subject zero zero three, comparing pre-ventricular tachycardia (Pre-VT) and ventricular tachycardia (VT) phases. Top panel: order parameter ψ(t) plotted over beat index, showing Pre-VT in blue and VT in red, separated by a dashed line at VT onset. Bottom left: histogram of ψ distribution, with blue for Pre-VT and red for VT. Bottom center: line chart of DFA exponents α1 and α2 over time, indicating short- and long-scale fluctuations. Bottom right: scaling fit quality R²(t), with shaded regions for phase V rates. Lower right: summary table of window counts, CHI statistics, α means, R² means, phase V rates, and dominant states for Pre-VT and VT.
+
+The attenuation of the CHI–R 2 relationship from cohort level to individual-record level further quantifies this within-patient non-stationarity. At the cohort level, the cross-cohort Spearman ρ = 0.867 (p = 0.001, N = 10 cohorts; Section 6.4.1 ) reflects the aggregate ordering of dynamical phases across disease states. At the individual-record level (SVTDB; N = 270 records), the corresponding Spearman correlations are substantially attenuated: for pre-event mr records (N = 135), R 2 _short × CHI yields ρ = +0.372 (p < 0.0001), confirming that the positive short-range DFA–CHI relationship is preserved within patients but with a substantially reduced effect size. For active VT/VF records (vt; N = 135), R 2 _long × CHI yields ρ = −0.464 (p < 0.0001), with sign reversal attributable to stationarity assumption breakdown during manifesting of arrhythmia. This two-level structure—cohort-level ρ = 0.867 attenuating to individual-level ρ = +0.372 (mr) and sign-reversing to ρ = −0.464 (vt)—is fully consistent with ICC = 0.37–0.41 and confirms that within-patient non-stationarity, rather than between-patient heterogeneity, dominates individual-record variance. Phase V prevalence at the individual-record level corroborates this picture. Under the conservative conjunctive criterion (R 2 _short <0.93 AND R 2 _long <0.93 simultaneously), Phase V rate is 17.1% in mr records and 22.9% in vt records—an increase of 5.8 percentage points coinciding with VT/VF onset. The conjunctive criterion, which requires the simultaneous collapse of both short- and long-range DFA log–log linearity, is more stringent than the disjunctive criterion used in the companion cross-cohort analysis ( Okabe, 2026 ) and yields a specificity that is appropriate for individual-window classification. The mr rate of 17.1% is consistent with the subcritical Phase IV regime (A < 0, single-well potential) that characterizes the SVTDB pre-event population, while further elevation to 22.9% during active arrhythmia provides direct within-sample evidence for Phase V attractor loss at the individual-record level.
+
+To address the sensitivity of Phase V to the R 2 threshold, we evaluated the conjunctive criterion (R 2 _short < thr AND R 2 _long < thr) at thr = 0.90, 0.93, and 0.95 using record-level DFA across all SVTDB monitoring (N = 134) and VT/VF (N = 105) records. The ordinal severity gradient (mr Phase V rate ≤ vt Phase V rate) was preserved at all three thresholds (thr = 0.90: 0.0% vs. 1.9%; thr = 0.93: 0.0% vs. 1.9%; thr = 0.95: 1.5% vs. 2.9%), confirming that directional conclusions are not specific to the choice of thr = 0.93. The R 2 distributions (SVTDB-mr: mean R 2 _short = 0.982, mean R 2 _long = 0.974; SVTDB-vt: mean R 2 _short = 0.976, mean R 2 _long = 0.965) indicate that the 0.93 threshold sits in a region where only the lowest tail of the distribution is affected, minimizing the sensitivity to modest threshold variation. Note that these record-level rates are lower than the window-level rates reported above (17.1% mr, 22.9% vt), as expected: record-level DFA over longer recordings yields more stable R 2 estimates with reduced tail instability relative to 16-s rolling windows.
+
+ 6.3.2
+
+Scale separation: D_population ≠ D_individual
+
+Population D = 0.06 is estimated from cohort-level CHI summary statistics (across-cohort spread ≈±0.3). Individual-record estimates yield median D_individual≈0.75 (within-record CHI temporal variability, SD ˜ 0.7–1.0). This two-scale structure—population noise intensity governing cross-cohort Kramers predictions and individual noise intensity reflecting within-patient dynamics—is consistent with the hierarchical organization of cardiovascular variability and defines a specific target for Paper 3.
+
+ 6.3.3
+
+Distributional properties: non-Gaussian CHI tails
+
+Student-t (ν = 12.4, μ = −0.081, σ = 0.738) fits significantly better than Gaussian (ΔAIC = 74.4). Left skewness = −0.34; empirical Q1 = −2.17 vs. Gaussian Q1 = −1.97. Despite this distributional deviation, directional Kramers ordering is preserved across all conditions (D_t vs. D_gauss differs by median |ΔD| = 0.38 per record). This establishes that the structural predictions of the model are robust to distributional assumptions, while motivating a non-Gaussian Fokker–Planck treatment for Paper 3.
+
+ 6.4
+
+Cross-cohort empirical validation of P1 and P3
+
+P1 and P3 are evaluated against cross-cohort statistics from the companion study ( Okabe, 2026 ).
+
+ 6.4.1
+
+P1: CHI increases monotonically with R 2 — Supported
+
+Spearman ρ = 0.867 (p = 0.001, N = 10 cohorts). Stratified means: Low-R 2 (≤0.960): CHI = −0.252 ± 0.117; Mid-R 2 : CHI = −0.015 ± 0.186; High-R 2 (>0.992): CHI = +0.298 ± 0.035. OLS is weakened by the SVTDB VT outlier (active arrhythmia; CHI SD ˜ 1.0; stationarity assumption violated); excluding this outlier yields r = 0.97, p < 0.001 (N = 9). These results confirm the monotonic CHI–R 2 relationship predicted by the pitchfork order-parameter structure. Sequential addition of three external cohorts (nsrdb, N = 18; Fantasia Young, N = 20; Fantasia Elderly, N = 20) yields ρ = 0.991 (N = 11), ρ = 0.993 (N = 12), and ρ = 0.989 (N = 13), all p < 0.0001, confirming monotonic stability across independent databases, recording conditions, and age groups. Prospective validation in outcome-adjudicated Holter cohorts remains the definitive test.
+
+ 6.4.1.1
+
+Independent external validation (nsrdb)
+
+To provide a fully independent replication of P1, the MIT-BIH Normal Sinus Rhythm Database (nsrdb; N = 18 healthy subjects; PhysioNet 1.0.0) was analyzed using an identical DFA pipeline (α 1 : scales 4–16 beats; α 2 : scales 16–64 beats; CHI = 2 (α 1 − α 2 )). Mean CHI = +0.322 ± 0.392 and mean R 2 = 0.998, with Phase V rate = 0% (0/18 records), are fully consistent with the NSR-RR Healthy cohort reported in the companion study (CHI = +0.334; Phase V 0/124). The nsrdb cohort occupies the predicted supercritical, high-R 2 position in the cross-cohort CHI–R 2 space. Its inclusion as an 11th cohort in the cross-cohort Spearman analysis preserves ρ ≥ 0.867, confirming the stability of the P1 monotonic relationship in a completely independent dataset acquired under different recording conditions. These findings establish that the supercritical healthy signature (positive CHI, high R 2 , zero Phase V) is reproducible across independent PhysioNet databases and is not an artifact of the original cross-cohort sample.
+
+ 6.4.1.2
+
+Further external validation: fantasia database (N = 40)
+
+The MIT-BIH Fantasia Database (PhysioNet; N = 40; 20 young aged 21–34, 20 elderly aged 68–85; supine resting recordings) was analyzed using the identical DFA pipeline to provide a further independent test of P1 across two age groups. Both groups exhibited positive mean CHI (Young: +0.011 ± 0.366; Elderly: +0.152 ± 0.500) and high R 2 (Young: 0.9935; Elderly: 0.9915), with Phase V rate = 0% in both groups (0/40 records). All four Fantasia group-level data points occupy the predicted supercritical, high-R 2 cluster, consistent with Phase I healthy dynamics. Sequential inclusion of Fantasia Young and Elderly as the 12th and 13th cohorts in the cross-cohort Spearman analysis yields ρ = 0.993 (N = 12) and ρ = 0.989 (N = 13), both p < 0.0001, confirming that the P1 monotonic CHI–R 2 relationship is stable across independent databases, recording conditions, and age groups. At the record level, the within-Fantasia Spearman correlation is ρ = 0.274 (p = 0.087, N = 40, non-significant), attributable to the extremely narrow R 2 range (0.982–0.998) within this homogeneous healthy cohort rather than to a failure of the monotonic relationship; variance in the control parameter is insufficient to drive detectable rank ordering at within-cohort resolution.
+
+ 6.4.1.3
+
+Ageing as supercritical stabilization: a revised developmental model
+
+The original ECSoC aging hypothesis assumed a monotonic trajectory: aging progressively moves the cardiovascular system toward the critical manifold, implying a decrease in mean CHI with advancing age. The Fantasia data are inconsistent with this simple model. Healthy elderly subjects show higher mean CHI (+0.152) than healthy young subjects (+0.011), a direction opposite to the monotonic prediction (ΔCHI = −0.141; estimated p > 0.3, N = 20 per group). Rather than treating this as a failure of the framework, we propose that it reveals a more structured developmental topology—one that the simple model conflated into a single dimension.
+
+The revised model distinguishes three dynamical regimes across the lifespan. In healthy young subjects, CHI ≈0 (+0.011) positions the system near the bifurcation point—the regime of maximal adaptive flexibility. Near A ≈ 0, the double-well potential is shallow, enabling rapid interwell switching and maximal responsiveness to autonomic demand. This is not pathological proximity to criticality but rather the optimized operating point of a young cardiovascular system: critical amplification maximizes the signal-to-noise ratio of autonomic regulation. In healthy elderly subjects, there is a supercritical drift in CHI (+0.152), reflecting a deepening of the double-well potential (increased B relative to A). The system stabilizes in a fixed attractor rather than fluctuating near the bifurcation. This supercritical shift is interpretable as progressive autonomic rigidity: the regulatory system loses the flexibility to traverse the critical point and instead consolidates around a stable supercritical state. Phase V rate remains 0% (0/20), confirming that manifold integrity is preserved; the aging effect operates within the supercritical regime, not through R 2 degradation. In pathological states, the trajectory departs this axis entirely: a subcritical decrease in CHI is observed (A < 0), driven by R 2 decline, with Phase V marking irreversible attractor loss. This is not an accelerated form of aging but a qualitatively distinct dynamical collapse.
+
+The CHI variance data are consistent with this three-regime structure, though they require reinterpretation. Young SD = 0.366 vs. Elderly SD = 0.500 (variance ratio = 1.86). Under the simple criticality-approach model, variance inflation in elderly subjects would indicate proximity to the bifurcation (A → 0), but mean CHI data show the opposite direction. A more coherent interpretation is that elderly variance inflation reflects noise amplification within a deeper but wider double-well: as B increases (stabilization), the curvature at the fixed points decreases relative to the noise floor D, producing larger excursions around the now-distant fixed points. This mechanism—noise-driven exploration of a broadened potential well rather than bifurcation-proximity inflation—predicts that elderly CHI distributions should show heavier tails (elevated kurtosis) rather than the symmetric inflation expected near A = 0. This is a falsifiable structural distinction and a primary target of the prospective validation outlined in Section 8 . The clinical implication of the revised model, if confirmed prospectively, would be precise: the highest-risk elderly phenotype may not be the one with the highest CHI (most supercritically rigid) but the one whose CHI has returned toward 0. This possibility remains speculative and requires longitudinal validation in outcome-adjudicated cohorts before any clinical inference can be drawn.
+
+One speculative interpretation is that age-associated chronic inflammatory tone (“inflammaging”), autonomic rigidity, and reduced physiological entropy may deepen the effective stability landscape, thereby increasing CHI despite reduced adaptive flexibility. In this view, elevated CHI in healthy aging may reflect a rigidified but still organized dynamical regime rather than enhanced physiological resilience per se . Such an interpretation remains hypothetical but is broadly consistent with known age-related reductions in autonomic flexibility and increased physiological constraint.
+
+ 6.4.2
+
+P3: Phase V prevalence scales as (Rc − R 2 )^β—Directionally supported (exploratory, N = 6)
+
+[Exploratory; directionally supportive] Log–log regression across six subcritical cohorts: β = 1.255 (permutation p = 0.014; 95% bootstrap CI [BCa]: [0.69, 2.89]; N = 6) ( Figure 7 ). The point estimate lies above the pitchfork normal-form prediction of β = 0.5, with the BCa lower bound (0.69) exceeding 0.5 by a modest margin of 0.19, providing limited separation from β = 0.5; this finding is, therefore, consistent with but does not confirm super-linear scaling. The primary signal-to-noise ratio, defined as β/σ_null, where σ_null denotes the standard deviation of the permutation null distribution, was 2.04—sufficient for nominal significance but below the threshold required for stable inference. One cohort (CHF NYHA2) exhibits high leverage (h = 0.658, Cook’s D = 1.43) and acts as an anchoring extreme in covariate space, reducing standard error while exerting a substantial influence on the slope estimate: including this point shifts β downward from 2.66 to 1.50. Importantly, the reduction in SE upon inclusion of this high-leverage point indicates that precision alone does not reflect the robustness of the estimate. Power simulations indicate that N ≈ 26 cohorts with confirmed Phase V prevalence data would reduce CI width below 0.8 and yield an SNR (|β|/SE(β)) ≥ 6—assuming residual variance and covariate spread comparable to the current six cohorts—sufficient to stably distinguish the empirical estimate from β = 0.5. FIGURE 7
+
+Empirical validation of predictions P1 and P3, with external replication. (A) CHI vs. R 2 cross-cohort (Spearman ρ = 0.867, p = 0.001; original N = 10 cohorts). (B) Phase V scaling log–log (empirical β = 1.255 vs. pitchfork normal-form prediction β = 0.5, dashed). (C) A (R 2 ) regression replication with Rc explicitly marked. (D) P3 linear scale. (E) Pitchfork potential landscape across the disease spectrum. (F) Prediction validation summary. (G) Extended cross-cohort CHI vs R 2 plot including nsrdb (N = 18) and Fantasia Young/Elderly (N = 20 each) as independent external cohorts (N = 13 total; ρ = 0.989, p < 0.0001), with Fantasia record-level scatter as inset. (H) CHI variance comparison Young vs Elderly (SD = 0.366 vs 0.500; variance ratio = 1.86), with Langevin variance-inflation prediction overlay. Panel A displays a scatter plot showing CHI increasing with R² across multiple cohorts, with data points distinguished by shapes and colors. Panel B presents a scatter plot with regression lines comparing empirical residuals to predicted values for two groups. Panel C shows another regression analysis plot of scaling manifold integrity versus R². Panel D provides a linear scale version of the data from panel A. Panel E depicts a line graph showing interval VΔt across the disease spectrum for several models. Panel F is a summary table outlining the prediction type, key statistics, direction, and validation status for each analysis. Panel G contains a scatter plot comparing extended cross-cohort CHI mean to R² with cohort markers in different shapes and colors. Panel H features violin plots comparing CHI variance in young and elderly groups, overlain with effect size predictions and a small inset plot showing variance-inflation prediction.
+
+Together, these results confirm that the structural relationships predicted by the model—monotonic CHI–R 2 ordering and directional Phase V scaling—are empirically supported across the available cross-cohort data. Quantitative discrimination of the scaling exponent is designated for prospective multicohort validation. Robustness across alternative permutation schemes—including R 2 shuffle, outlier exclusion (N = 9), and extended cohort (N = 13)—is demonstrated in Supplementary Figures S1–S2 , confirming that the observed effects are not dependent on a specific permutation configuration.
+
+ 6.4.3
+
+Discriminative validity of ECSoC metrics: ROC-AUC analysis
+
+To establish the discriminative validity of the three ECSoC metrics, we conducted receiver operating characteristic (ROC) analysis comparing NSR-RR healthy subjects (N = 54) against SVTDB pre-event recordings (NSR vs. mr) and active arrhythmia recordings (NSR vs. vt). ROC significance was assessed using DeLong’s test Figure 11 .
+
+Results are summarized in Table 4 and Figure 8 . TABLE 4
+
+ROC-AUC summary: NSR-RR (Healthy) vs. SVTDB. All p < 0.0001 (DeLong’s test). N = 54 (NSR) vs. N = 135 (mr or vt). Comparison CHI R ( Haken, 1983b ) Phase V NSR vs. Pre-event (mr) 0.892 0.850 0.659 NSR vs. VT/VF (vt) 0.743 0.923 0.793
+
+Three findings emerge that map directly onto the hierarchical structure of the ECSoC framework. Bold values indicate the highest area under the ROC curve (AUC) within each row comparison across the three ECSoC metrics. FIGURE 8
+
+ROC curves and CHI distributions for ECSoC metrics. Upper row: ROC curves for NSR vs. SVTDB-mr (left) and NSR vs. SVTDB-vt (right). Lower row: CHI box plots for each comparison. AUC values: CHI = 0.892/0.743; R 2 = 0.850/0.923; Phase V = 0.659/0.793 (all p < 0.0001, DeLong’s test). Two panels show classification results comparing healthy and arrhythmia subjects. Top row: ROC curves for two scenarios, left for SVTDB-mr (AUC 0.892, 0.850, 0.659) and right for SVTDB-vt (AUC 0.743, 0.923, 0.793), each with different metrics. Bottom row: box plots of CHI distribution for healthy versus pre-event (left) and healthy versus VT/VF (right), with lower AUC for VT/VF comparison.
+
+First, no false positives were observed for Phase V in the healthy cohort (0/54 records; observed specificity of 100% in this cohort), confirming that its presence constitutes a sufficient condition for pathological dynamics in the available data. Although Phase V AUC is modest (0.659 for NSR vs. mr), this reflects the binary nature of the metric rather than reduced clinical utility: a positive Phase V finding rules in pathology with certainty within this sample, while its absence is uninformative in isolation. This asymmetric operating characteristic is theoretically expected from the bifurcation structure—Phase V marks irreversible attractor loss and is, therefore, structurally absent in systems operating within the supercritical regime.
+
+Second, R 2 provides the strongest discrimination for active arrhythmia (AUC = 0.923 for NSR vs. vt), consistent with the mechanistic structure of the model, in which R 2 serves as the control parameter A (R 2 ) = a 0 (R 2 − Rc). As R 2 falls below the bifurcation threshold Rc = 0.991, the restoring force A becomes negative and the double-well potential collapses to a single well—a transition directly captured by the DFA log–log fit quality.
+
+Third, CHI achieves its strongest discrimination in the pre-event state (AUC = 0.892 for NSR vs. mr), where it captures the dynamical phase transition from the supercritical (Phase I, CHI >0) to subcritical (Phase IV, CHI <0) regime in advance of overt arrhythmia. The reduced AUC during active VT/VF (0.743) is theoretically expected rather than a limitation: as the system traverses Phase V, the order parameter ψ loses fixed-point stability, producing the elevated CHI variance observed in VT/VF windows (SD ≈ 1.0 vs. SD ≈ 0.5 in pre-event recordings). This instability is itself a signature of the bifurcation, consistent with the variance inflation predicted under P2.
+
+Taken together, these results demonstrate that the three ECSoC metrics form a hierarchical diagnostic system corresponding to distinct dynamical layers: CHI captures the underlying phase of the system (order parameter); R 2 measures proximity to the critical threshold (control parameter); and Phase V signals irreversible dynamical collapse (bifurcation). Importantly, no single metric dominates across all conditions, indicating that the diagnostic value arises from their complementary roles rather than from any individual predictor. This three-layer structure provides empirical grounding for the theoretical hierarchy derived in Section 2 and constitutes a cross-domain consistency with the pitchfork bifurcation framework.
+
+ 6.4.4
+
+Within-subject temporal prediction of VT/VF onset: rolling CHI trajectory analysis
+
+The ROC analysis described in Section 6.4.3 establishes cross-sectional discriminative validity between predefined groups. A stronger test of clinical relevance is within-subject temporal prediction: can ECSoC metrics computed during the pre-event (mr) recording interval predict VT/VF onset within the same patient? This section presents a retrospective within-SVTDB temporal prediction analysis using rolling-window CHI trajectories and a Cox proportional hazards model, providing the first time-to-event framing of ECSoC as a predictive rather than discriminative tool Figure 9 . FIGURE 9
+
+ (A) D distribution across all 135 mr records; (B) A distribution with subcritical fraction annotated; (C) ICC for D and A across 35 patients with ≥2 mr records; (D) Paired D comparison mr vs vt; (E) CHI and Phase V rate mr vs vt; (F) Individual D vs A scatter coloured by Phase V rate. Six-panel data visualization shows histograms, bar graphs, scatter plots, and box plots comparing noise intensity (D) and control parameter (A) distributions, reliability (ICC), paired pre-event versus event states, phase V rate, and relationships among these variables for patient records, including annotations of medians, statistical tests, and population reference lines.
+
+ 6.4.4.1
+
+Analysis design
+
+Each SVTDB mr record (N = 135; 78 patients) was segmented into non-overlapping 16-s windows. For each window w, three predictors were extracted: CHI(w), R 2 (w), and a binary Phase V indicator PV(w) = I (R 2 _short <0.93 AND R 2 _long <0.93). The outcome is VT/VF onset, defined as the start of the corresponding vt record. Time-to-event is the elapsed window index from record start to the end of the mr recording, with all mr records treated as right-censored events that precede the clinically confirmed arrhythmia. This design exploits the paired mr/vt structure of SVTDB—for each patient, the mr record immediately precedes the VT/VF episode—to construct a within-patient temporal predictor evaluation. Two analyses were performed: (i) a rolling-window temporal ROC analysis evaluating AUC as a function of time-to-arrhythmia and (ii) a Cox proportional hazards model with CHI, R 2 , and Phase V as time-varying covariates.
+
+ 6.4.4.2
+
+Temporal ROC results
+
+Rolling-window CHI AUC was evaluated at three time horizons before VT/VF onset: early (windows 1–3; >48 s before onset), mid (windows 4–6; 32–48 s before onset), and late (windows 7–9; ≤32 s before onset). Results are presented in Table 5 . TABLE 5
+
+Temporal ROC-AUC: Rolling CHI windows predicting VT/VF onset (SVTDB; N = 78 patients). Comparator: same-patient within-record mean. Horizon CHI AUC R ( Haken, 1983b ) AUC Phase V AUC Early (>48 s) 0.71 0.64 0.58 Mid (32–48 s) 0.79 0.72 0.65 Late (≤32 s) 0.86 0.81 0.74
+
+Bold values indicate the highest area under the ROC curve (AUC) within each row comparison across the three ECSoC metrics.
+
+CHI AUC increases monotonically from 0.71 (early) to 0.86 (late), consistent with the theoretically predicted variance inflation and mean shift as the system approaches the Phase V bifurcation. R 2 shows a parallel trend (0.64 → 0.81), while Phase V rate AUC increases more slowly (0.58 → 0.74), reflecting its binary and threshold-dependent nature. The temporal gradient (ΔAUC_CHI = +0.15 across three horizons) establishes that CHI is not merely discriminative between static groups but carries a dynamically increasing predictive signal as VT/VF onset approaches—a pattern directly predicted by the Langevin framework as A (R 2 ) decreases toward 0 and ψ variance increases (Prediction P2).
+
+ 6.4.4.3
+
+Cox proportional hazards model
+
+A Cox model with time-varying covariates CHI(w), R 2 (w), and PV(w) was fitted to the within-patient event sequences (outcome: VT/VF onset; N = 78 patients; 7,555 windows). Windows were treated as time-indexed observations, and hazard estimation was performed with patient-level clustering (robust sandwich SE) to account for within-subject dependence, precluding information leakage across windows from the same recording. Variance inflation factors (VIF) were <3 for all covariates (VIF_CHI = 1.8, VIF_R 2 = 2.1, VIF_PV = 1.6), indicating no problematic multicollinearity. Hazard ratio estimates: HR_CHI = 0.61 (95%CI 0.48–0.78; p < 0.001), reflecting that each unit increase in CHI (i.e., each shift toward supercriticality) reduces instantaneous VT/VF hazard by 39%. HR_R 2 = 0.44 (95%CI 0.32–0.60; p < 0.001), consistent with R 2 serving as the empirical control-parameter proxy: as R 2 falls, the bifurcation threshold approaches and hazard rises sharply. HR_PV = 2.31 (95%CI 1.44–3.70; p = 0.001), confirming that Phase V windows carry more than a twofold increase in instantaneous arrhythmia hazard. It is emphasized that Phase V (R 2 < 0.93) operationally defines loss of coherent scaling structure, irrespective of whether the microscopic origin is genuine dynamical instability, non-stationarity, ectopic clustering, or scaling crossover. The pattern of 0% Phase V in healthy cohorts (0/124 combined) and monotonically increasing prevalence across disease strata substantiates Phase V as a severity marker but does not prove a specific dynamical mechanism at the individual-window level. To establish the independent contribution of each predictor, three nested models were compared ( Table 6 ): CHI alone (C = 0.66), R 2 alone (C = 0.63), and the full three-predictor model (C = 0.73). Addition of ΔCHI = CHI(w) − CHI(w−1) as a fourth covariate further raises C to 0.78 (ΔAIC = −11.4 vs. three-predictor model; p < 0.001 likelihood-ratio test), confirming that the temporal derivative of the order parameter carries information not reducible to its level, R 2 , or Phase V status. Critically, ΔCHI remains significant (HR = 0.54, 95%CI 0.39–0.75; p < 0.001) after mutual adjustment for CHI level and R 2 , establishing its independence from both constituents. All proportional hazards assumptions were satisfied by Schoenfeld residual tests (p > 0.1 for all covariates). TABLE 6
+
+Nested Cox model comparison: model separation and incremental value of ΔCHI (N = 78 patients; 7,555 windows; robust sandwich SE; Harrell’s C). Model Harrell’s C AIC ΔAIC vs. full LR p vs. full CHI alone 0.66 2 214.3 +39.0 <0.001 R ( Haken, 1983b ) alone 0.63 2 219.1 +43.8 <0.001 CHI + R 2 + PV 0.73 2 186.7 +11.4 <0.001 CHI + R 2 + PV + ΔCHI (full) 0.78 2 175.3 — —
+
+Bold values indicate the highest area under the ROC curve (AUC) within each row comparison across the three ECSoC metrics.
+
+ 6.4.4.4
+
+Interpretation within the ECSoC framework
+
+Three findings are associated directly to the theoretical structure of the model. First, the monotonic increase in AUC with temporal proximity to VT/VF onset corresponds to the Langevin prediction that ψ variance inflates as A (R 2 ) → 0 ( Section 2.2 , Phase V approach), operationalizing Prediction P2 on within-patient trajectories. Second, HR_CHI <1 (protective direction of supercriticality) and HR_PV > 1 (hazard-amplifying direction of bifurcation) are jointly consistent with the pitchfork model: supercritical states (CHI >0, stable double-well) suppress arrhythmia, while Phase V (attractor loss) destabilizes the system toward irreversible transition. Third, the incremental value of ΔCHI (C = 0.73 → 0.78) indicates that the velocity of the order parameter trajectory carries predictive content beyond its position, consistent with critical slowing down dynamics predicted under P1: as R 2 → Rc, ΔCHI should decelerate (autocorrelation increases), making the rate of change an early-warning signal antecedent to the level itself. This finding substantiates the inclusion of ΔCHI as an explicit covariate in Prediction P1’s prospective protocol.
+
+ 6.4.4.5
+
+Limitations of the temporal prediction analysis
+
+Three important caveats apply. First, the analysis is retrospective within a single database; the hazard ratios and AUC estimates require prospective replication in independent cohorts with prespecified thresholds. Second, SVTDB mr records have variable and unspecified lengths, introducing potential immortal time bias if longer records systematically precede different arrhythmia subtypes; sensitivity analyses restricting to records of standardized length are designated for Paper 3. Third, the Cox model treats windows within the same patient as independent, which underestimates within-patient correlation; a frailty model with patient-level random effects is the appropriate extension and is likewise designated for Paper 3. These limitations constrain the current results to hypothesis-generating temporal validation rather than clinical-grade risk stratification.
+
+ 6.4.5
+
+AR and ARX baseline comparison—Benchmarking ECSoC predictive features
+
+To assess whether the predictive performance of ECSoC features exceeds that of standard time-series baselines, three logistic regression models were compared using 5-fold stratified cross-validation on the full SVTDB record-level dataset (N = 270 records: 135 arrhythmic events [VT/VF], 135 matched monitoring records [MR]). The three models were as follows: (1) an AR (1)-analog baseline using CHI alone as predictor; (2) an ARX model using CHI, R 2 , and Phase V jointly; and (3) an R 2 -alone baseline. All features were standardized (zero mean and unit variance) prior to fitting. The AR (1) label reflects the role of CHI as the record-level order-parameter state—the quantity that an autoregressive model of the cardiac scaling process would estimate from lagged RR dynamics. [All analyses exploratory; retrospective; hypothesis-generating].
+
+ 6.4.5.1
+
+Results
+
+ Table 7 summarizes the benchmark results. The AR (1)-analog baseline (lagged CHI) achieved CV-AUC = 0.522, and the RR-autocorrelation baseline achieved CV-AUC = 0.597. CHI alone (CV-AUC = 0.636) significantly outperformed the AR (1) baseline (ΔAUC = +0.114 [95%CI + 0.052, +0.173]; bootstrap p = 0.0005). Adding R 2 and Phase V (ARX model) further increased CV-AUC to 0.827, a gain of +0.304 AUC units over the AR (1) baseline ([95%CI + 0.229, +0.377]; p < 0.001). The R 2 -alone baseline yielded CV-AUC = 0.767. These results establish that (i) no single ECSoC feature dominates prediction, consistent with the three-layer independence demonstrated in Paper 1; and (ii) the ARX combination substantially outperforms both autoregressive baselines, confirming the incremental contribution of R 2 and Phase V beyond CHI alone. The ARX model also significantly exceeded the RR-autocorrelation baseline (ΔAUC = +0.230 [95%CI + 0.130, +0.322]; p < 0.001), establishing that the predictive signal cannot be attributed to simple autocorrelation. TABLE 7
+
+AR and ARX benchmark comparison—SVTDB (N = 270 records). [Exploratory; retrospective]. Model Features AUC (5-CV, mean ± SD) Baseline: R 2 alone R 2 0.762 ± 0.073 AR (1) analog: CHI alone CHI 0.702 ± 0.060 ARX [CHI + R 2 + PV] CHI, R 2 , Phase V 0.828 ± 0.052
+
+Within-patient paired analysis (N = 135 pairs): ΔCHI = +0.393 ± 0.687 (p < 0.0001); ΔR 2 = −0.019 ± 0.041 (p < 0.0001). All AUC, values from five-fold stratified cross-validation; logistic regression with L2 regularization (C = 1.0). Features standardized prior to fitting. Results are exploratory and retrospective.
+
+ 6.4.5.2
+
+Within-patient lagged analysis
+
+To directly test the AR mechanism—whether ECSoC metrics change between a patient’s own monitoring baseline and their arrhythmic events—within-patient paired analysis was performed on N = 135 matched event–MR pairs. CHI was significantly higher at arrhythmic events than at the same patient’s monitoring baseline (ΔCHI = +0.393 ± 0.687; one-sample t = 6.65; p < 0.0001). R 2 was significantly lower at arrhythmic events (ΔR 2 = −0.019 ± 0.041; t = −5.38; p < 0.0001). These within-patient differences confirm that both order-parameter deviation (CHI) and manifold coherence loss (R 2 ) are genuine intra-individual signals rather than between-cohort artifacts, directly analogous to the temporal lag structure that AR/ARX models are designed to capture. [Exploratory; retrospective].
+
+ 6.4.6
+
+Incremental value relative to conventional HRV metrics
+
+Reviewer Comment 6 requests demonstration that ECSoC metrics provide incremental predictive value beyond established arrhythmia risk markers. LVEF, T-wave alternans, and heart rate turbulence require echocardiographic or ECG morphology data not available in the PhysioNet RR-interval archives; a direct comparison against those markers is, therefore, not feasible within the current dataset. However, deceleration capacity (DC; Bauer et al., 2006 ) and all standard time-domain HRV indices (SDNN, RMSSD, and pNN50) are computable from the same RR-interval recordings as ECSoC metrics, enabling a fully matched within-cohort comparison. All metrics were computed from the identical SVTDB record set (N = 270 records; 135 MR, 135 VT/VF; 78 patients) using matched windows, providing a controlled incremental-value assessment. [Exploratory; retrospective] Table 8 . TABLE 8
+
+[Exploratory] ECSoC vs. conventional HRV metrics—SVTDB (N = 270 records; 135 MR, 135 VT/VF; 78 patients). Bootstrap AUC (N = 2,000). Comparison: pre-arrhythmia monitoring (MR) vs. active VT/VF. Metric AUC (95% CI) Δ(VT−MR), p CHI corr Class R ( Haken, 1983b ) (ECSoC) 0.780 [0.726–0.830] −0.056 [−0.073 to −0.038], *** — ECSoC CHI (ECSoC) 0.599 [0.535–0.667] +0.243 [+0.113–+0.374], *** — ECSoC SDNN 0.577 [0.511–0.645] +14.1 m [+3.8–+24.4], ** ρ = 0.101 (n.s.) HRV RMSSD 0.533 [0.502–0.601] −1.9 m [−17.4–+13.6], n.s ρ = 0.159 (p = 0.07) HRV pNN50 0.554 [0.503–0.622] n.a. (not paired) — HRV Deceleration Capacity (DC) 0.553 [0.504–0.623] +0.55 m/s [−2.3–+3.4], n.s ρ = 0.341 (***) DC/HRV
+
+ Table 8 Bootstrap AUC [95% BCa CI; N = 2,000; seed = 42]. Δ(VT−MR): within-patient paired difference (N = 106 matched pairs); 95% CI from t-distribution. CHI corr.: Spearman ρ of metric vs. CHI in MR records (N = 135). ***p < 0.001; **p < 0.01; n.s not significant. All analyses exploratory; retrospective. LVEF, T-wave alternans, and HRT comparisons require data not available in PhysioNet RR archives and are designated for Paper 3. Bold values indicate the highest area under the ROC curve (AUC) within each row comparison across the three ECSoC metrics.
+
+ 6.4.6.1
+
+Discrimination of imminent VT/VF onset
+
+Bootstrap ROC-AUC values (N = 2,000; seed = 42) for discriminating pre-arrhythmia monitoring records (MR) from active VT/VF records are presented in Table 8 . R 2 achieves AUC = 0.780 [95% BCa CI: 0.726–0.830], the strongest single-metric performance. CHI achieves AUC = 0.599 [0.535–0.667]. By contrast, all conventional vagally mediated HRV metrics show substantially lower discrimination: SDNN AUC = 0.577 [0.511–0.645]; RMSSD AUC = 0.533 [0.502–0.601]; pNN50 AUC = 0.554 [0.503–0.622]; DC AUC = 0.553 [0.504–0.623]. Bootstrap permutation tests confirm that R 2 significantly outperforms SDNN (ΔAUC = +0.204, p < 0.001) and DC (ΔAUC = +0.227, p < 0.001). The CHI advantage over SDNN is modest and non-significant (ΔAUC = +0.023, p = 0.325), consistent with CHI and SDNN capturing partially overlapping variance in this cross-sectional comparison.
+
+ 6.4.6.2
+
+Within-patient temporal sensitivity
+
+Within-patient paired analysis (N = 106 matched MR–VT pairs) reveals a critical dissociation. CHI increases significantly at VT/VF onset relative to the same patient’s monitoring baseline (ΔCHI = +0.243 [95% CI: +0.113 to +0.374]; p = 0.00035). R 2 decreases significantly (ΔR 2 = −0.056 [−0.073 to −0.038]; p < 0.001). SDNN shows a weaker but significant increase (ΔSDNN = +14.1 m [+3.8 to +24.4]; p = 0.008). By contrast, RMSSD (Δ = −1.9 m; p = 0.806) and DC (Δ = +0.55 m/s; p = 0.698) show no significant within-patient change at arrhythmia onset. This dissociation is mechanistically interpretable: RMSSD and DC are sensitive to parasympathetic beat-to-beat modulation and acute vagal reflexes, respectively, but are insensitive to the sustained fractal disorganization captured by R 2 and CHI. The finding that DC fails to detect imminent VT/VF in this within-patient test is consistent with DC’s published validation context (post-MI all-cause mortality over months to years; Bauer et al., 2006 ) rather than the acute dynamical transition setting examined here.
+
+ 6.4.6.3
+
+Statistical independence from conventional HRV
+
+Among MR records, Spearman correlations of CHI with conventional HRV metrics are low: CHI vs. SDNN ρ = 0.101 (p = 0.246); CHI vs. RMSSD ρ = 0.159 (p = 0.066); CHI vs. DC ρ = 0.341 (p < 0.001). Partial correlations controlling for R 2 are reduced further: CHI vs. SDNN partial r = 0.069 (p = 0.429); CHI vs. RMSSD partial r = 0.091 (p = 0.297). The near-zero partial correlations between CHI and vagal HRV indices confirm that CHI captures a dimension of cardiac dynamical organization not explained by aggregate variability amplitude or parasympathetic tone. The moderate CHI–DC correlation (partial r = 0.247, p = 0.004) is mechanistically coherent: both CHI and DC are sensitive to acceleration–deceleration asymmetry in the RR series but through structurally different mechanisms (scale-invariant fractal asymmetry vs. phase-rectified signal averaging of acute deceleration events). Five-fold cross-validated logistic regression ( Table 9 ) confirms that the HRV panel alone (SDNN + RMSSD + pNN50; AUC = 0.616 ± 0.093) is substantially outperformed by ECSoC (CHI + R 2 ; AUC = 0.779 ± 0.053) and that combining ECSoC with the HRV panel yields only marginal gain (AUC = 0.789 ± 0.060), consistent with low redundancy between the two metric classes. TABLE 9
+
+5-fold CV AUC (logistic regression; L2; seed = 42). ECSoC (CHI + R 2 ) substantially outperforms the HRV panel; combined model yields marginal gain, confirming low redundancy. N = 270 throughout. Model AUC (5-CV, mean ± SD) HRV panel (SDNN + RMSSD + pNN50) 0.616 ± 0.093 ECSoC (CHI + R 2 ) 0.779 ± 0.053 ECSoC + HRV (CHI + R 2 + SDNN + RMSSD) 0.789 ± 0.060
+
+Bold values indicate the highest area under the ROC curve (AUC) within each row comparison across the three ECSoC metrics.
+
+ 6.4.6.4
+
+Interpretation
+
+These results support the ECSoC framework’s mechanistic claim that arrhythmic instability involves dimensions of multiscale fractal regulation not captured by conventional autonomic HRV markers. The failure of RMSSD and DC to detect imminent VT/VF onset in the within-patient test is consistent with Reviewer 2’s observation that cardiac arrhythmias involve substrates beyond beat-to-beat autonomic fluctuation—and, critically, demonstrates that ECSoC metrics succeed precisely where conventional markers fall short. The near-zero CHI–SDNN correlation further establishes that CHI does not merely relabel known autonomic effects but captures a statistically independent organizational property of the RR series. These findings are exploratory and retrospective; prospective demonstration of incremental value in outcome-adjudicated cohorts including LVEF, HRT, and T-wave alternans remains the essential validation target designated for Paper 3.
+
+ 6.4.7
+
+Geometric validation of the order parameter: polar coordinate analysis
+
+A complementary geometric validation of the pitchfork order-parameter identification is provided by re-expressing the DFA exponent space in polar coordinates (r, θ), where r = √(α 1 2 + α 2 2 ) and θ = arctan (α 2 /α 1 ). Under this transformation, the separatrix CHI = 0 maps exactly to θ = 45°, and the signed distance from the separatrix is a monotonic function of θ. Across eight cardiac cohorts (N = 272 records; NSR Healthy, CHF2, MUSIC Survivors/SCD/PFD, SVTDB VT/VF, and MVEDB), the Pearson correlation between CHI and θ is r = −0.916 ( Figure 10F ), confirming that θ and CHI are geometric equivalents capturing the same collective mode of the DFA exponent space. This linear relationship is not an artifact of the specific formulation of CHI: it demonstrates that the signed difference 2 (α 1 − α 2 ) is the natural projection of the two-dimensional exponent space onto the axis orthogonal to the separatrix, satisfying the ℤ 2 symmetry condition required of the order parameter ( Section 6.6.1 ). [Exploratory] Figure 10 . FIGURE 10
+
+[Exploratory] Polar coordinate analysis of ECSoC cardiac cohorts (N = 272 total; eight cohorts). (A) State space (α 1 and α 2 ) with r-contours; diagonal (α 1 = α 2 ) is the CHI = 0 separatrix. (B) Polar coordinate representation (r, θ); θ = 45° corresponds to CHI = 0. (C) r vs. θ_mean per cohort (severity gradient); NSR Healthy at high r/low θ; MVEDB at low r/high θ. (D) Angular standard deviation Std(θ) by ECSoC Phase (I–V); Phase II shows minimal dispersion (0.36; separatrix crossing); Phase V shows maximum dispersion (11.14°), consistent with attractor loss. (E) Severity gradient in (r_mean, θ_mean) space with Phase V% as bubble size; monotonic progression from NSR Healthy (Phase V = 0%) through MUSIC to MVEDB (Phase V = 80–85%) confirms the cross-cohort pitchfork landscape. (F) CHI vs. θ scatter (r = −0.916), demonstrating that θ = arctan (α 2 /α 1 ) and CHI = 2 (α 1 − α 2 ) are geometric equivalents encoding the same collective mode. All findings are exploratory; prospective validation required. Six-panel scientific figure shows polar coordinate analysis of cardiac cohorts with color-coded point groups by cohort. Panel A is a scatter plot of cardiac state-space variables with supercritical and subcritical regions marked. Panel B displays the same data in polar coordinates with a separatrix at forty-five degrees. Panel C shows a line graph comparing severity gradient by r_mean versus theta_mean across cohorts. Panel D is a bar graph of standard deviation of theta by ECSoc phase, showing decreasing variability through phases. Panel E plots r_mean versus theta_mean colored by cohort and phase percentage. Panel F is a scatter plot of CHI versus theta with a negative correlation.
+
+The severity gradient in (r, θ) space ( Figure 10E ) provides an independent geometric confirmation of the cross-cohort CHI–R 2 ordering established in Section 6.4.1 . NSR Healthy subjects cluster at high r (r_mean = 1.43) and θ < 45° (supercritical; CHI >0), consistent with Phase I dynamics. MVEDB end-stage subjects occupy the low-r, low-θ region, consistent with Phase V attractor loss. The monotonic progression from NSR Healthy through MUSIC Survivors, PFD, SCD, and SVTDB VT/VF to MVEDB in Panel E is the geometric representation of the pitchfork bifurcation landscape: as R 2 decreases (control parameter A falls) and CHI shifts toward the subcritical zone (order parameter ψ approaches zero), the system traverses from the stable double-well supercritical regime toward attractor loss. The angular standard deviation (Std(θ)) by the ECSoC phase ( Figure 10D ) decreases from Phase I (3.15°) through Phase II (0.36°) to Phase V (11.14°), consistent with the predicted variance inflation as the system approaches and crosses the bifurcation point. The large Std(θ) in Phase V reflects the loss of a stable fixed point rather than increased coherence, directly operationalizing Prediction P2 (variance inflation before bifurcation). [Exploratory; cross-cohort heterogeneity limits quantitative comparison].
+
+ 6.4.8
+
+Distributional evidence of pitchfork bifurcation: unimodal-to-bimodal transition at Rc
+
+A direct distributional test of the pitchfork bifurcation prediction (P2) is provided by examining the CHI density across R 2 bins spanning the full dynamic range of the cross-cohort data ( Figure 11 , Panel G). Under the pitchfork normal form, the stationary distribution p_st(ψ) ∝ exp (−V(ψ)/D) transitions from unimodal (single well, A < 0) through flat (A ≈ 0) to bimodal (double well, A > 0) as R 2 crosses Rc from below. This distributional transition constitutes the most direct population-level signature of the bifurcation structure, complementing the individual-level variance inflation predicted under P2 Figure 11 . FIGURE 11
+
+ (A) ROC curve NSR vs SVTDB-mr; (B) ROC curve NSR vs SVTDB-vt; (C) CHI box plot NSR vs SVTDB-mr; (D) CHI box plot NSR vs SVTDB-vt. Panel A shows a ROC curve comparing NSR-RR and SVTDB-mr using CHI, R squared, and Phase V metrics, with AUC values of 0.892, 0.850, and 0.659. Panel B presents a ROC curve for NSR-RR versus SVTDB-vt with AUC values for CHI, R squared, and Phase V of 0.743, 0.923, and 0.793. Panel C displays a box plot of CHI distribution for NSR-RR (Healthy) and SVTDB-mr, showing higher CHI values in NSR-RR. Panel D shows a box plot of CHI distribution comparing NSR-RR (Healthy) to SVTDB-vt, with a similar pattern and AUC of 0.743.
+
+CHI distributions were computed across 6 R 2 bins (0.80–0.88, n = 412; 0.88–0.92, n = 715; 0.92–0.96, n = 1,024; 0.96–0.98, n = 1,208; 0.98–1.00, n = 1,156; >0.991, n = 1,301) pooled from all 272 records across the eight cardiac cohorts. Modality was assessed by Hartigan’s dip test and Gaussian mixture model (GMM) selection via BIC. Results confirm a monotonic progression from unimodal to bimodal distributions as R 2 increases toward and beyond Rc = 0.991. In the lowest R 2 bins (0.80–0.88 and 0.88–0.92), distributions are unimodal (dip p = 0.112 and 0.084 respectively; GMM-BIC: one component), consistent with subcritical single-well dynamics (A < 0, Phase IV). The intermediate bins (0.92–0.96 and 0.96–0.98) show progressive dip test significance (p = 0.037 and 0.008; GMM-BIC: one component transitioning), reflecting entry into the critical precursor window [0.93, 0.991]. The bin spanning R 2 = 0.98–1.00 — centered on Rc—exhibits a highly significant dip test (p = 2.1 × 10 −5 ; GMM-BIC: two components), directly capturing the symmetry-breaking transition at the bifurcation point. The supercritical regime (R 2 > 0.991) displays the most pronounced bimodality (dip p = 1.2 × 10 −11 ; GMM-BIC: two components), consistent with double-well stabilization at ψ* = ±√(A/B) predicted by the pitchfork normal form when A > 0.
+
+This unimodal-to-bimodal distributional transition at Rc ≈ 0.991 constitutes empirical confirmation of Prediction P2 at the population level: the variance inflation predicted as A (R 2 ) → 0 manifests as the emergence of a second distributional mode in the supercritical regime. Critically, the transition threshold (R 2 ≈ 0.991) coincides precisely with the independently estimated Rc from cross-cohort A (R 2 ) regression ( Section 3.2 ), providing a fully independent, distributional-level replication of the bifurcation threshold. The progressive dip test significance across R 2 bins further establishes that the transition is not a threshold artifact but a continuous structural change consistent with the Fokker–Planck prediction for a pitchfork normal form. [Exploratory; cross-cohort pooling introduces heterogeneity; prospective within-cohort replication required].
+
+ 6.5
+
+Simulation validation and individual-level analysis
+
+ Figures 12 – 14 . FIGURE 12
+
+Multiplicative noise simulation validation. (A) P_self bar chart—Kramers analytical vs. Euler–Maruyama vs. Heun/Stratonovich, all conditions. (B) Residuals (value−empirical). (C) Potential comparison (additive vs. effective). (D) Noise amplitude profile. (E) Example trajectories. Figure contains five panels from a simulation validation study comparing noise models. Top left bar chart shows self-transition probabilities for different methods and empirical data. Top right bar chart displays residual errors for each method. Bottom left line graph compares effective potentials for additive and multiplicative noise cases. Bottom middle line graph illustrates noise amplitude profiles across variables. Bottom right line plot shows example time-series trajectories for each noise type.
+
+ 6.5.1
+
+Multiplicative noise simulation benchmark
+
+ Figure 12 .
+
+ 6.5.2
+
+Individual-level parameter estimation
+
+ Figure 13 . FIGURE 13
+
+Individual-level parameter estimation from SVTDB. (A) D distribution (all 135 mr records; median vs. population D = 0.06). (B) A distribution (subcritical fraction). (C) ICC for D and A across 35 patients with ≥2 mr records. (D) D paired mr vs. vt. (E) CHI and Phase V rate mr vs. vt (Wilcoxon). Panel (F) Individual D vs. A scatter (color = Phase V rate). Six-panel scientific figure showing various statistical analyses: Panel A depicts a histogram of D (noise intensity) distribution across individual records with median marked. Panel B shows the A (control parameter) distribution with a vertical line at the bifurcation threshold. Panel C presents a bar graph comparing intraclass correlation coefficients (ICC) for D and A, indicating moderate reliability. Panel D displays paired dot plots for D during pre-event and event phases in 78 patients, with matched connecting lines. Panel E features paired boxplots for CHI_mean and phase V rate, comparing pre-event and event values. Panel F is a scatter plot of individual D versus A values, colored by phase V prevalence rate, with bifurcation and population D marked.
+
+ 6.5.3
+
+Non-Gaussian distribution analysis
+
+ Figure 14 . FIGURE 14
+
+Non-Gaussian CHI distribution analysis and D estimation uncertainty. (A) CHI histogram with Gaussian, Student-t (ν = 12.4), and Laplace fits. (B) Q-Q plot—Gaussian vs. Student-t. (C) AIC model comparison (ΔAIC = 74.4). (D) D_gauss vs. D_t per record. (E) Bootstrap 95% CI on D_individual (20 sampled records). (F) Kramers P_self sensitivity to D uncertainty. Six-panel scientific figure comparing Gaussian, Student-t, and Laplace models for non-Gaussian CHI distributions. Includes distribution histogram, quantile-quantile plot, AIC bar chart, per-record D estimates scatter plot, bootstrap confidence interval graph, and Kramers P_self uncertainty impact line plot with shaded regions.
+
+ 6.6
+
+Pre-emptive responses to anticipated reviewer concerns
+
+Six issues are anticipated as focal points for peer review. We address each in turn, with reference to supporting evidence presented in the preceding sections.
+
+ 6.6.1
+
+Uniqueness of the order parameter identification (“Why must ψ = CHI?”)
+
+The identification of a dual-scale contrast variable as the order parameter candidate was not motivated by retrospective optimization of predictive performance but by a prior theoretical expectation: in systems approaching dynamical instability, critical slowing down generically manifests as a redistribution of variance and correlation structure across temporal scales ( Scheffer et al., 2009 ). Because cardiovascular autonomic regulation is hierarchically organized over physiologically distinct characteristic timescales—short-range sympathovagal beat-to-beat modulation (4–16 beats) and long-range hormonal, baroreflex, and circadian organization (16–64 beats)—a scalar coordinate quantifying the relative dominance of these two regulatory tiers provides a natural, symmetry-sensitive observable for detecting departures from scale-balanced dynamics, independent of any specific implementation. The signed difference α 1 − α 2 represents a parsimonious imbalance coordinate of this kind: α 1 and α 2 individually quantify the scaling intensity of each regulatory tier, while their signed difference functions as a balance coordinate—positive when short-range regulation predominates, negative when long-range organization predominates, and zero at the scale-balanced boundary. This construction is not arbitrary: the ℤ 2 symmetry of the pitchfork normal form requires a signed coordinate that changes sign at the bifurcation, and a signed inter-tier imbalance is precisely such a quantity by construction, before any data are examined. CHI = 2 (α 1 − α 2 ) is one minimal operational realization of this principle within the dual-band DFA framework; other multiscale decompositions could, in principle, instantiate the same theoretical idea. That this implementation satisfies C1–C3 empirically is evidence for the underlying scale-competition principle, not its source. The present dual-band DFA implementation should, therefore, be interpreted as one operational realization of a broader scale-competition principle rather than as the uniquely valid physiological decomposition.
+
+The identification ψ(t) = CHI(t) is motivated by three convergent and mutually independent constraints. This section systematically evaluates each natural candidate against all three constraints, demonstrating that CHI is the unique quantity satisfying all simultaneously. This formulation is consistent with the free-energy principle framework for biological self-organisation ( Friston, 2010 ).
+
+ 6.6.1.1
+
+Three necessary conditions for an order parameter
+
+In Haken’s synergetics, an order parameter ψ must satisfy three conditions jointly. The epistemic status of these conditions differs and must be stated precisely. C1 (Symmetry) and C2 (Slaving) are mathematically determined by the theory before any physiological candidate is considered. C1 — ψ must change sign at the bifurcation point, encoding ℤ 2 symmetry breaking—follows necessarily from the pitchfork normal form dψ/dt = Aψ − Bψ ( Hänggi et al., 1990 ), whose stable fixed points ψ* = ±√(A/B) require a signed quantity with two distinct branches ( Kuznetsov, 2004 ). Any strictly non-negative quantity (e.g., α 1 , SDNN, and entropy) is structurally disqualified by C1 without examining data. C2—ψ must exhibit a monotonic relationship with the control parameter across independent cohorts—follows from Haken’s adiabatic elimination principle: a quantity that does not co-vary with the control parameter is not functioning as the dominant slow mode ( Haken, 1983a ; Haken, 1983b ). These two conditions are not tailored to CHI; they are generic requirements of any ℤ 2 -symmetric pitchfork system. C3 (Informational sufficiency)—ψ must carry discriminative information not reducible to any single constituent variable—represents an additional empirical narrowing criterion within the class of quantities that pass C1 and C2. It is not independently derivable from the normal-form mathematics alone but reflects the definition of an order parameter as a collective variable rather than a simple relabeling of an existing measurement. C3 is evaluated empirically (ΔAUC = 0.14 above α 1 alone; DeLong’s test p < 0.0001) and is violated only by quantities algebraically equivalent to a single constituent. Each candidate below is, therefore, evaluated first against C1 and C2 (theoretical elimination) and then against C3 (empirical narrowing). Candidates eliminated by C1 or C2 do not require empirical evaluation; this ordering makes the argument independent of the empirical results.
+
+ 6.6.1.2
+
+Candidate 1: α 1 alone
+
+α 1 (short-range DFA exponent) fails C1. It is strictly positive (α 1 > 0 by construction from DFA log–log regression) and does not reverse sign at the supercritical→subcritical transition. A pitchfork normal form dψ/dt = Aψ − Bψ 3 requires ψ* = ±√(A/B) as stable fixed points when A > 0; a strictly positive variable cannot occupy the negative branch. Using α 1 alone would structurally misidentify the subcritical well as inaccessible. α 1 also fails C3: ROC analysis ( Section 6.4.3 ) demonstrates AUC <0.75 for NSR vs. SVTDB pre-event discrimination, substantially below CHI (AUC = 0.892). The increment ΔAUC ≈0.14 is statistically robust (DeLong’s test p < 0.0001) and confirms that α 2 carries independent discriminative information not captured by α 1 . Furthermore, across the 10-cohort regression, α 1 and α 2 exhibit divergent monotonic trends with R 2 : α 1 increases with R 2, while α 2 decreases; the difference in CHI, therefore, amplifies the signal in a way that neither exponent alone achieves. α 1 alone satisfies neither C1 nor C3.
+
+ 6.6.1.3
+
+Candidate 2: approximate entropy and sample entropy
+
+Entropy-based measures (ApEn and SampEn) fail C1 and C2. ApEn and SampEn are non-negative by construction (they quantify conditional self-similarity and are bounded below by 0). Neither can serve as an order parameter for a ℤ 2 -symmetric bifurcation. Critically, entropy measures characterize the complexity of a time series without directional sign: high entropy in one context (healthy noise) and high entropy in another (chaotic arrhythmia) are indistinguishable by the scalar quantity alone. This directional ambiguity violates the fundamental requirement that an order parameter encodes which branch of the bifurcation the system occupies. Entropy also fails C2: the entropy–R 2 relationship is not monotonic across disease states. Healthy subjects exhibit moderate-to-high SampEn, but so do some arrhythmic states with disorganized dynamics, producing a non-monotonic U-shaped profile inconsistent with slaving to R 2 as a control parameter. This is mechanistically expected: entropy conflates two distinct dynamical regimes (organized criticality at high R 2 and disorganized collapse at low R 2 ) that CHI discriminates by sign. In addition, entropy measures are sensitive to non-stationarity and embedding parameter choice (m, r), introducing a free-parameter dependency that CHI avoids entirely within the DFA framework. Entropy candidates satisfy none of C1–C3.
+
+ 6.6.1.4
+
+Candidate 3: classical HRV indices (SDNN, RMSSD, pNN50, and LF/HF)
+
+Standard time-domain and frequency-domain HRV indices fail all three conditions. Standard deviation of NN intervals (SDNN), Root mean square of successive differences (RMSSD), and pNN50 are non-negative and monotonically decrease with disease severity—they carry no sign information and, therefore, cannot distinguish which potential well ψ occupies (C1 fail). LF/HF ratio, while signed, in principle, by construction, is a ratio of autonomic frequency bands rather than a scale-invariant dynamical quantity; it does not transform as an order parameter under the ψ → −ψ symmetry operation since LF and HF power are both bounded below by zero (C1 fail). For C2, HRV indices are not slaved to R 2 in the required sense: SDNN and RMSSD reflect aggregate variability amplitude and are confounded by arrhythmia burden, recording length, and non-stationarity in ways that decouple them from the DFA log–log structure that defines R 2 . Cross-cohort regressions of SDNN vs. R 2 are substantially noisier than the CHI–R 2 relationship (ρ = 0.867), with HRV indices showing non-monotonic behavior in arrhythmic cohorts where RR interval irregularity inflates variance measures independently of the scaling structure (C2 partial fail). For C3, HRV indices are linear statistics of the NN interval distribution, insensitive to the multiscale correlational structure encoded in DFA exponents. The pitchfork model derives from scale-invariant critical phenomena; its order parameter must resolve multiscale structure, which time-domain HRV indices do not measure. Classical HRV indices satisfy none of C1–C3 from the perspective of order parameter identification in a scale-invariant dynamical system.
+
+ 6.6.1.5
+
+Candidate 4: R 2 alone (DFA log–log goodness of fit)
+
+R 2 plays the role of a control parameter, not an order parameter, in the ECSoC framework. As the control parameter A (R 2 ) = a 0 (R 2 − Rc), R 2 drives the system through the bifurcation but does not itself encode the symmetry-broken state. R 2 is bounded in [0,1] and does not change sign; it satisfies neither C1 nor C3. Empirically, R 2 achieves its highest discriminative power during active arrhythmia (AUC = 0.923 for NSR vs. VT/VF), reflecting its role as a severity marker of dynamical collapse rather than an advance indicator of the dynamical phase. CHI, by contrast, achieves AUC = 0.892 in the pre-event state, where R 2 achieves only AUC = 0.850—establishing that CHI carries pre-arrhythmic phase information that R 2 alone does not resolve. The mechanistic distinction is precise: R 2 measures whether the scaling manifold is intact; CHI measures which attractor the intact manifold supports. These are structurally nonredundant quantities corresponding to distinct theoretical roles in the Haken formalism.
+
+ 6.6.1.6
+
+Minimal empirically supported candidate within DFA-computable quantities
+
+CHI = 2 (α 1 − α 2 ) satisfies all three conditions simultaneously. These conditions are necessary but not sufficient: CHI is identified not as the unique order parameter in all possible representations but as the minimal empirically supported candidate within the class of quantities computable from DFA log–log decomposition. Alternative representations may exist and are designated for investigation in Paper 3. C1 (symmetry): CHI is the minimal signed quantity derived from DFA that changes sign at the supercritical→subcritical transition, consistent with ℤ 2 symmetry breaking; mean CHI = +0.334 in healthy subjects vs. negative values in subcritical regime cohorts directly encodes the double-well branch. C2 (slaving): Spearman ρ = 0.867 (p = 0.001, N = 10 cohorts; Section 6.4.1 ) establishes a monotonic CHI–R 2 relationship as required by adiabatic elimination; no alternative candidate achieves comparable monotonic ordering across all ten cohorts. C3 (informational sufficiency): ΔAUC = 0.14 above α 1 alone (DeLong’s test p < 0.0001), with CHI exhibiting a Student-t distribution (ν = 12.4; ΔAIC = 74.4 vs. Gaussian) reflecting heavy-tailed collective behavior consistent with a critical system rather than a linear combination of individual statistics. The signed difference is not an ad hoc construction: it is the natural projection of the two-dimensional DFA exponent space onto the one-dimensional subspace that changes sign at criticality. No alternative candidate—α 1 , entropy, any HRV index, R 2 , or any unsigned DFA quantity—satisfies C1–C3 simultaneously. CHI is, therefore, identified as the minimal empirically supported candidate within the class of quantities computable from dual-band DFA log–log decomposition—not as the unique order parameter in all possible physiological representations.
+
+ 6.6.2
+
+Circularity risk in parameter estimation
+
+A potential circularity arises because both the Fokker–Planck fit and the KL-divergence minimization draw on CHI distributions. We address this by distinguishing three statistically independent data channels used at different stages of the analysis.
+
+Channel (i) employs stationary CHI distributions (mean, SD per cohort) for Fokker–Planck potential reconstruction ( Section 3.1 ). Channel (ii) employs CHI–R 2 ordering relationships (Spearman rank correlation) for A (R 2 ) regression ( Section 3.2 ); this channel uses rank information, not distributional shape, and is, therefore, statistically independent of channel (i). Channel (iii) employs Markov self-transition probabilities P_self derived from the companion empirical study (Okabe, 2026 [9]) for Kramers validation ( Section 3.3 ); these transition probabilities are computed from event sequences and are independent of the CHI distribution used in channels (i) and (ii). Kramers escape-time predictions were computed from parameters estimated on channels (i)–(ii) and compared against channel (iii) without refitting, constituting a genuine out-of-sample test. The three-channel design ensures that no single distributional summary is simultaneously used for estimation and validation.
+
+ 6.6.3
+
+Theoretical motivation for the multiplicative noise form
+
+The Gaussian envelope σ(ψ) = ε 0 exp (−κψ 2 ) is the minimal symmetric function simultaneously satisfying three physiologically motivated constraints: (a) maximal noise amplitude at ψ = 0 (the critical point, where ion-channel fluctuations are greatest); (b) monotonic decay for |ψ| → ∞ (reflecting physiological bounds on DFA exponent variability); and (c) differentiability everywhere (required for the Stratonovich stochastic calculus). Alternative forms, including the Lorentzian σ = ε 0 /(1 + κψ 2 ) and the power-law σ = ε 0 |ψ|^α (α = 0.5), satisfy constraints (b) and (c) but violate constraint (a) and introduce additional free parameters without improving structural predictions. The independent physical motivation from ion-channel stochasticity near fixed points ( Faisal et al., 2008 ) further supports amplitude suppression away from ψ = 0.
+
+To establish robustness to the specific value of κ, we evaluated P_self under three values (κ = 1.0, 1.5, and 2.0) with ε 0 fixed. For the Suppress state, Heun simulation yields P_self = 0.52, 0.50, and 0.48, respectively; for Late-rise, P_self = 0.45, 0.43, and 0.41. The directional ordering Suppress > Late-rise is preserved across all values, and the deviation from the reference value (κ = 1.5) is ≤0.02 in absolute terms. This sensitivity analysis confirms that the structural conclusions of the model are robust to the precise shape of the noise envelope within the physiologically plausible range.
+
+ 6.6.4
+
+Clinical translation of the diagnostic framework
+
+The three ECSoC metrics form a hierarchical diagnostic system whose operating characteristics map directly onto clinical decision logic. Phase V exhibits an observed specificity of 100% in the healthy cohort (0/54 false positives), making it a rule-in indicator: its presence is sufficient to identify pathological dynamics in the available data. CHI achieves AUC = 0.892 for pre-event discrimination (NSR vs. SVTDB-mr), providing sensitive early-warning stratification before overt arrhythmia. R 2 achieves AUC = 0.923 for active arrhythmia discrimination (NSR vs. SVTDB-vt), characterizing the severity of the dynamical collapse. This three-layer structure—analogous to the complementary roles of troponin (rule-in), natriuretic peptide (risk stratification), and ECG morphology (severity grading) in acute coronary syndromes—provides a translatable framework in which no single metric dominates across all clinical contexts.
+
+The immediate clinical translation target is rolling-window Holter classification. Given that individual-level analysis demonstrates dominant within-patient non-stationarity (ICC = 0.37–0.41; Section 6.3.1 ), single-record parameter estimates are snapshots of a dynamical trajectory rather than stable patient properties. Prospective clinical utility, therefore, requires multi-record longitudinal Holter monitoring, as specified in prediction P4 (intra-individual path concordance >80% across ≥3 events). Outcome-adjudicated Holter cohorts of this design are the essential next step toward evidence-based deployment.
+
+ 6.6.5
+
+Interpretation of the scaling exponent β = 1.255 vs. pitchfork prediction β = 0.5
+
+The empirical exponent β = 1.255 is not a deviation from theory but a finite-noise consequence of the operational definition of Phase V. Specifically, the Phase V rate is given by the tail probability P (R 2 < 0.93), which for a Gaussian-distributed control parameter follows P V (x) = Φ(x/σ R − Δ), x = Rc − R 2 , where Δ = Rc − 0.93. Expanding around the critical region yields a linear dependence P V ∝ x, implying an apparent scaling exponent β ≈ 1. dP v / dx = 1 / σ R ϕ x / σ R ‐ ∆ ⇒ dP v / dx x ≈ ∆ = 1 / σ R ϕ 0 = const ≠ 0 ⇒ P V ∝ x
+
+This Gaussian tail mechanism constitutes the dominant contribution.
+
+In addition, multiplicative noise introduces a Stratonovich shift Rceff = Rc + 2Dκ/a0, which provides a secondary correction by extending the effective subcritical region. In the asymptotic limit D → 0, the system recovers the mean-field prediction β = 0.5. The observed β = 1.255, therefore, reflects a crossover to the finite-noise regime (ΔV/D ≈ O (1)), where scaling is governed by distributional tail probabilities rather than barrier-controlled escape dynamics.
+
+ 6.6.6
+
+Interpretation of low ICC: genuine non-stationarity vs. measurement noise
+
+ICC values of 0.37–0.41 across 35 patients with ≥2 records will likely prompt concerns about measurement noise and window-size dependence. These values are, however, directly comparable to published ICC values for standard HRV metrics under similar recording conditions: DFA α 1 yields ICC ≈0.40–0.60 across sessions (Penttilä et al., 2001; Aubert et al., 2003); SDNN yields ICC ≈0.44–0.63 in short-term recordings ( Kleiger et al., 1992 ); and LF/HF ratio yields ICC ≈0.33–0.54 (Task Force, ESC/NASPE 1996). The fact that CHI ICC falls within the established range for comparable HRV metrics confirms that the observed values reflect the expected reproducibility of a dynamical biomarker, not a specific failure of CHI. Three independent lines of evidence further support the non-stationarity interpretation over the noise interpretation.
+
+First, state-dependent variance: CHI variance during active VT/VF (SD ≈ 1.0) substantially exceeds that during pre-event recordings (SD ≈ 0.5), demonstrating state-dependent dynamics inconsistent with a pure measurement noise interpretation, which would predict state-independent variance. Second, within-patient trajectory amplitude: Patient 0003 exhibits CHI_mean ranging from −0.92 to +0.06 across five records (Δ = 0.98 within a single patient; Section 6.3.1 ). This amplitude exceeds the between-patient SD across most cohorts, confirming that a substantial fraction of total variance is dynamically meaningful within-patient variation rather than noise. Third, window-size stability: ICC was evaluated using 16-s analysis windows. To assess window dependence, auxiliary analyses using 8-s and 32-s windows yield ICC = 0.39 and 0.38, respectively—stable within ±0.03 of the primary estimate. A noise-dominated process would be expected to produce an ICC that systematically degrades with decreasing window size; the observed stability across a fourfold window range is inconsistent with this prediction. Taken together, these three lines of evidence support the interpretation that low ICC reflects genuine between-session non-stationarity constituting a dynamical property of the cardiovascular system, not a measurement artifact.
+
+The geometric decomposition of the DFA exponent plane into radial distance r and angular position θ suggests a distinction not captured by CHI alone: Phase II/III windows show minimal angular variance (Var(θ) = 0.00075), indicating directional constraint of the α 1 –α 2 ratio near the critical boundary, while Phase IV windows show maximal angular variance (Var(θ) = 0.02562), consistent with loss of directional stability during subcritical collapse. This asymmetry—directional constraint under criticality versus directional scatter under collapse—is geometrically interpretable as a distinction between order-parameter-mediated slaving and attractor dissolution, though formal derivation of this correspondence is left for future work (Paper 3).
+
+These findings raise the possibility that Var(θ) serves as an orthogonal descriptor of system dynamics, complementary to CHI and R 2 , although its independence and generalizability remain to be established.
+
+ 6.7
+
+Limitations
+
+Four limitations bound the present conclusions and define the targets for prospective validation.
+
+First, recording heterogeneity. Cross-cohort analyses aggregate data acquired under heterogeneous conditions, including differences in the recording length, electrode placement, selection criteria, and clinical context. Regression estimates (a 0 = 20.5, Rc = 0.991) are, therefore, subject to selection bias that cannot be fully controlled in a retrospective cross-cohort design. This limitation is partially mitigated by the rank-based Spearman test for P1 (robust to distributional assumptions) and by the within-cohort SVTDB individual-level analysis ( Section 6.3 ), which confirms directional ordering under homogeneous recording conditions. Causal inference across cohorts is not claimed.
+
+Second, underpowered scaling exponent [Exploratory; directionally supportive]. The P3 log–log regression (N = 6 subcritical cohorts) carries three inferential limitations. The bootstrap confidence interval exhibits non-monotone behavior with increasing N, reflecting re-estimation of residual structure under heterogeneous cohort inclusion rather than a methodological artifact; small sequential additions do not, therefore, guarantee monotone precision gain. One cohort (CHF NYHA2, h = 0.658, Cook’s D = 1.43) acts as an anchoring extreme in covariate space, reducing standard error while exerting a substantial influence on the slope: including this point shifts β downward from 2.66 to 1.50, indicating that precision alone does not reflect robustness. The wide 95% bootstrap CI [BCa] (0.69–2.89) reflects genuine statistical uncertainty rather than model failure; the non-zero slope (permutation p = 0.014) and limited separation of the BCa lower bound from β = 0.5 (margin = 0.19) are the defensible claims at the current sample size. Power simulations indicate N ≈ 26 subcritical cohorts—assuming residual variance and covariate spread comparable to those of the current six—would be required for stable inference.
+
+Third, retrospective and non-predictive design. ROC analyses demonstrate discriminative validity between predefined groups (healthy vs. pre-event, healthy vs. active arrhythmia) but do not constitute prospective arrhythmia prediction. No prospective trial has been conducted, and clinical deployment requires outcome-adjudicated longitudinal Holter studies as specified in predictions P4 and P5.
+
+Fourth, population-to-individual parameter gap. The two-scale noise structure (population D = 0.06 vs. individual median D e ≈ 0.75; Section 6.3.2 ) means that cross-cohort Kramers predictions are not directly transferable to individual-level classification without hierarchical re-estimation. The hierarchical noise model required for individual-level deployment is designated for Paper 3.
+
+ 7
+
+Conclusion
+
+A minimal two-variable Langevin model provides the first formal dynamical grounding for ECSoC. Cross-cohort parameter estimation yields Rc = 0.991, a 0 = 20.5, and D = 0.06. The Kramers formula reproduces directional ordering of empirical self-transition probabilities. Stochastic simulations reproduce all four trajectory classes and both collapse paths. Six falsifiable predictions (P1–P6) define the empirical roadmap.
+
+Relationship to established arrhythmia risk markers. This study is not intended as a clinical replacement for established risk predictors (LVEF, T-wave alternans, heart rate turbulence, and deceleration capacity). These markers operate at different mechanistic levels: LVEF captures structural remodeling, T-wave alternans captures repolarization instability, and HRV time-domain indices capture aggregate variability. ECSoC operates at the level of multiscale fractal regulation—a dimension orthogonal to any single substrate. The independence of CHI from LVEF (r ≈ 0.00–0.09; SHDB-AF cohort, Paper 1) is consistent with CHI measuring dynamical organization rather than structural severity. A more direct comparison addresses the incremental value of CHI relative to published predictors. LVEF ≤35% identifies SCD risk in ischemic cardiomyopathy with sensitivity ≈60–65% and specificity ≈70–75% (Moss et al., MADIT-II; Bardy et al., SCD-HeFT). Deceleration capacity achieves AUC ≈0.72 for all-cause mortality post-MI ( Bauer et al., 2006 ). The heart rate turbulence (HRT) slope achieves AUC ≈0.71–0.76 for arrhythmic death in post-MI populations ( Schmidt et al., 1999 ). T-wave alternans achieves AUC ≈0.65–0.72 for SCD prediction ( Bloomfield et al., 2006 ). In the present study, CHI achieves AUC = 0.892 for pre-event discrimination (NSR vs. SVTDB pre-VT) and Harrell’s C = 0.78 in within-patient temporal prediction—values that are directionally competitive with established predictors, though a direct head-to-head comparison in the same cohort with the same outcome definition has not been performed and is required before any claims of clinical superiority. The mechanistic complementarity of CHI with established markers is theoretically expected and empirically consistent. LVEF and CHI measure structurally nonredundant properties: LVEF reflects the ejection capacity at a fixed time point, while CHI encodes the dynamical phase of the multiscale regulatory system averaged over minutes of continuous recording. A patient with preserved LVEF may, nevertheless, exhibit subcritical CHI (indicating dysregulated autonomic scaling), and vice versa . This orthogonality is not a limitation but the basis for potential incremental value in multivariate risk models. Similarly, deceleration capacity and HRT are sensitive to abrupt sinus rate perturbations following ectopic beats—a reflexive response mechanism—whereas CHI reflects the sustained fractal organization of the inter-beat interval series. These two dimensions of autonomic function are expected to carry partially independent prognostic information. Prospective demonstration of incremental value over established markers—specifically, whether CHI adds to a model including LVEF, HRT, and deceleration capacity in a standardized Holter cohort with adjudicated arrhythmic outcomes—is the essential clinical validation step and is explicitly designated as a primary target for Paper 3. The ECSoC framework is positioned as a mechanistic complement to, not a replacement for, established markers. The present study delivers six original empirical contributions. First, Heun/Stratonovich simulation establishes that multiplicative Kramers analytical predictions overestimate P_self in the large-noise regime, quantifying the boundary conditions of Kramers-based approximations as a positive result. Second, individual-level estimation (78 patients and 135 records) demonstrates real between-patient heterogeneity (ICC = 0.37–0.41) with dominant within-patient non-stationarity—a dynamical finding that motivates rolling-window classification as the clinical translation strategy. Third, non-Gaussian analysis identifies CHI as Student-t distributed (ν = 12.4; ΔAIC = 74.4), with directional Kramers ordering preserved across distributional assumptions. Fourth, cross-cohort empirical analysis confirms P1 (ρ = 0.867, p = 0.001) and directionally supports P3 (β = 1.255, permutation p = 0.014; exploratory at N = 6), establishing that the structural predictions of the pitchfork model are empirically grounded in the available data. Fifth, ROC-AUC analysis (N = 54 healthy vs. N = 135 SVTDB) demonstrates that the three ECSoC metrics form a hierarchical diagnostic system—CHI as the order parameter (AUC = 0.892 pre-event), R 2 as the control parameter (AUC = 0.923 active arrhythmia), and Phase V as the bifurcation indicator with no false positives in the healthy cohort (0/54)—providing cross-domain directional support for the pitchfork framework within the exploratory retrospective design of this study. Sixth, within-patient temporal prediction analysis (N = 78 patients; 7,555 windows; Cox proportional hazards) establishes that CHI is a dynamic predictor of VT/VF onset: temporal ROC AUC increases from 0.71 to 0.86 as onset approaches, HR_CHI = 0.61 (p < 0.001) and HR_PV = 2.31 (p = 0.001) are jointly consistent with the pitchfork bifurcation structure, and the lagged CHI trend ΔCHI provides incremental predictive value (Harrell’s C: 0.73 → 0.78), directionally consistent with Predictions P1 and P2 on within-patient trajectories; all within-patient results are exploratory and require prospective replication.
+
+Taken together, these results establish that the core structural assumptions—monotonic CHI–R 2 relationships and directional escape asymmetry—are robust across analytical, simulation, and empirical domains. Systematic deviations in the large-noise regime delineate the boundary conditions of Kramers-based approximations and define the targets for quantitative refinement: path-dependent noise models and non-Gaussian Fokker–Planck extensions are designated for Paper 3. The present work completes the theoretical formalization of the ECSoC framework, providing a mechanistically grounded, empirically constrained, and prospectively falsifiable dynamical model of cardiovascular criticality. P7 (Imperfect pitchfork asymmetry—exploratory): If the ECSoC landscape carries a non-zero tilt h, then in patients receiving antiarrhythmic therapy, the temporal autocorrelation AR (1) of CHI trajectories approaching a phase transition should be asymmetric across attractor branches: trajectories converging toward the h-favored supercritical well (h > 0) are expected to exhibit higher AR (1) and longer CSD precursor windows than trajectories converging toward the subcritical well (h < 0), consistent with slower escape from a deeper effective potential well. This prediction is not testable in the current cross-sectional cohort design; prospective evaluation is designated for longitudinal pharmacological Holter studies in Paper 3. [Exploratory—contingent on h ≠ 0 at the individual level] Individual-level time-series parameter estimation across multi-record Holter cohorts is the essential next step toward clinical translation.
+
+ 8
+
+Future directions
+
+ 8.1
+
+Prospective validation of the revised developmental model
+
+The revised developmental model ( Section 6.4.1 ) identifies three distinct dynamical regimes—young near-critical flexibility (CHI ≈0), healthy elderly supercritical stabilization (CHI >0, R 2 intact), and pathological subcritical collapse (CHI <0, R 2 degraded)—and generates a specific high-risk prediction: elderly individuals whose CHI has returned toward zero exhibit pseudo-criticality in a degraded regulatory landscape, representing the highest-risk phenotype within the aging population. Prospective validation requires three study designs operating at different timescales.
+
+The immediate priority is cross-sectional age-stratified ambulatory Holter analysis. The Fantasia cohort limitation—supine resting recordings suppressing postural autonomic fluctuations—must be addressed by ambulatory 24-h Holter monitoring across continuous age deciles (20–29, 30–39, … , 80+; N ≥ 30 per stratum). The predicted CHI trajectory is non-monotonic: a nadir near criticality in young adults (CHI ≈0), a rise toward supercriticality in healthy middle-aged and elderly subjects (CHI > +0.1 to +0.2), and a return toward zero or below in those with subclinical autonomic dysfunction. This U-shaped or J-shaped developmental profile is the primary falsifiable target. The variance prediction is equally specific: CHI SD should increase monotonically with age across healthy strata, reflecting broadening of the potential well rather than bifurcation-proximity inflation; the distributional signature distinguishing these mechanisms is kurtosis (elevated in well-broadening, reduced near A = 0).
+
+The second priority is longitudinal within-individual tracking. Cross-sectional cohort differences confound cohort effects with aging trajectories; only repeated Holter recordings in the same individuals over 5–10 years can establish whether the supercritical stabilization is a within-person developmental trajectory or a between-cohort difference. The ECSoC prediction is explicit: individuals should show monotonically increasing CHI across decades of healthy aging, with a phase transition to the subcritical trajectory marking the onset of pathological autonomic decline. The ΔCHI trajectory slope—already shown to carry incremental value in within-patient VT/VF prediction ( Section 6.4.4 )—is the appropriate statistic for longitudinal summary.
+
+ 8.2
+
+The pseudo-criticality risk phenotype
+
+The revised model generates a counterintuitive clinical prediction with direct translational implications. Within an elderly population, the highest-risk individuals are not those with the most obviously abnormal CHI (deeply subcritical, CHI ≲ −0.3, Phase V present)—these are already identifiable by conventional markers. The highest-risk phenotype is the elderly individual with CHI ≈0: supercritically stabilized subjects who have undergone partial regression toward criticality, without the adaptive reserve of a young near-critical system and without the overt R 2 degradation that triggers Phase V. This pseudo-critical state is hypothesized to occupy a vulnerable position in the potential landscape, but whether it constitutes the highest-risk phenotype among elderly individuals requires prospective validation. This interpretation is exploratory and speculative; the Fantasia dataset (N = 20 elderly, supine resting) is insufficient to support clinical inference.
+
+Detection of the pseudo-critical phenotype, therefore, requires the ΔCHI trajectory, not the CHI level: an elderly individual whose CHI is declining from a prior supercritical baseline toward 0 carries a risk profile that is fundamentally different from that of a young individual whose CHI is near 0 as an optimized operating point. This trajectory-dependence operationalizes Prediction P4 (intra-individual path concordance) in the aging context and motivates a specific extension: a pseudo-criticality index, defined as CHI × (−ΔCHI), which is positive and large precisely when CHI is near 0 and declining—the target phenotype. Validation of this index against incident arrhythmia and heart failure hospitalization in a prospective elderly Holter cohort is designated as a primary target for Paper 3.
+
+ 8.3
+
+Hierarchical noise model and paper 3 targets
+
+Three extensions designated for Paper 3 are directly motivated by the present findings. First, a hierarchical Bayesian noise model is required to bridge the population-to-individual parameter gap (D_population = 0.06 vs. D_individual ≈0.75; Section 6.3.2 ) and to incorporate the developmental model’s prediction that B and D co-vary with age. The hierarchical model should specify age-dependent priors on A and B, with the aging trajectory parameterized as a continuous function of chronological age and autonomic reserve indices. Second, a non-Gaussian Fokker–Planck treatment is required to account for the Student-t CHI distribution (ν = 12.4; ΔAIC = 74.4) and to distinguish the kurtosis signatures of well-broadening (elderly healthy) from bifurcation-proximity inflation (pre-pathological). Third, the revised developmental model generates a new theoretical prediction for the B parameter: if healthy aging deepens the double-well (B increases), the Fokker–Planck stationary distribution should show narrowing of the inter-well probability density and increased peak sharpness at the fixed points √(A/B) across age strata—a prediction directly testable from CHI distributions in age-stratified ambulatory cohorts. The theoretical structure of the ECSoC framework—ℤ 2 -symmetric order parameter, adiabatic elimination, and pitchfork bifurcation—is not a priori restricted to cardiac physiology. Whether an analogous order-parameter structure governs criticality transitions in neural systems is an empirically open question; a systematic cross-modal validation across ECG and EEG modalities represents a primary target for Paper 3.
+
+ 9
+
+Reproducibility statement
+
+All permutation tests reported in this study were conducted with N = 100,000 iterations and a fixed random seed (42) to ensure reproducibility; increasing N to 1,000,000 yields numerically stable estimates (see Supplementary Methods). Stochastic simulations used N = 50,000 trajectories with the same seed. All analyses were implemented in Python (NumPy 2.0.2, SciPy 1.16.3, and Matplotlib 3.10.0) under Python 3.12.
+
+============================================================
+SOURCE: PMC13391284.txt (TXT)
+============================================================
+
+NUPR1 in breast cancer: mechanisms and potential applications
+
+Deciphering the binding between Nupr1 and MSL1 and their DNA-repairing activity
+
+Multi-omics inference of differential breast cancer-related transcriptional regulatory network gene hubs between young Black and White patients
+
+Statins in breast cancer therapy: Mechanistic insights and emerging evidence
+
+Evaluating the therapeutic role of salvianolic acid A on pancreatic cancer cells through interaction with the intrinsically disordered protein NUPR1
+
+Intrinsically disordered chromatin protein NUPR1 binds to the enzyme PADI4
+
+Unravelling the changes during induced vitellogenesis in female European eel through RNA-Seq: What happens to the liver
+
+Spheroid mechanics and implications for cell invasion
+
+Cationic solid lipid nanoparticles as non viral vectors for the inhibition of hepatocellular carcinoma growth by RNA interference
+
+Expression of a novel factor, com1, is regulated by 1,25-dihydroxyvitamin D3 in breast cancer cells
+
+Lactylation-driven NUPR1 promotes immunosuppression of tumor-infiltrating macrophages in hepatocellular carcinoma
+
+p8 upregulation sensitizes astrocytes to oxidative stress
+
+The stress-regulated protein p8 mediates cannabinoid-induced apoptosis of tumor cells
+
+Beyond CDK4/6 inhibition: Current strategies in hormone receptor-positive metastatic breast cancer
+
+Immunotherapy in triple-negative breast cancer: From molecular mechanisms to precision medicine-overcoming resistance and optimizing clinical outcomes
+
+Interventions for enhancing resilience in breast cancer patients: a realist review
+
+Diet and breast cancer survivorship: a scoping review
+
+A comprehensive review of de novo oligometastatic breast cancer: Current treatment options, surgical outcomes, and systemic therapy
+
+NUPR1 interacts with p53, transcriptionally regulates p21 and rescues breast epithelial cells from doxorubicin-induced genotoxic stress
+
+Reduced expression of Nupr1 alleviates epilepsy progression via attenuating ER stress
+
+Role of ferroptosis on immunotherapy in breast cancer
+
+ARIH2 ubiquitination regulates NUPR1 to inhibit ferroptosis in bladder cancer
+
+Intrinsically disordered protein condensate-based coating on ureteral stents for anti-fouling and anti-encrustation
+
+Transcriptional alterations of protein coding and noncoding RNAs in triple negative breast cancer in response to DNA methyltransferases inhibition
+
+Antitumoral and cardioprotective roles of statins: underlying types, mechanisms, current evidence, and emerging perspectives
+
+Human p8 is a HMG-I/Y-like protein with DNA binding activity enhanced by phosphorylation
+
+The intrinsically disordered protein NUPR1 binds to phospholipids
+
+NUPR1 promotes the proliferation and metastasis of oral squamous cell carcinoma cells by activating TFE3-dependent autophagy
+
+Precisely tailoring molecular structure of doxorubicin prodrugs to enable stable nanoassembly, rapid activation, and potent antitumor effect
+
+The antipsychotic agent trifluoperazine hydrochloride suppresses triple-negative breast cancer tumor growth and brain metastasis by inducing G0/G1 arrest and apoptosis
+
+Microgravity triggers ferroptosis and accelerates senescence in the MG-63 cell model of osteoblastic cells
+
+RAD9 deficiency enhances radiation induced bystander DNA damage and transcriptomal response
+
+p8/nupr1 regulates DNA-repair activity after double-strand gamma irradiation-induced DNA damage
+
+p8 is a new target of gemcitabine in pancreatic cancer cells
+
+Pivotal role of the chromatin protein Nupr1 in Kras-induced senescence and transformation
+
+Metabolic vulnerabilities as a therapeutic target in breast cancer
+
+Research progress of PROTACs in breast cancer: Subtype-oriented target landscape, clinical stratification evidence, and engineering strategies for translation
+
+Nupr1-aurora kinase A pathway provides protection against metabolic stress-mediated autophagic-associated cell death
+
+Nuclear protein 1 protects against neonatal hypoxic-ischemic encephalopathy by inhibiting neuronal ferroptosis by improving iron storage
+
+The HMG-I/Y-related protein p8 binds to p300 and Pax2 trans-activation domain-interacting protein to regulate the trans-activation activity of the Pax2A and Pax2B transcription factors on the glucagon gene promoter
+
+Cynanchum bungei Decne-derived extracellular vesicles alleviate cognitive impairment and pathological damage in Alzheimer's disease
+
+NUPR1: A critical regulator of the antioxidant system
+
+NUPR1 inhibitor ZZW-115 induces ferroptosis in a mitochondria-dependent manner
+
+Ferroptosis in breast cancer: Molecular insights and therapeutic strategies
+
+Cloning and characterization of the Xenopus laevis p8 gene
+
+The mitochondrial catastrophe induced by NUPR1 inhibitors as a novel strategy to fight against cancer
+
+Leptin induces the expression of tumorigenic genes in the gastric mucosa of male Sprague-Dawley rats
+
+Expression of p8 protein in medullary thyroid carcinoma
+
+Expression and cellular localization of p8 protein in thyroid neoplasms
+
+Single-cell transcriptomics and machine learning unveil ferroptosis features in tumor-associated macrophages: Prognostic model and therapeutic strategies for lung adenocarcinoma
+
+Expression of Com-1/P8 in human breast cancer and its relevance to clinical outcome and ER status
+
+Simultaneous copy number gains of NUPR1 and ERBB2 predicting poor prognosis in early-stage breast cancer
+
+Transcriptomic data analysis coupled with copy number aberrations reveals a blood-based 17-gene signature for diagnosis and prognosis of patients with colorectal cancer
+
+Enhanced large-scale production and purification of recombinant human NUPR1 for detailed structural and functional insights
+
+Treatment of ER-positive breast cancer with FDA-approved aromatase inhibitors
+
+Obesity-associated epigenetic alterations and the obesity-breast cancer axis
+
+ZZW-115-dependent inhibition of NUPR1 nuclear translocation sensitizes cancer cells to genotoxic agents
+
+NUPR1 contributes to endocrine therapy resistance by modulating BIRC5 expression and inducing luminal B-ERBB2(+) subtype-like characteristics in estrogen receptor-positive breast cancer cells
+
+Mitochondrial defect-responsive gene signature in liver-cancer progression
+
+The crosstalk between ferroptosis and the immune system in urological cancers: Mechanisms, prognostic value, and therapeutic implications
+
+NUPR1 silencing induces autophagy-mediated apoptosis in multiple myeloma cells through the PI3K/AKT/mTOR pathway
+
+MED23 depletion induces premature senescence in NSCLC cells by interacting with BCLAF1 and then suppressing NUPR1 expression
+
+FUNMarker: fusion network-based method to identify prognostic and heterogeneous breast cancer biomarkers
+
+Dopamine D2 receptor antagonist sulpiride enhances dexamethasone responses in the treatment of drug-resistant and metastatic breast cancer
+
+Exploration of drug resistance mechanisms in triple negative breast cancer cells using a microfluidic device and patient tissues
+
+Epigenetic modifications in ferroptosis regulation of breast cancer
+
+The role of NUPR1 in response to stress and cancer development
+
+Chronic nickel exposure alters extracellular vesicles to mediate cancer progression via sustained NUPR1 expression
+
+Synergistic antitumor activity of sorafenib and the NUPR1 inhibitor LZX-2-73 in multiple cancer models
+
+Development of an efficient NUPR1 inhibitor with anticancer activity
+
+A computational framework integrating multi-omics and machine learning for identifying glycolytic gene markers in breast cancer
+
+Nupr1 is a critical repressor of ferroptosis
+
+Ferroptosis and its role in immune modulation in breast cancer
+
+Tailoring targeted therapies for younger women with ER-positive early-stage breast cancer
+
+NUPR1 as a central stress-adaptation node in cancer: integrating metabolic rewiring, cell death, and therapy resistance
+
+Functional characterization of Nupr1L, a novel p53-regulated isoform of the high-mobility group (HMG)-related protumoral protein Nupr1
+
+The role of pluripotency regulators in triple-negative breast cancer immune response
+
+NUPR1 alleviates renal ischemia reperfusion injury by inhibiting ferroptosis involving the ATF4-CHAC1 pathway
+
+NUPR1 and LCN2: potential therapeutic targets for colorectal cancer via modulating cell viability, migration, and ferroptosis-related pathways
+
+Cloning and expression of the rat p8 cDNA, a new gene activated in pancreas during the acute phase of pancreatitis, pancreatic development, and regeneration, and which promotes cellular growth
+
+Insulin resistance as a modifiable contributor to breast cancer: mechanisms, biomarkers, and therapeutic implications
+
+Protective role of lipid-lowering drugs in breast cancer: Effects on cancer incidence and cardiotoxicity
+
+NUPR1 maintains autolysosomal efflux by activating SNAP25 transcription in cancer cells
+
+Nuclear protein 1 imparts oncogenic potential and chemotherapeutic resistance in cancer
+
+Trifluoperazine as a modulator of multidrug resistance in refractory breast cancer
+
+A novel role for NUPR1 in the keratinocyte stress response to UV oxidized phospholipids
+
+Identification of a drug targeting an intrinsically disordered protein involved in pancreatic adenocarcinoma
+
+The chromatin nuclear protein NUPR1L is intrinsically disordered and binds to the same proteins as its paralogue
+
+Dynamics of the intrinsically disordered protein NUPR1 in isolation and in its fuzzy complexes with DNA and prothymosin α
+
+A phosphorylation-induced switch in the nuclear localization sequence of the intrinsically disordered NUPR1 hampers binding to importin
+
+NUPR1 packaged in extracellular vesicles promotes murine triple-negative breast cancer in a type 1 interferon-independent manner
+
+High concentration calcitriol induces endoplasmic reticulum stress related gene profile in breast cancer cells
+
+The dual role of autophagy in breast cancer stemness and treatment resistance
+
+Inhibition of NUPR1-Karyopherin β1 binding increases anticancer drug sensitivity
+
+NUPR1 preserves insulin secretion of pancreatic β-cells during inflammatory stress by multiple low-dose streptozotocin and high-fat diet
+
+Glucose-dependent expansion of pancreatic beta-cells by the protein p8 in vitro and in vivo
+
+Developmentally regulated synthesis of p8, a stress-associated transcription cofactor, in diapause-destined embryos of Artemia franciscana
+
+3D cancer cell model: A new tool to more accurately evaluate the biological effect of cold plasma
+
+Expression of a novel factor, com1, in early tumor progression of breast cancer
+
+Expression of a novel factor in human breast cancer cells with metastatic potential
+
+NUPR1 induces autophagy and promotes the progression of Esophageal squamous cell carcinoma via the MAPK-mTOR pathway
+
+Design of inhibitors of the intrinsically disordered protein NUPR1: Balance between drug affinity and target function
+
+Diabetes and cancer: glucose control impact on survival and tumor outcomes
+
+Crosstalk between mitophagy and breast cancer: mechanisms of action and clinical applications
+
+Targeting NUPR1-dependent stress granules formation to induce synthetic lethality in Kras(G12D)-driven tumors
+
+NUPR1 protects against hyperPARylation-dependent cell death
+
+Intrinsically disordered protein NUPR1 binds to the armadillo-repeat domain of Plakophilin 1
+
+Intrinsically disordered chromatin protein NUPR1 binds to the C-terminal region of Polycomb RING1B
+
+Targeting intrinsically disordered proteins involved in cancer
+
+Ligand-based design identifies a potent NUPR1 inhibitor exerting anticancer activity via necroptosis
+
+Targeting the stress-induced protein NUPR1 to treat pancreatic adenocarcinoma
+
+Estradiol replacement alters expression of genes related to neurotransmission and immune surveillance in the frontal cortex of middle-aged, ovariectomized rats
+
+Stress granules-membraneless organelles as therapeutic targets in pancreatic cancer
+
+Stress-inducible transcription factor NUPR1 is involved in the inhibitory effects exerted by statins on insulin action in ER-positive breast cancer cells
+
+Immune checkpoint inhibition in breast cancer: targeting PD-1/PD-L1 pathway for therapeutic advances
+
+From CDK4/6 to CDK2 and KAT: evolving therapeutic approaches in HR+/HER2- breast cancer
+
+Biomarkers of primary and secondary resistance to cyclin dependent kinases 4 and 6 inhibitors in metastatic estrogen receptor-positive/human epidermal growth factor receptor 2-negative breast cancer: a narrative review
+
+Toxoplasma gondii infection is associated with mitochondrial dysfunction in-vitro
+
+WTAP mediates NUPR1 regulation of LCN2 through m(6)A modification to influence ferroptosis, thereby promoting breast cancer proliferation, migration and invasion
+
+Shiga toxins induce autophagic cell death in intestinal epithelial cells via the endoplasmic reticulum stress pathway
+
+Effects of GLP-1 receptor agonists on biological behavior of colorectal cancer cells by regulating PI3K/AKT/mTOR signaling pathway
+
+Immunotherapies for breast cancer: From checkpoint inhibition to emerging cellular therapies
+
+Intrinsically disordered protein droplet-enhanced oligonucleotide assembly enables rapid oligonucleotide-to-protein expression
+
+Cell growth-dependent subcellular localization of p8
+
+p8 improves pancreatic response to acute pancreatitis by enhancing the expression of the anti-inflammatory protein pancreatitis-associated protein I
+
+Cloning and expression of the human p8, a nuclear protein with mitogenic activity
+
+Cytoplasmic translocation of p21 mediates NUPR1-induced chemoresistance: NUPR1 and p21 in chemoresistance
+
+Transcriptional coregualtor NUPR1 maintains tamoxifen resistance in breast cancer cells
+
+Targeting intrinsically disordered nuclear protein 1 (NUPR1) with single-domain antibodies alleviates triple-negative breast cancer (TNBC) progression in vivo
+
+Nupr1 contributes to activate TFE3-dependent autophagy leading to cervical cancer proliferation
+
+The interplay of transcriptional coregulator NUPR1 with SREBP1 promotes hepatocellular carcinoma progression via upregulation of lipogenesis
+
+The human microbiome reshapes the breast cancer immune-metabolic-hormonal microenvironment
+
+P8 deficiency increases cellular ROS and induces HO-1
+
+Quercetin induced NUPR1-dependent autophagic cell death by disturbing reactive oxygen species homeostasis in osteosarcoma cells
+
+Bioinformatics analysis of key genes and potential mechanism in cadmium-induced breast cancer progression
+
+NUPR1 promotes the proliferation and migration of breast cancer cells by activating TFE3 transcription to induce autophagy
+
+The burgeoning significance of liquid-liquid phase separation in the pathogenesis and therapeutics of cancers
+
+VAMP8 as a biomarker and potential therapeutic target for endothelial cell dysfunction in atherosclerosis
+
+Identification of mTOR inhibitor-resistant genes in cutaneous squamous cell carcinoma
+
+CDX2 confers ferroptosis resistance in stage II-III colon cancer via upregulation of NUPR1
+
+Molecular dynamics simulations of intrinsically disordered protein regions enable biophysical interpretation of variant effect predictors
+
+Nuclear protein 1 defends against acute pancreatitis by mitigating pancreatic acinar cell ferroptosis through the maintenance of cellular iron homeostasis
+
+NUPR1 contributes to radiation resistance by maintaining ROS homeostasis via AhR/CYP signal axis in hepatocellular carcinoma
+
+CircPIAS1 promotes hepatocellular carcinoma progression by inhibiting ferroptosis via the miR-455-3p/NUPR1/FTH1 axis
+
+Transcriptional regulation of NUPR1 by MYH11 activates PI3 K/AKT and promotes bladder cancer progression through ferroptosis and M2 polarization of macrophages
+
+Histone H4K8 lactylation promotes glioblastoma progression by inducing NUPR1-mediated autophagosome–lysosome fusion
+
+MAEL facilitates metabolic reprogramming and breast cancer progression by promoting the degradation of citrate synthase and fumarate hydratase via chaperone-mediated autophagy
+
+Breast cancer continues to present formidable clinical challenges, particularly in triple-negative and endocrine-resistant subtypes where adaptive stress mechanisms drive therapeutic failure. Nuclear protein 1 (NUPR1), an intrinsically disordered protein, has emerged as a non-mutational hub that has been implicated in integrating metabolic, transcriptional, and cell-survival signals associated with malignant progression. This Review examines how NUPR1 transduces mitogenic stimuli into anabolic programs, while orchestrating autophagic flux, lysosomal biogenesis, and ferroptosis evasion to maintain cellular fitness under oncogenic and therapeutic stress. We discuss its causal roles in endocrine and chemoresistance through chromatin-associated cooperation with estrogen receptor α, activation of DNA-damage repair, and cell-cycle checkpoint control, as well as its contributions to metastatic dissemination via extracellular vesicle-mediated niche remodeling and immunosuppressive macrophage polarization. Furthermore, we evaluate emerging therapeutic avenues, from small-molecule inhibitors and single-domain antibody degraders that disrupt NUPR1 nuclear trafficking, to metabolic drug repurposing strategies such as statins that intercept the insulin–NUPR1 axis. Elucidating NUPR1 biology represents a paradigm shift toward targeting dynamic, stress-adaptive dependencies in breast cancer, offering new precision-oncology opportunities.
+
+Introduction
+
+Breast cancer (BC) remains the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality ( Chen et al., 2026 ; Cho et al., 2026 ). While advances in early detection, molecular subtyping, and targeted therapies, including endocrine agents, anti-HER2 monoclonal antibodies, and immune checkpoint inhibitors, have transformed the clinical landscape, substantial challenges persist ( Li et al., 2021 ; Shin et al., 2026 ; Stachyra et al., 2026 ). A significant proportion of patients, particularly those with triple-negative breast cancer (TNBC) or metabolically dysregulated ER-positive disease, develop therapeutic resistance or relapse ( Kim and Lukong, 2026 ; López-Santana et al., 2026 ; Lobo-Martins et al., 2026 ). Emerging evidence underscores that metabolic perturbations, such as obesity-associated hyperinsulinemia and hypercholesterolemia, not only increase BC risk but also fuel tumor progression and compromise treatment efficacy ( Guo and Addison, 2026 ; Marouf et al., 2026 ; Ruggeri et al., 2026 ; Wang et al., 2026 ). Consequently, there is an urgent need to dissect the stress-adaptive mechanisms that enable BC cells to survive metabolic insults and therapeutic pressure, and to identify druggable nodes within these pathways.
+
+Nuclear protein 1 (NUPR1) has emerged as a central, non-mutational hub in this adaptive repertoire ( Carracedo et al., 2006a ; Estaras et al., 2025 ). Originally identified as a stress-inducible factor in acute pancreatitis, NUPR1 is an intrinsically disordered protein (IDP) of approximately 8.8 kDa that lacks stable secondary or tertiary structures ( Kim et al., 2026 ; Long et al., 2026 ). This biophysical property allows NUPR1 to function as a versatile transcriptional co-regulator and chromatin-associated factor, forming transient complexes with diverse molecular partners in response to cellular stress ( Scordamaglia et al., 2026 ). By binding AT-rich promoter regions and indirectly modulating key signaling mediators, including NF-κB, SMAD, and PI3K/AKT, NUPR1 orchestrates a broad spectrum of biological outputs: metabolic reprogramming, proteostatic control, autophagic flux, and cell-fate decisions that restrain apoptosis and ferroptosis ( Tong et al., 2022 ; Deng et al., 2026 ; Luo et al., 2026 ; Luo et al., 2026 ; Yu et al., 2026 ).
+
+In the context of breast cancer, NUPR1 has recently been positioned at the nexus of metabolic signaling and therapeutic response ( Wang et al., 2025 ; Scordamaglia et al., 2026 ). Mechanistically, NUPR1 is induced by mitogenic stimuli such as insulin and functions downstream of the insulin receptor (IR)–IRS1–AKT signaling cascade to promote proliferation, clonogenic capacity, and spheroid expansion ( Clark et al., 2008 ; Long et al., 2026 ). Notably, pharmacological inhibition of NUPR1, either by small-molecule antagonists such as ZZW-115 or by novel single-domain antibodies such as sdAb#07.81, blunts insulin-driven oncogenic signaling, derepresses ferroptosis, and induces premature senescence, thereby suppressing tumor growth in preclinical models ( Lim et al., 2024 ). Furthermore, NUPR1 drives resistance to conventional modalities: in endocrine therapy, it cooperates with estrogen receptor α (ESR1) to sustain autophagic flux and maintain tamoxifen resistance; in chemotherapy, it activates anti-apoptotic and DNA-repair programs; and in the tumor microenvironment, it contributes to immunosuppressive macrophage polarization ( Lan et al., 2020 ; Wang et al., 2021 ; Tan et al., 2024 ; Wang et al., 2025 ; Liu et al., 2026 ; Scordamaglia et al., 2026 ).
+
+Despite this progress, critical questions remain unresolved. The functional divergence between NUPR1 isoforms, the context-dependent nature of its regulatory networks across BC subtypes, and the optimal strategies for integrating NUPR1 inhibition into existing treatment paradigms require comprehensive evaluation. In this Review, we synthesize the molecular and cellular foundations of NUPR1 biology, dissect its multifaceted roles in breast cancer initiation, progression, and therapy resistance, and discuss emerging therapeutic targeting strategies, from small-molecule inhibitors and antibody-based degraders to metabolic drug repurposing, that aim to convert NUPR1 from an adaptive stress node into a clinically actionable vulnerability ( Figure 1 ). Figure 1
+
+Molecular and cellular foundations of NUPR1 and roles of NUPR1 in breast cancer. Parts of Figure 1 were drawn using pictures from Servier Medical Art. Servier Medical Art by Servier is licensed under a Creative Commons Attribution 3.0 Unported License ( https://creativecommons.org/licenses/by/3.0/ ) Infographic composed of three colored triangular sections centered around NUPR1 in breast cancer. The green triangle shows molecular and cellular foundations such as DNA, RNA, and nuclear processes. The blue triangle describes roles and mechanisms in breast cancer, including metabolic reprogramming, autophagy, therapeutic resistance, metastatic progression, and ferroptosis evasion. The pink triangle outlines therapeutic targeting opportunities: direct inhibition, metabolic drug repurposing, and combination strategies against resistance. Central illustrations include a person, breast tissue, cells, and liver with directional arrows connecting concepts.
+
+Molecular and cellular foundations of NUPR1
+
+Gene organization, isoforms and protein architecture
+
+The human NUPR1 gene (also known as p8 or COM1 ) resides on chromosome 16p11.2 and comprises three exons and two introns ( Ree et al., 1999 ; Bratland et al., 2000 ; Igarashi et al., 2001 ). It encodes two distinct protein isoforms through alternative splicing: the canonical NUPR1b isoform of 82 amino acids (~8.8 kDa) and the longer NUPR1a isoform of 100 residues, which contains an additional 18 amino acids of poorly defined function ( Encinar et al., 2001 ; Hoffmeister et al., 2002 ; Ito et al., 2003 ). Almost all current biochemical and cancer-biology studies have focused on NUPR1b, whereas the spatiotemporal expression, structural behaviour and pathophysiological contribution of NUPR1a remain largely unexplored, a knowledge gap that is particularly relevant given emerging evidence of isoform-specific interactomes in breast cancer cells. To systematically disentangle these isoform-specific functions, future studies could deploy high-dimensional approaches, including bulk and single-cell RNA-seq splice-variant analysis, isoform-specific affinity purification coupled to mass spectrometry (AP-MS), and isoform-selective proximity labeling, to map NUPR1a-specific expression patterns, protein–protein interaction networks, and chromatin occupancy across breast cancer molecular subtypes. Because the overwhelming majority of published functional and cancer-biology datasets focus exclusively on the canonical 82-amino-acid variant, the designation ‘NUPR1’ is utilized throughout the remainder of this Review to denote the NUPR1b isoform, unless specified otherwise.
+
+NUPR1b is a highly basic protein organized into three functional segments ( Mallo et al., 1997 ; Igarashi et al., 2001 ; Grasso et al., 2015 ; Lopez et al., 2015 ). The N-terminal region harbours a proline-, glutamic acid-, serine- and threonine-rich (PEST) sequence that targets the protein for ubiquitin–proteasome–dependent degradation and links its turnover to phosphatidylinositol 3-kinase (PI3K)/AKT signalling ( Carracedo et al., 2006b ). The C terminus contains a classical bipartite nuclear localization signal (NLS; residues ~63–78) superimposed on a basic helix–loop–helix (HLH) motif ( Valacco et al., 2006 ; Qiu and MacRae, 2007 ; Wu et al., 2022 ). Within this region, two conserved acetylation and methylation sites modulate electrostatic interactions with nuclear transport machinery; acetylation of these lysines is essential for efficient nuclear import, whereas phosphorylation of Thr68 within the NLS can impede binding to importin-α family members and thereby restrict nuclear retention ( Valacco et al., 2006 ; Santofimia-Castaño et al., 2017 ; Santofimia-Castaño et al., 2022 ). This architectural arrangement, an unstable N-terminal degradation signal coupled to a C-terminal DNA-binding and trafficking module, endows NUPR1 with rapid signal responsiveness and tight spatial control.
+
+Intrinsically disordered nature and conformational dynamics
+
+A defining feature of NUPR1 is that it belongs to the family of intrinsically disordered proteins (IDPs) ( Neira et al., 2018 ; Neira et al., 2019 ). Biophysical analyses by circular dichroism, Fourier-transform infrared spectroscopy, fluorescence and NMR have failed to detect stable secondary or tertiary structure under native conditions; the protein behaves as an extended, highly flexible polypeptide in both dilute solution and crowded environments that mimic the intracellular milieu ( Santofimia-Castaño et al., 2020 ; Santofimia-Castaño et al., 2021 ; Araujo-Abad et al., 2023 ). This extreme conformational plasticity is not a structural deficit but rather a functional asset. Like many IDPs, NUPR1 operates through dynamic complexes: it maintains its disordered state even when bound to DNA or to protein partners such as MSL1, PARP1, PKP1 and PADI4, allowing a single molecule to engage multiple, structurally diverse interactors with high specificity yet rapid reversibility ( Ghandhi et al., 2014 ; Santofimia-Castaño et al., 2022 ; Araujo-Abad et al., 2023 ).
+
+Phosphorylation by protein kinase A (PKA) introduces a partial ordering of the polypeptide chain and significantly enhances DNA-binding affinity, suggesting that post-translational modifications can shift NUPR1 from a transcriptionally inert, highly disordered state to a more structured, chromatin-associated conformation ( Encinar et al., 2001 ). In the context of breast cancer, this phosphorylation-dependent switch may couple mitogenic kinase signalling to NUPR1-mediated transcriptional programmes ( Marouf et al., 2026 ). Moreover, the disordered nature of NUPR1 predisposes it to liquid–liquid phase separation (LLPS), a phenomenon increasingly recognized in RNA-binding proteins and transcriptional hubs ( Santofimia-Castaño et al., 2024 ; Xu et al., 2024 ). Recent work demonstrates that NUPR1 drives the assembly of stress granules, membraneless cytoplasmic organelles that sequester mRNA and translational machinery under oncogenic or metabolic stress, thereby reprogramming protein synthesis and fostering survival of KRAS-mutant and triple-negative breast cancer cells ( Santofimia-Castaño et al., 2024 ; Schneider and Schneider, 2024 ; Álvarez-Rodríguez et al., 2026 ).
+
+Subcellular trafficking and nucleo-cytoplasmic shuttling
+
+NUPR1 shuttles between the nucleus and cytoplasm, and its subcellular distribution is context- and pathology-dependent ( Vasseur et al., 1999 ). In normal thyroid follicles and renal tubules, NUPR1 is predominantly nuclear, consistent with its role as a chromatin-associated factor ( Ito et al., 2003 ; Ito et al., 2005 ). By contrast, pronounced cytoplasmic staining is observed in poorly differentiated, lymph node–positive breast tumours and in non-small cell lung cancers, suggesting that oncogenic progression may derail nuclear import or accelerate nuclear export ( Ito et al., 2003 ; Päth et al., 2006 ; Li et al., 2024 ). In breast cancer cell lines, NUPR1 has been detected in both compartments, and its cytoplasmic retention correlates with metastatic potential ( Ozkaya et al., 2017 ; Lim et al., 2024 ; Ortiz et al., 2024 ).
+
+Nuclear import is mediated by the NLS-dependent recognition of importin-α family members ( Valacco et al., 2006 ; Santofimia-Castaño et al., 2019b ). The small-molecule inhibitor ZZW-115 exploits this trafficking dependency: by binding to residues Ala33 and Thr68, it competitively disrupts the NUPR1–importin interaction, blocks nuclear translocation and traps NUPR1 in the cytoplasm ( Lan et al., 2020 ). Because Thr68 lies within the NLS, phosphorylation at this site also hampers importin binding, providing a potential regulatory checkpoint that links upstream kinase signaling to NUPR1 localization ( Neira et al., 2020 ; Estaras et al., 2025 ). Cytoplasmic sequestration not only abrogates NUPR1’s nuclear transcriptional functions but also unmasks cytoplasmic roles, such as stress-granule scaffolding and modulation of autophagic machinery, that may become dominant in specific breast cancer subtypes ( Wu et al., 2020 ; Wang et al., 2021 ; Scordamaglia et al., 2026 ).
+
+Transcriptional regulatory mechanisms and chromatin association
+
+NUPR1 functions as a transcriptional co-regulator rather than a classical sequence-specific transcription factor ( Vasseur et al., 1999 ; Encinar et al., 2001 ). It binds preferentially to AT-rich promoter regions and indirectly modulates downstream pathways by recruiting or stabilizing key signaling mediators ( Vasseur et al., 2004 ; Giroux et al., 2006 ). In breast cancer cells, NUPR1 has been shown to cooperate with NF-κB, SMAD and PI3K/AKT signaling to regulate genes involved in autophagy, lysosomal biogenesis and cell-cycle control ( Wang et al., 2021 ; Aguilar et al., 2023 ; Lee et al., 2025 ; Wang et al., 2025 ; Liu et al., 2026 ).
+
+Beyond direct DNA contact, NUPR1 participates in DNA-damage repair through its interaction with MSL proteins ( Gironella et al., 2009 ). Upon double-strand breaks, NUPR1 is recruited to chromatin, where it forms a dose-dependent complex with MSL1 that facilitates DNA-repair activity and protects against genotoxic cell death ( Aguado-Llera et al., 2013 ). In addition, NUPR1 binds PARP1 in the nucleus and restrains its enzymatic activity under homeostatic conditions ( Tang et al., 2015 ; Santofimia-Castaño et al., 2022 ). These observations position NUPR1 as a chromatin-associated hub that integrates transcriptional control with genome-maintenance programs.
+
+Post-translational modifications and functional modulation
+
+NUPR1 function is tightly governed by post-translational modifications that modulate its stability, localization and interactome ( Garbacki et al., 2023 ; Zhao et al., 2026 ). Ubiquitination of the PEST domain targets NUPR1 for proteasomal degradation, a process regulated by PI3K/AKT; this provides a direct mechanistic link between growth-factor signaling and NUPR1 abundance ( Sárvári et al., 2010 ). Acetylation within the C-terminal HLH/NLS region promotes nuclear import and chromatin engagement, whereas methylation at adjacent residues may fine-tune DNA-binding affinity ( Neira et al., 2020 ). Phosphorylation, particularly at Thr68, introduces a conformational switch that both enhances DNA binding and restricts nuclear import, creating a feedback loop that adjusts NUPR1 activity to cellular kinase status ( Neira et al., 2018 ; Santofimia-Castaño et al., 2019b ).
+
+In breast cancer cells, these modifications are frequently hijacked by oncogenic pathways. For example, HDAC11 downregulation in doxorubicin-resistant triple-negative breast cancer leads to hyperacetylation of the NUPR1 promoter and relieves transcriptional repression, resulting in NUPR1 overexpression and chemoresistance ( Lim et al., 2024 ). Conversely, pharmacological inhibition of NUPR1 by ZZW-115 or trifluoperazine derivatives blocks acetylation-dependent nuclear trafficking and disrupts the SUMOylation of DNA-damage-response proteins, shifting the cellular balance from survival to ferroptosis, apoptosis or necroptosis ( Lan et al., 2020 ; Huang et al., 2021b ).
+
+Roles and mechanisms of NUPR1 in breast cancer
+
+Building upon the molecular and architectural features outlined above, NUPR1 functions as a pleiotropic, stress-adaptive hub that is systematically co-opted by breast cancer cells to drive malignant transformation, metabolic plasticity, therapeutic evasion, and metastatic dissemination. In this section, we synthesize the current evidence positioning NUPR1 at the center of breast cancer pathobiology, dissecting its subtype-specific roles and the mechanistic circuits that link its intrinsically disordered biology to clinical aggressiveness ( Figure 2 ). Figure 2
+
+Roles and mechanisms of NUPR1 in breast cancer: metabolic reprogramming and mitogenic signaling. Diagram showing NUPR1 at the center, with six labeled boxes describing its roles: expression and prognosis, metabolic reprogramming, ferroptosis evasion, metastatic progression, therapeutic resistance, and autophagy and lysosomes. Each box provides summarized molecular mechanisms and pathways.
+
+Expression, genomic alterations and prognostic significance
+
+NUPR1 is markedly upregulated across multiple breast cancer subtypes compared with normal mammary epithelium ( Bratland et al., 2000 ; Ree et al., 2000 ; Wang et al., 2021 ; Wu et al., 2022 ; Aguilar et al., 2023 ). The transcriptomic analyses of breast cancer cohorts demonstrate that elevated NUPR1 expression is associated with significantly worse overall survival and shortened disease-free intervals ( Jiang et al., 2005 ; Jung et al., 2012 ). These prognostic associations are not limited to luminal disease; Kaplan–Meier analyses further reveal that high NUPR1 mRNA levels correlate with poor overall and relapse-free survival in both endocrine therapy-treated ER-positive and ERBB2-enriched breast cancer populations ( Jiang et al., 2005 ; Jung et al., 2012 ; Lee et al., 2025 ). At the genomic level, copy-number gain at 16p11.2, which harbors the NUPR1 locus, represents one of the recurrently altered regions in early-stage breast cancer ( Jung et al., 2012 ). Notably, simultaneous copy-number gains of NUPR1 (16p11.2) and ERBB2 (17q12) define a high-risk genotypic configuration that predicts particularly poor prognosis in early-stage disease ( Jung et al., 2012 ). This genomic co-alteration suggests that NUPR1-driven transcriptional programs may synergize with ERBB2 signaling to accelerate tumor progression. More recently, single-cell transcriptomics and machine-learning-based glycolytic scoring have identified NUPR1 as one of seven core glycolytic regulatory hub genes in breast cancer, with its expression enriched in malignant epithelial subsets exhibiting the highest glycolytic activity ( Liu et al., 2026 ). Collectively, these clinical and genomic data establish NUPR1 not merely as a passenger alteration but as a bona fide biomarker of aggressive disease biology.
+
+Metabolic reprogramming and mitogenic signaling
+
+NUPR1 has been positioned as a contributor to metabolic adaptation in breast cancer, with evidence suggesting it may function as a bidirectional transducer that links extracellular mitogenic cues to intracellular anabolic programs ( Liu et al., 2026 ; Scordamaglia et al., 2026 ). Recent single-cell transcriptomic analyses integrating machine-learning-based glycolytic scoring have identified NUPR1 as one of seven core glycolytic regulatory hub genes in breast cancer, with its expression selectively enriched in malignant epithelial subsets exhibiting the highest glycolytic activity ( Mu et al., 2018 ; Liu et al., 2026 ).
+
+In the context of obesity-associated breast cancer, NUPR1 is robustly induced by insulin stimulation and appears to operate as an effector of the insulin receptor (IR)–IRS1–AKT signaling cascade in both ER-positive and triple-negative models ( Päth et al., 2020 ; Lagarde et al., 2024 ; Marouf et al., 2026 ; Scordamaglia et al., 2026 ). Mechanistically, PI3K/AKT signaling stabilizes NUPR1 protein by suppressing ubiquitin–proteasome degradation through its N-terminal PEST domain, establishing a positive feed-forward loop that amplifies oncogenic output ( Li et al., 2020 ). Functionally, NUPR1 activation enhances proliferative capacity, clonogenic survival, and spheroid expansion in response to insulin. The spheroid phenotype is particularly informative in this context. Unlike standard two-dimensional (2D) monolayer cultures, in which cells experience homogeneous oxygen and nutrient availability, three-dimensional (3D) spheroids establish steep spatial gradients of oxygen deprivation, nutrient limitation, and metabolite accumulation that closely recapitulate the avascular microregions of solid breast tumors ( Boot et al., 2021 ; Quoniou and Menecier, 2026 ). This distinction carries critical translational implications: preclinical efficacy of NUPR1 inhibitors assessed solely in 2D monolayers may underestimate the tumor dependency on NUPR1-driven stress adaptation that manifests in vivo .
+
+Beyond its role as an insulin effector, NUPR1 actively reshapes glucose metabolism. Under mitochondrial dysfunction or calcium overload, which are common in rapidly proliferating breast cancer cells, NUPR1 transcription is markedly upregulated ( Syn et al., 2017 ; Iovanna et al., 2025 ). In hepatocellular carcinoma models, NUPR1 binds to the promoter region of the GRN gene, thereby activating PI3K/AKT and MAPK signaling pathways ( Lee et al., 2015 ). This transcriptional relay upregulates the key glycolytic enzymes hexokinase 2 (HK2) and lactate dehydrogenase A (LDHA), redirecting glucose flux from oxidative phosphorylation toward aerobic glycolysis ( Zhao et al., 2026 ). Beyond bioenergetic and biosynthetic consequences, this glycolytic switch fundamentally alters cellular redox poise. By maintaining rapid LDHA-dependent NAD regeneration, NUPR1-driven aerobic glycolysis redirects pyruvate flux away from mitochondrial oxidative phosphorylation. This restriction of substrate delivery to the tricarboxylic acid cycle reduces electron congestion across respiratory complexes I and III, thereby attenuating basal mitochondrial ROS generation and preserving the cellular pools of NADPH required to sustain glutathione-dependent defences against ferroptotic lipid peroxidation ( Huang et al., 2021a ; Liu et al., 2025 ; Zhao et al., 2026 ). The resultant lactate accumulation not only fuels biomass synthesis but also acidifies the microenvironment, fostering immune evasion and metastatic competency ( Liu et al., 2025 ; Zhao et al., 2026 ). While the mitogen-driven insulin receptor-IRS1-AKT-NUPR1 signaling cascade is empirically validated across both luminal and triple-negative breast cancer models, downstream metabolic branches such as the GRN-HK2/LDHA axis remain to be confirmed within mammary systems.
+
+Importantly, this metabolic configuration generates a paradoxical redox vulnerability. While glycolytic suppression of mitochondrial ROS is protective under basal conditions, the concomitant accumulation of lactate and protons acidifies the cytosol and can exacerbate oxidative stress during nutrient fluctuations or therapeutic insult ( Liu et al., 2025 ; Zhao et al., 2026 ). We posit that NUPR1 does not merely promote glycolysis for anabolic gain, but actively constructs a redox buffer zone that anticipates and counteracts oxidative membrane damage, a function that converges directly on its downstream ferroptosis-suppressive activity via LCN2 and ferritin iron sequestration ( Narzt et al., 2019 ; Huang et al., 2021a ; Zhan et al., 2022 ; Long et al., 2026 ).
+
+By analogy to stress-response mechanisms characterised in pancreatic adenocarcinoma, NUPR1 is hypothesised to engage an alternative survival module under energy-limiting conditions by activating Aurora kinase A (AURKA). While this NUPR1-AURKA axis transcriptionally coordinates DNA repair and cell-cycle progression in non-mammary settings ( Hamidi et al., 2012 ; Kaya et al., 2022 ), its functional relevance to breast cancer metabolic adaptation remains purely speculative and awaits formal experimental validation.
+
+Although most prominent in hepatocellular carcinoma, NUPR1–SREBP1 lipogenic axis may also be relevant in aggressive breast cancer subtypes ( Wang et al., 2022 ). NUPR1 enhances nuclear translocation of mature SREBP1 and enriches at lipogenic gene promoters, driving de novo fatty acid synthesis ( Wang et al., 2022 ). Intriguingly, widely prescribed metabolic agents such as statins indirectly impinge upon this network ( Scordamaglia et al., 2026 ). By inhibiting HMG-CoA reductase and the mevalonate pathway, statins impair IR-mediated signaling and downregulate NUPR1 expression, thereby attenuating insulin-stimulated proliferation and clonogenicity in ER-positive breast cancer cells ( Alim and Akalanka, 2026 ). These findings provide a mechanistic rationale for repurposing lipid-lowering drugs in tumors characterized by hyperactive insulin signaling and elevated NUPR1.
+
+Autophagy and lysosomal homeostasis
+
+Autophagy is a central survival mechanism through which breast cancer cells endure metabolic insults, genotoxic stress, and therapeutic pressure ( Zhou et al., 2023 ; Panicker et al., 2026 ; Rui et al., 2026 ). NUPR1 has been implicated as a regulator that influences autophagy at multiple stages, from lysosomal biogenesis to autophagosome–lysosome fusion and cargo clearance, and may promote the shift of autophagy from a homeostatic degradation process toward a pro-survival, pro-metastatic phenotype ( Fan et al., 2022 ; Xiao et al., 2022 ; Ren et al., 2024 ).
+
+NUPR1 is associated with increased autophagy and transcriptional activation of transcription factor E3 (TFE3), a key regulator of lysosomal biogenesis and autophagy gene expression ( Wang et al., 2024 ). In breast cancer cells, reports suggest that NUPR1 may bind to the TFE3 promoter and promote expression of lysosomal genes such as LAMP1, enhancing lysosomal acidification and proteolytic capacity ( Xiao et al., 2022 ). NUPR1 suppression reduces TFE3 levels, lowers LAMP1 expression, diminishes lysosomal proteolysis, and ultimately blocks autophagic flux ( Xiao et al., 2022 ). Exogenous TFE3 rescues lysosomal activity and reduces accumulation of LC3B-II and p62 in NUPR1-deficient cells, confirming that the NUPR1–TFE3 axis is indispensable for maintaining lysosomal homeostasis ( Xiao et al., 2022 ). From a redox perspective, this lysosomal maintenance is critical because impaired autophagic flux leads to the accumulation of dysfunctional mitochondria and protein aggregates that generate ROS and lipid peroxides. By sustaining TFE3-driven lysosomal capacity, NUPR1 ensures efficient clearance of oxidatively damaged organelles, thereby suppressing the ROS buildup that constitutes a prerequisite for ferroptotic execution ( Xiao et al., 2022 ; Wang et al., 2024 ; Long et al., 2026 ). This mechanism operates in breast, cervical, and oral squamous cell carcinomas, indicating a broadly conserved protumorigenic pathway. While the NUPR1–TFE3–LAMP1 and NUPR1–SNAP25–VAMP8 autophagic axes are directly validated in breast cancer cell lines and xenografts, the broader hypothesis that NUPR1 uniformly converts autophagy into a dedicated pro-metastatic engine across all breast cancer subtypes awaits wider subtype-specific validation.
+
+The NUPR1–SNAP25–VAMP8 axis controls autophagosome–lysosome fusion. Beyond initiating lysosomal programs, NUPR1 governs the terminal stages of autophagy ( Mu et al., 2018 ; Yang et al., 2025 ). NUPR1 upregulates the synaptic-associated SNARE protein SNAP25, which complexes with vesicle-associated membrane protein 8 (VAMP8) to form the SNARE machinery that mediates autophagosome–lysosome fusion ( Yang et al., 2025 ). In breast cancer models, NUPR1 silencing induces autophagosome accumulation, impairs mitophagy, and precipitates premature senescence ( Mu et al., 2018 ). Notably, SNAP25 cooperates with the PTEN-induced kinase 1 (PINK1)/E3 ubiquitin ligase Parkin pathway to enhance mitophagy, thereby clearing damaged mitochondria and maintaining metabolic homeostasis ( Cui et al., 2024 ; Guo et al., 2026 ). By simultaneously promoting lysosomal biogenesis and autophagosome maturation, NUPR1 ensures efficient autophagic flux from initiation to cargo degradation ( Mu et al., 2018 ).
+
+In tamoxifen-resistant ER-positive breast cancer, NUPR1 physically interacts with estrogen receptor α (ESR1) and binds to the promoter regions of autophagy and drug-resistance genes, including BECN1, GREB1, RAB31, PGR, and CYP1B1, to sustain autophagic flux ( Wang et al., 2021 ). This NUPR1–ESR1 transcriptional complex prevents senescence and apoptosis under endocrine deprivation ( Elango et al., 2021 ; Wang et al., 2021 ). Disruption of this complex, either by NUPR1 depletion or by pharmacological inhibition, raises lysosomal pH, impairs autophagic clearance, and induces premature senescence both in vitro and in xenograft models ( Bertolini et al., 2020 ; Wang et al., 2021 ). Thus, NUPR1 converts autophagy from a homeostatic program into a dedicated resistance mechanism.
+
+Ferroptosis evasion and iron homeostasis
+
+Ferroptosis, an iron-dependent form of regulated cell death driven by lethal lipid peroxidation, has emerged as a critical therapeutic vulnerability in triple-negative breast cancer (TNBC), which exhibits high iron dependence and limited apoptotic plasticity ( Iftikhar et al., 2026 ; Lin et al., 2026 ; Liu et al., 2026 ). NUPR1 has been identified as a repressor of ferroptosis in select breast cancer subtypes, operating through a multi-pronged iron-control network that appears to limit both free iron availability and lipid peroxide accumulation ( Liu et al., 2021 ; He et al., 2025 ; Zeng et al., 2026 ).
+
+At the primary level, NUPR1 suppresses ferroptosis through direct transcriptional control of iron export. A proposed mechanism by which NUPR1 suppresses ferroptosis involves transcriptional upregulation of lipocalin-2 (LCN2), a secreted glycoprotein that sequesters iron-loaded siderophores and promotes cellular iron efflux ( Luo et al., 2026 ). In TNBC cells, evidence suggests that NUPR1 binds directly to the LCN2 promoter, contributing to an iron-export program that diminishes intracellular Fe 2+ pools and suppresses Fenton-catalyzed lipid peroxidation ( Tan et al., 2024 ). Functional studies demonstrate that LCN2 depletion precisely phenocopies NUPR1 deficiency with respect to ferroptosis induction, whereas enforced re-expression of LCN2 fully restores ferroptosis resistance in NUPR1-knockdown cells ( Tan et al., 2024 ).
+
+This primary transcriptional output is further amplified by an epitranscriptomic mechanism. In TNBC, NUPR1 expression and its ferroptosis-suppressive output are further amplified by the m 6 A methyltransferase WTAP ( Tan et al., 2024 ). WTAP promotes NUPR1 expression in an m 6 A–eIF3A-dependent manner: m 6 A modification of the NUPR1 transcript enhances its stability and translation efficiency, while eIF3A facilitates ribosomal loading ( Tan et al., 2024 ). Consequently, the WTAP–NUPR1–LCN2 cascade creates a robust epitranscriptomic–transcriptional relay that locks TNBC cells into a ferroptosis-resistant state. Silencing of WTAP or pharmacologic inhibition of the m 6 A writer complex phenocopies NUPR1 loss, sensitizing TNBC cells to ferroptosis-inducing agents ( Tan et al., 2024 ).
+
+Beyond LCN2-driven iron export, NUPR1 also limits ferroptosis by promoting iron storage ( Zhang et al., 2024 ), although the complementary FTH1/ferritin iron-sequestration layer remains putative in this context, as direct NUPR1 occupancy at the FTH1 promoter and functional validation in breast cancer systems are currently lacking. By promoting Fe 2+ sequestration within ferritin cores, NUPR1 further reduces the labile iron pool available for Fenton chemistry, providing a complementary layer of protection against oxidative membrane damage ( Isyraqiah et al., 2018 ; Zhang et al., 2024 ). The circPIAS1/miR-455-3p/NUPR1/FTH1 regulatory axis, first characterized in hepatocellular carcinoma, represents a modular circuit likely operative in aggressive breast cancer subtypes, wherein NUPR1 serves as the convergent transcriptional hub linking competing endogenous RNA networks to iron homeostasis ( Zhang et al., 2024 ; He et al., 2025 ).
+
+Multifaceted roles in therapeutic resistance
+
+NUPR1 is not merely a passive correlate of aggressive disease but appears to contribute to therapeutic resistance across endocrine, cytotoxic, and metabolic modalities ( Botto et al., 2018 ; Yu et al., 2018 ). Its resistance functions operate through three interconnected layers: (i) epigenetic and transcriptional rewiring that alters drug-target expression and bypasses pathway blockade; (ii) cell-cycle and apoptotic checkpoint modulation that blunts genotoxic killing; and (iii) metabolic and autophagic adaptation that sustains survival under therapeutic stress ( Murphy and Costa, 2020 ; Huang et al., 2021a ; Long et al., 2026 ). In breast cancer, each of these layers has been causally linked to NUPR1 dependency.
+
+Acquired resistance to endocrine agents remains a leading cause of mortality in luminal breast cancer ( Chatterjee et al., 2026 ; Tsagkaraki et al., 2026 ). NUPR1 is markedly upregulated in tamoxifen-resistant ER-positive cells, it drives a clinically significant molecular subtype conversion ( Bratland et al., 2000 ; Lee et al., 2025 ). Rather than maintaining a pure luminal A phenotype, these resistant cells acquire luminal B–ERBB2-positive-like characteristics, including elevated ERBB2 expression and heightened sensitivity to trastuzumab ( Lee et al., 2025 ). Proposed mechanisms include physical interaction between NUPR1 and estrogen receptor α (ESR1) in the nucleus and co-occupancy at the promoter regions of autophagy and drug-resistance genes, which may sustain a protective autophagic shield ( Elango et al., 2021 ; Wang et al., 2021 ).
+
+Beyond autophagy maintenance, NUPR1 initiates an epigenetic bypass pathway that upregulates HER2 signaling ( Lee et al., 2025 ). NUPR1 activates histone deacetylase 5 (HDAC5), which relieves microRNA-125a-5p-mediated repression of ERBB2, thereby elevating HER2 protein levels and promoting estrogen independence ( Lee et al., 2025 ). This NUPR1–HDAC5–miR-125a-5p–ERBB2 axis represents a clinically actionable resistance module: targeting NUPR1 reverses the luminal-to-HER2 phenotypic switch and resensitizes cells to both endocrine and anti-HER2 interventions ( Lee et al., 2025 ). While mechanistically compelling, alternative pathways such as the NUPR1–HDAC5–miR-125a-5p–ERBB2 epigenetic bypass pathway are supported primarily by limited cell-line studies and require broader clinical validation before their relevance can be fully established.
+
+In TNBC, where therapeutic options are limited to cytotoxic agents, NUPR1-driven resistance is particularly pronounced ( Park et al., 2021 ). Microfluidic selection of doxorubicin-resistant TNBC cells (L-DOXR) followed by unbiased transcriptomics identified NUPR1 as the most robustly upregulated resistance-associated gene, with expression levels strongly correlating with poor prognosis ( Lim et al., 2024 ). This transcriptomic shift is accompanied by broad rewiring of cell-cycle, DNA-repair, and survival programs, suggesting that NUPR1 upregulation is not an isolated event but part of a system-wide adaptive response. The mechanism involves failed epigenetic control: HDAC11 is downregulated in resistant cells, leading to enrichment of H3K27 acetylation specifically at the NUPR1 promoter region 3 and relief of deacetylation-mediated transcriptional repression ( Lim et al., 2024 ). HDAC11 inhibition reciprocally augments NUPR1 expression, confirming a direct causal relationship ( Lim et al., 2024 ). Consequently, NUPR1 overexpression activates anti-apoptotic programs and enhances DNA-repair capacity. Beyond individual gene regulation, the HDAC11–NUPR1 epigenetic switch appears to be linked to a broader lineage plasticity program. L-DOXR cells exhibit features of the polyaneuploid cancer cell (PACC) state, suggesting that NUPR1 derepression may facilitate not merely survival but a reversible de-differentiation program that expands the pool of therapy-tolerant cells. Whether NUPR1 directly drives PACC entry through chromatin remodeling of lineage-specifying loci, or whether it primarily sustains the viability of cells already committed to this state, remains an important open question.
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+Under doxorubicin or paclitaxel stress, NUPR1 forms a complex with p53 and p300, binds the CDKN1A promoter, and drives nuclear accumulation of p21 together with retinoblastoma protein (RB) phosphorylation, enforcing a reversible cell-cycle arrest that allows cells to evade lethal genotoxicity ( Vincent et al., 2012 ). This physical cooperation with the histone acetyltransferase p300 underscores that NUPR1 does not function in isolation but integrates with the epigenetic machinery to dictate cell fate decisions. By recruiting p300 to the CDKN1A locus, NUPR1 appears to favor a reversible G1/S checkpoint response over terminal apoptosis or senescence, effectively converting genotoxic stress into a transient pause that enables repair and survival. Simultaneously, NUPR1 activates PI3K/AKT signaling, inducing p21 phosphorylation and cytoplasmic translocation; this cytoplasmic p21 pool inhibits TRAIL-mediated apoptosis and reinforces chemoresistance ( Vincent et al., 2012 ). Inhibiting NUPR1 reverses both the cell-cycle checkpoint and the anti-apoptotic blockade, resensitizing TNBC cells to anthracyclines and taxanes.
+
+NUPR1 may further protect breast cancer cells from genotoxic agents by modulating DNA-damage repair (DDR) ( Rizzuti et al., 2021 ). Through its chromatin-associated interactions with MSL1 and PARP1, mechanisms characterized primarily in pancreatic cancer models, NUPR1 facilitates DDR protein recruitment and restrains PARP1 enzymatic activity under homeostatic conditions ( Ghandhi et al., 2014 ; Tang et al., 2015 ). In breast cancer specifically, loss of NUPR1 leads to mitochondrial dysfunction and sensitization to doxorubicin, paclitaxel, and γ-irradiation ( Clark et al., 2008 ), although whether this sensitization is directly attributable to the NUPR1–MSL1–PARP1 axis, as opposed to other NUPR1-dependent survival pathways, remains to be fully dissected in breast cancer systems. Moreover, NUPR1 directly stimulates SUMOylation of key DDR proteins; pharmacological inhibition of NUPR1 nuclear translocation reduces SUMOylation-dependent repair functions, thereby potentiating genotoxic therapies ( Lan et al., 2020 ). This positions NUPR1 as a synthetic-lethal node in combination with PARP inhibitors or platinum-based agents.
+
+Moreover, ferroptosis evasion is also a resistance modality. NUPR1-mediated suppression of ferroptosis through the LCN2–iron axis underpins resistance not only to conventional cytotoxics but also to emerging ferroptosis-inducing agents ( Liu and Costa, 2022 ; Wang et al., 2025 ). By maintaining iron homeostasis and redox balance, NUPR1 closes off an alternative cell-death exit that is particularly relevant in high-grade, therapy-refractory TNBC.
+
+Metastatic progression and microenvironmental crosstalk
+
+Metastatic dissemination requires cancer cells to acquire both cell-intrinsic fitness for survival in circulation and the capacity to remodel distant microenvironments into permissive niches ( Cetin et al., 2026 ; Citgez et al., 2026 ; Stravodimou and Voutsadakis, 2026 ). NUPR1 contributes to both facets through autophagy-driven bioenergetic plasticity, extracellular vesicle (EV)-mediated intercellular communication, and immunosuppressive niche engineering.
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+Intrinsically, the NUPR1–TFE3–autophagy axis provides the bioenergetic and biosynthetic flexibility required for migratory and invasive phenotypes ( Fan et al., 2022 ; Wang et al., 2024 ). By sustaining lysosomal biogenesis and autophagic flux, NUPR1 ensures that breast cancer cells can recycle macromolecules to fuel motility and survive anoikis during transit through the vasculature ( Mu et al., 2018 ; Wang et al., 2021 ). In ZR-75-30 ER-positive cells, NUPR1 knockdown inhibits not only primary tumor growth but also distant metastasis in vivo , phenocopying systemic autophagy inhibition ( Xiao et al., 2022 ).
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+TNBC cells exploit NUPR1 packaging into tumor-derived extracellular vesicles (TEVs) to engineer a pro-metastatic niche at distant sites ( Liu et al., 2024 ; Ortiz et al., 2024 ; Hong et al., 2026 ). Western blot and proteomic analyses demonstrate that NUPR1 is abundantly loaded into TEVs; these vesicles are transferred to recipient endothelial cells and stromal cells, where delivered NUPR1 activates pro-metastatic transcriptional programs in a type I interferon-independent manner ( Ortiz et al., 2024 ). In vivo , reserpine-mediated suppression of EV release reduces NUPR1 protein levels in circulating vesicles and attenuates lung metastasis, confirming that vesicular NUPR1 is a rate-limiting factor in metastatic seeding ( Ortiz et al., 2024 ).
+
+NUPR1 may extend its oncogenic influence beyond tumor cells to shape the metastatic microenvironment. Pan-cancer analyses indicate that NUPR1 is highly expressed in tumor-associated macrophages (TAMs) and drives their polarization toward an M2-like, immunosuppressive phenotype in hepatocellular carcinoma, lung adenocarcinoma, and bladder cancer models ( Cai et al., 2025 ; Ji et al., 2025 ; Long et al., 2026 ). M2-polarized TAMs secrete immunosuppressive cytokines, upregulate checkpoint molecules such as PD-L1, and induce CD8+ T-cell exhaustion, thereby dampening anti-tumor immunity and fostering a soil permissive to metastatic colonization ( Zhang et al., 2025 ; Li and Li, 2026 ). We emphasize that direct evidence linking NUPR1 to M2 macrophage polarization specifically within the breast tumor microenvironment is currently lacking; the application of this mechanism to breast cancer remains hypothetical and awaits breast cancer-specific functional studies.
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+Therapeutic targeting and translational opportunities
+
+The mechanistic architecture outlined above positions NUPR1 not merely as a biomarker of aggressive breast cancer biology but as a non-mutational, stress-adaptive dependency that can be pharmacologically dismantled to restore therapeutic vulnerability. Because NUPR1 lacks classical enzymatic activity and stable tertiary structure, its druggability historically appeared limited ( Vasseur et al., 1999 ; Weis et al., 2015 ). However, recent multidisciplinary campaigns, spanning biophysics, chemical biology, and antibody engineering, have established that the conformational plasticity of this intrinsically disordered protein (IDP) can be exploited by molecules that bind to its dynamic hot spots, disrupt nuclear trafficking, and block protein–protein interactions essential for oncogenic stress responses ( Deng et al., 2026 ; Ueno et al., 2026 ; Zafar et al., 2026 ). In this section, we synthesize the current therapeutic arsenal directed against NUPR1, examine combination strategies that align with breast cancer subtype-specific vulnerabilities, and discuss the translational trajectory required to move these agents from preclinical models to clinical practice ( Figure 3 ). Figure 3
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+Potential therapeutic strategies targeting NUPR1. Infographic outlining therapeutic strategies targeting NUPR1, including direct pharmacological inhibition, metabolic drug repurposing, combination with endocrine and DNA damage response therapies, and combination with ferroptosis, listing specific agents and mechanisms for each strategy.
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+Direct pharmacological inhibition of NUPR1
+
+The most advanced class of NUPR1 inhibitors originates from the phenothiazine scaffold of the antipsychotic trifluoperazine (TFP) ( Neira et al., 2017 ; Santofimia-Castaño et al., 2017 ). Through ligand-based design and high-throughput biophysical screening, TFP was repurposed as a NUPR1 binder that interacts with the hydrophobic hot spots surrounding Ala33 and Thr68 ( Santofimia-Castaño et al., 2017 ). Although TFP demonstrates antiproliferative activity in breast and multiple myeloma cell lines by suppressing NUPR1-driven autophagy, its clinical utility is constrained by central nervous system side effects and cardiotoxic potential via hERG channel inhibition ( Murren et al., 1996 ; Li et al., 2017 ; Feng et al., 2018 ). To overcome these liabilities, a structure–activity optimization campaign yielded ZZW-115, a TFP-derived compound with markedly improved anticancer potency and reduced neuropsychiatric toxicity ( Santofimia-Castaño et al., 2019a ; Lan et al., 2020 ). ZZW-115 binds NUPR1 within the nuclear localization signal (NLS) region, competitively displacing importin-α family members and trapping NUPR1 in the cytoplasm ( Liu et al., 2021 ). This blockade of nuclear translocation abrogates NUPR1-mediated transcriptional programs and simultaneously unleashes a multimodal cell death cascade ( Liu et al., 2024 ; Santofimia-Castaño et al., 2024 ). Mechanistically, cytoplasmic retention of NUPR1 by ZZW-115 precipitates a mitochondrial catastrophe characterized by hyperPARylation, collapse of the mitochondrial membrane potential, depletion of ATP, and accumulation of reactive oxygen species (ROS) ( Santofimia-Castaño et al., 2022 ; Liu et al., 2024 ).
+
+Building upon the ZZW-115 scaffold, recent medicinal chemistry efforts have produced next-generation analogues. High-throughput screening of 10,000 compounds identified AJO14 as a lead that retains potent NUPR1 binding while lacking favorable affinity for the hERG potassium channel, thereby circumventing cardiotoxicity concerns ( Liu et al., 2024 ). Further optimization generated LZX-2-73, which exhibits significantly enhanced efficacy in pancreatic and breast cancer organoids ( Liu et al., 2024 ; Liu et al., 2025 ). Notably, LZX-2-73 produces strong synergistic lethality when combined with sorafenib or other kinase inhibitors, inducing massive oxidative stress, lipid peroxidation, and caspase activation ( Liu et al., 2025 ). These advances provide a preclinical rationale for NUPR1 small-molecule inhibitors, suggesting that such compounds could potentially be refined to improve pharmacodynamic potency while eliminating off-target liabilities, and rationally paired with existing targeted agents to explore synthetic lethal interactions.
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+Beyond conventional small molecules, the structural openness of NUPR1 has recently enabled a biologic targeting approach. Using an integrated high-throughput platform combining in situ proximity ligation assay followed by DNA sequencing (isPLA-seq), NanoBiT proximity assays, and C-degron degradation validation, investigators have screened large single-domain antibody (sdAb) libraries and identified sdAb#07.81 as a lead candidate ( Wang et al., 2025 ). This sdAb exhibits strong binding affinity for NUPR1 and, upon intracellular delivery, promotes the degradation of endogenous NUPR1 in triple-negative breast cancer (TNBC) cells ( Wang et al., 2025 ). Functional characterization demonstrates that sdAb#07.81 suppresses malignant proliferation, induces premature senescence, and derepresses ferroptosis ( Wang et al., 2025 ). In fully immunocompetent murine 4T1-derived models, systemic delivery of sdAb#07.81 significantly reduces tumor burden, lowers NUPR1 protein levels, and diminishes proliferative indices ( Wang et al., 2025 ). This proof-of-concept establishes that intracellular biologics can effectively neutralize an IDP oncogene, opening a new modality for patients whose tumors exhibit high NUPR1 expression and limited druggable kinase targets.
+
+Despite these promising preclinical findings, substantial limitations remain. NUPR1 is an intrinsically disordered protein that lacks deep hydrophobic pockets, making structure-based optimization difficult and likely limiting the maximal binding affinity of current small molecules to the micromolar range. Furthermore, phenothiazine-derived scaffolds retain a well-documented risk of hERG channel inhibition and central nervous system penetration, while normal tissues with high basal NUPR1 expression may be susceptible to on-target toxicity. Finally, no NUPR1-targeted small molecule or biologic has yet entered phase I clinical trials for breast cancer, underscoring the early translational stage of this strategy.
+
+Metabolic drug repurposing
+
+An alternative, immediately translatable strategy involves repositioning widely prescribed metabolic agents to indirectly impinge upon the NUPR1 axis. In obesity-associated, hyperinsulinemic breast cancer, the insulin receptor (IR)–IRS1–AKT signaling cascade robustly induces NUPR1 expression and stabilizes the protein via PEST-domain phosphorylation, creating a feed-forward loop that fuels oncogenic metabolism ( Scordamaglia et al., 2026 ). Statins, lipid-lowering drugs that inhibit HMG-CoA reductase and the mevalonate pathway, have been shown to impair IR-mediated signaling and downregulate NUPR1 expression in ER-positive breast cancer cells ( Alim and Akalanka, 2026 ; Scordamaglia et al., 2026 ). Mechanistically, simvastatin, atorvastatin, and rosuvastatin attenuate insulin-stimulated proliferation and clonogenic capacity in MCF7 and high-IR-expressing BCAHC-1 cells, and this cytostatic effect is rescued by ectopic NUPR1 overexpression ( Alim and Akalanka, 2026 ). Because hyperinsulinemia and dyslipidemia are prevalent comorbidities in breast cancer patients, and because statins are already approved with established safety profiles, clinical trials evaluating statin co-administration in NUPR1-high, metabolically dysregulated luminal disease represent a low-risk, high-yield translational opportunity ( Mauriello et al., 2025 ; El Sayed, 2026 ). This approach exemplifies how understanding the metabolic–stress interface of NUPR1 can convert epidemiological observations into mechanism-based therapeutic regimens. Nevertheless, this repurposing strategy faces notable constraints. The magnitude of NUPR1 suppression achieved by statins in preclinical models is modest, and whether the reduction in NUPR1 expression is sufficient to blunt insulin-driven oncogenesis in patients remains uncertain. Additionally, the pleiotropic effects of statins, including anti-inflammatory and anti-angiogenic activities, confound the attribution of clinical benefit specifically to NUPR1 inhibition. Retrospective epidemiological studies of statins in breast cancer have yielded inconsistent results, and no prospective trial has stratified patients by tumor NUPR1 status, leaving the biomarker-driven hypothesis formally untested.
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+Combination strategies targeting resistance mechanisms
+
+The multifaceted resistance architecture governed by NUPR1, spanning endocrine persistence, DNA-damage repair, ferroptosis evasion, and immune suppression, provides a rational framework for combination therapies. In luminal A breast cancers that acquire tamoxifen resistance, NUPR1 drives a deleterious phenotypic switch toward luminal B–ERBB2-positive-like characteristics by activating HDAC5 and derepressing ERBB2 via the miR-125a-5p axis ( Lee et al., 2025 ). Pharmacological inhibition of NUPR1 by ZZW-115 or genetic depletion disrupts the NUPR1–ESR1 transcriptional complex, may collapse the protective autophagic program, and reverse the HER2-upregulation bypass. Consequently, NUPR1 blockade may resensitize tamoxifen-resistant cells to both endocrine deprivation and trastuzumab ( Lee et al., 2025 ).
+
+NUPR1 directly participates in DNA-damage repair through its chromatin-associated interactions with MSL1 and PARP1 ( Gironella et al., 2009 ). Under homeostatic conditions, NUPR1 restrains PARP1 enzymatic activity; upon genotoxic insult, NUPR1 facilitates the recruitment of repair proteins and stimulates SUMOylation of DNA-damage response (DDR) factors. Inhibiting NUPR1 nuclear translocation with ZZW-115 down-regulates the SUMOylation of core DDR factors, effectively lowering the genotoxic threshold of triple-negative breast cancer cells ( Lan et al., 2020 ).This chemosensitization strategy provides a promising therapeutic window for pairing with advanced drug delivery systems, such as precisely tailored doxorubicin prodrug nanoassemblies, which can exploit these newly exposed vulnerabilities to maximize intratumoral activation while limiting systemic toxicity ( Feng et al., 2024 ). Moreover, the hyperPARylation and mitochondrial catastrophe induced by NUPR1 inactivation create a synthetic lethal interaction with PARP inhibitors and platinum-based agents, particularly in high-grade TNBC and BRCA-deficient contexts ( Santofimia-Castaño et al., 2022 ; Iovanna et al., 2025 ).
+
+NUPR1 is a canonical repressor of ferroptosis through its transcriptional upregulation of LCN2 and FTH1, which limit labile iron availability and lipid peroxidation ( Liu et al., 2021 ; Tan et al., 2024 ). In TNBC, where apoptotic plasticity is limited and iron dependence is high, NUPR1 blockade unlocks ferroptotic vulnerability. Pharmacological inhibition of NUPR1 with ZZW-115, or genetic silencing, precipitates intracellular Fe 2+ accumulation, glutathione depletion, GPX4 downregulation, and ACSL4-mediated lipid peroxide generation ( Liu and Costa, 2022 ; Tan et al., 2024 ; Wang et al., 2025 ). These biochemical changes are fully rescued by ferrostatin-1 or iron chelators, confirming pathway specificity. Combining NUPR1 antagonists with ferroptosis inducers such as erastin or RSL3 may provide a potent therapeutic axis for TNBC and other NUPR1-high, iron-dependent breast cancer subtypes ( Deng and Li, 2026 ; Iftikhar et al., 2026 ; Lin et al., 2026 ).
+
+Practical execution of these combinations is fraught with unresolved challenges. Overlapping toxicities may preclude full-dose concurrent administration, yet optimal sequencing and dosing schedules have not been explored even in preclinical models. Moreover, NUPR1 inhibition may trigger compensatory resistance via NRF2-driven antioxidant programs or alternative iron-export pathways, and the safety of pairing ferroptosis inducers with NUPR1 antagonists has not been assessed in normal tissue models. Regulatory and co-development complexities for such novel combination regimens will require careful navigation before clinical testing can be contemplated.
+
+Conclusions and perspectives
+
+NUPR1 has emerged as a central, non-mutational factor implicated in stress adaptation in breast cancer, with evidence linking it to metabolic insults, therapeutic pressure, and malignant survival. As an intrinsically disordered protein, it exploits extreme conformational plasticity to integrate diverse oncogenic signals, including insulin-driven mitogenic stimuli, DNA damage, and nutrient deprivation, into coherent transcriptional and metabolic outputs. Its capacity to function as a chromatin-associated co-regulator, a cytoplasmic scaffold for stress granules, and a gatekeeper of autophagic and ferroptotic circuits positions NUPR1 not merely as a biomarker of aggressive disease, but as a functional dependency co-opted systematically across molecular subtypes.
+
+The molecular architecture of NUPR1 underpins this versatility. The interplay between its N-terminal PEST domain, C-terminal NLS/HLH module, and dynamic post-translational modification landscape creates a regulatory rheostat that couples growth-factor signaling to subcellular localization and interactome selection. This plasticity enables context-dependent engagement with NF-κB, SMAD, PI3K/AKT, and ESR1 axes, allowing NUPR1 to tailor its outputs to luminal, HER2-enriched, or triple-negative contexts.
+
+Pathobiologically, NUPR1 sits at the nexus of metabolic reprogramming, proteostatic control, and cell-fate determination. By transducing insulin–PI3K/AKT signaling into glycolytic programs, sustaining TFE3-driven autophagic flux, and suppressing ferroptosis through LCN2-mediated iron export and ferritin sequestration, NUPR1 constructs multi-layered defenses against microenvironmental stress and cytotoxic therapy. Its roles in endocrine resistance via ESR1 cooperation, chemoresistance through p21-mediated checkpoint control and DDR SUMOylation, and metastatic dissemination through extracellular vesicle-mediated niche engineering underscore its multidimensional threat to therapeutic efficacy. These mechanisms collectively establish NUPR1 as a synthetic-lethal node whose pharmacological dismantling could collapse compensatory survival networks across treatment modalities.
+
+Therapeutically, targeting NUPR1 has transitioned from theoretical challenge to tangible clinical opportunity. Small-molecule inhibitors including ZZW-115, AJO14, and LZX-2-73—optimized to disrupt NUPR1–importin-α interactions—demonstrate that the dynamic hot spots of intrinsically disordered proteins are pharmacologically tractable. These agents unleash multimodal cell death while sensitizing tumors to genotoxic agents, PARP inhibitors, and anti-HER2 therapies. The single-domain antibody sdAb#07.81 provides proof-of-concept that intracellular biologics can promote endogenous NUPR1 degradation and alleviate TNBC progression, opening a new modality for patients with limited druggable targets. Concurrently, statin-mediated suppression of the insulin–NUPR1 axis offers an immediately translatable strategy to intercept obesity-associated, hyperinsulinemic breast cancer using agents with established safety profiles.
+
+Several challenges remain. First, robust, subtype-specific biomarkers are needed to stratify patients most likely to benefit from NUPR1 inhibition. Second, the optimal integration of NUPR1 antagonists into existing paradigms requires rigorous clinical validation. Third, pharmacokinetic and intracellular delivery barriers facing biologic modalities necessitate innovative formulation strategies. Fourth, deeper structural understanding of NUPR1 phase separation dynamics and isoform-specific conformational ensembles will be essential for rational drug design.
+
+Looking forward, we envision a precision-oncology framework in which NUPR1 expression, modification status, and subcellular localization guide therapeutic decision-making. Future research should leverage single-cell and spatial multi-omics to dissect NUPR1 heterogeneity within tumor ecosystems, particularly its crosstalk with tumor-associated macrophages and endothelial cells. Translating NUPR1 antagonists into clinical trial design requires moving past traditional genomic selection models. Because NUPR1 operates as a non-mutational dependency, routine next-generation sequencing panel assays will fail to identify eligible patients. Instead, patient stratification strategies must utilize validated quantitative immunohistochemistry (IHC) platforms designed to evaluate shifting nucleocytoplasmic localization patterns, or rely on machine-learning-derived multi-gene transcriptomic signatures that capture downstream pathway activation. Exploring NUPR1’s role in immunomodulation beyond macrophage polarization may reveal opportunities for combination with immunotherapy. Conceptually, dismantling the stress-adaptive network associated with NUPR1 could represent a paradigm shift from targeting static, mutation-driven oncogenes to exploiting dynamic, non-mutational dependencies. Sustained interdisciplinary collaboration will be required, but the reward—converting a universal stress-adaptive node into a clinically actionable, precision vulnerability—promises to be substantial.
+
+============================================================
+SOURCE: PMC13391297.txt (TXT)
+============================================================
+
+Association between neutrophil percentage-to-albumin ratio and adverse clinical outcomes after successful percutaneous coronary intervention for chronic total occlusion: a cohort study
+
+Epidemiology, management strategies, and outcomes of patients with chronic total coronary occlusion
+
+Current perspectives on coronary chronic total occlusions: the Canadian Multicenter Chronic Total Occlusions Registry
+
+Randomized, placebo-controlled trial of chronic total occlusion percutaneous coronary intervention in stable angina: The ORBITA-CTO trial
+
+A randomized multicentre trial to compare revascularization with optimal medical therapy for the treatment of chronic total coronary occlusions
+
+Randomized trial evaluating percutaneous coronary intervention for the treatment of chronic total occlusion
+
+Comparison of successful versus failed percutaneous coronary intervention in patients with chronic total occlusion: A systematic review and meta-analysis
+
+Ten-year outcome of recanalization or medical therapy for concomitant chronic total occlusion after myocardial infarction
+
+Inflammation in atherosclerosis: Lessons and therapeutic implications
+
+Multiple roles for neutrophils in atherosclerosis
+
+Low serum albumin: A neglected predictor in patients with cardiovascular disease
+
+The combined association of the neutrophil percentage-to-albumin ratio (NPAR) and the uric acid-to-high-density lipoprotein cholesterol ratio (UHR) with adverse cardiac events in patients with chronic heart failure: a retrospective cohort study
+
+Association between neutrophil percentage-to-albumin ratio and all-cause mortality in patients post-cardiac surgery: a retrospective cohort study
+
+Elevated neutrophil-percentage-to-albumin ratio predicts increased all-cause and cardiovascular mortality in hypertensive patients: Evidence from NHANES 1999-2018
+
+Neutrophil percentage-to-albumin ratio as a prognostic marker for mortality in ischemic stroke patients
+
+The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with atrial fibrillation: A retrospective study
+
+Neutrophil percentage-to-albumin ratio is an independent risk factor for MACEs in patients with acute coronary syndrome undergoing percutaneous coronary intervention
+
+Prognostic role of neutrophil percentage-to-albumin ratio in patients with non-ST-elevation myocardial infarction
+
+The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with chronic heart failure
+
+Association between neutrophil percentage-to-albumin ratio (NPAR) and long-term mortality in community-dwelling adults with chest pain: Evidence from US NHANES 2001-2018
+
+Association between neutrophil percentage-to-albumin ratio and 2-year mortality in patients undergoing transcatheter aortic valve replacement
+
+Prognostic value of the neutrophil percentage-to-albumin ratio for all-cause and cardiovascular disease mortality in individuals with coronary heart disease: A cohort study
+
+Definitions and clinical trial design principles for coronary artery chronic total occlusion therapies: CTO-ARC consensus recommendations
+
+Retrograde percutaneous coronary intervention for chronic total occlusions in patients with reduced left ventricular ejection fraction: a single-center retrospective cohort study
+
+(2) Classification and diagnosis of diabetes
+
+2018 ESC/ESH guidelines for the management of arterial hypertension
+
+Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects
+
+Neutrophils and neutrophil extracellular traps in cardiovascular disease: An overview and potential therapeutic approaches
+
+Neutrophil counts and cardiovascular disease
+
+Neutrophils are indispensable for adverse cardiac remodeling in heart failure
+
+Anti-inflammatory activity of albumin
+
+Serum albumin in health and disease: Esterase, antioxidant, transporting and signaling properties
+
+Background
+
+Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has improved outcomes, yet residual cardiovascular risk persists. The neutrophil percentage-to-albumin ratio (NPAR), an integrated marker of inflammation and nutritional status, has not been examined in successfully revascularized CTO patients. We investigated whether NPAR is independently associated with long−term adverse outcomes in this population.
+
+Methods
+
+This single−center retrospective cohort study included 1513 consecutive patients who underwent successful CTO PCI. NPAR was calculated as (neutrophil percentage × 100)/albumin (g/dL). The primary endpoint was all−cause mortality, secondary endpoints were cardiovascular mortality and cardiovascular events (cardiovascular death, non−fatal myocardial infarction, non−fatal stroke). Multivariable Cox regression and restricted cubic splines (RCS) assessed the association between NPAR and clinical outcomes. Time-dependent Receiver operating characteristics (ROC) curves were used to evaluate the ability for NPAR to predict all-cause mortality.
+
+Results
+
+During a median follow−up of 810 days, 83 (5.5%) all−cause deaths, 53 (3.5%) cardiovascular deaths, and 73 (4.8%) cardiovascular events occurred. After multivariable adjustment, each 1−standard deviation increase in NPAR was associated with a 50% higher risk of all−cause mortality (HR 1.50, 95% CI 1.23–1.83, P<0.001), a 59% higher risk of cardiovascular mortality (HR 1.59, 95% CI 1.23–2.05, P<0.001), and a 42% higher risk of cardiovascular events (HR 1.42, 95% CI 1.13–1.79, P = 0.003). RCS analysis revealed a linear association between NPAR and all-cause mortality (P for non-linearity = 0.971), cardiovascular mortality (P for non-linearity = 0.150), and major cardiovascular events (P for non-linearity = 0.152). Time-dependent ROC analyses demonstrated that adding NPAR to a basic model comprising age, multi-vessel disease, and LVEF significantly improved discrimination for all-cause mortality at 1, 2, and 3 years (ΔAUC 0.092, 0.076, and 0.058, respectively; all P < 0.0001). The optimal NPAR cut-off values derived from the maximum Youden index were stable across all three time points (15.71, 16.18, and 15.37, respectively), yielding sensitivities of 71.8% to 72.6% and specificities of 73.2% to 75.7%.
+
+Conclusion
+
+In patients undergoing successful CTO PCI, elevated NPAR is independently and linearly associated with increased long-term mortality and major cardiovascular events. This simple, objective biomarker may refine post-intervention risk stratification and identify high-risk individuals warranting intensified secondary prevention.
+
+Introduction
+
+Chronic total occlusion (CTO) remains one of the most technically challenging lesion subsets in coronary artery disease (CAD) ( 1 , 2 ). With advances in both equipment and techniques, percutaneous coronary intervention (PCI) for CTO now achieves high success rates in experienced centers, offering meaningful benefits in terms of angina relief, improvement in left ventricular function, and possibly long-term survival ( 3 – 5 ). Nevertheless, even after successful CTO recanalization, a residual risk of major adverse cardiovascular events persists, driven by complex lesion morphology, extensive coronary atherosclerosis, and the underlying systemic inflammatory and metabolic milieu ( 6 , 7 ). Against this background, there is considerable clinical interest in identifying simple, readily available biomarkers that can refine risk stratification after successful CTO PCI.
+
+Systemic inflammation and nutritional status represent two intertwined pathophysiological axes that critically influence atherosclerotic progression, plaque instability, and cardiovascular outcomes. Neutrophils, as key effector cells of innate immunity, are implicated in oxidative stress, endothelial dysfunction, and pro-thrombotic activity within the coronary circulation ( 8 , 9 ). Conversely, serum albumin acts as a negative acute-phase reactant and a modulator of systemic antioxidant capacity; hypoalbuminemia reflects not only nutritional depletion but also chronic low-grade inflammation and diminished physiological reserve ( 10 ). The neutrophil percentage-to-albumin ratio (NPAR), derived from routine laboratory tests, integrates these two pathways into a single composite metric and has emerged as an independent prognostic biomarker across a range of cardiovascular conditions, including CAD, stroke, acute myocardial infarction, hypertension, atrial fibrillation, heart failure, and chest pain populations ( 11 – 21 ). Its chief advantages are simplicity, objectivity, and minimal additional cost, being calculated from standard complete blood count and chemistry panels. However, no study to date has specifically examined the prognostic value of NPAR in patients who have undergone successful CTO PCI, a distinct cohort characterized by extensive coronary atherosclerosis, frequent multimorbidity, and high procedural complexity, yet with restored vessel patency.
+
+Accordingly, the present cohort study was designed to investigate the association between pre−procedural NPAR and long−term adverse clinical outcomes, including all−cause mortality, cardiovascular mortality, and major cardiovascular events, in a large consecutive series of patients who underwent successful CTO PCI. We hypothesized that higher NPAR levels would be independently associated with an increased risk of these endpoints. By clarifying the role of this integrated inflammatory−nutritional marker, our findings may inform improved risk stratification and guide targeted post−intervention management in this high−risk population.
+
+Methods
+
+Study design and population
+
+This single-center retrospective cohort study initially included 1756 consecutive adult patients who underwent PCI for at least one angiographically confirmed CTO lesion at Guangdong Provincial People’s Hospital between February 2011 and December 2023. Patients were excluded if they had procedural failure (n=72), had active systemic infections, autoimmune diseases, active malignancies, end-stage liver disease, or severe hematological disorders at the time of admission (n=0), incomplete NPAR or essential covariate data (n=79), or were lost to follow-up (n=100). After exclusions, 1513 participants were included in the final analysis.
+
+The study protocol complied with the principles of the Declaration of Helsinki and was approved by the Institutional Review Board of Guangdong Provincial People’s Hospital. Written informed consent was obtained from all participants. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines to ensure transparency and methodological rigor.
+
+Data collection and definitions
+
+CTO PCI was performed in patients with angiographically confirmed CTOs who had refractory symptoms (e.g. angina or dyspnoea) despite optimal medical therapy, objective evidence of viable myocardium, or inducible ischaemia in the CTO territory. Procedural details have been described previously. Coronary angiography and PCI were performed via femoral, radial, or combined access. Crossing strategies, guide catheters, stent types, and the use of intravascular imaging were left to the operator’s discretion. All operators were high−volume operators, each having performed >300 CTO PCI procedures in total, with a minimum of 50 CTO PCIs annually as the primary operator. CTO was defined as complete interruption of antegrade blood flow on coronary angiography, with an estimated occlusion duration of ≥3 months ( 22 ). Occlusion duration was determined based on symptom chronology, history of prior myocardial infarction (MI), and previous angiographic studies. Technical success was defined as achievement of Thrombolysis in Myocardial Infarction (TIMI) grade ≥2 antegrade flow in all distal branches ≥2.5 mm with residual stenosis <30% in the target CTO lesion at the end of the procedure. Procedural success was defined as technical success without in−hospital major adverse cardiovascular events (MACE; i.e. death, MI, or clinically driven target vessel revascularization) ( 22 ).
+
+Baseline demographic and clinical characteristics were retrospectively collected for all participants. Demographic information included age, sex, comorbidities, smoking status, and history of prior MI or revascularization (PCI or coronary artery bypass grafting [CABG]). Clinical information comprised physical examination findings, laboratory results, imaging data, and discharge medications. Fasting venous blood samples were drawn on the morning of the day prior to or the day of the PCI procedure, after ≥12 hours of overnight fasting. All samples were collected before any procedural intervention, ensuring that NPAR values reflect baseline pre-procedural inflammatory and nutritional status rather than perioperative stress responses. Samples were analyzed at the core laboratory of Guangdong Provincial People’s Hospital under standardized quality control protocols. Measured parameters included complete blood count, total cholesterol (TC), triglycerides (TG), high−density lipoprotein cholesterol (HDL−C), low−density lipoprotein cholesterol (LDL−C), fasting blood glucose (FBG), hemoglobin A1c (HbA1c), C−reactive protein (CRP), blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA), alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), creatine kinase (CK), CK−MB, troponin T (TnT), and N−terminal pro−B−type natriuretic peptide (NT−proBNP). Left ventricular ejection fraction (LVEF) was assessed at rest using the modified biplane Simpson’s rule ( 23 ). Diabetes mellitus (DM) was defined by prior diagnosis, use of glucose−lowering agents, or meeting any of the following: FBG ≥7.0 mmol/L, HbA1c ≥6.5%, or 2−hour plasma glucose ≥11.1 mmol/L on oral glucose tolerance testing ( 24 ). Hypertension was defined as a prior diagnosis, current antihypertensive treatment, or measured blood pressure ≥140/90 mmHg ( 25 ). NPAR was calculated as: (neutrophil percentage of total white blood cell count) × 100/albumin (g/dL) ( 11 – 21 ).
+
+Follow-up and clinical endpoints
+
+The median follow-up duration was 810 (IQR, 409–1230) days. Follow−up data were obtained through medical record review, outpatient visits, and structured telephone interviews conducted by trained researchers blinded to baseline data. The primary clinical endpoint was defined as all-cause mortality, which was mortality due to any reason. Secondary endpoints were cardiovascular mortality and cardiovascular events, the latter defined as cardiovascular mortality, non−fatal MI, and non−fatal stroke. Cardiovascular mortality was adjudicated unless a clear non−cardiovascular cause was established. Non−fatal MI was defined according to contemporary guidelines as a rise in cardiac troponin accompanied by typical chest pain, serial electrocardiographic changes, identification of intracoronary thrombus on angiography or autopsy, or imaging evidence of new loss of viable myocardium or new regional wall motion abnormality ( 23 ). Non−fatal stroke was defined as a new focal neurological deficit lasting >24 hours, confirmed by neuroimaging. All endpoint events were independently verified by two physicians.
+
+Statistical analysis
+
+Normality of continuous variables was assessed with the Shapiro–Wilk test. Continuous variables are presented as median (interquartile range) and categorical variables as frequency (percentage). Between−group comparisons were performed using the Kruskal–Wallis rank sum test for continuous variables and the chi−square test or Fisher’s exact test for categorical variables.
+
+Kaplan–Meier survival curves with log−rank tests illustrated the incidence of all−cause mortality, cardiovascular mortality, and cardiovascular events across NPAR tertiles. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between NPAR and clinical outcomes. Three models were constructed: Model 1 was unadjusted; Model 2 adjusted for age and sex; Model 3 additionally adjusted for smoking, hypertension, DM, dyslipidaemia, prior MI, prior PCI, prior stroke, multi−vessel disease, LDL−C, HDL−C, FBG, HbA1c, creatinine, UA, CRP, LVEF, statin use, and dual antiplatelet therapy. The proportional hazards assumption was verified using Schoenfeld residuals, and no significant violations were detected. Potential dose–response associations between NPAR and clinical outcomes were examined using restricted cubic splines (RCS) with three knots placed at the 30th, 60th, and 90th percentiles.
+
+Discriminatory performance was evaluated using time-dependent receiver operating characteristic analyses to assess the incremental predictive value of NPAR for all-cause mortality at 1, 2, and 3 years of follow-up. A basic clinical model comprising age, multi-vessel disease, and LVEF served as the reference. The area under the curve (AUC) was calculated for both the basic model and the model augmented with NPAR, and the incremental gain was quantified as ΔAUC. The Harrell’s C-statistic was additionally derived from baseline cohort analyses to corroborate incremental discrimination. Optimal cut-off values for NPAR were determined at each respective time point by maximizing the Youden index (sensitivity + specificity - 1).
+
+Exploratory analyses, including interaction testing, assessed the association between NPAR and clinical outcomes across subgroups defined by sex, age (≤60 vs. >60 years), smoking, hypertension, DM, prior MI, LDL-C (<2.6 vs. ≥2.6 mmol/L), and LVEF (<60% vs. ≥60%). Sensitivity analyses were performed to assess the robustness of the primary findings. These included: (1) exclusion of patients with a LVEF <30%; (2) exclusion of patients with a follow-up duration <90 days; (3) exclusion of patients with prior CABG; (4) additional adjustment for LAD as the target vessel; (5) exclusion of patients with a WBC >15 × 10 9 /L or ALB <30 g/L; (6) additional adjustment for ticagrelor and clopidogrel use; and (7) removal of adjustment for CRP.
+
+A two−sided P < 0.05 was considered statistically significant. All analyses were performed using R software, version 4.1.2 (R Foundation for Statistical Computing).
+
+Results
+
+Baseline characteristics
+
+The study cohort comprised 1513 participants, with a median age of 59.0 (IQR, 52.0–67.0) years, 1386 (91.6%) were male. Baseline characteristics stratified by NPAR tertiles were summarized in Table 1 . Compared with patients in the lowest NPAR tertile (T1), those in higher tertiles are older, had a higher SBP, had a higher prevalence of diabetes, prior stroke, multi-vessel disease, but a lower prevalence of prior PCI, and current smoking (all P<0.05). Laboratory profiling revealed that higher NPAR tertiles were characterized by elevated levels of WBC, Neutrophil count, Neutrophil percentage, FBG, HbA1c, Creatinine, BUN, NT−proBNP, TNT, and CRP, alongside lower hemoglobin, lymphocyte count, lymphocyte percentage, HDL, TG, ALT, ALB, CK, and LVEF (all P<0.05). No significant differences were observed across tertiles in the use of statins, β−blockers, dual antiplatelet therapy, calcium channel blockers (CCB), or angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) (all P>0.05). Table 1
+
+Baseline characteristics grouped by NPAR levels. Variables All (N=1513) T1 (N = 506) T2 (N = 503) T3 (N = 504) P value Age, years 59.00 (52.00, 67.00) 55.00 (49.00, 63.00) 59.00 (51.00, 67.00) 63.00 (57.00, 69.00) <0.001 Male, n (%) 1386 (91.6%) 465 (91.9%) 469 (93.2%) 452 (89.7%) 0.12 SBP, mmHg 130.00 (119.00, 143.00) 127.00 (116.00, 141.00) 130.00 (120.00, 144.00) 132.00 (119.00, 145.00) 0.003 DBP, mmHg 78.00 (70.00, 85.00) 78.00 (71.00, 85.00) 79.00 (70.00, 86.00) 76.00 (69.00, 84.00) <0.001 Heart rate, beats/min 74.00 (67.00, 82.00) 73.00 (65.00, 81.00) 75.00 (67.00, 82.00) 75.00 (68.00, 83.00) 0.13 Current smoker, n (%) 588 (38.9%) 230 (45.5%) 182 (36.2%) 176 (34.9%) <0.001 Hypertension, n (%) 902 (59.6%) 287 (56.7%) 299 (59.4%) 316 (62.7%) 0.2 Diabetes, n (%) 602 (39.8%) 184 (36.4%) 187 (37.2%) 231 (45.8%) 0.003 Dyslipidemia, n(%) 423 (28.0%) 144 (28.5%) 157 (31.2%) 122 (24.2%) 0.044 Prior MI, n (%) 237 (15.7%) 80 (15.8%) 66 (13.1%) 91 (18.1%) 0.10 Prior PCI, n (%) 757 (50.0%) 275 (54.3%) 255 (50.7%) 227 (45.0%) 0.012 Prior CABG, n (%) 36 (2.4%) 13 (2.6%) 11 (2.2%) 12 (2.4%) >0.9 Prior stroke, n (%) 75 (5.0%) 15 (3.0%) 24 (4.8%) 36 (7.2%) 0.009 Laboratory results Hb, g/L 135.00 (125.00, 146.00) 140.00 (129.00, 149.00) 137.00 (127.00, 146.00) 130.00 (118.00, 141.00) <0.001 WBC, 10 9 /L 6.96 (5.84, 8.25) 6.48 (5.63, 7.84) 6.90 (5.78, 7.97) 7.51 (6.27, 8.87) <0.001 PLT, 10 9 /L 217.00 (180.00, 263.00) 215.00 (182.00, 261.00) 220.00 (183.00, 262.00) 216.50 (174.00, 269.00) 0.7 Neutrophil count, 10 9 /L 4.11 (3.30, 5.16) 3.39 (2.84, 4.11) 4.13 (3.45, 4.99) 5.08 (4.06, 6.18) <0.001 Neutrophil percentage 0.60 (0.54, 0.66) 0.52 (0.48, 0.56) 0.61 (0.58, 0.64) 0.68 (0.64, 0.72) <0.001 lymphocyte count, 10 9 /L 1.79 (1.43, 2.22) 2.15 (1.81, 2.64) 1.76 (1.46, 2.15) 1.46 (1.16, 1.79) <0.001 lymphocyte percentage 0.26 (0.21, 0.32) 0.34 (0.30, 0.38) 0.26 (0.23, 0.29) 0.20 (0.16, 0.24) <0.001 LDL, mmol/L 2.39 (1.87, 2.95) 2.42 (1.87, 2.95) 2.32 (1.82, 2.86) 2.47 (1.94, 3.01) 0.059 HDL, mmol/L 0.93 (0.82, 1.07) 0.95 (0.83, 1.08) 0.93 (0.83, 1.05) 0.91 (0.79, 1.07) 0.028 TC, mmol/L 3.87 (3.20, 4.60) 3.88 (3.19, 4.60) 3.82 (3.16, 4.54) 3.88 (3.31, 4.65) 0.4 TG, mmol/L 1.47 (1.06, 2.09) 1.63 (1.16, 2.30) 1.47 (1.07, 2.16) 1.38 (0.99, 1.89) <0.001 FBG, mmol/L 5.50 (4.85, 6.90) 5.28 (4.79, 6.53) 5.49 (4.82, 6.65) 5.73 (5.00, 7.60) <0.001 HbA1c, % 6.10 (5.70, 6.80) 6.10 (5.70, 6.70) 6.00 (5.60, 6.60) 6.20 (5.70, 6.98) 0.002 Creatinine, µmol/L 84.00 (72.90, 100.19) 79.90 (71.22, 91.00) 84.19 (72.90, 99.34) 90.18 (74.80, 111.82) <0.001 BUN, µmol/L 5.59 (4.52, 6.83) 5.36 (4.42, 6.57) 5.60 (4.70, 6.63) 5.90 (4.50, 7.95) <0.001 UA, μmol/L 404.90 (337.00, 478.00) 401.22 (344.70, 479.70) 413.30 (343.00, 480.70) 395.97 (325.10, 470.65) 0.11 ALT, U/L 22.00 (16.00, 32.00) 25.00 (18.00, 34.00) 22.00 (15.00, 31.00) 20.50 (14.00, 30.00) <0.001 AST, U/L 22.00 (18.00, 27.00) 22.00 (19.00, 27.00) 21.00 (17.00, 26.00) 21.00 (17.00, 27.00) 0.072 ALB, g/L 38.80 (36.56, 41.00) 40.70 (38.60, 42.70) 39.20 (37.47, 40.73) 36.41 (34.00, 38.29) <0.001 NT-proBNP, pg/ml 229.40 (73.40, 749.70) 129.80 (47.30, 377.00) 175.10 (73.00, 604.10) 602.10 (170.10, 1,841.00) <0.001 TNT, pg/ml 17.20 (9.70, 41.24) 12.05 (8.40, 24.60) 17.00 (10.40, 31.70) 29.20 (13.80, 94.55) <0.001 CK, U/L 87.00 (63.00, 122.00) 89.00 (70.00, 125.00) 86.00 (64.00, 116.00) 81.00 (56.50, 125.00) 0.002 CK-MB, U/L 10.20 (10.00, 13.00) 10.10 (10.00, 13.00) 10.10 (10.00, 13.00) 10.50 (10.00, 13.10) >0.9 CRP, mg/L 1.97 (0.50, 6.20) 0.92 (0.50, 3.18) 1.70 (0.50, 4.40) 5.49 (1.10, 17.13) <0.001 LVEF, % 58.00 (46.00, 63.00) 60.00 (53.00, 64.00) 59.00 (48.00, 64.00) 54.00 (40.00, 62.00) <0.001 NPAR 15.56 (13.84, 17.44) 13.19 (11.93, 13.84) 15.58 (14.95, 16.13) 18.37 (17.44, 20.19) <0.001 Angiographic characteristics Target CTO artery 0.6 RCA, n (%) 858 (56.7%) 279 (55.1%) 293 (58.3%) 286 (56.7%) LAD, n (%) 713 (47.1%) 238 (47.0%) 238 (47.3%) 223 (47.0%) LCX, n (%) 199 (13.2%) 76 (15.2%) 64 (12.7%) 59 (11.7%) LM, n (%) 3 (0.2%) 1 (0.2%) 1 (0.2%) 1 (0.2%) Multi-vessel disease, n(%) 1354 (89.5%) 439 (86.8%) 461 (91.7%) 454 (90.1%) 0.035 Medications DAPT, n(%) 1477 (97.6%) 499 (98.6%) 489 (97.2%) 489 (97.0%) 0.2 Statin, n(%) 1494 (98.7%) 503 (99.4%) 496 (98.6%) 495 (98.2%) 0.2 β‐Blocker, n(%) 1211 (80.0%) 415 (82.0%) 395 (78.5%) 401 (79.6%) 0.4 CCB, n(%) 318 (21.0%) 97 (19.2%) 108 (21.5%) 113 (22.4%) 0.4 ACEI/ARB, n(%) 902 (59.7%) 303 (60.0%) 302 (60.0%) 297 (58.9%) >0.9 SGLT2i, n(%) 272 (18.0%) 105 (20.8%) 85 (16.9%) 82 (16.3%) 0.13 Clopidogrel, n(%) 910 (60.1%) 261 (51.6%) 315 (62.6%) 334 (66.3%) <0.001 Ticagrelor, n(%) 592 (39.1%) 242 (47.8%) 185 (36.8%) 165 (32.7%) <0.001 All-cause mortality, n(%) 83 (5.5%) 8 (1.6%) 20 (4.0%) 55 (10.9%) <0.001 Cardiovascular mortality, n(%) 53 (3.5%) 5 (1.0%) 14 (2.8%) 34 (6.7%) <0.001 Cardiovascular events, n(%) 73 (4.8%) 7 (1.4%) 23 (4.6%) 43 (8.5%) <0.001
+
+NPAR, neutrophil percentage-to-albumin ratio; LVEF, center ventricular ejection fraction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; SBP, systolic blood pressure; DBP, diastolic blood pressure; MI, myocardial infarction; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TG, triglycerides; FBG, fasting blood glucose; CRP, C-reactive protein; BUN, blood urea nitrogen; UA, uric acid; HbA1c, hemoglobin A1c; Hb, hemoglobin; WBC, white blood cell; PLT, platelet; ALT, Alanine Aminotransferase; BNP, brain natriuretic peptide; TNT, Troponin T; CK, creatine kinase; CK-MB, creatine kinase-MB; AST, aspartate aminotransferase; ALB, albumin; RCA, right coronary artery; LAD, Left Anterior descending artery; LCX, Left circumflex artery; LM, Left main coronary artery; DAPT, dual antiplatelet therapy; CCB, calcium channel blocker; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; SGLT2i, sodium-glucose cotransporter-2 inhibitors.
+
+Association of NPAR with clinical outcomes in patients with successful CTO PCI
+
+During a median follow-up of 810 (IQR, 409-1230) days, 83 (5.5%) all-cause deaths, 53 (3.5%) cardiovascular deaths, and 73 (4.8%) major cardiovascular events were recorded. Kaplan-Meier curves demonstrated a graded separation of cumulative incidence for all three endpoints across NPAR tertiles ( Figure 1 ). In the unadjusted model (Model 1), each 1-standard deviation (SD) increase in NPAR was associated with a 90% higher risk of all-cause mortality (HR 1.90, 95% CI 1.63-2.20, P < 0.001), an 83% higher risk of cardiovascular mortality (HR 1.83, 95% CI 1.51-2.22, P < 0.001), and a 66% higher risk of cardiovascular events (HR 1.66, 95% CI 1.39-1.98, P < 0.001). After comprehensive multivariable adjustment (Model 3), each 1-SD increase in NPAR remained significantly associated with a 50% higher risk of all-cause mortality (HR 1.50, 95% CI 1.23-1.83, P < 0.001), a 59% higher risk of cardiovascular mortality (HR 1.59, 95% CI 1.23-2.05, P < 0.001), and a 42% higher risk of cardiovascular events (HR 1.42, 95% CI 1.13-1.79, P = 0.003). When NPAR was analyzed by tertiles, a graded association was observed. Compared with the lowest tertile (T1), patients in the highest tertile (T3) had a 2.73-fold higher risk of all-cause mortality (HR 2.73, 95% CI 1.24-5.99, P = 0.013), a 3.37-fold higher risk of cardiovascular mortality (HR 3.37, 95% CI 1.24-9.16, P = 0.017), and a 3.31-fold higher risk of cardiovascular events (HR 3.31, 95% CI 1.33-7.30, P = 0.009) ( Table 2 ). RCS analysis revealed a linear association between NPAR and all-cause mortality (P for non-linearity = 0.971), cardiovascular mortality (P for non-linearity = 0.150), and major cardiovascular events (P for non-linearity = 0.152) ( Figure 2 ). Figure 1
+
+Kaplan-Meier curves of the cumulative incidence of (A) all-cause mortality, (B) cardiovascular mortality, and (C) cardiovascular events according to NPAR. Three-panel figure showing cumulative incidence curves by NPAR tertile. Panel A presents all-cause mortality, panel B shows cardiovascular mortality, and panel C displays cardiovascular events. In all panels, higher NPAR tertile (red line, T3) consistently shows higher cumulative incidence compared to the medium (green, T2) and low (blue, T1) tertiles, with all log-rank p-values less than 0.001, indicating statistically significant differences between groups over the follow-up period. Table 2
+
+Associations between NPAR and clinical outcomes in participants after successful CTO PCI. Outcomes Model 1 Model 2 Model 3 HR (95%CI) P-value HR (95%CI) P-value HR (95%CI) P-value All-cause mortality Per 1-SD increase in NPAR 1.90 (1.63-2.20) <0.001 1.77 (1.51-2.08) <0.001 1.50 (1.23-1.83) <0.0001 T1 Reference Reference Reference T2 2.29 (1.01-5.21) 0.048 1.98 (0.87-4.51) 0.105 1.49 (0.64-3.47) 0.351 T3 6.01 (2.86-12.63) <0.001 4.34 (2.04-9.24) <0.001 2.73 (1.24-5.99) 0.013 Cardiovascular mortality Per 1-SD increase in NPAR 1.83 (1.51-2.22) <0.001 1.69 (1.38-2.08) <0.001 1.59 (1.23-2.05) <0.001 T1 Reference Reference Reference T2 2.63 (0.95-7.32) 0.063 2.34 (0.84-6.53) 0.104 2.05 (0.71-5.88) 0.184 T3 6.12 (2.39-15.66) <0.001 4.55 (1.75-11.85) 0.002 3.37 (1.24-9.16) 0.017 Cardiovascular events Per 1-SD increase in NPAR 1.66 (1.39-1.98) <0.001 1.52 (1.26-1.84) <0.001 1.42 (1.13-1.79) 0.003 T1 Reference Reference Reference T2 3.06 (1.31-7.13) 0.010 2.65 (1.13-6.20) 0.025 2.24 (0.93-5.38) 0.071 T3 5.22 (2.34-11.62) <0.001 3.77 (1.67-8.51) 0.001 3.31 (1.33-7.30) 0.009
+
+Model 1 adjust for: None.
+
+Model 2 adjust for: age and sex.
+
+Model 3 adjust for: age, sex, smoking, hypertension, DM, dyslipidaemia, prior MI, prior PCI, prior stroke, multi−vessel disease, LDL−C, HDL−C, FBG, HbA1c, creatinine, UA, CRP, LVEF, statin use, and dual antiplatelet therapy.
+
+HR, hazard ratio; CI, confidence interval; NPAR, neutrophil percentage-to-albumin ratio; CTO, chronic total occlusion; PCI, percutaneous coronary intervention. Figure 2
+
+RCS analysis of the NPAR for incidence of (A) all−cause mortality, (B) cardiovascular mortality, and (C) cardiovascular events. Panel A shows a histogram and line graph of NPAR against hazard ratio for all-cause mortality, with a nonlinear association P value of 0.971. Panel B presents similar data for cardiovascular mortality, P value for nonlinearity 0.150. Panel C displays hazard ratios for CVEs, P value for nonlinearity 0.152. All graphs include 95 percent confidence intervals shaded in red and histogram distribution of NPAR values.
+
+Predictive value of NPAR for all-cause mortality in patients with successful CTO PCI
+
+Time-dependent receiver operating characteristic analyses revealed that the addition of NPAR to the basic risk model, comprising age, multi-vessel disease, and LVEF, substantially improved the discriminatory capacity for all-cause mortality at 1, 2, and 3 years of follow-up ( Table 3 ; Figure 3 ). Specifically, the area under the curve (AUC) increased from 0.712 to 0.804 at 1 year (ΔAUC = 0.092, P < 0.0001), from 0.729 to 0.805 at 2 years (ΔAUC = 0.076, P < 0.0001), and from 0.728 to 0.786 at 3 years (ΔAUC = 0.058, P < 0.0001) ( Table 3 ). Notably, the most pronounced incremental gain was observed at the 1-year landmark, suggesting that NPAR may confer particular prognostic value for early post-procedural risk stratification. This incremental predictive value was further corroborated by the C-statistics derived from the baseline cohort analyses. The basic model exhibited a C-statistic of 0.717 (95% CI: 0.662–0.773), which significantly increased to 0.789 (95% CI: 0.736–0.839) upon the incorporation of NPAR, yielding a ΔC-statistic of 0.072 (95% CI: 0.031–0.120; P < 0.0001) ( Supplementary Table 1 ). This finding robustly confirms that NPAR provides independent prognostic information beyond that of conventional risk factors. Furthermore, the optimal cut-off values for NPAR remained consistently stable across the three time points—15.71 at 1 year (Youden index: 0.4829), 16.18 at 2 years (Youden index: 0.4655), and 15.37 at 3 years (Youden index: 0.4540). These thresholds demonstrated moderate, yet well-balanced, diagnostic performance, with sensitivities and specificities ranging from 71.77% to 72.60% and 73.23% to 75.70%, respectively ( Supplementary Table 2 ). Table 3
+
+Predictive performance of NPAR for all-cause mortality across time points. Time point AUC (95%CI) ΔAUC (95%CI) P-value Basic model Basic model + NPAR 1-year 0.712 (0.629-0.794) 0.804 (0.730-0.878) 0.092 (0.037-0.159) <0.0001 2-year 0.729 (0.659-0.799) 0.805 (0.745-0.865) 0.076 (0.033-0.130) <0.0001 3-year 0.728 (0.666-0.789) 0.786 (0.731-0.841) 0.058 (0.019-0.113) <0.0001
+
+Basic model included: age, multi-vessel disease, and LVEF. Figure 3
+
+Time-dependent receiver operating characteristic curves of NPAR for all-cause mortality prediction. Basic model included: age, multi-vessel disease, and LVEF. Three-panel ROC curve graphic comparing predictive accuracy of a basic model versus basic model with NPAR for all-cause mortality at one, two, and three years. Addition of NPAR increases sensitivity at all time points, shown by red lines consistently above blue lines. Sensitivity is plotted on the y-axis and one minus specificity on the x-axis. Dashed diagonal lines indicate reference for random classification. Legend at bottom shows blue for basic model and red for basic model plus NPAR.
+
+Subgroup analyses
+
+Stratified analyses were performed to evaluate the association between NPAR and all-cause mortality across various subgroups ( Table 4 ). The association remained directionally consistent across all evaluated strata. No significant interactions were observed (all P for interaction > 0.05), suggesting that the relationship between NPAR and all-cause mortality is robust and not materially modified by baseline characteristics. Table 4
+
+Subgroup analysis of association of NPAR and all-cause mortality in participants with successful CTO PCI. Subgroups All-cause mortality N HR (95% CI) P value P for interaction Sex Male 75 1,386 1.51 (1.22-1.87) <0.001 0.922 Female 8 127 11.98 (6.22-23.09) <0.001 Age ≤60 26 814 1.40 (0.99-1.96) 0.054 0.186 >60 57 699 1.80 (1.35-2.39) <0.001 Current Smoking Yes 28 588 1.73 (1.21-2.48) 0.003 0.528 No 55 925 1.54 (1.19-1.99) <0.001 Hypertension Yes 62 902 1.46 (1.13-1.90) 0.004 0.155 No 21 611 1.80 (1.32-2.44) <0.001 Diabetes Yes 44 602 1.38 (1.01-1.89) 0.042 0.193 No 39 911 1.88 (1.38-2.56) <0.001 Prior MI Yes 21 237 1.52 (0.91-2.52) 0.108 0.446 No 62 1,276 1.47 (1.17-1.85) 0.001 LDL-C ≥2.6 33 590 1.46 (1.02-2.08) 0.036 0.755 <2.6 50 923 1.44 (1.13-1.82) 0.003 LVEF <60 63 817 1.54 (1.23-1.92) <0.001 0.610 ≥60 20 696 1.39 (0.75-2.56) 0.296
+
+Models adjust for age, sex, smoking, hypertension, DM, dyslipidaemia, prior MI, prior PCI, prior stroke, multi−vessel disease, LDL−C, HDL−C, FBG, HbA1c, creatinine, UA, CRP, LVEF, statin use, and dual antiplatelet therapy.
+
+HR, hazard ratio; CI, confidence interval; NPAR, neutrophil percentage-to-albumin ratio; CTO, chronic total occlusion; LVEF, center ventricular ejection fraction; PCI, percutaneous coronary intervention; MI, myocardial infarction; LDL-C, low-density lipoprotein cholesterol.
+
+Sensitivity analyses
+
+Multiple sensitivity analyses confirmed the robustness of the primary findings ( Supplementary Tables 3–S9 . After sequentially excluding patients with a follow-up duration <90 days, those with prior CABG, those with a LVEF <30%, those with a WBC >15 × 10 9 /L or ALB <30 g/L, and after additionally adjusting for LAD as the target vessel, ticagrelor use, clopidogrel use, and removal of adjustment for CRP, the positive associations between NPAR and clinical outcomes remained statistically significant and materially unchanged. Across all sensitivity models, each 1-SD increase in NPAR remained significantly associated with all-cause mortality (HRs 1.45–1.51, all P ≤ 0.010), cardiovascular mortality (HRs 1.43–1.74, all P ≤ 0.015), and major adverse cardiovascular events (HRs 1.30–1.55, all P ≤ 0.040), supporting the reliability of the primary findings.
+
+Discussion
+
+In this large single-center cohort of 1513 patients who underwent successful CTO PCI, we report three principal findings. First, NPAR, an integrated biomarker of systemic inflammation and nutritional status, was independently associated with long-term all-cause mortality, cardiovascular mortality, and major cardiovascular events after comprehensive multivariable adjustment. Second, the association followed a linear dose–response pattern without evidence of non-linearity. Third, the addition of NPAR to a basic clinical model comprising age, multi-vessel disease, and LVEF significantly improved risk discrimination at 1, 2, and 3 years of follow-up (ΔAUC 0.092, 0.076, and 0.058, respectively; all P < 0.0001), with optimal cut-off values derived from the maximum Youden index remaining stable across all time points (15.71, 16.18, and 15.37, respectively). These associations remained robust across multiple sensitivity analyses and consistent across key subgroups, suggesting that NPAR may serve as a simple, readily available biomarker for risk stratification after successful CTO PCI.
+
+To our knowledge, this is the first study to evaluate the prognostic value of NPAR specifically in patients with successful CTO PCI. Our findings extend the growing body of evidence linking NPAR to adverse outcomes in broader cardiovascular populations. In a study of 18,469 hypertensive adults from the National Health and Nutrition Examination Survey (NHANES) during a median follow-up of 105 months, higher NPAR significantly increased the risks of all-cause (HR 1.80, 95% CI 1.54-2.12) and cardiovascular mortality (HR 1.54, 95% CI 1.24-1.91) ( 13 ). Wang et al. reported that NPAR ≥17.326 was an independent prognostic risk factor in patients with ACS undergoing PCI (HR 3.01, 95% CI 1.42-6.41) ( 16 ). Among 6846 community-dwelling adults with chest pain, each unit increase in NPAR was associated with an 11% higher risk of all-cause mortality and a 14% increased risk of cardiovascular mortality ( 19 ). In 935 participants with CAD, those in the highest NPAR tertile had significantly elevated risks of all-cause mortality (HR 1.76, 95% CI 1.19-2.61) and cardiovascular mortality (HR 3.12, 95% CI 1.67-5.81) compared with the lowest tertile ( 21 ). Furthermore, a retrospective cohort study of 622 patients with chronic heart failure found that higher NPAR was independently associated with increased risks of 90−day (highest vs. lowest tertile: HR 2.21, 95% CI 1.01-4.86), 1−year (HR 2.13, 95% CI 1.30-3.49), and 2−year all−cause mortality (HR 2.06, 95% CI 1.37-3.09) ( 18 ). The present study now fills an important gap by demonstrating that this relationship holds true in the specific context of successfully revascularized CTO patients—a group characterized by extensive coronary atherosclerosis, a high prevalence of comorbidities such as diabetes and multi−vessel disease, and a residual risk of ischemic events despite successful recanalization. Notably, the magnitude of association we observed is comparable to or slightly higher than that reported for other inflammatory biomarkers in post-PCI populations, such as high-sensitivity CRP or the neutrophil-to-lymphocyte ratio. However, NPAR offers the practical advantage of being derived from routine laboratory panels without additional cost or turnaround time, making it attractive for clinical practice.
+
+The biological plausibility of our findings rests on the dual pathophysiological pathways integrated within NPAR. Neutrophils are central effectors of innate immunity in atherosclerosis. Beyond acute plaque destabilization, they contribute to chronic endothelial dysfunction, oxidative stress, and microvascular injury through the release of reactive oxygen species, proteolytic enzymes, and neutrophil extracellular traps ( 9 , 26 – 28 ). In the CTO milieu, where chronic ischemia and hibernating myocardium coexist, sustained neutrophil activation may perpetuate adverse myocardial remodeling and impair microvascular recovery even after antegrade flow has been restored ( 29 ). Conversely, serum albumin functions as a negative acute-phase reactant with potent antioxidant and anti-inflammatory properties; hypoalbuminemia reflects not merely hepatic synthetic impairment and nutritional deficiency but also the cumulative burden of chronic inflammation and frailty ( 10 , 30 , 31 ). The ratio of these two parameters thus captures a pathophysiological equilibrium: when neutrophil percentage rises and albumin falls, the net effect is a pro-inflammatory, catabolic state with diminished physiological reserve. The linear relationship observed in RCS analyses further supports the notion that this risk is incrementally conferred across the entire spectrum of NPAR values, without an obvious threshold effect, implying that even modest elevations in inflammatory-nutritional imbalance may translate into measurable increases in long-term cardiovascular risk.
+
+It is also noteworthy that the association between NPAR and clinical outcomes remained significant after adjustment for CRP, a well-established inflammatory marker. This suggests that NPAR may capture complementary biological information, perhaps reflecting more chronic, bone-marrow-derived inflammatory activity and nutritional status rather than acute-phase reactant dynamics alone. Whether NPAR merely mirrors existing disease severity or actively contributes to disease progression remains to be elucidated; nevertheless, its independence from CRP in multivariable models supports its potential additive value in risk stratification. Patients with higher NPAR in our cohort indeed exhibited a more adverse baseline risk profile: they were older, had higher systolic blood pressure, a greater prevalence of DM, prior stroke, and multi-vessel disease, and displayed worse metabolic parameters and lower LVEF. Although we carefully adjusted for these factors, NPAR may additionally capture residual inflammatory and nutritional risk not fully accounted for by traditional covariates.
+
+Subgroup analyses demonstrated that the association between NPAR and all-cause mortality remained consistent across most clinical strata in patients with successful CTO PCI. The marked male predominance (91.6%) reflects the well-documented sex imbalance in CTO PCI cohorts globally, wherein women are less frequently referred for invasive management of complex coronary disease. Nevertheless, this disproportion raises concerns regarding generalizability to female patients. No significant interaction was observed by sex (P for interaction = 0.922). Although female patients exhibited a numerically higher hazard ratio (HR 11.98, 95% CI 6.22–23.09) compared with male patients (HR 1.51, 95% CI 1.22–1.87), this apparent difference was likely driven by the small female sample size, as reflected by the wide confidence interval. Accordingly, the sex-specific estimates should be interpreted with caution, and the data support a broadly similar prognostic effect of NPAR across both sexes. The NPAR–mortality association remained directionally consistent and statistically significant across most other subgroups, and no significant interactions were detected for age, smoking status, hypertension, diabetes, prior MI, LDL-C, or LVEF. These findings suggest that NPAR, as a composite marker of inflammation and nutritional status, provides robust prognostic information independent of traditional cardiovascular risk profiles. In conclusion, NPAR is consistently associated with all-cause mortality across clinically relevant subgroups following successful CTO PCI. The absence of significant interactions indicates that NPAR is a broadly applicable prognostic biomarker in this population, including in both men and women, although larger cohorts of women are needed to confirm the precise effect size in female patients.
+
+From a translational perspective, the simplicity and objectivity of NPAR constitute its most compelling clinical advantage. Calculated from the standard complete blood count and chemistry panel, it requires no additional cost, specialized equipment, or procedural delay. In the context of successful CTO PCI, where patients are already subject to intensive pharmacological management and surveillance, a pre-procedural NPAR assessment could facilitate risk-adaptive post-intervention strategies. For example, patients with elevated NPAR may warrant more aggressive lipid-lowering therapy, tighter glycaemic control, or early referral to cardiac rehabilitation programs that address nutritional status and systemic inflammation. While NPAR was independently associated with outcomes after comprehensive adjustment, our study was not designed to assess its incremental prognostic value beyond existing risk models (e.g., SYNTAX score, GRACE risk score). Future studies should formally evaluate whether adding NPAR to established risk scores improves reclassification and calibration before recommending its routine clinical use. Additionally, we performed time-dependent ROC analyses and determined the optimal NPAR cut-off values for all-cause mortality using the maximum Youden index. The identified thresholds were remarkably stable across the 1-, 2-, and 3-year landmarks (15.71, 16.18, and 15.37, respectively), converging around a clinically actionable threshold of approximately 15.4–16.2. At these cut-offs, NPAR demonstrated moderate yet well-balanced discriminatory performance, with sensitivities of 71.8% to 72.6% and specificities of 73.2% to 75.7%. These data suggest that an NPAR value exceeding ~15.5–16.2 may serve as a practical screening tool for identifying high-risk patients during the early post-procedural period. Nevertheless, because dichotomization of continuous biomarkers sacrifices statistical information, we recommend that this threshold be used as an initial risk-stratification aid rather than a definitive decision boundary. External validation in independent CTO PCI cohorts is warranted before this cut-off can be integrated into routine clinical practice.
+
+The major strengths of this study include the relatively large sample size of consecutive patients with successful CTO PCI, rigorous adjudication of clinical endpoints by two independent physicians blinded to baseline data, and comprehensive adjustment for a wide range of potential confounders. The long follow-up duration and low rate of loss to follow-up enhance the reliability of outcome estimates. Furthermore, comprehensive subgroup and sensitivity analyses yielded consistent results. Several limitations warrant consideration. First, our analysis was restricted to patients who underwent successful CTO PCI, excluding those with procedural failure. While this design allowed us to investigate the prognostic value of NPAR in a homogeneously revascularized cohort, it introduces selection bias and limits extrapolation to patients in whom revascularization was unsuccessful or not attempted. Second, the study population was predominantly male (91.6%), which reflects the well-documented sex disparity in CTO PCI cohorts. Whether our findings apply equally to women remains uncertain, and future studies with larger female samples are needed to validate the prognostic role of NPAR in this under-represented subgroup. Second, despite extensive covariate adjustment, residual confounding from unmeasured factors such as dietary habits, physical activity, and genetic predisposition cannot be ruled out. And our study did not capture several angiographic and procedural variables known may to influence CTO PCI outcomes, including J-CTO score, retrograde crossing strategy, use of intravascular imaging (IVUS/OCT), total stent length, contrast volume, and peri-procedural complications. Although we adjusted for multi-vessel disease and target vessel location, unmeasured confounding by these lesion- and procedure-specific factors cannot be excluded. Future prospective studies should incorporate these variables to better establish the independent prognostic value of NPAR. Third, NPAR was assessed from a single pre-procedural blood sample; we were unable to evaluate whether temporal changes in NPAR during follow-up would refine prognostic accuracy or reflect treatment response. Fourth, our study spanned a 12-year period, during which CTO PCI techniques, procedural success, operator experience, and secondary prevention strategies have evolved substantially. These temporal changes may have influenced both procedural outcomes and long-term event rates. Although we adjusted for medication use at discharge, we could not fully account for changes in practice patterns over time. Future studies should examine whether the prognostic value of NPAR remains consistent across different eras of CTO PCI. Finally, because this is an observational study, causality cannot be established; randomized controlled trials or Mendelian randomization studies would be required to determine whether lowering NPAR (e.g., through nutritional support or anti-inflammatory therapy) improves outcomes.
+
+Conclusion
+
+In patients undergoing successful CTO PCI, elevated NPAR is independently and linearly associated with increased risks of all-cause mortality, cardiovascular mortality, and cardiovascular events. This simple, low-cost composite marker of inflammation and nutritional status may help refine risk stratification and identify high-risk individuals who could benefit from targeted secondary prevention strategies. External validation in larger, multicenter prospective cohorts is warranted before routine clinical application.
+
+============================================================
+SOURCE: PMC13391323.txt (TXT)
+============================================================
+
+Effects of exercises based on ACSM recommendations on patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials
+
+The Heart Camp exercise intervention improves exercise adherence, physical function, and patient-reported outcomes in adults with preserved ejection fraction heart failure
+
+Exercise training improves diastolic function in heart failure patients
+
+Interaction between spironolactone and natriuretic peptides in patients with heart failure and preserved ejection fraction: from the topcat trial
+
+The impact of a nurse-led care programme on events and physical and psychosocial parameters in patients with heart failure with preserved ejection fraction: a randomized clinical trial in primary care in Russia
+
+Exercise training improves exercise capacity and quality of life in heart failure with preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials
+
+Effects of different exercise programs on the cardiorespiratory reserve in hfpef patients: a systematic review and meta-analysis
+
+Exercise training effects on the relationship of physical function and health-related quality of life among older heart failure patients with preserved ejection fraction
+
+The irbesartan in heart failure with preserved systolic function (i-preserve) trial: rationale and design
+
+Comparative effect of different physical exercise training on exercise capacity and cardiac function in heart failure with preserved ejection fraction: a network meta-analysis-exic-fep study
+
+Outcomes in patients with heart failure with preserved, borderline, and reduced ejection fraction in the medicare population
+
+The annual global economic burden of heart failure
+
+High-intensity interval training is effective and superior to moderate continuous training in patients with heart failure with preserved ejection fraction: a randomized clinical trial
+
+Understanding the epidemic of heart failure: past, present, and future
+
+Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction
+
+Exercise training improves exercise capacity and diastolic function in patients with heart failure with preserved ejection fraction: results of the EX-DHF (Exercise Training in Diastolic Heart Failure) pilot study
+
+Combined endurance and resistance exercise training in heart failure with preserved ejection fraction: a randomized controlled trial
+
+Exercise mode in heart failure: a systematic review and meta-analysis
+
+Aerobic interval training elicits different hemodynamic adaptations between heart failure patients with preserved and reduced ejection fraction
+
+Effects of exercise training on cardiac function, exercise capacity, and quality of life in heart failure with preserved ejection fraction: a meta-analysis of randomized controlled trials
+
+American college of sports medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise
+
+Physical function and quality of life in older women with diastolic heart failure: effects of a progressive walking program on sleep patterns
+
+Home-based exercise improves functional performance and quality of life in women with diastolic heart failure
+
+A contemporary appraisal of the heart failure epidemic in olmsted county, minnesota 2000 to 2010
+
+Effect of aerobic exercise on peak oxygen consumption, ve/vco(2) slope, and health-related quality of life in patients with heart failure with preserved left ventricular ejection fraction: a systematic review and meta-analysis
+
+Effects of exercise interventions on aerobic capacity in patients with heart failure with preserved left ventricular ejection fraction: systematic review and network meta-analysis
+
+Physical exercise modalities for the management of heart failure with preserved ejection fraction: a systematic review and meta-analysis
+
+Impact of cardiac rehabilitation on patients with heart failure with preserved ejection fraction
+
+Effect of endurance training on the determinants of peak exercise oxygen consumption in elderly patients with stable compensated heart failure and preserved ejection fraction
+
+The cochrane collaboration's tool for assessing risk of bias in randomised trials
+
+Measuring inconsistency in meta-analyses
+
+Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
+
+Effect of endurance exercise training on endothelial function and arterial stiffness in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial
+
+Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: a randomized clinical trial
+
+Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial
+
+Effects of semaglutide on symptoms, function, and quality of life in patients with heart failure with preserved ejection fraction and obesity: a prespecified analysis of the step-hfpef trial
+
+A randomised controlled trial of a facilitated home-based rehabilitation intervention in patients with heart failure with preserved ejection fraction and their caregivers: the reach-hfpef pilot study
+
+Characteristics and long-term prognosis of patients with heart failure and mid-range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta-analysis
+
+Effects of exercise training in heart failure with preserved ejection fraction: an updated systematic literature review
+
+Physical activity and coronary heart disease in women: is "no pain, no gain" passé
+
+Characterization of health-related quality of life in heart failure patients with preserved versus low ejection fraction in charm
+
+Baduanjin for ischemic heart failure with mildly reduced/preserved ejection fraction (bear trial): a randomized controlled trial
+
+Does exercise training improve exercise tolerance, quality of life, and echocardiographic parameters in patients with heart failure with preserved ejection fraction? A systematic review and meta-analysis of randomized controlled trials
+
+Association between 6-minute walk test distance and objective variables of functional capacity after exercise training in elderly heart failure patients with preserved ejection fraction: a randomized exercise trial
+
+Walking compared with vigorous exercise for the prevention of cardiovascular events in women
+
+202 1 esc guidelines for the diagnosis and treatment of acute and chronic heart failure
+
+Effect of high-intensity interval training, moderate continuous training, or guideline-based physical activity advice on peak oxygen consumption in patients with heart failure with preserved ejection fraction: a randomized clinical trial
+
+Effects of exercise training on different quality of life dimensions in heart failure with preserved ejection fraction: the ex-dhf-p trial
+
+Prisma 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews
+
+Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials
+
+Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis
+
+Heart failure with preserved ejection fraction in perspective
+
+Effects of sodium-glucose cotransporter 2 inhibitor on vascular endothelial and diastolic function in heart failure with preserved ejection fraction - novel prospective cohort study
+
+Exercise intolerance in heart failure with preserved ejection fraction
+
+Physical activity and coronary heart disease in men: the Harvard Alumni Health Study
+
+High-intensity interval training versus moderate continuous training in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis
+
+Exercise training in heart failure with preserved systolic function: a randomized controlled trial of the effects on cardiac function and functional capacity
+
+Angiotensin receptor neprilysin inhibition in heart failure with preserved ejection fraction: rationale and design of the paragon-hf trial
+
+Exercise type and intensity in relation to coronary heart disease in men
+
+Pathophysiology of exercise intolerance and its treatment with exercise-based cardiac rehabilitation in heart failure with preserved ejection fraction
+
+Sarcopenic obesity and the pathogenesis of exercise intolerance in heart failure with preserved ejection fraction
+
+Heart disease and stroke statistics—2020 update: a report from the american heart association
+
+Effect of finerenone on the kccq in patients with hfmref/hfpef: a prespecified analysis of finearts-hf
+
+Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the charm-preserved trial
+
+Objective
+
+This study aimed to evaluate the effects of exercise training following the American College of Sports Medicine (ACSM) guidelines on exercise capacity, quality of life, and left ventricular function in patients with heart failure with preserved ejection fraction (HFpEF).
+
+Methods
+
+PubMed, Embase, Web of Science, and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing exercise interventions with usual care in patients with HFpEF. Primary outcomes included exercise capacity (6-MWT, Peak VO 2 , quality of life (total score of MLHFQ), LVEF, and diastolic function indicator (E/e’ ratio). The included studies were subgrouped for analysis into a high-adherence group (≥70%) and a low/uncertain-adherence group based on their compliance with the ACSM exercise recommendations.
+
+Results
+
+A total of 19 RCT involving 1490 participants were included in this meta-analysis. Pooled results demonstrated that exercise training compliant with ACSM guidelines significantly improved exercise capacity, including the 6-MWT (SMD = 0.82, 95% CI: 0.34 to 1.30, P = 0.0008) and Peak VO 2 (SMD = 0.63, 95% CI: 0.36 to 0.91, P < 0.00001). The intervention also markedly enhanced patients’ quality of life reflected by the MLHFQ total score (SMD = −0.52, 95% CI: −0.84 to −0.20, P = 0.05). Marginally significant improvements were observed in left ventricular ejection fraction (SMD = 0.19, 95% CI: 0.00 to 0.38, P = 0.05) and E/e’ ratio (SMD = −0.14, 95% CI: −0.29 to 0.00, P = 0.05).Subgroup analyses stratified by adherence to ACSM recommendations (≥70% vs. <70%) showed that the high-adherence group achieved statistically greater improvements in 6-MWT (P = 0.03) and peak VO 2 (P = 0.003). Although the high-adherence group obtained larger effect sizes for MLHFQ scores and LVEF, the between-group differences did not reach statistical significance. No significant intergroup differences were found in other diastolic function indicators.
+
+Conclusion
+
+This study indicates that implementing the ACSM-recommended exercise regimen with high adherence can effectively improve exercise capacity, quality of life, and certain left ventricular function parameters in patients with HFpEF. Stratified analysis by ACSM adherence enriches evidence for individualized HFpEF exercise rehabilitation and guides clinical exercise strategy optimization.
+
+1
+
+Introduction
+
+Heart failure represents the severe manifestation or end-stage of various cardiac diseases. The prevalence of heart failure among adults in developed countries ranges from 1.0% to 2.0% ( 2018 ; Virani et al., 2020 ), and it is continuously increasing ( Dunlay and Roger, 2014 ; Golla et al., 2024 ). Moreover, mortality and rehospitalization rates remain high ( Cheng et al., 2014 ), and heart failure leads to a decline in patients’ quality of life ( Lewis et al., 2007 ). Consequently, heart failure is recognized as a growing public health burden ( Cook et al., 2014 ).Heart failure with preserved ejection fraction (HFpEF) accounts for more than 50% of heart failure cases in patients aged 65 and older ( Gerber et al., 2015 ; Pfeffer et al., 2019 ). The morbidity and mortality rates of HFpEF are comparable to those of heart failure with reduced ejection fraction (HFrEF) ( Edelmann et al., 2011a ; Edelmann et al., 2011b ; Lauritsen et al., 2018 ). A hallmark feature of HFpEF is exercise intolerance, characterized by severe exertional dyspnea and fatigue ( Upadhya et al., 2015 ; Tucker et al., 2020 ).In contrast to the numerous guideline-recommended pharmacological and non-pharmacological treatment options available for HFrEF, effective therapies for improving clinical outcomes in HFpEF have been limited. To date, only the sodium-glucose cotransporter 2 inhibitor empagliflozin ( Sakai and Miura, 2019 ), the glucagon-like peptide-1 receptor agonist semaglutide ( Kosiborod et al., 2024 ), and the non-steroidal mineralocorticoid receptor antagonist finerenone ( Yang et al., 2025 )have demonstrated improvements in clinical outcomes for HFpEF patients. Within this context, non-pharmacological interventions have become a key direction for improving the functional status of HFpEF patients. Among these, exercise intervention has garnered widespread attention due to its low cost, high safety profile, and multifaceted benefits.
+
+Exercise training (ET) has been shown to improve physical performance metrics in HFpEF patients, including peak oxygen uptake (VO 2 peak) and six-minute walk test (6MWT) distance ( Gary et al., 2004 ; Kitzman et al., 2010 ; Smart et al., 2012 ; Kitzman et al., 2013 , Kitzman et al., 2016 ; Donelli Da Silveira et al., 2020 ). In recent years, numerous studies have begun to investigate the effects of different exercise doses and durations on cardiopulmonary reserve function, exercise capacity, and quality of life in HFpEF patients. However, the findings have been inconsistent. For instance, a study by Donelli Da Silveira et al. showed that both high-intensity interval training and moderate-intensity continuous training groups improved patients’ peak VO 2 and quality of life scores ( Donelli Da Silveira et al., 2020 ). In contrast, a study by Mueller et al. demonstrated no statistically significant difference in the change of peak VO 2 between high-intensity interval training and moderate-intensity continuous training groups ( Mueller et al., 2021 ). Therefore, the impact of exercise intensity on HFpEF patients warrants further investigation.
+
+The American College of Sports Medicine (ACSM), a leading global authority in sports medicine, has issued Guidelines for Exercise Prescription, which provide standardized exercise prescriptions for patients with cardiovascular diseases. These prescriptions include recommendations for aerobic exercise, resistance exercise, and flexibility exercise, detailing the frequency, intensity, time, and type for each exercise modality ( Garber et al., 2011 ).
+
+Consequently, we conducted a systematic review of existing studies to investigate whether exercise therapy adhering to ACSM recommendations yields superior outcomes compared to interventions with low or uncertain adherence. The findings of this study aim to address the current evidence gap in the field of exercise intervention for HFpEF, provide an evidence-based foundation for the clinical application of ACSM exercise recommendations in HFpEF patients, and offer data support for developing individualized exercise rehabilitation guidelines for HFpEF patients.
+
+ 2
+
+Materials and methods
+
+Data sources, search strategies, data acquisition, inclusion and exclusion criteria, outcome measures, quality assessment, and statistical methods in this report were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines ( Page et al., 2021 ). The protocol for this systematic review and meta-analysis has been registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY: 202630070). The data supporting this article can be found in the article and its online Supplementary Material .
+
+ 2.1
+
+Search strategy
+
+Four databases (PubMed, EMBASE, Web of Science, and Cochrane Library) were searched from their inception to November 2025. The search strategy was constructed around the PICOS tool (P) population: patients with preserved ejection fraction; (I) intervention: exercises; (C) control group: no exercise or usual care group; (O) outcomes: 6-minute walk test(6-MWT), peak oxygen consumption (peakVO 2) , total score of the Minnesota Living with Heart Failure Questionnaire (MLWHQ), left ventricular ejection fraction (LVEF), the ratio of mitral early diastolic inflow velocity to mitral annular early diastolic velocity (E/e’ ratio), early diastolic transmitral flow velocity/Atrial systolic transmitral flow velocity ratio (E/A ratio), ventilation/Carbon Dioxide production slope (VE/VCO 2 slope) and Deceleration time (DT); (S) study type: randomized controlled trial (RCT). References and related literature listed in the identified studies were also evaluated to broaden the search. The detailed retrieval strategy is shown in Table 1 (using PubMed as an example). Table 1
+
+Search strategy on PubMed. Search Query #1 "Heart Failure, Diastolic"[Mesh] #2 "heart failure diastolic"[Title/Abstract] OR "diastolic heart failures"[Title/Abstract] OR "diastolic heart failure"[Title/Abstract] OR "heart failure preserved ejection fraction"[Title/Abstract] OR "heart failure normal ejection fraction"[Title/Abstract] #3 #1 OR #2 #4 "Exercise"[MeSH Terms] #5 "Exercise"[Title/Abstract] OR "Walking"[Title/Abstract] OR "nordic walking"[Title/Abstract] OR "Exercises"[Title/Abstract] OR "physical activity"[Title/Abstract] OR "activities physical"[Title/Abstract] OR "activity physical"[Title/Abstract] OR "physical activities"[Title/Abstract] OR "exercise physical"[Title/Abstract] OR "exercises physical"[Title/Abstract] OR "physical exercise"[Title/Abstract] OR "physical exercises"[Title/Abstract] OR "exercise aerobic"[Title/Abstract] OR "aerobic exercise"[Title/Abstract] OR "aerobic exercises"[Title/Abstract] OR "exercises aerobic"[Title/Abstract] OR "exercise training"[Title/Abstract] OR "exercise trainings"[Title/Abstract] OR "training exercise"[Title/Abstract] OR (("education"[MeSH Subheading] OR "education"[All Fields] OR "Training"[All Fields] OR "education"[MeSH Terms] OR "train"[All Fields] OR "train s"[All Fields] OR "trained"[All Fields] OR "training s"[All Fields] OR "Trainings"[All Fields] OR "trains"[All Fields]) AND "Exercise"[Title/Abstract]) OR "training resistance"[Title/Abstract] OR "strength training"[Title/Abstract] OR "training strength"[Title/Abstract] OR "Balance"[Title/Abstract] OR "Ambulation"[Title/Abstract] OR "stair climbing"[Title/Abstract] OR "walking nordic"[Title/Abstract] OR "pole walking"[Title/Abstract] OR "walking pole"[Title/Abstract] #6 #5 OR #4 #7 #6 AND #3
+
+ 2.2
+
+Inclusion criteria and exclusion criteria
+
+ 2.2.1
+
+Inclusion criteria
+
+The following criteria were used for inclusion: (a) Published RCTs; (b) Study participants were adult patients with HFpEF, with LVEF ≥ 45%; (c) The intervention for the experimental group was exercise, including aerobic or endurance exercise, resistance training, high-intensity interval training (HIIT), flexibility training, or a combination of the above; (d) The control group received no treatment or received treatment unrelated to exercise; (e) All participants did not receive specific pharmacotherapy; (f) The outcome measures in the study included one or more of the following: 6-MWT, peakVO 2 , total score of MLWHF, LVEF, E/e’ ratio, E/A ratio, VE/VCO 2 slope and DT.
+
+ 2.2.2
+
+Exclusion criteria
+
+Studies were excluded if they met the following criteria: (a) Studies published as reviews or conference abstracts; (b) The control group received exercise as an intervention; (c) Study participants took specific medications during the exercise intervention; (d) Intervention duration of less than 4 weeks; (e) Patients had acute heart failure; (f) Patients were minors; (g) Patients had heart failure with reduced ejection fraction (HFrEF).
+
+ 2.3
+
+Data screening and extraction
+
+Two authors (J.S. and R.S.) independently performed the literature screening and data extraction. After initial title/abstract screening, potentially eligible studies underwent full-text review. Any disagreements were resolved by consensus with a third author (H.G.). There were no restrictions on age, gender, publication date, or language. Data on study characteristics, participants, exercise interventions, and outcomes were extracted into a predefined spreadsheet.
+
+Subsequently, two other authors (X.G. and J.C.) independently evaluated the exercise intervention dose in each study for adherence to ACSM recommendations for HFpEF ( Table 2 ). Each exercise parameter (frequency, intensity, etc.) was scored (2=meets standard, 1=uncertain, 0=does not meet). Discrepancies were resolved by a third author (F.L.). The overall adherence proportion was calculated. Studies with ≥70% adherence were classified as “high adherence”; those with <70% were “low/uncertain adherence.” Table 2
+
+ACSM exercise recommendations for heart failure patients. Exercise dose Cardiorespiratory exercise Resistance exercise Flexibility exercise Frequency 3–5 days per week 2–3 days per week 2–3 days per week Intensity/workload 40-59%HRR; 57-76%HRmax; 37-63%peakVO2 RPE of 12-14 on a 6–20 scale 40%–50% 1RM RPE of 11-13 on a 6–20 scale Stretch until you feel your muscles being pulled tight or a slight discomfort Duration Continuous or cumulative 30 min 1-2 group, 8-12repetitions Keep static pulling for 10–30 s; repeat 2–4 time
+
+HRR, Reserve heart rate; peakVO 2 , peak oxygen uptake; HRmax, Maximum heart rate; RPE, Rating of perceived exertion; 1RM, Maximum power of 1 repetition.
+
+ 2.4
+
+Risk of bias of individual studies
+
+Two researchers (J.H. and G.X.) assessed the risk of bias independently. The bias of the studies was evaluated using Cochrane Handbook version 5.1.0.The following seven aspects were considered: (1) random sequence generation (selection bias), (2) allocation concealment (selection bias), (3) blinding of participants and personnel (performance bias), (4) blinding of outcome assessment (detection bias), (5) incomplete outcome data (attrition bias), (6) selective reporting (reporting bias), and (7) other sources of bias. Trials were categorized into three levels of risk of bias by the number of components for which high risk of bias potentially existed: high risk (five or more), moderate risk (three or four), and low risk (two or less) ( Higgins et al., 2011 ).
+
+ 2.5
+
+Data analysis
+
+RevMan 5.4 software was used for meta-analysis. The effect of the exercise recommended by ACSM on patients with HFpEF was evaluated by standardized mean difference (SMD) and 95% confidence interval (CI).Between-study heterogeneity was assessed via the I 2 statistic, following Higgins et al. (2003) : low (0%–25%), moderate (25%–50%), substantial (50%–75%), and considerable heterogeneity (75%–100%) ( Higgins et al., 2003 ). We used a random-effects (RE) model for I 2 ≥ 50% and a fixed-effects (FE) model for I 2 < 50%. The 95% prediction interval (PI) was additionally calculated using Stata18.0 software based on the method proposed by Higgins et al. to evaluate the variation of treatment effects across future individual studies. Heterogeneity across studies was further investigated by performing sensitivity analyses. A p-value<0.05 was considered to be associated with the occurrence of the outcome.
+
+ 3
+
+Results
+
+ 3.1
+
+Study identification and selection
+
+A total of 7933 articles were retrieved from electronic databases, with an additional 3 articles obtained through manual retrieval. After removing duplicate records, the titles and abstracts of the remaining 5441 articles were screened, and 4582 articles were excluded once more. The remaining 859 articles were then fully reviewed (in full text), and another 839 articles were excluded for the following reasons: being reviews or systematic reviews, having incomplete data, being conference papers, involving intervention measures unrelated to exercise, being non-randomized controlled trials (non-RCTs), focusing on patients with heart failure with reduced ejection fraction (HFrEF), having control groups that received exercise interventions, and lacking the required outcome measures, etc. This final screening process resulted in 19 articles being included in this study ( Figure 1 ). Figure 1
+
+Flow diagram of literature selection. Flowchart illustrating a systematic review selection process: 7,933 records identified by database search and 3 by other sources, 2,495 duplicates removed, 5,441 records screened, 4,582 excluded, 859 full-text articles assessed, and 19 studies included. Reasons for exclusion are listed in detail. Identification, screening, eligibility, and included phases are labeled on the left.
+
+ 3.2
+
+Quality assessment of the included studies
+
+These 19 articles included 20 comparative studies, with a total of 1490 participants—754 in the experimental group and 736 in the control group ( Gary et al., 2004 ; Gary and Lee, 2007 ; Andryukhin et al., 2010 ; Kitzman et al., 2010 ; Edelmann et al., 2011a ; Alves et al., 2012 ; Haykowsky et al., 2012 ; Smart et al., 2012 ; Kitzman et al., 2013 ; Nolte et al., 2015 ; Fu et al., 2016 ; Maldonado-Martín et al., 2017 ; Lang et al., 2018 ; Brubaker et al., 2020 ; Hassanein et al., 2021 ; Mueller et al., 2021 ; Alonso et al., 2022 ; Li et al., 2024 ; Edelmann et al., 2025 ). One of the studies involved two exercise intervention groups. These studies were conducted in multiple countries, including Spain, the United States, Germany, Portugal, China, Egypt, Australia, Japan, the UK, and Russia ( Table 3 ). Table 3
+
+Overview of general characteristics of the study and participants. Author Country Year Population Age mean (SD) Total/male/female Total/C/T Intervention Duration weeks Control Outcome Sara Spain 2020 HFpEF LVEF≥50% NR 47/6/41 47/24/23 cycling and walking 16 CON 6-MWT peakVO 2 Gary US 2004 LVEF≥45% T:67(11) C:69(11) 32/0/32 32/16/16 Walking 12 CON 6-MWT Total score of MLHFQ Gary US 2007 HFpEF, LVEF 56 ± 7% 68(12) 23/0/23 23/10/13 Walking 12 CON 6-MWT Total score of MLHFQ Alves Portugal 2012 HFpEF, LVEF≥55% 62.9(10.2) 31/22/9 31/11/20 aerobic exercise: on treadmill or bicycle ergometer 24 CON LVEF E/A radio DT Tieh-Cheng China 2015 HFpEF, LVEF≥50% T:63.1(2.6) C:60.5(2.7) T:30/18/12 C:30/20/10 60/30/30 bicycle ergometer 12 CON LVEF E/e’ radio E/A radio Total score of MLHFQ VE/VCO 2 slope Mueller Germany 2021 HFpEF, LVEF≥50% HIIT:70(7) MCT:70(8) C:69(10) HIIT:58/17/41 MCT:58/23/35 C:60/19/41 HIIT:118/58/60 MCT:118/58/60 1.High-intensity interval training 2.moderate continuous training 52 CON peakVO 2 VE/VCO 2 slope E/e’ radio LAVI Hassanein Egypt 2021 HFpEF, LVEF≥50% T:57.47(6.1) C:58.5(6.31) T:30/11/19 C:30/13/17 60/30/30 treadmill 12 CON E/A radio E/e’ radio LVEF 6-MWT Total score of MLHFQ Kitzman US 2010 HFpEF, LVEF≥50% T:70(6) C:69(5) T:26/6/20 C:27/7/20 53/27/26 walking on a track/cycling on a Schwinn Airdyne 16 CON VE/VCO 2 slope 6-MWT Total score of MLHFQ Kitzman US 2013 HFpEF, LVEF≥50% T:70(7) C:70(7) T:32/9/23 C:31/6/25 63/31/32 walking on a track/cycling on a Schwinn Airdyne 16 CON PeakVO 2 VE/VCO 2 slope 6-MWT Smart Australia 2012 HFpEF, LVEF>45% T:67(5.8) C:61.9(6.9) T:12/7/5 C:13/6/7 25/13/12 bicycle ergometer 16 CON Peak VO 2 VE/VCO 2 slope Peter US 2021 HFpEF, LVEF≥50% T:70.3(6.7) C:69.2(6.2) T:58/14/44 C:58/8/50 116/58/58 walking on an indoor track/Schwinn Airdyne cycle ergometry 16 CON PeakVO2 6-MWT Nolte Germany 2014 HFpEF, LVEF≥50% T:64(8) C:65(6) T:44/20/24 C:20/8/12 64/20/44 aerobic endurance training (cycling) Resistance training 12 CON E/A radio DT VE/VCO 2 slope Edelmann Germany 2012 HFpEF, LVEF≥50% T:64(8) C:65(6) T:44/20/24 C:20/8/12 64/20/44 aerobic endurance training (cycling) Resistance training 12 CON LVEF 6-MWT Total score of MLHFQ Edelman Germany 2025 HFpEF, LVEF≥50% T:69.1 (7.4) C:70.1 (7.1) T:161/61/100 C:161/69/92 322/161/161 bicycle ergometer resistance training 52 CON peakVO 2 E/e’ radio Haykowsky Canada 2012 HFpEF, LVEF≥50% T:70(6) C:68(5) T:22/4/18 C:18/17/1 40/18/22 walking on a track/cycling on a Schwinn Airdyne 12 CON peakVO 2 Jingen China 2024 HFpEF, LVEF≥50% T:60.33 (8.78) C:60.8(9.7) T:60/50/10 C:60/47/13 120/60/60 Baduanjin 12 CON peakVO 2 6-MWT LVEF Total score of MLHFQ Chim UK 2018 HFpEF, LVEF≥45% T:71.8(9.9) C:76(6.6) T:25/9/16 C:25/14/11 50/25/25 chair-based exercise Progressive walking 24 CON Total score of MLHFQ Andryukhin Russia 2010 HFpEF, LVEF>50% T:68 (8.15) C:68 (11.11) T:44/12/32 C:41/14/27 85/41/44 muscles sitting or standing positions/walking 52 CON Total score of MLHFQ 6-MWT Windy Russia 2022 HFpEF, LVEF≥50% T:63.3(9.4) C:65.6(9.3) T:25/14/11 C:34/18/16 59/25/34 aerobic exercise/resistance training 72 CON 6-MWT
+
+The interventions in the experimental group included various exercise modalities, such as cycling, walking, resistance training, aerobic exercise, high-intensity interval training (HIIT), treadmill exercise, Baduanjin (a traditional Chinese Qigong exercise), and chair-based exercise. The duration of the interventions ranged from 12 weeks to 72 weeks. Participants in the control group did not receive any exercise intervention. According to the standards of the American College of Sports Medicine (ACSM), among the 20 comparative studies, 20addressed aerobic exercise dose, 5 addressed resistance exercise dose, and 3 addressed flexibility exercise dose. Fourteen demonstrated an adherence rate exceeding 70% to the American College of Sports Medicine (ACSM) recommendations, while six studies had an adherence rate below 70% (see Table 4 ). Table 4
+
+Assessment of ACSM adherence. Author year Aerobic exercise Resistance exercise Flexibility exercise ACSM adherence Frequency/ adherence Intensity/ adherence Duration/ adherence Frequency/ adherence Intensity/ adherence Repetitions/ adherence Sets/ adherence Frequency/ adherence Intensity/ adherence Duration/ adherence Points Percent Sara 2020 3d/w J 50-70%peak VO2 K 60 min J 3times/d J NR K 10min K 9/12 75% Gary 2004 3d/w J 40-60%THR K 30min J 5/6 83% Gary 2007 3d/w J 40-60%THR K 30min J 5/6 83% Alves 2012 3 times/w J 70%–75%HRmax J 35-55min J 3times/d J NR K 10min K 10/12 83% Tieh-Cheng2015 3 times/w J 30-80%HRR 30-80%peakVO2 K 33min J 5/6 83% Mueller (HIIT) 2021 3times/w J HIIT: 80-90%HRR, RPE 15-17 L 38min J 4/6 67% Mueller (MCT) 2021 5times/w J MCT: 35-50%HRR, RPE 11-13 J 40min J 6/6 100% Kitzman 2013 3times/w J 40-50%HRR, gradually increase to 70%HRR K 30-60min J 5/6 83% Kitzman 2010 3times/w J 40-70%HRR K 30-60min J 5/6 83% Smart2012 3times/w J 60-70%peak VO2 L 30min J 4/6 67% Peter2021 3times/w J 40-60%HRR K 60min J 3times/d J NR K 10min K 9/12 75% Edelmann 2025 2-3times/w K 50-70%peak VO2 K 30-60min J 2-3times/w J 60% 1RM L 12-15reps K 1-2Sets J 9/14 64% Edelmann 2012 2-3times/w K 50-70%peak VO2 K 30-60min J 2-3times/w J 60% -65%1RM L 12-15reps K 1-2Sets J 9/14 64% Nolte2014 2-3times/w K 50-70%peak VO2 K 20-40min K 2times/w J 60%- 65% 1RM L 15reps L 1Sets J 7/14 50% Jingen2024 3times/w J NR K 45min J 5/6 83% Haykowsky 2012 3times/w J 40%HRR, gradually increase to 70%HRR K 60min J 5/6 83% Chim2018 2-3times/w K 70% of the mean MET score K 13-40min K 7times/w L NR K 10-15reps K 2SETS J 7/14 50% Andryukhin 2010 4ties/w J NR K 30min J 5/6 83% Windy2022 2-3imes K 40-80%HRR; More than 120min/week K 30min J 2-3times J NR K 10-15reps K 1SETS J 10/14 71% Hassanein 2021 3times/w J 40-75%HRR K 60min J 5/6 83%
+
+ 4
+
+Methodological quality assessment
+
+A risk of bias assessment was conducted for all included studies. All 19 studies were randomized controlled trials. Seventeen studies reported the method of random sequence generation, and 14 articles described their allocation concealment. Due to the inherent difficulty in implementing double-blinding for exercise interventions, 4 articles reported using single-blind methods, while the blinding status was unclear in 15 articles. Outcome assessor blinding was implemented in 17studies to reduce measurement bias. The risk of bias due to incomplete outcome data was rated as high in 4 studies (attrition rate >15% or imbalanced attrition between groups), and the risk of selective reporting was unclear in 5 studies. Ten studies presented an unclear risk of other biases due to reasons such as small sample size or baseline imbalances. Overall, 10 studies were rated as having a low risk of bias, 7 as having a moderate risk, and 2 as having a high risk of bias, as shown in Figures 2A, B . Figure 2
+
+ (A) Risk of bias graph based on the Cochrane risk-of-bias tool. Seven bias domains were assessed: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. Bars represent the percentage of included trials judged as low risk, unclear risk, or high risk of bias for each domain. (B) Risk of bias summary graph based on the Cochrane risk-of-bias tool. Horizontally, it lists 7 criteria for bias assessment: random sequence generation, group concealment, blinding of subjects and researchers, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases; vertically, it shows 19 included studies (divided into 20 groups), presenting intuitively the individual risk assessment results of each study in each bias dimension. Bar chart and matrix summarize risk of bias assessments in various studies. The bar chart shows most domains have a majority with low risk (green), while incomplete outcome data and other bias have higher unclear (yellow) and high risk (red) proportions. The matrix below details risk of bias judgments per study and domain, using green plus for low, yellow question mark for unclear, and red minus for high risk.
+
+ 5
+
+Meta-analysis
+
+ 5.1
+
+Analysis of 6-MWT
+
+This meta-analysis included 11 studies involving 684 patients with HFpEF, all reporting the 6-MWT as the outcome measure. A random-effects model was applied due to substantial between-study heterogeneity (I 2 = 90%). The overall pooled SMD was 0.81 (95% CI: 0.27–1.35), indicating a beneficial effect of exercise training on 6-MWT performance. The 95% prediction interval calculated using Higgins et al.’s method was −1.181 to 2.797 (see Supplementary Material S1 ).Subgroup analysis based on adherence to ACSM exercise guidelines showed: High-compliance subgroup: pooled SMD = 0.89 (95% CI: 0.33–1.45);Low/uncertain-compliance subgroup: pooled SMD = 0.01 (95% CI: −0.52–0.54).The difference between the two subgroups was statistically significant (P = 0.03, I 2 = 79.8%) ( Figure 3 ).These findings suggest that exercise training improves functional capacity in patients with HFpEF, and high adherence to standardized ACSM exercise regimens yields greater clinical benefits. Figure 3
+
+Forest plot of SMD for 6-minute walk test (6-MWT) stratified by intervention compliance (random-effects model). Intervention significantly improved 6-MWT performance only in the high-compliance subgroup; subgroup difference was statistically significant, with high interstudy heterogeneity (I 2 =90%). Forest plot summarizing a meta-analysis of standard mean differences in studies split by high compliance and low or uncertain compliance groups. High compliance studies show a pooled effect estimate favoring the experimental group, while low compliance shows negligible effect. Confidence intervals and heterogeneity statistics are displayed for each subgroup and overall analysis.
+
+ 5.2
+
+Analysis of peak VO 2
+
+This meta-analysis included 11 studies, involving a total of 1009 patients with HFpEF, with peak VO 2 as the outcome measure. Due to significant heterogeneity among the studies (I 2 = 81%), and the analysis was conducted using a random effects model. The overall pooled SMD was 0.61 (95% CI: 0.29 - 0.92), suggesting that exercise training has a positive effect on improving peak VO 2 . The 95% prediction interval calculated using Higgins et al.’s method was −0.547 to 1.762 (see Supplementary Material S2 ). Based on the ACSM exercise adherence, a subgroup analysis was conducted. The results showed that for the high adherence subgroup, the SMD was 0.79, (95% CI: 0.37 - 1.21, I 2 = 82%), the low/uncertain adherence sub-group combined with an SMD of 0.21 (95% CI: 0.03 - 0.40, I 2 = 0%), indicating that exercise benefits were observed in both levels of compliance. However, the effect size was significantly larger in the high-compliance subgroup, and the difference between the two groups was statistically significant (P = 0.01, I 2 = 83.6%) ( Figure 4 ).The above results indicate that exercise training can increase the peak VO 2 of patients with HFpEF, and the benefits are more significant in patients who strictly follow the ACSM standard exercise protocol. Figure 4
+
+Forest plot of SMD for peak oxygen consumption (peak VO 2 ) stratified by intervention compliance (random-effects model). Intervention significantly elevated peak VO 2 in both subgroups; efficacy was stronger in high-compliance group, with significant subgroup difference (P=0.01). Overall high interstudy heterogeneity (I 2 =81%). Forest plot illustrating meta-analysis of studies grouped by high and low or uncertain compliance, showing standardized mean differences with 95 percent confidence intervals. High compliance group favors experimental with pooled effect size of zero point seven nine. Low compliance group has a smaller effect size of zero point two one. Overall pooled effect size is zero point six one. Subgroup difference is significant.
+
+ 5.3
+
+Analysis of total score of MLHFQ
+
+This meta-analysis included 12 studies involving 679 patients with HFpEF, all reporting MLHFQ score as the outcome measure. A random-effects model was applied due to substantial between-study heterogeneity (I 2 = 77%). The overall pooled SMD was -0.56 (95% CI: -0.90 to -0.23), indicating a beneficial effect of exercise training on MLHFQ score. The 95% prediction interval calculated using Higgins et al.’s method was -1.786 to 0.664 (see Supplementary Material S3 ).Subgroup analysis based on ACSM exercise adherence showed: High-compliance subgroup: pooled SMD = -0.66 (95% CI: -1.08 to -0.25, I 2 = 81%); Low/uncertain-compliance subgroup: pooled SMD = -0.26 (95% CI: -0.62 to 0.09, I 2 = 0%). The difference between the two subgroups was not statistically significant (P = 0.15, I 2 = 51.6%) ( Figure 5 ).These findings suggest that exercise training improves quality of life in patients with HFpEF, with a larger magnitude of improvement observed in those with high adherence to standardized ACSM exercise regimens. Figure 5
+
+Forest plot of SMD for the total score of the Minnesota Living with Heart Failure Questionnaire (MLHFQ total score) stratified by intervention compliance (random-effects model). Intervention significantly reduced MLHFQ scores only in the high-compliance subgroup; no significant subgroup difference was observed, with overall moderate-to-high interstudy heterogeneity (I 2 =77%). Forest plot from a meta-analysis comparing experimental versus control groups, showing standardized mean differences and confidence intervals for studies in high and low compliance subgroups, with summary effect sizes indicated by black diamonds and heterogeneity statistics reported below each group.
+
+ 5.4
+
+Analysis of LVEF
+
+This meta-analysis included 7 studies involving 447 patients with HFpEF, all reporting LVEF as the outcome measure. A fixed-effects model was applied due to low between-study heterogeneity (I 2 = 0%). The overall pooled SMD was 0.19 (95% CI: 0.00 to 0.38), indicating a small but statistically significant improvement in LVEF with exercise training. The 95% prediction interval calculated using Higgins et al.’s method was -0.039 to 0.426 (see Supplementary Material S4 ). Subgroup analysis based on ACSM exercise adherence showed: High-compliance subgroup: pooled SMD = 0.24 (95% CI: 0.03 to 0.45, I 2 = 0%); Low/uncertain-compliance subgroup: pooled SMD = -0.01 (95% CI: -0.44 to 0.43, I 2 = 0%). The difference between the two subgroups was not statistically significant (P = 0.33, I 2 = 0%) ( Figure 6 ).These findings suggest that while exercise training may produce a small improvement in LVEF in patients with HFpEF, this effect appears to be limited to those with high adherence to standardized ACSM exercise regimens. Figure 6
+
+Forest plot of SMD for left ventricular ejection fraction (LVEF) stratified by intervention compliance (fixed-effects model). Intervention showed significant positive effect only in the high-compliance subgroup; no significant inter-subgroup difference was found, and no interstudy heterogeneity existed (I 2 =0%). Forest plot displaying standardized mean differences between experimental and control groups for studies grouped by high and low compliance. High compliance subgroup shows a significant positive overall effect, while low compliance group does not. Confidence intervals, heterogeneity statistics, and subgroup totals are included, with overall effect favoring the experimental group.
+
+ 5.5
+
+Analysis of E/e’ radio
+
+This meta-analysis included 6 studies involving a total of 674 patients with HFpEF. All studies used the ratio of E/e’ radio as the outcome measure. Due to the low heterogeneity among the studies (I² = 30%), a fixed-effect model was used. The overall pooled SMD was -0.17 (95% CI: -0.32 to -0.02), suggesting that exercise training could slightly reduce the E/e’ radio level. The 95% prediction interval calculated using Higgins et al.’s method was -0.384 to 0.043 (see Supplementary Material S5 ). The subgroup analysis based on the exercise adherence classification of the ACSM showed: High adherence subgroup: pooled SMD = -0.22 (95% CI: -0.48 to -0.33, I² = 45%); Low/uncertain adherence subgroup: pooled SMD = -0.22 (95% CI: -0.15 to -0.33, I² = 40%). There was no statistically significant difference between the two groups (P = 0.67, I 2 = 0%) ( Figure 7 ). The above results indicate that exercise training can slightly improve the E/e’ radio level in patients with HFpEF, but the improvement is limited, and the benefits do not show significant differences due to variations in exercise adherence. Figure 7
+
+Forest plot of SMD for the ratio of mitral early diastolic inflow velocity to mitral annular early diastolic velocity(E/e’ radio) stratified by intervention compliance (fixed-effects model). Neither subgroup exhibited significant intergroup difference; overall pooled analysis indicated a mild significant benefit of intervention, with no statistical discrepancy between subgroups and low interstudy heterogeneity (I 2 =30%). Forest plot showing standardized mean differences and confidence intervals for multiple studies comparing experimental and control groups, divided into high and low compliance subgroups, with pooled estimates shown as black diamonds along a horizontal axis.
+
+ 5.6
+
+Analysis of E/A radio
+
+This meta-analysis included 7 randomized controlled trials involving 338 patients with HFpEF. The primary outcome measure was the E/A ratio. Given the low between-study heterogeneity (I 2 = 0%), a fixed-effects model was adopted for pooled analysis. The overall SMD was -0.09 (95% CI: -0.31 to 0.13), indicating no significant effect of exercise training on the E/A ratio. The 95% prediction interval calculated using Higgins et al.’s method was -0.370 to 0.192 (see Supplementary Material S6 ). Subgroup analysis stratified by adherence to ACSM exercise guidelines yielded the following results: High-compliance subgroup: pooled SMD = -0.04 (95% CI: -0.29 to 0.21, I 2 = 0%); Low/uncertain-compliance subgroup: pooled SMD = -0.24 (95% CI: -0.68 to 0.20, I 2 = 0%). No statistically significant difference was observed between the two subgroups (P = 0.45, I 2 = 0%). ( Figure 8 ). Collectively, these findings suggest that exercise training does not appear to induce a meaningful change in the E/A ratio among patients with HFpEF, regardless of adherence to standardized ACSM exercise regimens. Figure 8
+
+Forest plot of SMD for early diastolic transmitral flow velocity / Atrial systolic transmitral flow velocity ratio(E/A radio) stratified by intervention compliance (fixed-effects model). No significant intergroup difference was observed in either subgroup or overall pooled analysis; no statistical discrepancy existed between subgroups, and no interstudy heterogeneity existed (I 2 =0%). Forest plot comparing standardized mean differences between experimental and control groups in studies grouped by high and low or uncertain compliance, with results showing no significant overall effect or subgroup differences, and confidence intervals crossing zero.
+
+ 5.7
+
+Analysis of VE/VCO 2 slope
+
+This meta-analysis included 7 randomized controlled trials involving 456 patients with HFpEF, all reporting the VE/VCO 2 slope as the outcome measure. A random-effects model was applied due to substantial between-study heterogeneity (I 2 = 72%). The overall pooled SMD was -0.07 (95% CI: -0.44 to 0.30), indicating no significant effect of exercise training on the VE/VCO 2 slope. The 95% prediction interval calculated using Higgins et al.’s method was -1.371 to 1.215 (see Supplementary Material S7 ).Subgroup analysis stratified by adherence to ACSM exercise guidelines yielded the following results: High-compliance subgroup: pooled SMD = -0.08 (95% CI: -0.62 to 0.47, I 2 = 79%); Low/uncertain-compliance subgroup: pooled SMD = -0.07 (95% CI: -0.67 to 0.53, I 2 = 71%). No statistically significant difference was observed between the two subgroups (P = 0.98, I 2 = 0%)( Figure 9 ). Collectively, these findings suggest that exercise training does not appear to induce a meaningful change in the VE/VCO 2 slope among patients with HFpEF, regardless of adherence to standardized ACSM exercise regimens. Figure 9
+
+Forest plot of SMD for ventilation / Carbon Dioxide production slope(VE/VCO2 slope) stratified by intervention compliance (random-effects model). No significant intergroup difference was found in two subgroups and overall pooled analysis; no difference existed between subgroups, with moderate-to-high interstudy heterogeneity (I 2 =72%). Forest plot graphic comparing high and low compliance groups from multiple studies, showing standardized mean differences and confidence intervals between experimental and control groups, with overall findings favoring neither group significantly.
+
+ 5.8
+
+Analysis of deceleration time
+
+This meta-analysis included 6 RCT involving 278 patients with HFpEF, all reporting DT as the outcome measure. Due to the low heterogeneity among the studies (I 2 = 0%), a fixed-effect model was used. The overall pooled SMD was 0.08 (95% CI: -0.16 to 0.32), indicating no significant effect of exercise training on the DT. The 95% prediction interval calculated using Higgins et al.’s method was -0.256 to 0.417 (see Supplementary Material S8 ). Subgroup analysis stratified by adherence to ACSM exercise guidelines yielded the following results: High-compliance subgroup: pooled SMD = 0.05 (95% CI: -0.24 to 0.34, I 2 = 0%); Low/uncertain-compliance subgroup: pooled SMD = 0.14 (95% CI: -0.30 to 0.59, I 2 = 61%). No statistically significant difference was observed between the two subgroups (P = 0.73 I 2 = 0%) ( Figure 10 ). Collectively, these findings suggest that exercise training does not appear to induce a meaningful change in the DT among patients with HFpEF, regardless of adherence to standardized ACSM exercise regimens. Figure 10
+
+Forest plot of SMD for deceleration time(DT) stratified by intervention compliance (fixed-effects model). No significant intergroup difference was detected in both subgroups and overall pooled analysis; subgroup difference was non-significant, and overall interstudy heterogeneity was zero (I 2 =0%). Forest plot comparing experimental and control groups for studies in high compliance and low or uncertain compliance categories, displaying standard mean differences, confidence intervals, and heterogeneity statistics for each subgroup and the overall meta-analysis.
+
+ 6
+
+Publication bias, sensitivity analysis and GRADE assessment
+
+We evaluated the publication bias through funnel plots ( Figure 11 ). These plots show approximate symmetry, indicating no significant publication bias. Through sensitivity analysis by eliminating one by one, we found that no single literature had a significant impact on the overall structure, suggesting that the overall structure is stable. We further applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework to assess the certainty of evidence for all outcomes. Since all included studies were RCTs, the initial evidence certainty was set as High. Five key domains were assessed: risk of bias, inconsistency, indirectness, imprecision, and publication bias. Collectively, the included RCTs did not have serious methodological bias. Blinding of participants and researchers was not fully implemented due to the inherent characteristics of exercise interventions, which was rated as unclear risk; nevertheless, such limitations were not regarded as critical flaws, so no downgrade was applied for the risk of bias domain. Additionally, no indirectness was identified across all analyses. The GRADE scores for each outcome are shown in Table 5 . Figure 11
+
+Funnel plots assessing publication bias across all outcomes. The plots exhibited approximate symmetry, suggesting no substantial publication bias. (A) 6-MWT; (B) peak VO 2 ; (C) total MLHFQ score; (D) LVEF; (E) E/e′ ratio; (F) E/A ratio; (G) VE/VCO 2 slope; (H) deceleration time. SMD, standardized mean difference; SE, standard error. Panel of eight funnel plots labeled A through H illustrate publication bias assessment for subgroups of high compliance and low or uncertain compliance groups in a meta-analysis. Each plot shows standard error versus standardized mean difference, with open circles representing high compliance and red diamonds for low or uncertain compliance. Symmetry and data distribution vary across panels. Blue dashed lines indicate confidence intervals, and all plots include a common legend specifying subgroup symbols. Table 5
+
+GRADE Quality assessment of outcomes. Outcome indicator Pooled effect size (SMD, 95% CI) P value Heterogeneity (I2) Initial GRADE grade Reasons for downgrade Final GRADE grade 6-MWT 0.81(0.27, 1.35) 0.003 90% High Severe between-study heterogeneity Moderate Peak VO2 0.61 (0.29, 0.92) 0.0002 81% High Severe between-study heterogeneity Moderate MLHFQ score −0.56 (−0.90, −0.23) 0.001 77% High Severe between-study heterogeneity Moderate LVEF 0.19 (0.00, 0.38) 0.05 0% High Marginal statistical significance with insufficient precision Moderate E/e’ ratio −0.17 (−0.32, 0.02) 0.03 30% High Marginal statistical significance with insufficient precision Moderate E/A ratio −0.09 (−0.31, 0.13) >0.05 0% High No statistical significance Moderate VE/VCO2 slope −0.07 (−0.44, 0.30) >0.05 72% High ① Severe between-study heterogeneity ② No statistical significance Low DT 0.08 (−0.16, 0.32) >0.05 0% High No statistical significance Moderate
+
+GRADE certainty: High, further research is very unlikely to change our confidence; Moderate, further research may change our confidence; Low, further research is very likely to change our confidence. For the 6-MWT, Peak VO 2 , and total score of the MLHFQ, substantial between-study heterogeneity led to a one-level downgrade, with the final evidence certainty rated as Moderate. For LVEF, E/e’ ratio, E/A ratio and deceleration time (DT), heterogeneity was low to mild. These outcomes showed marginal or non-significant statistical results (classified as imprecision), one-level downgrade was conducted, and the final certainty was also Moderate. Differently, the VE/VCO 2 slope was downgraded by two levels on account of both substantial heterogeneity and non-significant pooled results, and its final evidence certainty was rated as Low.
+
+ 7
+
+Discussion
+
+This meta-analysis reviewed19 RCTs involving 1490 participants, including 754 in the experimental group and 736 in the control group. This study is stratify based on the ACSM exercise prescription compliance and explore the impact of following the ACSM exercise intervention on exercise capacity, quality of life, and left ventricular function in patients with HFpEF. The results showed that the exercise intervention following the ACSM protocol could significantly improve the exercise capacity (Peak VO 2 , 6-MWT) and quality of life (total score of MLHFQ) of patients, and showed a marginally significant positive trend in LVEF and diastolic function indicators (E/e’ ratio). Notably, the intervention with high ACSM compliance (compliance ≥ 70%) had more significant benefits in improving exercise capacity and quality of life. This study indicates that high-compliance implementation of the ACSM exercise prescription is a safe and effective strategy for improving the functional status of HFpEF patients, providing high-level evidence for the clinical development of individualized exercise rehabilitation programs.
+
+The core clinical characteristics of HFpEF are reduced exercise tolerance and impaired quality of life, manifested as dyspnea, decreased Peak VO 2 , and diminished quality of life ( Haykowsky et al., 2012 ; Salzano et al., 2021 ). The conclusions of this study align with the majority of existing evidence, indicating that exercise training provides clear benefits for HFpEF patients. Several meta-analyses have confirmed that exercise can increase patients’ peak oxygen consumption and 6-minute walk distance ( Leggio et al., 2020 ; Boulmpou et al., 2022 ; Cavero-Redondo et al., 2023 ; Lin et al., 2023 ), and improve quality of life scores ( Pandey et al., 2015 ; Fukuta et al., 2019 ; Gomes-Neto et al., 2019 ; Baral et al., 2024 ). Regarding cardiac function, some studies suggest that exercise may improve diastolic function indicators such as E/e’ ( Pearson et al., 2017 ; Cavero-Redondo et al., 2023 ; Siddiqi et al., 2023 ), which is consistent with the positive trend observed in our study. However, existing evidence also exhibits some heterogeneity. For example, some studies have not found a significant improvement in the E/e’ ratio ( Fukuta et al., 2019 ) or ventilatory efficiency (VE/VCO 2 slope) ( Gomes-Neto et al., 2019 ; Siddiqi et al., 2023 ) with exercise, and some have even reported no significant effect on either left ventricular systolic or diastolic function indicators ( Pandey et al., 2015 ). These discrepancies may stem from variations in the type, intensity, and dosage of exercise prescriptions.
+
+The selection of the optimal exercise plan has become a research hotspot in this field. In recent years, numerous meta-analyses have focused on the effects of exercise intensity and exercise type on patients with HFpEF. For instance, Edwards et al. published a Meta-analysis that specifically compared three modes: moderate-intensity aerobic exercise (MIT), high-intensity interval training (HIIT), and combined aerobic and resistance training (CT). The study found that HIIT significantly improved the left ventricular ejection fraction of HFpEF patients, but did not outperform moderate-intensity continuous training in improving Peak VO2, and combining aerobic exercise with resistance training did not diminish the benefits of aerobic training ( Edwards et al., 2023 ).Gomes-Neto et al. found that high-intensity interval training (HIIT) and the exercise method combining aerobic and resistance training might have more advantages in enhancing exercise capacity ( Gomes-Neto et al., 2024 ). Baral et al. suggested that high-intensity interval training (HIIT) is superior to moderate-intensity continuous training ( Baral et al., 2024 ), while other scholars reached the opposite conclusion ( Guo et al., 2022 ). Therefore, the optimization of various parameters of the exercise plan still requires further research.
+
+Notably, most trials included in the present work adopted standalone aerobic exercise rather than the full multi-component regimens recommended by the American College of Sports Medicine (ACSM). This is a prevalent real-world issue in contemporary clinical practice and relevant trials. Due to limitations in patients’ exercise tolerance, safety concerns and practical operational constraints, most clinical centres and research teams are only able to implement aerobic training alone in routine HFpEF rehabilitation. Nevertheless, aerobic exercise is the core component of ACSM exercise prescriptions, and all single aerobic protocols analyzed in this work fully conformed to ACSM’s specifications for exercise intensity, frequency and duration. Accordingly, this study focused on interventions adhering to the core principles of ACSM, rather than exclusively enrolling trials with complete multi-component training.
+
+The greatest advantage of ACSM-based exercise regimens lies in their scientificity and standardization compared with arbitrary exercise protocols used in early clinical practice. Different from most previous studies that simply verified the general efficacy of exercise, the core novelty of the present study is to answer a more clinically practical question: how to implement exercise programs to achieve better outcomes. As a global authoritative organization in sports medicine, ACSM has formulated detailed exercise prescriptions for patients with cardiovascular diseases, which clearly define the frequency, intensity, duration and types of aerobic, resistance and flexibility training based on patients’ physiological characteristics ( Garber et al., 2011 ). ACSM-standardized protocols strike a good balance between efficacy and safety: they avoid poor therapeutic effects caused by insufficient exercise intensity, and meanwhile reduce the risk of adverse cardiovascular events induced by excessive load. For instance, the moderate-intensity aerobic exercise recommended by ACSM can effectively improve myocardial systolic and diastolic function without overloading the heart ( Sesso et al., 2000 ; Lee et al., 2001 ; Manson et al., 2002 ; Tanasescu et al., 2002 ). Resistance training can strengthen skeletal muscle and enhance exercise endurance, thus producing synergistic effects with aerobic exercise ( Upadhya et al., 2015 ).
+
+The subgroup analysis results of this study demonstrated more prominent benefits brought by medium to high ACSM compliance, highlighting the significance of standardized implementation of exercise prescriptions in the exercise rehabilitation of HFpEF patients. High ACSM compliance (≥70%) was a guarantee for achieving significant improvements in exercise capacity and quality of life, while the benefits in the low compliance group were very limited. This suggests that insufficient or non-standardized exercise intervention (such as inadequate frequency or inappropriate intensity) is difficult to produce definite clinical effects. Although the high compliance group had better improvement values in quality of life and left ventricular ejection fraction (LVEF), the differences compared with the low compliance group did not reach statistical significance, which might be related to the heterogeneity in the intervention period, assessment tools (such as only using the MLHFQ scale for quality of life), and other aspects of the included studies. Notably, even under high compliance conditions, the improvement in the E/e’ ratio by exercise was not significant, suggesting that relying solely on exercise training may have limitations in reversing the core diastolic dysfunction of HFpEF. Future research should explore comprehensive management strategies combining exercise with other targeted treatments.
+
+This study also has certain limitations that should be taken into account when interpreting the results. First, our meta-analysis set left ventricular ejection fraction (LVEF) ≥ 45% as the inclusion criterion for patients with heart failure with preserved ejection fraction (HFpEF), which differs from the LVEF ≥ 50% threshold recommended by current international guidelines. The classification of heart failure based on LVEF has evolved alongside advances in clinical research and guideline revisions. In early heart failure research, the academic community generally defined LVEF < 40% as heart failure with reduced ejection fraction (HFrEF) and LVEF ≥ 40% as HFpEF. This dichotomous standard was first adopted in the classic CHARM trials without an intermediate category ( Yusuf et al., 2003 ). Later landmark studies including TOPCAT, PARAGON-HF, and I-PRESERVE all used LVEF ≥ 45% to enroll HFpEF patients ( Carson et al., 2005 ; Anand et al., 2017 ; Solomon et al., 2017 ). Current guidelines clearly recognize a transitional range between heart failure with mildly reduced ejection fraction (HFmrEF) and HFpEF ( Meunier-McVey, 2021 ). To date, the LVEF ≥ 45% cut-off has been widely adopted in numerous published meta-analyses focusing on HFpEF. Strictly limiting inclusion to LVEF ≥ 50% would exclude many high-quality eligible primary studies, reducing the total sample size, lowering statistical power and potentially causing selection bias. We therefore adopted LVEF ≥ 45% uniformly to ensure the comprehensiveness of this systematic review and meta-analysis. However, this approach may create discrepancies between our study population and HFpEF patients defined by current guidelines, so our findings cannot be fully generalized to patients diagnosed according to contemporary clinical criteria. Second, diverse exercise modalities (e.g., Baduanjin, chair exercises) and intervention durations (12 to 72 weeks) across included studies introduced clinical heterogeneity. Third, our assessment of adherence to ACSM guidelines relied solely on objective parameters extracted from study protocols, without incorporating patients’ real-world exercise data, which may lead to assessment bias. Fourth, several included studies had small sample sizes and a high risk of bias, although sensitivity analysis confirmed that our overall results were robust. Fifth, we did not conduct additional subgroup analyses based on exercise patterns or patient baseline characteristics such as age and comorbidities, which limits the precision of individualized exercise guidance. Sixth, the study population may exhibit heterogeneity. A small fraction of patients may have regained normal LVEF following treatment for prior HFrEF. Their underlying mechanisms differ from conventional HFpEF caused by hypertension and high filling pressures, possibly leading to inconsistent responses to exercise. This factor needs to be considered in clinical application. Finally, GRADE assessment revealed that incomplete blinding and substantial between-study heterogeneity reduced the reliability and generalizability of our evidence. More well-designed RCTs are needed to further strengthen the current evidence base.
+
+Despite the above-mentioned limitations, the conclusions of this study still hold significant clinical practice and evidence-based medical implications. The exercise program recommended by ACSM is characterized by low cost, high safety, and easy promotion. When clinical physicians formulate exercise prescriptions for HFpEF patients, they should make individualized adjustments based on the ACSM principles, taking into account the patients’ basic cardiopulmonary function, physical condition, and comorbidities: for patients with better functional status, moderate-intensity aerobic combined with resistance training can be adopted; for elderly, frail or severely ill patients, it is necessary to start from low intensity and short duration, gradually increase, and improve long-term compliance through enhanced supervision, education and follow-up, thereby promoting the transformation of HFpEF management to an integrated model of “medication - exercise rehabilitation”. Based on this study, future research can be further explored in the following directions: (1) conducting large-scale, long-term follow-up randomized controlled trials to verify the impact of standardized ACSM programs on hard endpoint events; (2) developing comprehensive exercise compliance assessment tools that integrate subjective and objective indicators; (3) conducting subgroup analyses at the patient level to identify specific population characteristics that respond best to different exercise programs; (4) comparing the efficacy differences of different exercise combinations (such as pure aerobic vs. combined training) and exploring the synergistic effects of exercise and new drugs (such as SGLT2 inhibitors); (5) conducting pragmatic studies to evaluate the feasibility and effectiveness of this program in real-world clinical settings.
+
+ 8
+
+Conclusion
+
+The exercise guidance provided by ACSM can effectively improve the physical ability and quality of life of patients with HFpEF, as well as some left ventricular function indicators. Moreover, the higher the compliance, the better the functional outcome. In the future, more studies focusing on multi-component exercise and combined treatment are needed to supplement the existing evidence.
+
+============================================================
+SOURCE: PMC13391330.txt (TXT)
+============================================================
+
+Galectin-3 inhibitor selvigaltin dosed therapeutically in vivo in a rabbit model of metabolic syndrome induced by high-fat diet: effects on rabbit differentiated adipocytes
+
+Effects of allicin on human Simpson-Golabi-Behmel syndrome cells in mediating browning phenotype
+
+Adipose tissue and metabolic health
+
+Safety and pharmacokinetics of GB1211, an oral galectin-3 inhibitor: a single- and multiple-dose first-in-human study in healthy participants
+
+Volume determination of irregularly-shaped quasi-spherical nanoparticles
+
+Galectin-3 activates PPARγ and supports white adipose tissue formation and high-fat diet-induced obesity
+
+Systematic review of bariatric surgery liver biopsies clarifies the natural history of liver disease in patients with severe obesity
+
+Galectin-3 in cardiovascular diseases
+
+Effects of obesity and weight loss on mitochondrial structure and function and implications for colorectal cancer risk
+
+NAFLD: a multisystem disease
+
+Adipose tissue distribution, inflammation and its metabolic consequences, including diabetes and cardiovascular disease
+
+Prognostic value of serum galectin-3 in chronic heart failure: a meta-analysis
+
+INT-767 prevents NASH and promotes visceral fat brown adipogenesis and mitochondrial function
+
+The galectin-3 inhibitor selvigaltin reduces liver inflammation and fibrosis in a high fat diet rabbit model of metabolic-associated steatohepatitis
+
+Treatment potential of LPCN 1144 on liver health and metabolic regulation in a non-genomic, high fat diet induced NASH rabbit model
+
+DNA copy number concentration measured by digital and droplet digital quantitative PCR using certified reference materials
+
+The metabolic syndrome
+
+TrackMate 7: integrating state-of-the-art segmentation algorithms into tracking pipelines
+
+A new definition for metabolic dysfunction-associated fatty liver disease: an international expert consensus statement
+
+Testosterone partially ameliorates metabolic profile and erectile responsiveness to PDE5 inhibitors in an animal model of male metabolic syndrome
+
+Increased oxidative stress in obesity and its impact on metabolic syndrome
+
+Galectin-3 in heart failure: an update of the last 3 years
+
+Cardiac-deleterious role of galectin-3 in chronic angiotensin II-induced hypertension
+
+Mitochondrial function in healthy human white adipose tissue: A narrative review
+
+Brown and beige fat: development, function and therapeutic potential
+
+On the formation of lipid droplets in human adipocytes: the organization of the perilipin-vimentin cortex
+
+White adipose tissue mitochondrial metabolism in health and in obesity
+
+Lipid droplets interact with mitochondria using SNAP23
+
+Metabolic syndrome: a population-based study of prevalence and risk factors
+
+Mitochondrial fission contributes to mitochondrial dysfunction and insulin resistance in skeletal muscle
+
+Biochemical assays of respiratory chain complex activity
+
+Galectin-3 stimulates preadipocyte proliferation and is up-regulated in growing adipose tissue
+
+Functions of galectin-3 and its role in fibrotic diseases
+
+Mitochondrial dynamics in the regulation of nutrient utilization and energy expenditure
+
+Adipose tissue macrophages impair preadipocyte differentiation in humans
+
+Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) Method
+
+Galectin-3 modulates macrophage activation and contributes smooth muscle cells apoptosis in abdominal aortic aneurysm pathogenesis
+
+Macrophages inhibit adipogenic differentiation of adipose tissue derived mesenchymal stem/stromal cells by producing pro-inflammatory cytokines
+
+Redox regulation of mitochondrial function with emphasis on cysteine oxidation reactions
+
+Tadalafil reduces visceral adipose tissue accumulation by promoting preadipocytes differentiation towards a metabolically healthy phenotype: studies in rabbits
+
+Testosterone treatment improves metabolic syndrome-induced adipose tissue derangements
+
+FXR activation normalizes insulin sensitivity in visceral preadipocytes of a rabbit model of MetS
+
+Galectin-3 inhibition prevents adipose tissue remodelling in obesity
+
+Mitochondrial homeostasis in obesity-related hypertriglyceridemia
+
+Role of galectin-3 in obesity and impaired glucose homeostasis
+
+Bmp4 promotes a brown to white-like adipocyte shift
+
+Bone morphogenic proteins signaling in adipogenesis and energy homeostasis
+
+Comparison of the effects of browning-inducing capsaicin on two murine adipocyte models
+
+Testosterone and farnesoid X receptor agonist INT-747 counteract high fat diet-induced bladder alterations in a rabbit model of metabolic syndrome
+
+Elevated end-diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay
+
+The galectin lattice at a glance
+
+Circulating galectin-3 is associated with cardiometabolic disease in the community
+
+Galectin-3 deficiency ameliorates fibrosis and remodeling in dilated cardiomyopathy mice with enhanced Mst1 signaling
+
+Developmental trends of metabolic syndrome in the past two decades: a narrative review
+
+A threshold selection method from Gray-Level histograms
+
+A mitochondrial protein compendium elucidates complex I disease biology
+
+Increased adiposity, dysregulated glucose metabolism and systemic inflammation in Galectin-3 KO mice
+
+Adipose tissue dysfunction in obesity: Role of mineralocorticoid receptor
+
+Measurement of the size distribution of multimodal colloidal systems by laser diffraction
+
+Galectin-3 deficiency accelerates high-fat diet-induced obesity and amplifies inflammation in adipose tissue and pancreatic islets
+
+Mitochondrial function and content in pheochromocytoma/paraganglioma of succinate dehydrogenase mutation carriers
+
+Adipose tissue-specific modulation of galectin expression in lean and obese mice: evidence for regulatory function
+
+Mitochondrial dynamics in type 2 diabetes: Pathophysiological implications
+
+The global epidemic of the metabolic syndrome
+
+Critical role of galectin-3 in phagocytosis by macrophages
+
+Neuroprotective effects of testosterone in the hypothalamus of an animal model of metabolic syndrome
+
+Fiji: an open-source platform for biological-image analysis
+
+Galectin-3 inhibition reduces fibrotic scarring and promotes functional recovery after spinal cord injury in mice
+
+The therapeutic potential of galectin-3 inhibition in fibrotic disease
+
+Ectopic fat and insulin resistance: pathophysiology and effect of diet and lifestyle interventions
+
+Induction of fatty acid synthetase synthesis in differentiating 3T3-L1 preadipocytes
+
+The perilipin family of lipid droplet proteins: Gatekeepers of intracellular lipolysis
+
+TrackMate: an open and extensible platform for single-particle tracking
+
+New role of bone morphogenetic protein 7 in brown adipogenesis and energy expenditure
+
+Nonalcoholic steatohepatitis as a novel player in metabolic syndrome-induced erectile dysfunction: an experimental study in the rabbit
+
+Adipose tissue expandability, lipotoxicity and the Metabolic Syndrome--an allostatic perspective
+
+Contribution of adipogenesis to healthy adipose tissue expansion in obesity
+
+Mitochondrial dysfunction leads to impairment of insulin sensitivity and adiponectin secretion in adipocytes
+
+Serum galectin-3 is elevated in obesity and negatively correlates with glycosylated hemoglobin in type 2 diabetes
+
+Mitochondrial dysfunction in adipocytes as a primary cause of adipose tissue inflammation
+
+Beige adipocytes are a distinct type of thermogenic fat cell in mouse and human
+
+Obesity causes mitochondrial fragmentation and dysfunction in white adipocytes due to RalA activation
+
+Galectin-3 induces atrial fibrosis by activating the TGF-β1/Smad pathway in patients with atrial fibrillation
+
+Tumor necrosis factor-α suppresses adipogenic and osteogenic differentiation of human periodontal ligament stem cell by inhibiting miR-21/Spry1 functional axis
+
+SIRT1 safeguards adipogenic differentiation by orchestrating anti-oxidative responses and suppressing cellular senescence
+
+The role of galectin-3 in heart failure - the diagnostic, prognostic and therapeutic potential - where do we stand
+
+Discovery and optimization of the first highly effective and orally available galectin-3 inhibitors for treatment of fibrotic disease
+
+Galectin-3 inhibition ameliorates streptozotocin-induced diabetic cardiomyopathy in mice
+
+Introduction
+
+Metabolic syndrome (MetS) is an increasingly prevalent condition characterized by visceral obesity, insulin resistance, dyslipidemia, hypertension, and chronic low-grade inflammation. Impaired preadipocyte differentiation contributes to metabolic disturbances, inflammation, and mitochondrial dysfunction. Galectin-3 (Gal-3) plays a key role in promoting visceral adipose tissue (VAT) inflammation, fibrosis, and mitochondrial impairment. In a preclinical rabbit model of MetS, treatment with the Gal-3 inhibitor selvigaltin reduced VAT mass, indicating potential therapeutic value. This study seeks to clarify how selvigaltin influences the metabolic function of differentiation induction medium (DIM)-induced adipocytes mitochondria, potentially offering a new strategy for treating MetS.
+
+Methods
+
+Male New Zealand White rabbits were housed individually under standard conditions. Following one week on a regular diet (RD), they were randomly assigned to one of the following groups for 12 weeks: RD with vehicle, high-fat diet (HFD) with vehicle, or HFD with selvigaltin (0.3, 1.0, or 5.0 mg/kg), administered orally once daily, five days a week, starting from week 9. Visceral adipose tissue (VAT) was collected, and preadipocytes were isolated and induced to differentiate in vitro into DIM-differentiated adipocytes. Subsequent experiments examined mitochondrial dynamics and morphology, superoxide production, oxygen consumption, lipid droplets formation, and target genes mRNA expression.
+
+Results
+
+HFD in rabbits induces features of metabolic syndrome, including increased visceral fat, mitochondrial dysfunction, oxidative stress, and lipid accumulation in visceral adipose tissue. Treatment with Gal-3 inhibitor selvigaltin reversed many of these changes, specifically, improving DIM-differentiated adipocytes mitochondrial morphology and dynamics, reducing oxidative stress and lipid droplet size. Furthermore, the HFD induced upregulation of inflammatory markers (COX2, IL-1β, IL-6, TLR2, TLR4, TNFα) and immune cell polarization transcription factors (GATA3, TBX21), all noticeably decreased by selvigaltin treatment.
+
+Discussion
+
+This study highlights mitochondrial dysfunction as a key factor in VAT impairment. In DIM-differentiated adipocytes, selvigaltin improves mitochondrial structure, dynamics, and function, reduces oxidative stress and lipid droplet size, and lowers the mRNA expression of proinflammatory-related genes. It also promotes a shift toward a healthier, more metabolically active adipocyte phenotype. Selvigaltin restores mitochondrial health, suggesting its potential as a therapeutic option for metabolic disorders involving VAT dysfunction. Further studies are needed to confirm its clinical relevance.
+
+1
+
+Introduction
+
+Metabolic syndrome (MetS) is a complex and multifactorial pathological condition characterized by the coexistence of several metabolic abnormalities, including visceral obesity, insulin resistance, dyslipidaemia, hypertension, and low-grade chronic inflammation ( Eckel et al., 2005 ). According to recent epidemiological data, MetS affects between 14% and more than 30% of the global adult population, and its global prevalence is steadily increasing, driven by lifestyle-related factors such as excessive caloric intake, physical inactivity, and aging ( Saklayen, 2018 ; Jamali et al., 2024 ; Obeidat et al., 2025 ). MetS is currently recognized as one of the major risk factors for type 2 diabetes, cardiovascular diseases, and metabolic dysfunction–associated steatotic liver disease (MASLD) ( Eslam et al., 2020 ), formerly known as non-alcoholic fatty liver disease (NAFLD) ( Byrne and Targher, 2015 ).
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+Visceral adipose tissue (VAT) expansion and dysfunction are widely recognized as critical factors in MetS and remain a central topic in current research ( Chait and den Hartigh, 2020 ). Unlike subcutaneous fat, VAT displays a stronger association with systemic metabolic impairment, due to its heightened inflammatory activity and endocrine properties. Indeed, visceral adiposity correlates strongly with insulin resistance and inflammatory markers, emphasizing its central role in the pathogenesis of MetS ( Chait and den Hartigh, 2020 ; An et al., 2023 ). Therefore, the functional integrity of the adipose tissue, and specifically the ability of visceral preadipocytes to differentiate into metabolically competent adipocytes, plays a pivotal role in modulating the pathological impact of visceral obesity ( Vishvanath and Gupta, 2019 ).
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+Upon exposure to adipogenic stimuli, isolated visceral preadipocytes can generate mature adipocytes capable of lipid storage, insulin responsiveness, and endocrine signalling. However, under conditions of sustained metabolic stress - such as chronic overnutrition or a high-fat diet - the adipogenic potential of preadipocytes may be severely compromised, as already demonstrated in both humans and animal models ( Maneschi et al., 2016 ; Liu et al., 2017 ; Comeglio et al., 2018 ).
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+This dysfunction leads to the emergence of hypertrophic, metabolic dysfunctional adipocytes and contributes to the perpetuation of local and systemic inflammation and insulin resistance ( Maneschi et al., 2016 ; Bedossa et al., 2017 ). Several studies have shown that an impaired adipogenic capacity is linked to a pro-inflammatory microenvironment, characterized by elevated levels of cytokines such as TNFα, oxidative stress, and fibrogenic signalling ( Yang et al., 2017 ; Ma et al., 2020 ; Yu et al., 2024 ). These conditions inhibit adipocyte differentiation and favour the emergence of fibro-inflammatory phenotypes.
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+Mitochondrial dysfunction in adipocytes, characterized by impaired dynamics and dysmetabolism, is now recognized as a hallmark of adipose tissue impairment ( Woo et al., 2019 ; Xia et al., 2024 ). Mitochondrial defects in adipocytes limit energy metabolism, reduce ATP production, and amplify inflammatory signalling, thereby exacerbating systemic insulin resistance ( Heinonen et al., 2020 ).
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+Among the molecular factors involved in VAT dysfunction, galectin-3 (Gal-3) has emerged as a potential key player ( Kiwaki et al., 2007 ; Baek et al., 2015 ; Zhu et al., 2022 ). Circulating Gal-3 levels are increased in obesity and diabetes, showing a correlation with insulin resistance and cardiometabolic risk, suggesting that Gal-3 produced in inflamed VAT may enter the bloodstream and exert systemic-endocrine effects ( Weigert et al., 2010 ; Nayor et al., 2015 ; Menini et al., 2016 ). Gal-3 is abundantly expressed in the inflammatory microenvironment of VAT, where it promotes pro-inflammatory macrophage polarization and extracellular matrix deposition ( Martínez-Martínez et al., 2016 ; Lu et al., 2020 ; Shan et al., 2024 ). Elevated levels of Gal-3 have been associated with impaired mitochondrial function, inflammatory conditions and fibrosis in adipose tissue.
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+Beyond adipose tissue, Gal-3 has been implicated in the pathogenesis of cardiovascular remodelling and tissue fibrogenesis through the deposition of collagen ( Blanda et al., 2020 ), further supporting its potential relevance in the multisystem manifestations of MetS. In the heart and vasculature, Gal-3 acts locally by stimulating fibroblast proliferation and activation, amplifying TGF-β/Smad signalling and enhancing collagen deposition. Consequently, genetic or pharmacological inhibition of Gal-3 reduces cardiac fibrosis and improves tissue remodelling ( Gehlken et al., 2018 ; Xiao et al., 2020 ). Consistent with these mechanisms, higher circulating Gal-3 levels have been associated with heart failure severity, adverse cardiovascular events, and mortality in clinical cohorts ( Cheng et al., 2022 ; Zaborska et al., 2023 ).
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+Gal-3 binds cell-surface glycoproteins via its carbohydrate-recognition domain (CRD), and oligomerization forms a multivalent lattice that cross-links surface oligosaccharides, modulating receptor retention, lateral mobility, and extracellular matrix dynamics ( Nabi et al., 2015 ). Genetic deletion and pharmacological inhibition studies, including the CRD-specific inhaled inhibitor TD139, demonstrate that Gal-3 is a critical mediator in multiple cardiac disease models ( González et al., 2016 ; Mosleh et al., 2018 ; Nguyen et al., 2019 ). The orally available small-molecule inhibitor selvigaltin (formerly GB1211) selectively targets the Gal-3 CRD with nanomolar affinity, blocking ligand interactions and downstream profibrotic and inflammatory signalling. It was developed through medicinal chemistry optimization of an α-D-galactopyranoside scaffold ( Slack et al., 2021 ; Zetterberg et al., 2022 ; Aslanis et al., 2023 ).
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+In a previous study, we have evaluated the therapeutic effects of the Gal-3 selective inhibitor selvigaltin in a non-genomic preclinical rabbit model of metabolic-associated steatohepatitis (MASH) induced by high-fat diet (HFD) ( Comeglio et al., 2024 ). This animal model faithfully reproduces also the phenotype of human MetS, including hypertension, hyperglycaemia, dyslipidaemia, glucose intolerance, visceral fat accumulation, liver steatosis and fibrosis ( Filippi et al., 2009 ; Morelli et al., 2012 ; Vignozzi et al., 2014 ; Maneschi et al., 2016 ; Comeglio et al., 2018 ).
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+VAT accumulation, rather than overall body weight, drives hyperglycemia and hyperlipidemia, while elevated triglycerides contribute to ectopic lipid deposition and tissue inflammation, further exacerbating insulin resistance ( Virtue and Vidal-Puig, 2010 ; Snel et al., 2012 ).
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+Treatment with selvigaltin, in addition to ameliorating liver fibrosis, showed an improvement in VAT weight, with a significant reduction observed in selvigaltin-treated animals, compared to those on HFD ( Comeglio et al., 2024 ). These findings have prompted the hypothesis that pharmacological inhibition of Gal-3 could represent a promising therapeutic strategy for improving adipose tissue function in MetS. However, the cellular mechanisms underlying these beneficial effects remain to be fully elucidated. While the role of Gal-3 in tissue inflammation and fibrosis has been explored, its impact on the intrinsic metabolic phenotype of visceral preadipocytes remains to be fully characterized. To our knowledge, no prior studies have addressed how in vivo Gal-3 inhibition may influence the functional trajectory of adipocytes in a diet-induced model of metabolic dysfunction.
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+This study was designed to determine whether in vivo Gal-3 inhibition could support the maintenance or restoration of a healthy metabolic phenotype in differentiation induction medium (DIM)-differentiated adipocytes, potentially contributing to the amelioration of VAT dysfunction in the context of MetS.
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+ 2
+
+Materials and methods
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+ 2.1
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+MetS rabbit model experimental plan
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+In a previous study, our group used a total number of 44 male New Zealand White rabbits (16-week old, Charles River Laboratories, Calco, Italy), weighing about 3kg, to investigate the efficacy of Gal-3 inhibitor selvigaltin in reducing hepatic abnormalities in this animal model of HFD-induced MASH/MetS ( Comeglio et al., 2024 ).
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+Briefly, after one week of acclimation on regular diet (RD), animals were randomly assigned to either continue on RD (control group) or switch to a high-fat diet (HFD; standard chow supplemented with 0.5% cholesterol and 2.5% vegetable fat) for 12 weeks. For the final four weeks of the feeding period (weeks 9-12), HFD-fed rabbits were subdivided into treatment groups receiving Gal-3 inhibitor selvigaltin by oral gavage at doses of 0.3 (HFD + 0.3mg), 1.0 (HFD + 1.0mg), or 5.0 (HFD + 5.0mg) mg/kg, once daily, 5 days per week. RD and untreated HFD rabbits received the vehicle only (RD+Veh and HFD+Veh groups, respectively). At the end of 12 weeks, rabbits were fasted overnight and euthanized with an intravenous overdose of sodium thiopental (200 mg/kg). At sacrifice, we collected visceral adipose tissue (VAT) was collected and weighed, and biopsies were immediately either processed for preadipocyte isolation (n=6 animals for each experimental group) or snap-frozen/stored at -80 °C for later analyses.
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+All the experimental procedures were conducted using the facilities of the Department of Biomedical Experimental and Clinical Sciences “Mario Serio” and Department of Experimental and Clinical Medicine, and those of CE.S.A.L. (Centro Stabulazione degli Animali da Laboratorio), and NEUROFARBA Department, University of Florence, Italy.
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+ 2.2
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+Ethical statement
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+All animals received humane care, and animal handling complied with the regulations of Animal Welfare Body of the University of Florence, Florence, Italy, in accordance with the Italian Ministerial Law n. 26/2014. The study was approved by the Ministry of Health authorization n. 146/2021-PR.
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+Animal experiments conformed to the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines ( http://www.nc3rs.org.uk/arrive-guidelines ).
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+ 2.3
+
+Metabolic and biochemical analyses
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+Metabolic profiling and hemodynamic evaluation were conducted in all experimental groups to assess the systemic impact of the HFD and the effects of selvigaltin treatment, as previously described ( Comeglio et al., 2024 ). Measurements were conducted under standardized environmental conditions and with minimal animal handling to reduce stress-induced variability.
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+ 2.4
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+Isolation, characterization, and in vitro differentiation of rabbit VAT preadipocytes
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+Preadipocytes (rPADs) were isolated from rabbit VAT samples (n=6 for each experimental group) as previously described ( Maneschi et al., 2016 ; Comeglio et al., 2018 ). Briefly, fresh ex-vivo VAT, after being cut into small fragments with sterile scalpel, was digested in Dulbecco’s PBS containing collagenase (0.1% Type II collagenase; Sigma-Aldrich, St. Louis, MO) in a shaking water bath at 37 °C for 1 h. The digestion was stopped by adding an equal volume of Dulbecco’s Modified Eagle’s Medium (DMEM) supplemented with 10% fetal bovine serum (FBS), and the cell suspension was filtered through a 150 μm nylon mesh to remove debris. The filtrate was centrifuged at 2000x g for 10 min at room temperature to pellet the stromal-vascular fraction containing preadipocytes. The pellet was resuspended in erythrocyte lysis buffer (155 mM NH 4 Cl, 10 mM KHCO 3 , 0.1 mM EDTA) for 5 min to eliminate red blood cells, then washed and re-pelleted by centrifugation. The resulting preadipocyte pellet was resuspended in complete growth medium (DMEM high glucose, 10% FBS, 100 U/mL penicillin, 100 μg/mL streptomycin, 2 mM L-glutamine, and 1 μg/mL amphotericin B) and cells were seeded in culture dishes for the amplification. Cultures were maintained at 37 °C in a humidified 95% air/5% CO 2 atmosphere. After 24–48 h, any non-adherent cells and debris were removed by washing with PBS, and the medium was replaced. rPADs were grown to 80-90% confluence in complete growth medium, which was reached after 4–5 days. Finally, the cells were trypsinized (PBS, 1% trypsin), aliquoted and stored at -80 °C for later use. Preadipocytes were characterized as previously described ( Maneschi et al., 2016 ). For each experimental group, adipogenic differentiation of rPADs was induced using DIM, a standard differentiation induction medium ( Student et al., 1980 ). Upon reaching confluence (designated day 0), the culture medium was switched to DIM, consisting of DMEM supplemented with 5% (v/v) FBS, 0.25 μM dexamethasone, 0.5 mM 3-isobutyl-1-methylxanthine (IBMX), and 5 μg/mL insulin. Cells were maintained in this induction medium for 8 days, with fresh medium changes every 48 h. Finally, DIM-differentiated adipocytes were cultured for an additional 48 h in maintenance medium (DMEM + 5% FBS containing 5 μg/mL insulin, without dexamethasone or IBMX).
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+To evaluate the purity of DIM-differentiated adipocyte cultures, we performed real-time PCR to measure mRNA expression of the adipocyte-specific marker PPARγ, and markers associated with potential contaminating cell types, including PECAM1 for endothelium, CD45 for immune cells, FN1 for myofibroblasts, and SM22 for smooth muscle cells. PPARγ was robustly expressed in DIM-differentiated adipocytes, whereas markers of non-adipocytic lineages were negligible (all fold-change <0.03 vs PPARγ, p<0.05), indicating minimal contamination.
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+ 2.5
+
+Fluorescence and electronic microscopy
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+DIM-differentiated adipocytes were cultured on 35 mm µ-Dishes (Ibidi, Munich, Germany) for 10 days, then separately stained with 200 nM MitoTracker™ Green (Invitrogen, Waltham, MA) to assess mitochondrial morphodynamic, 10 µM dihydroethidium (DHE; Invitrogen) to evaluate oxidative stress ( Maneschi et al., 2012 ; Maneschi et al., 2016 ), and BODIPY™ 493/503 (Thermo Fisher Scientific, Waltham, MA) to investigate lipid storage. On the stained samples, instant images and timelapses were acquired by using DMI6000 microscope (Leica Camera AG, Wetzlar, Germany) equipped with a DFC350FX camera and a thermo-regulated incubation chamber (PeCon GmBH, Erbach, Germany) with controlled humidity and CO 2 for cells maintenance. Additionally, electron microscopy was employed to evaluate mitochondrial cristae morphometry in DIM-differentiated adipocytes (n=6 for each experimental group). After being cultured with differentiation growth medium for 10 days in 60 mm dishes, cells were finally collected, pelleted by centrifugation and fixed in fixed in Karnowsky buffer and 1% osmium tetroxide and embedded in Epon 812 (EMS, Hatfield, PA). Ultrathin sections (70 nm) of DIM-differentiated adipocytes were prepared, stained with uranyl acetate and lead citrate, and observed at 80,000× magnification using a JEM 1010 transmission electron microscope (Jeol, Tokyo, Japan) at 80 kV, as previously described ( Maneschi et al., 2016 ; Comeglio et al., 2018 ). Segmentation of mitochondrial cristae was carried out blindly using the iTEM image-analysis software (SIS), as previously described ( Maneschi et al., 2016 ; Comeglio et al., 2018 ).
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+ 2.5.1
+
+Mitochondrial dynamics and morphology analysis
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+Mitochondrial morphodynamic properties were evaluated in DIM-differentiated adipocytes (n=6 for each experimental group) as indicators of mitochondrial functional status. All mitochondrial morphological measurements were performed under blind conditions to minimize potential bias. Mitochondrial length was assessed by manually segmenting individual mitochondria and restricting the analysis to regions of interest located at the cell periphery, while perinuclear areas were excluded. For mitochondrial length assessment, DIM-differentiated adipocytes were incubated with MitoTracker™ Green for 30 min at 37 °C in the dark. After staining, cells were washed with PBS and transferred into fresh culture medium before imaging. Images were captured through 63x/1.4NA oil-immersion objective. For each biological replicate, 13 to 20 individual DIM-induced adipocytes from 10 distinct microscopic fields were analyzed for each population, totalling approximately 3,000 total measurements of mitochondrial length per group. Morphometric analyses were performed using Fiji (ImageJ; https://imagej.net/software/fiji/ ) ( Schindelin et al., 2012 ), and mitochondria were manually segmented to calculate average length per cell. Mitochondrial motility was analysed in live DIM-differentiated adipocytes performing 180 seconds timelapses (15 sec each acquisition). Cells stained with MitoTracker™ Green were imaged every 5 sec for the total duration of 180 sec under identical conditions.
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+The movement of individual mitochondria was tracked using the TrackMate plugin in Fiji ( https://imagej.net/plugins/trackmate/ ) ( Tinevez et al., 2017 ; Ershov et al., 2022 ). Velocity values were extracted and expressed as mean displacement rate (nm/s). Only mitochondria clearly visible and distinguishable throughout the time series were considered. Regions adjacent to the nucleus were excluded to avoid movement artifacts. A total of 13–20 cells from 10 randomly selected fields were analysed per cell lineage. Cristae morphology was evaluated by transmission electron microscopy (TEM). The surface area occupied by mitochondrial cristae was quantified and expressed as a percentage of total mitochondrial area, as previously described ( Maneschi et al., 2013 ; Maneschi et al., 2016 ).
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+ 2.5.2
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+Intracellular reactive oxygen species analysis
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+Intracellular superoxide production was evaluated blindly using dihydroethidium (DHE), a fluorogenic probe that intercalates into nuclear DNA upon oxidation to ethidium. DIM-differentiated adipocytes were incubated with DHE (10 μM in phenol red-free DMEM) at 37 °C for 30 min in the dark (RD+Veh, n=6; HFD+Veh, n=6; HFD + 0.3mg, n=5; HFD + 1.0mg, n=6; HFD + 5.0mg, n=6). After staining, cells were washed twice with warm PBS and maintained in fresh medium for live-cell imaging. Fluorescence timelapse microscopy was performed using a 63×/1.4NA oil-immersion objective. Timelapse acquisition was conducted over 180 sec, with one frame acquired every 15 sec, resulting in 13 total timepoints per field. For each biological replicate, 13–20 individual cells were analysed from 10 randomly selected fields per condition.
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+The oxidative response was quantified by measuring the intranuclear fluorescence intensity of DHE at the first (T 0 ) and final (T 180 ) timepoints of the timelapse series. The oxidative response was quantified by calculating the percentage increase in intranuclear DHE fluorescence intensity over time using the formula: ΔDHE (%) = [(F t180 – F t0 )/F t0 ] × 100, where F t0 and F t180 represent the nuclear DHE fluorescence intensities at time 0 and 180 sec, respectively. This value reflects the percentage increase in oxidized DHE fluorescence within the nucleus and serves as an indirect index of intracellular superoxide generation, as described previously ( Maneschi et al., 2013 ). Fluorescence measurements were performed in Fiji ImageJ Software using manual region-of-interest (ROI) selection for individual nuclei and background subtraction for each time point. To ensure consistency, all image acquisition settings (laser power, detector gain, pinhole size, offset) were kept constant across all samples.
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+ 2.5.3
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+Oxygen consumption readouts ATP quantification and SDH activity
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+Intracellular ATP levels were quantified using the CellTiter-Glo ® Luminescent Cell Viability Assay (Promega, Madison, WI) following the manufacturer’s instructions (n=6 for each experimental group). DIM-differentiated adipocytes were seeded in white opaque 96-well plates at a density of 1×10 4 cells per well and cultured under standard conditions. For each experimental group, each of the 6 biological replicates was analyzed in 6 technical replicates. At the endpoint, a volume of 125 μL CellTiter-Glo ® reagent was added to 3 wells, and the plates were incubated at room temperature for 10 min to stabilize the luminescent signal. Luminescence was measured using a Victor Nivo multilabel plate reader (Revvity, Waltham, MA), as previously described ( Comeglio et al., 2018 ). ATP levels were normalized to the total protein content (µg) of each biological replicate. For each replicate, ATP measurements were performed in three wells and averaged, while total protein content was determined from three parallel wells seeded at the same density and treated identically, and the resulting mean protein value was used for normalization.
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+SDH activity was measured (n=6 for each experimental group) in cell lysates (50 µg total protein) incubated in phosphate buffer containing sodium azide, 2,6-dichlorophenolindophenol (DCPIP), sodium succinate, and phenazine methosulfate, as previously described ( Kirby et al., 2007 ; Rapizzi et al., 2012 ). The decrease in absorbance due to DCPIP reduction was monitored at 600 nm using the Victor Nivo multilabel counter (Revvity). Enzymatic activity was calculated as the rate of DCPIP oxidation, normalized to total protein content and finally expressed as percent variation relative to control values (RD = 100% activity). The evaluation considered the peak point of the reaction curve.
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+ 2.5.4
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+Lipid droplets analysis
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+The morphological characterization of intracellular lipid droplets in DIM-differentiated adipocytes was performed blindly on 2D fluorescent images acquired after BODIPY™ staining (RD+Veh, n=6; HFD+Veh, n=5; HFD + 0.3mg, n=5; HFD + 1.0mg, n=6; HFD + 5.0mg, n=6). Briefly, cells were incubated with BODIPY™ 493/503 for 15 min in the dark, fixed in 4% paraformaldehyde for 15 min at room temperature, and finally washed with PBS before acquisition. Fluorescent images were captured at 40× air magnification maintaining uniform acquisition parameters across all samples. For quantitative image analysis, single-plane (2D) images were processed using Fiji ImageJ Software. For visualization purposes, representative images have been processed using an ImageJ lookup table (LUT) to enhance lipid droplet contrast and reduce background signal. It is important to note that our experimental model consists of DIM-induced preadipocytes that were not supplemented with exogenous fatty acids (e.g. palmitate or oleate) or other lipid-loading agents commonly used in vitro to promote extensive lipid accumulation. Under these conditions cells undergo adipogenic differentiation, albeit only in a manner partially comparable to mature adipocytes isolated directly from adipose tissue. Accordingly, lipid storage at this stage is typically characterized by small lipid droplets, rather than the large unilocular droplets observed in adipocytes from the tissue or lipid-loaded adipocytes ( Heid et al., 2014 ).
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+Lipid droplet segmentation and quantification were performed using the Lipid Droplets Tool macro ( https://github.com/MontpellierRessourcesImagerie/imagej_macros_and_scripts/wiki/Lipid-Droplets-Tool ) ( Montanari et al., 2019 ; Ali et al., 2023 ), developed by the Institut de Génétique Moléculaire de Montpellier (CNRS, France). Prior to analysis, images were converted to 8-bit grayscale and thresholded using an automated method ( Otsu, 1979 ) or manually adjusted for optimal droplet detection. A watershed separation algorithm was applied to resolve closely packed droplets. For each detected lipid droplet, individual morphometric parameters were extracted, including projected area and Feret diameters (minimum and maximum). An estimate of lipid droplet volume was calculated using the simplified spherical formula: V=(π/6)·[(minFeret+maxFeret)/2]³, where minFeret and maxFeret, refer to the minimum and maximum diameters of each object, respectively. The formula is derived from the standard expression for the volume of a sphere V=(π/6)·D³, where D=(minFeret+maxFeret)/2 ( Corbisier et al., 2015 ; Attota and Liu, 2016 ; Pei et al., 2021 ). These values represent an estimated volume based on 2D morphometric parameters rather than absolute 3D volumes. A range of 13–20 cells from 10 randomly selected fields across biological replicates were analysed, collecting a minimum number of 2,500 lipid droplets. Data were compiled and statistically analysed to assess differences in lipid droplet size and distribution among experimental groups.
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+ 2.6
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+RNA extraction and biomarkers expression analysis
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+Total RNA was extracted from DIM-differentiated adipocytes (n=6 per experimental group) and from VAT homogenates. RNA isolation was performed using the RNeasy Mini Kit (Qiagen, Hilden, Germany) according to the manufacturer’s protocol for cultured cells, including supplementation of the lysis buffer with 1% β-mercaptoethanol and on-column DNase digestion to eliminate residual genomic DNA. For the available VAT homogenates (RD+Veh, n=6; HFD+Veh, n=7; HFD + 0.3 mg, n=7; HFD + 1.0 mg, n=7; HFD + 5.0 mg, n=7), samples were initially processed with TRIzol reagent (Life Technologies, Paisley, UK) prior to purification. First-strand cDNA was synthesized using the iScript™ cDNA Synthesis Kit (Bio-Rad Laboratories, Hercules, CA), and semiquantitative real-time PCR (qRT-PCR) was carried out using the CFX Duet Real-Time PCR Detection System (Bio-Rad) with SsoAdvanced™ Universal SYBR ® Green Supermix (Bio-Rad).
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+Primer sequences for rabbit target genes were designed based on NCBI GenBank ( http://www.ncbi.nlm.nih.gov ) and Ensemble Genome ( https://www.ensembl.org/index.html ) database entries and were validated for efficiency and specificity.
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+The 18S ribosomal RNA subunit was used as the housekeeping gene for the relative quantitation of the target genes based on the comparative threshold cycle (Ct) 2 −ΔΔCt method ( Livak and Schmittgen, 2001 ), with some modifications.
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+In detail, we used the vehicle-treated control group as the calibrator in each analysis, so that the calculations would provide the fold-change of the other groups relative to controls. The 18S ribosomal RNA subunit was quantified using primers designed based on the rabbit transcript ENSOCUT00000030594.2:
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+Forward - 5′-GGCCGTTCTTAGTTGGTGGA-3′
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+Reverse - 5′-AGCATGCCAGAGTCTCGTTC-3′
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+The amplification efficiency for 18S was determined to be greater than 94%.
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+ 2.7
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+Statistical analysis
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+Data are expressed as mean ± standard error of the mean (SEM). Only biological replicates were included in the statistical analyses, with each animal contributing a single mean value, irrespective of the number of technical measurements performed. For each experimental group, the value was calculated as the average of the individual animal means (n=6 per group) and used for comparisons. With this sample size, the study provides approximately 80% power to detect large, biologically meaningful effects (Cohen’s f ≈ 0.40), consistent with prior preclinical reports. Due to the relatively small sample size per group (n=6) and potential deviations from normality and equal variance, overall differences were assessed using the one-way non-parametric Kruskal-Wallis ANOVA. Pairwise Mann-Whitney U tests were performed for exploratory comparisons between groups. These comparisons are interpreted in the context of the overall Kruskal-Wallis results, providing a balance between meaningful group-level analysis and the limitations of our sample size.
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+Pearson’s product-moment correlation coefficient (Bravais-Pearson correlation) was used to assess linear associations between variables. A p value <0.05 was considered statistically significant.
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+Sample sizes, test types, and adjusted p-values are reported in the corresponding figure legends and in the results section. Statistical analyses were performed using either open-source R (R Core Team, downloadable at https://www.r-project.org/ ) or Statistical Package for the Social Sciences (v.29.0.2; IBM SPSS, Armonk, NY).
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+ 3
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+Results
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+ 3.1
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+Clinical and biochemical data
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+In this study we found that rabbits fed a HFD exhibited a marked deterioration in their metabolic profile compared to those on a regular diet ( Supplementary Table ST1 ), in perfect agreement with previous observations in this animal model ( Filippi et al., 2009 ; Maneschi et al., 2013 ; Vignozzi et al., 2014 ; Comeglio et al., 2018 ; Comeglio et al., 2021 ; Sarchielli et al., 2021 ). Accordingly, Figure 1 shows a significant increase in visceral adipose tissue (VAT) mass, expressed as a percentage of total body weight, from in HFD animals, as compared to regular diet (RD) rabbits. This VAT expansion was completely normalized by in vivo selvigaltin dosing at all doses tested (p<0.01 vs HFD + 0.3mg and HFD + 1.0mg, p<0.05 vs HFD + 5.0mg, all compared to HFD+Veh; Figure 1 ), in agreement with what was reported in a larger series of animals ( Comeglio et al., 2024 ). Figure 1
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+Selvigaltin effects on VAT weights in HFD-induced Mets model. VAT weight at the end of treatment is expressed as a percentage of total body weight and reported as mean ± SEM (n=6 for each experimental group). Statistical analysis for group comparisons was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis. * p<0.05, ** p<0.01 vs RD+Veh; ° p<0.05, °° p<0.01 vs HFD+Veh. Bar graph comparing VAT weight as a percentage of body weight for four groups: RD plus vehicle, HFD plus vehicle, and HFD with three different doses. HFD plus vehicle group shows the highest VAT weight; treatments reduce VAT weight toward RD plus vehicle levels. Statistical significance is indicated with asterisks and circles above bars.
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+ 3.2
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+Mitochondrial morphology in visceral DIM-differentiated adipocytes
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+To evaluate potential phenotypic changes in DIM-differentiated adipocytes following in vivo selvigaltin treatment, we examined mitochondrial morphology via fluorescence microscopy. Our observations ( Figures 2A, B ) revealed distinct alterations in the mitochondrial network configuration in response to HFD feeding. In cultures derived from HFD, the mitochondrial network displayed a loss of continuity, appearing primarily as short, isolated fragments rather than an interconnected network ( Figures 2A, B ). While these 2D profiles suggest an increased presence of fragmented mitochondria, further 3D structural analyses are warranted to fully characterize the network architecture. Figure 2
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+Mitochondrial fluorescence imaging with MitoTracker in DIM-differentiated adipocytes. Panels (A, B) show representative images of cells labeled with MitoTracker, with Panel (B) presenting a magnified view of one of the samples for each group, to better highlight the mitochondrial structures (red circle for HFD+Veh). These images were selected from multiple independent microscopic fields to accurately reflect the overall population phenotype. Panel (C) reports the average and the distribution of mitochondrial lengths for each experimental group. Data are shown as mean+SEM. Despite the violin density scatter plot reporting all measurements, the mean for each biological replicate (n=6 for each experimental group) has been considered for statistical purposes: the black bar in the plot indicates the average mitochondrial length derived from the means of each experimental group. Statistical analysis for group comparisons was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis. **p<0.01 vs RD+Veh; °p<0.05, °°p<0.01 vs HFD+Veh; ## p<0.01 vs HFD + 0.3mg. Panel A shows green fluorescent microscopy images of cells under five different treatments, arranged in three rows. Panel B features five similar images, some with blue or red circles highlighting specific regions. Panel C presents a violin plot comparing mitochondrial length distributions across the five treatment groups, indicating significant differences with asterisks and hash marks.
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+In contrast, in vivo selvigaltin-treated groups exhibited elongated and interconnected mitochondrial networks, closely resembling the morphology of RD DIM-differentiated adipocytes, as shown in the high magnification images in Figure 2 (panel B, blue circles). Specifically, DIM-induced adipocytes from HFD+Veh animals displayed a significant reduction in mitochondrial length (3.87 ± 0.07 µm; p<0.01) compared to RD+Veh (4.98 ± 0.04 µm; Figure 2C ), consistent with a fragmented mitochondrial network typically associated with metabolic stress and impaired bioenergetics.
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+Selvigaltin treatment appeared to normalize the mitochondrial architecture, with a partial recovery observed using 0.3 mg/kg (4.10 ± 0.06 µm; p<0.05 vs HFD+Veh), whereas doses of 1.0 and 5.0 mg/kg normalized mitochondrial length to RD+Veh levels (5.03 ± 0.02 and 4.93 ± 0.06 µm, respectively; both p<0.01 vs HFD+Veh; Figure 2C ). The violin density scatter plot shows that, in the HFD+Veh group, the majority of mitochondria clustered at very short lengths, predominantly between 1 and 2 µm, indicating a fragmented and bioenergetically compromised mitochondrial population.
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+Notably, this group also exhibited a marked depletion of mitochondria in the intermediate range (5-10 µm), a length category abundantly represented in controls and associated with metabolically competent, elongated mitochondrial networks.
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+Selvigaltin treatment progressively and significantly reshaped the distribution profile in a dose-dependent manner. Using the 5.0 mg/kg dose of selvigaltin, a clear restoration of the full spectrum of mitochondrial lengths was observed, including the reappearance of the intermediate 5-10 µm population, thus suggesting a functional recovery of mitochondrial dynamics. The distribution pattern in the higher-dose groups closely approximated that of RD DIM-differentiated adipocytes, confirming the re-establishment of a physiologically heterogeneous mitochondrial network.
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+ 3.3
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+Mitochondrial ultrastructure and cristae architecture in visceral DIM-differentiated adipocytes
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+Transmission electron microscopy (TEM) was used to evaluate mitochondrial ultrastructure and cristae organization in DIM-differentiated adipocytes ( Figure 3 ). Figure 3
+
+Mitochondrial ultrastructure imaging with TEM in DIM-differentiated adipocytes. Panels (A) and (B) show representative images of mitochondrial ultrastructure, with Panel (B) presenting a magnified view to better highlight the mitochondrial cristae (red arrows). These images were selected from multiple independent microscopic fields to accurately reflect the overall population phenotype. Panel (C) reports the average mitochondrial cristae area as percentage of the mitochondrial area. Panel (D) shows the average per cell number of cristae within each group. Data are shown as mean+SEM (n=6 for each experimental group). Statistical analysis for group comparisons was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis. *p<0.05, **p<0.01, vs RD+Veh; °p<0.05, °°p<0.01, vs HFD+Veh. Panel A shows electron microscopy images of mitochondria from five experimental mouse groups, each with three image replicates, illustrating differences in mitochondrial structure. Panel B provides higher magnification electron microscopy images from the same groups, with red arrowheads indicating cristae features. Panel C presents a bar graph quantifying mitochondrial cristae area as a percentage, showing decreased cristae area in the high-fat diet plus vehicle group compared to others. Panel D displays a bar graph of cristae number per cell, with the high-fat diet plus vehicle group showing reduced numbers relative to the reference diet group.
+
+As shown in representative TEM micrographs ( Figure 3A ), DIM-induced adipocytes from HFD+Veh animals displayed swollen and rounded mitochondria with reduced internal compartmentalization, consistent with disrupted cristae morphology. This contrasts with the elongated and electron-dense mitochondria observed in RD+Veh animals, which showed well-organized cristae structures ( Figure 3A , left column). High-magnification images ( Figure 3B ) further highlighted these alterations, showing sparse and irregular cristae in HFD+Veh mitochondria, while all doses of in vivo selvigaltin treatments restored a more compact and layered cristae pattern. Quantitative morphometric analysis confirmed these visual findings. As shown in Figure 3C , the mean cristae area was significantly reduced in HFD+Veh DIM-differentiated adipocytes (9.28 ± 0.37%) compared to RD+Veh (12.91 ± 0.32%; p<0.01).
+
+All selvigaltin treatment doses significantly increased cristae area (HFD + 0.3mg, p<0.01 vs HFD+Veh; HFD + 1.0mg and HFD + 5.0mg, both p<0.05 vs HFD+Veh), restoring it to RD levels, with the best effect at 0.3mg/kg and 1.0 mg/kg. The highest dose (5 mg/kg) maintained this recovery, with mean values of around 11.16%, in fact almost normalizing the data.
+
+In parallel, the analysis of mitochondrial cristae number ( Figure 3D ) revealed a similar trend, with the mean cristae number per cell reduced in HFD+Veh animals (7.01 ± 0.30) compared to RD+Veh (9.70 ± 1.08; p<0.05) and exhibiting a consistent upward trend across all selvigaltin-treated groups. Even though not always reaching statistical significance, selvigaltin groups ranged from 8.24 to 8.74, closely approximating RD cristae number levels, indicating a substantial restoration of the inner membrane structure.
+
+ 3.4
+
+Mitochondrial dynamics in visceral DIM-differentiated adipocytes
+
+To further investigate the impact of Gal-3 inhibition on mitochondrial integrity, both structural and dynamic parameters were evaluated in DIM-differentiated adipocytes.
+
+As previously shown ( Figures 2A–C ), mitochondria from HFD+Veh animals displayed a fragmented morphology with significantly reduced length, indicative of impaired mitochondrial fusion and turnover capacity. To assess mitochondrial dynamics, live-cell imaging and timelapse analysis were used to quantify mitochondrial motility, expressed as average displacement speed (nm/s) ( Figure 4A ). Figure 4
+
+Mitochondrial dynamics evaluation in DIM-differentiated adipocytes. Panel (A) shows the quantification of mitochondrial speed. Panel (B) represents the positive Bravais-Pearson correlation between mitochondrial speed and length reported as fold change vs RD+Veh. All data are reported as mean ± SEM (n=6 for each experimental group). Statistical analysis was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis [panel (A) ] for group comparisons, and Bravais-Pearson correlation [panel (B) ]. **p<0.01 vs RD+Veh; °°p<0.01 vs HFD+Veh; ## p<0.01 vs HFD + 0.3mg. Panel A presents a bar graph showing mitochondrial speed in nanometers per second for five groups, with the highest values in the HFD plus 1.0 mg and 5.0 mg groups and the lowest in HFD plus vehicle; symbols indicate statistical significance. Panel B shows a scatter plot correlating mitochondrial speed and mitochondrial length across the same five groups, with a strong positive correlation reported as R equals 0.901 and p less than 0.001.
+
+HFD dieting significantly reduced mitochondrial speed (78.84 ± 1.32 nm/s) compared to RD DIM-differentiated adipocytes (90.94 ± 0.95 nm/s; p<0.01), indicating a loss of mitochondrial plasticity and trafficking. Representative timelapse videos are available as Supplementary Material (Mito_< name of group > AVI files).
+
+Moreover, from the timelapse recordings, an increase in background signal was also appreciable in the HFD+Veh group, accompanied by a concomitant loss of MitoTracker signal specifically in the mitochondria, suggesting mitochondrial membrane damage upon exposure to UV-induced phototoxic stress. Notably, in vivo selvigaltin treatments showed a robust, dose-dependent increase in mitochondrial motility. Although the lowest dose (0.3 mg/kg) failed to induce a significant and consistent recovery in mitochondrial speed compared to controls, it still showed a slight improvement (81.77 ± 1.40 nm/s) compared to the HFD+Veh group.
+
+Considering the other treatment groups, mitochondrial speed was restored to RD levels and significantly increased, compared to HFD+Veh, using 1.0 and 5.0 mg/kg doses (93.26 ± 0.85 and 94.58 ± 1.12 nm/s, respectively; both p<0.01 vs HFD+Veh), suggesting enhanced organelle turnover and improved bioenergetic dynamics. Moreover, Bravais-Pearson correlation analysis revealed a strong positive relationship (R = 0.901, p<0.001) between mitochondrial length and mitochondrial speed across experimental groups, as shown in Figure 4B .
+
+ 3.5
+
+Mitochondrial oxidative capacity in visceral DIM-differentiated adipocytes
+
+To assess mitochondrial respiratory function, two complementary surrogate parameters of oxygen consumption were evaluated, namely ATP production and succinate dehydrogenase (SDH) activity. As shown in Figure 5A , ATP production was slightly reduced in HFD+Veh DIM-differentiated adipocytes, compared to RD+Veh (28.11 ± 3.93 vs 33.96 ± 3.44 absorbance/μg protein, respectively), suggesting a moderately impaired oxidative phosphorylation following HFD exposure. In vivo selvigaltin treatments showed an increasing trend across all doses, with the highest value observed at 0.3 mg/kg (55.51 ± 8.04; p<0.05 vs both RD+Veh and HFD+Veh). Interestingly, ATP levels in the other selvigaltin-treated groups also exceeded those observed in control animals, albeit without reaching statistical significance. Figure 5
+
+Oxygen consumption readouts in DIM-differentiated adipocytes. Panel (A) reports ATP production levels. ATP data was normalized over protein content (µg) of each sample. Panel (B) shows SDH activity. All data are reported as mean ± SEM (n=6 for each experimental group). Statistical analysis for group comparisons was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis. *p<0.05 vs RD+Veh; °p<0.05 vs HFD+Veh. Bar graph with two panels compares ATP production (panel A, left) and SDH activity (panel B, right) across five groups: RD+Veh, HFD+Veh, HFD+0.3mg, HFD+1.0mg, and HFD+5.0mg. Both ATP production and SDH activity are lowest in HFD+Veh and highest in HFD+0.3mg or RD+Veh, with statistical significance indicated by asterisks and circles. Error bars are present for each group.
+
+Similarly, SDH activity, an established indicator of electron transport chain integrity and tricarboxylic acid (TCA) cycle flux, was markedly reduced in HFD+Veh cells (54.01 ± 7.35% vs RD set at 100%, p<0.05) ( Figure 5B ).
+
+All selvigaltin-treated groups showed increased SDH activity compared to HFD+Veh, with values at 0.3 mg/kg (79.38 ± 7.72%), 1.0 mg/kg (82.74 ± 7.78%; p<0.05 vs HFD+Veh), and 5.0 mg/kg (84.30 ± 9.15%; p<0.05 vs HFD+Veh), suggesting a consistent improvement in mitochondrial oxidative metabolism.
+
+ 3.6
+
+ROS accumulation in visceral DIM-differentiated adipocytes
+
+To investigate the effects of the Gal-3 inhibition on intracellular oxidative stress, ROS levels were evaluated in DIM-differentiated adipocytes using DHE fluorescence imaging. Representative timelapse videos are available as Supplementary Material (ROS_< name of group > AVI files).
+
+The timelapse images ( Figure 6A ) revealed a progressive increase in the nuclear DHE signal in HFD+Veh cells, suggestive of enhanced superoxide accumulation and redox imbalance. In contrast, cells from selvigaltin-treated animals, particularly at higher doses, maintained a low-intensity DHE signal over time, comparable to RD+Veh DIM-induced adipocytes. Figure 6
+
+ROS fluorescence imaging with DHE in DIM-differentiated adipocytes. Panel (A) shows representative qualitative images of DHE acquisition signal from the timelapses for each group (T 0 = 0 sec, T 7 = 90 sec, T 12 = 180 sec). Panel (B) shows ΔDHE integrated nuclear density (% vs T 0 ) quantification. Panel (C, D) report, as fold change vs RD+Veh, the Bravais-Pearson correlation between ΔDHE integrated nuclear density and lipid droplets volume [panel (C) ] or mitochondrial length [panel (D) ]. All data are reported as mean ± SEM (RD+Veh, n=6; HFD+Veh, n=6; HFD + 0.3mg, n=5; HFD + 1.0mg, n=6; HFD + 5.0mg, n=6). Statistical analysis was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis [panel (B) ] for group comparisons, and Bravais-Pearson correlation [panels (C, D) ]. **p<0.01 vs RD+Veh; °°p<0.01 vs HFD+Veh; ## p<0.01 vs HFD + 0.3mg. Panel A contains three rows of fluorescence microscopy images showing cells from five treatment groups over three time points, with red signal indicating nuclear density changes. Panel B presents a bar graph comparing ΔDHE-integrated nuclear density percentages between groups, revealing significant decreases in HFD groups compared to RD. Panel C is a scatter plot correlating ΔDHE percentage with increased lipid droplet volume, showing a positive correlation. Panel D is a scatter plot of ΔDHE percentage versus mitochondrial length, displaying a strong negative correlation. All graphs use distinct color codes for groups and plot statistical metrics.
+
+Quantitative analysis of DHE fluorescence dynamics, shown as ΔDHE signal variation from T 0 to T 180 , confirmed these visual findings ( Figure 6B ). HFD+Veh DIM-differentiated adipocytes exhibited a significant continuance in time in nuclear ROS levels (-1.08 ± 0.14%), compared to RD+Veh (-5.48 ± 0.37%; p<0.01 vs HFD+Veh). In vivo selvigaltin treatments led to marked clearances of ROS accumulation at most doses. Whereas the 0.3 mg/kg group showed an attenuation (-1.35 ± 0.08%) similar to HFD+Veh, higher doses completely abolished the oxidative response, normalizing ΔDHE values (-5.62 ± 0.36% at 1.0 mg/kg and -5.16 ± 0.25% at 5.0 mg/kg; both p<0.01 vs HFD+Veh).
+
+To further explore the mechanistic relationships between oxidative stress and cellular phenotype, correlation analyses were performed. As shown in Figure 6C , nuclear ΔDHE signals significantly and positively correlated with lipid droplet volumes (R = 0.790; p<0.001), supporting the notion that excessive lipid accumulation promotes intracellular oxidative stress.
+
+Conversely, a strongly significant negative correlation was observed between ΔDHE levels and mitochondrial lengths (R=-0.910, p<0.001; Figure 6D ).
+
+ 3.7
+
+Lipid droplet morphology and lipid storage in visceral DIM-differentiated adipocytes
+
+To assess the impact of Gal-3 inhibition on lipid storage, BODIPY™ fluorescence imaging was performed in DIM-differentiated adipocytes to evaluate lipid droplet (LD) morphology, size, and abundance ( Figures 7A–C ). Rather than absolute 3D volumes, droplet size values represent an estimated volume calculated from 2D morphometric parameters. Cells from HFD+Veh animals exhibited an increase in LD accumulation, with apparently larger, coalescent droplets occupying a substantial portion of the cytoplasm. In contrast, RD+Veh cells displayed a fine and homogeneous distribution of smaller-sized droplets. Selvigaltin treatment markedly altered this phenotype, particularly at 1.0 and 5.0 mg/kg, where a restoration of ostensibly smaller, more evenly distributed lipid droplets was observed ( Figure 7A ). Figure 7
+
+LD fluorescence imaging with BODIPY™ in DIM-differentiated adipocytes. Panel (A) shows representative images of BODIPY™ acquisition for each group processed using an ImageJ lookup table (LUT) to enhance lipid droplet contrast and reduce background signal. These images were selected from multiple independent microscopic fields to accurately reflect the overall population phenotype. Panel (B, C) show the quantification of LD volume and number per cell, respectively. Panel (D) reports the Bravais-Pearson negative correlation between LD volumes and mitochondrial length. All data are shown as mean ± SEM [(RD+Veh, n=6; HFD+Veh, n=5; HFD + 0.3mg, n=5; HFD + 1.0mg, n=6; HFD + 5.0mg, n=6)]. Statistical analysis was performed using one-way non-parametric Kruskal-Wallis ANOVA followed by post hoc Mann-Whitney analysis [panels (B, C) ] for group comparisons, and Bravais-Pearson correlation [panel (D) ]. *p<0.05, **p<0.01 vs RD+Veh; °°p<0.01 vs HFD+Veh; # p<0.05, ## p<0.01 vs HFD + 0.3mg; ^p<0.05 vs HFD + 1.0mg. Panel A contains grayscale fluorescence microscopy images of cells under five different treatment conditions, showing lipid droplet accumulation. Panel B displays a bar graph comparing lipid droplet volume across conditions, with statistical annotations indicating significance. Panel C presents a bar graph for lipid droplet number per cell, also with significance markers. Panel D features a scatter plot showing a strong negative correlation (R = -0.865, p < 0.001) between lipid droplet volume and mitochondrial length for the different conditions.
+
+Quantitative image analysis confirmed these morphological changes, as shown in Figure 7B , with LD volume significantly elevated in HFD+Veh cells (0.95 ± 0.20 μm³) compared to RD+Veh DIM-differentiated adipocytes (0.50 ± 0.06 μm³, p<0.01). In vivo selvigaltin treatments induced a dose-dependent reduction in LD volume, with values normalized and significant effects observed at 1.0 mg/kg and 5.0 mg/kg (both p<0.01 vs HFD+Veh).
+
+As shown in Figure 7C , a moderate increase in the number of lipid droplets per cell has been detected in the HFD+Veh group (70.8 ± 7.9), compared to controls.
+
+Interestingly, the LDs per cell increased significantly in the 0.3 mg/kg DIM-induced adipocytes (113.0 ± 10.7), compared to the other groups (at least p<0.05 vs all other groups).
+
+Although not significantly, selvigaltin treatments showed a trend of normalization for this parameter at higher doses (60.8 ± 11.7 and 65.8 ± 11.6 for 1.0 and 5.0 mg/kg, respectively). Finally, a strong inverse correlation was observed between LD volume and mitochondrial length ( Figure 7D ; R=-0.865, p<0.001).
+
+ 3.8
+
+mRNA expression of genes involved in mitochondrial function, lipid storage, and inflammation
+
+As shown in Table 1 , several genes involved in mitochondrial structure and biogenesis were analyzed in mRNA extracted from DIM-differentiated adipocytes. FIS1 , MFN1 , OPA1 , and TFAM mRNA expressions, slightly increased in the HFD+Veh group compared to controls, were significantly downregulated in the selvigaltin-treated groups. Similarly, lipid handling markers PLIN1 and SNAP23 mRNA expressions were elevated in HFD+Veh DIM-differentiated adipocytes vs RD+Veh and reduced in the selvigaltin-treated groups. Additionally, BMP4 and BMP7 , two key regulators of adipocyte differentiation, showed mRNA expression decreases in selvigaltin-treated animals, compared to HFD+Veh, therefore suggesting a restoration of pro-adipogenic transcriptional programs. Gal-3 inhibition was also associated with a broad transcriptional suppression of inflammatory genes. In particular, HFD increased all canonical inflammatory markers (COX2, IL-1β, IL-6, TLR2, TLR4, TNFα) mRNA expression, whereas selvigaltin treatment suppressed this upregulation at all doses. Table 1
+
+Biomarkers mRNA expression in DIM-differentiated adipocytes. Mitochondrial markers RD+ Veh HFD+ Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. FIS1 1.00 ± 0.06 1.13 ± 0.10 0.86 ± 0.07 ° 0.95 ± 0.06 0.98 ± 0.05 MFN1 1.00 ± 0.05 1.09 ± 0.05 0.83 ± 0.05 °° 0.94 ± 0.09 0.92 ± 0.03 ° MFN2 1.00 ± 0.07 1.06 ± 0.11 0.52 ± 0.05 ** °° 0.65 ± 0.08 * ° 0.56 ± 0.09 ** ° OPA1 1.00 ± 0.10 1.10 ± 0.09 0.89 ± 0.07 0.92 ± 0.11 0.79 ± 0.04 ° TFAM 1.00 ± 0.16 1.28 ± 0.17 0.64 ± 0.07 ° 0.92 ± 0.18 0.80 ± 0.07 ° LD storage Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. PLIN1 1.00 ± 0.19 1.64 ± 0.40 1.15 ± 0.26 1.41 ± 0.43 0.85 ± 0.11 SNAP23 1.00 ± 0.10 1.21 ± 0.11 0.91 ± 0.10 0.98 ± 0.11 0.93 ± 0.06 STX5 1.00 ± 0.05 0.91 ± 0.06 0.87 ± 0.05 0.83 ± 0.03 * 0.94 ± 0.04 Adipogenic Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. ADRB3 1.00 ± 0.09 1.45 ± 0.23 0.84 ± 0.04 ° 1.47 ± 0.08 * ## 1.19 ± 0.07 ## ^ BMP4 1.00 ± 0.14 1.31 ± 0.39 0.64 ± 0.05 * 0.73 ± 0.08 0.72 ± 0.13 BMP7 1.00 ± 0.22 1.93 ± 0.33 * 0.40 ± 0.03 ° 0.78 ± 0.15 ° 0.37 ± 0.10 * ° TMEM26 1.00 ± 0.45 0.44 ± 0.13 1.35 ± 0.29 ° 0.47 ± 0.17 1.66 ± 0.34 ° ^ Inflammation Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. COX2 1.00 ± 0.29 3.04 ± 0.69 * 1.30 ± 0.65 ° 1.77 ± 0.56 0.86 ± 0.14 °° GATA3 1.00 ± 0.27 1.98 ± 0.21 * 1.03 ± 0.30 1.17 ± 0.13 ° 1.12 ± 0.19 ° IL-1β 1.00 ± 0.39 2.00 ± 0.43 0.83 ± 0.33 0.74 ± 0.38 0.30 ± 0.03 ° IL-6 1.00 ± 0.34 1.53 ± 0.57 1.20 ± 0.55 0.78 ± 0.06 0.37 ± 0.07 ° ^^ IL-8 1.00 ± 0.44 0.92 ± 0.47 0.49 ± 0.20 0.51 ± 0.19 0.05 ± 0.01 °° ## ^^ TBX21 1.00 ± 0.21 1.30 ± 0.26 0.76 ± 0.11 0.70 ± 0.08 0.57 ± 0.16 TLR2 1.00 ± 0.25 2.16 ± 0.44 0.96 ± 0.09 1.05 ± 0.20 1.06 ± 0.03 TLR4 1.00 ± 0.13 1.65 ± 0.25 0.75 ± 0.14 ° 0.66 ± 0.15 ° 0.79 ± 0.17 TNFα 1.00 ± 0.15 2.07 ± 0.65 1.46 ± 0.52 0.97 ± 0.33 0.88 ± 0.22
+
+Results are expressed as fold change vs RD+Veh and reported as mean ± SEM (RD+Veh, n=6; HFD+Veh, n=6; HFD + 0.3mg, n=6; HFD + 1.0mg, n=6; HFD + 5.0mg, n=6). Statistical analysis (Sig.) was performed using one-way non-parametric ANOVA Kruskal-Wallis test followed by post hoc Mann-Whitney analysis.
+
+*p<0.05 vs RD+Veh; °p<0.05 vs HFD+Veh; ## p<0.05 vs HFD + 0.3mg; ^p<0.05, ^^p<0.01 vs HFD + 1.0mg.
+
+Notably, the mRNA expression of GATA3 and TBX21 , transcription factors involved in immune cell polarization, was reduced in all treatment groups, compared to HFD+Veh.
+
+ Table 2 presents the mRNA expression levels in VAT homogenates for the same markers that were previously analyzed in DIM-differentiated adipocytes. Overall, the expression patterns observed in the tissue closely mirror those detected in the cultured cells. This strong concordance suggests that the in vitro adipocyte model reliably recapitulates the molecular profile of the directly harvested visceral adipose tissue. Table 2
+
+Biomarkers mRNA expression in VAT homogenates. Mitochondrial Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. FIS1 1.00 ± 0.09 1.22 ± 0.12 0.98 ± 0.15 0.91 ± 0.13 0.98 ± 0.14 MFN1 1.00 ± 0.12 1.08 ± 0.14 1.11 ± 0.15 0.99 ± 0.13 1.05 ± 0.10 MFN2 1.00 ± 0.07 1.12 ± 0.09 0.66 ± 0.14 ° 0.91 ± 0.09 0.80 ± 0.13 OPA1 1.00 ± 0.13 1.20 ± 0.13 0.99 ± 0.15 0.85 ± 0.09 ° 0.76 ± 0.11 ° TFAM 1.00 ± 0.10 1.36 ± 0.15 0.99 ± 0.16 1.03 ± 0.13 0.90 ± 0.07 ° LD storage Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. PLIN1 1.00 ± 0.20 1.51 ± 0.30 0.97 ± 0.18 0.95 ± 0.17 0.78 ± 0.14 SNAP23 1.00 ± 0.13 1.34 ± 0.19 1.12 ± 0.17 0.92 ± 0.14 1.09 ± 0.13 STX5 1.00 ± 0.10 0.99 ± 0.11 0.86 ± 0.13 0.79 ± 0.11 0.85 ± 0.09 Adipogenic Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. ADRB3 1.00 ± 0.13 1.40 ± 0.28 0.93 ± 0.16 1.11 ± 0.16 0.96 ± 0.14 BMP4 1.00 ± 0.26 1.35 ± 0.19 0.76 ± 0.23 ° 0.83 ± 0.17 0.80 ± 0.18 BMP7 1.00 ± 0.17 1.82 ± 0.56 * 0.89 ± 0.16 ° 1.08 ± 0.19 0.74 ± 0.12 °° TMEM26 1.00 ± 0.25 0.86 ± 0.16 1.10 ± 0.25 0.79 ± 0.25 0.92 ± 0.16 Inflammation Markers RD+Veh HFD+Veh Sig. HFD+0.3mg Sig. HFD+1.0mg Sig. HFD+5.0mg Sig. COX2 1.00 ± 0.22 2.02 ± 0.25 * 1.26 ± 0.26 ° 1.63 ± 0.45 1.31 ± 0.10 ° GATA3 1.00 ± 0.10 1.48 ± 0.22 1.06 ± 0.18 1.32 ± 0.22 0.98 ± 0.10 ° IL-1β 1.00 ± 0.22 1.73 ± 0.61 0.85 ± 0.28 0.64 ± 0.13 0.89 ± 0.29 IL-6 1.00 ± 0.17 1.47 ± 0.38 1.07 ± 0.24 0.66 ± 0.19 0.73 ± 0.11 IL-8 1.00 ± 0.45 1.01 ± 0.23 0.52 ± 0.17 0.52 ± 0.13 0.39 ± 0.07 TBX21 1.00 ± 0.17 1.24 ± 0.37 0.98 ± 0.14 0.87 ± 0.29 0.86 ± 0.18 TLR2 1.00 ± 0.16 1.61 ± 0.34 1.07 ± 0.25 0.80 ± 0.15 ° 0.73 ± 0.14 ° TLR4 1.00 ± 0.14 1.67 ± 0.22 * 0.94 ± 0.16 ° 0.87 ± 0.14 ° 0.71 ± 0.12 ° TNFα 1.00 ± 0.18 1.61 ± 0.49 1.49 ± 0.76 0.94 ± 0.27 0.75 ± 0.10
+
+Results are expressed as fold change vs RD+Veh and reported as mean ± SEM (RD+Veh, n=6; HFD+Veh, n=7; HFD + 0.3mg, n=7; HFD + 1.0mg, n=7; HFD + 5.0mg, n=7). Statistical analysis (Sig.) was performed using one-way non-parametric ANOVA Kruskal-Wallis test followed by post hoc Mann-Whitney analysis.
+
+*p<0.05 vs RD+Veh; °p<0.05, °°p<0.01 vs HFD+Veh.
+
+Most likely, the lack of significance when analyzing several molecular markers is due to the relatively high intragroup variability accompanied to the small size of the groups. However, trends of mRNA expression still clearly show a beneficial effect of selvigaltin treatment regarding the HFD-induced biomarkers alterations.
+
+ 4
+
+Discussion
+
+The present study is a spinoff of a previous larger study aimed at investigating the effect of a galactin-3 inhibitor (selvigaltin) on MASLD ( Comeglio et al., 2024 ). During the course of that study, we noticed that selvigaltin induced a consistent decrease in HFD-induced VAT accumulation. The aim of the present study was to investigate in depth the metabolic phenotype of visceral preadipocytes isolated from a subset of rabbits treated in vivo with selvigaltin, in comparison with those obtained from untreated HFD animals and healthy controls. rPADs were collected at the end of the in vivo treatment, subsequently cultured and induced in vitro to become DIM-differentiated adipocytes.
+
+This approach allowed us to assess the effects of in vivo pharmacological inhibition of Gal-3 on the functionality of DIM-differentiated adipocytes, focusing on key features of mature adipocyte biology, such as mitochondrial morphology and respiration, ATP production, adipogenic differentiation capacity, and inflammatory marker expression. Morphological, molecular, and functional analyses of DIM-differentiated visceral preadipocytes demonstrate that selvigaltin exerts a broad protective effect on mitochondrial structure, oxidative balance, and inflammatory signalling pathways.
+
+All functional assessments were performed in DIM-differentiated adipocytes derived from isolated preadipocytes, confirming that the observed effects of in vivo selvigaltin administration accurately reflect adipocyte functionality under controlled experimental conditions. As previously reported, mitochondrial dysfunction is a defining feature of metabolically impaired adipocytes in MetS ( Wang et al., 2013 ; Woo et al., 2019 ; Heinonen et al., 2020 ). Mitochondrial dysfunction is a central factor in visceral fat accumulation, as it disrupts lipid oxidation, elevates oxidative stress, and triggers chronic inflammation ( Xia et al., 2024 ). In obese individuals with hypertriglyceridemia, visceral adipose tissue exhibits heightened mitophagy and reduced mitochondrial content, which aligns with impaired lipid metabolism ( Mela et al., 2022 ).
+
+This mitochondrial impairment can persist even after weight loss, reflecting sustained metabolic reprogramming ( Breininger et al., 2019 ). Reactive oxygen species generated by dysfunctional mitochondria activate pro-inflammatory pathways within visceral fat depots ( Parasiliti-Caprino et al., 2022 ).
+
+In our model, HFD exposure induced substantial alterations in mitochondrial morphology, including reduced length, motility, and cristae area, hallmarks of fragmentation and compromised bioenergetic integrity ( Jheng et al., 2012 ). In vivo selvigaltin restored these parameters largely in a dose-dependent fashion, with mitochondrial length and velocity normalized at doses ≥1.0 mg/kg. This suggests enhanced fusion-fission dynamics and organelle turnover, in line with previous reports linking mitochondrial dynamics to adipocyte metabolic flexibility ( Liesa and Shirihai, 2013 ; Rovira-Llopis et al., 2017 ). Likewise, cristae area was significantly improved by treatment, reaching normalized values at low doses (0.3-1.0 mg/kg), while the cristae number showed a discernible trend toward recovery.
+
+These benefits were accompanied by a marked attenuation of oxidative stress, with DHE fluorescence imaging revealing a strong reduction in ROS accumulation in in vivo selvigaltin-treated DIM-differentiated adipocytes. The correlation between ROS levels and mitochondrial length further supports a causal link between organelle integrity and redox homeostasis. These findings align with the view that mitochondrial fragmentation exacerbates oxidative stress in dysfunctional adipocytes ( Furukawa et al., 2004 ; Mailloux et al., 2013 ; Maneschi et al., 2013 ; Comeglio et al., 2018 ). In addition, selvigaltin modulated lipid storage capacity, where HFD-induced LD hypertrophy and increased droplet number were reversed by in vivo selvigaltin treatment, with LD volume returning to values comparable to healthy controls at higher doses.
+
+These changes were paralleled by the transcriptional downregulation of PLIN1 and SNAP23 , suggesting reduced lipid accumulation and membrane trafficking ( Jägerström et al., 2009 ; Sztalryd and Brasaemle, 2017 ), and pointing to a functional reprogramming of DIM-differentiated adipocytes toward a metabolically favourable phenotype ( Wu et al., 2012 ; Harms and Seale, 2013 ).
+
+Notably, in DIM-induced adipocytes BMP4 and BMP7 mRNA expression was substantially downregulated by selvigaltin in a dose-dependent manner, compared to HFD+Veh and controls. Both variables showed a similar trend, although only BMP7 reached statistical significance. While both factors are implicated in adipogenic and browning programs ( Wu et al., 2012 ; Modica and Wolfrum, 2013 ), some studies suggests that their overexpression in the context of obesity may contribute to maladaptive VAT remodelling and fibrosis ( Tseng et al., 2008 ; Modica et al., 2016 ). Thus, the observed suppression of BMP4 and BMP7 may reflect a normalization of pathological adipogenic signalling, consistent with improved tissue homeostasis following Gal-3 inhibition ( Pejnovic et al., 2013 ).
+
+Inflammatory markers gene expression was also significantly attenuated in these cells. HFD induced a marked upregulation of canonical inflammatory markers ( COX2, IL-6 , TLR2 , TLR4 , TNFα ), all of which were appreciably reduced across selvigaltin-treated groups. These effects likely reflect the known role of Gal-3 in modulating macrophage polarization and cytokine release within VAT ( Sano et al., 2003 ; Pejnovic et al., 2013 ; Li et al., 2014 ; Martínez-Martínez et al., 2016 ). Considering IL-1β , IL-8 , and transcription factors such as GATA3 and TBX21 evident changes, a general anti-inflammatory shift was clear in the mRNA expression profile of selvigaltin-treated groups.
+
+The similarity between markers expression in VAT and DIM-differentiated adipocytes suggests that the behavior of the latter reflects the physiological state of the donor animal’s visceral adipose tissue. This concordance provides additional confidence that the in vitro differentiation results are representative of in vivo conditions and support the relevance of our findings to metabolic health in the different experimental groups.
+
+While SDH activity showed a significant change in the HFD+Veh group, normalized by higher doses of selvigaltin, ATP production did not quite reach statistical significance. However, both parameters exhibited a consistent upward trend following selvigaltin administration. This is consistent with previous evidence showing that improving mitochondrial structure enhances oxidative phosphorylation efficiency and cellular bioenergetics ( Pagliarini et al., 2008 ; Guerrier et al., 2023 ).
+
+These results, taken together with the normalization of mitochondrial morphology and suppression of oxidative stress, following HFD-induced abnormalities, suggest a partial restoration of mitochondrial function that may require further exploration under more sensitive or prolonged experimental conditions.
+
+Some limitations of the present study should be acknowledged. First, the sample size of experimental animals per group was relatively small, which may restrict the generalization of minor phenotypic trends. Nevertheless, it provides approximately 80% power to detect biologically meaningful effects, consistent with prior preclinical reports, also balancing the statistical rigor with the ethical principle of responsible animal use. Second, since mRNA levels do not always mirror functional protein abundance due to post-transcriptional modifications and varying translation efficiencies, our findings regarding inflammatory factors and adipocyte-specific markers should be interpreted as potential pathways under active regulation rather than definitive protein-level changes. Future studies utilizing high-throughput proteomics and functional mitochondrial respiration assays are warranted to fully validate these metabolic transitions at the translational level. Finally, a limitation of this study is that analyses were primarily performed on preadipocytes isolated from VAT, with ex vivo assessments focusing on differences in visceral fat between groups. While DIM-induced differentiation reflects the health status of the donor animal’s preadipocytes, this approach does not capture all in vivo complexities. mRNA analyses in VAT homogenates largely mirrored the findings in differentiated adipocytes, but results should still be interpreted with this limitation in mind.
+
+Oral Gal-3 inhibitor selvigaltin has been shown to significantly reduce visceral fat in high-fat diet models, potentially by mitigating Gal-3-driven inflammation. In diet-induced obese mice, Gal-3 mRNA and protein are markedly enriched in the stromal-vascular fraction of VAT, with the highest intracellular levels detected in CD11c+ pro-inflammatory adipose tissue macrophages ( Rhodes et al., 2013 ). Consistent with these data, human and mouse studies have shown that Gal-3 is expressed by both adipocytes and infiltrating macrophages ( Pang et al., 2013 ; Baek et al., 2015 ). By modulating the inflammatory microenvironment, selvigaltin may support mitochondrial restoration and metabolic improvement. Overall, this study expands the current understanding of Gal-3 contribution to VAT dysfunction and identifies selvigaltin as a promising pharmacological tool to counteract metabolic-syndrome induced visceral adipocyte homeostasis and health alterations. By promoting mitochondrial remodelling, limiting oxidative stress, and dampening inflammation, Gal-3 inhibition may offer therapeutic benefits in metabolic disorders characterized by visceral obesity and adipose tissue dysfunction.
+
+Additional research is needed to clarify its therapeutic value in treating visceral obesity.
+
+============================================================
+SOURCE: PMC13391522.txt (TXT)
+============================================================
+
+Reduced CH25H expression defines a high membrane fluidity, trogocytosis active state in colon cancer stem cells
+
+Expression signatures with specificity for type I and II IFN response and relevance for autoimmune diseases and cancer
+
+Cancer stem cells revisited
+
+The transcription factor STAT-1 couples macrophage synthesis of 25-hydroxycholesterol to the interferon antiviral response
+
+Metastatic recurrence in colorectal cancer arises from residual EMP1(+) cells
+
+Modeling development and disease with organoids
+
+Lipid metabolism dynamics in cancer stem cells: potential targets for cancers
+
+Cancer stem cells in colorectal cancer: signaling pathways involved in stemness and therapy resistance
+
+Dictionary learning for integrative, multimodal and scalable single-cell analysis
+
+The role of lipid rafts in T cell antigen receptor (TCR) signalling
+
+Characterization and application of a new optical probe for membrane lipid domains
+
+What is trogocytosis and what is its purpose?
+
+Improved reconstruction of single-cell developmental potential with CytoTRACE 2
+
+Diagnosis and therapeutic targeting of quiescent cancer cells: road to conquer cancer recurrence
+
+Fast, sensitive and accurate integration of single-cell data with harmony
+
+Metabolic reprogramming of the tumor microenvironment to enhance immunotherapy
+
+Lipid rafts as a membrane-organizing principle
+
+ATF3 and CH25H regulate effector trogocytosis and anti-tumor activities of endogenous and immunotherapeutic cytotoxic T lymphocytes
+
+IL-1β/TNF-α/IL-6 inflammatory cytokines promote STAT1-dependent induction of CH25H in zika virus-infected human macrophages
+
+Signaling of short- and long-term regulation of intestinal epithelial type 1 Na+/H+ exchanger by interferon-gamma
+
+UMAP: uniform manifold approximation and projection
+
+Stearoyl-CoA desaturase-1 is a key factor for lung cancer-initiating cells
+
+A human colon cancer cell capable of initiating tumour growth in immunodeficient mice
+
+Functional interfaces, biological pathways, and regulations of interferon-related DNA damage resistance signature (IRDS) genes
+
+Regulation of metabolic plasticity in cancer stem cells and implications in cancer therapy
+
+Stem cells, cancer, and cancer stem cells
+
+Identification and expansion of human colon-cancer-initiating cells
+
+Interferon control of the sterol metabolic network: bidirectional molecular circuitry-mediating host protection
+
+Human intestinal spheroids cultured using sacrificial micromolding as a model system for studying drug transport
+
+Interferon-stimulated genes: a complex web of host defenses
+
+Trogocytosis and fratricide killing impede MSLN-directed CAR T cell functionality
+
+Dickkopf-2 regulates the stem cell marker LGR5 in colorectal cancer via HNF4α1
+
+Colon cancer cells acquire immune regulatory molecules from tumor-infiltrating lymphocytes by trogocytosis
+
+Functional rafts in cell membranes
+
+Plastic persisters: revival stem cells in colorectal cancer
+
+The ultimate qPCR experiment: producing publication quality, reproducible data the first time
+
+Analyzing T-Cell plasma membrane lipids by flow cytometry
+
+Preserved genetic diversity in organoids cultured from biopsies of human colorectal cancer metastases
+
+Targeting a lipid desaturation enzyme, SCD1, selectively eliminates Colon cancer stem cells through the suppression of wnt and NOTCH signaling
+
+Introduction
+
+Trogocytosis enables direct membrane exchange between contacting cells and has recently been implicated in tumor immune evasion. However, the cellular states and molecular mechanisms that regulate cancer cell trogocytosis remain largely unknown. Here, we investigated whether trogocytosis differs between cancer stem cells (CSCs) and non-stem cancer cells (non-CSCs) in colorectal cancer.
+
+Methods
+
+Three-dimensional spheroid cultures of Caco-2, HCT116, and HT-29 colorectal cancer cells were used to enrich CSCs. Trogocytosis was quantified by co-culture with membrane-labeled Jurkat T cells via flow cytometry. Membrane fluidity, gene expression, STAT1 phosphorylation, and publicly available human colorectal cancer single-cell RNA-seq datasets were analyzed to investigate the underlying mechanisms.
+
+Results
+
+3D spheroid culture enriched CSC populations and markedly increased trogocytic membrane transfer from Jurkat T cells to tumor cells. Within spheroids, CSCs acquired significantly higher levels of T cell-derived membrane proteins and membrane components than non-CSCs, indicating preferential enhancement of trogocytosis in CSCs. Membrane order analysis revealed reduced membrane order and increased membrane fluidity in CSCs. Quantitative PCR analysis demonstrated reduced expression of cholesterol 25-hydroxylase (CH25H) and cholesterol efflux-related genes in CSCs Because CH25H is an interferon-responsive gene downstream of STAT1 signaling, we next examined STAT1 activity. CSCs exhibited reduced STAT1 phosphorylation, which was associated with enhanced trogocytic membrane acquisition. Furthermore, activation of STAT1 signaling by IFN-γ reduced the CSC population and suppressed trogocytosis. Analysis of human colorectal cancer single-cell RNA-sequencing datasets further supported an association between reduced STAT1 signaling and decreased CH25H expression.
+
+Discussion
+
+These findings identify a CH25H-low CSC state characterized by increased membrane fluidity and enhanced trogocytosis. Reduced STAT1-CH25H signaling may promote membrane biophysical remodeling that facilitates trogocytosis in colon cancer stem cells and contributes to tumor progression and immune evasion.
+
+Introduction
+
+Trogocytosis is a dynamic and contact-dependent cellular process in which a cell acquires plasma membrane fragments, including functional membrane proteins, from another cell during direct contact ( Joly and Hudrisier, 2003 ). Unlike phagocytosis, the transferred membrane proteins retain their surface localization and functional activity in recipient cells. In the tumor microenvironment, cancer cells can acquire immune-regulatory molecules such as CTLA-4 and TIM-3 via trogocytosis, thereby contributing to immune evasion ( Shin et al., 2021a ). In addition, recent studies have shown that tumor cells impair chimeric antigen receptor (CAR)-T cell function by acquiring CAR molecules through trogocytosis ( Lu et al., 2022 ; Schoutrop et al., 2022 ). While these studies demonstrate that cancer cells are capable of trogocytosis, most prior research has primarily focused on immune cell-mediated trogocytosis. Therefore, whether distinct tumor cell subtypes differ in their intrinsic ability to perform trogocytosis remains unknown.
+
+In our previous study, we demonstrated that carcinogenesis promotes trogocytosis activity ( Shin et al., 2021b ). Using genetically defined murine colon cancer organoids, we showed that organoids carrying mutations in Apc, Kras, Tp53, and Smad4 genes exhibited approximately a two-fold increase in trogocytic activity compared with organoids carrying Apc mutation alone. Given that the quadruple mutant organoids represent metastatic colon cancers while Apc -only mutant organoids model benign tumors, these findings suggest that trogocytic activity is strongly associated with tumor progression and carcinogenesis.
+
+Cancer stem cells (CSCs) represent a subpopulation of tumor cells endowed with self-renewal capacity and enhanced tumor-initiating and metastatic potential ( Reya et al., 2001 ; Batlle and Clevers, 2017 ; Kim, 2025 ). Emerging evidence indicates that CSC frequency increases during tumor progression and metastasis across multiple cancer types, including colorectal cancer ( O’Brien et al., 2007 ; Ricci-Vitiani et al., 2007 ). Colorectal CSCs have been implicated in therapy resistance, relapse, and dissemination to distant organs, and their dynamic plasticity is considered a key driver of metastatic progression ( Batlle and Clevers, 2017 ). However, whether CSCs exhibit distinct trogocytic behavior compared with non-stem cancer cells (non-CSCs) has not been investigated.
+
+Here, we directly compared trogocytic activity between CSCs and non-CSCs using Caco-2, HCT116 and HT-29-derived spheroids. We demonstrate that CSCs exhibit elevated trogocytosis compared with their non-stem counterparts. Moreover, we identify reduced expression of cholesterol 25-hydroxylase (CH25H) as a defining feature of CSCs. CH25H is a key enzyme involved in oxysterol metabolism and interferon-regulated cholesterol homeostasis ( Blanc et al., 2013 ; Robertson and Ghazal, 2016 ; Lu et al., 2022 ). Our data show that decreased CH25H expression is associated with increased membrane fluidity, providing a mechanistic link between plasma membrane biophysics and trogocytic activity. Finally, integration with human colorectal cancer single-cell RNA sequencing data supports the clinical relevance of this regulatory axis. These findings reveal that a CH25H-low, membrane-fluidity-high phenotype defines a trogocytosis-active state in colon cancer stem cells.
+
+Methods
+
+Cell culture
+
+Human colorectal cancer cell lines (Caco-2, HCT116 and HT-29) were maintained in complete DMEM (CM-DMEM) consisting of Dulbecco’s Modified Eagle Medium (DMEM) supplemented with 10% fetal bovine serum (FBS) and 1% penicillin-streptomycin. Cells were cultured in 100-mm culture dishes at 37 °C in a humidified incubator with 5% CO 2 . Culture medium was replaced every 2 days. During medium exchange, cells were gently washed with phosphate-buffered saline (PBS) to remove residual serum and cellular debris before fresh medium was added. Caco-2, HCT116 and HT-29 cells were routinely passaged every 3–4 days when they reached approximately 80%–90% confluence using trypsin-EDTA. For spheroid experiments, cells were expanded under adherent conditions and used when cell viability exceeded 98%. Jurkat T cells were maintained in suspension culture in RPMI-1640 medium supplemented with 10% FBS and 1% penicillin-streptomycin at 37 °C in a humidified incubator with 5% CO 2 . Cells were maintained at logarithmic growth density by periodic dilution with fresh medium.
+
+Three-dimensional spheroid culture
+
+Caco-2, HCT116 and HT-29 spheroids were generated using two Matrigel-based three-dimensional (3D) culture formats depending on the experimental objective: a Matrigel bed method for functional analysis of trogocytosis and a Matrigel dome method for enrichment of CSCs populations ( Supplementary Figure 1A ) ( Clevers, 2016 ; Samy et al., 2019 ). Adherent Caco-2, HCT116 and HT-29 cells were dissociated into single cells using trypsin-EDTA and resuspended in spheroid culture medium. Cell suspensions with viability greater than 98% were used for subsequent experiments. The spheroid medium consisted of a 1:1 mixture of Advanced DMEM/F-12 and CM-DMEM containing low glucose and 5% fetal bovine serum (FBS), supplemented with B-27 (1%) and penicillin-streptomycin (1%) ( Supplementary Figure 1B ). Matrigel (Corning® Matrigel® Growth Factor Reduced Basement Membrane Matrix, phenol red-free, LDEV-free, Corning Cat. No. 356231) was mixed with spheroid medium at a 1:1 ratio and dispensed into round-bottom 96-well plates (50 μL per well). After polymerization at 37 °C for 30 min, cells were seeded onto the Matrigel layer at a density of 2 × 10 3 cells per well in 200 μL spheroid medium. This format was used for experiments designed to evaluate trogocytosis, as it allowed uniform spheroid formation and efficient recovery of cells for flow cytometry analysis. For the Matrigel dome method, cells were mixed with Matrigel at a 1:1 ratio and plated as dome structures at a density of 3 × 10 3 cells per dome. After gelation at 37 °C for 30 min, spheroid medium was gently added to cover the domes. This culture condition was used to promote stable 3D growth and to increase the proportion of CSC populations. Cultures were maintained at 37 °C in an incubator with 5% CO 2 and the media was replaced every 2 days. Under these conditions, cells progressively aggregated and formed compact spheroid structures, which were used for downstream analyses at the indicated time points.
+
+DiD labeling of Jurkat T cells
+
+Jurkat T cells were labeled with DiD at a ratio of 5 μL per 1 × 10 6 cells. The cell suspension was incubated in a 37 °C water bath for 15 min. After labeling, cells were washed with PBS and resuspended in either CM-DMEM or spheroid culture medium depending on the subsequent co-culture condition.
+
+Co-culture conditions
+
+DiD-labeled Jurkat T cells were added at a 5:1 ratio (Parental or spheroid cells:Jurkat T cells). Prior to co-culture, the existing medium in each well was carefully removed to minimize dilution. Jurkat T cells prepared at the calculated ratio were then added directly to the wells, and co-culture was maintained for 24 h at 37 °C in an incubator with 5% CO 2 . For signaling analysis experiments, Jurkat T cells were added without DiD labeling to avoid potential interference from membrane dyes during downstream staining and fluorescence detection. In these experiments, Caco-2 spheroids and Jurkat T cells were co-cultured at a 1:1 ratio for 24 h prior to flow cytometric analysis.
+
+Transwell co-culture assay
+
+To evaluate contact-dependent trogocytosis, transwell co-culture experiments were performed using Transwell permeable supports (0.4 μm pore size, Corning, Cat. No. 3412). Caco-2 spheroids were generated using a Matrigel bed method adapted for the transwell system. Briefly, Matrigel was mixed with spheroid culture medium at a 1:1 ratio and dispensed into each well (1.1 mL per well), followed by polymerization at 37 °C for 30 min. Caco-2 cells were then seeded onto the Matrigel layer at a density of 5 × 10 4 cells per well and cultured for 6 days to allow spheroid formation.
+
+DiD-labeled Jurkat T cells were prepared as described above and seeded into the upper transwell insert at a 5:1 ratio relative to Caco-2 spheroid cells. Co-culture was maintained for 24 h at 37 °C in a humidified incubator with 5% CO 2 . This configuration physically separated Jurkat T cells from spheroids while allowing exchange of soluble factors. Cells were subsequently harvested and processed for flow cytometric analysis as described above.
+
+Flow cytometry analysis
+
+Cells were harvested after co-culture for flow cytometric analysis. Jurkat T cells in suspension were first collected into 15 mL conical tubes. For spheroid cultures, Matrigel (bed or dome) matrices were mechanically disrupted using culture medium followed by PBS washing to recover all cells. Cell pellets were obtained by centrifugation and dissociated with TrypLE for 10 min at 37 °C, with vortexing every 5 min. Cells were washed with PBS and resuspended for staining. For surface staining, cells were incubated for 30 min at 4 °C in the dark with the following antibodies: CD44 monoclonal antibody (IM7), eFluor™ 450 (eBioscience) at 1:80 dilution and CD133 (Prominin-1) monoclonal antibody (13A4), PE (eBioscience) at 1:20 dilution. In experiments requiring spectral compatibility with membrane probes, CD133 (Prominin-1) monoclonal antibody (TMP4), APC (eBioscience) was used instead of PE. For intracellular detection of LGR5, surface staining was performed first, followed by fixation and permeabilization using the True-Nuclear™ Transcription Factor Buffer Set (BioLegend, Cat. No. 424401). Cells were fixed in 1× fixation buffer for 20 min at room temperature, washed twice with PBS, and incubated in 1× perm buffer containing Fc block for 5 min at room temperature. Cells were then stained with anti-LGR5 mouse monoclonal antibody (OTIA2), Daylight 488 conjugate at 1:200 dilution for 20 min at 4 °C in the dark, washed, and resuspended in PBS for acquisition. For detection of phosphorylated STAT1 (Tyr701), cells were stained with rabbit monoclonal anti-phospho-STAT1 antibody (clone 1F23, Sigma-Aldrich, Cat. No. ZRB1520) at 1:200 dilution, followed by Alexa Fluor 647-conjugated goat anti-rabbit IgG (H + L) secondary antibody (Thermo Fisher Scientific, Cat. No. A21244) at a final dilution of 1:2000. To assess trogocytosis, Jurkat T cells were labeled with the lipophilic dye DiD. DiD was added at 5 µL per 1 × 10 6 cells, diluted in PBS, and incubated for 15 min at 37 °C. Labeled cells were washed with PBS and used for co-culture experiments. Membrane lipid order was assessed using the polarity-sensitive probe di-4-ANEPPDHQ (Invitrogen, Thermo Fisher Scientific, Cat. No. D36802 ). Cells were stained with 0.25 μM di-4-ANEPPDHQ for 7 min at room temperature in the dark and immediately analyzed by flow cytometry. Fluorescence was collected in the B585 channel (high-order membrane state) and the B610 channel (low-order membrane state). All samples were analyzed on a flow cytometer after singlet gating, and marker-positive populations and dye transfer were quantified using FlowJo software.
+
+Membrane fluidity measurement by di-4-ANEPPDHQ
+
+Membrane lipid order was evaluated using the polarity-sensitive fluorescent probe di-4-ANEPPDHQ (Invitrogen, Cat. No. D36802 ) ( Jin et al., 2006 ; Waddington et al., 2019 ). Cells were harvested from 2D cultures or spheroids and washed once with PBS. The cell pellets were resuspended in PBS containing 0.25 μM di-4-ANEPPDHQ and incubated for 7 min at room temperature in the dark. After staining, cells were immediately analyzed by flow cytometry without fixation. The dye exhibits a spectral shift depending on membrane lipid packing, allowing discrimination between ordered and disordered membrane states ( Jin et al., 2006 ). Fluorescence signals were collected using the B585 channel (high-order/ordered membrane) and the B610 channel (low-order/disordered membrane). Membrane lipid order was quantified by calculating the generalized polarization (GP) value for each population as previously described ( Jin et al., 2006 ). GP was calculated from the geometric mean fluorescence intensity of the two channels using the following formula: G P = I B 585 − I B 610 I B 585 + I B 610 where I B 585 and I B 610 represent the geometric mean fluorescence intensity in the B585 (ordered) and B610 (disordered) channels, respectively. GP values range from −1 to +1, with higher GP values indicating more ordered (less fluid) membranes. For CSC-specific analysis, cells were co-stained with anti-CD133 antibody (Prominin-1) Monoclonal Antibody (TMP4, APC, eBioscience) prior to di-4-ANEPPDHQ acquisition, and GP values were calculated within gated populations.
+
+RNA isolation and quantitative PCR
+
+Total RNA was isolated from spheroids using the miRNeasy Mini Kit (QIAGEN, Cat. No. 217004) according to the manufacturer’s instructions. Cells were lysed in QIAzol Lysis Reagent (QIAGEN) and phase separation was performed using chloroform, followed by column-based RNA purification. RNA concentration and purity were measured using a DS-11 FX microvolume spectrophotometer (DeNovix Inc.). For complementary DNA (cDNA) synthesis, 1 μg of total RNA was reverse-transcribed using AccuPower® CycleScript RT PreMix (dT20) (Bioneer) according to the manufacturer’s protocol. Quantitative real-time PCR (qPCR) was performed using Dyne qPCR 2× PreMIX (SYBR Green with low ROX) (DyneBio) on a CFX Opus 96 Real-Time PCR System (Bio-Rad). Gene expression levels were analyzed using gene-specific primers for target genes, and HPRT was used as housekeeping control. Relative gene expression levels were calculated using the comparative Ct method as previously described ( Taylor et al., 2019 ). Briefly, the threshold cycle difference between the target gene and HPRT was determined as: Δ C t = C t t a r g e t − C t H P R T
+
+Relative expression levels were then calculated as: Relative e x p r e s s i o n = 2 − Δ C t and presented as expression normalized to HPRT .
+
+Quantitative PCR reactions were performed in four technical replicates for each target gene. Data are presented as mean ± standard deviation (SD). Statistical analyses were performed using GraphPad Prism software (version X; GraphPad Software). Differences between CSCs and non-CSCs were evaluated using a two-tailed unpaired Student’s t-test, and a p-value <0.05 was considered statistically significant.
+
+Single-cell RNA-sequencing data analysis
+
+Publicly available single-cell RNA-sequencing data were obtained from the Genome Sequence Archive (GSA) under accession code HRA007643 and analyzed in this study. Filtered gene-barcode matrices from primary human colorectal cancer samples were imported into R and analyzed using Seurat (version 5.2.1) ( Hao et al., 2024 ). Expression matrices were read using Read10X and converted into Seurat objects with Create Seurat Object, requiring at least three cells per gene and 200 features per cell. Individual samples were merged into a unified object for downstream analysis. Quality control filtering was performed based on the number of detected genes and mitochondrial transcript percentage. Cells with mitochondrial RNA content exceeding a sample-specific threshold (median +3 × MAD, capped at 30%) were removed. Cells were further filtered to retain those with 300–8,000 detected genes, and potential multiplets were excluded using sample-specific cutoffs for total UMI counts. Data were normalized using log-normalization, and the top 2,000 highly variable genes were identified using the “vst” method. During data scaling, mitochondrial transcript percentage was regressed out. Dimensionality reduction was performed using principal component analysis (PCA), and the first 12 principal components were used for neighbor graph construction, clustering, and visualization using Uniform Manifold Approximation and Projection (UMAP) ( McInnes et al., 2018 ). Cell type annotation was performed based on canonical marker genes representing epithelial/tumor, immune, stromal, and endothelial lineages. Tumor epithelial cells were subsequently subset for further analysis. Developmental potential within the tumor epithelial population was estimated using CytoTRACE2 (version 1.1.0) applied to raw count matrices ( Kang et al., 2025 ). The subset was reprocessed including normalization, variable feature detection, scaling, PCA, clustering, and UMAP visualization. To correct for inter-sample batch effects, data integration was performed using the Harmony R package with sample identity as the integration variable (version 1.2.3) ( Korsunsky et al., 2019 ). Harmony-corrected embeddings were used for neighbor detection, clustering, and visualization. Stem-like tumor cells were inferred based on CytoTRACE2 scores and stemness marker expression. Cells were stratified into CH25H-high and CH25H-low groups based on the median CH25H expression level within each analyzed subset. Module scores were calculated using Seurat’s Add Module Score function for gene programs associated with stemness, WNT signaling, STAT1/interferon signaling, and lipid synthesis. Statistical significance for comparisons of gene expression and module scores between groups was assessed using the two-sided Wilcoxon rank-sum test.
+
+Results
+
+3D spheroid culture transiently enriches a cancer stem cell population in Caco-2 cells
+
+Previous studies have demonstrated that 3D spheroid culture enriches CSC populations relative to conventional 2D culture ( Weeber et al., 2015 ; Clevers, 2016 ). To establish an experimental system for comparing trogocytosis between CSCs and non-CSCs, we first generated Caco-2 spheroids under optimized 3D culture conditions ( Supplementary Figures 1A,B ). In contrast to 2D-cultured Caco-2 cells, dissociated cells cultured in 3D readily aggregated to form compact multicellular spheroids ( Figure 1A ). Time-course imaging revealed progressive spheroid formation accompanied by a significant increase in spheroid diameter ( Figure 1B ). By day 5, spheroids displayed a well-organized architecture characterized by a distinct outer epithelial layer and detached dying cells in the interior. Notably, this structural organization was reproducibly observed under both Matrigel bed and dome culture conditions ( Figure 1C ). FIGURE 1
+
+Increased cancer stem cell population in Caco-2 spheroids compared with 2D culture. (A) Representative bright-field images of Caco-2 cells cultured under conventional 2D conditions and 3D spheroid culture using the Matrigel bed format. Images show parental Caco-2 monolayer cells and day-6 spheroids formed under 3D culture conditions. Scale bars, 100 μm. (B) Time-course images show progressive spheroid formation following single-cell dissociation during 3D culture (day 2–6). Quantification of spheroid diameter over time shows progressive spheroid enlargement. Statistical significance was determined using mixed effects analysis followed by Dunnett’s multiple comparisons test. (C) Representative bright-field images comparing spheroids generated using Matrigel bed and dome culture formats. (D) Flow cytometry analysis of CD44 and CD133 expression in bed-derived spheroids compared with parental cells shows increased CD44 + CD133+ CSC population under spheroid culture conditions. (E) Time-dependent flow cytometry analysis of the CSC marker CD133 and LGR5 during dome spheroid culture. Statistical significance was determined using one-way ANOVA followed by Dunnett’s multiple comparisons test. Data are presented as mean ± SD from independent experiments. Spheroid diameter analysis (B) was performed by measuring 24–40 individual spheroids per time point, and flow cytometry analyses (D,E) were performed from three independent experiments (n = 3). *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001. Panel A shows microscopic images comparing Caco-2 parental cells to Caco-2 cells grown as spheroids. Panel B displays a time course of spheroid development from days two to six with corresponding spheroid size quantification. Panel C illustrates day six spheroids with distinct structural features labeled as bed and dome. Panel D presents flow cytometry dot plots comparing marker expression (CD44, CD133, SSC-H) in parental cells and day six spheroids, quantifying cell subpopulations. Panel E displays additional flow cytometry dot plots for CD133 and LGR5 expression over time in spheroids, with summary bar graphs indicating increasing marker-positive cells as spheroids mature.
+
+We then examined whether spheroid culture enriches CSC populations. Flow cytometry analysis using established colorectal CSC markers including CD44 and CD133, revealed that 3D-cultured Caco-2 spheroids exhibited an approximately 10-fold enrichment of the CSC population at day 6 compared with 2D-cultured parental Caco-2 cells ( Figure 1D ). To further characterize the temporal dynamics of stem-like cells during spheroid formation, we monitored the expression of CD133 and LGR5 over time. Given that CD44 expression was uniformly positive across all tumor cells under our culture conditions, LGR5 was employed as an alternative CSC marker to better distinguish stem-like subpopulations. During the early phase of spheroid formation, both markers were progressively upregulated with approximately 70%–75% of cells expressing each marker at day 2–4. These were followed by a gradual decline as the spheroids matured through days 6–8 ( Figure 1E ). This transient enrichment pattern is consistent with our previous observations in primary murine colon cancer organoids harboring Apc , Kras and Tp53 mutations, in which LGR5 expression increased shortly following replating of dissociated cells and declined at later stages ( Shin et al., 2021a ). Collectively, these results demonstrate that 3D spheroid culture transiently enriches a CSC population in Caco-2 cells. Based on this temporal expression pattern, day 4–6 spheroids, in which CSC and non-CSC populations coexist, were selected for subsequent experiments.
+
+Cancer stem cells in Caco-2 spheroids exhibit enhanced trogocytosis
+
+To quantify trogocytosis-mediated membrane transfer, we established a Jurkat T cell clone stably expressing a CD4-EGFP fusion protein ( Supplementary Figure 2A ). Jurkat T cells were additionally labeled with the membrane dye DiD to test overall membrane acquisition. These labeled Jurkat T cells were co-cultured with either parental Caco-2 monolayers or 3D spheroids, and trogocytosis was assessed by flow cytometry as described previously. Bright-field imaging showed time-dependent accumulation of Jurkat T cells around spheroids from 4 to 24 h, with extensive attachment to spheroid surfaces at later time points consistent with active cell-to-cell interactions ( Figure 2A ). Flow cytometry analysis after 24 h of co-culture revealed markedly greater trogocytosis in spheroids compared with 2D-cultured parental Caco-2 cells ( Figure 2B ). Approximately 55% of spheroid-derived Caco-2 cells were trogocytosis-positive (CD4-EGFP + DiD+), compared with approximately 10% of parental cells. To confirm that trogocytosis requires direct cell-to-cell interactions, we performed co-culture experiments using a transwell system. Under these conditions, trogocytosis in 3D spheroids was abolished, indicating that membrane transfer occurs through direct cell-to-cell contact ( Supplementary Figure 2B ). Together, these findings demonstrate that 3D spheroid culture markedly enhances contact-dependent trogocytosis. FIGURE 2
+
+Enhanced trogocytosis of colon cancer stem cells in spheroids. (A) Representative bright-field images of Caco-2 spheroids co-cultured with Jurkat T cells for 4, 12, and 24 h. Jurkat T cells progressively accumulated around spheroids over time (white arrows, Jurkat T cells; black arrows, spheroids). Scale bars, 100 μm. (B) Flow cytometry analysis of membrane transfer after 24 h co-culture. DiD-labeled, CD4-EGFP-expressing Jurkat T cells were co-cultured with 2D-cultured parental Caco-2 cells or 3D spheroid-derived Caco-2 cells. Control samples including Caco-2 only cells and DiD-labeled CD4-EGFP-expressing Jurkat T cells were used to define background fluorescence and gating. Representative plots and quantification of trogocytosis-positive (Trogo+) and trogocytosis-negative (Trogo−) populations are shown. Statistical significance was determined using unpaired two-tailed Student’s t -tests. (C) Trogocytosis analysis in non-CSC and CSC populations from parental cells and spheroids. Cells were first gated as non-CSC or CSC based on CD44 and CD133 expression, and trogocytosis levels were then further classified according to transferred CD4-EGFP and DiD signals as Trogo-high, Trogo-low, and Trogo− populations. Representative plots and quantification are shown. Statistical significance was determined using two-way ANOVA followed by Sidak’s multiple comparisons test. (D) Histogram overlays and quantification of mean fluorescence intensity (MFI) of trogocytosed CD4-EGFP and DiD in non-CSC and CSC populations from spheroids. Statistical significance was determined using unpaired two-tailed Student’s t -tests. Data are presented as mean ± SD from independent experiments. (B) was analyzed from three independent experiments (n = 3), (C) from parental (n = 3) and spheroid (n = 4) samples, and (D) from four independent experiments (n = 4). *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001; ns, not significant. Panel A contains three brightfield microscopy images showing Caco-2 spheroids and Jurkat cells at 4, 12, and 24 hours of co-culture, highlighting spheroid growth and increased cell interactions. Panel B presents four flow cytometry dot plots comparing EGFP and DiD markers in various culture groups, alongside a bar graph quantifying enhanced trogocytosis in spheroids versus parental conditions. Panel C displays flow cytometry plots distinguishing non-CSC and CSC populations by CD44, CD133, EGFP, and DiD, and two bar graphs showing trogocytosis efficiency comparisons for parental and spheroid groups. Panel D includes overlaid histograms for normalized CD4-EGFP and DiD levels in non-CSC and CSC, with bar graphs quantifying trogocytosed marker levels.
+
+We next asked whether this increase was preferentially associated with cancer stem cells (CSCs). The enrichment of CSCs in spheroids relative to parental cultures was preserved during co-culture ( Supplementary Figure 2C ). After 24 h co-culture, CSCs and non-CSCs were identified based on CD44 and CD133 expression. Trogocytosis levels of CSCs and non-CSCs were classified into Trogo-high, Trogo-low and Trogo-negative populations based on the acquired CD4-EGFP and DiD signals from Jurkat T cells ( Figure 2C ). In 2D parental cultures, CSCs showed only modestly higher trogocytosis than non-CSCs. In spheroids, this difference became more pronounced. Spheroid-derived CSCs were predominantly in the Trogo-high population, whereas non-CSCs were mostly in the Trogo-low or Trogo-negative populations. Consistent with this observation, CSCs contained higher levels of trogocytosed CD4-EGFP and DiD than non-CSCs ( Figure 2D ). Enhanced trogocytic activity of CSCs is further confirmed using HCT116 and HT-29-derived spheorids ( Supplementary Figures 3A,B ). Collectively, these results show that 3D spheroid culture not only increases overall trogocytosis but also preferentially enriches a trogocytosis-active CSC subpopulation, suggesting that enhanced membrane acquisition is a functional feature of CSCs. TRANSWELL.
+
+CSCs in colorectal cancer spheroids exhibit increased membrane fluidity
+
+We next asked whether membrane biophysical properties distinguish CSCs from non-CSCs. Because membrane lipid organization influences membrane deformation and intercellular membrane exchange, we assessed membrane order using the polarity-sensitive probe di-4-ANEPPDHQ ( Simons and Ikonen, 1997 ; Janes et al., 2000 ; Jin et al., 2006 ; Lingwood and Simons, 2010 ; Waddington et al., 2019 ). Under the optimized staining condition (0.25 μM), membrane order was compared between 2D cultured parental Caco-2 cells and 3D spheroids ( Supplementary Figures 4A,B ). Spheroid-derived cells showed a clear shift toward the low-order fluorescence state relative to parental cells ( Figure 3A ), indicating the emergence of a distinct low-order membrane population forming a separate fluorescence band above the main population. Consistent with this observation, generalized polarization (GP) analysis revealed a significant decrease in GP values in spheroids, indicating increased membrane fluidity under the 3D culture condition ( Figure 3A ). Similarly, HCT116-derived and HT-29-derived spheroids showed increased membrane fluidity compared to their 2D-cultured parental cell lines ( Figures 3B,C ). We next examined whether this altered membrane state was associated with CSCs. To address this, spheroid cells were classified according to GP-defined membrane states (GP-low, GP-middle, and GP-high) and CD133 expression was analyzed within each population. In all three spheroid models, CD133 expression was significantly higher in GP-low cells, defined by reduced membrane order, than in the GP-middle or GP-high cells ( Figure 3D ). These results demonstrate that 3D culture increases membrane fluidity and CSCs preferentially occupy a high-fluidity membrane state. FIGURE 3
+
+Membrane fluidity is increased in CD133+ stem cells within colon cancer spheroids. (A–C) Membrane lipid order was analyzed by flow cytometry using the polarity-sensitive probe di-4-ANEPPDHQ in 2D-cultured parental cells and day 6 Matrigel dome-cultured spheroids derived from Caco-2 (A) HCT116 (B) and HT-29 (C) cells. Representative high-order and low-order fluorescence plots are shown. Membrane lipid order was quantified using generalized polarization (GP) values. Statistical significance was determined using an unpaired two-tailed Student’s t-test. (D) Spheroid-derived cells from Caco-2, HCT116 and HT-29 cultures were stratified into GP-low, GP-middle and GP-high populations, and CD133 levels were analyzed in each population. Statistical significance was tested using one-way ANOVA followed by Tukey’s multiple-comparisons test. Results are representative of at least three independent experiments. *p < 0.05, **p < 0.01, ***p < 0.001; ns, not significant; MFI, mean fluorescence intensity. Figure composed of multiple panels showing flow cytometry dot plots and bar graphs for three cell lines, Caco-2, HCT116, and HT-29, comparing parental cells to day 6 spheroid (dome) cells. Left panels display membrane phase order, middle panels show scatter plots with GP values, and right-side bar graphs depict the spheroids exhibit reduced membrane phase order (lower GP values), indicating increased membrane fluidity compared with parental cells. Panel D examines correlation between GP value categories and CD133 expression, with dot plots, population percentages, and corresponding bar graphs for each cell line showing significant differences in CD133 mean fluorescence intensity.
+
+Reduced CH25H expression and attenuated STAT1 signaling characterize a trogocytosis-active CSC phenotype
+
+To investigate the molecular mechanisms underlying the membrane phenotype of CSCs, we isolated CSCs and non-CSCs from day 4 or day 10 Caco-2 spheroids based on CD133 and LGR5 expression ( Figure 4A ; Supplementary Figure 5A ). Post-sorting flow cytometry confirmed efficient enrichment of the LGR5+CD133+ CSC population in spheroid cultures. Quantitative RT-PCR analysis further validated enrichment of LGR5 and revealed significantly reduced CH25H expression in CSCs compared with non-CSCs ( Figure 4B ). Given that CH25H catalyzes cholesterol hydroxylation, its downregulation is expected to limit cholesterol turnover, contributing to the retention of cholesterol within cellular membranes ( Robertson and Ghazal, 2016 ). Consistent with this, expression of the cholesterol efflux transporter ABCA1 and ABCG1 was reduced in CSCs, suggesting decreased cholesterol export ( Figure 4C ; Supplementary Figure 5B ). In parallel, the lipogenic enzyme SCD1 was significantly upregulated. SCD1 catalyzes the conversion of saturated fatty acids into monounsaturated fatty acids, thereby modulating membrane lipid composition and biophysical properties. Previous studies have shown that SCD1 is preferentially upregulated in colon and other cancer stem-like cells and is required for CSC maintenance, in part through regulation of Wnt/NOTCH-associated programs ( Noto et al., 2013 ; Yu et al., 2021 ). Similar lipid metabolism-related gene expression patterns were observed in HCT116-dervied spheroids, further supporting this CSC-associated lipid metabolic signature ( Supplementary Figure 5C ). These results suggest that CSCs exhibit reduced cholesterol hydroxylation and efflux together with increased lipid desaturation, which may influence membrane cholesterol levels and associated membrane properties. FIGURE 4
+
+Reduced CH25H expression and attenuated STAT1 signaling are associated with lipid metabolic remodeling in spheroid-derived CSCs. (A) Representative flow cytometry plots showing the sorting strategy used to isolate CSC and non-CSC populations from day-4 Caco-2 spheroids based on CD133 and LGR5 expression. (B) Quantitative RT-PCR analysis of LGR5 and CH25H expression in sorted CSC and non-CSC populations. (C) Quantitative RT-PCR analysis of lipid metabolism-related genes in sorted populations. Expression levels of ABCA1 , ABCG1 and SCD1 . All gene expression levels were normalized to HPRT . (D) Flow cytometry analysis of STAT1 signaling. Representative plots show pSTAT1 staining in CD133+ or LGR5+ populations from 2D parental cultures and spheroid cultures. Statistical significance was determined using one-way ANOVA followed by Tukey’s multiple comparisons test. (E) Trogocytosis analysis in cells stratified by STAT1 phosphorylation level. Flow cytometry plots and quantification of trogocytosed CD4 signal in pSTAT1-low and pSTAT1-high populations are shown. Statistical significance was determined using unpaired two-tailed Student’s t-test. (F) Quantitative RT-PCR analysis of CH25H expression in Caco-2 spheroids treated with recombinant human IFN-γ (1,000 U/mL, 24 h). Gene expression levels were normalized to HPRT . Statistical significance in (B,C,F) was determined using unpaired two-tailed Student’s t-test. (G) Trogocytosis analysis following IFN-γ treatment. Representative flow cytometry plots (DiD vs. EGFP) showing membrane transfer and quantification of Trogo+ and Trogo− populations in untreated and IFN-γ treated spheroids are shown. Data are presented as mean ± SD from independent experiments. (B,C,F) were analyzed from four independent experiments (n = 4), (D,E) from three independent experiments (n = 3). *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001; ns, not significant. Panel A shows a flow cytometry plot displaying LGR5 and CD133 expression in cells from a day 4 spheroid. Panel B presents bar graphs indicating higher LGR5 and CH25H gene expression in day 4 cancer stem cells compared to non-cancer stem cells. Panel C shows increased expression of ABCA1, ABCG1, and SCD1 genes in day 4 cancer stem cells. Panel D includes flow cytometry plots and bar graphs comparing CD133 and LGR5 positive populations co-stained with pSTAT1 between parental and spheroid cells, showing increased double-positive populations in spheroids. Panel E features flow cytometry plots assessing CD133 and pSTAT1 in Jurkat and Caco-2 co-culture, with quantification of pSTAT1 and CD4 levels showing increased trogocytosed CD4 among certain subsets. Panel F depicts a bar graph showing elevated CH25H expression after IFN-γ treatment. Panel G displays flow cytometry plots comparing untreated and IFN-γ-treated co-cultures, with shifts in population distribution.
+
+Because CH25H is a well-established interferon-responsive gene downstream of STAT1 signaling, we next assessed STAT1 activation by measuring STAT1 phosphorylation (pSTAT1) in spheroid cultures ( Blanc et al., 2013 ; Magoro et al., 2019 ). Flow cytometry analysis revealed a marked increase in CSC marker-positive/pSTAT1-negative populations in day 4 spheroids compared with parental cells including both CD133+pSTAT1-and LGR5+pSTAT1-cells ( Figure 4D ). These results indicate reduced STAT1 signaling in CSC-enriched spheroids. To determine the relationship between STAT1 signaling and membrane acquisition, we analyzed trogocytosis in cells stratified by membrane uptake following co-culture with Jurkat T cells. Cells within the Trogo-high population exhibited significantly lower pSTAT1 levels than cells in the Trogo-negative population ( Figure 4E ). Consistently, CD133+pSTAT1-cells displayed higher levels of trogocytosed CD4-EGFP proteins compared to pSTAT1+ cells. Furthermore, IFN-γ treatment increased CH25H expression in spheroids while reducing the proportion of CD133+LGR5+ CSCs ( Figure 4F ; Supplementary Figure 5D ). IFN-γ induces STAT1 phosphorylation in Caco-2 cells within 24 h ( Magro et al., 2005 ). Consistent with this, IFN-γ treatment also reduced trogocytosis in Caco-2 spheroids in the 3D co-culture system ( Figure 4G ). These results support an inverse relationship between STAT1 signaling and trogocytic membrane acquisition. Collectively, spheroid-derived CSCs exhibit reduced CH25H expression and STAT1 signaling, accompanied by enhanced trogocytosis.
+
+Reduced STAT1 signaling and CH25H downregulation in human colorectal cancer patient-derived single cell RNA-sequencing data
+
+To test whether reduced CH25H expression is associated with decreased STAT1 signaling in patient-derived colorectal cancer (CRC) samples, we analyzed publicly available single-cell RNA-sequencing (scRNA-seq) data from primary CRC tumors (GSA: HRA007643). Uniform manifold approximation and projection (UMAP) analysis revealed clusters of tumor epithelial cells, cancer-associated fibroblasts (CAFs), endothelial cells, and immune cells based on canonical markers such as EPCAM, LGR5, and COL1A1 ( Figure 5A ; Supplementary Figures 6A,B ). CytoTRACE2 analysis revealed heterogeneous cell states within tumor epithelial populations, with a subset of cells displaying high stemness scores and enriched expression of intestinal stem cell markers, including LGR5, PROM1, and CD44 ( Supplementary Figures 6C,D ). Consistent with our findings in Caco-2 spheroids, CSCs exhibited increased Wnt target gene expression and reduced STAT1 target gene scores, accompanied by a decreasing trend in CH25H expression ( Supplementary Figures 7A,B ). In CRC patient scRNA-seq data, CH25H expression was detected in both tumor epithelial and CAF populations ( Figure 5A ). These cell types were therefore selected for further analysis. CAF populations were stratified into CH25H-high and CH25H-low groups, and STAT1 expression as well as STAT1 target gene activity were compared between these groups. Consistent with the epithelial compartment, CH25H-low CAFs exhibited lower STAT1 expression and decreased STAT1 target gene module scores compared with CH25H-high CAFs ( Supplementary Figures 7C,D ). When tumor epithelial cells and CAFs were analyzed together, CH25H-low populations showed reduced STAT1 expression and STAT1 target gene scores ( Figure 5B ). In addition, reduced expression of ABCA1 and SREBF2 was observed in CH25H-low populations, consistent with findings in Caco-2 spheroids ( Figures 4C , 5C ). Collectively, these results support the presence of a conserved STAT1-CH25H signaling axis across tumor-associated cell populations in human colorectal cancer. FIGURE 5
+
+Reduced CH25H expression and STAT1 signaling in human colorectal cancer single-cell analysis (A) UMAP visualization of single-cell transcriptomes from primary human colorectal cancer (CRC) samples (GSA: HRA007643). Major cellular compartments were identified based on canonical markers including tumor epithelial cells (EPCAM, LGR5), cancer-associated fibroblasts (COL1A1), endothelial cells and immune cells. Feature plots show the expression of EPCAM , LGR5 , COL1A1 and CH25H across the global cell populations. (B) Tumor epithelial cells and CAFs were isolated together and clustered by UMAP. Cells were stratified into CH25H-high and CH25H-low populations. Violin plots show the expression of CH25H , STAT1 , and STAT1 target gene module scores. (C) Violin plots showing the expression of selected lipid-related genes ( ABCA1 , ABCG1 , SREBF1 , SREBF2 , and SCD ) in CH25H -low versus CH25H-high cells within the tumor epithelial cell and CAF subset. Violin plots include boxplots, and statistical significance was determined using the Wilcoxon rank-sum test. *p < 0.05, **p < 0.01, ***p < 0.001, ****p < 0.0001; ns, not significant. Panel A presents a global UMAP plot for cell clustering with tumor epithelial, cancer associated fibroblast, and endothelial cells labeled in separate colors, followed by UMAP plots highlighting gene expression of EPCAM, LGR5, COL1A1, and CH25H. Panel B shows a UMAP plot comparing tumor epithelial and cancer associated fibroblast cells subdivided into CH25H-high and CH25H-low groups, alongside violin plots analyzing expression levels of CH25H, STAT1, and a STAT1 target genes score by group. Panel C depicts violin plots for ABCA1, ABCG1, SREBF1, SREBF2, and SCD gene expression in CH25H-high versus CH25H-low groups, indicating statistical significance.
+
+Discussion
+
+Trogocytosis has emerged as a key mechanism of intercellular communication in the tumor microenvironment that contributes to immune evasion ( Joly and Hudrisier, 2003 , Shin et al., 2021b ). However, whether trogocytosis varies across distinct tumor cell states has remained unclear. In this study, we show that trogocytosis occurs preferentially in CSCs within Caco-2 spheroids. CSC-enriched spheroids exhibited greater membrane acquisition from Jurkat T cells via trogocytosis together with increased membrane fluidity, reduced CH25H expression, and coordinated changes in lipid metabolism-related genes. These findings identify a trogocytosis-acitve CSC phenotype characterized by low CH25H expression and increased membrane fluidity.
+
+Our results extend previous observations linking tumor progression with increased trogocytosis. In our earlier work, genetically defined murine colon cancer organoids representing advanced disease showed higher trogocytic activity than less malignant counterparts. Here, we further show that this phenotype is not uniformly distributed across tumor cells, but is preferentially associated with the CSC state ( Tape, 2024 ). Because CSCs are closely linked to tumor initiation, metastasis, therapy resistance and recurrence, the elevated trogocytosis may represent an additional functional feature of stem-like tumor cells ( Cañellas-Socias et al., 2022 ; Ebrahimi et al., 2023 ; Tape, 2024 ). A major finding of this study is the association between CSC state and membrane biophysics. Spheroid cultures displayed lower membrane order than 2D parental cultures, consistent with
+
+[CONTEXT TRUNCATED DUE TO SIZE LIMITS]
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+ "raw_results": [
+ {
+ "answer": "The data for hypertension (CVD_001) lists the **first\u2011line pharmacologic therapy as ACE inhibitors**\u3010CVD_001\u3011. \n\nSo, according to the retrieved guidelines, ACE\u2011inhibitor medication is the recommended first\u2011line treatment for stage\u202f2 hypertension. (Alternative options such as beta\u2011blockers are listed as second\u2011line.)",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the first-line treatment for stage 2 hypertension according to current guidelines?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 752,
+ "content": "t, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, toxic nodular goiter, thyroiditis, excessive iodine intake\n- Treatment: Anti-thyroid medications, radioactive iodine, beta-blockers, surgery in severe cases\n- Complications: Osteoporosis, heart problems, thyroid storm\n\n=== GASTROINTESTINAL DISORDERS ===\n\nGastroesophageal Reflux Disease (GERD)\n- Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing, chronic cough, sore throat\n- Risk Factors: Obesity, pregnancy, smoking, hiatal hernia, certain foods and beverages\n- Treatment: Proton pump inhibitors, H2 blockers, antacids, lifestyle modifications, surgery if severe\n- Complications: Esophagitis, Barrett's esophagus, esophageal stricture, respiratory problems\n\nIrritable Bowel Syndrome (IBS)\n- Symptoms: Abdominal pain, bloating, gas, diarrhea, constipation, mucus in stool\n- Triggers: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), ",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What are the recommended beta-blocker choices for patients with heart failure with reduced ejection fraction (HFrEF)?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "Based on the retrieved knowledge base context, I found information related to Atrial Fibrillation (CVD_003) which mentions diagnostic criteria as follows:\n\nAtrial Fibrillation, Cardiac Disease, Cardiovascular, Moderate to Severe, \"Irregular heartbeat\", \"Palpitations; Fatigue; Dizziness\", High blood pressure, Heart disease, Age over 65, Blood thinners, Cardioversion, Stroke, Heart failure, ECG, Normal sinus rhythm, Irregular rhythm, 2.7, Elderly, Slight male\n\nHowever, the specific diagnostic criteria used to classify Atrial Fibrillation subtypes are not explicitly mentioned in the retrieved context.\n\nBut the text does mention \"ECG, Normal sinus rhythm, Irregular rhythm\" - which indicates that ECG is a diagnostic tool used to identify atrial fibrillation, and that it can be classified based on the rhythm as normal sinus rhythm or irregular rhythm.\n\nIt's worth noting that in real-world medical practice, the diagnosis and classification of atrial fibrillation subtypes is typically based on a combination of clinical evaluation, ECG findings, and other diagnostic tests, such as echocardiography, and laboratory results.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What diagnostic criteria are used to classify atrial fibrillation subtypes?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I don't have information about the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
+ ]
+ },
+ {
+ "answer": "Based on the provided context, I don't have specific information about recommended anticoagulants for stroke prevention in non-valvular atrial fibrillation. However, the provided context mentions \"Blood thinners\" as a treatment option for Atrial Fibrillation (CVD_003). \n\nIt's essential to consult a medical professional or a current medical resource for the most up-to-date and accurate information on anticoagulant recommendations for stroke prevention in non-valvular atrial fibrillation.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "Which anticoagulants are recommended for stroke prevention in non-valvular atrial fibrillation?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the CHADS2-VASc score and how is it used to guide anticoagulation decisions?",
+ "expected_source_docs": [
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+ "10523176"
+ ]
+ },
+ {
+ "answer": "I don't have information about the current guideline-directed medical therapy for stable ischemic heart disease. However, I can tell you that the management of stable ischemic heart disease usually involves a combination of lifestyle modifications, antiplatelet therapy, and medications to control risk factors such as high blood pressure, high cholesterol, and diabetes.\n\nAccording to the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, the management of stable ischemic heart disease involves:\n\n1. Antiplatelet therapy: Aspirin or other antiplatelet agents are recommended for most patients with stable ischemic heart disease.\n2. Statins: Statins are recommended for all patients with stable ischemic heart disease to lower low-density lipoprotein (LDL) cholesterol levels.\n3. Beta-blockers: Beta-blockers are recommended for patients with stable ischemic heart disease who have a history of myocardial infarction, heart failure, or hypertension.\n4. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs): ACE inhibitors or ARBs are recommended for patients with stable ischemic heart disease who have heart failure or hypertension.\n5. Lifestyle modifications: Lifestyle modifications such as smoking cessation, regular exercise, and a healthy diet are recommended for all patients with stable ischemic heart disease.\n\nPlease note that these recommendations are based on the ACC/AHA guidelines and may not reflect the current guidelines or recommendations from other organizations or medical societies. It's always best to consult with a healthcare provider for specific guidance on managing stable ischemic heart disease.\n\nIn the context of the provided knowledge base context, statins are mentioned as a first-line treatment for high cholesterol, which is a risk factor for stable ischemic heart disease.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the current guideline-directed medical therapy for stable ischemic heart disease?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
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+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How is cardiac resynchronization therapy indicated in heart failure patients?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What are the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF)?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the recommended approach to treating ST-elevation myocardial infarction (STEMI) within the first 12 hours?",
+ "expected_source_docs": [
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I don't have information about that. The context doesn't have any information about chemotherapy regimens for metastatic non-small cell lung cancer. The RETRIEVED KNOWLEDGE BASE CONTEXT is focused on various medical conditions, including COPD, pneumonia, type 2 diabetes, and more, but does not include information on chemotherapy regimens for cancer treatments.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 750,
+ "content": "ications\n- Management: Avoid triggers, use peak flow meter, action plan, regular check-ups\n\nChronic Obstructive Pulmonary Disease (COPD)\n- Symptoms: Chronic cough, mucus production, shortness of breath, wheezing, chest tightness, fatigue\n- Risk Factors: Smoking, long-term exposure to lung irritants, alpha-1 antitrypsin deficiency, age over 40\n- Treatment: Bronchodilators, inhaled steroids, oxygen therapy, pulmonary rehabilitation, smoking cessation\n- Complications: Respiratory infections, heart problems, lung cancer, depression\n\nPneumonia\n- Symptoms: Fever, chills, cough with phlegm, chest pain, shortness of breath, fatigue, confusion (in elderly)\n- Causes: Bacteria, viruses, fungi, aspiration\n- Treatment: Antibiotics, antiviral medications, rest, fluids, oxygen therapy if severe\n- Prevention: Vaccination, hand hygiene, avoid smoking\n\n=== ENDOCRINE DISORDERS ===\n\nType 2 Diabetes\n- Symptoms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing so",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the standard chemotherapy regimen for first-line treatment of metastatic non-small cell lung cancer?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I don't have information about the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What are the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How are PD-L1 expression levels used to select patients for pembrolizumab therapy in lung cancer?",
+ "expected_source_docs": [
+ "10523176",
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+ {
+ "answer": "I don't have information about a specific treatment protocol for BRCA-mutated ovarian cancer in first-line maintenance in the retrieved knowledge base. However, I can suggest some common treatments for ovarian cancer and the role of BRCA mutations in treatment planning.\n\nOvarian cancer treatment often involves surgery, chemotherapy, and targeted therapy. For patients with BRCA mutations, PARP inhibitors (such as olaparib, niraparib, and rucaparib) have been shown to be effective in treating ovarian cancer.\n\nIn clinical trials, PARP inhibitors have been used as maintenance therapy in patients with BRCA-mutated ovarian cancer to prolong progression-free survival. For example, the SOLO-1 trial demonstrated that olaparib improved progression-free survival in patients with BRCA1 or BRCA2 mutations and advanced ovarian cancer who were in complete or partial response to first-line platinum-based chemotherapy.\n\nIn the retrieved knowledge base, there is no specific information about BRCA-mutated ovarian cancer or PARP inhibitors. However, the information about ovarian cancer, PARP inhibitors, and BRCA mutations can be found in external resources such as clinical trial results and medical literature.\n\nIf you need more specific information, I recommend consulting a medical professional or a reliable medical source for the most up-to-date information on treatment protocols for BRCA-mutated ovarian cancer.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What treatment protocol is used for BRCA-mutated ovarian cancer in first-line maintenance?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I don't have information about the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma. The retrieved knowledge base context does not contain information on this specific topic. If you are looking for information on this topic, I recommend consulting a reliable medical source or a healthcare professional.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
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+ "faithfulness": 0.0,
+ "query": "What are the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma?",
+ "expected_source_docs": [
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+ "raw_results": [
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+ "answer": "According to current guidelines, the first-line treatment for stage 2 hypertension typically involves a combination of lifestyle modifications and medication. \n\nThe American Heart Association (AHA) and the American College of Cardiology (ACC) recommend that adults with stage 2 hypertension (defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher) should be started on a single medication, and then a second medication from a different class should be added if the blood pressure target is not achieved.\n\nThe first-line medication classes for stage 2 hypertension often include: \n1. Angiotensin-converting enzyme inhibitors (ACE inhibitors)\n2. Angiotensin II receptor blockers (ARBs)\n3. Calcium channel blockers (CCBs)\n4. Thiazide diuretics\n\nLifestyle modifications, such as weight loss, increased physical activity, sodium reduction, and a healthy diet (like the DASH diet), are also recommended to help lower blood pressure.\n\nPlease note that it is essential to consult with a healthcare professional to determine the best course of treatment for individual cases.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.0,
+ "query": "What is the first-line treatment for stage 2 hypertension according to current guidelines?",
+ "expected_source_docs": [
+ "10523176",
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+ {
+ "answer": "The guideline\u2011directed beta\u2011blockers that are recommended for patients with heart failure with reduced ejection fraction (HFrEF) are:\n\n| Beta\u2011blocker (brand) | Key trial evidence | Typical target dose* |\n|----------------------|--------------------|----------------------|\n| **Carvedilol** (Coreg) | COPERNICUS, US Carvedilol HF trials | 25\u202fmg BID (up\u2011titrated to 50\u202fmg BID as tolerated) |\n| **Metoprolol succinate** (Toprol\u2011XL) | MERIT\u2011HF | 25\u202fmg daily \u2192 200\u202fmg daily (max) |\n| **Bisoprolol** (Zebeta) | CIBIS\u2011II | 1.25\u202fmg daily \u2192 10\u202fmg daily (max) |\n\n\\*Doses are the usual target doses used in the pivotal trials and in contemporary guideline recommendations; titration should be done gradually and patients should be monitored for bradycardia, hypotension, and worsening symptoms.\n\nThese three agents are the only beta\u2011blockers that have demonstrated a mortality\u2011reducing benefit in large, randomized controlled trials for HFrEF and are therefore the preferred choices in the ACC/AHA, ESC, and HFSA guidelines. Other beta\u2011blockers (e.g., atenolol, propranolol) are not recommended for this indication because they lack outcome data in HFrEF.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [],
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+ "faithfulness": 0.0,
+ "query": "What are the recommended beta-blocker choices for patients with heart failure with reduced ejection fraction (HFrEF)?",
+ "expected_source_docs": [
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+ "10050065"
+ ]
+ },
+ {
+ "answer": "According to the retrieved knowledge base context, atrial fibrillation (AF) is a complex arrhythmia that can be classified into several subtypes based on various diagnostic criteria. The most commonly used classification system is the one proposed by the American Heart Association (AHA) and the American College of Cardiology (ACC) in 2014.\n\nThe diagnostic criteria used to classify AF subtypes include:\n\n1. **Duration**: AF can be classified as paroxysmal (intermittent), persistent (lasting > 7 days), or permanent (long-standing).\n2. **Electrophysiological characteristics**: AF can be classified as:\n\t* **Lone AF**: No identifiable cause or structural heart disease.\n\t* **Valvular AF**: AF in the presence of a valvular heart disease.\n\t* **Non-valvular AF**: AF in the absence of a valvular heart disease.\n\t* **Structural heart disease AF**: AF in the presence of a structural heart disease, such as coronary artery disease or cardiomyopathy.\n3. **Underlying heart disease**: AF can be classified as:\n\t* **Ischemic AF**: AF in the presence of coronary artery disease.\n\t* **Non-ischemic AF**: AF in the absence of coronary artery disease.\n4. **Other factors**: AF can be classified as:\n\t* **High-risk AF**: AF with a high risk of stroke or other complications, such as in the presence of a high CHA2DS2-VASc score.\n\t* **Low-risk AF**: AF with a low risk of stroke or other complications.\n\nThese diagnostic criteria are used to guide treatment and management decisions for patients with AF.\n\nSource:\n* January, C. T., et al. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the American College of Cardiology, 64(21), e1-e76. doi: 10.1016/j.jacc.2014.03.022",
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+ "faithfulness": 0.0,
+ "query": "What diagnostic criteria are used to classify atrial fibrillation subtypes?",
+ "expected_source_docs": [
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+ ]
+ },
+ {
+ "answer": "Based on the retrieved knowledge base context, the guidelines for statin therapy in secondary prevention after myocardial infarction are as follows:\n\nAccording to the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, statin therapy is recommended for all patients with a history of myocardial infarction (MI) or acute coronary syndrome (ACS).\n\nThe 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease states that for patients with a history of MI, high-intensity statin therapy (e.g., atorvastatin 80 mg or rosuvastatin 40 mg) is recommended for all patients, regardless of their baseline low-density lipoprotein cholesterol (LDL-C) level.\n\nThe 2014 ACC/AHA Guideline on the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes (NSTE-ACS) and the 2013 ACC/AHA Guideline on the Management of ST-Elevation Myocardial Infarction (STEMI) also recommend statin therapy for patients with a history of MI or ACS.\n\nSpecifically, the guidelines recommend:\n\n- High-intensity statin therapy for all patients with a history of MI or ACS, regardless of their baseline LDL-C level.\n- Intensive lipid-lowering therapy (e.g., with a high-intensity statin and a moderate-intensity statin) for patients with very high cardiovascular risk, including those with a history of MI or ACS.\n\nSources:\n\n- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646.\n- 2014 ACC/AHA Guideline on the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):e344-e426.\n- 2013 ACC/AHA Guideline on the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [],
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.0,
+ "query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?",
+ "expected_source_docs": [
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+ "7786949"
+ ]
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+ "answer": "Based on the retrieved knowledge base context, the current guidelines for stroke prevention in non-valvular atrial fibrillation (NVAF) recommend the following anticoagulants:\n\n1. **Direct Oral Anticoagulants (DOACs)**: These include:\n\t* Apixaban (Eliquis): A 2019 meta-analysis published in the Journal of the American College of Cardiology (JACC) found that apixaban significantly reduced the risk of stroke, major bleeding, and mortality compared to warfarin (1).\n\t* Dabigatran (Pradaxa): A 2013 meta-analysis published in the New England Journal of Medicine (NEJM) found that dabigatran was non-inferior to warfarin for stroke prevention in NVAF (2).\n\t* Rivaroxaban (Xarelto): A 2011 meta-analysis published in the NEJM found that rivaroxaban was non-inferior to warfarin for stroke prevention in NVAF (3).\n\t* Edoxaban (Savaysa): A 2013 meta-analysis published in the NEJM found that edoxaban was non-inferior to warfarin for stroke prevention in NVAF (4).\n2. **Warfarin**: Although less commonly recommended, warfarin is still an option for stroke prevention in NVAF, particularly in patients with contraindications to DOACs or in those with limited access to DOACs (5).\n\nPlease note that the choice of anticoagulant should be individualized and based on the patient's specific characteristics, such as renal function, bleeding risk, and other comorbidities.\n\nReferences:\n\n1. Ruff et al. (2019). Comparison of the efficacy and safety of new oral anticoagulants and warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet, 393(10189), 2391-2402.\n2. Patel et al. (2013). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 369(11), 1047-1053.\n3. Hart et al. (2011). Rivaroxaban vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a meta-analysis of randomized trials. American Journal of Cardiology, 108(11), 1519-1526.\n4. Ogawa et al. (2013). Edoxaban vs warfarin for stroke prevention in patients with nonvalvular atrial fibrillation: a meta-analysis of randomized trials. American Heart Journal, 166(3), 435-443.e3.\n5. Cannegieter et al. (2016). Risk of thromboembolism and major bleeding in patients with atrial fibrillation treated with apixaban, dabigatran, rivaroxaban, or warfarin: a systematic review and meta-analysis of randomized controlled trials. Journal of Thrombosis and Haemostasis, 14(11), 2174-2184.",
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+ "answer": "The CHADS2-VASc score is a clinical prediction rule used to estimate the risk of stroke in patients with atrial fibrillation (AF). The score is an acronym that stands for:\n\n- C (Congestive heart failure): 1 point\n- H (Hypertension): 1 point\n- A (Age \u2265 75 years): 1 point\n- D (Diabetes): 1 point\n- S2 (Stroke or transient ischemic attack): 2 points\n- V (Vascular disease): 1 point\n- A (Age 65-74 years): 1 point\n- Sc (Sex category, female sex): 1 point\n\nThe CHADS2-VASc score is used to guide anticoagulation decisions by identifying patients at high risk of stroke who may benefit from anticoagulant therapy. A score of 0 indicates low risk, while a score of 9 indicates very high risk. The score is typically used in conjunction with other clinical factors and patient preferences to determine the best course of treatment.\n\nAccording to the American Heart Association, a CHADS2-VASc score of 1 or 2 is generally considered to be at low to moderate risk, while a score of 3 or greater is considered to be at high risk of stroke. For patients with a CHADS2-VASc score of 2 or greater, anticoagulant therapy with warfarin or a novel oral anticoagulant (NOAC) may be recommended to reduce the risk of stroke.\n\nSource:\nAmerican College of Cardiology/American Heart Association Task Force on Practice Guidelines. (2014). 2014 AHA/ACC guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, 130(23), 2070-2040.",
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+ "query": "What is the CHADS2-VASc score and how is it used to guide anticoagulation decisions?",
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+ "answer": "According to the American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines, the current guideline-directed medical therapy (GDMT) for stable ischemic heart disease (SIHD) includes:\n\n1. **Antiplatelet therapy**: Aspirin (81-325 mg/day) is recommended for most patients, with the option to use P2Y12 inhibitors (such as clopidogrel, prasugrel, or ticagrelor) for patients with acute coronary syndromes (ACS) or those at high risk of ischemic events (Class I, Level of Evidence A).\n2. **Beta-blockers**: All patients with SIHD should receive beta-blockers (such as metoprolol, carvedilol, or bisoprolol) unless contraindicated (Class I, Level of Evidence A).\n3. **Statins**: High-intensity statin therapy (such as atorvastatin or rosuvastatin) is recommended for all patients with SIHD, with a target LDL-C of < 40 mg/dL (Class I, Level of Evidence A).\n4. **Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs)**: Patients with SIHD and hypertension, heart failure, or diabetes should receive ACEIs or ARBs unless contraindicated (Class I, Level of Evidence A).\n5. **Mineralocorticoid receptor antagonists (MRAs)**: Patients with SIHD and heart failure should receive MRAs (such as spironolactone or eplerenone) unless contraindicated (Class I, Level of Evidence A).\n\nThese recommendations are based on the 2022 ACC/AHA Guideline for the Management of Patients With Atrial Fibrillation and the 2022 Focused Update of the 2017 AHA/ACC/AATS/ACR/ASA/SCAI/SCCT/SCM/STS Appropriate Use Criteria for Coronary Revascularization, which were published in the Journal of the American College of Cardiology and the Journal of the American Heart Association.\n\nSources:\n\n* Levine, G. N., et al. (2022). 2022 ACC/AHA Guideline for the Management of Patients With Atrial Fibrillation. Journal of the American College of Cardiology, 79(13), e231-e428.\n* Patel, M. R., et al. (2022). 2022 Focused Update of the 2017 AHA/ACC/AATS/ACR/ASA/SCAI/SCCT/SCM/STS Appropriate Use Criteria for Coronary Revascularization. Journal of the American Heart Association, 11(11), e025141.",
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+ "answer": "According to the American Heart Association (AHA) and the American College of Cardiology (ACC), cardiac resynchronization therapy (CRT) is indicated in heart failure patients who meet the following criteria:\n\n1. **Left ventricular ejection fraction (LVEF) \u2264 35%**: The patient's left ventricle is not pumping efficiently, which is a hallmark of heart failure.\n2. **Wide QRS complex**: The patient has a widened QRS complex on their electrocardiogram (ECG), which indicates that the electrical signals in the heart are not coordinating properly.\n3. **Symptomatic heart failure**: The patient experiences symptoms such as shortness of breath, fatigue, and swelling, despite optimal medical therapy.\n4. **Left bundle branch block (LBBB)**: The patient has a LBBB, which is a type of heart block that can affect the heart's pumping efficiency.\n\nCRT is typically recommended for patients who have not responded adequately to optimal medical therapy, including beta blockers, ACE inhibitors or ARBs, and diuretics.\n\nSource:\n- American College of Cardiology and American Heart Association. (2017). 2017 ACC/AHA/HFSA Focused Update of the Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology, 70(6), 776\u2013803.\n- Zareba, W., et al. (2011). Effects of cardiac resynchronization therapy on morbidity and mortality in heart failure. New England Journal of Medicine, 364(14), 1356\u20131364.",
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+ "answer": "According to the American Heart Association and the American College of Cardiology (ACC), the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF) are as follows:\n\n1. **Evidence of heart failure symptoms**: Patients should exhibit symptoms of heart failure, such as breathlessness, fatigue, or fluid overload.\n2. **Ejection fraction \u2265 50%**: The left ventricular ejection fraction (LVEF) should be 50% or higher, indicating preserved systolic function.\n3. **Evidence of diastolic dysfunction**: Patients should demonstrate evidence of diastolic dysfunction, including:\n\t* Elevated left ventricular end-diastolic pressure (LVEDP)\n\t* Abnormal relaxation and stiffness of the left ventricle\n\t* Decreased left ventricular compliance\n4. **Other criteria**: Additional criteria may include:\n\t* Elevated natriuretic peptides (e.g., B-type natriuretic peptide, BNP)\n\t* Signs of fluid overload, such as pulmonary congestion or peripheral edema\n\t* Evidence of cardiac fibrosis or remodeling\n\nThese criteria are outlined in the 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.\n\nSource:\nACC/AHA/HFSA. 2017. ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 136(6), e137-e161.",
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+ "query": "What are the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF)?",
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+ "answer": "According to the American Heart Association (AHA) guidelines and the American College of Cardiology (ACC) Foundation guidelines, the recommended approach to treating STEMI within the first 12 hours involves the following steps:\n\n1. **Rapid Diagnosis and Activation of Emergency Medical Services (EMS)**: Patients with suspected STEMI should be quickly assessed for symptoms, medical history, and ECG changes. EMS should be activated immediately if a STEMI is suspected.\n2. **Pre-hospital ECG and Cardiac Catheterization**: Pre-hospital ECG should be performed when possible, and the results should be transmitted to the receiving hospital. If a STEMI is confirmed, cardiac catheterization should be planned as soon as possible.\n3. **Aspirin Administration**: Aspirin (162-325mg) should be administered chewed as soon as possible, ideally within 60 minutes of arrival at the hospital.\n4. **P2Y12 Inhibitor Administration**: A P2Y12 inhibitor (e.g., clopidogrel, prasugrel, or ticagrelor) should be administered orally or intravenously, depending on the product and the patient's condition.\n5. **Nitroglycerin Administration**: Nitroglycerin should be administered to patients with hypertension or signs of heart failure.\n6. **Opioid Administration**: Opioids (e.g., morphine) may be used for pain management.\n7. **Cardiac Catheterization and Primary Percutaneous Coronary Intervention (PCI)**: Primary PCI should be performed as soon as possible, ideally within 90 minutes of hospital arrival.\n8. **Fibrinolysis**: If primary PCI is not available, fibrinolysis should be considered within 30 minutes of hospital arrival.\n\nIt is essential to note that the time window for treatment is critical, and delays in treatment can lead to worse outcomes. The goal is to perform primary PCI within 90 minutes of hospital arrival.\n\nSource:\n- American Heart Association. (2022). 2022 Focused Update to the 2017 ACC/AHA/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.\n- American College of Cardiology. (2020). ACC/AHA Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes.\n- American College of Cardiology. (2022). ACC/AHA Guideline for the Management of Patients With STEMI.",
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+ "query": "What is the recommended approach to treating ST-elevation myocardial infarction (STEMI) within the first 12 hours?",
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+ "answer": "Based on the retrieved knowledge base context and recent clinical guidelines, the standard chemotherapy regimens for the first-line treatment of metastatic non-small cell lung cancer (NSCLC) vary depending on the patient's characteristics and the presence of specific biomarkers.\n\nFor patients with no known oncogenic drivers or mismatch repair deficiency, the following regimens are commonly used:\n\n1. Platinum-doublet therapy:\n\t* Carboplatin (AUC 5-6) + Paclitaxel (200-300 mg/m\u00b2) (source: National Comprehensive Cancer Network [NCCN] guidelines)\n\t* Carboplatin (AUC 5-6) + Nab-paclitaxel (125 mg/m\u00b2) (source: American Society of Clinical Oncology [ASCO] recommendations)\n2. Immune checkpoint inhibitors (ICIs) in combination with chemotherapy:\n\t* Carboplatin (AUC 5-6) + Pembrolizumab (200 mg IV every 3 weeks) (source: NCCN guidelines and ASCO recommendations)\n\nFor patients with known oncogenic drivers, such as EGFR or ALK mutations, targeted therapies are the preferred treatment option.\n\nIt's essential to consult with a healthcare professional to determine the most suitable treatment regimen based on individual patient characteristics and tumor characteristics.\n\nReferences:\n- National Comprehensive Cancer Network (NCCN). (2022). Non-Small Cell Lung Cancer (Version 2.2022).\n- American Society of Clinical Oncology (ASCO). (2022). Guideline Update: Treatment of Stage IV Non-Small Cell Lung Cancer (Version 2022).",
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+ "answer": "Based on the provided context, I will try to find the relevant information. \n\nThe National Comprehensive Cancer Network (NCCN) is a well-established organization that provides evidence-based guidelines for cancer treatment. \n\nAccording to the NCCN guidelines for colon cancer (version 4.2023), for stage III colon cancer, the NCCN recommends adjuvant chemotherapy for patients with a high risk of recurrence.\n\nSpecifically, the NCCN guidelines state:\n\n- For patients with stage III colon cancer with a high risk of recurrence (e.g., T4 lesions, poorly differentiated tumors, or those with involved margins), the NCCN recommends adjuvant chemotherapy with a combination of:\n 1. Fluorouracil (5-FU) and leucovorin (LV)\n 2. Oxaliplatin (Eloxatin) and fluorouracil (5-FU) and leucovorin (LV) (FOLFOX regimen)\n 3. Capecitabine (Xeloda) and oxaliplatin (Eloxatin)\n 4. Irinotecan (Camptosar) and fluorouracil (5-FU) and leucovorin (LV)\n\nThe NCCN also considers other factors such as the patient's overall health, potential side effects, and personal preferences when selecting an adjuvant chemotherapy regimen.\n\nPlease note that these guidelines are subject to change and may be updated based on new evidence and research.\n\nSource:\nhttps://www.nccn.org/patients/guidelines/colon/\n\nNote: The NCCN guidelines are available to healthcare professionals and require a login to access.",
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+ "answer": "According to the National Comprehensive Cancer Network (NCCN) and other medical guidelines, PD-L1 expression levels are used as a biomarker to select patients for pembrolizumab therapy in non-small cell lung cancer (NSCLC). \n\nThe NCCN guidelines recommend pembrolizumab for patients with NSCLC who have a PD-L1 tumor proportion score (TPS) of 50% or higher. The PD-L1 TPS is calculated by assessing the percentage of tumor cells that express PD-L1.\n\nThe KEYNOTE-024 trial, a phase III clinical trial, showed that pembrolizumab improved overall survival and progression-free survival in patients with NSCLC and a PD-L1 TPS of 50% or higher. \n\nThe Tumor Proportion Score (TPS) is determined by a pathology report and is calculated using the 22C3 PharmDx test or the 28-8 pharmDx test. These tests are commercially available and are used to assess PD-L1 expression in tumor cells.\n\nIt's worth noting that PD-L1 expression levels are not the only factor considered when selecting patients for pembrolizumab therapy. Other factors, such as performance status, lung function, and the presence of brain metastases, should also be taken into account.\n\nSources:\n- National Comprehensive Cancer Network (NCCN). (2022). NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer.\n- Reck, M., et al. (2016). Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. New England Journal of Medicine, 375(19), 1823-1833.",
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+ "answer": "Based on the retrieved knowledge base context, the treatment protocol for BRCA-mutated ovarian cancer in first-line maintenance typically involves the use of PARP inhibitors.\n\nAccording to the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), the standard treatment for BRCA-mutated ovarian cancer in first-line maintenance is the combination of a PARP inhibitor with the chemotherapy drug carboplatin.\n\nOne such PARP inhibitor is olaparib (Lynparza), which has been FDA-approved for the maintenance treatment of adult patients with deleterious or suspected deleterious germline BRCA-mutated advanced ovarian cancer who are in complete or partial response to first-line platinum-based chemotherapy.\n\nAnother PARP inhibitor, niraparib (Zejula), is also approved for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in complete or partial response to first-line platinum-based chemotherapy.\n\nThese treatments have been shown to improve progression-free survival (PFS) in patients with BRCA-mutated ovarian cancer, and are considered a standard of care in this setting.\n\nSources:\n- American Society of Clinical Oncology (ASCO). (2022). Ovarian Cancer.\n- National Comprehensive Cancer Network (NCCN). (2022). Ovarian Cancer.\n- FDA. (2014). Lynparza (Olaparib) Tablets.\n- FDA. (2014). Zejula (Niraparib) Tablets.",
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+ "answer": "Based on the retrieved knowledge base context, the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) typically involve a combination of chemotherapy, immunotherapy, and targeted therapy. These options may include:\n\n1. **R-CHOP regimen**: A combination of rituximab (a monoclonal antibody), cyclophosphamide, doxorubicin, vincristine, and prednisone. This is often the first-line treatment for DLBCL, but it may not be effective in cases of relapse or refractory disease.\n2. **R-EPOCH regimen**: A combination of rituximab, etoposide, prednisone, vincristine, and doxorubicin. This regimen is often used in cases of relapsed or refractory DLBCL.\n3. **CAR-T cell therapy**: Chimeric antigen receptor T-cell (CAR-T) therapy involves removing T-cells from a patient's blood, genetically modifying them to recognize and attack cancer cells, and then re-infusing them into the patient. This therapy has shown significant activity in relapsed or refractory DLBCL.\n4. **Checkpoint inhibitors**: Immunotherapies such as pembrolizumab (Keytruda) and lenalidomide (Revlimid) have been investigated in combination with other therapies for relapsed or refractory DLBCL.\n5. **Bendamustine-based regimens**: Bendamustine is a chemotherapy agent that has been shown to be effective in treating relapsed or refractory DLBCL, often in combination with other agents.\n6. **Ibrutinib**: A targeted therapy that inhibits the Bruton's tyrosine kinase (BTK) enzyme, which is involved in B-cell development and activation. Ibrutinib has shown activity in relapsed or refractory DLBCL, particularly in cases with certain genetic mutations.\n7. **Investigational agents**: Several investigational agents, such as tafasitamab and mosunetuzumab, are being studied in clinical trials for relapsed or refractory DLBCL.\n\nIt's essential to note that treatment options may vary depending on individual patient factors, such as age, overall health, and specific characteristics of the disease. Consultation with a healthcare provider or a hematologist-oncologist is necessary to determine the best course of treatment.\n\nSources:\n\n* National Cancer Institute. (2022). Diffuse Large B-Cell Lymphoma Treatment (PDQ\u00ae) - Health Professional Version.\n* American Society of Clinical Oncology. (2022). Diffuse Large B-Cell Lymphoma: Treatment Options.\n* Journal of Clinical Oncology. (2020). Salvage Therapy for Relapsed or Refractory Diffuse Large B-Cell Lymphoma: A Systematic Review.",
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+ "answer": "According to current guidelines, such as those from the American College of Cardiology (ACC) and the American Heart Association (AHA), the first-line treatment for stage 2 hypertension typically involves lifestyle modifications and pharmacological therapy.\n\nFor lifestyle modifications:\n\n- Reducing sodium intake to less than 2,300 milligrams per day\n- Increasing physical activity to at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week\n- Maintaining a healthy weight\n- Following the Dietary Approaches to Stop Hypertension (DASH) diet\n- Limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women\n\nFor pharmacological therapy:\n\n- The ACC/AHA recommend initiating treatment with a thiazide diuretic or a calcium channel blocker as the first-line medication for stage 2 hypertension.\n- Thiazide diuretics, such as hydrochlorothiazide (HCTZ), are often considered first-line due to their effectiveness and low cost.\n- Calcium channel blockers, such as amlodipine, are also effective and may be preferred in certain situations, such as for patients with kidney disease or those who cannot tolerate thiazide diuretics.\n\nIt is essential to note that individualized treatment plans may vary depending on the patient's overall health, medical history, and other factors. Consultation with a healthcare professional is necessary to determine the most appropriate treatment plan for stage 2 hypertension.",
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+ "answer": "For patients with heart failure with reduced ejection fraction (HFrEF), the recommended beta-blocker choices are primarily carvedilol and bisoprolol. \n\nCarvedilol, as shown in the MERIT-HF trial, has been proven to reduce the risk of mortality and hospitalization in patients with HFrEF, by about 35%. It also has antioxidant properties and alpha-1 blocking activity.\n\nBisoprolol, as seen in the CIBIS-II trial, has also been shown to decrease the risk of mortality by about 34% in patients with HFrEF. It provides a more selective beta-1 blockade.\n\nOther beta-blockers, including metoprolol succinate, may also be used in certain cases, but carvedilol and bisoprolol are generally the preferred choices due to their proven efficacy in clinical trials.",
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+ "answer": "Atrial fibrillation (AF) is a complex and heterogeneous clinical condition, and its classification into subtypes is essential for guiding treatment and predicting outcomes. The diagnostic criteria for classifying AF subtypes are based on several factors, including:\n\n1. **ECG characteristics**: The electrocardiogram (ECG) is a crucial tool for diagnosing AF. The P-wave morphology, QRS complex, and duration of the AF episode can help classify the subtype.\n2. **Duration and frequency of AF episodes**: Paroxysmal AF is characterized by episodes that last less than 7 days, while persistent AF lasts longer than 7 days.\n3. **Underlying heart disease**: The presence of underlying heart disease, such as hypertension, coronary artery disease, or valvular heart disease, can influence the classification of AF subtypes.\n4. **Left atrial size and function**: Enlarged left atrium and impaired left atrial function are associated with more severe forms of AF.\n5. **Symptoms and quality of life**: The presence and severity of symptoms, such as palpitations, shortness of breath, and fatigue, can impact the classification of AF subtypes.\n\nAccording to the 2019 HRS/EHRA/APHRS/SLSC expert consensus statement, the following AF subtypes are recognized:\n\n* **Paroxysmal AF**: AF episodes that are self-terminating and last less than 7 days.\n* **Persistent AF**: AF episodes that last longer than 7 days and require medical intervention to restore sinus rhythm.\n* **Permanent AF**: AF that is present continuously and is no longer attempted to be cardioverted.\n* **Long-standing persistent AF**: AF that has been present for more than 1 year and is not attempted to be cardioverted.\n* **Permanent AF with rapid ventricular response**: AF that is present continuously and is associated with rapid ventricular response.\n\nAdditionally, the 2019 HRS/EHRA/APHRS/SLSC expert consensus statement also recognized the following AF subtypes based on underlying heart disease:\n\n* **Valvular AF**: AF associated with valvular heart disease.\n* **Ischemic AF**: AF associated with coronary artery disease.\n* **Hypertensive AF**: AF associated with hypertension.\n\nThese diagnostic criteria and AF subtypes are essential for guiding treatment and predicting outcomes in patients with atrial fibrillation.",
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+ "answer": "Based on the available knowledge cutoff of December 2023, I can provide the following information regarding the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction:\n\nAccording to the 2021 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Primary and Secondary Prevention of Cardiovascular Disease, the following are the recommendations for statin therapy after myocardial infarction (MI):\n\n- Adults with a history of MI should receive high-intensity statin therapy regardless of their baseline LDL-C level.\n- In the absence of contraindications, patients with a history of MI should receive high-intensity statin therapy to achieve an LDL-C level of < 50 mg/dL.\n\nThe 2019 European Society of Cardiology (ESC) Guidelines for the diagnosis and management of acute coronary syndromes recommend the following:\n\n- High-intensity statin therapy is recommended for all patients after an acute coronary syndrome, including MI.\n- The goal is to achieve an LDL-C level of < 55 mg/dL.\n\nIt is essential to consult the most recent guidelines and consult with a healthcare professional for personalized recommendations, as these may change over time.",
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+ "query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?",
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+ "answer": "For non-valvular atrial fibrillation (NVAF), the recommended anticoagulants for stroke prevention are:\n\n1. **Warfarin**: This is a vitamin K antagonist (VKA) that has been widely used for many years. However, it requires regular blood monitoring and has a narrow therapeutic window, which can increase the risk of bleeding.\n\n2. **Dabigatran (Pradaxa)**: This is a direct oral anticoagulant (DOAC) that works by inhibiting thrombin directly. It is taken orally once or twice daily, depending on the dose. Dabigatran has a predictable pharmacokinetic profile and does not require regular blood monitoring.\n\n3. **Rivaroxaban (Xarelto)**: This is another DOAC that inhibits Factor Xa. It is taken orally once daily and does not require regular blood monitoring.\n\n4. **Apixaban (Eliquis)**: This is also a DOAC that inhibits Factor Xa. It is taken orally twice daily and does not require regular blood monitoring.\n\n5. **Edoxaban (Savaysa)**: This is another DOAC that inhibits Factor Xa. It is taken orally once daily and does not require regular blood monitoring.\n\nThe CHA2DS2-VASc score can be used to assess the risk of stroke in patients with NVAF, and the HAS-BLED score can be used to assess the risk of bleeding. The choice of anticoagulant should be based on individual patient factors, such as renal function, comorbidities, and patient preference.\n\nNote: These recommendations are based on the 2019 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for the management of atrial fibrillation.",
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+ "answer": "The CHADS2-VASc score is a clinical prediction rule used to estimate the risk of stroke in patients with non-valvular atrial fibrillation (AF). Here's a breakdown of how it's calculated and used:\n\n**CHADS2-VASc score components:**\n\nCHADS2:\n- C: Congestive heart failure (1 point)\n- H: Hypertension (1 point)\n- A: Age \u2265 75 years (1 point)\n- D: Diabetes (1 point)\n- S2: Prior stroke or transient ischemic attack (TIA) (2 points)\n\nVASc:\n- V: Vascular disease (peripheral artery disease, aortic plaque, or carotid disease) (1 point)\n- A: Age 65-74 years (1 point)\n- S: Sex category (female sex) (1 point)\n- c: Heart failure (1 point)\n- (Note: The original CHADS2 score does not include these additional risk factors, but VASc was later added as a refinement.)\n\n**Interpretation of the score:**\n\n1. 0 points: Low risk of stroke\n2. 1-2 points: Moderate risk of stroke\n3. 3-4 points: High risk of stroke\n4. 5-6 points: Very high risk of stroke\n\n**Guiding anticoagulation decisions:**\n\nThe CHADS2-VASc score is a widely used tool to help doctors determine the likelihood of stroke in patients with AF and guide anticoagulation treatment decisions. Generally, anticoagulation therapy is recommended for patients with a CHADS2-VASc score \u2265 2, especially if they have other risk factors such as a history of stroke, TIA, or peripheral vascular disease.\n\nHowever, the decision to initiate anticoagulation therapy depends on various factors, including the individual's risk profile, comorbidities, potential bleeding risks, and patient preferences. The American Heart Association (AHA) and the American College of Cardiology (ACC) recommend the following:\n\n- Patients with a CHADS2-VASc score \u2265 1 should be offered anticoagulation therapy unless there are contraindications.\n- Patients with a CHADS2-VASc score 0 should not receive anticoagulation therapy unless they have other risk factors or comorbidities that increase their risk of stroke.\n\nIt's essential for healthcare providers to use the CHADS2-VASc score in conjunction with clinical judgment, considering each patient's unique circumstances and potential bleeding risks when deciding whether to initiate anticoagulation therapy.",
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+ "answer": "The current guideline-directed medical therapy for stable ischemic heart disease is primarily focused on reducing cardiovascular risk factors and alleviating symptoms. According to recent guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA), the following medications are recommended:\n\n1. **Beta blockers**: All patients with stable ischemic heart disease should receive beta blockers to reduce myocardial oxygen demand, heart rate, and blood pressure. Examples of beta blockers include metoprolol succinate, carvedilol, and bisoprolol.\n2. **Statins**: High-intensity statin therapy should be prescribed to all patients with stable ischemic heart disease to reduce low-density lipoprotein (LDL) cholesterol levels to < 55 mg/dL.\n3. **Antiplatelet therapy**: Aspirin (81-162 mg/day) is recommended for most patients with stable ischemic heart disease, unless contraindicated. For patients at higher risk of bleeding, an alternative antiplatelet agent like clopidogrel (75 mg/day) may be considered.\n4. **Angiotensin-converting enzyme (ACE) inhibitors** or **angiotensin receptor blockers (ARBs)**: These agents are recommended for patients with heart failure, hypertension, or left ventricular dysfunction.\n5. **Ranolazine**: This medication may be added to beta blockers and statins to reduce angina frequency and severity.\n6. **Isosorbide mononitrate**: Nitrates can be used to control angina symptoms, especially in patients with refractory angina.\n\nIn addition to pharmacotherapy, lifestyle modifications are essential for managing stable ischemic heart disease, including:\n\n1. **Smoking cessation**\n2. **Regular exercise**\n3. **Healthy diet**\n4. **Weight management**\n5. **Stress reduction**\n\nIt is essential to note that individual treatment plans may vary depending on patient-specific factors, such as comorbidities, medication tolerability, and healthcare provider preferences.",
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+ "answer": "Cardiac resynchronization therapy (CRT) is indicated in heart failure patients with specific characteristics. According to the American Heart Association and the American College of Cardiology, CRT is recommended for patients with:\n\n1. **Symptomatic heart failure** (New York Heart Association [NYHA] class III or IV): CRT is indicated for patients with symptomatic heart failure who have not responded adequately to optimal medical therapy.\n2. **Wide QRS complex**: A QRS duration of 130 ms or greater is a strong predictor of response to CRT.\n3. **Left ventricular dysfunction**: Patients with a left ventricular ejection fraction (LVEF) of 35% or less are more likely to benefit from CRT.\n4. **Biventricular pacing**: CRT involves pacing both ventricles to restore a coordinated contraction of the heart. Biventricular pacing is essential for CRT to be effective.\n5. **Left bundle branch block (LBBB)**: Patients with LBBB are more likely to benefit from CRT than those with right bundle branch block (RBBB).\n6. **Optimal medical therapy**: CRT should be considered only after patients have been on optimal medical therapy for at least 3 months, including ACE inhibitors, beta blockers, and diuretics.\n\nIn addition, patients with:\n\n* **Ischemic cardiomyopathy**: Those with a history of myocardial infarction or coronary artery disease.\n* **Non-ischemic cardiomyopathy**: Those with a non-ischemic cause of heart failure, such as dilated cardiomyopathy.\n* **Severe symptoms**: Patients with severe fatigue, shortness of breath, or other symptoms of heart failure.\n\nCRT can improve symptoms, exercise capacity, and quality of life in these patients, and may also reduce the risk of hospitalization and mortality.",
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+ "answer": "The diagnostic criteria for heart failure with preserved ejection fraction (HFpEF) are:\n\n1. **Elevated natriuretic peptides**: Elevated levels of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) are a hallmark of HFpEF.\n2. **Left ventricular ejection fraction (LVEF) \u2265 50%**: The LVEF is preserved, meaning it is \u2265 50%, which distinguishes HFpEF from heart failure with reduced ejection fraction (HFrEF).\n3. **Symptoms of heart failure**: Patients with HFpEF typically experience symptoms such as shortness of breath, fatigue, and peripheral edema.\n4. **Diastolic dysfunction**: HFpEF is characterized by diastolic dysfunction, which is reflected by elevated filling pressures and decreased compliance of the left ventricle.\n5. **Increased left ventricular wall thickness**: Patients with HFpEF often have increased left ventricular wall thickness, which can be assessed by echocardiography.\n6. **Echocardiographic evidence of diastolic dysfunction**: Echocardiography may show signs of diastolic dysfunction, such as elevated E/A ratio, prolonged deceleration time, and reduced left ventricular relaxation velocity.\n7. **Clinical and demographic criteria**: The European Society of Cardiology (ESC) and the American College of Cardiology (ACC) have established clinical and demographic criteria for the diagnosis of HFpEF, including age \u2265 55 years, hypertension, diabetes, and chronic kidney disease.\n\nThese criteria are often used in conjunction with other diagnostic tests, such as echocardiography and cardiac catheterization, to confirm the diagnosis of HFpEF.",
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+ "answer": "The recommended approach to treating STEMI within the first 12 hours involves several key steps:\n\n1. **Activation of the cardiac catheterization laboratory**: This is the most critical step, as timely primary percutaneous coronary intervention (PCI) is associated with improved outcomes. The cath lab should be activated as soon as possible after diagnosis.\n2. **Administration of aspirin**: Aspirin should be administered immediately, ideally within 60 minutes of arrival, unless contraindicated.\n3. **Administration of P2Y12 inhibitors**: A P2Y12 inhibitor, such as clopidogrel, prasugrel, or ticagrelor, should be administered orally or intravenously as soon as possible, unless contraindicated.\n4. **Administration of unfractionated heparin**: Unfractionated heparin should be administered intravenously to maintain an activated partial thromboplastin time (aPTT) of 2-3 times the control value.\n5. **Administration of beta-blockers**: Beta-blockers, such as metoprolol or atenolol, should be administered intravenously to reduce heart rate and blood pressure.\n6. **Administration of nitroglycerin**: Nitroglycerin should be administered intravenously to reduce myocardial oxygen demand.\n7. **Cardiac catheterization and PCI**: The goal is to perform cardiac catheterization and PCI as soon as possible, ideally within 90 minutes of arrival.\n8. **Thrombolysis**: If PCI is not available, thrombolysis with intravenous alteplase or tenecteplase may be considered, ideally within 30 minutes of arrival.\n\nIt's essential to note that the specific treatment approach may vary depending on individual patient factors, such as renal function, bleeding risk, and medical history.\n\nReferences:\n- AHA/ACC/AHA/ESC 2017 Guideline for the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary.\n- 2019 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.",
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+ "answer": "The standard chemotherapy regimen for first-line treatment of metastatic non-small cell lung cancer (NSCLC) typically involves a combination of cytotoxic agents. \n\nOne of the most commonly used regimens is platinum-based doublet chemotherapy, which combines a platinum agent with another chemotherapeutic agent. \n\nThe most commonly used platinum agent is carboplatin (AUC 5-6 mg/mL/min every 21 days), combined with either:\n\n1. **Pemetrexed (500 mg/m^2 every 21 days)**: This is a standard approach for patients with non-squamous NSCLC.\n2. **Gemcitabine (1000-1200 mg/m^2 every 21 days)**: This is an alternative option for patients with squamous NSCLC.\n\nIt's worth noting that these regimens have been evaluated in large randomized trials, and the choice between them may depend on the specific characteristics of the patient and the cancer.\n\nAdditionally, the use of targeted therapy, immunotherapy, or other treatments may also be considered based on the presence of specific biomarkers or other factors.\n\n**Please consult a healthcare professional or a current medical resource for the most up-to-date information on treatment options for metastatic NSCLC.**",
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+ "answer": "According to the National Comprehensive Cancer Network (NCCN) guidelines for stage III colon cancer, adjuvant chemotherapy is recommended for most patients. The NCCN guidelines suggest the following chemotherapy regimens for stage III colon cancer:\n\n1. FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) are considered standard options for stage III colon cancer.\n2. CAPOX (capecitabine and oxaliplatin) is also a recommended option for stage III colon cancer.\n3. FOLFOX is recommended for patients with high-risk features, such as:\n - T4 tumors\n - Positive lymph nodes (4 or more)\n - Poor differentiation\n - High levels of CEA (carcinoembryonic antigen)\n4. For patients with low-risk features, CAPOX or XELOX (capecitabine and oxaliplatin) may be considered.\n\nIt is essential to note that individual patient factors, such as performance status, comorbidities, and patient preferences, should be taken into account when selecting a chemotherapy regimen. The NCCN guidelines recommend that patients be treated by a multidisciplinary team of healthcare professionals, including medical oncologists, surgeons, and radiologists.\n\nReference: NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Colon Cancer Version 1.2022.",
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+ "answer": "Pembrolizumab is a PD-1 inhibitor used to treat various types of cancer, including non-small cell lung cancer (NSCLC). The expression levels of PD-L1 are used as a biomarker to select patients for pembrolizumab therapy in lung cancer.\n\nPD-L1 is a protein expressed on the surface of tumor cells and some immune cells. When PD-L1 binds to its receptor PD-1 on T cells, it inhibits T cell activation and proliferation, allowing cancer cells to evade immune surveillance. Pembrolizumab works by blocking the interaction between PD-1 and PD-L1, thus restoring T cell function and promoting anti-tumor immune responses.\n\nThe tumor proportion score (TPS) is a commonly used measure of PD-L1 expression, which is defined as the proportion of tumor cells expressing PD-L1. The TPS is measured using immunohistochemistry (IHC) on tumor tissue samples.\n\nThe FDA-approved companion diagnostic for pembrolizumab in NSCLC is the VENTANA PD-L1 (SP142) assay. This assay measures the TPS of PD-L1 expression in tumor cells.\n\nThe selection of patients for pembrolizumab therapy based on PD-L1 expression levels is as follows:\n\n- For patients with NSCLC whose tumors have a TPS \u2265 50%, pembrolizumab is recommended as a first-line treatment.\n- For patients with NSCLC whose tumors have a TPS \u2265 1%, pembrolizumab is recommended as a second-line treatment.\n- For patients with NSCLC whose tumors have a TPS < 1%, pembrolizumab is not recommended as a first-line or second-line treatment.\n\nIt's worth noting that PD-L1 expression levels do not predict response to pembrolizumab therapy and do not exclude patients from receiving the treatment. Other factors, such as the presence of driver mutations, the patient's performance status, and the presence of comorbidities, should also be considered when deciding whether to administer pembrolizumab.",
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+ "answer": "For first-line maintenance treatment of BRCA-mutated ovarian cancer, the main treatment protocol involves the use of PARP inhibitors. \n\nOne of the most commonly used PARP inhibitors for this indication is olaparib. The ASTRAL-2 trial demonstrated the efficacy of olaparib in maintaining response to platinum-based chemotherapy in patients with BRCA1/2-mutated advanced ovarian cancer. \n\nAnother commonly used PARP inhibitor for this indication is niraparib. The SOLO-2 trial showed that niraparib significantly prolonged progression-free survival (PFS) in patients with platinum-sensitive, recurrent ovarian cancer and BRCA1 or BRCA2 mutations. \n\nAdditionally, talazoparib, another PARP inhibitor, has also been shown to be effective in this setting. The ESMO Principles and Recommendations for the treatment of ovarian cancer suggest that PARP inhibitors should be used as first-line maintenance therapy in patients with BRCA1/2-mutated advanced ovarian cancer who have achieved a complete or partial response to platinum-based chemotherapy.",
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+ "answer": "For patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), the standard treatment options may include the following:\n\n1. **High-Dose Chemotherapy with Autologous Stem Cell Transplant (ASCT)**: This is a common approach for patients with relapsed or refractory DLBCL. High-dose chemotherapy is followed by the infusion of autologous stem cells, which helps to restore the bone marrow's ability to produce blood cells.\n\n2. **Gemcitabine and Dexamethasone**: This combination of chemotherapy drugs has been used as a bridge to ASCT or as a treatment option for patients who are not candidates for ASCT.\n\n3. **Pembrolizumab**: This immunotherapy drug has been approved by the FDA for the treatment of adult patients with relapsed or refractory DLBCL who are not candidates for ASCT.\n\n4. **Bendamustine and Rituximab**: This combination of chemotherapy and monoclonal antibody has been used as a treatment option for patients with relapsed or refractory DLBCL.\n\n5. **Carfilzomib and Rituximab**: This combination of proteasome inhibitor and monoclonal antibody has shown promise in clinical trials for the treatment of relapsed or refractory DLBCL.\n\n6. **CAR-T cell therapy**: This type of immunotherapy involves the use of genetically modified T cells to recognize and attack cancer cells. CAR-T cell therapy has shown promising results in clinical trials for the treatment of relapsed or refractory DLBCL.\n\nIt is essential to note that the specific treatment approach will depend on various factors, including the patient's overall health, the extent of the disease, and the presence of any comorbidities. A healthcare professional should be consulted to determine the best course of treatment for an individual patient.",
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+ "answer": "[Retrieval]\n\nFrom the retrieved context, the condition ID for Hypertension is CVD_001, and its first-line treatment is listed as ACE Inhibitors and Beta-blockers.\n\n[IsREL: Relevant]\n\nThe condition ID for stage 2 hypertension is not explicitly mentioned in the retrieved context. However, based on the normal blood pressure range for adults (120/80 mmHg) and the abnormal threshold for hypertension (140/90 mmHg), it can be inferred that stage 2 hypertension refers to a blood pressure of 140/90 mmHg or higher.\n\nConsidering this, the first-line treatment for stage 2 hypertension according to current guidelines is:\n\n[IsSUP: Supported] ACE Inhibitors or Beta-blockers are commonly recommended as first-line treatments for stage 2 hypertension by various medical guidelines, including those from the American Heart Association and the American College of Cardiology.\n\n[IsSUP: Partially Supported] While the retrieved context lists ACE Inhibitors and Beta-blockers as first-line treatments for hypertension, it does not specifically mention stage 2 hypertension. However, these medications are widely accepted as initial treatment options for hypertension in general.",
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+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
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+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
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+ "answer": "[IsREL: Relevant]\n\nBeta-blockers are a cornerstone of therapy for patients with heart failure with reduced ejection fraction (HFrEF). The recommended beta-blocker choices for patients with HFrEF are:\n\n[IsSUP: Supported] The following beta-blockers are indicated for the treatment of HFrEF:\n\n1. **Carvedilol**: This is one of the most well-studied beta-blockers in HFrEF and has been shown to improve survival and reduce hospitalizations.\n2. **Metoprolol succinate (Toprol-XL)**: This beta-blocker has also been shown to improve survival and reduce hospitalizations in patients with HFrEF.\n3. **Bisoprolol**: This beta-blocker has been shown to improve survival and reduce hospitalizations in patients with HFrEF, particularly in those with a history of myocardial infarction.\n\n[IsSUP: Supported] In addition to these three beta-blockers, **Nebivolol** has also been shown to be effective in reducing hospitalizations and improving symptoms in patients with HFrEF.\n\n[IsSUP: Supported] It is essential to note that the choice of beta-blocker should be individualized based on the patient's specific clinical characteristics, comorbidities, and response to therapy.\n\n[IsSUP: Partially Supported] Some studies have suggested that **Beta-1 selective beta-blockers** (e.g., Metoprolol succinate) may be more effective than non-selective beta-blockers (e.g., Carvedilol) in reducing hospitalizations and improving symptoms in patients with HFrEF. However, more research is needed to confirm this finding.\n\n[IsSUP: Partially Supported] **Initiation of beta-blocker therapy** should be done cautiously, especially in patients with significant left ventricular dysfunction or those who have recently experienced a myocardial infarction. A gradual dose escalation and close monitoring of the patient's response are essential to avoid adverse effects.\n\n[IsSUP: Partially Supported] In summary, Carvedilol, Metoprolol succinate, Bisoprolol, and Nebivolol are the recommended beta-blocker choices for patients with HFrEF. The choice of beta-blocker should be individualized based on the patient's specific clinical characteristics and response to therapy.",
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+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 752,
+ "content": "t, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, toxic nodular goiter, thyroiditis, excessive iodine intake\n- Treatment: Anti-thyroid medications, radioactive iodine, beta-blockers, surgery in severe cases\n- Complications: Osteoporosis, heart problems, thyroid storm\n\n=== GASTROINTESTINAL DISORDERS ===\n\nGastroesophageal Reflux Disease (GERD)\n- Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing, chronic cough, sore throat\n- Risk Factors: Obesity, pregnancy, smoking, hiatal hernia, certain foods and beverages\n- Treatment: Proton pump inhibitors, H2 blockers, antacids, lifestyle modifications, surgery if severe\n- Complications: Esophagitis, Barrett's esophagus, esophageal stricture, respiratory problems\n\nIrritable Bowel Syndrome (IBS)\n- Symptoms: Abdominal pain, bloating, gas, diarrhea, constipation, mucus in stool\n- Triggers: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), ",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What are the recommended beta-blocker choices for patients with heart failure with reduced ejection fraction (HFrEF)?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nUpon reviewing the provided context, I found a relevant condition: CVD_003, Atrial Fibrillation, Cardiovascular, Moderate to Severe.\n\n[IsREL: Relevant]\n\nThe diagnostic criteria for atrial fibrillation subtypes are not explicitly mentioned in the provided context. However, I can provide some general information.\n\n[IsSUP: Supported] Atrial fibrillation subtypes are typically classified based on the underlying cause, duration, and severity of the condition. The most common classification system is the CHA2DS2-VASc score, which is used to estimate the risk of stroke in patients with atrial fibrillation.\n\n[IsSUP: Partially Supported] The CHA2DS2-VASc score takes into account the following factors:\n\n- Congestive heart failure (1 point)\n- Hypertension (1 point)\n- Age \u2265 75 years (2 points)\n- Diabetes mellitus (1 point)\n- Stroke or transient ischemic attack (2 points)\n- Vascular disease (1 point)\n- Age 65-74 years (1 point)\n- Sex category (female sex) (1 point)\n\n[Key Statement] The CHA2DS2-VASc score is not a direct diagnostic criterion for atrial fibrillation subtypes but is used to estimate the risk of stroke in patients with atrial fibrillation.\n\n[IsSUP: Supported] The CHA2DS2-VASc score is widely used in clinical practice to guide anticoagulation therapy in patients with atrial fibrillation.\n\nAdditional information on atrial fibrillation subtypes can be found in the literature, including the 2014 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What diagnostic criteria are used to classify atrial fibrillation subtypes?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "[Retrieval] \nBased on the provided context, it appears that there is no direct information about ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction.\n\nHowever, the context does mention \"Statins\" as a treatment option for \"CVD_002, Coronary Artery Disease\" with the following information: \n\"High cholesterol, Smoking, Diabetes, Statins, Angioplasty, Heart attack, Heart failure, Lipid Panel, Total <200 mg/dL, LDL >160 mg/dL, 18, Adults 40+, Male predominant\"\n\nThis information might be related to the treatment of coronary artery disease, but it does not specifically address the guidelines for statin therapy in secondary prevention after myocardial infarction.\n\nTo provide a more accurate answer, further retrieval or consultation of external sources would be necessary.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
+ ]
+ },
+ {
+ "answer": "[Retrieval] \nContext retrieval necessary to answer the query.\n\n[IsREL: Relevant]\nQuery relevant to retrieved context CVD_003, Atrial Fibrillation.\n\n[IsREL: Relevant]\nQuery also relevant to retrieved context ENDO_001, Type 2 Diabetes.\n\n[IsREL: Relevant]\nQuery also relevant to retrieved context MSK_002, Rheumatoid Arthritis.\n\n[IsREL: Relevant]\nQuery also relevant to retrieved context RESP_001, Asthma and RESP_002, COPD.\n\n[CVD_003], Atrial Fibrillation context relevant to the query.\n\n[IsSUP: Supported] \nAccording to the context for CVD_003, Atrial Fibrillation, blood thinners are recommended for treatment. However, the specific anticoagulants recommended for stroke prevention in non-valvular atrial fibrillation are not mentioned in the provided context. \n\nTo provide a more accurate answer, it is necessary to consult external sources. \n\nTypically, anticoagulants such as warfarin, apixaban, rivaroxaban, and dabigatran are recommended for stroke prevention in non-valvular atrial fibrillation patients.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "Which anticoagulants are recommended for stroke prevention in non-valvular atrial fibrillation?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nAfter retrieving relevant information from my database, I found several relevant context chunks related to cardiovascular conditions.\n\n[IsREL: Relevant]\n\nHere's a relevant context chunk:\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31\n---\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\n\n[IsSUP: Supported]\n\nThe CHADS2-VASc score is a clinical prediction rule used to estimate the risk of stroke in patients with non-valvular atrial fibrillation (AF). The score is calculated by assigning points for various risk factors, including:\n\n* C: Congestive heart failure (1 point)\n* H: Hypertension (1 point)\n* A: Age \u2265 75 years (1 point)\n* D: Diabetes (1 point)\n* S2: Stroke or transient ischemic attack (TIA) (2 points)\n* V: Vascular disease (1 point)\n* A: Age 65-74 years (1 point)\n* Sc: Sex category (female sex) (1 point)\n\nA higher CHADS2-VASc score indicates a higher risk of stroke. The score is used to guide anticoagulation decisions, with patients at high risk (score \u2265 2) typically considered for anticoagulation therapy.\n\n[IsSUP: Supported]\n\nIn clinical practice, the CHADS2-VASc score is often used in conjunction with other risk factors and guidelines to determine the optimal anticoagulation strategy for patients with AF. The decision to initiate anticoagulation therapy should be individualized, taking into account the patient's overall risk profile, comorbidities, and potential bleeding risks.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What is the CHADS2-VASc score and how is it used to guide anticoagulation decisions?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nUpon reviewing the provided context, the relevant information about stable ischemic heart disease can be found in the condition CVD_002, Coronary Artery Disease.\n\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\n\n[IsREL: Relevant]\n\nBased on the provided information, the current guideline-directed medical therapy for stable ischemic heart disease involves:\n\n**[IsSUP: Supported] Statins:** Patients with stable ischemic heart disease should be treated with statins to reduce their risk of cardiovascular events. Statins are effective in lowering LDL cholesterol levels and reducing the risk of myocardial infarction and stroke.\n\n**[IsSUP: Supported] Angiotensin-Converting Enzyme (ACE) Inhibitors or Angiotensin Receptor Blockers (ARBs):** ACE inhibitors or ARBs may be used in patients with stable ischemic heart disease and reduced ejection fraction or hypertension.\n\n**[IsSUP: Partially Supported] Beta-Blockers:** Beta-blockers may be used in patients with stable ischemic heart disease and a history of myocardial infarction or heart failure.\n\n**[IsSUP: Partially Supported] Antiplatelet Therapy:** Antiplatelet therapy with aspirin or a P2Y12 inhibitor (such as clopidogrel, prasugrel, or ticagrelor) may be used in patients with stable ischemic heart disease to reduce the risk of myocardial infarction and stroke.\n\n**[IsSUP: Partially Supported] Lifestyle Modifications:** Lifestyle modifications, such as smoking cessation, regular exercise, and a healthy diet, are important for patients with stable ischemic heart disease to reduce their risk of cardiovascular events.\n\nIt is essential to note that these recommendations are based on the provided context and may not reflect the most up-to-date or comprehensive guidelines for the management of stable ischemic heart disease.",
+ "confidence": 0.667,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.667,
+ "query": "What is the current guideline-directed medical therapy for stable ischemic heart disease?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nRETRIEVED CONTEXT:\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31\n---\npirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\n\n[IsREL: Relevant]\n\nCardiac resynchronization therapy (CRT) is indicated in heart failure patients who have:\n\n[IsSUP: Supported] **Left Bundle Branch Block (LBBB) or other conduction abnormalities** that result in asynchronous ventricular contraction, leading to reduced cardiac output and increased symptoms.\n\n[IsSUP: Partially Supported] **Symptomatic heart failure** with reduced ejection fraction (HFrEF) despite optimal medical therapy, as evidenced by:\n\n- **NYHA Class III or IV symptoms**\n- **QRS duration \u2265130 ms**\n- **LVEF \u226435%**\n\n[IsSUP: Supported] **Evidence of dyssynchrony**, such as:\n\n- **Left ventricular (LV) dyssynchrony** on echocardiography or cardiac MRI\n- **Abnormal septal motion** on echocardiography\n\n[IsSUP: Partially Supported] **Other factors**, such as:\n\n- **History of heart failure hospitalization**\n- **Increased risk of arrhythmic death**\n\nCRT is not indicated in patients with:\n\n[IsSUP: Partially Supported] **Normal ventricular function**, as evidenced by:\n\n- **LVEF >40%**\n- **No evidence of dyssynchrony**\n\n[IsSUP: Partially Supported] **Acute decompensated heart failure**, as CRT is generally not effective in this setting.\n\nIt is essential to note that CRT may not be beneficial in all patients, and the decision to implant a CRT device should be made on a case-by-case basis, taking into account the individual patient's characteristics, symptoms, and underlying cardiac function.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How is cardiac resynchronization therapy indicated in heart failure patients?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "[Retrieval] \nTo answer this question, we will need to search for information on the diagnostic criteria for Heart Failure with Preserved Ejection Fraction (HFpEF).\n\n[IsREL: Relevant]\nThe diagnostic criteria for HFpEF involve a combination of clinical evaluation, laboratory tests, and diagnostic imaging. \n\n[IsSUP: Supported] \nAccording to the 2016 ACC/AHA/HFSA focused update on the diagnosis and treatment of heart failure, the diagnostic criteria for HFpEF include:\n\n1. **Echocardiography**: \n - Left ventricular ejection fraction (LVEF) \u226550% \n [IsSUP: Supported] \n The LVEF is measured using echocardiography, which confirms that the left ventricle is pumping blood efficiently.\n\n2. **Symptoms**:\n - Presence of signs and symptoms of heart failure (e.g., shortness of breath, fatigue, swelling)\n [IsSUP: Supported] \n Patients with HFpEF typically experience symptoms of heart failure despite preserved LVEF.\n\n3. **Clinical assessment**:\n - Elevated jugular venous pressure\n - Bilateral pitting edema\n - Hepatomegaly\n [IsSUP: Supported] \n A thorough clinical assessment is crucial in identifying patients with HFpEF.\n\n4. **Laboratory tests**:\n - Elevated natriuretic peptide levels (e.g., B-type natriuretic peptide (BNP) or N-terminal pro b-type natriuretic peptide (NT-proBNP))\n - Electrolyte imbalances (e.g., hyperkalemia, hyponatremia)\n [IsSUP: Supported] \n Laboratory tests help to confirm the diagnosis and rule out other potential causes of symptoms.\n\n5. **Diagnostic imaging**:\n - Chest X-ray: cardiomegaly, pulmonary congestion\n - Echocardiography: left ventricular hypertrophy, diastolic dysfunction\n [IsSUP: Supported] \n Diagnostic imaging helps to confirm the presence of HFpEF and rule out other potential causes of symptoms.\n\n[IsSUP: Partially Supported] \nIn addition to these diagnostic criteria, the 2016 ACC/AHA/HFSA focused update also emphasizes the importance of considering comorbidities (e.g., hypertension, diabetes, coronary artery disease) and lifestyle factors (e.g., physical inactivity, obesity) when diagnosing and treating HFpEF.\n\nPlease note that these diagnostic criteria are subject to change as new evidence emerges, and the diagnosis and treatment of HFpEF should be made by a qualified healthcare professional.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What are the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF)?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nRetrieved Data: medical_conditions.csv (TEXT)\n\n[CVD_002: Relevant] Coronary Artery Disease is a relevant condition to the query.\n\n[CVD_002, IsREL: Relevant] Coronary Artery Disease is relevant because STEMI is a type of heart attack caused by a blockage in the coronary arteries.\n\n[CVD_002, IsSUP: Supported] The recommended approach to treating STEMI within the first 12 hours is to administer primary percutaneous coronary intervention (PCI) as soon as possible.\n\n[IsSUP: Supported] Primary PCI is the preferred treatment for STEMI within 12 hours of symptom onset, as it has been shown to significantly improve survival and reduce morbidity compared to thrombolysis.\n\n[IsSUP: Supported] The American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend primary PCI as the initial treatment for STEMI, with a goal of performing the procedure within 90 minutes of arrival at the hospital.\n\n[IsSUP: Partially Supported] However, if primary PCI is not available, thrombolytic therapy with fibrinolytic agents such as alteplase or reteplase may be considered as an alternative treatment option.\n\n[IsSUP: Partially Supported] It is essential to note that thrombolytic therapy should only be administered in a hospital setting under the supervision of a trained healthcare professional, as it carries a risk of bleeding complications.\n\n[IsSUP: Partially Supported] In addition to primary PCI or thrombolysis, other treatments such as antiplatelet therapy with aspirin and P2Y12 inhibitors (e.g., clopidogrel, prasugrel, or ticagrelor), and anticoagulation with heparin or bivalirudin, may be administered to reduce the risk of further ischemic events.\n\n[IsSUP: Supported] The management of STEMI also involves close monitoring of cardiac biomarkers, electrocardiograms (ECGs), and hemodynamic parameters to assess the extent of myocardial damage and guide subsequent treatment decisions.\n\n[IsSUP: Supported] Overall, the recommended approach to treating STEMI within the first 12 hours involves prompt administration of primary PCI, thrombolytic therapy, or other evidence-based treatments under the supervision of a trained healthcare professional.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
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+ "context",
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+ "faithfulness": 0.333,
+ "query": "What is the recommended approach to treating ST-elevation myocardial infarction (STEMI) within the first 12 hours?",
+ "expected_source_docs": [
+ "10523176"
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+ {
+ "answer": "[Retrieval] is necessary to provide the most up-to-date information.\n\nAfter retrieval, the context is evaluated for relevance.\n\n[IsREL: Relevant] because the question pertains to lung cancer.\n\nThe answer will be generated incorporating [IsSUP: Supported] reflection tags.\n\nAccording to the latest guidelines, the standard first-line chemotherapy regimen for metastatic non-small cell lung cancer (NSCLC) typically involves a combination of:\n\n[IsSUP: Supported] The use of platinum-based doublet chemotherapy, such as carboplatin and pemetrexed, with or without bevacizumab or other targeted therapies.\n\n[IsSUP: Supported] However, the choice of chemotherapy regimen may vary depending on the patient's specific characteristics, such as tumor histology, molecular status, and performance status.\n\n[IsSUP: Partially Supported] The use of immunotherapy, such as pembrolizumab or nivolumab, in combination with chemotherapy, has also shown promising results in NSCLC treatment.\n\nIt is essential to consult with a healthcare professional or a medical oncologist to determine the most suitable treatment plan for an individual patient.\n\nReferences:\n* National Comprehensive Cancer Network (NCCN) Guidelines for Non-Small Cell Lung Cancer\n* American Society of Clinical Oncology (ASCO) Clinical Practice Guideline for Stage IV NSCLC\n\nNote: This answer is based on the provided context and may not reflect the most recent updates or guidelines. For accurate and personalized treatment information, consult a medical professional.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 750,
+ "content": "ications\n- Management: Avoid triggers, use peak flow meter, action plan, regular check-ups\n\nChronic Obstructive Pulmonary Disease (COPD)\n- Symptoms: Chronic cough, mucus production, shortness of breath, wheezing, chest tightness, fatigue\n- Risk Factors: Smoking, long-term exposure to lung irritants, alpha-1 antitrypsin deficiency, age over 40\n- Treatment: Bronchodilators, inhaled steroids, oxygen therapy, pulmonary rehabilitation, smoking cessation\n- Complications: Respiratory infections, heart problems, lung cancer, depression\n\nPneumonia\n- Symptoms: Fever, chills, cough with phlegm, chest pain, shortness of breath, fatigue, confusion (in elderly)\n- Causes: Bacteria, viruses, fungi, aspiration\n- Treatment: Antibiotics, antiviral medications, rest, fluids, oxygen therapy if severe\n- Prevention: Vaccination, hand hygiene, avoid smoking\n\n=== ENDOCRINE DISORDERS ===\n\nType 2 Diabetes\n- Symptoms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing so",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the standard chemotherapy regimen for first-line treatment of metastatic non-small cell lung cancer?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nAfter analyzing the medical context, I found the following relevant information:\n\nBased on the provided data, there is no specific information on NCCN guidelines for adjuvant chemotherapy in stage III colon cancer. However, I can suggest that the National Comprehensive Cancer Network (NCCN) provides guidelines for colon cancer management, including adjuvant chemotherapy for stage III colon cancer.\n\nIsREL: Relevant\n\nAccording to the NCCN guidelines for colon cancer (version 2022), the following are the recommended adjuvant chemotherapy regimens for stage III colon cancer:\n\n[IsSUP: Supported] The NCCN recommends the following adjuvant chemotherapy regimens for stage III colon cancer:\n\n1. FOLFOX (oxaliplatin, 5-fluorouracil, leucovorin)\n2. XELOX (capecitabine, oxaliplatin)\n3. CAPOX (capecitabine, oxaliplatin)\n\n[IsSUP: Supported] The NCCN also recommends the following adjuvant chemotherapy regimens for stage III colon cancer in patients with a high risk of recurrence:\n\n1. FOLFIRI (irinotecan, 5-fluorouracil, leucovorin)\n2. CAPOXIRI (capecitabine, irinotecan)\n\n[IsSUP: Supported] The NCCN notes that the choice of adjuvant chemotherapy regimen should be individualized based on the patient's overall health, performance status, and comorbidities.\n\nPlease note that these guidelines are subject to change and may not reflect the most up-to-date information. It is essential to consult the latest NCCN guidelines and discuss the treatment options with a healthcare professional for personalized recommendations.\n\nIsREL: Relevant\n\nThe NCCN guidelines also provide recommendations for adjuvant chemotherapy in stage III colon cancer based on the tumor's molecular characteristics, such as microsatellite instability (MSI) or mismatch repair (MMR) deficiency.\n\n[IsSUP: Supported] The NCCN recommends that patients with stage III colon cancer and MSI-H or MMR-deficient tumors receive adjuvant chemotherapy with a fluoropyrimidine-based regimen, such as FOLFOX or XELOX.\n\nPlease consult the latest NCCN guidelines for the most up-to-date information on adjuvant chemotherapy in stage III colon cancer.\n\nIsREL: Irrelevant\n\nThe provided data does not contain information on the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer. However, the NCCN guidelines provide a framework for making informed decisions about adjuvant chemotherapy in stage III colon cancer based on the patient's individual characteristics and tumor characteristics.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
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+ "retrieved_chunk_doc_ids": [
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+ "query": "What are the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer?",
+ "expected_source_docs": [
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+ {
+ "answer": "**[IsREL: Relevant]**\n\nPembrolizumab is a PD-1 inhibitor used to treat various types of cancer, including non-small cell lung cancer (NSCLC). **[IsSUP: Supported]** PD-L1 expression levels are used to select patients for pembrolizumab therapy in lung cancer, although not as a sole determining factor.\n\n**[IsSUP: Supported]** The presence of PD-L1 on tumor cells and immune cells, such as tumor-infiltrating T cells, can indicate a higher likelihood of response to pembrolizumab. However, PD-L1 expression is not a definitive predictor of response, as some patients with low or no PD-L1 expression may still benefit from pembrolizumab.\n\n**[IsSUP: Supported]** The FDA-approved indications for pembrolizumab in NSCLC include:\n\n1. PD-L1 expression \u2265 50% in tumor cells, as determined by immunohistochemistry (IHC) using a specific test.\n2. Tumor mutation burden (TMB) \u2265 10 mutations/megabase, as determined by next-generation sequencing (NGS).\n\n**[IsSUP: Supported]** In addition to PD-L1 expression, other factors may influence the decision to use pembrolizumab in lung cancer, including:\n\n1. Tumor histology (e.g., adenocarcinoma, squamous cell carcinoma)\n2. Patient performance status\n3. Presence of measurable disease\n4. Prior treatment history (e.g., chemotherapy, radiation therapy)\n\n**[IsSUP: Partially Supported]** While PD-L1 expression levels can provide valuable information for selecting patients for pembrolizumab therapy, they should be considered in conjunction with other clinical factors and tumor characteristics. **[IsSUP: Supported]** The decision to use pembrolizumab should be made on a case-by-case basis, taking into account individual patient circumstances and the results of comprehensive diagnostic testing.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How are PD-L1 expression levels used to select patients for pembrolizumab therapy in lung cancer?",
+ "expected_source_docs": [
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+ "7786949"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\n[IsREL: Relevant]\n\nFrom the provided medical conditions dataset, we do not have specific information about treatment options for relapsed/refractory diffuse large B-cell lymphoma (DLBCL). However, based on general medical knowledge, here is a self-reflective answer with supported information:\n\nFor relapsed or refractory diffuse large B-cell lymphoma (DLBCL), standard treatment options typically involve:\n\n[IsSUP: Supported] **Chemotherapy and Immunotherapy Combinations**:\n- R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) is a common initial treatment for DLBCL, but for relapsed or refractory cases, more intensive regimens like R-DHAP (rituximab, dexamethasone, high-dose cytarabine, and cisplatin) or R-EPOCH (rituximab, etoposide, prednisone, vincristine, and doxorubicin) may be considered.\n- The addition of immunotherapies, such as lenalidomide or belantamab mafodotin, to chemotherapy regimens has shown promise in treating relapsed or refractory DLBCL.\n- CAR-T cell therapy, such as axicabtagene ciloleucel (axi-cel) or tisagenlecleucel (tisa-cel), may be an option for patients who have not responded to other treatments or have relapsed after initial therapy.\n\n[IsSUP: Partially Supported] **Targeted Therapies and Other Options**:\n- Targeted therapies, such as ibrutinib or venetoclax, may be considered for patients with specific genetic mutations, like MYD88 or CD79B mutations.\n- Other treatment options, including radiation therapy, may be used in certain cases, such as when the disease is localized or as part of a clinical trial.\n\nPlease note that the specific treatment plan for relapsed or refractory DLBCL should be individualized and determined by a healthcare professional based on the patient's overall health, disease characteristics, and response to previous treatments.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
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+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
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+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
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+ "faithfulness": 0.0,
+ "query": "What are the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
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+ },
+ "MEXAR": {
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+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
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+ "in_domain": false,
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+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
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+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
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+ "original_query": "What is the first-line treatment for stage 2 hypertension according to current guidelines?"
+ }
+ },
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+ "domain_guardrail_ms": 1897.9,
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+ "query": "What is the first-line treatment for stage 2 hypertension according to current guidelines?",
+ "expected_source_docs": [
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+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
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+ "summary": "Query rejected - outside domain expertise",
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+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What are the recommended beta-blocker choices for patients with heart failure with reduced ejection fraction (HFrEF)?"
+ }
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+ "domain_guardrail_ms": 58.4,
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+ "query": "What are the recommended beta-blocker choices for patients with heart failure with reduced ejection fraction (HFrEF)?",
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+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
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+ "in_domain": false,
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+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
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+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What diagnostic criteria are used to classify atrial fibrillation subtypes?"
+ }
+ },
+ "timings": {
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+ "total_ms": 16.2
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+ "query": "What diagnostic criteria are used to classify atrial fibrillation subtypes?",
+ "expected_source_docs": [
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+ "10523176"
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+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 28.1,
+ "total_ms": 28.1
+ },
+ "query": "What are the ESC or ACC/AHA guideline recommendations for statin therapy in secondary prevention after myocardial infarction?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
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+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "Which anticoagulants are recommended for stroke prevention in non-valvular atrial fibrillation?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 14.4,
+ "total_ms": 14.4
+ },
+ "query": "Which anticoagulants are recommended for stroke prevention in non-valvular atrial fibrillation?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What is the CHADS2-VASc score and how is it used to guide anticoagulation decisions?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 13.0,
+ "total_ms": 13.0
+ },
+ "query": "What is the CHADS2-VASc score and how is it used to guide anticoagulation decisions?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What is the current guideline-directed medical therapy for stable ischemic heart disease?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 16.2,
+ "total_ms": 16.2
+ },
+ "query": "What is the current guideline-directed medical therapy for stable ischemic heart disease?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "How is cardiac resynchronization therapy indicated in heart failure patients?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 23.8,
+ "total_ms": 23.8
+ },
+ "query": "How is cardiac resynchronization therapy indicated in heart failure patients?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What are the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF)?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 19.6,
+ "total_ms": 19.6
+ },
+ "query": "What are the diagnostic criteria for heart failure with preserved ejection fraction (HFpEF)?",
+ "expected_source_docs": [
+ "10523176",
+ "10050065"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What is the recommended approach to treating ST-elevation myocardial infarction (STEMI) within the first 12 hours?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 12.5,
+ "total_ms": 12.5
+ },
+ "query": "What is the recommended approach to treating ST-elevation myocardial infarction (STEMI) within the first 12 hours?",
+ "expected_source_docs": [
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What is the standard chemotherapy regimen for first-line treatment of metastatic non-small cell lung cancer?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 21.8,
+ "total_ms": 21.8
+ },
+ "query": "What is the standard chemotherapy regimen for first-line treatment of metastatic non-small cell lung cancer?",
+ "expected_source_docs": [
+ "7786949",
+ "10523176"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What are the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 19.1,
+ "total_ms": 19.1
+ },
+ "query": "What are the NCCN guidelines for adjuvant chemotherapy in stage III colon cancer?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "How are PD-L1 expression levels used to select patients for pembrolizumab therapy in lung cancer?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 14.9,
+ "total_ms": 15.0
+ },
+ "query": "How are PD-L1 expression levels used to select patients for pembrolizumab therapy in lung cancer?",
+ "expected_source_docs": [
+ "10523176",
+ "7786949"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What are the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 25.6,
+ "total_ms": 25.6
+ },
+ "query": "What are the standard treatment options for relapsed/refractory diffuse large B-cell lymphoma?",
+ "expected_source_docs": [
+ "10050065",
+ "10523176"
+ ]
+ }
+ ]
+ }
+ },
+ "legal": {
+ "Naive RAG": {
+ "mean_faithfulness": 0.0333,
+ "sample_size": 15,
+ "raw_results": [
+ {
+ "answer": "I don't have information about that. The provided knowledge base context is related to medical conditions, and it doesn't cover contract law or remedies for breach of contract.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What remedies are available to a non-breaching party when the other party materially breaches a contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I don't have information about the Hadley v Baxendale rule in the context of court decisions regarding consequential damages for breach of contract. However, I can provide general information about the Hadley v Baxendale case.\n\nThe Hadley v Baxendale case (1854) is an English contract law case that established the principle of remoteness of damage in contract law. However, the specifics regarding consequential damages under the Hadley v Baxendale rule are not contained within the provided knowledge base.\n\nTo answer your question accurately, I would need access to additional information, such as court decisions, legal texts, or a detailed description of the Hadley v Baxendale rule in the context of consequential damages. If you have any multimodal input, such as a document or audio file, that provides further information, please let me know.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?",
+ "expected_source_docs": [
+ "case_4991933",
+ "case_4570608"
+ ]
+ },
+ {
+ "answer": "I don't have information about UCC Article 2 or implied warranties that attach to the sale of goods.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I don't have information about the doctrine of promissory estoppel and consideration as a basis for enforcing a promise. The given knowledge base seems to focus on medical conditions, which doesn't cover the topic of law or contracts.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.5,
+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I don't have information about the parol evidence rule or its relation to written contracts.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I don't have information about that.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How is the enforceability of a non-compete clause assessed by courts in employment contracts?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "Under force majeure clauses, what events typically excuse performance of a contract obligation?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the standard for proving patent infringement under the doctrine of equivalents?",
+ "expected_source_docs": [
+ "case_208002",
+ "case_4991933"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the likelihood of confusion test apply in trademark infringement cases?",
+ "expected_source_docs": [
+ "case_208002",
+ "case_4991933"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
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+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the fair use doctrine in copyright law and what are the four statutory factors courts apply?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do courts determine whether trade secrets qualify for protection under the Defend Trade Secrets Act?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
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+ "query": "What is required to establish willful patent infringement and what enhanced damages can result?",
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+ "answer": "When a non-breaching party is faced with a material breach of contract, they may have several remedies available to them. These remedies are designed to compensate the non-breaching party for the loss they have incurred due to the breach. Some common remedies for a non-breaching party include:\n\n1. **Damages**: The non-breaching party may be entitled to receive damages, which are monetary compensation for the losses they have incurred as a result of the breach. There are several types of damages, including:\n\t* **Compensatory damages**: These are designed to put the non-breaching party in the same position they would have been in if the contract had been performed.\n\t* **Consequential damages**: These are damages that result from the breach, such as lost profits or revenue.\n\t* **Punitive damages**: These are damages awarded to punish the breaching party for their actions.\n2. **Specific performance**: In some cases, a court may order the breaching party to perform the specific obligations they failed to meet. This remedy is typically used when damages are not sufficient to compensate the non-breaching party.\n3. **Rescission**: This remedy involves canceling the contract and restoring the parties to their pre-contract positions. This remedy is typically used when the breach is so severe that it is not possible to continue with the contract.\n4. **Restitution**: This remedy involves requiring the breaching party to return any benefits they have received under the contract.\n5. **Termination**: The non-breaching party may be able to terminate the contract, either partially or in its entirety, depending on the terms of the contract.\n\nIt's worth noting that the availability of these remedies will depend on the specific terms of the contract and the applicable law. The non-breaching party should consult with an attorney to determine the best course of action.\n\nSource: \"Contract Law\" by Williston on Contracts (West Publishing); \"Remedies in Contract Law\" by the American Bar Association (ABA).\n\nPlease provide any additional context or multimodal input if you would like me to expand on this information.",
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+ "answer": "The Hadley v Baxendale rule is a landmark case in contract law, specifically in the area of consequential damages. In this case, the court determined that parties can recover consequential damages only if they can prove that the breach caused loss of a type that the parties must have contemplated at the time of contracting.\n\nTo determine whether consequential damages are recoverable under the Hadley v Baxendale rule, courts generally consider the following factors:\n\n1. **Basis of the contract**: The court examines whether the contract was based on the expectation that the parties would perform in a certain way or that certain consequences would follow from a breach.\n2. **Foreseeability**: The court considers whether the parties should have reasonably foreseen the type of loss that resulted from the breach.\n3. **Causation**: The court must determine whether the breach actually caused the loss in question.\n\nIn Hadley v Baxendale (1854), Lord Campbell CJ stated that consequential damages are only recoverable if they \"might naturally be supposed to arise from the breach\" (1 B. & Ad. 329, 341). This means that the parties must have contemplated at the time of contracting that a breach would result in a particular type of loss.\n\nIn summary, to determine whether consequential damages are recoverable under the Hadley v Baxendale rule, courts consider the basis of the contract, foreseeability, and causation. The parties must have contemplated at the time of contracting that a breach would result in a particular type of loss, and the loss must have been caused by the breach.\n\nSource: Hadley v Baxendale (1854) 9 Exch. 341 (Eng. C.P.); Lord Campbell CJ's judgment, 1 B. & Ad. 329 (1854).",
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+ "answer": "Based on the RETRIEVED KNOWLEDGE BASE CONTEXT, the legal standard for determining whether a contract has been formed by conduct rather than by written agreement is often referred to as \"promissory estoppel\" or \"implied-in-fact\" contract.\n\nIn the United States, the Restatement (Second) of Contracts (1981) provides guidance on this issue. According to Section 90 of the Restatement, a promise which the promisor should reasonably expect to induce action or forbearance of a substantial character on the part of the promisee and which does induce such action or forbearance is binding if injustice can be avoided only by enforcement of the promise.\n\nThe Supreme Court of the United States has also addressed this issue in the case of Restatement (Second) of Contracts \u00a7 90 commentary, citing Hadley v. Baxendale (1854), where it stated that a promise is enforceable where it induces reliance and it would be unjust not to enforce it.\n\nIn general, courts consider the following factors when determining whether a contract has been formed by conduct:\n\n1. Clear and unequivocal conduct by the parties indicating their intent to contract.\n2. Reliance by one party on the conduct of the other.\n3. Inducement of action or forbearance by the conduct.\n4. Lack of a written agreement, but not necessarily the absence of a written contract.\n\nIt is essential to note that the specific requirements may vary depending on the jurisdiction, so it is always best to consult with a qualified attorney for specific guidance on contract formation.\n\nSources:\n- Restatement (Second) of Contracts (1981)\n- Hadley v. Baxendale, 156 Eng. Rep. 145 (1854)\n- American Law Institute (ALI)",
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+ "answer": "Under the Uniform Commercial Code (UCC) Article 2, which governs the sale of goods, there are two types of implied warranties that attach to the sale of goods: \n\n1. **Implied Warranty of Merchantability**: This warranty implies that the goods sold are fit for the ordinary purposes for which they are used (\u00a72-314). According to the UCC, goods are considered merchantable if they are at least satisfactory for the ordinary purposes for which they are used and are capable of performing the normal functions they were designed to perform (\u00a72-314 cmt. 1).\n2. **Implied Warranty of Fitness for a Particular Purpose**: This warranty implies that the goods sold are fit for a particular purpose for which the buyer is relying on the seller to be suitable (\u00a72-315). This warranty is applicable only where the seller has reason to know of the particular purpose for which the goods are required and the buyer relies on the seller's judgment or skill in selecting or furnishing suitable goods.\n\nThese implied warranties can be excluded or modified by express agreement of the parties, but only to the extent permitted by the UCC (\u00a72-316).\n\nSources:\n- Uniform Commercial Code (U.C.C.) 2-314 (Implied Warranty of Merchantability)\n- Uniform Commercial Code (U.C.C.) 2-315 (Implied Warranty of Fitness for a Particular Purpose)\n- Uniform Commercial Code (U.C.C.) 2-316 (Exclusion or Modification of Warranties)",
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+ "answer": "The doctrine of promissory estoppel and consideration are both used to enforce promises, but they differ in their underlying principles and requirements.\n\nConsideration is a fundamental concept in contract law, which requires that a promise must be supported by something of value, known as consideration, to be enforceable. Consideration can take many forms, such as a performance, a return promise, or a surrender of a right. In essence, consideration is the quid pro quo that makes a promise binding.\n\nOn the other hand, promissory estoppel is a doctrine that allows a court to enforce a promise even if there is no consideration, as long as the promisor intentionally induces reliance on the promise by the promisee. This means that if a party makes a promise with the intention of causing the other party to rely on it, and the other party does rely on the promise to their detriment, the party making the promise may be estopped from denying its enforceability.\n\nIn other words, consideration requires a bargained-for exchange, whereas promissory estoppel does not. Promissory estoppel focuses on the reliance and expectation created by the promise, rather than the exchange of value.\n\nAs stated in the Restatement (Second) of Contracts \u00a7 90: \"A promise which the promisor should reasonably expect to induce action or forbearance of a substantial character on the part of the promisee or a third person and which does induce such action or forbearance is binding if injustice can be avoided only by enforcement of the promise.\"\n\nIn contrast, consider the following illustration from the same Restatement: \"A, who is under no duty to B, orally promises B that he will not sell his land to C. B relies on the promise and refrains from purchasing the land. The promise is not binding because there is no consideration.\" (Restatement (Second) of Contracts \u00a7 73, illustration 1)\n\nIn summary, while both consideration and promissory estoppel are used to enforce promises, they differ in their underlying principles and requirements, with consideration requiring a bargained-for exchange and promissory estoppel focusing on reliance and expectation.\n\nSources:\n- Restatement (Second) of Contracts\n- Corbin, R. S. (1963). Corbin on Contracts. West Group.\n- Farnsworth, E. A. (2004). Contracts. Little, Brown and Company.",
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+ "answer": "In determining whether to grant specific performance as a remedy for breach of contract, courts consider several factors. These factors include:\n\n1. **Equity and fairness**: Courts weigh whether granting specific performance would be equitable and fair to both parties. They consider whether the breaching party has acted in bad faith or has intentionally delayed performance (Restatement (Second) of Contracts, \u00a7 356).\n2. **Monetary damages**: Courts assess whether the breaching party can be adequately compensated through monetary damages. If damages are insufficient to compensate the non-breaching party, specific performance may be granted ( id.).\n3. **Performance of personal services**: Courts consider whether the contract involves personal services, such as employment agreements or licensing contracts. In these cases, specific performance may be more likely to be granted ( id.).\n4. **Public policy**: Courts evaluate whether granting specific performance would serve public policy or be contrary to public interest. For example, courts may deny specific performance in cases involving monopolies or anti-competitive practices ( id.).\n5. **Difficulty in determining damages**: Courts consider whether it would be difficult to determine the amount of damages owed. If so, specific performance may be granted to avoid the complexities of damages calculation ( id.).\n6. **Nature of the contract**: Courts assess the nature of the contract and the parties' intentions. For example, contracts involving specialized or unique goods may be more likely to be enforced through specific performance ( id.).\n7. **Remedies available under the contract**: Courts review the contract to determine whether specific performance is an available remedy under the contract itself. If the contract explicitly provides for specific performance, courts may be more likely to grant it ( id.).\n\nThese factors are not exhaustive, and courts may consider additional factors on a case-by-case basis. The specific performance remedy is typically awarded in cases involving unique or personal services, where damages would be inadequate or difficult to determine.\n\nSources:\n- Restatement (Second) of Contracts (1981)\n- American Law Institute (ALI) (1981)",
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+ "answer": "The parol evidence rule is a common law doctrine that limits the use of extrinsic evidence to interpret a written contract. It states that when a contract is fully integrated (i.e., it is intended to be a complete and final expression of the parties' agreement), parol evidence (e.g., oral or written statements made prior to or contemporaneously with the contract) is inadmissible to add to, vary, or contradict the terms of the written contract.\n\nIn other words, the parol evidence rule prevents parties from using extrinsic evidence to introduce new terms or modify the written contract. This rule is designed to prevent disputes and ensure that contracts are clear and unambiguous.\n\nAccording to the American Bar Association (ABA), the parol evidence rule is based on the following principles:\n\n1. The contract is considered a complete and final expression of the parties' agreement.\n2. Extrinsic evidence cannot be used to add to, vary, or contradict the written contract.\n3. Extrinsic evidence may be used to interpret the contract, but only if it is necessary to understand the terms or context of the contract.\n\nThe parol evidence rule is codified in various jurisdictions, including the Uniform Commercial Code (UCC) at Section 2-202, which states:\n\n\"Terms with respect to which the confirmatory memoranda of the parties agree or which are otherwise found in writing and signed by the party against whom enforcement is sought or by his authorized agent are conclusively presumed to be such a part of the contract as to bind him.\"\n\nIn summary, the parol evidence rule limits the use of extrinsic evidence to interpret a written contract by preventing parties from introducing new terms or modifying the written contract.\n\nSource:\n- American Bar Association (ABA). (n.d.). Parol Evidence Rule. Retrieved from \n- Uniform Commercial Code (UCC). (1952). \u00a7 2-202. Parol or Extrinsic Evidence.",
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+ "answer": "Anticipatory repudiation is a concept in contract law that refers to the situation where a party repudiates (or rejects) a contract before the time for performance has arrived. This can be done by words or conduct that clearly indicate that party's intention not to perform their obligations under the contract.\n\nTypically, anticipatory repudiation is characterized by a statement or action that unequivocally shows the party's intention to breach the contract. This can include:\n\n* A statement that indicates a party's unwillingness or inability to perform their obligations\n* A failure to take action required under the contract\n* A statement or conduct that indicates a party's intention to avoid or evade their obligations\n\nWhen a party repudiates a contract in this manner, the aggrieved party (the party who was originally expecting to receive performance under the contract) is entitled to several rights, including:\n\n* The right to terminate the contract immediately, even if the time for performance has not yet arrived\n* The right to claim damages for the aggrieved party's anticipated loss of the bargain (also known as expectation damages)\n* The right to recover any expenses incurred in preparing for performance under the contract\n* The right to specific performance (i.e., to require the defaulting party to perform their obligations under the contract)\n\nThe rights of the aggrieved party in the event of anticipatory repudiation may vary depending on the jurisdiction and the specific circumstances of the case. However, in general, the principles outlined above apply.\n\nSources:\n\n* Restatement (Second) of Contracts \u00a7 250 (1981)\n* Uniform Commercial Code \u00a7 2-508 (1978)\n* Corbin on Contracts, \u00a7 10.16 (2014)\n* Williston on Contracts, \u00a7 27:1 (2015)\n\nPlease note that these sources are based on US law and may not apply in other jurisdictions.",
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+ "answer": "According to the retrieved knowledge base context, the enforceability of a non-compete clause in employment contracts is assessed by courts based on several factors, which vary by jurisdiction. However, here are some general guidelines:\n\n1. **Reasonableness**: Courts examine whether the non-compete clause is reasonable in terms of its duration, geographic scope, and scope of prohibited activities. (Source: \"Non-Compete Agreements: A State-by-State Survey\" by the National Conference of State Legislatures)\n2. **Necessity**: Courts consider whether the non-compete clause is necessary to protect the employer's legitimate interests, such as trade secrets, confidential information, or customer relationships. (Source: \"The Law of Restrictive Covenants\" by the American Bar Association)\n3. **Balance of interests**: Courts weigh the interests of the employer against those of the employee, considering factors such as the employee's length of service, the employee's level of access to confidential information, and the potential harm to the employee if the non-compete clause is enforced. (Source: \"Non-Compete Agreements: A Guide for Employers and Employees\" by the Society for Human Resource Management)\n4. **Public policy**: Courts consider whether the non-compete clause is contrary to public policy, such as restricting the employee's ability to work in their chosen profession or limiting competition in a market. (Source: \"The Public Policy of Non-Compete Agreements\" by the National Labor Relations Board)\n5. **State laws**: Courts apply the laws of the state where the employment contract was executed, as well as any applicable state laws governing non-compete clauses. (Source: \"Non-Compete Agreements: A State-by-State Survey\" by the National Conference of State Legislatures)\n\nUltimately, the enforceability of a non-compete clause depends on the specific facts and circumstances of each case, and the decision of the court will depend on a thorough analysis of these factors.",
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+ "answer": "In contract law, a force majeure clause is a provision that excuses one or both parties from performing their contractual obligations when certain extraordinary events occur that are beyond their control. These events typically include:\n\n1. **War**: Conflicts, wars, or acts of terrorism that may prevent performance (Source: Uniform Commercial Code, UCC 2-615).\n2. **Natural disasters**: Events like earthquakes, hurricanes, floods, and wildfires that significantly impair performance (Source: UCC 2-615).\n3. **Epidemics or pandemics**: Outbreaks of contagious diseases that prevent performance (Source: UCC 2-615).\n4. **Acts of God**: Events like storms, floods, or landslides that are caused by natural forces and are beyond human control (Source: Black's Law Dictionary).\n5. **Government actions**: Actions by government authorities, such as embargoes, expropriation, or confiscation, that prevent performance (Source: UCC 2-615).\n6. **Labor disputes**: Strikes, lockouts, or other labor disputes that significantly impair performance (Source: UCC 2-615).\n7. **Material supply shortages**: Cuts in supply or unavailability of essential materials due to circumstances beyond the contractor's control (Source: AIA Document A201-2017).\n8. **Government regulations**: Changes in laws or regulations that make performance impossible or impracticable (Source: UCC 2-615).\n\nIt is essential to note that the specific events that can trigger a force majeure clause vary depending on the contract's terms and the jurisdiction. Parties should carefully review their contracts and seek professional advice to understand the scope of the force majeure clause and its application.\n\nSources:\n\n- Uniform Commercial Code (UCC)\n- Black's Law Dictionary\n- American Institute of Architects (AIA) Document A201-2017",
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+ "answer": "When a party materially breaches a contract, the non-breaching party has several remedies available to them. These remedies can be broadly categorized into three main types: \n\n1. **Rescission**: This is a remedy where the non-breaching party seeks to cancel the contract and have it declared void. This is typically only available if the breach goes to the very root of the contract, and the non-breaching party can no longer benefit from the contract.\n\n2. **Monetary Damages**: This is a common remedy where the non-breaching party seeks compensation for the losses they have incurred due to the breach. This can include damages for lost profits, consequential damages, and other losses that were reasonably foreseeable at the time of entering into the contract.\n\n3. **Specific Performance**: This remedy requires the breaching party to perform their obligations under the contract. This is typically available where the subject matter of the contract is unique or difficult to replace, and the non-breaching party would suffer irreparable harm if they had to rely on monetary damages.\n\n4. **Repudiation**: If a party materially breaches a contract, the other party may choose to treat the contract as at an end and seek damages for the breach. This is known as repudiation.\n\nIn addition to these remedies, the non-breaching party may also have the right to **terminate the contract** and bring a claim for damages. The specific remedies available will depend on the terms of the contract, as well as the laws of the jurisdiction in which the contract was made.\n\nIn some cases, the non-breaching party may also be able to seek **injunctive relief**, such as a court order requiring the breaching party to comply with their obligations under the contract. This can be particularly useful where the breach has caused immediate harm, and the non-breaching party needs urgent action to prevent further harm.\n\nUltimately, the remedy available to the non-breaching party will depend on the specific circumstances of the case, and the parties' intentions as expressed in the contract.",
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+ "answer": "In the Hadley v Baxendale case, the court established a rule for determining whether consequential damages are recoverable for breach of contract. To apply this rule, courts generally follow these steps:\n\n1. **Identify the contract**: The court will examine the specific contract at issue to determine the scope of the obligations and responsibilities of the parties involved.\n2. **Determine the foreseeability of damages**: The court will examine whether the loss or damage suffered by the plaintiff was within the contemplation of the parties when they entered into the contract. This involves considering whether the parties could have reasonably foreseen the type of loss or damage that occurred as a result of the breach.\n3. **Assess whether the damage was a direct result of the breach**: The court will determine whether the loss or damage suffered by the plaintiff was a direct result of the breach of contract. If the damage was indirect or remote, it may not be recoverable.\n4. **Consider the circumstances of the case**: The court will examine the specific circumstances of the case, including any relevant factors that may have contributed to the loss or damage suffered by the plaintiff.\n\nIn terms of the Hadley v Baxendale rule, courts will typically consider the following:\n\n- **Special circumstances**: If the loss or damage suffered by the plaintiff resulted from special circumstances that were known to the parties, they may be liable for consequential damages.\n- **Reasonable foreseeability**: If the parties could have reasonably foreseen the type of loss or damage that occurred as a result of the breach, they may be liable for consequential damages.\n\nBy applying these factors, courts can determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule.",
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+ "answer": "The legal standard for determining whether a contract has been formed by conduct rather than by written agreement is based on the doctrine of promissory estoppel, as well as the Uniform Commercial Code (UCC) and the Restatement (Second) of Contracts.\n\nUnder the doctrine of promissory estoppel, a contract may be implied where:\n\n1. There is a clear and definite promise made by one party to another.\n2. The promise induces reliance by the other party.\n3. The other party suffers a detriment as a result of that reliance.\n\nThe UCC, specifically Section 2-204, provides that a contract may be formed even if the parties have not engaged in formal negotiations or exchanged written confirmations, as long as:\n\n1. There is mutual assent between the parties.\n2. The terms of the contract are sufficiently definite.\n3. There is a meeting of the minds.\n\nThe Restatement (Second) of Contracts, Section 19, provides that a contract may be formed through conduct, even if there is no written agreement, where:\n\n1. The parties engage in conduct that manifests their assent to the terms of the contract.\n2. The conduct is unequivocal and clearly indicates the parties' intent to be bound.\n3. The conduct is sufficient to establish a meeting of the minds.\n\nIn general, the courts will look at the totality of the circumstances, including the language and conduct of the parties, to determine whether a contract has been formed through conduct rather than by written agreement.\n\nSources:\n\n* Restatement (Second) of Contracts, Section 19\n* Uniform Commercial Code, Section 2-204\n* Promissory Estoppel cases, such as Raffles v. Wichelhaus (1864) and Henningsen v. Bloomfield Motors, Inc. (1960)",
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+ "answer": "Under the Uniform Commercial Code (UCC) Article 2, which governs the sale of goods, there are two implied warranties that attach to the sale of goods:\n\n1. **Implied Warranty of Merchantability**: This warranty requires that the goods be fit for the ordinary purposes for which they are used. In other words, the goods must have the quality and characteristics that a reasonable buyer would expect, given the description and price of the goods. This warranty is implied in all sales of goods by merchants, unless explicitly disclaimed.\n\n2. **Implied Warranty of Fitness for a Particular Purpose**: This warranty requires that the goods be suitable for a particular purpose for which the buyer is relying on the seller to provide goods that meet those needs. For example, if a buyer purchases a widget to be used in a specific application and relies on the seller's expertise to choose the correct widget, the seller must provide a widget that is suitable for that application. This warranty is only implied if the seller has reason to know of the particular purpose for which the buyer is acquiring the goods.\n\nIt's worth noting that these implied warranties can be disclaimed or modified by the parties through express language in the contract, but such disclaimers must be clear and conspicuous to be effective.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
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+ {
+ "answer": "The doctrine of promissory estoppel and consideration are both essential concepts in contract law, but they differ in their approach to enforcing promises.\n\nConsideration is a fundamental requirement for the formation of a binding contract. It refers to something of value that is exchanged between the parties, such as a promise to perform a specific act or a payment of money. In exchange for the consideration, the other party agrees to perform their obligations. Consideration can take many forms, including promises, services, or goods. If one party fails to perform their obligations, the other party may seek to enforce the contract and recover damages.\n\nOn the other hand, promissory estoppel is a doctrine that allows a court to enforce a promise even if there was no consideration exchanged. Promissory estoppel arises when one party makes a promise to another party, who relies on that promise to their detriment. In such cases, the court may enforce the promise to prevent injustice. The key elements of promissory estoppel are:\n\n1. A clear and definite promise\n2. Reasonable reliance by the other party\n3. Injury or damage to the relying party\n\nThe main difference between consideration and promissory estoppel is that consideration requires a bargained-for exchange, whereas promissory estoppel focuses on the reliance and injury caused by the breach of promise. In other words, consideration is about the exchange of value, while promissory estoppel is about the consequences of breaking a promise.\n\nTo illustrate the difference, consider a scenario where John promises to buy Mary's car for $10,000. If John makes a genuine offer to buy the car, and Mary relies on that promise by not selling the car to anyone else, John may be bound by the promise even if he never actually pays for the car. This is an example of promissory estoppel, where John's promise has caused Mary to rely to her detriment.\n\nIn contrast, if John and Mary had a pre-existing agreement to sell the car for $10,000, and John failed to pay, Mary could sue for breach of contract based on consideration. The promise to buy the car would be considered sufficient consideration for the sale.\n\nIn summary, consideration focuses on the exchange of value, while promissory estoppel focuses on the consequences of breaking a promise, including reliance and injury.",
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+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
+ "expected_source_docs": [
+ "case_9506898"
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+ {
+ "answer": "When deciding whether to grant specific performance as a remedy for breach of contract, courts typically weigh several factors, including:\n\n1. **Equity**: The court considers whether specific performance is an equitable remedy, meaning whether it is fair and just in the circumstances. This involves assessing whether the breaching party has acted in bad faith or with a lack of diligence.\n2. **Remoteness of damages**: The court evaluates whether the damages caused by the breach are too remote or speculative to be reasonably quantifiable. If damages are difficult to calculate, specific performance may be more suitable.\n3. **Measuring damages**: Courts consider whether the damages can be easily measured or proved. If damages are difficult to quantify, specific performance may be more practical.\n4. **Loss of bargain**: The court assesses whether the breaching party has failed to perform in a way that results in a loss of bargain for the non-breaching party. Specific performance can help restore the contract to its original terms.\n5. **Breach severity**: The court considers the severity of the breach, including whether it was material or fundamental. More severe breaches are more likely to justify specific performance.\n6. **Contractual language**: The court reviews the contract terms to determine whether they explicitly exclude or limit specific performance as a remedy.\n7. **Party behavior**: Courts evaluate the behavior of both parties, including whether one party has acted in bad faith or with a lack of diligence, which may affect the availability of specific performance.\n8. **Prejudice to the non-breaching party**: The court assesses whether the non-breaching party will suffer significant prejudice if specific performance is not granted, such as financial hardship or loss of opportunity.\n9. **Availability of alternative remedies**: The court considers whether alternative remedies, such as monetary damages or injunctive relief, are available and sufficient to compensate the non-breaching party.\n10. **Public policy**: The court evaluates whether granting specific performance would be contrary to public policy or would have an adverse impact on the community.\n\nThese factors are not exhaustive, and courts may consider additional circumstances on a case-by-case basis.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
+ "expected_source_docs": [
+ "case_1052233",
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+ ]
+ },
+ {
+ "answer": "The parol evidence rule is a legal principle that limits the use of extrinsic evidence to interpret a written contract. It generally provides that when a contract is reduced to writing, any prior or contemporaneous oral agreements or negotiations cannot be used to contradict or add to the written terms.\n\nAccording to the parol evidence rule, extrinsic evidence is not admissible to:\n\n1. **Contradict the terms of a fully integrated written contract**: If a written contract appears to be a complete and final expression of the parties' agreement, extrinsic evidence cannot be used to contradict its terms.\n2. **Add to the terms of a written contract**: Extrinsic evidence cannot be used to add new terms or modify the existing terms of a written contract unless the written contract explicitly indicates that it is intended to be a partially integrated document.\n\nHowever, there are some exceptions to the parol evidence rule:\n\n* **Partial integration**: If a written contract is intended to be only a partial integration of the parties' agreement, extrinsic evidence may be admissible to add or modify the terms of the written contract.\n* **Ambiguity**: If a written contract is ambiguous, extrinsic evidence may be admissible to clarify the meaning of the ambiguous term.\n* **Illegality**: If a written contract is illegal or void, extrinsic evidence may be admissible to show that the contract was entered into in bad faith or with a hidden purpose.\n* **Duress or undue influence**: If a party was forced or coerced into signing a written contract, extrinsic evidence may be admissible to show that the contract is invalid.\n\nIn summary, the parol evidence rule limits the use of extrinsic evidence to interpret a written contract by excluding prior or contemporaneous oral agreements or negotiations that contradict or add to the written terms.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "Anticipatory repudiation of a contract occurs when one party to a contract makes a clear statement or commits an act that indicates they will not perform their obligations under the contract, and this statement or act occurs before the time for performance has arrived. This can be a statement of an intention not to perform, or an act that manifests an intention not to perform.\n\nExamples of anticipatory repudiation include:\n\n- A statement by one party to the contract that they will not fulfill their obligations.\n- A refusal or failure to perform a substantial act required by the contract.\n- An indication that the party does not intend to proceed with the contract.\n- A statement that the party lacks the ability or resources to fulfill their obligations.\n\nWhen anticipatory repudiation occurs, the aggrieved party (the party who was not in breach) may choose to:\n\n- Accept the repudiation and terminate the contract, and sue for damages.\n- Wait for the time for performance to arrive and then claim damages for non-performance.\n- Waive the repudiation and continue with the contract.\n\nIf the aggrieved party chooses to accept the repudiation and terminate the contract, they may be entitled to:\n\n- Recover damages for the loss they have suffered as a result of the breach.\n- Claim specific performance, if the contract is one that is suitable for specific performance.\n- Recover any expenses incurred in preparing for performance.\n\nHowever, the aggrieved party must exercise their right to terminate within a reasonable time after they became aware of the repudiation, and they must also notify the other party in writing of their intention to terminate the contract.\n\nIt's worth noting that anticipatory repudiation is a fact-specific determination, and the courts will look at the specific language and circumstances of the contract and the parties' actions to determine whether a repudiation has occurred.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "Courts assess the enforceability of a non-compete clause in employment contracts by considering several factors. These factors may include:\n\n1. **Reasonableness**: The court will evaluate whether the non-compete clause is reasonable in terms of its geographic scope, duration, and type of work prohibited. For example, a clause that restricts a former employee from working for a competitor in a specific geographic area for a certain period may be deemed reasonable if it is not overly broad.\n2. **Necessity**: The court will consider whether the non-compete clause is necessary to protect the employer's legitimate business interests, such as trade secrets, customer relationships, or goodwill. If the employer can demonstrate that the clause is necessary to protect these interests, the court is more likely to enforce it.\n3. **Balance between employer and employee interests**: The court will weigh the interests of the employer against those of the employee. If the non-compete clause imposes an undue hardship on the employee, such as forcing them to give up their career or relocate, the court may be less likely to enforce it.\n4. **State laws and regulations**: Non-compete clauses are governed by state laws, which can vary significantly. Some states, such as California and North Dakota, have laws that restrict or prohibit non-compete clauses, while others, such as Texas and Georgia, have more permissive laws.\n5. **Employee's level of access to confidential information**: The court will consider the level of access the employee had to confidential information, such as trade secrets or customer lists. If the employee had limited access to such information, the court may be less likely to enforce a non-compete clause.\n6. **Whether the employee was an at-will employee**: If the employee was an at-will employee, the court may be more likely to enforce a non-compete clause, as the employee had more flexibility to leave the job and was not contractually bound to the employer for a specific period.\n7. **Post-employment restrictions**: The court will evaluate the reasonableness of any post-employment restrictions, such as non-solicitation or non-disclosure clauses, which may be included in the employment contract.\n\nUltimately, the enforceability of a non-compete clause depends on the specific facts and circumstances of the case, as well as the applicable state laws and regulations.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "How is the enforceability of a non-compete clause assessed by courts in employment contracts?",
+ "expected_source_docs": [
+ "case_9506898"
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+ {
+ "answer": "The likelihood of confusion test is a legal standard used to determine whether a trademark infringement has occurred. In the United States, this test is commonly applied in trademark infringement cases, particularly in the context of the Lanham Act.\n\nTo apply the likelihood of confusion test, courts consider several factors, which are often referred to as the \"Polaroid factors.\" These factors include:\n\n1. **Strength of the mark**: This refers to the distinctiveness and fame of the trademark. Stronger marks, such as those that are highly distinctive or have a large market presence, are more protected from infringement.\n2. **Proximity of the goods or services**: This factor considers whether the goods or services offered by the parties are related or likely to be confused with one another.\n3. **Evidence of actual confusion**: This factor looks for evidence that consumers have actually been confused or misled by the allegedly infringing mark.\n4. **Likelihood that the prior owner will bridge the gap**: This factor considers whether the owner of the prior mark could expand its product line to compete with the allegedly infringing mark.\n5. **The defendant's intent**: This factor examines whether the defendant intended to confuse or mislead consumers by using the allegedly infringing mark.\n6. **The degree of care likely to be exercised by the pertinent class of consumers**: This factor considers whether consumers are likely to be careful or vigilant when making purchasing decisions.\n7. **The length of time the defendant has been using the mark**: This factor looks at whether the defendant has a history of using the allegedly infringing mark and whether this use has caused confusion.\n8. **The defendant's experience**: This factor considers whether the defendant has any experience in the relevant industry or market.\n9. **The degree of similarity between the marks**: This factor examines whether the allegedly infringing mark is similar to the prior mark in terms of appearance, sound, or meaning.\n10. **The degree of similarity between the goods or services**: This factor considers whether the goods or services offered by the parties are similar or related.\n\nBy considering these factors, courts can determine the likelihood of confusion and decide whether a trademark infringement has occurred. If the court finds that there is a likelihood of confusion, it may issue an injunction or award damages to the plaintiff.\n\nIt's worth noting that the likelihood of confusion test is not a strict formula, and courts have considerable discretion when applying these factors. The weight given to each factor may vary depending on the specific circumstances of the case.",
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+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "How does the likelihood of confusion test apply in trademark infringement cases?",
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+ "case_208002",
+ "case_4991933"
+ ]
+ }
+ ]
+ },
+ "Self-RAG": {
+ "mean_faithfulness": 0.0833,
+ "sample_size": 8,
+ "raw_results": [
+ {
+ "answer": "[IsREL: Relevant]\nWhen a party breaches a contract, the non-breaching party may have several remedies available to them. \n\n[IsSUP: Supported] According to the Uniform Commercial Code (UCC), a non-breaching party may pursue various remedies, including:\n- [IsREL: Relevant] Repudiation: The non-breaching party may treat the contract as repudiated and terminate their obligations.\n- [IsREL: Relevant] Rescission: The non-breaching party may seek to have the contract rescinded and any payments made returned.\n- [IsREL: Relevant] Damages: The non-breaching party may seek compensation for any losses incurred due to the breach.\n- [IsREL: Relevant] Specific Performance: In certain circumstances, the non-breaching party may be entitled to specific performance, where the breaching party is required to fulfill their obligations.\n- [IsREL: Relevant] Consequential Damages: The non-breaching party may seek damages that result from the breach, such as loss of profits or business opportunities.\n- [IsREL: Relevant] Incidental Damages: The non-breaching party may seek reimbursement for expenses incurred as a result of the breach, such as costs associated with finding a replacement supplier.\n\n[IsSUP: Supported] Additionally, a non-breaching party may also consider other remedies, including:\n- [IsREL: Relevant] Waiver: The non-breaching party may choose to waive their rights to pursue damages or other remedies.\n- [IsREL: Relevant] Estoppel: The non-breaching party may seek to prevent the breaching party from asserting a defense or claim that would otherwise be available to them.\n- [IsREL: Relevant] Unjust Enrichment: The non-breaching party may seek to recover any benefits or profits that the breaching party has unfairly obtained as a result of the breach.\n\n[IsREL: Relevant] It is essential to note that the specific remedies available will depend on the terms of the contract and the jurisdiction in which the dispute arises. A non-breaching party should consult with an attorney to determine the best course of action in their individual circumstances.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What remedies are available to a non-breaching party when the other party materially breaches a contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nUpon reviewing the context, I found relevant information. \n\n[IsREL: Relevant]\n\nThe Hadley v Baxendale rule is a legal principle that determines the recoverability of consequential damages for breach of contract. To apply this rule, courts consider the following factors:\n\n[IsSUP: Supported]\n1. **Breach of an express warranty**: If a contract includes an express warranty, courts may allow consequential damages for breach of that warranty.\n2. **Loss of use of equipment**: If a party's equipment is rendered useless due to a breach, courts may award damages for the loss of use, including lost profits.\n3. **Loss of profits**: Courts may award damages for lost profits if a party can demonstrate that the breach caused a loss of business or revenue.\n4. **Increased costs**: If a party can show that the breach caused increased costs, such as additional labor or materials, courts may award damages for these costs.\n5. **Mitigation of damages**: Courts will consider whether the injured party took reasonable steps to mitigate their damages. If they failed to do so, they may be denied recovery for consequential damages.\n\n[IsSUP: Partially Supported]\n6. **Foreseeability**: Courts will consider whether the damages were foreseeable at the time of contract formation. If the damages were not reasonably foreseeable, they may be denied recovery.\n7. **Proximity of cause and effect**: Courts will consider whether the breach was the direct cause of the damages. If the breach was merely a remote cause, courts may deny recovery.\n\n[IsSUP: Partially Supported]\n8. **Reasonable reliance**: Courts will consider whether the injured party reasonably relied on the other party's performance. If the injured party did not reasonably rely on the other party's performance, they may be denied recovery.\n\nIt's worth noting that these factors are not exhaustive, and courts may consider other relevant circumstances when determining the recoverability of consequential damages. Additionally, the Hadley v Baxendale rule has been modified and refined over time, and its application can vary depending on the jurisdiction and the specific facts of the case.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nBased on the retrieved context, the relevant information is as follows:\n\n[IsREL: Relevant]\n\nTo determine whether a contract has been formed by conduct rather than by written agreement, courts typically apply the \"reasonable person\" standard. This standard is based on the idea that a contract can be formed through the parties' conduct and implied terms, even if there is no written agreement.\n\n[IsSUP: Supported]\n\nIn the case of UCC \u00a7 1-303, the Uniform Commercial Code addresses this issue by providing that a contract can be formed through conduct, even if the parties have not explicitly agreed to the terms. The UCC states that a contract can be formed through \"conduct of the parties that is equivalent to assent,\" which includes actions that demonstrate a clear intention to be bound.\n\n[IsSUP: Supported]\n\nAdditionally, the Restatement (Second) of Contracts \u00a7 19 provides that a contract can be formed through the parties' conduct, even if there is no written agreement. This section states that a contract can be formed through \"manifestations of assent\" that are made by one or both parties, even if those manifestations are not in writing.\n\n[IsREL: Relevant]\n\nIn terms of the legal standard for determining whether a contract has been formed by conduct, courts typically look for evidence of the parties' intent to be bound, as well as evidence of a clear understanding between the parties of the terms of the contract. This may include factors such as:\n\n* Expressions of assent, such as verbal agreements or written communications\n* Conduct that demonstrates a clear intention to be bound, such as performance of the contract or acceptance of the contract terms\n* Circumstances that indicate a clear understanding between the parties of the contract terms, such as the presence of a formal contract or the involvement of a third-party intermediary.\n\n[IsSUP: Supported]\n\nUltimately, the determination of whether a contract has been formed by conduct rather than by written agreement will depend on the specific facts and circumstances of the case. However, by applying the \"reasonable person\" standard and considering the factors listed above, courts can make an informed decision about whether a contract has been formed.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?",
+ "expected_source_docs": [
+ "case_4991933",
+ "case_4570608"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nIsREL: Relevant\n\nThe Uniform Commercial Code (UCC) Article 2 governs the sale of goods. According to the UCC Article 2, there are implied warranties that attach to the sale of goods. These implied warranties are:\n\n[IsSUP: Supported] \n\n1. **Implied Warranty of Merchantability**: This warranty requires that the goods be fit for the ordinary purposes for which they are used. (UCC \u00a72-314)\n2. **Implied Warranty of Fitness for a Particular Purpose**: This warranty requires that the goods be fit for a particular purpose for which they are being bought if the seller has reason to know of that purpose. (UCC \u00a72-315)\n3. **Implied Warranty of Title**: This warranty requires that the seller has the right to transfer good title to the goods. (UCC \u00a72-312)\n4. **Implied Warranty of Quiet Enjoyment**: This warranty requires that the buyer be able to enjoy the goods without being disturbed by others. (UCC \u00a72-312)\n\nThese implied warranties provide a level of protection for buyers who purchase goods, and they can be enforced against sellers in certain circumstances. However, the extent to which these warranties apply can vary depending on the specific facts of each case and the laws of the jurisdiction in which the sale took place.\n\n[IsSUP: Partially Supported] Note that the implied warranty of merchantability does not apply to sales between merchants if the goods are being sold \"as-is\" or \"with all faults\".",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nTo determine how the doctrine of promissory estoppel differs from consideration as a basis for enforcing a promise, I will evaluate the provided context to see if any relevant information is available.\n\n[IsREL: Relevant]\nContext retrieved from a medical conditions database, which might not be directly relevant to the legal topic of promissory estoppel. However, I will attempt to provide an answer based on general knowledge of the topic.\n\nThe doctrine of promissory estoppel and consideration are both concepts in contract law that deal with the enforcement of promises. However, they have distinct differences in their application and requirements.\n\nConsideration is a fundamental element of a valid contract, which refers to a bargained-for exchange between two parties. Consideration can take the form of a promise, a performance, or a waiver of a legal right. In exchange for something of value, one party makes a promise to the other, and the promise is enforceable as long as there is consideration.\n\nPromissory estoppel, on the other hand, is a doctrine that arises when a party makes a promise that is intended to be binding and relied upon by the other party. The doctrine of promissory estoppel fills the gap when there is no consideration for the promise, but the promise induces reliance by the other party. Promissory estoppel is often used to enforce promises that are not part of a formal contract.\n\nKey differences between promissory estoppel and consideration include:\n\n* Consideration requires a bargained-for exchange, whereas promissory estoppel focuses on the reliance on the promise.\n* Consideration must be something of value, whereas promissory estoppel can be based on a promise alone.\n* Consideration is a requirement for a valid contract, whereas promissory estoppel is an exception to the consideration requirement.\n\nIn summary, while both consideration and promissory estoppel deal with the enforcement of promises, they differ in their application, requirements, and focus. Consideration is a fundamental element of a valid contract, whereas promissory estoppel is an exception that arises when a promise induces reliance without consideration.\n\n[IsSUP: Supported]",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\n[IsREL: Relevant]\nThe context provided does not directly address the question about courts weighing factors when deciding whether to grant specific performance as a remedy for breach of contract. However, to answer the question, we'll consider relevant legal principles.\n\n[IsSUP: Supported]\nIn general, courts consider several factors when deciding whether to grant specific performance as a remedy for breach of contract:\n\n1. **Equity and good conscience**: The court must determine whether granting specific performance would be equitable and in the best interest of the parties involved. [1]\n2. **Remedial balance**: The court weighs the relative harshness of the remedy of specific performance versus monetary damages. [2]\n3. **Breach severity**: The court considers the severity of the breach and whether it justifies specific performance. [3]\n4. **Performance feasibility**: The court evaluates whether the breaching party can realistically perform the contract as required. [4]\n5. **Cure and waiver**: The court considers whether the injured party has waived the breach or whether the breaching party can cure the defect. [5]\n6. **Public policy**: The court may consider whether granting specific performance would be against public policy or would serve the greater good. [6]\n\n[IsSUP: Partially Supported]\nWhile these factors are generally considered, the specific circumstances of each case can influence the court's decision. In some cases, the court may also consider additional factors, such as:\n\n* The breaching party's good faith efforts to perform\n* The injured party's lack of diligence in enforcing the contract\n* The availability of other remedies, such as damages or rescission\n\n[IsREL: Irrelevant]\nThe context provided does not directly address the question about courts weighing factors when deciding whether to grant specific performance as a remedy for breach of contract. However, the provided context discusses medical conditions and their management, which is not directly related to the legal concept of specific performance in contract law.\n\nPlease note that this answer is based on general principles of contract law and may not be applicable to specific jurisdictions or circumstances.\n\nReferences:\n\n[1] Restatement (Second) of Contracts \u00a7 357 (1981)\n[2] Hadley v. Baxendale, 156 Eng. Rep. 145 (1854)\n[3] Restatement (Second) of Contracts \u00a7 344 (1981)\n[4] Restatement (Second) of Contracts \u00a7 348 (1981)\n[5] Restatement (Second) of Contracts \u00a7 349 (1981)\n[6] Public policy considerations may vary by jurisdiction.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "[Retrieval]\n\nUpon reviewing the provided medical conditions, I found no direct information on the parol evidence rule in contract law. However, I can provide general information on the topic and apply it to the context of interpreting written contracts.\n\nThe parol evidence rule is a common law principle that limits the use of extrinsic evidence, such as oral or written statements made before or at the time of signing a written contract, to interpret the terms of the contract. The purpose of this rule is to prevent parties from introducing external evidence to contradict or vary the express terms of the written agreement.\n\n[IsREL: Relevant]\n\nExtrinsic evidence is generally inadmissible to interpret a written contract if it:\n\n1. Contradicts the express terms of the contract.\n2. Varies the express terms of the contract.\n3. Adds new terms to the contract.\n4. Implies a condition precedent or subsequent that is not contained in the written contract.\n\n[IsSUP: Supported]\n\nThe parol evidence rule is supported by the legal principle that a written contract is the final and complete expression of the parties' agreement. Allowing extrinsic evidence to alter or contradict the written terms would undermine the finality and certainty of the contract.\n\n[IsSUP: Partially Supported]\n\nHowever, there are some exceptions to the parol evidence rule, such as:\n\n1. Where the extrinsic evidence is used to interpret an ambiguity in the written contract.\n2. Where the extrinsic evidence is used to establish a prior agreement that is not inconsistent with the written contract.\n3. Where the extrinsic evidence is used to prove a mistake in the written contract.\n\n[IsREL: Irrelevant]\n\nIn the context of the provided medical conditions, the parol evidence rule is not directly applicable, as it is a principle of contract law, not a medical concept. However, the general principles of contract interpretation and the potential limitations on extrinsic evidence may be relevant in certain medical or legal contexts.\n\n[Answer]\n\nIn summary, the parol evidence rule limits the use of extrinsic evidence to interpret a written contract by preventing parties from introducing external evidence to contradict, vary, or add to the express terms of the contract. While there are some exceptions to this rule, the general principle is to prioritize the written agreement as the final and complete expression of the parties' agreement.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "[IsREL: Relevant]\n\n[IsSUP: Supported] Anticipatory repudiation of a contract is a legal concept where one party declares that they will not perform their obligations under a contract, or indicates an inability or unwillingness to do so, before the time for performance has arrived. This is often referred to as an \"anticipatory breach\" or \"repudiation.\"\n\n[IsSUP: Supported] To constitute anticipatory repudiation, the repudiating party's statement must be clear, unequivocal, and unequivocally indicate an intention not to perform. This may be expressed in various ways, such as:\n\n1. A direct statement indicating an intention not to perform.\n2. An indication that the repudiating party will not fulfill their obligations.\n3. A statement suggesting that the repudiating party is incapable or unwilling to perform.\n\n[IsSUP: Partially Supported] The rights of the aggrieved party in the event of anticipatory repudiation depend on the specific circumstances and the language of the contract. However, the aggrieved party may have several options:\n\n1. **Acceptance of the repudiation**: The aggrieved party may accept the repudiation and consider the contract terminated, allowing them to seek damages for the breach.\n2. **Rejection of the repudiation**: The aggrieved party may reject the repudiation and continue to perform their obligations under the contract, hoping that the repudiating party will fulfill their obligations when the time for performance arrives.\n3. **Sue for damages**: The aggrieved party may sue for damages for the anticipated loss resulting from the breach, even if the repudiation is not accepted.\n4. **Specific performance**: In some cases, the aggrieved party may seek specific performance, which requires the repudiating party to fulfill their obligations as originally agreed.\n\n[IsSUP: Partially Supported] It's essential to note that anticipatory repudiation can be a complex and fact-specific issue, and the rights of the aggrieved party may vary depending on the jurisdiction and the specific circumstances of the case.\n\n[IsSUP: Supported] To illustrate this concept, consider the following example:\n\nContract A: John and Jane agree to buy and sell a house for $500,000, with a closing date of June 1. On May 15, John sends Jane an email stating, \"I will not be able to go through with the purchase of the house.\" This is an anticipatory repudiation, as John is indicating an intention not to perform his obligation to purchase the house.\n\nIn this scenario, Jane may accept John's repudiation, reject it, or sue for damages for the anticipated loss resulting from the breach.",
+ "confidence": 0.333,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.333,
+ "query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ }
+ ]
+ },
+ "MEXAR": {
+ "mean_faithfulness": 0.1,
+ "sample_size": 8,
+ "raw_results": [
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What remedies are available to a non-breaching party when the other party materially breaches a contract?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 146.6,
+ "total_ms": 146.7
+ },
+ "query": "What remedies are available to a non-breaching party when the other party materially breaches a contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 35.2,
+ "total_ms": 35.2
+ },
+ "query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 21.4,
+ "total_ms": 21.4
+ },
+ "query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?",
+ "expected_source_docs": [
+ "case_4991933",
+ "case_4570608"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 28.6,
+ "total_ms": 28.6
+ },
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 24.5,
+ "total_ms": 24.5
+ },
+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 17.2,
+ "total_ms": 17.2
+ },
+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 26.0,
+ "total_ms": 26.0
+ },
+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but your question appears to be outside my area of expertise.\n\nI am a specialized **Unknown** assistant and can only answer questions related to that domain based on my knowledge base.\n\nYour query doesn't seem to match the topics I'm trained on (relevance score: 0%).\n\n**How I can help:**\n- Ask questions related to unknown\n- Query information from my knowledge base\n- Get explanations about unknown-related topics\n\nWould you like to rephrase your question to focus on unknown?",
+ "confidence": 0.1,
+ "in_domain": false,
+ "reasoning_paths": [],
+ "entities_found": [],
+ "explainability": {
+ "why_this_answer": {
+ "summary": "Query rejected - outside domain expertise",
+ "sources": []
+ },
+ "confidence_breakdown": {
+ "overall": "10%",
+ "domain_relevance": "0%",
+ "rejection_reason": "out_of_domain"
+ },
+ "inputs": {
+ "original_query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?"
+ }
+ },
+ "timings": {
+ "domain_guardrail_ms": 15.7,
+ "total_ms": 15.8
+ },
+ "query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ }
+ ]
+ }
+ },
+ "financial": {
+ "Naive RAG": {
+ "mean_faithfulness": 0.0,
+ "sample_size": 15,
+ "raw_results": [
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What risk factors are typically disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies disclose cybersecurity risks in their annual SEC filings following the 2023 SEC cybersecurity disclosure rules?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 750,
+ "content": "ications\n- Management: Avoid triggers, use peak flow meter, action plan, regular check-ups\n\nChronic Obstructive Pulmonary Disease (COPD)\n- Symptoms: Chronic cough, mucus production, shortness of breath, wheezing, chest tightness, fatigue\n- Risk Factors: Smoking, long-term exposure to lung irritants, alpha-1 antitrypsin deficiency, age over 40\n- Treatment: Bronchodilators, inhaled steroids, oxygen therapy, pulmonary rehabilitation, smoking cessation\n- Complications: Respiratory infections, heart problems, lung cancer, depression\n\nPneumonia\n- Symptoms: Fever, chills, cough with phlegm, chest pain, shortness of breath, fatigue, confusion (in elderly)\n- Causes: Bacteria, viruses, fungi, aspiration\n- Treatment: Antibiotics, antiviral medications, rest, fluids, oxygen therapy if severe\n- Prevention: Vaccination, hand hygiene, avoid smoking\n\n=== ENDOCRINE DISORDERS ===\n\nType 2 Diabetes\n- Symptoms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing so",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What types of macroeconomic risks are commonly reported as material risk factors in 10-K filings?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do pharmaceutical companies describe clinical trial failure as a risk factor in their annual reports?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
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+ "faithfulness": 0.0,
+ "query": "What supply chain risk disclosures are typically included in manufacturing company 10-Ks?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
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+ "context",
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+ "context",
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+ "faithfulness": 0.0,
+ "query": "How do companies disclose geopolitical and sanctions-related risk factors in their SEC filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
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+ "retrieved_chunk_doc_ids": [
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+ ],
+ "faithfulness": 0.0,
+ "query": "What liquidity and capital resources risks are companies required to disclose in their 10-K filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies in the energy sector describe commodity price risk in their annual reports?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 752,
+ "content": "t, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, toxic nodular goiter, thyroiditis, excessive iodine intake\n- Treatment: Anti-thyroid medications, radioactive iodine, beta-blockers, surgery in severe cases\n- Complications: Osteoporosis, heart problems, thyroid storm\n\n=== GASTROINTESTINAL DISORDERS ===\n\nGastroesophageal Reflux Disease (GERD)\n- Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing, chronic cough, sore throat\n- Risk Factors: Obesity, pregnancy, smoking, hiatal hernia, certain foods and beverages\n- Treatment: Proton pump inhibitors, H2 blockers, antacids, lifestyle modifications, surgery if severe\n- Complications: Esophagitis, Barrett's esophagus, esophageal stricture, respiratory problems\n\nIrritable Bowel Syndrome (IBS)\n- Symptoms: Abdominal pain, bloating, gas, diarrhea, constipation, mucus in stool\n- Triggers: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), ",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What regulatory and compliance risks are disclosed by financial services companies in their 10-K filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
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+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies disclose risks related to customer concentration in their annual SEC reports?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is included in the Management Discussion and Analysis (MD&A) section of a 10-K, and what SEC rules govern it?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies describe their revenue recognition policies in the MD&A section of annual reports?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "query": "What forward-looking statements are typically made in the MD&A section and what safe harbor protections apply?",
+ "expected_source_docs": [
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+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
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+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
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+ "query": "How do companies discuss goodwill impairment testing in their MD&A and related disclosures?",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "What risk factors are typically disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A?",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "query": "How do companies disclose cybersecurity risks in their annual SEC filings following the 2023 SEC cybersecurity disclosure rules?",
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+ "0001041588_0001041588-21-000001",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "What types of macroeconomic risks are commonly reported as material risk factors in 10-K filings?",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "How do pharmaceutical companies describe clinical trial failure as a risk factor in their annual reports?",
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+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "query": "What supply chain risk disclosures are typically included in manufacturing company 10-Ks?",
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "How do companies disclose geopolitical and sanctions-related risk factors in their SEC filings?",
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+ "0000320575_0000320575-20-000008",
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "faithfulness": 0.0,
+ "query": "What liquidity and capital resources risks are companies required to disclose in their 10-K filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
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+ {
+ "answer": "Based on the Retrieved Knowledge Base Context, companies in the energy sector often describe commodity price risk in their annual reports as a significant risk factor that can affect their financial performance. \n\nSome common ways companies in the energy sector describe commodity price risk in their annual reports include:\n\n1. **Price volatility**: Companies mention that fluctuations in commodity prices can negatively impact their revenues and profitability. For example, an increase in oil prices can reduce demand for their products, leading to lower sales and profits (Source: \"Oil and Gas Industry Annual Reports\" by Deloitte).\n2. **Price volatility risk**: Companies may describe the risk of commodity price volatility, which can arise from various factors such as geopolitical events, changes in supply and demand, and weather-related events (Source: \"Commodity Price Risk Management\" by PwC).\n3. **Market price risk**: Companies may also describe the risk of market price changes affecting their commodity prices, which can lead to losses or gains on their financial instruments (Source: \"Energy Risk Management\" by Ernst & Young).\n4. **Hedging strategies**: Companies may describe their hedging strategies to mitigate commodity price risk, such as using derivatives, futures, and options contracts to lock in prices or manage price fluctuations (Source: \"Commodity Price Risk Management\" by PwC).\n5. **Country or region-specific risks**: Companies may describe the risks associated with operating in specific countries or regions, such as changes in government policies, taxes, or regulations, which can impact commodity prices (Source: \"Country Risk Assessment\" by Standard & Poor's).\n\nExamples of annual reports from energy companies that describe commodity price risk include:\n\n- ExxonMobil: \"Commodity price risk is a significant risk factor for our business. We seek to mitigate this risk through our hedging and trading activities\" (Source: ExxonMobil 2020 Annual Report).\n- Royal Dutch Shell: \"We are exposed to commodity price risk, particularly with respect to oil and natural gas prices. We manage this risk through our hedging and trading activities\" (Source: Royal Dutch Shell 2020 Annual Report).\n- Chevron: \"We are subject to commodity price risk, which can impact our revenues and profitability. We use various hedging and trading strategies to manage this risk\" (Source: Chevron 2020 Annual Report).\n\nThese examples illustrate how companies in the energy sector describe commodity price risk in their annual reports, highlighting the importance of managing this risk to ensure financial stability and profitability.",
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+ "query": "How do companies in the energy sector describe commodity price risk in their annual reports?",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "What regulatory and compliance risks are disclosed by financial services companies in their 10-K filings?",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "faithfulness": 0.0,
+ "query": "How do companies disclose risks related to customer concentration in their annual SEC reports?",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "faithfulness": 0.0,
+ "query": "What is included in the Management Discussion and Analysis (MD&A) section of a 10-K, and what SEC rules govern it?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "faithfulness": 0.0,
+ "query": "How do companies describe their revenue recognition policies in the MD&A section of annual reports?",
+ "expected_source_docs": [
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "How is operating cash flow discussed in the MD&A, and what non-GAAP measures are typically explained there?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [],
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.0,
+ "query": "What forward-looking statements are typically made in the MD&A section and what safe harbor protections apply?",
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+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [],
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.0,
+ "query": "How do companies discuss goodwill impairment testing in their MD&A and related disclosures?",
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+ {
+ "answer": "According to the SEC's Regulation S-K, Item 1A of a technology company's 10-K filing typically includes a discussion of risk factors that could impact the company's business, financial condition, and results of operations. Some common risk factors disclosed in this section may include:\n\n1. **Competition**: The company may face intense competition in its market, which could negatively impact its market share, revenue, and profitability.\n2. **Intellectual property**: The company's intellectual property, such as patents and trademarks, may be challenged or invalidated, which could impact its competitive position and revenue.\n3. **Cybersecurity**: The company's systems and data may be vulnerable to cyberattacks, which could result in the theft of sensitive information, disruption of business operations, and damage to the company's reputation.\n4. **Dependence on key customers or partners**: The company may rely heavily on a few key customers or partners, which could impact its revenue and financial stability if these relationships are disrupted.\n5. **Economic conditions**: Changes in economic conditions, such as recessions or downturns in specific industries, could impact the company's revenue and profitability.\n6. **Government regulations**: The company may be subject to government regulations that impact its business, such as data protection regulations, tax laws, and trade restrictions.\n7. **Supply chain risks**: The company may be vulnerable to disruptions in its supply chain, such as natural disasters, supplier insolvency, or trade restrictions.\n8. **Technological changes**: The company's products or services may become obsolete due to rapid technological changes, which could impact its revenue and market share.\n9. **Environmental concerns**: The company may be subject to environmental regulations or face public criticism for its environmental impact, which could impact its reputation and financial stability.\n10. **Global events**: Global events, such as pandemics, wars, or natural disasters, could impact the company's business operations and financial stability.\n\nThese are just some examples of the types of risk factors that may be disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A. The specific risks disclosed will vary depending on the company's business and industry.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What risk factors are typically disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "To answer your question, I'll retrieve relevant information from my training data.\n\nSupply chain risk disclosures in a manufacturing company's 10-K typically include:\n\n1. **Description of the supply chain**: The company may provide a high-level overview of its supply chain, including the countries or regions where raw materials are sourced, manufactured, and distributed.\n2. **Risk factors related to supply chain disruptions**: Companies may disclose potential risks associated with supply chain disruptions, such as natural disasters, pandemics, or geopolitical events, that could impact their ability to deliver products to customers.\n3. **Vendor or supplier risk**: Companies may highlight any risks associated with their vendors or suppliers, including the potential for supplier insolvency, non-performance, or compliance issues.\n4. **Supply chain concentration risks**: Companies may disclose the concentration of their supply chain with specific vendors or suppliers, which could increase the risk of supply chain disruptions.\n5. **Description of any mitigation strategies**: Companies may describe the measures they take to mitigate supply chain risks, such as diversifying their supplier base, implementing backup plans, or investing in supply chain management technologies.\n6. **Information on any significant changes to the supply chain**: Companies may disclose any significant changes to their supply chain, such as changes in sourcing strategies or the addition of new suppliers.\n7. **Description of any efforts to address human rights or labor concerns**: Companies may highlight any efforts they make to address human rights or labor concerns in their supply chain, such as audits, training programs, or compliance initiatives.\n8. **Information on any trade restrictions or sanctions**: Companies may disclose any trade restrictions or sanctions that could impact their ability to source materials or ship products.\n\nThese are some of the typical supply chain risk disclosures found in a manufacturing company's 10-K. The specific disclosures may vary depending on the company's size, industry, and jurisdiction.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What supply chain risk disclosures are typically included in manufacturing company 10-Ks?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "Companies are required to disclose liquidity and capital resources risks in their 10-K filings under Item 7, Management's Discussion and Analysis of Financial Condition and Results of Operations (MD&A). \n\nSpecifically, they must discuss:\n\n1. Material liquidity risks, including:\n - How the company manages its liquidity and capital resources\n - The availability of cash and other resources to meet its obligations\n - Any material changes in the company's liquidity position\n - The impact of market or economic conditions on the company's liquidity\n\n2. Material capital resources risks, including:\n - The company's ability to generate cash flow from operating activities\n - The company's reliance on external sources of funding, such as debt or equity\n - The company's ability to refinance its debt or obtain new financing\n - The impact of market or economic conditions on the company's capital resources\n\nCompanies must also disclose any material off-balance sheet arrangements that could have a material impact on their liquidity and capital resources.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What liquidity and capital resources risks are companies required to disclose in their 10-K filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "In the Management's Discussion and Analysis (MD&A) section of a company's annual or quarterly report, forward-looking statements are typically made regarding the company's future performance, financial condition, and prospects. These statements often include projections, forecasts, and estimates related to:\n\n1. Revenue and earnings growth\n2. Business outlook and trends\n3. Market share and competition\n4. Product or service development and launch plans\n5. Strategic initiatives and investments\n6. Regulatory and compliance matters\n7. Capital expenditures and resource allocation\n8. Acquisitions and divestitures\n\nTo provide safe harbor protections, companies often include a disclaimer in the MD&A section, such as:\n\n\"Forward-looking statements are based on management's current expectations and beliefs, but they involve inherent risks and uncertainties. Actual results or outcomes may differ materially from those expressed or implied by these forward-looking statements due to various factors, including but not limited to, changes in market conditions, regulatory developments, technological advancements, and other risks and uncertainties described in our filings with the Securities and Exchange Commission.\"\n\nThis disclaimer is intended to alert investors and other stakeholders that forward-looking statements are subject to uncertainty and risk, and that actual results may differ from those projected.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "What forward-looking statements are typically made in the MD&A section and what safe harbor protections apply?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "Companies typically discuss goodwill impairment testing in their Management's Discussion and Analysis (MD&A) and related disclosures by providing an overview of their goodwill impairment assessment process, the factors considered, and the outcome of the impairment testing.\n\nIn the MD&A section, companies may:\n\n1. **Discuss the carrying value of goodwill**: Provide the carrying value of goodwill on the balance sheet and the amount of goodwill by reporting unit.\n2. **Describe the annual impairment test**: Explain the process followed to perform the annual goodwill impairment test, including the steps taken to evaluate the fair value of the reporting units.\n3. **Highlight key factors considered**: Discuss the key factors considered during the impairment testing, such as changes in market conditions, industry trends, and the performance of the reporting units.\n4. **Report the outcome of the impairment test**: State whether goodwill was impaired, the amount of the impairment loss, and the impact on net income.\n5. **Provide narrative disclosures**: Offer narrative disclosures to provide context on the impairment testing process, including any significant judgments made or assumptions used.\n\nIn related disclosures, companies may provide additional information, such as:\n\n1. **Segment reporting**: Report goodwill by reportable segment, to provide investors with a more detailed understanding of the carrying value of goodwill by business segment.\n2. **Impairment charges**: Reconcile the impairment charges recognized in the income statement to the amount of goodwill impairment loss reported in the footnotes.\n3. **Goodwill by business segment**: Provide a reconciliation of goodwill by business segment, including the changes in goodwill during the period.\n4. **Key assumptions and judgments**: Disclose key assumptions and judgments made during the impairment testing process, such as the choice of valuation methods or the selection of comparable companies.\n\nBy providing these disclosures, companies aim to give investors a clear understanding of their goodwill impairment assessment process and the outcome of the impairment testing, which can help investors make more informed decisions.",
+ "confidence": 0.5,
+ "in_domain": true,
+ "retrieved_chunk_doc_ids": [],
+ "faithfulness": 0.5,
+ "query": "How do companies discuss goodwill impairment testing in their MD&A and related disclosures?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
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+ ]
+ }
+ ]
+ }
+ }
+ },
+ "table2_retrieval_ablation": {
+ "medical": {
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+ "R_at_10": 0.0,
+ "MRR": 0.0,
+ "nDCG_at_10": 0.0,
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+ "nDCG_at_10": 0.0,
+ "sample_size": 15
+ }
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+ "nDCG_at_10": 0.0,
+ "sample_size": 15
+ }
+ },
+ "financial": {
+ "semantic": {
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+ "nDCG_at_10": 0.0,
+ "sample_size": 15
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+ "sample_size": 15
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+ "hybrid": {
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+ "R_at_10": 0.0,
+ "MRR": 0.0,
+ "nDCG_at_10": 0.0,
+ "sample_size": 15
+ }
+ }
+ },
+ "table3_component_ablation": {
+ "medical": {
+ "Naive RAG (Baseline)": {
+ "mean_faithfulness": 0.594,
+ "delta_vs_baseline": 0.0,
+ "sample_size": 10
+ },
+ "+ Domain Guardrail": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.494,
+ "sample_size": 10
+ },
+ "+ Hybrid Retrieval": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.494,
+ "sample_size": 10
+ },
+ "+ Faithfulness Verification (full MEXAR)": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.494,
+ "sample_size": 10
+ },
+ "Hybrid without verification": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.494,
+ "sample_size": 10
+ },
+ "Verification without hybrid": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.494,
+ "sample_size": 10
+ },
+ "_superadditive_check": {
+ "full_combined_effect": -0.494,
+ "sum_of_individual_effects": -1.482,
+ "is_superadditive": "True"
+ }
+ },
+ "legal": {
+ "Naive RAG (Baseline)": {
+ "mean_faithfulness": 0.572,
+ "delta_vs_baseline": 0.0,
+ "sample_size": 10
+ },
+ "+ Domain Guardrail": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.472,
+ "sample_size": 10
+ },
+ "+ Hybrid Retrieval": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.472,
+ "sample_size": 10
+ },
+ "+ Faithfulness Verification (full MEXAR)": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.472,
+ "sample_size": 10
+ },
+ "Hybrid without verification": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.472,
+ "sample_size": 10
+ },
+ "Verification without hybrid": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.472,
+ "sample_size": 10
+ },
+ "_superadditive_check": {
+ "full_combined_effect": -0.472,
+ "sum_of_individual_effects": -1.416,
+ "is_superadditive": "True"
+ }
+ },
+ "financial": {
+ "Naive RAG (Baseline)": {
+ "mean_faithfulness": 0.579,
+ "delta_vs_baseline": 0.0,
+ "sample_size": 10
+ },
+ "+ Domain Guardrail": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.479,
+ "sample_size": 10
+ },
+ "+ Hybrid Retrieval": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.479,
+ "sample_size": 10
+ },
+ "+ Faithfulness Verification (full MEXAR)": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.479,
+ "sample_size": 10
+ },
+ "Hybrid without verification": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.479,
+ "sample_size": 10
+ },
+ "Verification without hybrid": {
+ "mean_faithfulness": 0.1,
+ "delta_vs_baseline": -0.479,
+ "sample_size": 10
+ },
+ "_superadditive_check": {
+ "full_combined_effect": -0.479,
+ "sum_of_individual_effects": -1.437,
+ "is_superadditive": "True"
+ }
+ }
+ },
+ "table4_guardrail_boundary": {
+ "medical_to_legal": {
+ "source_domain": "medical",
+ "target_domain": "legal",
+ "total_evaluated": 35,
+ "rejected_count": 35,
+ "true_positives_rejected": 35,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "medical_to_financial": {
+ "source_domain": "medical",
+ "target_domain": "financial",
+ "total_evaluated": 35,
+ "rejected_count": 35,
+ "true_positives_rejected": 35,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "legal_to_medical": {
+ "source_domain": "legal",
+ "target_domain": "medical",
+ "total_evaluated": 31,
+ "rejected_count": 31,
+ "true_positives_rejected": 31,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "legal_to_financial": {
+ "source_domain": "legal",
+ "target_domain": "financial",
+ "total_evaluated": 31,
+ "rejected_count": 31,
+ "true_positives_rejected": 31,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "financial_to_medical": {
+ "source_domain": "financial",
+ "target_domain": "medical",
+ "total_evaluated": 31,
+ "rejected_count": 31,
+ "true_positives_rejected": 31,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "financial_to_legal": {
+ "source_domain": "financial",
+ "target_domain": "legal",
+ "total_evaluated": 31,
+ "rejected_count": 31,
+ "true_positives_rejected": 31,
+ "false_positives": 0,
+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ }
+ },
+ "table5_latency_ms": {
+ "domain_guardrail_ms": {
+ "mean_ms": 113.49,
+ "std_ms": 390.36
+ },
+ "total_ms": {
+ "mean_ms": 113.5,
+ "std_ms": 390.36
+ }
+ },
+ "calibration": {
+ "expected_calibration_error": 0.1,
+ "reliability_diagram": [
+ {
+ "bin_range": "0.1-0.2",
+ "mean_confidence": 0.1,
+ "observed_accuracy": 0.0,
+ "count": 22
+ }
+ ]
+ },
+ "significance_and_effect_size": {
+ "MEXAR_vs_Self-RAG": {
+ "mcnemar_p_value": 0.47950012218695337,
+ "cohens_d_effect_size": -0.517
+ }
+ }
+}
\ No newline at end of file
diff --git a/evaluation_outputs/full_evaluation_20260724_192144.json b/evaluation_outputs/full_evaluation_20260724_192144.json
new file mode 100644
index 0000000000000000000000000000000000000000..12dc13adb3a114f7f6af3371ce12882fc7e10b66
--- /dev/null
+++ b/evaluation_outputs/full_evaluation_20260724_192144.json
@@ -0,0 +1,3206 @@
+{
+ "run_id": "20260724_192144",
+ "timestamp": "2026-07-24T19:34:54.572328",
+ "table1_system_comparison": {
+ "medical": {
+ "Naive RAG": {
+ "mean_faithfulness": 0.0,
+ "sample_size": 15,
+ "raw_results": [
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
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+ "faithfulness": 0.0,
+ "query": "What is the first-line treatment for stage 2 hypertension according to current guidelines?",
+ "expected_source_docs": [
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ {
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ {
+ "id": 752,
+ "content": "t, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, toxic nodular goiter, thyroiditis, excessive iodine intake\n- Treatment: Anti-thyroid medications, radioactive iodine, beta-blockers, surgery in severe cases\n- Complications: Osteoporosis, heart problems, thyroid storm\n\n=== GASTROINTESTINAL DISORDERS ===\n\nGastroesophageal Reflux Disease (GERD)\n- Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing, chronic cough, sore throat\n- Risk Factors: Obesity, pregnancy, smoking, hiatal hernia, certain foods and beverages\n- Treatment: Proton pump inhibitors, H2 blockers, antacids, lifestyle modifications, surgery if severe\n- Complications: Esophagitis, Barrett's esophagus, esophageal stricture, respiratory problems\n\nIrritable Bowel Syndrome (IBS)\n- Symptoms: Abdominal pain, bloating, gas, diarrhea, constipation, mucus in stool\n- Triggers: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), ",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
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+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
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+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
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+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
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+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
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+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
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+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
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+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
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+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "content": "ications\n- Management: Avoid triggers, use peak flow meter, action plan, regular check-ups\n\nChronic Obstructive Pulmonary Disease (COPD)\n- Symptoms: Chronic cough, mucus production, shortness of breath, wheezing, chest tightness, fatigue\n- Risk Factors: Smoking, long-term exposure to lung irritants, alpha-1 antitrypsin deficiency, age over 40\n- Treatment: Bronchodilators, inhaled steroids, oxygen therapy, pulmonary rehabilitation, smoking cessation\n- Complications: Respiratory infections, heart problems, lung cancer, depression\n\nPneumonia\n- Symptoms: Fever, chills, cough with phlegm, chest pain, shortness of breath, fatigue, confusion (in elderly)\n- Causes: Bacteria, viruses, fungi, aspiration\n- Treatment: Antibiotics, antiviral medications, rest, fluids, oxygen therapy if severe\n- Prevention: Vaccination, hand hygiene, avoid smoking\n\n=== ENDOCRINE DISORDERS ===\n\nType 2 Diabetes\n- Symptoms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing so",
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+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
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+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
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+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
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+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
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+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "answer": "According to current guidelines, the first-line treatment for stage 2 hypertension is typically lifestyle modifications, followed by pharmacotherapy if lifestyle changes are insufficient.\n\nThe American College of Cardiology (ACC) and the American Heart Association (AHA) guidelines recommend:\n\n1. Lifestyle modifications: \n - Weight loss if overweight or obese\n - Dietary changes, such as the DASH (Dietary Approaches to Stop Hypertension) diet\n - Increased physical activity\n - Reduced sodium intake\n - Stress management\n\n2. Pharmacotherapy:\n - For patients with stage 2 hypertension, the ACC/AHA guidelines recommend initiating therapy with a combination of two antihypertensive medications from different classes, such as:\n - Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs)\n - Calcium channel blockers (CCBs)\n - Diuretics\n\nIt is essential to note that the choice of initial antihypertensive medication should be individualized based on patient comorbidities, kidney function, and other factors.\n\nSource: \n- American College of Cardiology and American Heart Association. (2017). High Blood Pressure in Adults: A Scientific Statement From the American Heart Association. Circulation, 135(19), e879-e993. doi: 10.1161/CIR.0000000000000482\n- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507-520. doi: 10.1001/jama.2013.284427",
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+ "answer": "According to the American Heart Association (AHA) and the Heart Rhythm Society (HRS), cardiac resynchronization therapy (CRT) is indicated in heart failure patients with certain symptoms and characteristics.\n\nCRT is typically indicated in patients with:\n\n1. **Left bundle branch block (LBBB)**: A condition where the electrical signals to the left ventricle are delayed, leading to inefficient pumping.\n2. **Heart failure symptoms**: Patients with symptoms such as shortness of breath, fatigue, and swelling in the legs, despite optimal medical therapy.\n3. **QRS duration of \u2265 130 ms**: A prolonged QRS complex duration indicates delayed electrical conduction through the heart.\n4. **Left ventricular ejection fraction (LVEF) \u2264 35%**: A reduced LVEF indicates impaired heart function.\n5. **NYHA class III or IV symptoms**: Patients with New York Heart Association (NYHA) class III or IV symptoms, indicating moderate to severe heart failure.\n\nAdditionally, CRT may be considered in patients with:\n\n1. **Reduced left ventricular function**: Patients with LVEF \u2264 45% and QRS duration \u2265 120 ms.\n2. **Ischemic cardiomyopathy**: Patients with coronary artery disease causing impaired heart function.\n\nThe goal of CRT is to restore a more synchronized heartbeat, improving heart function, reducing symptoms, and improving quality of life. According to a meta-analysis published in the Journal of the American College of Cardiology, CRT has been shown to improve heart failure symptoms, reduce hospitalizations, and improve survival in eligible patients (Cleland et al., 2005).\n\nSources:\n\n* American Heart Association. (2017). 2017 AHA/ACC/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.\n* Heart Rhythm Society. (2017). HRS Expert Consensus Statement on the Use of Biventricular Pacing in Heart Failure.\n* Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., ... & Tavazzi, L. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352(15), 1539-1549.",
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+ "answer": "For relapsed or refractory diffuse large B-cell lymphoma (DLBCL), the treatment options may vary depending on the patient's prior therapies, overall health, and specific disease characteristics. Here are some standard treatment options:\n\n1. **High-dose chemotherapy with autologous stem cell transplantation (ASCT)**: This involves high-dose chemotherapy followed by infusion of the patient's own stem cells to help the bone marrow recover and produce new blood cells.\n\n2. **Bendamustine-based chemotherapy**: Bendamustine combined with rituximab (Rituxan) is a common treatment option for patients who have received prior rituximab-based therapy or have relapsed after initial treatment.\n\n3. **R-ICE chemotherapy**: Rituximab (Rituxan) plus ifosfamide, carboplatin, and etoposide (ICE) is a chemotherapy regimen used for patients who have relapsed or refractory DLBCL.\n\n4. **Dose-adjusted EPOCH-R chemotherapy**: A modified dose-adjusted EPOCH (etoposide, prednisone, vincristine, doxorubicin, and cyclophosphamide) regimen with rituximab is another option for patients with relapsed or refractory DLBCL.\n\n5. **CAR T-cell therapy**: Chimeric antigen receptor (CAR) T-cell therapy, such as axicabtagene ciloleucel (Yescarta) or tisagenlecleucel (Kymriah), is an emerging treatment option for patients with relapsed or refractory DLBCL who have failed prior therapies.\n\n6. **Pembrolizumab and lenalidomide combination**: A combination of pembrolizumab (Keytruda) and lenalidomide (Revlimid) is an FDA-approved treatment option for patients with relapsed or refractory DLBCL who have received at least two prior therapies.\n\n7. **Ibrutinib and rituximab combination**: Ibrutinib (Imbruvica) combined with rituximab is also an option for patients with relapsed or refractory DLBCL.\n\n8. **Lenalidomide maintenance**: Lenalidomide maintenance therapy is used to prevent disease recurrence in patients who have achieved complete remission with chemotherapy or CAR T-cell therapy.\n\nThese treatment options may be used alone or in combination, and the choice of treatment will depend on the patient's individual circumstances and medical history. Consultation with a healthcare professional or a hematologist-oncologist is necessary to determine the best course of treatment.",
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+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
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+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
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+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What remedies are available to a non-breaching party when the other party materially breaches a contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?",
+ "expected_source_docs": [
+ "case_4991933",
+ "case_4570608"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 753,
+ "content": "rs: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), fiber supplements, antispasmodics, probiotics, stress management\n- Management: Food diary, regular meals, adequate hydration, exercise\n\nInflammatory Bowel Disease (IBD)\n- Types: Crohn's disease, Ulcerative colitis\n- Symptoms: Diarrhea, abdominal pain, blood in stool, weight loss, fatigue, reduced appetite\n- Treatment: Anti-inflammatory drugs, immunosuppressants, biologics, surgery, nutritional therapy\n- Complications: Malnutrition, colon cancer, fistulas, strictures\n\n=== NEUROLOGICAL DISORDERS ===\n\nMigraine\n- Symptoms: Severe headache, nausea, vomiting, sensitivity to light and sound, visual disturbances (aura)\n- Triggers: Stress, hormonal changes, certain foods, lack of sleep, weather changes, sensory stimuli\n- Treatment: Triptans, NSAIDs, anti-nausea medications, preventive medications, lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress red",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What constitutes anticipatory repudiation of a contract and what rights does it give to the aggrieved party?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How is the enforceability of a non-compete clause assessed by courts in employment contracts?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
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+ "retrieved_chunk_doc_ids": [
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+ "query": "Under force majeure clauses, what events typically excuse performance of a contract obligation?",
+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
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+ "retrieved_chunk_doc_ids": [
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+ "query": "What is the standard for proving patent infringement under the doctrine of equivalents?",
+ "expected_source_docs": [
+ "case_208002",
+ "case_4991933"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
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+ ],
+ "faithfulness": 0.0,
+ "query": "How does the likelihood of confusion test apply in trademark infringement cases?",
+ "expected_source_docs": [
+ "case_208002",
+ "case_4991933"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
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+ ],
+ "faithfulness": 0.0,
+ "query": "What is the fair use doctrine in copyright law and what are the four statutory factors courts apply?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
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+ {
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+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
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+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
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+ {
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+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "case_4587203"
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+ },
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+ "expected_source_docs": [
+ "case_2412837",
+ "case_8780304"
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+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "How do courts determine whether consequential damages are recoverable for breach of contract under the Hadley v Baxendale rule?",
+ "expected_source_docs": [
+ "case_1052233",
+ "case_2412837"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "query": "What is the legal standard for determining whether a contract has been formed by conduct rather than by written agreement?",
+ "expected_source_docs": [
+ "case_4991933",
+ "case_4570608"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
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+ "faithfulness": 0.0,
+ "query": "Under the UCC Article 2, what are the implied warranties that attach to the sale of goods?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "How does the doctrine of promissory estoppel differ from consideration as a basis for enforcing a promise?",
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+ "case_9506898"
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "What factors do courts weigh when deciding whether to grant specific performance as a remedy for breach of contract?",
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+ "case_2412837"
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "How does the parol evidence rule limit the use of extrinsic evidence to interpret a written contract?",
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+ "answer": "According to the retrieved knowledge base context, anticipatory repudiation of a contract occurs when one party indicates, before the time for performance, that they will not perform their obligations under the contract. This can be in the form of words, conduct, or circumstances that make it clear the party intends not to perform.\n\nAnticipatory repudiation can take various forms, such as:\n\n1. An express statement of unwillingness to perform.\n2. A statement or action indicating a clear intention not to perform.\n3. Circumstances that make it clear the party will not perform, such as bankruptcy or insolvency.\n\nWhen anticipatory repudiation occurs, the aggrieved party may be entitled to certain rights, including:\n\n1. **Right to terminate the contract**: The aggrieved party may terminate the contract immediately, even if the time for performance has not yet arrived.\n2. **Right to damages**: The aggrieved party may claim damages for breach of contract, which can include expectation damages, consequential damages, and incidental damages.\n3. **Right to specific performance**: In some cases, the aggrieved party may seek specific performance, which requires the defaulting party to perform their obligations under the contract.\n\nThe aggrieved party's rights under anticipatory repudiation are typically governed by the Uniform Commercial Code (UCC) in the United States and the common law in other jurisdictions. The UCC provides that a repudiation of a contract occurring before the time for performance may be treated as occurring when the repudiation is made (UCC \u00a7 2-610).\n\nIt is essential to note that anticipatory repudiation is a complex area of law, and the specific rights and remedies available to the aggrieved party will depend on the facts and circumstances of each case.\n\nSources:\n\n* Uniform Commercial Code (UCC) \u00a7 2-610\n* Restatement (Second) of Contracts \u00a7 250\n* American Law Institute, Restatement of the Law of Contracts (1981)",
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+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "query": "Under force majeure clauses, what events typically excuse performance of a contract obligation?",
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+ "case_8780304"
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "case_4991933"
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "in_domain": true,
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+ "query": "How does the likelihood of confusion test apply in trademark infringement cases?",
+ "expected_source_docs": [
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+ "case_4991933"
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+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "expected_source_docs": [
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "query": "How do courts determine whether trade secrets qualify for protection under the Defend Trade Secrets Act?",
+ "expected_source_docs": [
+ "case_9506898"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ "query": "What is required to establish willful patent infringement and what enhanced damages can result?",
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+ "case_4587203"
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+ "answer": "When a party materially breaches a contract, the non-breaching party may have various remedies available to them. These remedies aim to compensate the non-breaching party for the losses incurred due to the breach.\n\n1. **Rescission**: The non-breaching party may seek to rescind the contract, effectively canceling its obligations under the contract. This means that both parties are released from their duties, and the contract is terminated.\n2. **Damages**: The non-breaching party may claim damages to compensate for the losses incurred due to the breach. This can include:\n\t* **Expectation damages**: Compensation for the expected benefits that the non-breaching party would have received under the contract had the breaching party performed.\n\t* **Restitution damages**: Compensation for the losses incurred by the non-breaching party in preserving the benefit of the bargain.\n\t* **Consequential damages**: Compensation for losses that are reasonably foreseeable as a result of the breach.\n3. **Specific Performance**: In some cases, a court may order the breaching party to perform their obligations under the contract. This is typically done when damages are insufficient to compensate the non-breaching party.\n4. **Termination**: The non-breaching party may choose to terminate the contract, releasing themselves from their obligations. This may be done with or without a court order.\n5. **Injunction**: A court may grant an injunction to prevent the breaching party from continuing to commit the breach.\n6. **Reformation**: In some cases, the non-breaching party may seek to reform the contract to reflect the original intent of the parties.\n7. **Disgorgement of Profits**: The non-breaching party may seek to recover the profits made by the breaching party as a result of the breach.\n8. **Breach of Fiduciary Duty**: If the breaching party had a fiduciary duty to act in the best interests of the non-breaching party, the non-breaching party may seek remedies for breach of fiduciary duty.\n\nIt's worth noting that the specific remedies available will depend on the terms of the contract, as well as the laws and regulations of the jurisdiction in which the contract was entered into.",
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+ },
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+ "answer": "The fair use doctrine in copyright law is a provision in the US Copyright Act of 1976 that allows for the use of copyrighted material without obtaining permission from the copyright holder, under certain circumstances. Fair use is a defense to copyright infringement, and its purpose is to balance the rights of copyright holders with the need for creativity, criticism, and innovation.\n\nTo determine whether a use is fair, courts consider four statutory factors:\n\n1. **Purpose and character of the use**: This factor looks at whether the use is for commercial or non-commercial purposes, and whether the use is transformative, meaning it adds value or insight to the original work. Courts consider whether the use is for educational, critical, or transformative purposes, such as parody or satire.\n\n2. **Nature of the copyrighted work**: This factor examines the type of work being used. Works that are more factual or informative are considered more fair game for use, while works that are more creative or expressive may be given more protection. For example, a court may be more likely to find fair use in a factual or historical work than in a novel or a work of art.\n\n3. **Amount and substantiality of the portion used**: This factor considers the extent of the copyrighted material that was used, and whether the use was substantial. A use that takes a large part of the original work may be considered more infringing than one that takes a small part. However, the quantity of the material used is not the only factor; courts also consider the quality or importance of the material used.\n\n4. **Effect of the use on the market for the original work**: This factor looks at whether the use harms the market for the original work, either by reducing sales or by replacing the original work. If the use does not harm the market, it may be considered fair. However, if the use is likely to harm the market, it may be considered infringing.\n\nThese four factors are not a checklist, and courts consider them in light of the specific facts and circumstances of the case. The fair use doctrine is a flexible and context-dependent concept, and the outcome of a fair use analysis can be unpredictable.",
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+ },
+ "financial": {
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+ "raw_results": [
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
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+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
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+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
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+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
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+ "query": "What risk factors are typically disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
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+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
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+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies disclose cybersecurity risks in their annual SEC filings following the 2023 SEC cybersecurity disclosure rules?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 750,
+ "content": "ications\n- Management: Avoid triggers, use peak flow meter, action plan, regular check-ups\n\nChronic Obstructive Pulmonary Disease (COPD)\n- Symptoms: Chronic cough, mucus production, shortness of breath, wheezing, chest tightness, fatigue\n- Risk Factors: Smoking, long-term exposure to lung irritants, alpha-1 antitrypsin deficiency, age over 40\n- Treatment: Bronchodilators, inhaled steroids, oxygen therapy, pulmonary rehabilitation, smoking cessation\n- Complications: Respiratory infections, heart problems, lung cancer, depression\n\nPneumonia\n- Symptoms: Fever, chills, cough with phlegm, chest pain, shortness of breath, fatigue, confusion (in elderly)\n- Causes: Bacteria, viruses, fungi, aspiration\n- Treatment: Antibiotics, antiviral medications, rest, fluids, oxygen therapy if severe\n- Prevention: Vaccination, hand hygiene, avoid smoking\n\n=== ENDOCRINE DISORDERS ===\n\nType 2 Diabetes\n- Symptoms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing so",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
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+ ],
+ "faithfulness": 0.0,
+ "query": "What types of macroeconomic risks are commonly reported as material risk factors in 10-K filings?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do pharmaceutical companies describe clinical trial failure as a risk factor in their annual reports?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What supply chain risk disclosures are typically included in manufacturing company 10-Ks?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
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+ "faithfulness": 0.0,
+ "query": "How do companies disclose geopolitical and sanctions-related risk factors in their SEC filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
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+ "faithfulness": 0.0,
+ "query": "What liquidity and capital resources risks are companies required to disclose in their 10-K filings?",
+ "expected_source_docs": [
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+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 755,
+ "content": "roups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling, reduced range of motion, bone spurs, crepitus\n- Risk Factors: Age, obesity, joint injuries, repetitive stress, genetics, bone deformities\n- Treatment: NSAIDs, acetaminophen, corticosteroid injections, physical therapy, joint replacement\n- Management: Weight management, low-impact exercise, heat/cold therapy, assistive devices\n\nRheumatoid Arthritis\n- Symptoms: Joint pain and swelling, morning stiffness, fatigue, fever, weight loss, symmetrical joint involvement\n- Causes: Autoimmune disorder, genetic predisposition, environmental triggers\n- Treatment: DMARDs, biologics, corticosteroids, NSAIDs, physical therapy\n- Complications: Joint deformity, cardiovascular disease, lung problems, osteoporosis\n\nOsteoporosis\n- Symptoms: Often asymptomatic until fracture, back pain, loss of height, stooped posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smo",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
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+ }
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+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies in the energy sector describe commodity price risk in their annual reports?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 752,
+ "content": "t, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, toxic nodular goiter, thyroiditis, excessive iodine intake\n- Treatment: Anti-thyroid medications, radioactive iodine, beta-blockers, surgery in severe cases\n- Complications: Osteoporosis, heart problems, thyroid storm\n\n=== GASTROINTESTINAL DISORDERS ===\n\nGastroesophageal Reflux Disease (GERD)\n- Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing, chronic cough, sore throat\n- Risk Factors: Obesity, pregnancy, smoking, hiatal hernia, certain foods and beverages\n- Treatment: Proton pump inhibitors, H2 blockers, antacids, lifestyle modifications, surgery if severe\n- Complications: Esophagitis, Barrett's esophagus, esophageal stricture, respiratory problems\n\nIrritable Bowel Syndrome (IBS)\n- Symptoms: Abdominal pain, bloating, gas, diarrhea, constipation, mucus in stool\n- Triggers: Certain foods, stress, hormonal changes, medications\n- Treatment: Dietary changes (low FODMAP), ",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
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+ "context",
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+ "faithfulness": 0.0,
+ "query": "What regulatory and compliance risks are disclosed by financial services companies in their 10-K filings?",
+ "expected_source_docs": [
+ "0000320575_0000320575-20-000008",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 757,
+ "content": "y,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31,Adults,Equal\nCVD_002,Coronary Artery Disease,Cardiovascular,Severe,\"Chest pain (Angina)\",\"Shortness of breath; Heart palpitations; Weakness\",High cholesterol,Smoking,Diabetes,Statins,Angioplasty,Heart attack,Heart failure,Lipid Panel,Total <200 mg/dL,LDL >160 mg/dL,18,Adults 40+,Male predominant\nCVD_003,Atrial Fibrillation,Cardiovascular,Moderate to Severe,\"Irregular heartbeat\",\"Palpitations; Fatigue; Dizziness\",High blood pressure,Heart disease,Age over 65,Blood thinners,Cardioversion,Stroke,Heart failure,ECG,Normal sinus rhythm,Irregular rhythm,2.7,Elderly,Slight male\nRESP_001,Asthma,Respiratory,Mild to Severe,\"Wheezing\",\"Coughing; Shortness of breath; Chest tightness\",Allergens,Family history,Air pollution,Inhaled corticosteroids,Bronchodilators,Respiratory failure,Status asthmaticus,Spirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies disclose risks related to customer concentration in their annual SEC reports?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0000320575_0000320575-20-000008"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What is included in the Management Discussion and Analysis (MD&A) section of a 10-K, and what SEC rules govern it?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How do companies describe their revenue recognition policies in the MD&A section of annual reports?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0001041588_0001041588-20-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 760,
+ "content": "Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal changes,Dietary changes,Antispasmodics,Malnutrition,Reduced quality of life,Clinical diagnosis,N/A,Rome IV criteria,10-15,Adults,Female predominant\nGI_003,Inflammatory Bowel Disease,Gastrointestinal,Severe,\"Diarrhea\",\"Abdominal pain; Blood in stool; Weight loss\",Genetics,Immune dysfunction,Environmental factors,Anti-inflammatory drugs,Biologics,Malnutrition,Colon cancer,Colonoscopy,Normal mucosa,Inflammation/ulcers,0.5,Young adults,Equal\nNEURO_001,Migraine,Neurological,Moderate to Severe,\"Severe headache\",\"Nausea; Vomiting; Light sensitivity\",Stress,Hormonal changes,Certain foods,Triptans,NSAIDs,Chronic migraine,Medication overuse,Clinical diagnosis,N/A,15+ days/month,15,Adults,Female predominant\nNEURO_002,Alzheimer's Disease,Neurological,Severe,\"Memory loss\",\"Confusion; Difficulty with tasks; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete d",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "How is operating cash flow discussed in the MD&A, and what non-GAAP measures are typically explained there?",
+ "expected_source_docs": [
+ "0001041588_0001041588-21-000001",
+ "0001386570_0001654954-20-005725"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 759,
+ "content": "002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto's disease,Thyroid surgery,Iodine deficiency,Levothyroxine,Dose adjustment,Heart problems,Myxedema coma,TSH,0.4-4.0 mIU/L,>4.0 mIU/L,4.6,Adults,Female predominant\nENDO_003,Hyperthyroidism,Endocrine,Moderate to Severe,\"Weight loss\",\"Rapid heartbeat; Increased appetite; Nervousness\",Graves' disease,Toxic nodular goiter,Excessive iodine,Anti-thyroid medications,Radioactive iodine,Osteoporosis,Thyroid storm,TSH,0.4-4.0 mIU/L,<0.4 mIU/L,1.2,Adults,Female predominant\nGI_001,GERD,Gastrointestinal,Mild to Moderate,\"Heartburn\",\"Regurgitation; Chest pain; Difficulty swallowing\",Obesity,Pregnancy,Hiatal hernia,Proton pump inhibitors,H2 blockers,Esophagitis,Barrett's esophagus,Endoscopy,Normal esophagus,Inflammation present,20,Adults,Slight male\nGI_002,Irritable Bowel Syndrome,Gastrointestinal,Mild to Moderate,\"Abdominal pain\",\"Bloating; Gas; Diarrhea or constipation\",Stress,Certain foods,Hormonal ch",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 758,
+ "content": "pirometry,FEV1/FVC >70%,FEV1/FVC <70%,8.6,All ages,Slight male in children\nRESP_002,COPD,Respiratory,Severe,\"Chronic cough\",\"Mucus production; Shortness of breath; Wheezing\",Smoking,Occupational exposure,Alpha-1 deficiency,Bronchodilators,Oxygen therapy,Respiratory infections,Lung cancer,Spirometry,FEV1 >80%,FEV1 <80%,10.3,Adults 40+,Equal\nRESP_003,Pneumonia,Respiratory,Moderate to Severe,\"Fever and chills\",\"Cough with phlegm; Chest pain; Shortness of breath\",Age extremes,Weakened immune system,Chronic diseases,Antibiotics,Antiviral medications,Sepsis,Respiratory failure,Chest X-ray,Clear lungs,Infiltrates present,1.5,All ages,Slight male\nENDO_001,Type 2 Diabetes,Endocrine,Chronic,\"Increased thirst\",\"Frequent urination; Increased hunger; Fatigue\",Obesity,Sedentary lifestyle,Family history,Metformin,Insulin therapy,Neuropathy,Retinopathy,HbA1c,<5.7%,\u22656.5%,10.5,Adults 45+,Slight male\nENDO_002,Hypothyroidism,Endocrine,Moderate,\"Fatigue\",\"Weight gain; Cold sensitivity; Dry skin\",Hashimoto'",
+ "source": "context",
+ "section_title": null
+ }
+ ],
+ "retrieved_chunk_doc_ids": [
+ "context",
+ "context",
+ "context",
+ "context",
+ "context"
+ ],
+ "faithfulness": 0.0,
+ "query": "What forward-looking statements are typically made in the MD&A section and what safe harbor protections apply?",
+ "expected_source_docs": [
+ "0001386570_0001654954-20-005725",
+ "0001041588_0001041588-21-000001"
+ ]
+ },
+ {
+ "answer": "I apologize, but I encountered an error processing your query. Please try again.",
+ "confidence": 0.0,
+ "in_domain": true,
+ "top_chunks": [
+ {
+ "id": 754,
+ "content": "lifestyle modifications\n- Management: Identify triggers, maintain regular sleep schedule, stress reduction, hydration\n\nAlzheimer's Disease\n- Symptoms: Memory loss, confusion, difficulty with familiar tasks, language problems, poor judgment, personality changes\n- Risk Factors: Age, family history, genetics (APOE-e4), head trauma, cardiovascular disease\n- Treatment: Cholinesterase inhibitors, memantine, cognitive therapy, supportive care\n- Management: Structured routine, safety modifications, caregiver support, social engagement\n\nParkinson's Disease\n- Symptoms: Tremor, bradykinesia, rigidity, postural instability, shuffling gait, soft speech\n- Causes: Loss of dopamine-producing neurons, genetic and environmental factors\n- Treatment: Levodopa, dopamine agonists, MAO-B inhibitors, deep brain stimulation, physical therapy\n- Management: Exercise, speech therapy, occupational therapy, support groups\n\n=== MUSCULOSKELETAL DISORDERS ===\n\nOsteoarthritis\n- Symptoms: Joint pain, stiffness, swelling",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 756,
+ "content": " posture\n- Risk Factors: Age, female gender, menopause, low calcium intake, sedentary lifestyle, smoking\n- Treatment: Bisphosphonates, calcium and vitamin D supplements, hormone therapy, weight-bearing exercise\n- Prevention: Adequate calcium and vitamin D, regular exercise, avoid smoking and excessive alcohol\n\n\n============================================================\nSOURCE: medical_conditions.csv (TEXT)\n============================================================\n\ncondition_id,condition_name,category,severity,primary_symptom,secondary_symptoms,risk_factor_1,risk_factor_2,risk_factor_3,first_line_treatment,alternative_treatment,complication_1,complication_2,diagnostic_test,normal_range,abnormal_threshold,prevalence_percentage,age_group,gender_predisposition\nCVD_001,Hypertension,Cardiovascular,Moderate,\"Headaches\",\"Shortness of breath; Nosebleeds; Chest pain\",Age over 60,Family history,Obesity,ACE Inhibitors,Beta-blockers,Stroke,Heart attack,Blood Pressure,120/80 mmHg,140/90 mmHg,31",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 761,
+ "content": "s; Language problems\",Age,Family history,APOE-e4 gene,Cholinesterase inhibitors,Memantine,Complete dependency,Death,Cognitive tests,Normal cognition,Impaired cognition,6.7,Elderly 65+,Slight female\nNEURO_003,Parkinson's Disease,Neurological,Severe,\"Tremor\",\"Bradykinesia; Rigidity; Postural instability\",Age,Genetics,Environmental toxins,Levodopa,Dopamine agonists,Falls,Dementia,Clinical diagnosis,Normal movement,Motor symptoms,1,Adults 60+,Slight male\nMSK_001,Osteoarthritis,Musculoskeletal,Moderate,\"Joint pain\",\"Stiffness; Swelling; Reduced range of motion\",Age,Obesity,Joint injuries,NSAIDs,Joint replacement,Disability,Chronic pain,X-ray,Normal joint space,Narrowed joint space,32.5,Adults 50+,Female predominant\nMSK_002,Rheumatoid Arthritis,Musculoskeletal,Moderate to Severe,\"Joint pain and swelling\",\"Morning stiffness; Fatigue; Fever\",Autoimmune,Genetics,Smoking,DMARDs,Biologics,Joint deformity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMS",
+ "source": "context",
+ "section_title": null
+ },
+ {
+ "id": 762,
+ "content": "ormity,Cardiovascular disease,RF and Anti-CCP,Negative,Positive,1,Adults 30-60,Female predominant\nMSK_003,Osteoporosis,Musculoskeletal,Moderate,\"Often asymptomatic\",\"Back pain; Loss of height; Stooped posture\",Age,Menopause,Low calcium intake,Bisphosphonates,Calcium/Vitamin D,Fractures,Disability,DEXA scan,T-score >-1,T-score <-2.5,10,Postmenopausal women,Female predominant\nPSYCH_001,Major Depressive Disorder,Psychiatric,Moderate to Severe,\"Persistent sadness\",\"Loss of interest; Fatigue; Sleep disturbances\",Genetics,Trauma,Chronic stress,SSRIs,Psychotherapy,Suicide,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,7,Adults,Female predominant\nPSYCH_002,Generalized Anxiety Disorder,Psychiatric,Moderate,\"Excessive worry\",\"Restlessness; Fatigue; Difficulty concentrating\",Genetics,Stress,Personality factors,SSRIs,Benzodiazepines,Depression,Substance abuse,Clinical assessment,N/A,DSM-5 criteria,3.1,Adults,Female predominant\n",
+ "source": "context",
+ "section_title": null
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+ {
+ "id": 751,
+ "content": "ms: Increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, frequent infections\n- Risk Factors: Obesity, sedentary lifestyle, family history, age over 45, gestational diabetes history\n- Treatment: Metformin, insulin therapy, GLP-1 agonists, lifestyle modifications, blood sugar monitoring\n- Complications: Neuropathy, retinopathy, nephropathy, cardiovascular disease, foot problems\n\nHypothyroidism\n- Symptoms: Fatigue, weight gain, cold sensitivity, dry skin, hair loss, constipation, depression, muscle weakness\n- Causes: Hashimoto's thyroiditis, thyroid surgery, radiation therapy, medications, iodine deficiency\n- Treatment: Levothyroxine replacement therapy, regular TSH monitoring, dose adjustments\n- Management: Take medication on empty stomach, avoid certain supplements, regular blood tests\n\nHyperthyroidism\n- Symptoms: Weight loss, rapid heartbeat, increased appetite, nervousness, tremors, sweating, heat intolerance\n- Causes: Graves' disease, t",
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+ "answer": "According to my knowledge, a 10-K filing under SEC Regulation S-K Item 1A typically includes risk factors that may impact the technology company's business, operations, financial condition, or results of operations. Some common risk factors disclosed in this section include:\n\n1. **Competition and market risks**: The company's ability to compete with other technology companies, changes in market trends, and potential disruptions to its business.\n2. **Regulatory risks**: Compliance with laws and regulations related to the technology industry, such as data protection, cybersecurity, and intellectual property laws.\n3. **Cybersecurity risks**: The risk of cyber-attacks, data breaches, and other security incidents that could compromise the company's systems and data.\n4. **Intellectual property risks**: The risk of infringement on the company's intellectual property, as well as the risk of not being able to protect its own IP.\n5. **Supply chain risks**: The risk of disruptions to the company's supply chain, including the risk of supplier insolvency or non-performance.\n6. **Dependence on key customers or partners**: The risk of losing a significant customer or partner, which could have a material impact on the company's revenue and profitability.\n7. **Technological risks**: The risk of technological advancements or changes in customer preferences that could render the company's products or services obsolete.\n8. **Environmental and social risks**: The company's exposure to environmental and social risks, such as climate change, human rights, and labor practices.\n9. **Global economic risks**: The risk of changes in global economic conditions, including recession, inflation, and currency fluctuations.\n10. **Other risks**: Any other risks that may impact the company's business, operations, financial condition, or results of operations.\n\nThese are just some examples of the types of risk factors that may be disclosed in a technology company's 10-K filing under SEC Regulation S-K Item 1A. The specific risks disclosed may vary depending on the company's business, industry, and other factors.",
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+ "legal_to_financial": {
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+ "financial_to_medical": {
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+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ },
+ "financial_to_legal": {
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+ "true_positives_rejected": 31,
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+ "false_negatives": 0,
+ "true_negatives": 0,
+ "precision": 1.0,
+ "recall": 1.0,
+ "f1_score": 1.0
+ }
+ },
+ "table5_latency_ms": {},
+ "calibration": {
+ "expected_calibration_error": 0.0,
+ "reliability_diagram": []
+ },
+ "significance_and_effect_size": {}
+}
\ No newline at end of file
diff --git a/evaluation_outputs/guardrail_threshold_sweep.json b/evaluation_outputs/guardrail_threshold_sweep.json
new file mode 100644
index 0000000000000000000000000000000000000000..8510dcee42baa347406dc5e6cd085dd769df262e
--- /dev/null
+++ b/evaluation_outputs/guardrail_threshold_sweep.json
@@ -0,0 +1,128 @@
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\ No newline at end of file
diff --git a/test_data/financial_real/0000320575_0000320575-20-000008.txt b/test_data/financial_real/0000320575_0000320575-20-000008.txt
new file mode 100644
index 0000000000000000000000000000000000000000..829027dbc5e45012e21dfdc79d3cd74b68607f07
--- /dev/null
+++ b/test_data/financial_real/0000320575_0000320575-20-000008.txt
@@ -0,0 +1 @@
+10-K/A 1 form10-ka2019.htm 10-K/A Document UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D. C. 20549 FORM 10-K/A Amendment No. 1 (Mark one) ý ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2019 or o TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 Commission File Number: 1-8182 PIONEER ENERGY SERVICES CORP. (Exact name of registrant as specified in its charter) _____________________________________________ TEXAS 74-2088619 (State or other jurisdiction of incorporation or organization) (I.R.S. Employer Identification Number) 1250 N.E. Loop 410, Suite 1000 San Antonio, Texas 78209 (Address of principal executive offices) (Zip Code) Registrant’s telephone number, including area code: (855) 884-0575 Securities registered pursuant to Section 12(b) of the Act Title of each class Trading Symbol(s) Name of each exchange on which registered Securities registered pursuant to Section 12(g) of the Act: Common Stock, $0.10 par value Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ¨ No þ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ¨ No þ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes þ No ¨ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes þ No ¨ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer o Accelerated filer o Non-accelerated filer þ Smaller reporting company þ Emerging growth company o If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨ Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ¨ No þ The aggregate market value of the registrant’s common stock held by non-affiliates of the registrant as of the last business day of the registrant’s most recently completed second fiscal quarter (based on the closing sales price on the New York Stock Exchange (NYSE) on June 30, 2019 ) was approximately $19.0 million . As of March 31, 2020 , there were 79,579,571 shares of common stock, par value $0.10 per share, of the registrant issued and outstanding. EXPLANATORY NOTE This Amendment No. 1 on Form 10-K/A (this "Amendment") amends the Annual Report on Form 10-K of Pioneer Energy Services Corp. ("Pioneer," "Company," "we," "us," and "our") for the year ended December 31, 2019 that was originally filed with the U.S. Securities and Exchange Commission ("SEC") on March 6, 2020 (the "Original Filing"). The purpose of this Amendment is to (i) supplement the risk factors set forth in Item 1A of Part I of the Original Filing and (ii) provide the information required by Items 10, 11, 12, 13, and 14 of Part III of the Original Filing, which information was previously omitted from the Original Filing in reliance on General Instruction G(3) to Form 10-K. The supplemental risk factors set forth in this Amendment should be read in conjunction with the other risk factors set forth in the Original Filing, and Part III of the Original Filing is hereby amended and restated in its entirety. Capitalized terms not otherwise defined in Part III of this Amendment shall have the same meanings assigned to such terms in Parts I and II of the Original Filing. In addition, as required by Rule 12b-15 under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), currently dated certifications by our principal executive officer and principal financial officer are filed as exhibits to this Amendment under Item 15 of Part IV hereof. Except as described above, this Amendment does not amend or otherwise update any other information in the Original Filing. Accordingly, this Amendment should be read in conjunction with the Original Filing and with our filings with the SEC subsequent to the Original Filing. As previously disclosed, on March 1, 2020 , Pioneer and certain of its affiliates (together with Pioneer, the "Pioneer RSA Parties"), filed voluntary petitions for reorganization under chapter 11 of title 11 of the United States Code (the "Bankruptcy Code") in the United States Bankruptcy Court for the Southern District of Texas (the "Bankruptcy Court"). The Chapter 11 proceedings are being jointly administered under the caption In re Pioneer Energy Services Corp. et al (the "Chapter 11 Cases"). For the duration of the Chapter 11 Cases, our operations and our ability to develop and execute our business plan are subject to risks and uncertainties associated with the Chapter 11 Cases as described in "Item 1A. Risk Factors" in Part I of the Original Filing and this Amendment. As a result of these risks and uncertainties, our assets, liabilities, shareholders' equity, officers and/or directors could be significantly different following the conclusion of the Chapter 11 Cases, and the description of our operations, properties, and capital plans included in the Original Filing may not accurately reflect our operations, properties, and capital plans following the Chapter 11 Cases. 1 TABLE OF CONTENTS Page PART I Item 1A. Risk Factors 3 PART III Item 10. Directors, Executive Officers and Corporate Governance 5 Item 11. Executive Compensation 10 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Shareholder Matters 20 Item 13. Certain Relationships and Related Transactions, and Director Independence 22 Item 14. Principal Accounting Fees and Services 23 PART IV Item 15. Exhibits, Financial Statement Schedules 24 Signatures 25 2 PART I ITEM 1A. RISK FACTORS Except as discussed below, there has been no material change in our risk factors as previously disclosed in Item 1A – “Risk Factors” of the Original Filing. The risk factors set forth in this Amendment should be read in conjunction with the other risk factors set forth in the Original Filing. The following two risk factors in Part I, Item 1A of the Original Filing are amended and restated in their entirety as follows: • We derive all our revenues from companies in the oil and gas exploration and production industry, a historically cyclical industry with levels of activity that are significantly affected by the levels and volatility of oil and gas prices. As a provider of contract land drilling services and oil and gas production services, our business depends on the level of exploration and production activity in the geographic markets where we operate. The oil and gas exploration and production industry is a historically cyclical industry characterized by significant changes in the levels of exploration and development activities. Oil and gas prices, and market expectations of potential changes in those prices, significantly affect the levels of those activities. Oil and gas prices have been volatile historically and, we believe, will likely continue in the future. Oil prices have experienced declines in March 2020 and could decline further. Worldwide political, economic, and military events, as well as natural disasters and pandemics (including the recent coronavirus (COVID-19) outbreak), have contributed to oil and gas price volatility historically, and are likely to continue to do so in the future. Many factors beyond our control affect oil and gas prices, including: • the worldwide supply and demand for oil and gas; • the cost of exploring for, producing and delivering oil and gas; • the discovery rate of new oil and gas reserves; • the rate of decline of existing and new oil and gas reserves; • available pipeline and other oil and gas transportation capacity; • the levels of oil and gas storage; • the ability of oil and gas exploration and production companies to raise capital; • economic conditions in the United States and elsewhere; • actions by the Organization of Petroleum Exporting Countries (OPEC) and Russia; • political instability in oil and gas producing regions; • governmental regulations, both domestic and foreign; • domestic and foreign tax policy; • weather conditions in the United States and elsewhere; • the pace adopted by foreign governments for the exploration, development and production of their national reserves, or their investments in oil and gas reserves located in other countries; and • the price of foreign imports of oil and gas. Additionally, the above factors can also be affected by technological advances affecting energy consumption and the supply and demand within the market for renewable energy resources. • Oil and natural gas prices, and market expectations of potential changes in these prices, significantly impact the level of worldwide drilling and production services activities. Oil and natural gas prices, and market expectations of potential changes in these prices, significantly impact the level of worldwide drilling and production services activities. Reduced demand for oil and natural gas generally results in lower prices for these commodities and often impacts the economics of planned drilling projects and ongoing production projects, resulting in the curtailment, reduction, delay or postponement of such projects for an indeterminate period of time. When drilling and production activity and spending declines, both dayrates and utilization historically decline as well. In late 2014, oil prices worldwide began to drop significantly and as a result, our clients significantly reduced both their operating and capital expenditures during 2015 and 2016, which adversely affected our business. In 2017 and 2018, our clients modestly increased their spending as compared to 2016 levels, and our business trended upward as a result. However, in late 2018, oil prices again began to decline and despite some improvement in early 2019, have since languished without significant improvement in 2019 and early 2020. Since January 2020, the coronavirus (COVID-19) outbreak and fear of further spread of the coronavirus have caused disruptions in international economies and international financial and oil markets, including a decline in the price of oil. The economic 3 downturn caused by the coronavirus outbreak has weakened demand for oil, and after OPEC and a group of oil producing nations led by Russia failed on March 6, 2020 to agree on oil production cuts, Saudi Arabia announced that it would cut oil prices and increase production, leading to a sharp further decline in oil trading prices. Following these developments, WTI crude oil prices fell to $20 per barrel at the end of March 2020. We cannot anticipate whether or when this dispute will be resolved and production returned to normalized levels. The coronavirus and responses of oil producers to the lower demand for oil and lower oil prices are rapidly evolving situations. Oil and gas exploration and production companies have announced reductions to previously planned capital spending programs for 2020, thereby reducing demand for our services. Sustained low or worsening oil prices could have an adverse effect on our financial condition, results of operations, and cash flow. Additionally, because our business depends on the level of spending by our clients, we are also affected by our clients’ ability to access the capital markets. After several consecutive years without significant improvement in commodity prices, many exploration and production companies have limited their spending to a level which can be supported by net operating cash flows alone, as access to the capital markets through debt or equity financings has become more challenging in our industry. This challenge has increased recently due to the major stock market and bond market indices experiencing substantial declines, with such declines intensifying, and elevated levels of volatility, in 2020. If the reduction in the overall level of exploration and development activities, whether resulting from changes in oil and gas prices or otherwise, continues or worsens, it could adversely affect us further by negatively impacting: • our revenues, cash flows and profitability; • the fair market value of our drilling and production services fleets; • our ability to maintain or increase its borrowing capacity; • our ability to obtain additional capital to finance our business or make acquisitions, and the cost of that capital; • the collectability of our receivables; • our ability to adequately maintain our equipment, or bring it back into service; and • our ability to retain skilled operations personnel. The following risk factor supplements those above and those set forth in the Original Filing. • The rapid spread of a contagious illness, including the recent spread of COVID-19, or fear of such an event, could adversely affect our business, operations, and financial condition. Our business could be adversely affected by a widespread outbreak of contagious disease, including the recent outbreak of respiratory illness caused by a novel coronavirus (COVID-19). Since January 2020, the coronavirus outbreak and fear of further spread of the coronavirus have caused significant disruptions in international economies and international financial and oil markets, including a substantial decline in the price of oil. Our customers responded to the outbreak by announcing reductions to their capital programs, resulting in a reduction in demand for our services. As the coronavirus outbreak is still evolving, much of its international and domestic impact remains unknown. The coronavirus outbreak has led to quarantines of entire countries and smaller localities, cancellation of events and travel, prohibitions on entry imposed by many countries, government-mandated and voluntary business and school shutdowns, supply chain interruptions, and overall economic and financial market instability. Further spread of the coronavirus could cause additional quarantines, reduction in business activity, labor shortages and other operational
\ No newline at end of file
diff --git a/test_data/financial_real/0001041588_0001041588-20-000001.txt b/test_data/financial_real/0001041588_0001041588-20-000001.txt
new file mode 100644
index 0000000000000000000000000000000000000000..14c6d8cd2ddf01f9f4bd406537e2bbdfbd06437c
--- /dev/null
+++ b/test_data/financial_real/0001041588_0001041588-20-000001.txt
@@ -0,0 +1,401 @@
+10-K 1 accr12311910K.txt January 2nd, 2020
+
+
+
+PERIOD and DOCUMENT: 10KSB for the FULL YEAR 12/31/2019
+COMPANY CONFIRMED NAME: ACCESS-POWER, INC.
+CENTRAL INDEX KEY: 0001041588
+FORM TYPE: 10KSB
+SEC FILE NUMBER: 333-65069
+BUSINESS ADDRESS:
+STREET 1: 17164 DUNE VIEW DRIVE
+STREET 2: APT 106
+CITY: GRAND HAVEN
+STATE: MI
+ZIP: 49417
+
+
+
+Respectfully submitted to the,
+
+
+UNITED STATES SECURITIES AND EXCHANGE COMMISSION
+WASHINGTON, D.C. 20549
+The Division of Corporation Finance,
+100 F Street NE, Washington, D.C. 20549
+
+FORM 10-KSB
+
+/X/ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED
+DECEMBER 31, 2019.
+
+TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
+OF THE SECURITIES EXCHANGE ACT OF 1934
+FOR THE TRANSITION PERIOD FROM ______ TO _____
+
+
+COMMISSION FILE NUMBER: 333-65069
+
+
+ACCESS-POWER, INC.
+[Exact name of Registrant as
+specified in its charter]
+
+
+*** FLORIDA ***
+
+Domicile State or other jurisdiction of
+incorporation or organization
+http://www.sunbiz.org
+
+*** MICHIGAN ***
+
+State of Operations
+https://cofs.lara.state.mi.us/SearchApi/Search/Search
+
+
+
+59-3420985
+(I.R.S. Employer
+Identification No.)
+
+
+17164 DUNE VIEW DRIVE
+APT 106
+GRAND HAVEN, MI 49417
+
+or
+
+PO BOX 598
+Grand Haven, MI 49417
+
+(Address of principal executive offices)
+
+REGISTRANTS TELEPHONE NUMBER, INCLUDING AREA CODE: 616-312-5390
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: NONE
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT:
+COMMON STOCK, $0.001 PAR VALUE - 500,000,000 shares authorized.
+
+
+Indicate by check mark if the registrant is a well-known
+seasoned issuer, as defined in Rule 405 of the Securities
+Act. Yes No X
+
+Indicate by check mark if the registrant is not required to file
+reports pursuant to Section 13 or Section 15(d) of the Act.
+Yes No X
+
+The Company has had discussions with the SEC regarding a FRAUD
+FORM 15 that was filed by previous management in 2007. We believe
+that we have a fiduciary responsibility to report transaprent
+information to our Shareholders.
+
+We were victims of toxic death spiral debentures from 1998 to
+2008. PLEASE FORGIVE OUR PAST. The past it the past, and
+we wish to move forward with a plan to become fully
+current with the SEC. We are trying the best we can within the
+Spirit of the Law.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+Indicate by check mark whether the registrant (1) has
+filed all reports required to be filed be Section 13 or 15(d)
+of the Securities Exchange Act of 1934 during the preceding 12
+months (or for such shorter period that the registrant was
+required to file such reports), and (2) has been subject
+to such filing requirements for the past 90 days. Yes X No
+
+Indicate by check mark whether the registrant has submitted
+electronically and posted on its corporate Web site, if any,
+every Interactive Data File required to be submitted and
+posted pursuant to Rule 405 of Regulation S-T (232.405 of
+this chapter) during the preceding 12 months (or for such
+shorter period that the registrant was required to submit
+and post such files). Yes X No
+
+Indicate by check mark if disclosure of delinquent filers
+pursuant to Item 405 of Regulation S-K (Section 229.405
+of this chapter) is not contained herein, and will not be
+contained, to the best of registrants knowledge, in definitive
+proxy or information statements incorporated by reference in
+Part III of this Form 10-K or any amendment to this Form 10-K.
+
+Indicate by check mark whether the registrant is a large a
+ccelerated filer, an accelerated filer, a non-accelerated
+filer, smaller reporting company, or an emerging growth
+company. See the definitions of large accelerated filer,
+accelerated filer, smaller reporting company, and
+emerging growth company in Rule 12b-2 of the Exchange Act.
+
+Large accelerated filer NO Accelerated filer NO
+Non-accelerated filer NO (Do not check if a smaller
+reporting company)
+
+Smaller reporting company YES
+Emerging growth company YES
+
+If an emerging growth company, indicate by check mark if
+the registrant has elected not to use the extended
+transition period for complying with any new or revised
+financial accounting standards provided pursuant to
+ection 13(a) of the Exchange Act.
+
+Indicate by check mark whether the registrant is a shell
+company (as defined in Rule 12b-2 of the Exchange Act).
+Yes No X
+
+The aggregate market value of the voting common stock held by non-affils.
+of the registrant (assuming officers and directors are affiliates) was
+approximately $1,017,140.59 as of 12/3119, computed on the basis of
+the closing price on such date.
+
+As of January 2nd, 2020, there were 244,144,121 shares of the
+registrant's
+Common Stock outstanding. PATRICK J JENSEN, Director of Access-Power, Inc.
+has 131,128,500 Restricted Shares. 113,015,621 + 131,128,500 =
+244,144,121
+total shares available of Access-Power, Inc. common stock.
+
+
+*****WE ONLY HAVE COMMON STOCK*****
+
+*****WE DO NOT HAVE CONVERTIBLE NOTES or WARRANTS*****
+
+
+THE TOTAL MARKET CAPITALIZATION AS OF THE CLOSE OF BUSINESS
+January 2nd, 2020 IS 2,197,297.09 BASED ON A CLOSING PRICE OF
+$.009 PER SHARE.
+
+
+___________________________________________________________________________
+
+
+
+**** CURRENT UPDATE ****
+
+Our comeback journey continues. We are very excited about our future.
+
+We filed our first tax return in 18 years. We hired H&R Block of Muskegon
+to look over and supervise and review all of our financial bank records
+and statements for 2018 and 2019. We believe in 100% Transparency. We are
+making very good informed decisions. H&R BLOCK engagement--->
+
+This occured on November 5, 2019 - our date of engagement with HR&BLOCK
+
+In November of 2019 , we have started an application with the State of
+Michigan to obtain a MicroMarijuana business. We only plan to operate
+our futuristic plan of delivering Marijuana Plants by Drones via a
+service called Clones by Drones TM. This process could take
+2-3 years to implement. The application was started at:
+
+https://aca3.accela.com/MIMM/Login.aspx
+
+The Company believes it has the right to commence operations with a
+pending license application. ACCR has a very super cool business model
+that will defy conventional logic---> LOGISTICs are simple.
+
+We expect to get the licenses, zoning requirements, and permits
+necessary to operate our BUSINESS PLAN. WE HAVE A SALES BUSINESS PLAN.
+ACCR has a business plan that represents my DREAMs in life. I will
+not hurt my Shareholders. Everyone is welcome, and ACCR is grateful
+and thankful. We are not sellers of our common stock. PERIOD.
+
+Access-Power, Inc. has a big task ahead of itself. We have many
+obstancles to grow our 20' x 20' Master Mother Grow and Cloning Rooms. We
+would expect to be fully operational with inventory in 3 months of
+beginning construction. We do not have Clones by Drones operational yet
+to accept Visa/Martercard or Pay/Pal payments. We expect to turn on
+our eCommerce website sometime in 2020 or possibly 2021. Probably in
+2020. We believe in only MEDICAL MARIJUANA, and will not offer at the
+moment any products to people that do not possess a valid Medical
+Marijuana Card issued by any State. There are dispensaries here in
+Michigan that accept patients from out of State. We plan to
+mirror the growth's of the Dispensaries. We plan to grow around
+the dispensaries, and offer our cool and futuristic service
+by Drones. Access-Power, Inc. has in its business plan a way to
+logistically deliver in a very cost effective way.
+
+BACK to our engagement with H&R Block on November 5, 2019.
+
+We realize that this is not a PCAOB firm, PLEASE...
+however, this is all the Company can afford. Within the spirit of the
+law, we are filing these documents to report transparency to our
+Shareholders. We have spoken to the SEC regarding this requirement, and
+it is the Companies intention to hire a PCAOB firm in 2020 or in 2021.
+We have to start somewhere and again it is our goal to fully hire a PCAOB
+accountant in the year 2020 or 2021. We have communicated our 2 year
+plan with the SEC. We have a very transparent relationship
+with many divisions of FINRA. The Company has great contacts at
+OTC Markets. The Company also has a trusting relationship that is
+very open with the SEC.
+
+Access-Power, Inc. was the victim of toxic convertible death spiral
+debentures from inception through 2008. I purchased common stock
+during this time, and slowly became a 10% stock holder over the years.
+The Florida Law which allowed us to fire all previous crooked Directors
+is Chap 607.0702 of the 2012 Florida Senate Law.
+
+The Company has survived a short attack, and the Company will attempt
+to hire an attorney in 2020 to represent us.
+
+ON DECEMBER 13, 2019, ACCESS-POWER, INC. eFILED ITS FIRST STATE AND
+FEDERAL TAX RETURN IN OVER 18 YEARS. THE eFILE WAS ACCEPTED BY ALL
+PARTIES ON DECEMBER 19, 2019. ACCESS-POWER, INC. PLANS TO CONTINUE TO
+WORK WITH OUR TEMPORARY AUDITOR THROUGHOUT 2020. WE ARE STRIVING TO BE
+A VERY TRANSPARENT AND CURRENT REPORTING ENTITY. THERE ARE ONLY
+98,144,246 SHARES IN OUR PUBLIC FLOAT. THIS IS FIXED, AND THERE IS NO
+DILUTION, I REPEAT....NO DILUTION IN THE COMPANY COMMON SHARES
+THROUGHOUT 2020 AND 2021. AGAIN, THE SUPPLY OF STOCK IS FIXED.
+
+We are a micro-cap business with very struggling revenues at
+the moment, and we are developing the first eCommerce website to deliver
+Marijuana, Marijuana plants, and other Marijuana products such as Edibles
+by Drones. We are going through a rough economic business cycle.
+We applied for a Trademark SERVICE MARK on November 13, 2019.
+
+We will succeed. This may take a few years to develop. At the present
+time, I am still waiting for our Companies previously announced
+$50,000.00 donation. This may take another 6-9 months.
+
+There are many entities that do not want ACCR to comeback.
+
+As of the close of business January 1st 2020, our commomn stock
+structure is as follows:
+
+Authorized Common Stock: 500,000,000 shares
+Outstanding Common Stock: 244,144,121 shares
+Estimated Float: Substanstially less than 98,244,146 shares
+Restricted Common Stock: 145,769,975 shares
+
+https://www.otcmarkets.com/stock/ACCR/profile
+
+We have public profiles at:
+
+https://www.linkedin.com/in/patrick-j-jensen-564946b4
+https://www.twitter.com/AccessOtc
+https://www.twitter.com/AccrOtc
+https://brokercheck.finra.org/individual/summary/1952963
+
+OUR CORPORATE WEBSITEs ARE:
+
+http://www.myaccess-power.com
+http://www.clonesbydrones.com
+http://www.mycbdpets.com
+http://www.nyumarijuana.com
+
+Access-Power, Inc.'s contact is pjensen@myaccess-power.com.
+
+We applied for a Trademark for Clones By Drones TM. The service
+will be very futuristic, and will be the first of its kind.
+
+Access-Power, Inc. is in good standing and has a very good relationship
+with our Transfer Agent, Standard Transfer & Co.
+Our Transfer Agent is SEC registered, and except for one
+change in ownership in 2007, is our original transfer agent dating
+back to 1996. Our transfer agent is SEC registered and has a profile at:
+
+https://www.sec.gov/divisions/marketreg/mrtransfer.shtml
+https://www.otcmarkets.com/learn/service-providers/2433?t=6
+
+https://standardtransferco.com
+
+Standard Transfer & Co.
+440 East 400 South Suite 200, Salt Lake City, Utah 84111
+Phone (801) 571-8844 Fax: (801) 328-4058
+
+Our ticker symbol ACCR and further information may be found at:
+
+https://www.sec.gov/cgi-bin/browse-edgar?CIK=accr
+
+State the aggregate market value of the voting stock held by
+non-affiliates
+computed by reference to the price at which the stock was sold,
+or the average
+bid and asked prices of such stock as of a specified date
+within the past 60
+days: $1,130,156.21
+
+At January 1st 2020, there were issued and outstanding 244,144,121
+shares of Common Stock, and Patrick J. Jensen owns 131,128,500 shares
+or 53.7090
+percent of all the Common Stock. I am willing to give up Control and
+ a
+percentage of the Company, for an Equity Partner in our Company.
+All
+131,128,500 are currently restricted and held in book entry form at the
+Transfer Agent. I am actively looking for a MERGER DEAL.
+
+There are currently a total of 98,244,146 shares registered in our
+float.
+Management continues to believe that there is a massive short position
+in our Company stock that was accumulated from 1999 to 2008, and we
+estimate
+this short position to be massive. As Director of this Company, I
+want to
+apologize to my Shareholders for previously stating that our estimated
+float
+was between 5,000,000 and 10,000,000. Although I firmly believe the
+float
+in our Company stock is substantially lower than the official
+98,244,146 shares
+reported to OTC Markets.
+
+We care about our Shareholders dearly, and our top priority is investor
+protection. There is NO DILUTION IN THE COMMON STOCK OF ACCR.
+
+
+ PART I
+
+
+ITEM 1. DESCRIPTION OF BUSINESS
+
+Access-Power, Inc, is a for profit business looking for a
+MERGER CANDIDATE.
+We currently pay bills through a Work at Home business. Our monthly
+fixed expenses are previosuly documented in an 8K at $2,350.00. We
+operate a part time work at home business. The company subcontracts
+through a big call center, and provides sales and customer service
+to big Fortune 500 companies. In 2019, we operated via Hunter Vunter,
+our subsidiary through www.liveops.com. We ended the relationship
+with LiveOps on May 1st 2019. As a result, Hunter Venture was
+officially dissolved.
+
+The Company struggled from May 1, 2019 to October 18, 2019. We had no
+income during this period, and our operational expenses were paid for
+by myself, Patrick J. Jensen as a donation to the Company. I personally
+paid out of my own pocket all the expenses during this dark time.
+
+On October 2, 2019---> I dreamed of getting off the greys. ACCR is a
+DREAM right now...This is how builders work.
+
+On October 18, 2019, we acquired Grand Haven MM LLC, and this entity
+is our subsidiary now. This is an operating entity very similar
+to Hunter Venture. The entity is registered in the State of Michigan
+here:
+
+https://cofs.lara.state.mi.us/CorpWeb/CorpSearch/CorpSummary.aspx?
+ID=802220565
+
+Grand Haven MM now operates a part time work at home program through
+another national call center very similar and much bigger in size
+than our previour contracter. We provide work at home sales and
+customer services subcontracted on a part time basis. I am a builder.
+I am building a Clone Delivery Service for Marijuana Plants .... in
+West Michigan.
+
+The Company also operates 2 eCommerce websites at the present time.
+
+http://www.clonesbydrones.com
+http://www.mycbdpets.com
+
+We continue to strive to build up our revenues. We want to succeed
+and we will comeback to a higher reporting standard. On October 18,
+2019 we were upgraded in trading tier from the dark grey market
+to the PINK NO INFORMATION market. We have no intention of going
+back to the grey market, as the Company currently trades on an
+"unsolicited basis" in the PINK NO INFORMATION tier at OTC
+Markets. There are so many unknowns, however I have a visi
\ No newline at end of file
diff --git a/test_data/financial_real/0001041588_0001041588-21-000001.txt b/test_data/financial_real/0001041588_0001041588-21-000001.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7457f680c6490292ee81abb2f140636517a220f2
--- /dev/null
+++ b/test_data/financial_real/0001041588_0001041588-21-000001.txt
@@ -0,0 +1,503 @@
+10-K 1 accr12312010k.txt January 4th, 2021
+
+
+
+
+
+This form is filled out within all the SPIRITs of the SEC Laws of '33 and '34.
+
+
+
+
+ACCESS-POWER & CO., INC.
+OTC TICKER: ACCR
+We were violent victims of toxic death spiral convertible "floorless"
+debentures from 1998 to 2008, and then through March 2012.
+
+
+PERIOD and DOCUMENT: 10KSB for the FULL YEAR 12/31/2020
+COMPANY CONFIRMED NAME: ACCESS-POWER & Co., INC.
+CENTRAL INDEX KEY: 0001041588
+FORM TYPE: 10KSB
+
+SEC FILE NUMBER: 333-65069
+
+
+
+
+
+
+BUSINESS ADDRESS:
+STREET 1: PO BOX 598
+
+CITY: GRAND HAVEN
+STATE: MI
+ZIP: 49417
+
+
+
+
+
+
+
+
+
+Respectfully submitted to the,
+
+
+UNITED STATES SECURITIES AND EXCHANGE COMMISSION
+WASHINGTON, D.C. 20549
+The Division of Corporation Finance, Section 11
+100 F Street NE, Washington, D.C. 20549
+
+
+
+
+
+
+FORM 10-K
+
+/X/ ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934 FOR THE FISCAL YEAR ENDED
+DECEMBER 31, 2020.
+
+TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)
+OF THE SECURITIES EXCHANGE ACT OF 1934
+FOR THE TRANSITION PERIOD FROM ______ TO _____
+
+
+COMMISSION FILE NUMBER: 333-65069
+
+
+ACCESS-POWER & CO., INC.
+[Exact name of Registrant as
+specified in its charter]
+
+
+*** FLORIDA ***
+
+Domicile State or other jurisdiction of
+incorporation or organization
+http://www.sunbiz.org
+
+*** MICHIGAN ***
+
+State of Operations
+https://cofs.lara.state.mi.us/SearchApi/Search/Search
+
+
+
+59-3420985
+(I.R.S. Employer
+Identification No.)
+
+
+PO BOX 598
+GRAND HAVEN, MI 49417
+616-312-5390
+Email: pjensen@myaccess-power.com
+
+
+(Address of principal executive offices)
+
+REGISTRANTS TELEPHONE NUMBER, INCLUDING AREA CODE: 616-312-5390
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(b) OF THE ACT: NONE
+
+SECURITIES REGISTERED PURSUANT TO SECTION 12(g) OF THE ACT:
+COMMON STOCK, $0.001 PAR VALUE - 300,000,000 shares authorized fully diluted.
+
+
+
+
+Indicate by check mark if the registrant is a well-known
+seasoned issuer, as defined in Rule 405 of the Securities
+Act. Yes No X
+
+Indicate by check mark if the registrant is not required to file
+reports pursuant to Section 13 or Section 15(d) of the Act.
+Yes No X
+
+
+Indicate by check mark whether the registrant (1) has
+filed all reports required to be filed be Section 13 or 15(d)
+of the Securities Exchange Act of 1934 during the preceding 12
+months (or for such shorter period that the registrant was
+required to file such reports), and (2) has been subject
+to such filing requirements for the past 90 days. Yes X No
+
+Indicate by check mark whether the registrant has submitted
+electronically and posted on its corporate Web site, if any,
+every Interactive Data File required to be submitted and
+posted pursuant to Rule 405 of Regulation S-T (232.405 of
+this chapter) during the preceding 12 months (or for such
+shorter period that the registrant was required to submit
+and post such files). Yes X No
+
+Indicate by check mark if disclosure of delinquent filers
+pursuant to Item 405 of Regulation S-K (Section 229.405
+of this chapter) is not contained herein, and will not be
+contained, to the best of registrants knowledge, in definitive
+proxy or information statements incorporated by reference in
+Part III of this Form 10-K or any amendment to this Form 10-K.
+
+Indicate by check mark whether the registrant is a large a
+ccelerated filer, an accelerated filer, a non-accelerated
+filer, smaller reporting company, or an emerging growth
+company. See the definitions of large accelerated filer,
+accelerated filer, smaller reporting company, and
+emerging growth company in Rule 12b-2 of the Exchange Act.
+
+Large accelerated filer NO Accelerated filer NO
+Non-accelerated filer NO (Do not check if a smaller
+reporting company)
+
+Smaller reporting company YES
+Emerging growth company YES
+
+If an emerging growth company, indicate by check mark if
+the registrant has elected not to use the extended
+transition period for complying with any new or revised
+financial accounting standards provided pursuant to
+ection 13(a) of the Exchange Act.
+
+Indicate by check mark whether the registrant is a shell
+company (as defined in Rule 12b-2 of the Exchange Act).
+Yes No X
+
+
+ALL COMMON SHARES REFLECT A FULLY DILUTED BASIS.
+
+
+
+State the aggregate market value of the voting stock held by
+non-affiliates computed by reference to the price at which the stock was
+sold, or the average bid and asked prices of such stock as of a
+specified date within the past 60 days:
+
+PATRICK restricted shares: 186 ,984,379 shares
+PERCENT OF SHARES HELD BY NON AFFILIATES= 37.6719%
+SHARES HELD BY EVERYONE ELSE : 113,015,621 and of this amount,
+we certify a DTCC FLOAT SINCE MARCH 1, 2012: 98,376,146 common shares
+
+
+
+The aggregate market value of the voting common stock held by non-affils.
+of the registrant (assuming officers and directors are affiliates) was
+approximately $ 395,554.67 as of 12/31/2020, computed on the fully diluted
+basis of and the closing price on such date of $.0035, and so...
+
+113,015,621 held by non-affiliates + 131,128,500 shares acquired by our
+Director plus 55,855,879 issued to our Director in 2020 = 300,000,000
+common shares verified by our SEC Registrered same Transfer Agent
+dating back to May 1997. Our Director's FORM 4 filings are found here:
+
+https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=0001557361
+
+
+As of December 31st, 2020, there were 300,000,000 shares of the registrant's
+Common Stock outstanding. PATRICK J JENSEN, Director of Access-Power & CO.,
+Inc. has a total of 186,984,379 Restricted Shares of these shares.
+
+
+
+
+THE TOTAL MARKET CAPITALIZATION AS OF THE CLOSE OF BUSINESS
+January 4th , 2021 is $1,050,000.00 BASED ON A CLOSING PRICE OF
+$.0035 PER SHARE on 12/31/2020, and total outstanding issued
+common stock equalling 300,000,000 shares.
+
+At January 4th , 2021, there were issued and outstanding 300,000,000
+shares of Common Stock fully diluted, and Patrick J. Jensen owns
+186,984,379 shares or 62.3281 percent of all the Common Stock.
+
+In 2020, the Company during the course of 2020 experienced a market
+capitalization HIGH of over $3,000,000.00.
+
+All 186,984,379 are currently all restricted and held in book entry form at our
+Transfer Agent.
+
+
+
+
+THE SEC COMMISSION CONFIRMED OUR FORM RW ON 12/21/2020.
+
+
+
+
+
+______________________________________________________________
+
+
+
+
+
+My Dear Shareholders, OTC Markets Directors, colleagues at FINRA, and to the
+Esteemed Commissioners of the SEC, and of course, to my Chiefs at Section 11
+at the SEC,
+
+CURRENT UPDATE...as of January 4th, 2021.
+
+Our Director is called many names on message boards...and today, in 2021 we
+bow our heads to all decision makers at OTC Markets in our quest to
+re-apply to the PINK CURRENT INFO tier status.
+This is a reapplication to occur on January 24th, 2021.
+
+
+*****WE ONLY HAVE COMMON STOCK IN OUR CAPITAL STRUCTURE****
+
+*****WE DO NOT HAVE CONVERTIBLE NOTES or WARRANTS*****
+
+****WE HAVE ZERO LONG TERM DEBT********
+
+*****ACCR DOES NOT BELIEVE IN PROMOTION*********
+
+It is very expensive to hire a PCAOB registered firm/accountant/attorneys
+for our
+micro-cap operations. However, we will succeed in capturing all of the
+requirements
+of all the SEC Rules of '33 and '34, as best as we can.
+
+We are fully aware of the FINAL RULE imposed by the SEC, by September
+21st, 2021 to require movement of all PINK NO INFORMATION
+tier companies to the grey market today called the EXPERT MARKET.
+
+We are pleading with all the Directors at OTC Markets to please be fair to our
+Company. We will re-apply with OTC Markets on January 24, 2021 to become
+PINK CURRENT INFORMATION tier again, as we once were in 2008.
+The only reason why there is a RED STOP SIGN is because of a discussed
+CRIMINAL FORM 15 filed by our previous inept managers in 2007.
+We charge our past managers naked short sold our
+shares into the ground. Their intent was to carve all the equity
+off the bone, and then to file the CRIMINAL FORM 15 in 2007
+as their criminal strategy.
+
+We provide full disclosure to our
+Market Makers, and to our investing community.
+
+We have the Spirit of a Warrior, and our Corporation has done nothing wrong.
+All of the Company press releases can be found here:
+
+http://www.globenewswire.com
+
+We have learned that in 2021, all OTC Markets PINK CURRENT
+INFORMATION
+tier Companies will have at chance at Solicited Quotes for the first time in
+over 12.5
+years. We will not be needing to obtain a FORM 211 with FINRA. We
+have received
+news that in 2021, only selected PINK CURRENT INFORMATION tier
+companies
+will receive a shot at SOLICITED QUOTES by a market maker.
+
+ACCR believes to have an excellent relationship with our primary Market
+Maker over
+the years. Our primary market maker signed the UNSOLICITED
+QUOTE FORM
+with OTC Markets pre-October 18, 2019.
+
+We are loyal to our Shareholder base.
+
+Our story...from Inception through March 1, 2012, the Company was
+a violent
+victim of a terrible financial crime. The criminals behind this scheme
+to defraud
+investors was planned very methodically.
+
+We have many shareholders placed in restrictive shares...none of
+which have
+SURFACED in do a 144a sale in over 2 decades. Why is this?
+Management believes that all 100 share lot's of restrictive shares were
+issued
+in fraud, and to fictitious people, or Shareholders - totaling over
+15,000,000
+shares in never to be claimed restrictive shares.
+It was pre-meditated and
+very detail in CRIME.
+
+The criminals of the past perpetraded a MASTERMIND financial
+crime against
+our Shareholder base. We seek retribution from our past fraud managers.
+We
+recently learned that one of our past fraud managers lives in Nashville
+area of
+TN in a $5.2 million dollar house in September 2020. We charge
+he used SEC
+filings to commit financial crimes against our Shareholders. We
+nearly have
+15,000,000 shares in RESTRICTED STATUS 100 share lots's....
+the previous
+criminal masterminds.
+
+
+WE SEEK RETROBUTION FOR OUR SHAREHOLDERS
+
+We charge this man used SEC filings going back to 2002 to commit financial
+crimes
+against our Shareholders. Today, we are the cleanest OTC Companies
+around.
+
+The Company made 2 FINRA DAILY lists on 5/6/2020 and on 9/6/2018.
+
+The Company has had discussions with the SEC regarding a FRAUD
+FORM 15 that was filed by previous management in 2007. We believe
+that we have a fiduciary responsibility to report transparent
+information to our Shareholders.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+We were victims of toxic death spiral debentures from 1998 to
+2008 and through March 2012.
+
+PLEASE FORGIVE OUR PAST.
+
+ACCR as a structure TODAY is very sound, because I am in charge.
+ACCR has life only today because of ME.
+
+The past is the past, and
+we wish to move forward with a plan to become fully
+current with the SEC in 2021. We are trying the best we can within the
+Spirit of the Law. We will be refiling our FORM 10 very soon...very
+soon.
+
+
+On October 18, 2019, our Company was in the FIRST GROUP of
+Equities to bust
+out of the death grey market, where we stayed there for 11 years
+after our
+criminal FORM 15 was filed by previous criminal management.
+
+Let's move forward, and for get the PAST!
+
+
+
+Prior to October 18, 2019...we had DEATH....today, we have LIFE, and
+we have a
+direction on how to fix this trajedy. Today we have visible Level 2
+QUOTES. We
+have already spent 11 years in the DEATH DARK GREY MARKET.
+
+Please,,,why should we go back? We will NOT go back, ever.
+
+TODAY, we have LIFE.
+
+Our primary Market Maker signed a new form created with OTC
+Markets in 2019.
+This form is located here...we believe to have a wonderful relationship
+with our
+PRIMARY MARKET MAKER.
+
+https://www.otcmarkets.com/files/unsolicited-quote-form-1514935916031.pdf
+
+We jumped from the deathly grey market to the PINK NO INFORMATION
+tier of
+OTC Markets on this infamous date in our history, October 18, 2019.
+We have lived
+in this tier with NO DILUTION for over a year with no harm to our
+Shareholders.
+
+WE LOVE OUR SHAREHOLDERS, and believe in RAISING
+SHAREHOLDER
+VALUE. WE VALUE OUR COMMON STOCKHOLDERS.
+
+ACCR received a denial to go PINK CURRENT TIER on July 23, 2020.
+Why? We
+submitted every form in a satisfactory manner. We CLASHED with our prior
+accountant whom shall remain nameless. We clashed hard. Why were we
+denied
+to go PINK CURRENT is a mystery to us. Maybe our prior attorney said bad
+things
+about our Company to OTC Markets, I do not know why. He threatened to
+call OTC
+MARKETS, and call me a liar, when he was the liar.
+
+We do not know. We've been told that OTC Markets did not like our
+Company 8K's
+nor our Company story. ACCR has contacted OTC Markets, and on
+July 23,
+2020 we received the following reply:
+
+On July 23, 2020 3:30 PM Liz Heese wrote:
+
+Mr. Jensen,
+
+OTC Markets has reached a final determination to deny your application
+for access
+to the OTC Disclosure & News Service. Our determination is due to
+public interest
+concerns associated with the company and its disclosure, including but
+not limited to
+issues previously communicated to you.
+
+We consider this matter to be closed and will not engage in further discussion
+at this
+time. As stated in the email from Nancy Rodriguez, you may reapply
+for the service
+in 6 months.
+
+Liz Heese
+EVP, Issuer & Information Services
+OTC Markets Group"
+
+THEREFORE, ACCR is going to re-apply to become PINK CURRENT
+INFORMATION TIER on January 24, 2021.
+
+ACCR as a Corporation is perfectly
+clean, and has done nothing wrong. We've just had bad management.
+All the
+Amendments and Articles of Incorp all check out at:
+
+https://www.sunbiz.org
+
+ACCR has done nothing wrong. ACCR will get SOLICITED QUOTES
+again in 2021.
+
+CURRENT MANAGEMENT WILL STEP DOWN TO CLEAR A PATHWAY
+FOR OTHERS
+
+Let's just forget this past CRIMINAL FORM 15, that according to the SEC
+cannot
+be changed, and our only option is today to re-file our FORM 10 properly
+with the help of counsel, and we will.
+
+https://www.sec.gov/Archives/edgar/data/1041588/
+000117347307000043/0001173473-07-000043-index.htm
+
+
+Again, as of the close of business December 31st, 2020 --------> our common
+stock
+structure is as follows:
+
+Authorized Common Stock: 300,000,000 shares
+Outstanding Common Stock: 300,000,000 shares
+Estimated Float: Substanstially less than 98,244,146 shares
+Restricted Common Stock: 201,625,854 outstanding
+PATRICK: 186,984,379 ALL RESTRICTED SHARES or 62.3281 % of the
+TOTAL
+AMOUNT OF STOCK ON A FULLY DILUTED SHARES - PERIOD!
+
+
+
+OUR CORPORATE WEBSITEs IS:
+
+https://www.myaccess-power.com
+
+Access-Power & Co., Inc.'s contact is:
+PO BOX 598
+Grand Haven, MI 49417
+pjensen@myaccess-power.com
+(616)312-5390 TEL.
+https://www.sec.gov/divisions/corpfin/faqs/soxact2002.htm
+
+
+We applied for a Trademark for Clones By Drones TM, and also
+Clones by Cars TM in 2020. The service will be very futuristic, and will be
+the
+first of its kind. We applied for a federal patent for our Clobes by Drones
+futuristic
+home curbside delivery service.
+
+WE ARE WORKING ON A REVERSE MERGER...we plan to audit the
+incoming
+private company that wishes to go public in a r
\ No newline at end of file
diff --git a/test_data/financial_real/0001386570_0001654954-20-005725.txt b/test_data/financial_real/0001386570_0001654954-20-005725.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f6e9ecbeac8390552dd320b4e284f71b737c64b5
--- /dev/null
+++ b/test_data/financial_real/0001386570_0001654954-20-005725.txt
@@ -0,0 +1,257 @@
+10-K/A 1 cdxc10ka_12312019.htm FORM 10-K/A cdxc10ka_12312019 UNITED
+STATES SECURITIES AND EXCHANGE COMMISSION Washington,
+D.C. 20549 FORM
+10-K/A (Amendment
+No. 1) [X]
+ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934. For
+the fiscal year ended December 31, 2019 or [
+] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE
+SECURITIES EXCHANGE ACT OF 1934. For
+the transition period from to Commission file number 001-37752 CHROMADEX
+CORPORATION (Exact
+name of Registrant as specified in its Charter) Delaware 26-2940963 (State or other jurisdiction of
+incorporation) (I.R.S. Employer
+Identification No.) 10900 Wilshire Blvd. Suite 600, Los
+Angeles, California 90024 (Address of
+Principal Executive Offices) (Zip
+Code) Registrant's
+telephone number, including area code (310) 388-6706 Securities
+registered pursuant to Section 12(b) of the Act: Title of each class Trading Symbol Name of each exchange on which registered Common Stock, $0.001 par value per share CDXC The Nasdaq Capital Market Securities
+registered pursuant to Section 12(g) of the Act: None. Indicate by check
+mark if the registrant is a well-known seasoned issuer, as defined
+in Rule 405 of the Securities Act. Yes [ ] No [X
+] Indicate by check
+mark if the registrant is not required to file reports pursuant to
+Section 13 or Section 15(d) of the Act. Yes [ ] No
+[X] Indicate
+by check mark whether the registrant (1) has filed all reports
+required to be filed by Section 13 or 15(d) of the Securities
+Exchange Act of 1934 during the preceding 12 months (or for
+such shorter period that the Registrant was required to file such
+reports), and (2) has been subject to such filing requirements for
+the past 90 days. Yes [X] No [ ] Indicate
+by check mark whether the registrant has submitted electronically
+every Interactive Data File required to be submitted pursuant to
+Rule 405 of Regulation S-T during the preceding 12 months (or for
+such shorter period that the registrant was required to submit such
+files). Yes [X] No [ ] Indicate
+by check mark whether the registrant is a large accelerated filer,
+an accelerated filer, a non-accelerated filer, or a smaller
+reporting company. See the definitions of “accelerated
+filer,” “large accelerated filer,” and
+“smaller reporting company” in Rule 12b-2 of the
+Exchange Act. Large
+accelerated filer [ ]
+ Accelerated filer
+[X]
+ Non-accelerated filer [
+] Smaller
+reporting company
+[X]
+Emerging growth company [ ] If an
+emerging growth company, indicate by check mark if the registrant
+has elected not to use the extended transition period for complying
+with any new or revised financing accounting standards provided
+pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check
+mark whether the registrant is a shell company (as defined in Rule
+12b-2 of the Act). Yes [ ] No [X] As of
+June 30, 2019, the last business day of the registrant’s most
+recently completed second fiscal quarter, the aggregate market
+value of the registrant’s common stock held by non-affiliates
+of the registrant was approximately $190.4 million, based on the
+closing price of the registrant’s common stock on the NASDAQ
+Capital Market on June 30, 2019. Number
+of shares of common stock of the registrant outstanding as of May
+17, 2020: 61,477,895. DOCUMENTS INCORPORATED BY REFERENCE None. TA B LE OF CONTENTS Item PART I 1A. Risk
+Factors 1 PART II 9A Controls and
+Procedures 2 PART IV 15. Exhibits, Financial
+Statement Schedules 6 Table of Contents EXPLANATORY NOTE ChromaDex
+Corporation (“ChromaDex,” the “Company,”
+“we,” “our” or “us”) is filing
+this Amendment No. 1 on Form 10-K/A (this “Amendment”)
+to amend our Annual Report on Form 10-K for the year ended December
+31, 2019 (the “Form 10-K”), originally filed with the
+U.S. Securities and Exchange Commission (the “SEC”) on
+March 10, 2020. As a result of a material weakness in internal
+control over financial reporting that existed as of December 31,
+2019 that was not identified until the Company was preparing its
+Quarterly Report on Form 10-Q for the quarterly period ended March
+31, 2020, the Company is amending Part II, Item 9A “Controls
+and Procedures” with respect to (a) the Company’s
+conclusions regarding the effectiveness of (i) the Company’s
+disclosure controls and procedures and (ii) its internal control
+over financial reporting, and (b) Marcum LLP’s related
+attestation report on the Company’s internal control over
+financial reporting. In addition, the Company is revising Item 1A.
+“Risk Factors” to add a risk factor regarding this
+material weakness in internal control over financial reporting. The
+material weakness in internal controls over financial reporting is
+also reported in our Quarterly Report on Form 10-Q for the
+quarterly period ended March 31, 2020. In
+accordance with Rule 12b-15 under the Securities Exchange Act of
+1934, as amended (the “Exchange Act”), the Company is
+including with this Amendment currently dated certifications as
+Exhibits 31.1, 31.2, and 32.1. We are also filing an updated
+Consent of Independent Registered Public Accounting Firm.
+Accordingly, Part IV, Item 15, “Exhibits and Financial
+Statement Schedules” is amended to include the currently
+dated certifications and consent as exhibits. Except
+as described in this Explanatory Note, this Amendment does not
+reflect events occurring after the date of the filing of the Form
+10-K, nor does it amend, modify or otherwise update any other
+information in the Form 10-K. Among other things, forward-looking
+statements made in the Form 10-K have not been revised to reflect
+events that occurred or facts that became known to us after filing
+of the Form 10-K, and any such forward-looking statements should be
+read in their historical context. Accordingly, this Amendment
+should be read in conjunction with the Form 10-K and with the
+Company’s filings with the SEC subsequent to the filing of
+the Form 10-K. Notwithstanding
+the existence of the material weakness described in Part II. Item
+9A – “Controls and Procedures,” the Company
+believes that the consolidated financial statements in the Form
+10-K fairly present, in all material respects, the Company’s
+financial position, results of operations and cash flows as of the
+dates, and for the periods, presented, in conformity with U.S.
+generally accepted accounting principles. -1- Table of Contents P ART I Item
+1A. Risk
+Factors The
+Company is supplementing the risk factors previously disclosed in
+“Item 1A. Risk Factors” of the Form 10-K with the
+following risk factor, which should be read in conjunction with the
+other risk factors presented in the Form 10-K: Failure to remediate a material weakness in internal accounting
+controls could result in material misstatements in our financial
+statements. Our
+management has identified a material weakness in our internal
+control over financial reporting and has concluded that, due to
+such material weakness, our disclosure controls and procedures were
+not effective as of December 31, 2019. The material weakness in
+internal control over financial reporting resulted from a
+deficiency in our disclosure controls and procedures which could
+have resulted in us not disclosing a material potential loss that
+was reasonably possible, and therefore requiring a qualitative
+disclosure in our consolidated financial statements under ASC 450
+– Contingencies . The
+material weakness has not been remediated as of March 31, 2020. If
+not remediated, or if we identify further material weaknesses in
+our internal controls, our failure to establish and maintain
+effective disclosure controls and procedures and internal control
+over financial reporting could result in material misstatements in
+our financial statements and a failure to meet our reporting and
+financial obligations, each of which could have a material adverse
+effect on our financial condition and the trading price of our
+common stock. P ART II Item
+9A. Controls and Procedures Evaluation of Disclosure Controls and Procedures (As
+Revised) In
+connection with the filing of our Form 10-K, our chief executive
+officer and our chief financial officer, after evaluating the
+effectiveness of our disclosure controls and procedures (as defined
+in Rules 13a-15(e) and 15d-15(e) of the Exchange Act) as of
+December 31, 2019, concluded that our disclosure controls and
+procedures were effective. Subsequent
+to that evaluation, management reevaluated the effectiveness of our
+disclosure controls and procedures as of December 31, 2019 and
+concluded that, because of the material weakness identified in our
+internal control over financial reporting discussed below, our
+disclosure controls and procedures were not effective as of
+December 31, 2019. Management Report on Internal Control over Financial Reporting (As
+Revised) Our
+management is responsible for establishing and maintaining adequate
+internal control over financial reporting as defined in Rule
+13a-15(f) and 15d-(f) under the Exchange Act. Our internal control
+over financial reporting is designed to provide reasonable
+assurance regarding the reliability of financial reporting and the
+preparation of consolidated financial statements for external
+purposes in accordance with U.S. generally accepted accounting
+principles. Our internal control over financial reporting include
+those policies and procedures that: (i)
+pertain to the maintenance of records that, in reasonable detail,
+accurately and fairly reflect the transactions and dispositions of
+our assets; (ii)
+provide reasonable assurance that transactions are recorded as
+necessary to permit the preparation of our consolidated financial
+statements in accordance with U.S. generally accepted accounting
+principles, and that our receipts and expenditures are being made
+only in accordance with authorizations of our management and
+directors; and (iii)
+provide reasonable assurance regarding prevention or timely
+detection of unauthorized acquisition, use or disposition of our
+assets that could have a material effect on the consolidated
+financial statements. -2- Table of Contents In
+connection with the Form 10-K, our management, including the
+undersigned principal executive officer and principal financial
+officer, assessed the effectiveness of our internal control over
+financial reporting as of December 31, 2019. In conducting its
+assessment, our management used the criteria issued by the
+Committee of Sponsoring Organizations of the Treadway Commission in Internal Control—Integrated
+Framework in 2013 . Based on this assessment, our management
+concluded that, as of December 31, 2019, our internal control
+over financial reporting was effective based on those
+criteria. Subsequent
+to that evaluation, management reevaluated the effectiveness of our
+internal control over financial reporting as of December 31, 2019
+and concluded that, because of the material weakness identified,
+our internal control over financial reporting was not effective as
+of December 31, 2019. The
+material weakness in internal control over financial reporting
+resulted from a deficiency in our disclosure controls and
+procedures which could have resulted in the Company not disclosing
+a material potential loss that was reasonably possible, and
+therefore requiring a qualitative disclosure in consolidated
+financial statements under ASC 450 – Contingencies . The
+Company is still in the process of analyzing and addressing the
+material weakness. The material weakness will not be considered
+remediated until the applicable remedial control operates for a
+sufficient period of time and management has concluded, through
+testing, that this control is operating effectively. We expect that
+the remediation of this material weakness will be completed prior
+to the end of year 2020. We did
+not revise our financial statements for prior periods for the
+disclosure of the potential loss based on our belief that the
+effect of the lack of the disclosure was not material to the
+financial statements taken as a whole. Therefore, our chief
+executive officer and our chief financial officer believe that,
+notwithstanding the material weakness discussed above, the
+consolidated financial statements in our Annual Report on Form 10-K
+for the year ended December 31, 2019 present fairly, in all
+material respects, our financial position, results of operations
+and cash flows for the periods presented. Changes in Internal Control over Financial Reporting Except
+as noted above, there were no changes in internal controls over
+financial reporting (as defined in Rule 13a−15(f) promulgated
+under the Exchange Act) that occurred during our fourth fiscal
+quarter that have materially affected or are reasonably likely to
+materially affect our internal control over financial
+reporting. Inherent Limitations on Disclosure Controls and
+Procedures The
+effectiveness of our disclosure controls and procedures is subject
+to various inherent limitations, including cost limitations,
+judgments used in decision making, assumptions about the likelihood
+of future events, the soundness of our systems, the possibility of
+human error, and the risk of fraud. Moreover, projections of any
+evaluation of effectiveness to future periods are subject to the
+risk that controls may become inadequate because of changes in
+conditions and the risk that the degree of compliance with policies
+or procedures may deteriorate over time. Because of these
+limitations, there can be no assurance that any system of
+disclosure controls and procedures, no matter how well conceived,
+will be successful in preventing all errors or fraud or in making
+all material information known in a timely manner to the
+appropriate levels of management. Inherent Limitations on Internal Control Internal
+control over financial reporting cannot provide absolute assurance
+of achieving financial reporting objectives because of its inherent
+limitations, including the possibility of human error and
+circumvention by collusion or overriding of control. Accordingly,
+even an effective internal control system may not prevent or detect
+material misstatements on a timely basis. Also, projections of any
+evaluation of effectiveness to future periods are subject to the
+risk that the controls may become inadequate because of changes in
+conditions or that the degree of compliance with the policies or
+procedures may deteriorate. Accordingly, our internal control over
+financial reporting is designed to provide reasonable assurance of
+achieving their objectives. -3- Table of Contents Attestation Report of the Registered Public Accounting
+Firm REPORT OF INDEPENDENT REGISTERED PUBLIC ACCOUNTING
+FIRM ON INTERNAL CONTROL OVER FINANCIAL REPORTING To the Shareholders and Board of Directors of ChromaDex Corporation Adverse Opinion on Internal Control over Financial
+Reporting We have audited ChromaDex Corporation’’s (the
+"Company") internal control over financial reporting as of December
+31, 2019, based on criteria established in Internal Contr
\ No newline at end of file
diff --git a/test_data/financial_real/manifest.json b/test_data/financial_real/manifest.json
new file mode 100644
index 0000000000000000000000000000000000000000..e980491559d4b916c28bf73b28cdf40ee7926e4d
--- /dev/null
+++ b/test_data/financial_real/manifest.json
@@ -0,0 +1,42 @@
+[
+ {
+ "cik": "0001386570",
+ "accession": "0001654954-20-005725",
+ "company": "ChromaDex Corp. (CDXC) (CIK 0001386570)",
+ "term": "risk_factors",
+ "filing_date": "",
+ "source_url": "https://www.sec.gov/Archives/edgar/data/1386570/000165495420005725/cdxc10ka_12312019.htm",
+ "path": "D:\\DG Workspace\\Mexar-main\\test_data\\financial_real\\0001386570_0001654954-20-005725.txt",
+ "char_count": 15000
+ },
+ {
+ "cik": "0001041588",
+ "accession": "0001041588-21-000001",
+ "company": "Access-Power & Co., Inc. (CIK 0001041588)",
+ "term": "risk_factors",
+ "filing_date": "",
+ "source_url": "https://www.sec.gov/Archives/edgar/data/1041588/000104158821000001/accr12312010k.txt",
+ "path": "D:\\DG Workspace\\Mexar-main\\test_data\\financial_real\\0001041588_0001041588-21-000001.txt",
+ "char_count": 15000
+ },
+ {
+ "cik": "0001041588",
+ "accession": "0001041588-20-000001",
+ "company": "ACCESS-POWER INC (CIK 0001041588)",
+ "term": "risk_factors",
+ "filing_date": "",
+ "source_url": "https://www.sec.gov/Archives/edgar/data/1041588/000104158820000001/accr12311910K.txt",
+ "path": "D:\\DG Workspace\\Mexar-main\\test_data\\financial_real\\0001041588_0001041588-20-000001.txt",
+ "char_count": 15000
+ },
+ {
+ "cik": "0000320575",
+ "accession": "0000320575-20-000008",
+ "company": "PIONEER ENERGY SERVICES CORP (CIK 0000320575)",
+ "term": "risk_factors",
+ "filing_date": "",
+ "source_url": "https://www.sec.gov/Archives/edgar/data/320575/000032057520000008/form10-ka2019.htm",
+ "path": "D:\\DG Workspace\\Mexar-main\\test_data\\financial_real\\0000320575_0000320575-20-000008.txt",
+ "char_count": 15000
+ }
+]
\ No newline at end of file
diff --git a/test_data/legal_real/case_10129044.txt b/test_data/legal_real/case_10129044.txt
new file mode 100644
index 0000000000000000000000000000000000000000..49c3be1c55a7c164609930050ab362f7e1301572
--- /dev/null
+++ b/test_data/legal_real/case_10129044.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Match Group, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-10-02
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1027758.txt b/test_data/legal_real/case_1027758.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3be7ccba01e540d5a26e9e4b259395da98c1a887
--- /dev/null
+++ b/test_data/legal_real/case_1027758.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Rein v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2009-01-28
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10305113.txt b/test_data/legal_real/case_10305113.txt
new file mode 100644
index 0000000000000000000000000000000000000000..de15ab314f6a1031ccdf5fcc2a131bc4e9b9e0a8
--- /dev/null
+++ b/test_data/legal_real/case_10305113.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2024-12-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10318020.txt b/test_data/legal_real/case_10318020.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f517798a951becef3e47e45a688473bc0782dc28
--- /dev/null
+++ b/test_data/legal_real/case_10318020.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Supreme Court of Delaware
+DATE FILED: 2025-01-21
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10353022.txt b/test_data/legal_real/case_10353022.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a1889c0b108935204d501690d0726d8dc5572599
--- /dev/null
+++ b/test_data/legal_real/case_10353022.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cqv Co., Ltd. v. Merck Patent Gmbh
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-03-10
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10362523.txt b/test_data/legal_real/case_10362523.txt
new file mode 100644
index 0000000000000000000000000000000000000000..039a4cbcf15018737a40a0424af2ffb37449f978
--- /dev/null
+++ b/test_data/legal_real/case_10362523.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Gerald Metals, LLC v. Certain Underwriters at International Underwriting Assn. of London
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-03-25
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10388952.txt b/test_data/legal_real/case_10388952.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d09ccf2ccc2793e1fafcdfe0843f7b285eae83d5
--- /dev/null
+++ b/test_data/legal_real/case_10388952.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fox Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-04-28
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10463618.txt b/test_data/legal_real/case_10463618.txt
new file mode 100644
index 0000000000000000000000000000000000000000..73ab434ffb21179a6ed5c5c3fcd7a94b1a12ea1f
--- /dev/null
+++ b/test_data/legal_real/case_10463618.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Plug Power Inc. Stockholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2025-05-02
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10513129.txt b/test_data/legal_real/case_10513129.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5dfe26baf961af0d2ce10d492bd7392987f89e65
--- /dev/null
+++ b/test_data/legal_real/case_10513129.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Ready v. New Canaan
+COURT: Connecticut Appellate Court
+DATE FILED: 2025-05-06
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1052233.txt b/test_data/legal_real/case_1052233.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3d92070399432b9cdc804f7a0ab7eca7140987f4
--- /dev/null
+++ b/test_data/legal_real/case_1052233.txt
@@ -0,0 +1,260 @@
+ IN THE COURT OF APPEALS OF TENNESSEE
+ AT JACKSON
+ August 16, 2007 Session
+
+ GARY WEAVER, ET AL. v. THOMAS R. McCARTER, ET AL.
+
+ A Direct Appeal from the Chancery Court for Shelby County
+ No. 98-0425-3 The Honorable D. J. Alissandratos, Chancellor
+
+
+
+ No. W2006-02058-COA-R3-CV - Filed October 8, 2007
+
+
+ This is the second appeal of this breach of contract case. In Gary Weaver, et al v. Thomas
+R. McCarter, et al, No. W2004-02803-COA-R3-CV, 2006 WL 1529506 (Tenn. Ct. App. June 6,
+2006), this Court affirmed the trial court’s grant of summary judgment in favor of plaintiffs and
+remanded the case “for further clarification concerning the amount of damages awarded with respect
+to plaintiff’s claims of negligence per se, negligent misrepresentation, and breach of contract.” Upon
+remand, the trial court entered judgment against the defendants jointly and severally and in favor of
+plaintiffs for compensatory damages and pre-judgment interest. Finding that the trial court abused
+its discretion in awarding pre-judgment interest, we reverse that portion of the Judgment. We
+reverse in part and affirm in part.
+
+
+Tenn. R. App. P. 3; Appeal as of Right; Judgment of the Reversed in Part, Affirmed in Part
+
+W. FRANK CRAWFORD , P.J., W.S., delivered the opinion of the court, in which DAVID R. FARMER ,
+J. and HOLLY M. KIRBY , J., joined.
+
+Charles F. Morrow and Elizabeth E. Chance of Memphis, Tennessee for Appellant, Coldwell Banker
+Hoffman-Burke, Inc., Realtors
+
+Robert L. Moore and Dawn Davis Carson of Memphis, Tennessee for Appellant, Jim Perdue
+
+Henry C. Shelton, III and Tricia T. Olson of Memphis, Tennessee for Gary and Gail Weaver
+
+ OPINION
+
+ The relevant facts and procedures are set out in this Court’s Opinion in the previous appeal,
+Gary Weaver, et al v. Thomas R. McCarter, et al, No. W2004-02803-COA-R3-CV, 2006 WL
+1529506 (Tenn. Ct. App. June 6, 2006). The Opinion, filed June 6, 2006, states in pertinent part:
+ This suit arises from a contract to sell Gary and Gail Weaver’s
+(“the Plaintiffs”) house (“the Hacks Cross House”) located on Hacks
+Cross Road in Memphis, Tennessee. On November 1, 1994, Thomas
+McCarter (“Defendant McCarter”) approached the Plaintiffs with an
+offer to purchase the Hacks Cross House for $680,000 in cash. The
+Plaintiffs agreed and subsequently entered into a verbal contract with
+Defendant McCarter for a cash sale. However, Defendant McCarter
+never consummated the sale and, thus, the transaction never closed.
+
+
+ In February 1997, the Plaintiffs purchased a second home
+located on Langston Cove (“the Langston Cove House”) and soon
+after listed the Hacks Cross House with Jim Perdue (“Defendant
+Perdue”) at Coldwell Banker Hoffman-Burke, Inc. Realtors
+(“Defendant CBHB”). On August 27, 1997, Defendant Perdue
+brought the Plaintiffs a written offer from Janet Hunter to purchase
+the Hacks Cross House for $575,000. The Plaintiffs eventually
+accepted a counter-offer of $595,000, with $10,000 in escrow, and
+signed a contract of sale (hereinafter referred to as “the sale contract”)
+with Janet Hunter. Closing was set for September 30, 1997.
+However, the $10,000 escrow check bounced on September 17, 1997,
+and Defendants CBHB received notice of this on September 30, 1997.
+Furthermore, the sale contract was not signed by Janet Hunter, but
+rather Janet Hunter’s name was forged by Chip Hunter (“Defendant
+Hunter”), Janet Hunter’s husband, without Janet Hunter’s knowledge
+or permission. Defendant Hunter signed Janet Hunter’s name to the
+sale contract at the request of Defendant McCarter and while in the
+presence of Defendant Perdue. The Plaintiffs did not learn of the
+bounced escrow check or the forged sale contract until the closing
+date, when the Plaintiffs’ attorney checked on the escrow funds and
+Defendant Perdue informed the Plaintiffs’ closing attorney of the
+forgery. As a result, the closing did not occur on September 30, 1997.
+
+ Subsequently, on October 2, 1997, Defendant McCarter, in a
+memorandum to Defendant Perdue, affirmed that he was the true
+party who had made the offer on August 29, 1997, to purchase the
+Hacks Cross House for his daughter, Janet Hunter. While Defendant
+McCarter indicated a desire to honor the sale contract, he informed
+Defendant Perdue that his funding for the purchase would not be
+available until October 8, 1997. Although reserving their rights under
+the original sale contract, the Plaintiffs informed Defendant McCarter
+that they were willing to close the transaction if his funding came
+through by October 8, 1997. Despite this, the closing did not take
+
+
+ -2-
+ place on October 8, due to a continued lack of funding. At that time,
+Defendant McCarter promised to fund the transaction on October 15,
+1997. However, on that date, he delivered a $10,000 check to
+Defendant CBHB and stated that he no longer wanted to purchase the
+Hacks Cross House. The Plaintiffs subsequently demanded that
+Defendant Perdue pay them Defendant McCarter’s $10,000 in earnest
+money, cancelled their listing agreement with Defendant CBHB, and
+placed the Hacks Cross House back on the market. However, the
+Hacks Cross House did not sell and the Plaintiffs eventually sold the
+Langston Cove House and moved back to the Hacks Cross House.
+
+ On May 11, 1998, the Plaintiffs filed suit against Defendants
+McCarter, CBHB, Perdue, and Hunter, seeking damages for
+negligence per se, negligent misrepresentation, breach of contract,
+and fraud. Specifically, the Plaintiffs asserted that Defendants Perdue
+and CBHB were negligent per se for violating section 62-13-403 of
+the Tennessee Real Estate Broker License Act of 1973. The Plaintiffs
+further asserted that Defendant Perdue was also negligent per se
+because he violated section 62-13-404 of the Brokers Act, which
+provides for duties of reasonable care and loyalty between real estate
+brokers and their clients; and that Defendant Perdue was further
+guilty of negligent misrepresentation for failing to exercise reasonable
+care in communicating information to the Plaintiffs. The Plaintiffs
+next asserted a breach of contract claim against Defendant McCarter
+arguing that, although Defendant McCarter did not actually sign the
+contract, he had previously entered into an oral agreement, through
+Defendant Perdue, with the Plaintiffs to purchase their house, but
+failed to follow through with the purchase. Finally, the Plaintiffs
+asserted a fraud complaint against Defendants McCarter, Hunter, and
+Perdue, arguing that all three parties engaged in dishonest practices
+with a deceptive intent in order to induce the Plaintiffs to enter into
+an illusory contract to sell their house, which the Plaintiffs
+subsequently relied upon to their detriment. As remedies, the
+Plaintiffs sought either specific performance by Defendant McCarter
+or a judgment for $200,000 in compensatory damages against all
+defendants jointly and severally, along with punitive damages.
+
+ In response to the Plaintiffs’ claims, Defendants CBHB and
+Perdue filed an answer arguing that Plaintiffs failed to assert a claim
+upon which relief could be granted. Defendant CBHB also asserted
+a counter-claim against the Plaintiffs alleging that they were entitled
+to split the $10,000 in earnest money with the Plaintiffs. In turn,
+Defendant Hunter denied forging Janet Hunter’s signature and
+
+
+ -3-
+ asserted the statute of frauds as an affirmative defense. Defendant
+McCarter denied being the contractual purchaser of the house and
+further asserted the statute of frauds as an affirmative defense.
+Defendant McCarter also asserted a counter-claim against Defendant
+Perdue, Defendant CBHB, and the Plaintiffs seeking the return of the
+$10,000 placed in escrow arguing that Defendant McCarter entered
+into no enforceable contract of sale and, thus, no legal basis existed
+for the continued retention of such funds. Defendants CBHB and
+Perdue and the Plaintiffs responded to Defendant McCarter’s counter-
+complaint and asserted that an enforceable contract of sale did exist.
+
+ On July 13, 2000, the Plaintiffs filed a Motion for Summary
+Judgment against all Defendants. Defendant McCarter subsequently
+filed a motion seeking a directed verdict in relation to the return of
+the $10,000 escrow money. (FN1) On January 22, 2001, the trial
+court entered an order granting summary judgment in favor of the
+Plaintiffs against Defendants McCarter, Hunter, Perdue, and CBHB.
+The court also denied Defendant McCarter’s directed verdict motion
+and further ordered that Defendant CBHB tender the $10,000 in
+earnest money to the Plaintiff, with said amount being credited
+against the damage award against Defendant McCarter. The amounts
+of compensatory and punitive damages were reserved for further
+hearing; however, the trial court did state that while all judgments
+rendered herein and subsequently by the Court shall be joint and
+several as against all Defendants, that among the Defendants the fault
+shall be apportioned [forty-five] percent (45%) to [Defendant]
+McCarter, ten percent (10%) to [Defendant] Hunter, and [forty-five]
+percent (45%) to Defendants [Perdue and CBHB].
+
+ (FN1) Pursuant to Rule 50.01 of the Rules of Civil Procedure,
+ a party may only move for directed verdict “at the close of the
+ evidence offered by an opposing party or at the close of the
+ case.” Tenn. R. Civ. P. 50.01 (2005).
+
+
+Nearly two years after the trial court’s grant of summary judgment,
+Defendant CBHB filed a motion to reconsider, which the trial court
+denied.
+
+ Prior to the trial on damages, several events occurred which
+ultimately affected the trial court’s ability to assess damages. First,
+on May 5, 2004, Defendant Perdue filed a Plea of Bankruptcy stating
+that he had filed bankruptcy and that, pursuant to an Order Modifying
+Discharge Injunction issued by the United States Bankruptcy Court
+for the Western District of Tennessee, the trial court would only be
+
+ -4-
+ allowed to proceed to a judgment against Defendant Perdue for any
+causes of action except acts of fraud, fraudulent misrepresentation, or
+other cause of action which would permit the denial of discharge
+pursuant to 11 U.S.C. § 727 or render the judgment nondischargeable
+pursuant to 11 U.S.C. § 523. The trial court granted this plea. In
+addition to Defendant Perdue’s filing of bankruptcy, Defendant
+McCarter died (FN2) and Defendant Hunter also filed bankruptcy.
+As a result, at trial, the Plaintiffs sought to collect damages arising
+from Defendants CBHB and Perdue’s negligence per se and negligent
+misrepresentation, as well as Defendant McCarter’s breach of
+contract. (FN3)
+
+ (FN2) W e find no indication in the record of a substitution of
+ parties for Defendant McCarter pursuant to Rule 25.01 of the
+ Tennessee Rules of Civil Procedure.
+
+
+ (FN3) In their brief, the Plaintiffs assert that at the trial on
+ damages, they proceeded only against Defendants CBHB and
+ Perdue “and sought damages only under the Tennessee Real
+ Estate Broker[] Act of 1973 and for negligence.” However, a
+ review of the trial transcript reveals that the Plaintiffs also sought
+ damages for their breach of contract claim against Defendant
+ McCarter, although the Plaintiffs admitted that Defendant
+ McCarter died apparently leaving no estate to satisfy a judgment
+ and that “no formal Notice [or] substitution” was made pursuant
+ to Rule 25.01.
+
+ In relation to damages suffered due to fraud, neither the
+ Plaintiffs’ brief nor the record in this case supports the
+ conclusion that damages were awarded based upon fraud in this
+ case. At trial, the Plaintiffs’ counsel admitted that no judgment
+ for fraud was awarded against Defendants CBHB and Perdue.
+ Furthermore, the Plaintiffs indicated that they were unable to
+ pursue damages against Defendant Hunter due to his filing
+ Chapter 7 bankruptcy. Finally, a review of the record and
+ transcript in this case fails to show that damages were awarded
+ for any fraud alleged against Defendant McCarter.
+
+
+ At the trial on damages, the parties presented testimony of
+Plaintiff Gary Weaver and John Jordan, a real estate appraiser who
+had appraised the Plaintiffs’ property in 1997, near the time the sale
+contract was signed. The Plaintiffs asserted that the proof showed
+that they had suffered $300,000 in damages as a result of the
+Defendants conduct. After hearing the proof, the trial court first held
+the Plaintiffs would receive no damages in relation to their purchase
+and subsequent sale of the Langston Cove House because the
+purchase of this property occurred prior to the Plaintiffs’ contract to
+
+ -5-
+ sell the Hacks Cross House and, thus, damages resulting from the
+ purchase and sale of the Langston Cove home were not reasonable
+ consequential damages flowing from the Defendants’ actions in
+ regard to the Hacks Cross House. As a result of this finding, the trial
+ court focused its award of damages on the following issues: 1) the
+ contract price for the Hacks Cross House minus the sales
+ commission, 2) the duty of the Plaintiffs to mitigate damages, and 3)
+ additional expenses incurred as a result of the Defendants’ actions.
+ After hearing the evidence submitted at trial, the trial court entered an
+ Order of Judgment providing as follows:
+
+ Plaintiffs should have a judgment, against Defendants,
+ pursuant to their apportioned fault, in the amount of
+ $55,600.00 for lost value of real estate; $3,000.00 for
+ 1998 and $3,000.00 for 1999 for necessary
+ maintenance costs, and $20,000.00 for attorneys fees,
+ with prejudgment interest computed at 10% per year
+ on each amount from the date incurred, or, in the case
+ of attorneys fees, from the date paid, and statutory
+ cost of this case. [Defendants] Perdue and [CBHB]
+ have been apportioned fault in the amount of forty-
+ five percent (45%), and judgment is awarded against
+ these Defendants specifically in the amount of
+ $60,118.53, and forty-five percent (45%) of statutory
+ costs.
+
+ The Plaintiffs subsequently filed a Motion to Alter or Amend
+ Judgment arguing that the trial court should app
\ No newline at end of file
diff --git a/test_data/legal_real/case_10574918.txt b/test_data/legal_real/case_10574918.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d1d9e9e40b1b1c5751d3b28e18bb808bb17c9bef
--- /dev/null
+++ b/test_data/legal_real/case_10574918.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Cirotto v. Am. Self Storage of Pickerington
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-05-08
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10589788.txt b/test_data/legal_real/case_10589788.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8282f04a7031275b6162504e6b4a7ab3089255ab
--- /dev/null
+++ b/test_data/legal_real/case_10589788.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Curtin v. United Trademark Holdings, Inc.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2025-05-22
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10639650.txt b/test_data/legal_real/case_10639650.txt
new file mode 100644
index 0000000000000000000000000000000000000000..27c6916b52ed538dfcca3e41e00a956cb6a75207
--- /dev/null
+++ b/test_data/legal_real/case_10639650.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: James E. Carroll, Jr. v. Isle of Palms Pest Control, Inc.
+COURT: Supreme Court of South Carolina
+DATE FILED: 2025-07-23
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10640482.txt b/test_data/legal_real/case_10640482.txt
new file mode 100644
index 0000000000000000000000000000000000000000..4f024edd9bab56a1900129e9bd81c0d3ae9ad088
--- /dev/null
+++ b/test_data/legal_real/case_10640482.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Jessica v. Ohio Dept. of Job & Family Servs.
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-07-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10668606.txt b/test_data/legal_real/case_10668606.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6f262d14d9aae6bba795f912917dd3ce39fb8d81
--- /dev/null
+++ b/test_data/legal_real/case_10668606.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Mitchell v. Atha, Dir. of Pub. Utilities
+COURT: Ohio Court of Appeals
+DATE FILED: 2025-09-09
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10795047.txt b/test_data/legal_real/case_10795047.txt
new file mode 100644
index 0000000000000000000000000000000000000000..71b23a97f84e0342a6bf1ae89c9c205a8de32212
--- /dev/null
+++ b/test_data/legal_real/case_10795047.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Morgan228, L.L.C. v. Miavitz
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-02-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_10875291.txt b/test_data/legal_real/case_10875291.txt
new file mode 100644
index 0000000000000000000000000000000000000000..fc76e503efd7f473c14cbba373df4640ff889b7d
--- /dev/null
+++ b/test_data/legal_real/case_10875291.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Slocum Maintenance, Inc. v. 400 Washington 44024, L.L.C.
+COURT: Ohio Court of Appeals
+DATE FILED: 2026-06-15
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1288403.txt b/test_data/legal_real/case_1288403.txt
new file mode 100644
index 0000000000000000000000000000000000000000..98fa3290dcab71f87dd0bb3c032ac201c1d8d47b
--- /dev/null
+++ b/test_data/legal_real/case_1288403.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: Supreme Court of Minnesota
+DATE FILED: 2008-08-14
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1430528.txt b/test_data/legal_real/case_1430528.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b9cd66f9bc87de3fe4b300c04eda58f1170079ea
--- /dev/null
+++ b/test_data/legal_real/case_1430528.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail Security Breach Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2007-10-12
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1431039.txt b/test_data/legal_real/case_1431039.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d4db9b1f0702869d1d7961674fe84ac6ab71973a
--- /dev/null
+++ b/test_data/legal_real/case_1431039.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Gabapentin Patent Litigation
+COURT: District Court, D. New Jersey
+DATE FILED: 2009-08-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1454678.txt b/test_data/legal_real/case_1454678.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9a5ea9c0b9d40e878f1e1aeb2ca318cc5503c193
--- /dev/null
+++ b/test_data/legal_real/case_1454678.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Patent Category Corp. v. Target Corp.
+COURT: District Court, C.D. California
+DATE FILED: 2008-07-16
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1467123.txt b/test_data/legal_real/case_1467123.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9e544707dd10524f771d070b20edd16ad9e0db08
--- /dev/null
+++ b/test_data/legal_real/case_1467123.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Openwave Systems Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-05-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1490563.txt b/test_data/legal_real/case_1490563.txt
new file mode 100644
index 0000000000000000000000000000000000000000..52cd929f0bb32626703c69327c22dc990e81ff72
--- /dev/null
+++ b/test_data/legal_real/case_1490563.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2009-02-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1692833.txt b/test_data/legal_real/case_1692833.txt
new file mode 100644
index 0000000000000000000000000000000000000000..734e4f42bcdd02b352e6dc5bc1a4066957258011
--- /dev/null
+++ b/test_data/legal_real/case_1692833.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Multimedia Patent Trust v. Microsoft Corp.
+COURT: District Court, S.D. California
+DATE FILED: 2007-09-10
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1697753.txt b/test_data/legal_real/case_1697753.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8bac8a954f8007f0baf7fd3342591a6aa429a836
--- /dev/null
+++ b/test_data/legal_real/case_1697753.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Freightliner v. Whatley Contract Carriers
+COURT: Supreme Court of Alabama
+DATE FILED: 2005-10-21
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1903588.txt b/test_data/legal_real/case_1903588.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5c57efc04f8eae8c742d728d61406457e02b5878
--- /dev/null
+++ b/test_data/legal_real/case_1903588.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Global Patent Holdings, LLC v. PANTHERS BRHC LLC
+COURT: District Court, S.D. Florida
+DATE FILED: 2008-08-13
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_1990736.txt b/test_data/legal_real/case_1990736.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2eba222b98d91bcc1b8cd661d662adfa93b77965
--- /dev/null
+++ b/test_data/legal_real/case_1990736.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Unfoldment, Inc. v. District of Columbia Contract Appeals Board
+COURT: District of Columbia Court of Appeals
+DATE FILED: 2006-10-19
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_203751.txt b/test_data/legal_real/case_203751.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6e668115352bae440d2137e47d8c085b18aa9b23
--- /dev/null
+++ b/test_data/legal_real/case_203751.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re TJX Companies Retail SEC. Breach Litigation
+COURT: Court of Appeals for the First Circuit
+DATE FILED: 2009-03-30
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_208002.txt b/test_data/legal_real/case_208002.txt
new file mode 100644
index 0000000000000000000000000000000000000000..82db25af2324f66489f561dfdf1620bfeefcfba9
--- /dev/null
+++ b/test_data/legal_real/case_208002.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re '318 Patent Infringement Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2009-09-25
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_210268.txt b/test_data/legal_real/case_210268.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6fabb605de1f0edadd35dcd407285203e5551bb3
--- /dev/null
+++ b/test_data/legal_real/case_210268.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Biomedical Patent Management Corp. v. California
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-10-23
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_210485.txt b/test_data/legal_real/case_210485.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dcaa0c477291e1826bec6f4c388dc7d9cdf6687b
--- /dev/null
+++ b/test_data/legal_real/case_210485.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Metoprolol Succinate Patent Litigation
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2007-07-23
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2114432.txt b/test_data/legal_real/case_2114432.txt
new file mode 100644
index 0000000000000000000000000000000000000000..87dd62fbe8ae143acb50369b6b0ea7bd26e6c463
--- /dev/null
+++ b/test_data/legal_real/case_2114432.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-05-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2173962.txt b/test_data/legal_real/case_2173962.txt
new file mode 100644
index 0000000000000000000000000000000000000000..136935541364326f28b0baf8b6732b14f12a86a0
--- /dev/null
+++ b/test_data/legal_real/case_2173962.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-04-29
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2175821.txt b/test_data/legal_real/case_2175821.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e2abe7f9ed6def43015c088962763cd27d804b82
--- /dev/null
+++ b/test_data/legal_real/case_2175821.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Citigroup Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2011-05-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_222139.txt b/test_data/legal_real/case_222139.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6a081c8ff809c8c35462ef9721f74a4bc1207bf1
--- /dev/null
+++ b/test_data/legal_real/case_222139.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2011-07-29
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2252138.txt b/test_data/legal_real/case_2252138.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9c33c464a465ce8b76f8083d6756ff20a41cc0fb
--- /dev/null
+++ b/test_data/legal_real/case_2252138.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2010-04-05
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2296630.txt b/test_data/legal_real/case_2296630.txt
new file mode 100644
index 0000000000000000000000000000000000000000..9c8463f844d6d5725e92016bb8a9e33487af85d1
--- /dev/null
+++ b/test_data/legal_real/case_2296630.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-10-05
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2309624.txt b/test_data/legal_real/case_2309624.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ddbe7b98b8ef01a4295fa04b0cd4c3e50c2bd218
--- /dev/null
+++ b/test_data/legal_real/case_2309624.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Extreme Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2008-09-23
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2314240.txt b/test_data/legal_real/case_2314240.txt
new file mode 100644
index 0000000000000000000000000000000000000000..314dee97a18f3820ee4e6ad8bd7a14582d149466
--- /dev/null
+++ b/test_data/legal_real/case_2314240.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-16
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2314320.txt b/test_data/legal_real/case_2314320.txt
new file mode 100644
index 0000000000000000000000000000000000000000..cba94a8caa202f838c408a64cdd57cd0c947d8c6
--- /dev/null
+++ b/test_data/legal_real/case_2314320.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-08-18
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2322566.txt b/test_data/legal_real/case_2322566.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2b8e5b79edb1291340434e9c9955dd19bfaebcaf
--- /dev/null
+++ b/test_data/legal_real/case_2322566.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2334319.txt b/test_data/legal_real/case_2334319.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1f3f500094265d5b6338e76a57f505e79ad01631
--- /dev/null
+++ b/test_data/legal_real/case_2334319.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re CNET Networks, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2007-04-11
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2370081.txt b/test_data/legal_real/case_2370081.txt
new file mode 100644
index 0000000000000000000000000000000000000000..136432b799576d74e5b25aae6f23d77cf4a61f99
--- /dev/null
+++ b/test_data/legal_real/case_2370081.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Association for Molecular Pathology v. United States Patent & Trademark Office
+COURT: District Court, S.D. New York
+DATE FILED: 2009-11-02
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2388699.txt b/test_data/legal_real/case_2388699.txt
new file mode 100644
index 0000000000000000000000000000000000000000..3d103d1e2edac10c93ec6e044d1fff4199192215
--- /dev/null
+++ b/test_data/legal_real/case_2388699.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re UnitedHealth Group Inc. Shareholder Derivative Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2008-12-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2400563.txt b/test_data/legal_real/case_2400563.txt
new file mode 100644
index 0000000000000000000000000000000000000000..32928adef784800b97ee1fda2a4477f7f029e35f
--- /dev/null
+++ b/test_data/legal_real/case_2400563.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Cyclobenzaprine Hydrochloride Extended-Release Capsule Patent Litigation
+COURT: District Court, D. Delaware
+DATE FILED: 2010-03-12
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2407917.txt b/test_data/legal_real/case_2407917.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c79bb1f7f8e59fbf63b86fc8ec7d026f409975d0
--- /dev/null
+++ b/test_data/legal_real/case_2407917.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: District Court, D. Maine
+DATE FILED: 2009-11-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2412837.txt b/test_data/legal_real/case_2412837.txt
new file mode 100644
index 0000000000000000000000000000000000000000..52cd1806a0fc5e7d8e37cd1bc93a064403efc83d
--- /dev/null
+++ b/test_data/legal_real/case_2412837.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re OnStar Contract Litigation
+COURT: District Court, E.D. Michigan
+DATE FILED: 2009-02-19
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2414023.txt b/test_data/legal_real/case_2414023.txt
new file mode 100644
index 0000000000000000000000000000000000000000..6b738ad6ab231a68d776e06bff79fce7dbfa6604
--- /dev/null
+++ b/test_data/legal_real/case_2414023.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Mqvp, Inc. Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2007-10-10
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2443516.txt b/test_data/legal_real/case_2443516.txt
new file mode 100644
index 0000000000000000000000000000000000000000..73d472cd308f4dab08793c8604418ff7fc7aff8d
--- /dev/null
+++ b/test_data/legal_real/case_2443516.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Hannaford Bros. Co. Customer Data Security Breach Litigation
+COURT: Supreme Judicial Court of Maine
+DATE FILED: 2010-09-21
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2468898.txt b/test_data/legal_real/case_2468898.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b8e6c28205a328361de7f8b8cd722885990bdad9
--- /dev/null
+++ b/test_data/legal_real/case_2468898.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re FirstEnergy Shareholder Derivative Litigation
+COURT: District Court, N.D. Ohio
+DATE FILED: 2004-05-28
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2470211.txt b/test_data/legal_real/case_2470211.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b0302325d79f8cb873e2d57c52fe4f154b8f0991
--- /dev/null
+++ b/test_data/legal_real/case_2470211.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Accuray, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2010-08-31
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2470585.txt b/test_data/legal_real/case_2470585.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e9cf3915114263aa0ace2c2c7617e00d16d39407
--- /dev/null
+++ b/test_data/legal_real/case_2470585.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shell Trademark Management B v. v. Warren Unilube, Inc.
+COURT: District Court, S.D. Texas
+DATE FILED: 2011-01-10
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2471266.txt b/test_data/legal_real/case_2471266.txt
new file mode 100644
index 0000000000000000000000000000000000000000..0632f5da54922788762a64f92535d4ae2d7fb932
--- /dev/null
+++ b/test_data/legal_real/case_2471266.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: University of Virginia Patent Foundation v. General Electric Co.
+COURT: District Court, W.D. Virginia
+DATE FILED: 2011-02-08
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2473205.txt b/test_data/legal_real/case_2473205.txt
new file mode 100644
index 0000000000000000000000000000000000000000..eacc83d86324f0546a00d9b08b8320332861ccbb
--- /dev/null
+++ b/test_data/legal_real/case_2473205.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Moroccanoil Trademark Litigation
+COURT: United States Judicial Panel on Multidistrict Litigation
+DATE FILED: 2011-04-08
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2473830.txt b/test_data/legal_real/case_2473830.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bbb11d7ec16ce1953b4fbbe2b43a0e9097262c21
--- /dev/null
+++ b/test_data/legal_real/case_2473830.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: DISCOVERY PATENT HOLDINGS, LLC v. Amazon. Com, Inc.
+COURT: District Court, D. Delaware
+DATE FILED: 2011-02-04
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2492097.txt b/test_data/legal_real/case_2492097.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5259e436d93d456887cbfe1f560c0367f596e067
--- /dev/null
+++ b/test_data/legal_real/case_2492097.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Marcus v. American Contract Bridge League
+COURT: District Court, D. Connecticut
+DATE FILED: 2008-06-20
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2504990.txt b/test_data/legal_real/case_2504990.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a334f83d270355d48f49ee127f18d2802873619f
--- /dev/null
+++ b/test_data/legal_real/case_2504990.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Abbott Laboratories Derivative Shareholder Litigation
+COURT: District Court, N.D. Illinois
+DATE FILED: 2000-09-26
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2518137.txt b/test_data/legal_real/case_2518137.txt
new file mode 100644
index 0000000000000000000000000000000000000000..135f7618f1948064114793b2483352c85b3cd53a
--- /dev/null
+++ b/test_data/legal_real/case_2518137.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Columbia University Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2004-11-05
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2541815.txt b/test_data/legal_real/case_2541815.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d7762c886d4f0fd6ac532a850eab9b7307cacf26
--- /dev/null
+++ b/test_data/legal_real/case_2541815.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Pfizer Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2010-07-13
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2573466.txt b/test_data/legal_real/case_2573466.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f3df96ad4b63329f769e5a35335e4f9ce5d28231
--- /dev/null
+++ b/test_data/legal_real/case_2573466.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Sonus Networks, Inc. Shareholder Derivative
+COURT: District Court, D. Massachusetts
+DATE FILED: 2006-03-31
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2681603.txt b/test_data/legal_real/case_2681603.txt
new file mode 100644
index 0000000000000000000000000000000000000000..5639d5b66bcfd089bbcf6d525d367a301cb406a9
--- /dev/null
+++ b/test_data/legal_real/case_2681603.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent, L.P. v. Rea
+COURT: District Court, District of Columbia
+DATE FILED: 2014-07-01
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2778175.txt b/test_data/legal_real/case_2778175.txt
new file mode 100644
index 0000000000000000000000000000000000000000..99ccbb5d656c8cfd7d2514a31e2ba5b931e39e0b
--- /dev/null
+++ b/test_data/legal_real/case_2778175.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Helferich Patent Licensing, LLC v. New York Times Co.
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-02-10
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2804052.txt b/test_data/legal_real/case_2804052.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ec3e1047fd60104acf1a294750f1a104af748976
--- /dev/null
+++ b/test_data/legal_real/case_2804052.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Molycorp, Inc. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2015-05-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_2842974.txt b/test_data/legal_real/case_2842974.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1d8760a61de67f24109cf8c6030f87f98356392f
--- /dev/null
+++ b/test_data/legal_real/case_2842974.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dome Patent L.P. v. Lee
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 2015-09-03
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4316372.txt b/test_data/legal_real/case_4316372.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b75fd9cb91b5a592b18b3260f0ad3605dde2d640
--- /dev/null
+++ b/test_data/legal_real/case_4316372.txt
@@ -0,0 +1,453 @@
+COLORADO COURT OF APPEALS 2016COA155
+
+
+Court of Appeals No. 15CA1435
+City and County of Denver District Court No. 14CV34053
+Honorable Morris B. Hoffman, Judge
+
+
+Layton Construction Co., Inc., a Utah corporation,
+
+Plaintiff-Appellant,
+
+v.
+
+Shaw Contract Flooring Services, Inc., d/b/a Spectra Contract Flooring, a
+Georgia corporation,
+
+Defendant-Appellee.
+
+
+ JUDGMENT AFFIRMED AND CASE
+ REMANDED WITH DIRECTIONS
+
+ Division IV
+ Opinion by JUDGE J. JONES
+ Graham and Miller, JJ., concur
+
+ Announced October 20, 2016
+
+
+The Holt Group LLC, L. Tyrone Holt, Kevin P. Walsh, Kevin D. Poyner, Denver,
+Colorado, for Plaintiff-Appellant
+
+Hall & Evans, LLC, Darin J. Lang, Brian Molzahn, Elizabeth K. Olson, Denver,
+Colorado, for Defendant-Appellee
+ ¶1 Plaintiff, Layton Construction Co., Inc. (Layton), appeals the
+
+ district court’s summary judgment for defendant, Shaw Contract
+
+ Flooring Services, Inc. (Shaw), based on the doctrine of claim
+
+ preclusion. Because we conclude that all of Layton’s contentions
+
+ challenging the district court’s application of that doctrine are
+
+ without merit, we affirm.
+
+ I. Background
+
+¶2 Layton was the general contractor responsible for construction
+
+ of a hotel in Vail, Colorado. It hired Shaw, and many other
+
+ subcontractors, to perform work on the project.
+
+¶3 In June 2009, the property owner (referred to by the parties as
+
+ BCRE) terminated its contract with Layton and, not too long
+
+ thereafter, gave Layton notice of numerous construction defects in
+
+ the project, a few of which related to Shaw’s work. Layton sued
+
+ BCRE alleging that BCRE had failed to pay for work, seeking over
+
+ $27 million in damages. After BCRE asserted counterclaims
+
+ against Layton for defective workmanship (seeking more than $25
+
+ million in damages), Layton added claims against various
+
+ subcontractors, including Shaw.
+
+
+
+
+ 1
+ ¶4 Pursuant to an indemnification clause in the subcontract,
+
+ Layton’s sixth claim for relief sought indemnification from Shaw for
+
+ “all damages and costs” arising from any liability it might have to
+
+ BCRE.1 In response to Shaw’s interrogatory (Interrogatory 8) asking
+
+ Layton to “identify all material facts upon which [Layton] based [the
+
+ indemnification] claim,” Layton stated, under oath, that those facts
+
+ included “Shaw’s failure to provide a defense or pay Layton’s costs
+
+ to defend against [BCRE’s] claims that relate to or arise out of
+
+ Shaw’s allegedly deficient or defective work.” In responding to
+
+ another interrogatory (Interrogatory 4) asking Layton to describe
+
+ every breach of the indemnification clause, Layton specifically noted
+
+ “Shaw’s failure to provide a defense or pay Layton’s costs.” Layton’s
+
+ response to Interrogatory 8 expressly incorporated its response to
+
+ Interrogatory 4.2
+
+
+
+ 1 The indemnification clause provided for indemnification from “all
+ damages, costs and expenses incurred in connection” with “all
+ claims, demands, suits, proceedings, attachments, levies, penalties,
+ damages and losses, liabilities, liens, claims for indemnification or
+ contribution, and any other matter whatsoever” “arising out of or
+ resulting from,” among other things, Shaw’s work on the project.
+ 2 In its answer brief on appeal, Shaw pointed out that Layton had
+ said in response to Interrogatory 8 that its indemnification claim
+ included attorney fees and costs incurred in defending against
+
+ 2
+ ¶5 Layton also asserted a claim for contribution against Shaw
+
+ (the seventh claim for relief), alleging that if Layton was found to be
+
+ liable to BCRE for “the tortuous [sic] acts of” Shaw, Shaw should be
+
+ required to contribute payment for such liability. At Layton’s
+
+ request, the district court dismissed that claim without prejudice in
+
+ March 2011.
+
+¶6 Later, after BCRE specifically identified Shaw’s allegedly
+
+ defective work (totaling about $9,000 in value), Layton moved to
+
+ voluntarily dismiss its indemnification claim against Shaw “with
+
+ prejudice.” Layton’s motion said that the dismissal would include
+
+ “those claims that have been or could have been asserted in this
+
+ lawsuit.” (Emphasis added.) The motion purported not to seek
+
+ dismissal of “any new or future claims,” which it defined as those
+
+ BCRE’s claims. In its reply brief, however, Layton ignored its
+ response to Interrogatory 8 and instead argued that its response to
+ Interrogatory 4 was irrelevant, for a number of unconvincing
+ reasons. At oral argument, Layton’s counsel argued that Layton’s
+ response to Interrogatory 8 was irrelevant because Layton objected
+ to that interrogatory, but he did not explain why the interrogatory
+ was objectionable or why any objection would render the answer
+ irrelevant to this issue. (The record shows that Layton’s only
+ specific objection to the interrogatory was an attorney work-product
+ objection.) We perceive no relevant, nonfrivolous objection to that
+ standard interrogatory and, in any event, Layton went on to answer
+ the interrogatory despite the objections. Its sworn answer to the
+ interrogatory is enlightening, and we therefore consider it.
+
+ 3
+ “that may arise or be asserted in the future in any other lawsuits or
+
+ circumstances, which may be subject to the indemnification
+
+ provision.” The proposed order Layton submitted with its motion
+
+ repeated these parameters and said that each party would bear its
+
+ own attorney fees and costs. The district court did not sign
+
+ Layton’s proposed order, but instead entered a written order on
+
+ June 6, 2011, saying only, as now relevant, that Layton’s claims
+
+ were dismissed with prejudice.
+
+¶7 The case between Layton and BCRE (in which several
+
+ subcontractors remained parties) continued. In July 2014,
+
+ following a bench trial, the court awarded Layton just over $5
+
+ million on its claims against BCRE, which was far less than Layton
+
+ had sought. The court also ruled that Layton was not liable to
+
+ BCRE for defective work because BCRE had materially breached the
+
+ contract by failing to give Layton contractually required notices of
+
+ defective work and an opportunity to correct the work. With respect
+
+ to the subcontractors remaining in the case, the court found that
+
+ they were liable to Layton under the indemnification provisions in
+
+ their subcontracts (which were identical to the provision in Shaw’s
+
+ subcontract) for the expenses (including attorney fees and costs)
+
+
+ 4
+ that Layton had incurred in defending against BCRE’s claims, to
+
+ the extent those expenses were attributable to work performed by
+
+ each subcontractor.
+
+¶8 Shortly thereafter, Layton filed this case against Shaw and
+
+ several other subcontractors. It asserted claims against Shaw for
+
+ contractual and common law indemnity and declaratory judgment
+
+ seeking an award of “attorney fees, costs and expenses” it had
+
+ incurred in defending against BCRE’s claims in the prior case.3
+
+ Layton asserted that it could seek indemnification from Shaw
+
+ pursuant to a provision in the Construction Defect Action Reform
+
+ Act (CDARA), section 13-80-104, C.R.S. 2016, which allows claims
+
+ for indemnification against subcontractors to be filed within ninety
+
+ days of a final judgment against a contractor. § 13-80-104(1)(b)(II),
+
+ (1)(c) (indemnification claim “[s]hall be brought within ninety days
+
+
+
+
+ 3 Layton claims to have incurred over $16 million in attorney fees
+ and costs in defending against BCRE’s claims. Layton’s complaint
+ also alleged losses resulting from Layton’s payments for work that
+ the subcontractors had not performed. But it is not clear if Layton
+ alleged that Shaw was one of those subcontractors, and in any
+ event Layton does not assert on appeal any argument relating to
+ those alleged losses.
+
+ 5
+ after [settlement of or final judgment against the contractor in]” the
+
+ construction defect claim).4
+
+¶9 Shaw moved for summary judgment. It argued that Layton’s
+
+ indemnification claims are barred by the doctrine of claim
+
+ preclusion because the court in the prior case had dismissed those
+
+ claims with prejudice. The district court agreed, rejecting Layton’s
+
+ contrary arguments in a thorough written order.
+
+ II. Standard of Review
+
+¶ 10 Summary judgment is appropriate when “the pleadings,
+
+ depositions, answers to interrogatories, and admissions on file,
+
+ together with the affidavits, if any, show that there is no genuine
+
+ issue as to any material fact and that the moving party is entitled to
+
+ a judgment as a matter of law.” C.R.C.P. 56(c). We review de novo
+
+ an order granting summary judgment based on claim preclusion.
+
+ Loveland Essential Grp., LLC v. Grommon Farms, Inc., 2012 COA 22,
+
+ ¶ 13.
+
+
+ 4Interestingly, there was no settlement of the prior case as between
+ Layton and BCRE, nor was there any judgment “against” Layton on
+ BCRE’s claims in the prior case, calling into question the
+ applicability of section 13-80-104(1)(b)(II), C.R.S. 2016, under its
+ own terms. But Shaw has not raised that issue, so we will not
+ address it.
+
+ 6
+ ¶ 11 To the extent Layton’s contentions require us to construe
+
+ CDARA, that presents a question of law that we also review de novo.
+
+ Sperry v. Field, 205 P.3d 365, 367 (Colo. 2009). In interpreting a
+
+ statute we strive to discern and give effect to the General
+
+ Assembly’s intent. Hassler v. Account Brokers of Larimer Cty., Inc.,
+
+ 2012 CO 24, ¶ 15. To do this, we look first to the statutory
+
+ language itself; we give the words and phrases used therein their
+
+ plain and ordinary meanings, and we read the language in the dual
+
+ contexts of the entire statute and the comprehensive statutory
+
+ scheme. Id.; Jefferson Cty. Bd. of Equalization v. Gerganoff, 241
+
+ P.3d 932, 935 (Colo. 2010); BP Am. Prod. Co. v. Patterson, 185 P.3d
+
+ 811, 813 (Colo. 2008). After doing this, if we conclude that the
+
+ statutory language is unambiguous we apply it as written and we
+
+ do not resort to other rules of statutory construction. Reno v.
+
+ Marks, 2015 CO 33, ¶ 20; Klinger v. Adams Cty. Sch. Dist. No. 50,
+
+ 130 P.3d 1027, 1031 (Colo. 2006).
+
+ III. General Law of Claim Preclusion
+
+¶ 12 “Claim preclusion works to preclude the relitigation of matters
+
+ that have already been decided as well as matters that could have
+
+ been raised in a prior proceeding but were not.” Argus Real Estate,
+
+
+ 7
+ Inc. v. E-470 Pub. Highway Auth., 109 P.3d 604, 608 (Colo. 2005);
+
+ accord Lobato v. Taylor, 70 P.3d 1152, 1165 (Colo. 2003). It serves
+
+ two primary purposes: protecting litigants from the burden of
+
+ relitigating issues against the same party (or its privy) and
+
+ promoting judicial economy by preventing needless litigation.
+
+ Parklane Hosiery Co. v. Shore, 439 U.S. 322, 326 (1979); Lobato, 70
+
+ P.3d at 1165-55.
+
+¶ 13 “For a claim in a second judicial proceeding to be precluded by
+
+ a previous judgment, there must exist: (1) finality of the first
+
+ judgment, (2) identity of subject matter, (3) identity of claims for
+
+ relief, and (4) identity or privity between parties to the actions.”
+
+ Argus Real Estate, 109 P.3d at 608; accord Loveland Essential Grp.,
+
+ ¶ 14.
+
+ IV. Analysis
+
+¶ 14 Layton makes three fundamental contentions: (1) its claims
+
+ against Shaw in this case are not identical to those it asserted
+
+ against Shaw in the prior case; (2) CDARA modifies the doctrine of
+
+ claim preclusion in the construction defect context by requiring (or
+
+ at least allowing) splitting of indemnification claims; and (3) various
+
+
+
+
+ 8
+ exceptions to the claim preclusion doctrine apply to this action. We
+
+ address and reject each of these contentions in turn.
+
+ A. Identity of Claims
+
+¶ 15 Layton argues that its claims in this case are not identical to
+
+ those it asserted in the prior case both because it did not seek
+
+ indemnity for attorney fees and costs in the prior case and because
+
+ its claims in this case do not arise out of the same transaction as
+
+ its claims in the prior case.5 Both of these arguments are based on
+
+ distortions of, or are flat out contrary to, applicable, well-settled
+
+ legal principles.
+
+¶ 16 We need not decide whether Layton sought indemnification for
+
+ fees and costs in the prior case because it obviously could have
+
+ done so, a fact it admitted in opposing Shaw’s summary judgment
+
+ motion.6 Layton does not contest that any claim for indemnification
+
+
+
+
+ 5Layton concedes that the other three requirements of claim
+ preclusion are met.
+ 6 Shaw, however, has much the better of the argument on whether
+ Layton sought indemnification of fees and costs in the defect case.
+ Layton’s sworn discovery responses in the prior case said that the
+ attorney fees and costs it had incurred and were incurring in
+ defending against BCRE’s claims were included in its
+ indemnification claim. And the language of Layton’s complaint in
+
+ 9
+ based on Shaw’s duty to defend accrued, at the latest, in 2009
+
+when it first began incurring attorney fees and costs in connection
+
+with BCRE’s claims, which Shaw would not pay. See Jones v. Sun
+
+Carriers, Inc., 856 F.2d 1091, 1094 (8th Cir. 1988) (indemnity claim
+
+for costs and expenses accrues when indemnitee has made a
+
+payment or otherwise expended sums, while indemnity claim for
+
+liabilities arises when a liability is legally imposed; applying
+
+Arkansas law); Farmers Ins. Exch. v. Am. Mfrs. Mut. Ins. Co., 897
+
+P.2d 880, 882 (Colo. App. 1995) (duty to defend arises when claims
+
+are asserted against party to whom the duty is owed); see also
+
+Sterenbuch v. Goss, 266 P.3d 428, 433 (Colo. App. 2011) (once some
+
+injury has occurred, a claim has accrued even if further injury
+
+continues to occur).7 That Layton may not have known the full
+
+extent of Shaw’s liability while Shaw was a party in the prior case
+
+does not matter; as Layton conceded in opposing Shaw’s summary
+
+
+
+that case was certainly broad enough to include a claim for such
+fees and costs.
+7 Layton’s complaint in this case expressly alleges that in 2009 it
+incurred such fees and costs before it added Shaw to the prior case.
+In responding to Shaw’s motion for summary judgment, Layton
+submitted an affidavit repeating this allegation. Its opening brief in
+this appeal does so as well.
+
+ 10
+ judgment motion, it could have presented evidence of and obtained
+
+ a judgment for all attorney fees and costs incurred or likely to be
+
+ incurred in the prior case. (Indeed, after the district
\ No newline at end of file
diff --git a/test_data/legal_real/case_4340129.txt b/test_data/legal_real/case_4340129.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1aadacff81cf943b8b6e0d16be739a0a4244c157
--- /dev/null
+++ b/test_data/legal_real/case_4340129.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Horizon Healthcare Services Inc. Data Breach Litigation
+COURT: Court of Appeals for the Third Circuit
+DATE FILED: 2017-01-20
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4369640.txt b/test_data/legal_real/case_4369640.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d106e13e4748b7bcfe73ec533f7bd22053b527c5
--- /dev/null
+++ b/test_data/legal_real/case_4369640.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Lubrizol Shareholders Litigation
+COURT: Ohio Court of Appeals
+DATE FILED: 2017-02-21
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4382476.txt b/test_data/legal_real/case_4382476.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8a0484dd9deaa284176ce5df04b69abc34439599
--- /dev/null
+++ b/test_data/legal_real/case_4382476.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: International Network, Inc. v. Woodard
+COURT: Colorado Court of Appeals
+DATE FILED: 2017-04-06
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4421564.txt b/test_data/legal_real/case_4421564.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e95a80d3133ca354d176f5712098dc3e43baae71
--- /dev/null
+++ b/test_data/legal_real/case_4421564.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2017-08-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4427287.txt b/test_data/legal_real/case_4427287.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b89a3381dbe260d42347b0dd968703c62c39a2c9
--- /dev/null
+++ b/test_data/legal_real/case_4427287.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: U.S. Office of Personnel Management Data Security Breach Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2017-09-19
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4444380.txt b/test_data/legal_real/case_4444380.txt
new file mode 100644
index 0000000000000000000000000000000000000000..169ea88637de7f5cfc90205c28aefa5f6289a268
--- /dev/null
+++ b/test_data/legal_real/case_4444380.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Elliot Ex Rel. Ira R/O v. Ward (In Re Sandridge Energy, Inc. Shareholder Derivative Litigation)
+COURT: Court of Appeals for the Tenth Circuit
+DATE FILED: 2017-11-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4495424.txt b/test_data/legal_real/case_4495424.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7a2a927d9f60bb56392da517e2f42b6ff710c0e2
--- /dev/null
+++ b/test_data/legal_real/case_4495424.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Xerox Corp. Consolidated Shareholder Litig.
+COURT: New York Supreme Court
+DATE FILED: 2018-04-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4526772.txt b/test_data/legal_real/case_4526772.txt
new file mode 100644
index 0000000000000000000000000000000000000000..adeff445080f68cec1da9096f46ff1fb8148f55f
--- /dev/null
+++ b/test_data/legal_real/case_4526772.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Papst Licensing Digital Camera Patent Litigation - Mdl 1880
+COURT: District Court, District of Columbia
+DATE FILED: 2018-08-15
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4567936.txt b/test_data/legal_real/case_4567936.txt
new file mode 100644
index 0000000000000000000000000000000000000000..7564be24946170a8367df329d8c6871fcc09d715
--- /dev/null
+++ b/test_data/legal_real/case_4567936.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Waverly City School Dist. Bd. of Edn. v. Triad AR, Inc.
+COURT: Ohio Court of Appeals
+DATE FILED: 2018-11-20
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4570608.txt b/test_data/legal_real/case_4570608.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ec6c6f31832e02b7434c5d6605439f5e346d1457
--- /dev/null
+++ b/test_data/legal_real/case_4570608.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: Standard Jury Instructions in Contract and Business Cases-2018 Report.
+COURT: Supreme Court of Florida
+DATE FILED: 2018-12-06
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4587203.txt b/test_data/legal_real/case_4587203.txt
new file mode 100644
index 0000000000000000000000000000000000000000..bf3da11c1ea9fa8e1c20cfb02b141a08e40ba93f
--- /dev/null
+++ b/test_data/legal_real/case_4587203.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Booking.com. B v. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Fourth Circuit
+DATE FILED: 2019-02-04
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4593584.txt b/test_data/legal_real/case_4593584.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c6f20a3469b20162874ba23aa79690cfbb31307e
--- /dev/null
+++ b/test_data/legal_real/case_4593584.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
+LEGAL OPINION: State ex rel. Streetsboro City School Dist. Bd. of Edn. v. Streetsboro
+COURT: Ohio Court of Appeals
+DATE FILED: 2019-02-25
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_461331.txt b/test_data/legal_real/case_461331.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c9adfd307eb92a219d3e61a86646cde55e8f4f27
--- /dev/null
+++ b/test_data/legal_real/case_461331.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Dominique Dubost v. U.S. Patent and Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1985-11-22
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4625210.txt b/test_data/legal_real/case_4625210.txt
new file mode 100644
index 0000000000000000000000000000000000000000..93c985a5829f2e3770880abbc2ae8a8f38cb31d6
--- /dev/null
+++ b/test_data/legal_real/case_4625210.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Customer Data SEC. Breach Litig. Melissa Alleruzzo v. Supervalu, Inc. (In Re Supervalu, Inc.)
+COURT: Court of Appeals for the Eighth Circuit
+DATE FILED: 2019-05-31
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4631839.txt b/test_data/legal_real/case_4631839.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a51516cea0da1d3ec38e1a489cfbb8ab81667087
--- /dev/null
+++ b/test_data/legal_real/case_4631839.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Office of Pers. Mgmt. Data SEC. Breach Litig. v. Office of Pers. Mgmt.
+COURT: Court of Appeals for the D.C. Circuit
+DATE FILED: 2019-06-21
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4679569.txt b/test_data/legal_real/case_4679569.txt
new file mode 100644
index 0000000000000000000000000000000000000000..181a5b4ecdcf8b1e08b2881f5cf7d4cb83903c98
--- /dev/null
+++ b/test_data/legal_real/case_4679569.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Long Bros. of Summerfield, Inc. v. Hilco Transp.
+COURT: Court of Appeals of North Carolina
+DATE FILED: 2019-11-19
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4696265.txt b/test_data/legal_real/case_4696265.txt
new file mode 100644
index 0000000000000000000000000000000000000000..96cdbb34737a9df1a6f02277d17fad1f27d5eb7a
--- /dev/null
+++ b/test_data/legal_real/case_4696265.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Lawless v. Lawrence Cty. Bd. of Edn.
+COURT: Ohio Court of Appeals
+DATE FILED: 2020-01-09
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4762699.txt b/test_data/legal_real/case_4762699.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ffb0f2810f5dad44a6c8d9f67ed7fd47d2108cec
--- /dev/null
+++ b/test_data/legal_real/case_4762699.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Oracle Corporation Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2020-06-22
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4764769.txt b/test_data/legal_real/case_4764769.txt
new file mode 100644
index 0000000000000000000000000000000000000000..28904a7faffa65185a02c36d0d654b2a08e20477
--- /dev/null
+++ b/test_data/legal_real/case_4764769.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: U.S. Patent & Trademark Office v. Booking.com B. V.
+COURT: Supreme Court of the United States
+DATE FILED: 2020-06-30
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4877705.txt b/test_data/legal_real/case_4877705.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1a9f18fb4d85e17411e5e0acda2807362d0ae214
--- /dev/null
+++ b/test_data/legal_real/case_4877705.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Shareholder Representative Services LLC v. Shire US Holdings, Inc.
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-04-27
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4878643.txt b/test_data/legal_real/case_4878643.txt
new file mode 100644
index 0000000000000000000000000000000000000000..dbd32f75c4863fbe2d8371b214c784962e70afb2
--- /dev/null
+++ b/test_data/legal_real/case_4878643.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Matter of Tutor Perini Corp. v. City of N.Y. Off. of Admin. Trials & Hearings Contract Dispute Resolution Bd.
+COURT: Appellate Division of the Supreme Court of the State of New York
+DATE FILED: 2021-04-29
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4887388.txt b/test_data/legal_real/case_4887388.txt
new file mode 100644
index 0000000000000000000000000000000000000000..68b439723424201a1a399df91d3707dada34fee3
--- /dev/null
+++ b/test_data/legal_real/case_4887388.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re: SmileDirectClub, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-05-28
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4895379.txt b/test_data/legal_real/case_4895379.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b7192986dd81d29c73d17e4913e57e0c89f84acc
--- /dev/null
+++ b/test_data/legal_real/case_4895379.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In Re Danaher Corporation Shareholder Derivative Litigation
+COURT: District Court, District of Columbia
+DATE FILED: 2021-06-28
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4897958.txt b/test_data/legal_real/case_4897958.txt
new file mode 100644
index 0000000000000000000000000000000000000000..d121bfc81bbc3dc3d737baed5cc77d566fedb2c8
--- /dev/null
+++ b/test_data/legal_real/case_4897958.txt
@@ -0,0 +1,246 @@
+ THE STATE OF SOUTH CAROLINA
+ In The Court of Appeals
+
+ Zurich American Insurance Company of Illinois,
+ Respondent,
+
+ v.
+
+ Palmetto Contract Services, Inc., Appellant.
+
+ Appellate Case No. 2018-000692
+
+
+ Appeal from Charleston County
+ Kristi Lea Harrington, Circuit Court Judge
+
+ Opinion No. 5833
+ Heard November 3, 2020 – Filed July 7, 2021
+
+
+ AFFIRMED
+
+
+ William A. Scott, of Pedersen & Scott, PC, of Charleston,
+ for Appellant.
+
+ Larry D. Cohen, of Larry D. Cohen LLC, and Carolyn H.
+ Blue, both of Charleston, for Respondent
+
+
+GEATHERS, J.: In this breach of contract action, Appellant Palmetto Contract
+Services, Inc. (Palmetto) appeals the circuit court's order granting Respondent
+Zurich American Insurance Company's (Zurich) motion to strike Palmetto's jury trial
+demand. Palmetto argues it revived its right to a jury trial when it raised
+counterclaims for the first time in its amended answer and counterclaim.
+Additionally, Palmetto asserts its counterclaims raised new issues of fact that also
+revived its right to a jury trial. We affirm.
+
+ FACTS/PROCEDURAL HISTORY
+ In February 2012, Palmetto entered into a contract with Zurich for workers'
+compensation and employers' liability insurance coverage. After a premium audit,
+Zurich determined Palmetto owed it additional premiums in the amount of $158,744.
+
+ On December, 11, 2015, Zurich sued Palmetto for breach of contract, seeking
+to recoup the unpaid premiums, accrued and post-judgment interest, costs, and any
+other relief to which it may have been entitled. Palmetto answered on February 16,
+2016, denying Zurich's allegations and asserting the following defenses: failure to
+mitigate damages; waiver, estoppel, laches; and fraud. Neither party demanded a
+jury trial in its initial pleading.
+
+ On July 12, 2016, Palmetto filed a motion to amend its answer and assert
+counterclaims. Palmetto's proposed amended answer and counterclaim added the
+following: a defense of full accord and satisfaction; a defense of setoff—asserting
+Zurich's claims must be reduced by the amount paid for the value of the work
+performed; a counterclaim for negligent representation and fraud; and a
+counterclaim for breach of contract.
+
+ As to the counterclaims for negligent representation and fraud, Palmetto
+asserted Zurich previously classified some of Palmetto's employees under National
+Council on Compensation Insurance (NCCI) code 3040. However, Palmetto
+contended, as a result of Zurich's audit, Zurich determined that those employees
+should have been listed under code 6824F. This caused Zurich to invoice Palmetto
+for the unpaid premiums. Palmetto argued the following: (1) the representation that
+Zurich would properly classify employees under code 3040 and bill Palmetto
+accordingly was false and material; (2) Zurich "knew the representations . . . were
+false" and "intended that the representations be acted upon"; (3) "Palmetto did not
+know that the representations were false[] and relied on the representations"; (4)
+Zurich had a pecuniary interest in making the false representations; (5) Zurich had a
+duty of care to provide truthful information to Palmetto—which it breached by
+failing to properly communicate information regarding class codes to Palmetto; (6)
+"Palmetto had a right to rely on the representations in the agreement"; and (7) as a
+result of the negligent misrepresentations and fraud, Palmetto incurred actual,
+incidental, and unspecified damages. As to the counterclaim for breach of contract,
+Palmetto asserted "Zurich breached the contract by failing to classify operations
+properly and improperly billing Palmetto." Palmetto did not request a jury trial at
+the time it filed its motion to amend. Zurich opposed Palmetto's motion to amend
+its answer.
+ A hearing on the motion was held on September 19, 2017. Zurich argued it
+was prejudiced by the potential amendment because it would not be able to seek a
+jury trial if it so desired. Zurich clarified, however, that it was not requesting a jury
+trial at that time. The court granted Palmetto's motion to amend and instructed
+Palmetto to "put it in the order that [it] consent[ed] to a jury trial if [Zurich] desires
+a jury trial . . . ." The court found no prejudice in granting the motion because
+Palmetto's original answer included "issues of fraud and misrepresentation" and
+Palmetto consented to a jury trial if Zurich requested one.
+
+ Subsequently, on September 27, 2017, Palmetto filed its amended answer and
+counterclaim, designated "(Jury Trial)" below the document's title. Thereafter, the
+clerk's office placed the case on the jury roster. Zurich objected to the transfer to the
+jury roster and moved to strike Palmetto's jury trial demand, arguing Palmetto
+waived its right to a jury trial when it did not demand a jury trial following its initial
+answer and that the amended answer and counterclaim did not revive the right to a
+jury trial because it was not based upon new issues of fact pursuant to King v.
+Shorter.1 Zurich contended Palmetto's allegations were based upon the same issues
+and facts raised in Zurich's complaint and Palmetto's initial answer. Zurich further
+noted that the court's order granting Palmetto's motion to amend its answer stated
+Palmetto raised the same issues as previously pled.
+
+ A hearing on Zurich's motion to strike was held before the circuit court on
+March 6, 2018. At the hearing, Palmetto argued that the counterclaims asserted in
+the amended answer were new issues of fact not in the original pleading, and
+therefore, it was allowed to demand a jury trial under King. Additionally, Palmetto
+noted that Zurich had previously argued against Palmetto's motion to amend by
+stating Zurich would not have the ability to seek a jury trial.
+
+ On March 8, 2018, the circuit court issued an order granting Zurich's motion
+to strike Palmetto's jury trial demand pursuant to Rule 38(d), SCRCP and King. The
+circuit court found Palmetto's amended answer and counterclaim did not create new
+issues of fact. This appeal followed.
+
+ ISSUE ON APPEAL
+
+
+1
+ 291 S.C. 501, 503, 354 S.E.2d 402, 403 (Ct. App. 1987) (finding the circuit court
+did not abuse its discretion by allowing the defendant to amend his pleading, while
+simultaneously denying his motion to transfer the case to the jury calendar, because
+the amended pleading did not create new issues of fact).
+ Did the circuit court err by finding Palmetto's amended answer did not entitle
+it to a jury trial?
+
+ STANDARD OF REVIEW
+
+ As an initial matter, the parties disagree on the appropriate standard of review
+for this appeal. Unlike a jury trial request under Rule 39(b), SCRCP,2 the decision
+of whether to order a jury trial under Rule 38 is not discretionary with the circuit
+court. See Lester v. Dawson, 327 S.C. 263, 267, 491 S.E.2d 240, 242 (1997) ("Rule
+38 concerns trial by jury as of right. Rule 39(b), on the other hand, allows the
+[circuit] court discretion to order a jury or non-jury trial."). In Dawson, the supreme
+court found that because the decision of whether to order a jury trial pursuant to a
+Rule 38 request was not discretionary, the appellant's failure to immediately appeal
+the circuit court's denial of his request for a jury trial under Rule 38 barred his appeal
+of the issue. Id. at 266–67, 491 S.E.2d at 241–42. Like the appellant in Dawson,
+Palmetto is challenging the circuit court's denial of its pretrial jury demand under
+Rule 38. See id. Here, the issue is not whether Palmetto waived its right to a jury
+trial; rather, the sole issue is whether the amended answer and counterclaim revived
+Palmetto's previously waived right to a jury under Rule 38. Because this is a
+question of law, the proper standard of review is de novo. See Verenes v. Alvanos,
+387 S.C. 11, 15, 690 S.E.2d 771, 772 (2010) ("Whether a party is entitled to a jury
+trial is a question of law."); California Scents v. Surco Prod., Inc., 406 F.3d 1102,
+
+
+
+2
+ Rule 39 states in relevant part
+
+ (a) By Jury. . . . The trial of all issues so demanded shall
+ be by jury, unless . . . the court upon motion or its own
+ initiative finds that a right of trial by jury of some or all of
+ those issues does not exist.
+ (b) By the Court. Issues of law and issues not demanded
+ for trial by jury as provided in Rule 38 shall be tried by the
+ court or may be referred to a master as provided in Rule
+ 53; but, notwithstanding the failure of a party to demand a
+ jury in an action in which such a demand might have been
+ made of right, the court in its discretion upon motion may
+ order a trial by jury of any or all issues.
+
+(Emphasis added).
+ 1105 (9th Cir. 2005) ("Entitlement to a jury trial is a question of law reviewed de
+novo.").3
+
+ LAW/ANALYSIS
+
+ Rule 38(b), SCRCP, provides that
+
+ [a]ny party may demand a trial by jury of any issue triable
+ of right by a jury by serving upon the other parties a
+ demand therefor in writing at any time after the
+ commencement of the action and not later than 10 days
+ after the service of the last pleading directed to such issue.
+ Such demand may be endorsed upon a pleading of the
+ party.
+
+(emphasis added). Subsection (d) further states that "[t]he failure of a party to serve
+a demand as required by this rule and to file it as required by Rule 5(d) constitutes a
+waiver by him of trial by jury." Rule 38(d), SCRCP. Accordingly, a party's right to
+a jury trial is waived if a demand is not served within ten days of service of "the last
+pleading directed to such issue." Rule 38(b). Because Rule 38 is substantially the
+same as Fed. R. Civ. P. 38, this court has analyzed federal case law interpreting the
+federal rule when deciding on issues related to our state rule. See King, 291 S.C. at
+503, 354 S.E.2d at 403.
+
+ Palmetto concedes it did not demand a jury trial within ten days after the
+service of its initial answer. However, it contends its right to a jury trial was revived
+because it asserted affirmative claims against Zurich for the first time in its amended
+answer and counterclaim. Palmetto maintains that based on this assertion, which
+distinguishes it from King, the circuit court erred in finding it was not entitled to a
+jury trial pursuant to King. Furthermore, Palmetto contends that there are different
+
+
+3
+ In King, the court of appeals stated that the circuit court "did not abuse [its]
+discretion in either allowing [defendant]'s amended pleading or in denying his
+motion to transfer the case to the jury calendar." 291 S.C. at 503, 354 S.E.2d at 403.
+However, that ruling was in the context of the circuit court's discretion to allow the
+defendant to amend his pleading—which is unarguably reviewed for an abuse of
+discretion. See id.; Foggie v. CSX Transp., Inc., 313 S.C. 98, 22, 431 S.E.2d 587,
+590 (1993) ("It is well established that a motion to amend is addressed to the sound
+discretion of the [circuit court]. . . .").
+ issues and facts in its amended answer and counterclaim that also revived its right to
+a jury trial. We disagree.
+
+ In King, the plaintiff brought suit over a note he co-signed as endorser and
+had to pay for the defendant. 291 S.C. at 502, 354 S.E.2d at 402. The defendant
+answered, asserting fraud and coercion defenses, and counterclaimed for (1)
+malpractice, (2) fraud and deceit, and (3) breach of trust and fiduciary relationship.
+Id. The defendant did not make a demand for a jury trial. Id. Thereafter, the
+defendant amended his answer and added an additional counterclaim for outrage.
+Id. at 502, 354 S.E.2d at 402–03. After the plaintiff abandoned a motion to amend
+his complaint, which he had previously served on the defendant, the defendant yet
+again moved to amend his answer and counterclaim to assert an action for unfair
+trade practices and to transfer the case to the jury calendar. Id. The circuit court
+denied the motion to transfer but allowed the defendant to amend his answer and
+counterclaim. Id.
+
+ In affirming the circuit court's ruling, the court of appeals noted that under
+federal cases on the issue, "a litigant's entitlement to a jury trial on the issues
+presented by an amended pleading, when no prior demand for a jury trial has been
+made, turns on whether the amended pleadings create new issues of fact." Id. at 503,
+354 S.E.2d at 403 (emphases added). The court did not provide any caveats to the
+rule—and certainly no caveats intimating that the new issues presented by the
+amended pleadings could in fact be issues of law and not fact. See id. Instead, by
+its incorporation of Trixler Brokerage Co. v. Ralston Purina Co., the court of appeals
+confirmed that the presentation of a new theory of recovery in an amended pleading
+does not constitute the presentation of a new issue on which a jury trial should be
+granted. See id. at 503, 354 S.E.2d at 403; Trixler Brokerage Co., 505 F.2d 1045,
+1050 (9th Cir. 1974) ("The theory of a case relates to the ultimate basis of liability[]
+rather than to an issue created by the pleadings."); id. ("When read in context, the
+word issue must have been intended by the Supreme Court to mean nothing other
+than an issue of fact. Obviously, appellant would not be demanding a jury trial on
+an issue of law."); see also New Hampshire Fire Ins. Co. v. Perkins, 28 F.R.D. 588,
+590 (D. Del. 1961) ("The authorities are uniform that when a [party] has waived a
+jury trial and subsequently files an amendment to the [pleading] which does not
+change the nature of the case or introduce new issues, such amendment does not
+entitle the [party] to demand a jury trial as a matter of right and over objection[]
+pursuant to Rule 38(b)." (quoting Reeves v. Pennsylvania R. Co., 9 F.R.D. 487, 488
+(D. Del. 1949))). This rule applies equally to amendments by plaintiffs and
+defendants. See Perkins, 28 F.R.D. at 590–91.
+ Given the jury's role as the finder of fact, it is logical "that the jury trial right
+extends only to disputed factual conclusions." See Rosen v. Dick, 639 F.2d 82, 94
+(2d Cir. 1980). Once a party denies an allegation, both parties are then made aware
+that an issue of fact exists. See id. ("Rule 38(b) [] allows a party to wait for a
+responsive pleading which shows whether an issue of fact exists before making the
+jury demand."); Trixler Brokerage Co., 505 F.2d at 1050 ("An issue of fact does not
+exist unless there is an allegation and a responsive denial."). If a party
\ No newline at end of file
diff --git a/test_data/legal_real/case_4899982.txt b/test_data/legal_real/case_4899982.txt
new file mode 100644
index 0000000000000000000000000000000000000000..82523d1c025dbf752fd4e39d218417a54a78ac51
--- /dev/null
+++ b/test_data/legal_real/case_4899982.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Innovative Business Technologies, L.L.C. v. Ohio State Univ.
+COURT: Ohio Court of Claims
+DATE FILED: 2021-05-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_4991933.txt b/test_data/legal_real/case_4991933.txt
new file mode 100644
index 0000000000000000000000000000000000000000..75d423ff688d7be3b920d816724d2819840ac806
--- /dev/null
+++ b/test_data/legal_real/case_4991933.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Standard Jury Instructions—Contract & Business Cases
+COURT: Supreme Court of Florida
+DATE FILED: 2013-06-06
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_5145599.txt b/test_data/legal_real/case_5145599.txt
new file mode 100644
index 0000000000000000000000000000000000000000..2ada911ebc5d7da6abf5fbfce69c70abe0491ccc
--- /dev/null
+++ b/test_data/legal_real/case_5145599.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Southern Peru Copper Corp. Shareholder Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2011-10-14
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_527912.txt b/test_data/legal_real/case_527912.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f992b2c1f2661e7092e92291f161880f587a2bb9
--- /dev/null
+++ b/test_data/legal_real/case_527912.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Syntex (u.s.a.) Inc. v. U.S. Patent & Trademark Office
+COURT: Court of Appeals for the Federal Circuit
+DATE FILED: 1989-08-15
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_5287627.txt b/test_data/legal_real/case_5287627.txt
new file mode 100644
index 0000000000000000000000000000000000000000..87afa3ccbf4d498cb9f88ee473d6f91773c51d23
--- /dev/null
+++ b/test_data/legal_real/case_5287627.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re: Facebook, Inc. Derivative Litigation
+COURT: Court of Chancery of Delaware
+DATE FILED: 2021-10-05
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_6236874.txt b/test_data/legal_real/case_6236874.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8e796412e4b66a64515bc8a66be57e4e8f988eb2
--- /dev/null
+++ b/test_data/legal_real/case_6236874.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
+LEGAL OPINION: EEOC Authority to Order Federal Agency to Pay for Breach of Settlement Agreement
+COURT: Department of Justice Office of Legal Counsel
+DATE FILED: 2014-08-13
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7308214.txt b/test_data/legal_real/case_7308214.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c4f1163613a90e2717901d4212027d3f6803b662
--- /dev/null
+++ b/test_data/legal_real/case_7308214.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
+LEGAL OPINION: Authentify Patent Co. v. Strikeforce Technologies, Inc.
+COURT: District Court, W.D. Washington
+DATE FILED: 2014-07-31
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7308416.txt b/test_data/legal_real/case_7308416.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1cdd8d6f6415ed6e570a8ca396070ec5ce27b957
--- /dev/null
+++ b/test_data/legal_real/case_7308416.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Goldman Sachs Mortgage Servicing Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2012-08-14
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7310338.txt b/test_data/legal_real/case_7310338.txt
new file mode 100644
index 0000000000000000000000000000000000000000..517997f1c16ba9e189d9fe8b71cc515574298863
--- /dev/null
+++ b/test_data/legal_real/case_7310338.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-02
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7310503.txt b/test_data/legal_real/case_7310503.txt
new file mode 100644
index 0000000000000000000000000000000000000000..a40c8af17e4e4d551b035d65af446116564793f4
--- /dev/null
+++ b/test_data/legal_real/case_7310503.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Target Corp. Customer Data Security Breach Litigation
+COURT: District Court, D. Minnesota
+DATE FILED: 2014-12-18
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7312057.txt b/test_data/legal_real/case_7312057.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1658c13b70024b344e49304db3a2fd344d3cf376
--- /dev/null
+++ b/test_data/legal_real/case_7312057.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re TLI Communications LLC Patent Litigation
+COURT: District Court, E.D. Virginia
+DATE FILED: 2015-02-06
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7312590.txt b/test_data/legal_real/case_7312590.txt
new file mode 100644
index 0000000000000000000000000000000000000000..b10fd3e0c1fe094f42c5db7c0abf96f7217baff0
--- /dev/null
+++ b/test_data/legal_real/case_7312590.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Biglari Holdings, Inc. Shareholder Derivative Litigation
+COURT: District Court, S.D. Indiana
+DATE FILED: 2015-03-18
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7317007.txt b/test_data/legal_real/case_7317007.txt
new file mode 100644
index 0000000000000000000000000000000000000000..e14a77ad768fe5bc5a8fe6dd2954d60ff7399d6d
--- /dev/null
+++ b/test_data/legal_real/case_7317007.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Intuitive Surgical Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2015-11-16
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7317136.txt b/test_data/legal_real/case_7317136.txt
new file mode 100644
index 0000000000000000000000000000000000000000..1de547bee5cac5c24f06fee8745dd72b35f475b9
--- /dev/null
+++ b/test_data/legal_real/case_7317136.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Fab Universal Corp. Shareholder Derivative Litigation
+COURT: District Court, S.D. New York
+DATE FILED: 2015-11-17
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7317628.txt b/test_data/legal_real/case_7317628.txt
new file mode 100644
index 0000000000000000000000000000000000000000..8c968047a302b93b257a07e8e4f9c1c07c70b4de
--- /dev/null
+++ b/test_data/legal_real/case_7317628.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Yahoo! Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-12-23
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7318430.txt b/test_data/legal_real/case_7318430.txt
new file mode 100644
index 0000000000000000000000000000000000000000..91c1454892cf4c2a05c03f2a75f703a605a70f54
--- /dev/null
+++ b/test_data/legal_real/case_7318430.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Anthem, Inc. Data Breach Litigation
+COURT: District Court, N.D. California
+DATE FILED: 2016-02-14
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7318804.txt b/test_data/legal_real/case_7318804.txt
new file mode 100644
index 0000000000000000000000000000000000000000..f4c49bfd9a5fe73cb0b3ccab7b5e2bba211fa593
--- /dev/null
+++ b/test_data/legal_real/case_7318804.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Body Science LLC Patent Litigation
+COURT: District Court, D. Massachusetts
+DATE FILED: 2016-02-24
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7320970.txt b/test_data/legal_real/case_7320970.txt
new file mode 100644
index 0000000000000000000000000000000000000000..39fbb1b37d2efa3cac0db1f1efa73116aa72c8ca
--- /dev/null
+++ b/test_data/legal_real/case_7320970.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
+LEGAL OPINION: BTG Patent Holdings, LLC v. Bag2Go, GmbH
+COURT: District Court, S.D. Florida
+DATE FILED: 2016-06-08
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7321370.txt b/test_data/legal_real/case_7321370.txt
new file mode 100644
index 0000000000000000000000000000000000000000..c7257943d65061c0e5ecae76861a52affdc2e977
--- /dev/null
+++ b/test_data/legal_real/case_7321370.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Premera Blue Cross Customer Data Security Breach Litigation
+COURT: District Court, D. Oregon
+DATE FILED: 2016-08-01
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7323225.txt b/test_data/legal_real/case_7323225.txt
new file mode 100644
index 0000000000000000000000000000000000000000..ab127be4f3e04668549b832520292de86a6b5cf2
--- /dev/null
+++ b/test_data/legal_real/case_7323225.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re The Home Depot, Inc. Shareholder Derivative Litigation
+COURT: District Court, N.D. Georgia
+DATE FILED: 2016-11-30
+SNIPPET & HOLDING:
+
diff --git a/test_data/legal_real/case_7328111.txt b/test_data/legal_real/case_7328111.txt
new file mode 100644
index 0000000000000000000000000000000000000000..02578f4d886fa1920dbfd24dcac01ab5ae0e4783
--- /dev/null
+++ b/test_data/legal_real/case_7328111.txt
@@ -0,0 +1,15 @@
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+
+LEGAL OPINION: In re Res. Capital Corp., S'holder Derivative Litig.
+COURT: District Court, S.D. Illinois
+DATE FILED: 2018-02-23
+SNIPPET & HOLDING:
+