Search

Background: Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users. Methods: The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined. Results: EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors. Conclusions: This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment. [ABSTRACT FROM AUTHOR]

The widespread implementation of artificial intelligence technologies provides an appealing alternative to traditional search engines for online patient healthcare education. This study assessed ChatGPT-3.5's capabilities as a source of obstructive sleep apnea (OSA) information, using Google Search as a comparison. Ten frequently searched questions related to OSA were entered into Google Search and ChatGPT-3.5. The responses were assessed by two independent researchers using the Global Quality Score (GQS), Patient Education Materials Assessment Tool (PEMAT), DISCERN instrument, CLEAR tool, and readability scores (Flesch Reading Ease and Flesch–Kincaid Grade Level). ChatGPT-3.5 significantly outperformed Google Search in terms of GQS (5.00 vs. 2.50, p < 0.0001), DISCERN reliability (35.00 vs. 29.50, p = 0.001), and quality (11.50 vs. 7.00, p = 0.02). The CLEAR tool scores indicated that ChatGPT-3.5 provided excellent content (25.00 vs. 15.50, p < 0.001). PEMAT scores showed higher understandability (60–91% vs. 44–80%) and actionability for ChatGPT-3.5 (0–40% vs. 0%). Readability analysis revealed that Google Search responses were easier to read (FRE: 56.05 vs. 22.00; FKGL: 9.00 vs. 14.00, p < 0.0001). ChatGPT-3.5 delivers higher quality and more comprehensive OSA information compared to Google Search, although its responses are less readable. This suggests that while ChatGPT-3.5 can be a valuable tool for patient education, efforts to improve readability are necessary to ensure accessibility and utility for all patients. Healthcare providers should be aware of the strengths and weaknesses of various healthcare information resources and emphasize the importance of critically evaluating online health information, advising patients on its reliability and relevance. [ABSTRACT FROM AUTHOR]

Complex medical terminology utilized in clinical documentation can present barriers to patients understanding their medical findings. We aimed to generate easy-to-understand summaries of clinical radiology reports using large language models (LLMs) and evaluate their safety and quality. Eight board-certified physician reviewers evaluated 1982 LLM-generated radiology report summaries (computed tomography, magnetic resonance imaging, ultrasound, and x-ray) for safety and quality, using predefined rating criteria and the corresponding original radiology reports for reference. Physician reviewers determined 99.2% (1967 out of 1982) of the LLM-generated summaries to be safe. The reviewers scored the quality of the LLM-generated summaries from "5—Very Good" to "1—Very Poor," respectively, as follows: 80.6%, 11.1%, 5.7%, 1.7%, and 0.9%. Safety varied significantly across imaging modality (P =.002). Large language models can be used to generate safe and high-quality summaries of clinical radiology reports. Further investigation is warranted to determine the impact of LLM-generated summaries on patient perception of understanding, knowledge of their medical conditions, and overall experience. [ABSTRACT FROM AUTHOR]

Objective: Families increasingly use online resources to acquire medical information about their child's condition with little understanding of the legitimacy of the source of information or of the information itself. We evaluate the quality and readability of online information related to positional head shape conditions and identify unmet needs for healthcare providers to improve online patient education. Design: The search terms "flat head baby," "brachycephaly," and "plagiocephaly" were queried on the Google search engine and the first 20 websites for each were reviewed. Included websites were evaluated for quality using the DISCERN Instrument and readability using the Flesch-Kincaid Reading Grade Level (FKGL) and Flesch Reading Ease Score (FRES). Websites were categorized by upload source and results were compared using one-way ANOVA. Results: 38 websites met inclusion criteria. There was no significant correlation between DISCERN score and Google search rank between the three search terms. Professional organizations provided websites with the highest mean DISCERN score (56.3) and commercial websites with the lowest score (36.6, P =.003), indicating "good" and "poor" quality content, respectively. Readability assessments showed an overall average FKGL of 9.9 and FRES of 54.4, suggesting "fairly difficult". Hospitals provided the most website results and tended to publish lower quality information, yet are the most readable. Conclusions: High quality websites written at an appropriate reading level for the general public are lacking. A review of online resources for positional head shape conditions can be used to derive recommendations to improve the content of online patient education for pediatric healthcare. [ABSTRACT FROM AUTHOR]

Background: End-of-life care (EOLC) is a critical aspect of healthcare, yet accessing reliable information remains challenging, particularly in culturally diverse contexts like India. Objective: This study investigates the potential of artificial intelligence (AI) in addressing the informational gap by analyzing patient information leaflets (PILs) generated by AI chatbots on EOLC. Methodology: Using a comparative research design, PILs generated by ChatGPT and Google Gemini were evaluated for readability, sentiment, accuracy, completeness, and suitability. Readability was assessed using established metrics, sentiment analysis determined emotional tone, accuracy, and completeness were rated by subject experts, and suitability was evaluated using the Patient Education Materials Assessment Tool (PEMAT). Results: Google Gemini PILs exhibited superior readability and actionability compared to ChatGPT PILs. Both conveyed positive sentiments and high levels of accuracy and completeness, with Google Gemini PILs showing slightly lower accuracy scores. Conclusion: The findings highlight the promising role of AI in enhancing patient education in EOLC, with implications for improving care outcomes and promoting informed decision-making in diverse cultural settings. Ongoing refinement and innovation in AI-driven patient education strategies are needed to ensure compassionate and culturally sensitive EOLC. [ABSTRACT FROM AUTHOR]

The effects of psychotherapy for men perpetrating violence toward their female partners have been found to be modest or equivocal; therefore, further research is necessary to determine how therapists can intervene to help clients stop acting violently. To obtain a better understanding of successful therapist strategies in a particular case, we conducted an interpretive phenomenological analysis of interactional patterns and change processes during therapy sessions in four carefully selected cases - two cases in which the use of violence ended after the completion of therapy (violence ended) were compared with two cases in which the client completed therapy but continued to act violently (violence continued). The client's use of violence was addressed repeatedly in all four cases, but the scripting of such events varied between the two case types. I) Violence ended: Joint explorations of the script of "the annoying other" led to therapist strategies that fostered new experiences of the states of mind of the client and partner. This seemed to help clients develop more caring and safer ways of relating to their partner. II) Violence continued: Engagement in the script of "hopeless me" was associated with therapist strategies that relied more on explanations of the client's vulnerability to acting violently. This seemed to hinder deeper comprehension of the clients' use of violence and the needs and intentions of their partners. Contrary to expectations, engagement in the script of "the annoying other" facilitated exploration of emotional states in both the client and his significant other. We present some empirically derived principles for moment-to-moment therapist strategies that facilitated in-session change with men acting violently toward their partner. [ABSTRACT FROM AUTHOR]

Rapid automatized naming (RAN) is a powerful predictor of reading fluency, and many digitized dyslexia screeners include RAN as an essential component. However, the validity of digitized RAN has not been established. Using a sample of 174 second-graders, this study tested (1) the comparability between paper and digitized versions of RAN and (2) the validity of the digitized version. We found that paper and digital versions were highly correlated, and such correlation was consistent across students' reading levels. Further, the digital RAN predicted children's word reading proficiency as well as the paper version. Moreover, the constructs measured by paper and digital versions of RAN were comparable. We conclude that the digitized RAN is a valid alternative to the traditional paper version for this age group. [ABSTRACT FROM AUTHOR]

Objective Internet-based patient education materials (PEMs) are often above the recommended sixth grade reading level recommended by the U.S. Department of Health and Human Services. In 2016 the U.S. Food and Drug Administration (FDA) released a warning statement against use of general anesthetic drugs in children and pregnant women due to concerns about neurotoxicity. The aim of this study is to evaluate readability, content, and quality of Internet-based PEMs on anesthesia in the pediatric population and neurotoxicity. Study Design The websites of U.S. medical centers with pediatric anesthesiology fellowship programs were searched for PEMs pertaining to pediatric anesthesia and neurotoxicity. Readability was assessed. PEM content was evaluated using matrices specific to pediatric anesthesia and neurotoxicity. PEM quality was assessed with the Patient Education Material Assessment Tool for Print. A one-sample t -test was used to compare the readability of the PEMs to the recommended sixth grade reading level. Results We identified 27 PEMs pertaining to pediatric anesthesia and eight to neurotoxicity. Mean readability of all PEMs was greater than a sixth grade reading (p <0.001). While only 13% of PEMs on anesthesia for pediatric patient mentioned the FDA warning, 100% of the neurotoxicity materials did. PEMs had good understandability (83%) and poor actionability (60%). Conclusion The readability, content, and quality of PEMs are poor and should be improved to help parents and guardians make informed decisions about their children's health care. Key Points The FDA issued a warning statement against the use of general anesthetic drugs in children and pregnant women. Readability, content, and quality of Internet-based patient education materials on the topic of neurotoxicity are poor. Improving the readability, content, and quality of PEMs could aid parents in making important health care decisions. [ABSTRACT FROM AUTHOR]

Purpose: This study examined narrative discourse in youth offenders, focusing on quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. Method: The participants were 15 incarcerated adolescents, ages 13–18 years (Mage = 16 years). Each was evaluated at their detention center via Zoom, using a standardized language test and language samples that elicited narrative speaking with fables. After retelling a fable, the participant answered questions that examined story comprehension and critical thinking. Results: Most participants performed below average on the standardized language test and had difficulty on one or more of the language sampling measures. Areas of concern included quality of story retelling, story comprehension, critical thinking, and the use of complex syntax. Had language sampling not been employed, those weaknesses might have been overlooked. Conclusions: When evaluating youth offenders, it is important to elicit language samples that can provide detailed information about an adolescent’s ability to communicate for genuine purposes. In this regard, the tasks employed in the current study could be helpful to speech-language pathologists in working with youth offenders, enabling them to pinpoint deficits and offer targeted intervention. [ABSTRACT FROM AUTHOR]

Background The capability of large language models (LLMs) to understand and generate human-readable text has prompted the investigation of their potential as educational and management tools for patients with cancer and healthcare providers. Materials and Methods We conducted a cross-sectional study aimed at evaluating the ability of ChatGPT-4, ChatGPT-3.5, and Google Bard to answer questions related to 4 domains of immuno-oncology (Mechanisms, Indications, Toxicities, and Prognosis). We generated 60 open-ended questions (15 for each section). Questions were manually submitted to LLMs, and responses were collected on June 30, 2023. Two reviewers evaluated the answers independently. Results ChatGPT-4 and ChatGPT-3.5 answered all questions, whereas Google Bard answered only 53.3% (P  < .0001). The number of questions with reproducible answers was higher for ChatGPT-4 (95%) and ChatGPT3.5 (88.3%) than for Google Bard (50%) (P  < .0001). In terms of accuracy, the number of answers deemed fully correct were 75.4%, 58.5%, and 43.8% for ChatGPT-4, ChatGPT-3.5, and Google Bard, respectively (P  = .03). Furthermore, the number of responses deemed highly relevant was 71.9%, 77.4%, and 43.8% for ChatGPT-4, ChatGPT-3.5, and Google Bard, respectively (P  = .04). Regarding readability, the number of highly readable was higher for ChatGPT-4 and ChatGPT-3.5 (98.1%) and (100%) compared to Google Bard (87.5%) (P  = .02). Conclusion ChatGPT-4 and ChatGPT-3.5 are potentially powerful tools in immuno-oncology, whereas Google Bard demonstrated relatively poorer performance. However, the risk of inaccuracy or incompleteness in the responses was evident in all 3 LLMs, highlighting the importance of expert-driven verification of the outputs returned by these technologies. [ABSTRACT FROM AUTHOR]

Background: Addressing disparities in living kidney donation requires making information accessible across literacy levels, especially important given that the average American adult reads at an 8th-grade level. This study evaluated the effectiveness of ChatGPT, an advanced AI language model, in simplifying living kidney donation information to an 8th-grade reading level or below. Methods: We usedChatGPTversions 3.5 and4.0 tomodify 27 questions and answers fromDonate Life America, a key resource on living kidney donation. We measured the readability of both original and modified texts using the Flesch-Kincaid formula. A paired t-test was conducted to assess changes in readability levels, and a statistical comparison between the two ChatGPT versions was performed. Results: Originally, the FAQs had an average reading level of 9.6 ± 1.9. Postmodification, ChatGPT 3.5 achieved an average readability level of 7.72 ± 1.85, while ChatGPT 4.0 reached 4.30±1.71, both with a p-value <0.001 indicating significant reduction. ChatGPT 3.5 made 59.26% of answers readable below 8th-grade level, whereas ChatGPT 4.0 did so for 96.30% of the texts. The grade level range for modified answers was 3.4-11.3 for ChatGPT 3.5 and 1-8.1 for ChatGPT 4.0. Conclusion: Both ChatGPT 3.5 and 4.0 effectively lowered the readability grade levels of complex medical information, with ChatGPT 4.0 being more effective. This suggests ChatGPT's potential role in promoting diversity and equity in living kidney donation, indicating scope for further refinement in making medical information more accessible. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate and compare the quality and readability of responses generated by five different artificial intelligence (AI) chatbots—ChatGPT, Bard, Bing, Ernie, and Copilot—to the top searched queries of erectile dysfunction (ED). Google Trends was used to identify ED-related relevant phrases. Each AI chatbot received a specific sequence of 25 frequently searched terms as input. Responses were evaluated using DISCERN, Ensuring Quality Information for Patients (EQIP), and Flesch-Kincaid Grade Level (FKGL) and Reading Ease (FKRE) metrics. The top three most frequently searched phrases were "erectile dysfunction cause", "how to erectile dysfunction," and "erectile dysfunction treatment." Zimbabwe, Zambia, and Ghana exhibited the highest level of interest in ED. None of the AI chatbots achieved the necessary degree of readability. However, Bard exhibited significantly higher FKRE and FKGL ratings (p = 0.001), and Copilot achieved better EQIP and DISCERN ratings than the other chatbots (p = 0.001). Bard exhibited the simplest linguistic framework and posed the least challenge in terms of readability and comprehension, and Copilot's text quality on ED was superior to the other chatbots. As new chatbots are introduced, their understandability and text quality increase, providing better guidance to patients. [ABSTRACT FROM AUTHOR]

Purpose: While the National Institutes of Health and American Medical Association recommend patient education materials (PEMs) should be written at the sixth‐grade reading level or below, many patient education materials related to traumatic orthopaedic injuries do not meet these recommendations. The purpose of this study is to create a standardised method for enhancing the readability of trauma‐related orthopaedic PEMs by reducing the use of ≥ three syllable words and reducing the use of sentences >15 words in length. We hypothesise that applying this standardized method will significantly improve the objective readability of orthopaedic trauma PEMs. Methods: A patient education website was queried for PEMs relevant to traumatic orthopaedic injuries. Orthopaedic trauma PEMs included (N = 40) were unique, written in a prose format, and <3500 words. PEM statistics, including scores for seven independent readability formulae, were determined for each PEM before and after applying this standard method. Results: All PEMs had significantly different readability scores when comparing original and edited PEMs (p < 0.01). The mean Flesch Kincaid Grade Level of the original PEMs (10.0 ± 1.0) was significantly higher than that of edited PEMs (5.8 ± 1.1) (p < 0.01). None of the original PEMs met recommendations of a sixth‐grade reading level compared with 31 (77.5%) of edited PEMs. Conclusions: This standard method that reduces the use of ≥ three syllable words and <15 word sentences has been shown to significantly reduce the reading‐grade level of PEMs for traumatic orthopaedic injuries. Improving the readability of PEMs may lead to enhanced health literacy and improved health outcomes. [ABSTRACT FROM AUTHOR]

Saudi Arabia has the second-highest prevalence of diabetes in the Middle East. Therefore, providing patients with high-quality materials is essential to help them understand their illness. The Patient Education Materials Assessment Tool (PEMAT) contrasts and evaluates materials regarding understandability and actionability. This study aimed to evaluate materials for type 2 diabetes using a printed version of the PEMAT. This observational study was conducted in Riyadh from December 2022 to May 2023. Sixty-nine samples were collected from hospitals affiliated with the Ministry of Health and the government sector. Materials evaluated in this study had an excellent understandability score of 78.9% and a low actionability score of 66.6%, with significant differences between the sources. Some of the materials (42%) achieved high quality regarding understandability and actionability. Less than half of the materials were considered high quality. Approximately 99% of the materials made their purposes completely evident and logically presented the information, and approximately 97% identified at least one action. However, only 17.4% of the materials provided summaries and tangible tools. Health Educators should consider including summaries and tangible tools when developing patient education materials to make them more understandable and actionable. [ABSTRACT FROM AUTHOR]

Background: Social media is a popular source of information about food and nutrition. There is a high degree of inaccurate and poor-quality nutrition-related information present online. The aim of this study was to evaluate the quality and accuracy of nutrition-related information posted by popular Australian Instagram accounts and examine trends in quality and accuracy based on author, topic, post engagement, account verification and number of followers. Methods: A sample of posts by Australian Instagram accounts with ≥ 100,000 followers who primarily posted about nutrition was collected between September 2020 and September 2021. Posts containing nutrition-related information were evaluated to determine the quality and accuracy of the information. Quality was assessed using the Principles for Health-Related Information on Social Media tool and accuracy was assessed against information contained in the Australian Dietary Guidelines, Practice-based Evidence in Nutrition database, Nutrient Reference Values and Metafact. Results: A total of 676 posts were evaluated for quality and 510 posts for accuracy, originating from 47 Instagram accounts. Overall, 34.8% of posts were classified as being of poor quality, 59.2% mediocre, 6.1% good and no posts were of excellent quality. A total of 44.7% of posts contained inaccuracies. Posts authored by nutritionists or dietitians were associated with higher quality scores (β, 17.8, CI 13.94–21.65; P < 0.001) and higher accuracy scores (OR 4.69, CI 1.81–12.14, P = 0.001) compared to brands and other accounts. Information about supplements was of lower accuracy (OR 0.23, CI 0.10–0.51, P < 0.001) compared to information about weight loss and other nutrition topics. Engagement tended to be higher for posts of lower quality (β -0.59, P = 0.012), as did engagement rate (β -0.57, P = 0.016). There was no relationship between followers or account verification and information quality or accuracy and no relationship between engagement and accuracy. Conclusions: Nutrition-related information published by influential Australian Instagram accounts is often inaccurate and of suboptimal quality. Information about supplements and posts by brand accounts is of the lowest quality and accuracy and information posted by nutritionists and dietitians is of a higher standard. Instagram users are at risk of being misinformed when engaging with Australian Instagram content for information about nutrition. [ABSTRACT FROM AUTHOR]

Words read correctly per minute (WCPM) is the reporting score metric in oral reading fluency (ORF) assessments, which is popularly utilized as part of curriculum-based measurements to screen at-risk readers and to monitor progress of students who receive interventions. Just like other types of assessments with multiple forms, equating would be necessary when WCPM scores are obtained from multiple ORF passages to be compared both between and within students. This article proposes a model-based approach for equating WCPM scores. A simulation study was conducted to evaluate the performance of the model-based equating approach along with some observed-score equating methods with external anchor test design. [ABSTRACT FROM AUTHOR]

Context.-- Health care providers were surveyed to determine their ability to correctly decipher laboratory test names and their preferences for laboratory test names and result displays. Objective.-- To confirm principles for laboratory test nomenclature and display and to compare and contrast the abilities and preferences of different provider groups for laboratory test names. Design.-- Health care providers across different specialties and perspectives completed a survey of 38 questions, which included participant demographics, real-life examples of poorly named laboratory orders that they were asked to decipher, an assessment of vitamin D test name knowledge, their preferences for ideal names for tests, and their preferred display for test results. Participants were grouped and compared by profession, level of training, and the presence or absence of specialization in informatics and/or laboratory medicine. Results.-- Participants struggled with poorly named tests, especially with less commonly ordered tests. Participants' knowledge of vitamin D analyte names was poor and consistent with prior published studies. The most commonly selected ideal names correlated positively with the percentage of the authors' previously developed naming rules (R = 0.54, P < .001). There was strong consensus across groups for the best result display. Conclusions.-- Poorly named laboratory tests are a significant source of provider confusion, and tests that are named according to the authors' naming rules as outlined in this article have the potential to improve test ordering and correct interpretation of results. Consensus among provider groups indicates that a single yet clear naming strategy for laboratory tests is achievable. [ABSTRACT FROM AUTHOR]

The attention hypothesis, which assumes that font emphasis captures readers' attention, is usually used to explain the mechanism by which such emphasis operates. This study further delineates the attention hypothesis by investigating the ways in which font emphasis captures attention and its effects on the integration of emphasized information into the previous context. We computed event-related potentials and frequency band-specific electroencephalographic power changes occurring while participants read sentences containing critical words that were either emphasized (i.e., displayed in a color different from the other words in the sentence) or not (i.e., shown in the same color as the rest of the sentence) and semantically congruent with prior words or not. The results showed that the emphasized words (as compared to control words) elicited a reduced N1 and increased P2, indicating that font emphasis reduced familiarity-based visuo-orthographic processing and instead increased controlled attentional processing. We also observed greater P300 and power decreases in the alpha and beta frequency range in response to critical words in the emphasized condition, suggesting that font emphasis enhances focal attention to promote a fuller integration of information into the sentence context. Furthermore, relative to the control condition, the emphasized condition induced delta and theta power increases for the incongruent words. These results suggest that font emphasis increases the efficiency of glyph processing, which facilitates lexical access. [ABSTRACT FROM AUTHOR]

People commonly and increasingly rely on the internet to search for health information, including those related to endometriosis-associated dyspareunia. Yet the content of such websites may be of variable accuracy and quality. This review aims to evaluate the quality, readability, and suitability of web-based resources on endometriosis-associated dyspareunia for patients. We searched 3 databases – Google, Bing, and Yahoo – to identify websites related to endometriosis-associated dyspareunia. Two independent reviewers screened the search results against inclusion and exclusion criteria. Another set of two reviewers evaluated the selected websites using validated measurement instruments. Out of 450 websites, 21 met the inclusion criteria and were evaluated. More than half of the websites had information on content updates, reported on authorship, or disclosed sponsorship information. The mean quality and suitability scores were 47.5 (SD = 13.3) and 65.2 (SD = 13.6) respectively, thus suggesting generally adequate quality and suitability levels. However, the mean readability scores exceeded the recommended level for health-related websites. The poor readability of the websites might limit accessibility for a significant proportion of patients with low educational levels. The findings of this review have implications for designing high-quality, readable and up-to-date web interventions for people who rely on web platforms as an alternative or complementary source of health information on dyspareunia. [ABSTRACT FROM AUTHOR]

Lay abstracts are brief descriptions or summaries of research that are targeted at a general audience. They are held as an important means for the research community to provide greater transparency to the general public and to increase visibility of the pertinent research. This study aims to examine the extent to which lay abstracts published in the journal Autism are comprehensible to a lay audience in terms of readability measures. Results showed that lay abstracts published in Autism were more readable than their corresponding abstracts but were less readable than plain English texts (e.g. news reports). To our knowledge, this is probably the first comparative study on the readability of lay abstracts. Possible explanations for and implications of these findings were offered. Research papers are sometimes hard to follow. Lay abstracts give a short account of research papers. However, it is unclear whether lay abstracts are readable to the lay people. This study examined the readability of 570 abstracts and lay abstracts published between 2020 and 2022 in the journal Autism. We found that that lay abstracts are easier to read than abstracts but are harder to read than news reports. The findings suggest that lay abstracts, on average, are hard to read for the lay people. We propose that the journal and its authors may invite reviewers from outside the research community to test whether a lay abstract is readable. [ABSTRACT FROM AUTHOR]

Purpose: This mixed-methods research sought to examine the experience of people with aphasia who used text-to-speech (TTS) support to read a novel for virtual book club participation. Method: Six people with chronic aphasia used a TTS system to review portions of a novel about which they conversed during eight virtual book club meetings occurring over 5 weeks. During one-on-one interactions prior to each meeting, participants answered comprehension questions and provided feedback about reading experiences. Then, during group meetings, they reviewed and discussed relevant book content and predicted upcoming content. During a structured individual interview, participants reflected on their supported reading and book club experience. Results: Participants reported a range of reading confidence prior to study participation, mostly influenced by decreased comprehension or reading speed. After book club participation, four participants expressed increased confidence. Some reported searching for key words and skipping difficult words as strategies additional to TTS support. All reviewed at least some book sections more than once either with or without TTS support. Highly motivated participants expressed low frustration and high reading ease and enjoyment. Perceived comprehension was roughly consistent with actual comprehension across participants. Most believed TTS support promoted faster reading than otherwise possible. Participants liked adjustable features affecting speech output rate, word or sentence highlighting, and font size. Psychosocial benefits included decreased isolation and increased friendship. Conclusions: The findings extend previous evidence about perceived and actual benefits associated with TTS support. People with aphasia express positive experiences when given TTS support during book club participation. [ABSTRACT FROM AUTHOR]

The study aimed to assess the quality and readability of webbased information regarding the gingival recession. An internet search was done using two engines (Google and Bing) with the terms "gingival recession," "gum recession," and "receding gums." Each search engine's top 100 results for each query were filtered out. The websites' reliability and level of quality were evaluated using the JAMA and DISCERN scores, respectively. Readability was analyzed by the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Gunning Fog index (GFI), Simple Measure of Gobbledygook (SMOG) index, the Coleman-Liau score (CL), the Linsear Write (LW) readability formula and the Automated Readability Index (ARI), via an online readability tool. Of the 151 websites, 81.5% were private dental clinics, 9.3% were advertising sites, 4.6% were national health services, and 4.6% were nonprofit organizations. 11.3% of the websites achieved all four JAMA benchmarks, and the JAMA average of all websites was 2.06. The mean FRES was 54.48, and the mean GFI was 12.82. The mean DISCERN scores for all websites were 43.64 and the DISCERN scores of the websites prepared by periodontologists were statistically significantly higher than the others. The online health information regarding gingival recession has fair reliability and difficult readability. It is essential to produce website information free from commercial bias and simple for patients to understand fully. [ABSTRACT FROM AUTHOR]

Purpose: Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles. Method: The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected. Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors. Results: Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores--as measured by the Peabody Picture Vocabulary Test-Fourth Edition--were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs. Conclusions: The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism. [ABSTRACT FROM AUTHOR]

Standard reading passages allow for the study of the integrated functions of speech and voice components in contextual, running speech, with target stimuli in a controlled environment. In both clinical practice and research, these texts provide rapid insight into the characteristics of the patient's speech, with fewer hesitations than in conversational speech and better predictability by the evaluator. Although a plethora of texts exist in different languages, they present various limitations. A specifically created standardised text in each language allowing for an ecological assessment of speech and voice functions, meeting most required criteria for standard speech and voice assessment and adapted to the target language's cultural and linguistic specificities, would therefore be an interesting option. However, no guidelines exist for the creation of such a reading passage. This article describes the international Delphi consensus study carried out to identify a minimal set of criteria to take into account when creating standard reading passages for an overall speech and voice assessment in adolescents and adults. This survey was conducted in three consecutive rounds; forty experts participated in the first round, with a total dropout of 17% from round 1 to round 3. It results in a minimal set of ten criteria which were selected by a majority of the experts and were rated as most important. This set contains five phoneme-level, two word-level, two sentence-level criteria and one global-level criterion. It can be used as a general guideline for the creation of standard reading passages in Indo-European Romance and Germanic languages such as English, French and German. The construction of a new reading passage in French following this guideline is briefly described. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the readability and reliability of online content related to cerebral palsy (CP) and to classify sites that contain quality and readable information. On April 30, 2022, the term "cerebral palsy" was searched on the Google search engine. The categories, quality, content, readability, Alexa rank values, and backlink numbers of the sites were analyzed. The Journal of American Medical Association score and HONcode seal were used for quality assessment, and the Flesch–Kincaid grade (FKG) and the Simple Measure of Gobbledygook (SMOG) were used for readability assessment. Of the 155 sites, 46 had high-quality content. The quality of health portal and scientific publishing sites appeared to be high. The top 10 sites were determined to be of significantly higher quality (p =.017) than the remaining sites. The average readability values of the sites were not at the recommended level. Despite the abundance of information available on CP-related websites, most of them were not of high quality. Additionally, many websites did not reach the recommended readability levels. Revision of existing online content related to CP and production of new high-quality content in line with readability recommendations is urgently required. [ABSTRACT FROM AUTHOR]

The problem in language comprehension in people with right hemisphere damage (RHD) is more equivocal than people with left hemisphere damage. This study explores the reading and listening comprehension of Cantonese-speaking individuals with RHD, left hemisphere damage, and neurotypical healthy controls using the Cantonese Computerized Revised Token Test (CRTT-Cantonese) adapted from the English CRTT. Eighteen native Cantonese-speaking individuals with RHD, 32 individuals with left hemisphere damage and aphasia (PWA), and 42 healthy controls participated in this study. All the participants completed the Cantonese Aphasia Battery, Hong Kong Oxford Cognitive Screen, the listening comprehension version of CRTT-Cantonese (CRTT-L-Cantonese), and the reading comprehension version of CRTT-Cantonese (CRTT-R-WF-Cantonese) across different sessions. Linear mixed-effect analysis revealed significant differences among the groups in CRTT-Cantonese tests. However, there were no significant difference between CRTT-L-Cantonese and CRTT-R-WF-Cantonese within the PWA, RHD and healthy control groups. Tukey post-hoc pairwise comparisons showed that PWA scored significantly lower than RHD and healthy control groups (p < 0.0001) in both CRTT-L-Cantonese and CRTT-R-WF-Cantonese, and the RHD group scored significantly lower than healthy control group only on the CRTT-R-WF-Cantonese. The results demonstrate that the CRTT-L-Cantonese and CRTT-R-WF-Cantonese differentiate language comprehension abilities among PWA, RHD and healthy control groups. Although the current findings did not show any diversion between reading and listening comprehension in RHD group, this group showed poorer performance in reading comprehension when compared to healthy controls. The latter findings may support the view that the right hemisphere contributes to reading comprehension in Chinese. [ABSTRACT FROM AUTHOR]

Self-efficacious children are expected to be more task-focused in challenging achievement situations and consequently have better chances of overcoming learning difficulties than children who have lower self-efficacy. The present study investigates this presumption with Finnish-speaking first graders struggling with reading acquisition (N = 285). The development of the children's reading fluency, self-efficacy, and task avoidance was followed from the middle of Grade 1 to the end of Grade 2, and a 6-week mobile game-based intervention was administered to those who exhibited the greatest risk for reading disabilities (≤ 5th percentile). Exploratory structural equation modeling was used to test the theoretical model. The results suggest that higher self-efficacy in the middle of Grade 1 predicted lower task avoidance and higher reading fluency at the end of Grade 1, but no support for the mediating role of task avoidance was found. The intervention benefited both self-efficacy and reading fluency. [ABSTRACT FROM AUTHOR]

How does linguistic structure affect children's developing cardinal number knowledge? The bootstrapping theory proposes that children might use syntactic information provided by known words such as quantifiers to bootstrap the meanings of unfamiliar words such as number words. Prior studies of numeral and quantifier development have indicated that the bootstrapping mechanism that children can use to discover numeral meanings might work differently in different languages. Nevertheless, support for this conclusion remains preliminary. The present study explored this hypothesis through an investigation of the possible relations between cardinal number knowledge and quantifier comprehension in Mandarin Chinese-speaking children. Notably, in contrast with previous studies, this study also offered a glimpse into children's receptive vocabulary development and its relation with cardinal number knowledge and quantifier comprehension. Results showed that cardinal number knowledge did not seem to be correlated with quantifier comprehension (both "exact" and "non-exact" quantifiers) when controlling for such covariates as children's age, gender, parent education, and family income. Moreover, children's receptive vocabulary size explained a significant amount of variance in their quantifier knowledge over and above children's age, gender, parent education, and family income, but not in their cardinal number development over and above these covariates. These results provide further evidence for the hypothesis that while the bootstrapping mechanism may facilitate number word learning in children speaking languages like English, it might play a lesser role in children speaking classifier languages such as Mandarin Chinese. Implications for the role that general receptive vocabulary plays in the acquisition of number words and quantifiers are also discussed. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) affects the language processes, with a significant impact on the patients' daily communication. We aimed to describe specific alterations in the comprehension of syntactically complex sentences in patients with PD (PwPD) as compared to healthy controls (HC) and to identify the neural underpinnings of these deficits using a functional connectivity analysis of the striatum. A total of 20 patients PwPD and 15 HC participated in the fMRI study. We analyzed their performance of a Test of sentence comprehension (ToSC) adjusted for fMRI. A task-dependent functional connectivity analysis of the striatum was conducted using the psychophysiological interaction method (PPI). On the behavioral level, the PwPD scored significantly lower (mean sd: 77.3 12.6) in the total ToSC score than the HC did (mean sd: 86.6 8.0), p = 0.02, and the difference was also significant specifically for sentences with a noncanonical word order (PD-mean sd: 69.9 14.1, HC-mean sd: 80.2 11.5, p = 0.04). Using PPI, we found a statistically significant difference between the PwPD and the HC in connectivity from the right striatum to the supplementary motor area [SMA, (4 8 53)] for non-canonical sentences. This PPI connectivity was negatively correlated with the ToSC accuracy of non-canonical sentences in the PwPD. Our results showed disturbed sentence reading comprehension in the PwPD with altered task-dependent functional connectivity from the right striatum to the SMA, which supports the synchronization of the temporal and sequential aspects of language processing. The study revealed that subcorticalcortical networks (striatal-frontal loop) in PwPD are compromised, leading to impaired comprehension of syntactically complex sentences. [ABSTRACT FROM AUTHOR]

This study investigated young children's ability to draw psychological and nonpsychological inferences during reading comprehension. Whereas nonpsychological inferences require the retrieval of general background knowledge, psychological inferences rely on more contextualised knowledge relating to mental states. Based on several pretests, children, who were able to read fluently, aged 7-8 years (second graders; n = 42) and 8-9 years (third graders; n = 46) were assigned to either a skilled comprehenders group or a less skilled comprehenders group, based on their listening comprehension. They were then given short stories to read, followed by comprehension questions. Some questions required the drawing of psychological or nonpsychological inferences. Generalized linear mixed models revealed that (a) psychological inferences were more difficult to generate than nonpsychological inferences for all the children, skilled and less skilled comprehenders alike, (b) both types of inference skills (psychological and nonpsychological) were associated with similar improvements as grade level increased, and (c) less skilled comprehenders had greater difficulty than skilled comprehenders generating psychological and nonpsychological inferences. [ABSTRACT FROM AUTHOR]

The consistency effect, prevalent in the text comprehension literature, comprises longer reading times for inconsistent than equivalent consistent text continuations. It is widely interpreted as reflecting readers' effective "validation" of text coherence. However, there are also numerous phenomena of readers' deficient validation, sometimes collectively labelled "misinformation effects." This study asked whether readers become consciously aware of the text discrepancies diagnosed by the consistency effect. Experiment 1 scrutinized (a) conspicuous conceptual inconsistencies and (b) character-trait inconsistencies. It replicated the consistency effect both at a critical target sentence and at a subsequent sentence (spillover). Experiment 2 replaced self-paced reading with consistency judgments about the target sentences. The subjects overlooked almost half of the inconsistencies, thus denying that readers reliably become aware of consistency-effect discrepancies. In Experiment 3, the former target sentences were reframed as explicit questions. Accuracy for inconsistencies was statistically indistinguishable from accuracy for consistent targets, favoring the interpretation that Experiment 2 subjects overlooked known, encoded discrepancies. The results are interpreted with reference to Kintsch's (Psychological Review, 95, 163-182, Kintsch, 1988; Comprehension. New York: Cambridge University Press, Kintsch, 1998) construction-integration model, a refinement of which adds an immediate, passive stage of validation processing to construction and integration. It is proposed that passive validation affords the detection of text inconsistencies that do not reach the level of readers' conscious awareness. [ABSTRACT FROM AUTHOR]

Importance: Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions. Objective: To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL. Design: Cross-sectional, repeated observation, test–retest. Setting: Elementary schools in Taiwan. Participants: We recruited 25 lower-grade children for the examination of test–retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility. Outcomes and Measures: Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale. Results: The CAM-CHL demonstrated good to excellent test–retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children. Conclusions and Relevance: The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure. This study supports the use of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) as an outcome measure with acceptable psychometrics for the comprehensive evaluation of the handwriting legibility of school-age children. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the method of developing initial codes from interview recordings • To learn the advantages and disadvantages of generating initial codes from reading transcriptions and from listening to recordings • To create strategies for efficiently analysing data in a grounded theory study Background: Interviewing is a vital and common method of collecting data in qualitative research. The interview is usually recorded and a written transcription is created from the recording. The transcription document is then analysed by reading and re-reading to fracture the data and develop initial codes, as in grounded theory methodology. However, this method has disadvantages. Aim: To report on how the authors used the process of generating initial codes during their analysis in a research study. Discussion: The authors compare the rigour and efficiency of generating initial codes from reading written transcripts with generating initial codes from listening to recordings. The most notable difference between the two methods is the length of time needed to transcribe the recording before coding can start. The authors discuss the lessons they learned from their pragmatic decision to expedite initial coding by listening to rather than reading the interview data. Conclusion: Grounded theory requires concurrent data generation and analysis. Audio analysis is efficient in developing initial codes from interview recordings. Implications for practice: Nurse researchers can use the audio method of analysing interview data [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the ease of reading cochlear implant (CI) brochures provided to parents and caregivers who are making informed decisions about the management of their child's hearing loss. Method: CI brochures from three Food and Drug Administration--approved CI manufacturers were examined: Advanced Bionics, Cochlear Americas, and MED-EL. Reading grade levels and ease of reading were analyzed using a commercially available computer software program, applying six readability formulas commonly used to examine hearing-related patient education materials (PEMs). Results: The readability of the CI brochures exceeds the fifth- to sixth-grade reading-level guidelines. The CI brochures may be difficult for the average English-speaking adult to read with ease and requires at least a 10th-grade comparable reading level. Conclusions: Despite health literacy initiatives, audiology-focused PEMs continue to be created without full consideration of the burden for the reader. Authors of PEMs should consider the average reading level of the reader as a variable potentially influencing the decision-making process. Likewise, clinicians should consider the average reading level needed to understand PEMs when presenting information and resources to parents and caregivers for informed and shared decision making. [ABSTRACT FROM AUTHOR]

Three patient education texts from the National Cancer Institute (NCI) were subjected to a Coh-Metrix analysis, then further analyzed to obtain Gist Inference Scores (GIS), a new measure of the likelihood that readers will make appropriate inferences about a text's bottom-line meaning. In the GIS formula, the Coh-Metrix psycholinguistic variables referential cohesion, deep cohesion, and latent semantic analysis (LSA) verb overlap increase GIS because cohesive texts that describe related actions are likely to induce gist representations. The Coh-Metrix variables word concreteness, imagability for content words, and hypernymy for nouns and verbs are negatively weighted because they tend to promote verbatim mental representations. NCI texts were modified for a cloze procedure with every tenth word replaced by a blank starting with the second sentence. Participants in two studies received all three cloze-modified texts. Fuzzy-Trace Theory suggests that people are more likely to comprehend high GIS texts "in their own words," and thus fill-the-blanks with multiple words that differ from those omitted by the cloze procedure expressing comparable meaning. In Study One, non-native English speakers appropriately filled blanks with different words at the same rate for all three texts of low-, medium-, and high-GIS. In Study Two, replicating previous findings, for high GIS texts, native English speakers filled blanks appropriately with words other than those removed significantly more often than for medium- or low-GIS texts. High GIS texts apparently afford readers more semantic and lexical flexibility, but non-native English speakers may be ill-equipped to capitalize on this characteristic of high GIS texts. [ABSTRACT FROM AUTHOR]

This study analyzes the compositions of Hong Kong English as a second language (ESL) learners and English as a foreign language (EFL) learners in Mainland China in terms of lexical and syntactic features. A program based on the CoreNLP was developed and used to analyze written language texts, and differences in tags of parts of speech and syntactic dependencies between the two groups of texts were compared statistically to examine differences in the lexical and syntactic features of the learners’ written language. The results show significant differences in the lexical and syntactic features of learners’ writing. Specifically, in EFL learners’ writing, there is a salient group pattern of higher lexical diversity, whereas ESL compositions are more flexible in vocabulary use with higher information density, in that they use more syntactic phrases and content words. In terms of syntax, Hong Kong ESL students use more adverbials and adverbial clauses, which is advantageous in syntactic simplicity and readability over their counterparts, whereas Mainland China EFL students prefer using more specific expressions to demonstrate syntactic relations. Compared to EFL compositions, ESL compositions are more informative, coherent, and grammatical in lexical features and more readable in syntactic features, which require more attention and further improvements in terms of EFL teaching. [ABSTRACT FROM AUTHOR]

• Traumatic brain injury (TBI) increases risk for negative life outcomes. • Individuals with a history of TBI are overrepresented in the criminal justice system. • Understanding Miranda warnings is an early high stakes test in the criminal system. • Adults with TBI are less accurate than non-injured peers on measure of Miranda warning comprehension. • Simplifying the language used in legal contexts may improve outcomes post-TBI. To compare comprehension of Miranda rights in adults with traumatic brain injury (TBI) versus adults without TBI as measured by response accuracy on the Miranda Right Comprehension Instruments. Data were collected virtually via teleconferencing from July 2022 to February 2023. Participants included 25 adults with moderate-severe TBI (12 females, 13 males) and 25 adults without TBI (12 females, 13 males), ages 20-55 years. In this observational study, both groups (with and without TBI) completed the Miranda Right Comprehension Instruments (MRCI), which includes four instruments including Comprehension of Miranda Rights, Comprehension of Miranda Rights-Recognition, Function of Rights in Interrogation, Comprehension of Miranda Vocabulary instruments. Response accuracy on the MRCI was compared across groups. The TBI group was significantly less accurate when responding to questions on the MRCI compared to the NC group. Individuals with chronic moderate-severe TBI underperform their non-injured peers on the Miranda Rights Comprehension Instruments, a tool used in legal settings when there is doubt about an individual's understanding of their Miranda rights. TBI is a risk factor for disruptions in comprehension of language in legal contexts that may, in part, contribute to the increased interaction with the criminal justice system and incarceration for individuals with TBI. Implications for policy, advocating, and intervention are discussed. [ABSTRACT FROM AUTHOR]

• The results of two large-scale eye-tracking studies are reported. • A novel variable trailing mask paradigm was used to determine whether amount or location of rereading of NP/Z garden-path sentences was related to offline comprehension. • E1 presented comprehension questions after each sentence, and E2 presented the comprehension questions both before and after each sentence. • Results provide strong evidence (of multiple types) against selective reanalysis of NP/Z garden-paths. When people read temporarily ambiguous ("garden-path") sentences, the forward movement of their eyes is often interrupted by regressions. These regressions are usually followed by rereading some portion of the previously read text. Frazier and Rayner (1982) proposed the Selective Reanalysis Hypothesis (SRH), which proposed that readers regress to critical choice points in the syntactic phrase marker of garden-paths where misparses had occurred, and furthermore, then reanalyzed the syntactic structure to arrive at a correct parse in most cases. A considerable amount of more recent work, however, suggests that readers often do not derive a correct parse or interpretation from such sentences. If these more recent observations are accurate, perhaps rereading is not necessarily strategic, controlled, or predictable. The current study consists of two large-scale eye-tracking experiments designed specifically to examine where and how much people reread garden-path sentences, and whether rereading influences comprehension accuracy. A variable text-masking paradigm was employed to restrict access to portions of garden-paths and non-garden-paths during rereading. Scanpath analyses were used to determine whether some or all participants targeted syntactically critical parts of previously read text. Comprehension questions probed final interpretations. In short, readers often misinterpreted the garden-paths, and no rereading measures predicted better comprehension. Furthermore, scanpath analyses revealed considerable variation across and within readers; only small percentages of trials conformed to structurally-based predictions. Taken together, we fail to find support for structurally strategic rereading. We therefore propose that rereading of these sentences is more often "confirmatory" than "revisionary" in nature. [ABSTRACT FROM AUTHOR]

Electrophysiological studies suggest that situational event knowledge plays an important role in language processing, but often fail to distinguish whether observed effects are driven by combinatorial expectations, or simple association with the context. In two ERP experiments, participants read short discourses describing ongoing events. We manipulated the situational expectancy of the target word continuing the event as well as the presence of an associated, but inactive event in the context. In both experiments we find an N400 effect for unexpected compared to expected target words, but this effect is significantly attenuated when the unexpected target is nonetheless associated with non-occurring context events. Our findings demonstrate that the N400 is simultaneously influenced by both simple association with – and combinatorial expectations derived from – situational event knowledge. Thus, experimental investigations and comprehension models of the use of event knowledge must accommodate the role of both expectancy and association in electrophysiological measures. [ABSTRACT FROM AUTHOR]

Background: Consent is an important component of surgical care. Poorly attempted consent bears significant ethical and legal implications. We assessed the effectiveness of handouts in improving postoperative consent understanding and recall compared to standard verbal consent during laparoscopic cholecystectomy as a tool that may improve information retention and leads to better treatment satisfaction.Methods: This is a prospective block randomized, non-blinded study conducted at a single tertiary hospital. Patients undergoing elective laparoscopic cholecystectomy between August 2017 and October 2018 were recruited and randomized into Handout Assisted Consent (HC) and Verbal Consent (VC) group. The HC group was given an adjunct handout on laparoscopic cholecystectomy during consent process in addition to the standard verbal consent. A validated open-ended verbal understanding and recall questionnaire was administered to all patients in both groups at Day 1, 30 and 90 after surgery. Patient satisfaction of the consent process was evaluated with Likert scale.Results: A total of 79 patients were enrolled, 41 patients and 38 patients in VC and HC groups respectively. Level of understanding among patients were equal and consistent across time in both groups (P > 0.05). There was significant decline (P < 0.0001) for both groups in ability to recall information between Day 1 to Day 30 and Day 30 to Day 90. A slightly higher satisfaction rate was found among patients that received HC (P > 0.05).Conclusion: There is good consistent understanding of the surgery in both groups. However, recall of specific surgical consent items decreased significantly over time in both groups. Handouts may have increased satisfaction among patients but did not improve recall in this preliminary study.Trial Registration: MREC No.:201783-5468. [ABSTRACT FROM AUTHOR]

Objective: Pictograms on prescription medication labels enhance medication literacy and medication adherence. However, pictograms need to be contextually validated. We assessed the validity of 52 International Pharmaceutical Federation pictograms among 250 older Singaporeans with limited English proficiency.Methods: Participants were randomly assigned 11 pictograms each. For each pictogram, participants were first asked its intended meaning. Then, they were told the intended meaning and asked to rate how well the pictogram represented the meaning, on a scale of 1-7. Pictograms were classified as valid (≥66% participants assigned the pictogram interpreted its intended meaning correctly [transparency criterion] and ≥85% participants rated its representativeness as ≥5 [translucency criterion]), partially valid (only transparency criterion was fulfilled) or not valid. Open-ended questions gathered feedback to improve pictograms.Results: 14 pictograms (26.9%) achieved validity and 6 pictograms (11.5%) achieved partial validity. A greater proportion of pictograms for dose and route of administration, and dosage frequency achieved validity or partial validity versus those depicting precautions, indications or side effects.Conclusion: Majority (61.5%) of the assessed pictograms did not achieve validity or partial validity, highlighting the importance of contextual validation.Practice Implications: Low pictogram comprehension emphasizes the importance of facilitating pictogram understanding during medication counseling. [ABSTRACT FROM AUTHOR]

Background: Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing. Objective: This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women. Design: A 2 (modality [textual vs. audiovisual]) × 3 (narration style [factual vs. process narrative vs. experience narrative]) online experiment was conducted. Information about breast cancer care was used as a case example. Age (younger [<65] vs. older [≥65]) was included as a potential effect modifier. Setting and Participants: A total of 631 disease‐naïve women (Mage = 56.06) completed an online survey. The outcomes were perceived cognitive load, satisfaction, comprehension, information recall and decisional conflict. Data were analysed using AN(C)OVAs. Results: Audiovisual (vs. textual) information resulted in higher information satisfaction across age groups, but was associated with lower comprehension in older women. An experience narrative (vs. factual information) increased satisfaction with attractiveness and emotional support of the information only in older women. A three‐way interaction effect was found, suggesting that older women were most satisfied with the comprehensibility of audiovisual factual or textual process narrative information. Younger women were most satisfied with the comprehensibility of audiovisual process narrative or textual factual information. Discussion and Conclusion: Audiovisual and narrative information in an HRC showed beneficial effects on satisfaction measures. In particular, audiovisual information could be incorporated into HRCs to increase satisfaction with information. Public Contribution: Lay persons helped in optimizing the visuals used in the stimulus materials by checking for clarity. [ABSTRACT FROM AUTHOR]

We conducted two separate but related multiple baseline with alternating treatment single-case design studies to investigate the effect of the same reading intervention for students with autism spectrum disorder being implemented under different conditions. We conducted a researcher-implemented study in a public school (Study 1) and a teacher-implemented study in a specialized private charter school for children with ASD (Study 2). In each study, we compared a typical intervention approach with interest-based text intervention that included reading on each child's interest area. The treatment included systematic vocabulary instruction and main-summarization strategy instruction. Findings from Study One showed consistent increases in comprehension and vocabulary outcomes compared to baseline. In Study Two the baselines phases were unstable with small differences in mean scores detected for vocabulary during the intervention phase favoring the interest-based treatment for three of four participants. The results across studies were mixed indicating the importance of taking into account contextual factors including student characteristics and learning environment. [ABSTRACT FROM AUTHOR]

This study investigates reading comprehension in adult deaf and hearing readers. Using correlational analysis and stepwise regression, we assess the contribution of English language variables (e.g., vocabulary comprehension, reading volume, and phonological awareness), cognitive variables (e.g., working memory (WM), nonverbal intelligence, and executive function), and language experience (e.g., language acquisition and orthographic experience) in predicting reading comprehension in deaf and hearing adult bilinguals (native American Sign Language (ASL) signers, non-native ASL signers, and Chinese–English bilinguals (CEB)), and monolingual (ML) controls. For all four groups, vocabulary knowledge was a strong contributor to reading comprehension. Monolingual English speakers and non-native deaf signers also showed contributions from WM and spoken language phonological awareness. In contrast, CEB showed contributions of lexical strategies in English reading comprehension. These cross-group comparisons demonstrate how the inclusion of multiple participant groups helps us to further refine our understanding of how language and sensory experiences influence reading comprehension. [ABSTRACT FROM AUTHOR]

PURPOSE Treatment Summaries and Survivorship Care Plans (TS/SCPs) may be difficult for patients to comprehend because of readability, magnitude of information, and complex medical verbiage. METHODS Readability scores were calculated for TS/SCP templates including ASCO, Oncolink, Journey Forward, and the authors' institution. The Simple Measure of Gobbledygook (SMOG) index, Flesch-Kincaid reading grade level, Coleman-Liau Index, and Gunning Fog index were used to assess readability. RESULTS The Flesch-Kincaid reading ease scores for the blank ASCO templates ranged from 47.4 to 53.3, requiring a reading grade level of 10-12. Coleman-Liau and Gunning Fog scores showed that an 11th grade reading level is essential, and SMOG required a college education to comprehend the ASCO templates. For the colorectal case exemplar, Oncolink's template resulted in the lowest SMOG score (11.3; 11th grade), Flesch-Kincaid reading grade level (11; 11th grade), and Coleman-Liau score (12; 12th grade). Journey Forward's TS/SCP template scored the highest on the SMOG (21.2; college graduate), Flesch-Kincaid reading grade level (18.3; college graduate), and Gunning-Fog index (25.8; college graduate) compared with other TS/SCPs. CONCLUSION The existing TS/SCP templates used by US cancer centers are written at a grade level beyond the comprehension of most adults. Cancer care teams should assess TS/SCP content for readability and use of plain language and reduce medical jargon. [ABSTRACT FROM AUTHOR]

Background: Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making before major surgery.Study Design: We audio-recorded 90 preoperative patient-surgeon conversations before major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the US and Canada. Transcripts were scored for 11 elements of informed consent based on the American College of Surgeons' definition and 9 elements of informed decision-making using Braddock's validated scale. Uni- and bivariate analyses tested associations between decision outcomes as well as patient, consultation, and surgeon characteristics.Results: Overall, surgeons discussed more elements of informed consent than informed decision-making. They most frequently described the nature of the illness, the operation, and potential complications, but were less likely to assess patient understanding. When a final treatment decision was deferred, surgeons were more likely to discuss elements of informed decision-making focusing on uncertainty (50% vs 15%, p = 0.006) and treatment alternatives (63% vs 27%, p = 0.02). Conversely, when surgery was scheduled, surgeons completed more elements of informed consent. These results were not associated with the presence of family, history of previous surgery, location, or surgeon specialty.Conclusions: Surgeons routinely discuss components of informed consent with patients before high-risk surgery. However, surgeons often fail to review elements unique to informed decision-making, such as the patients' role in the decision, their daily life, uncertainty, understanding, or patient preference. [ABSTRACT FROM AUTHOR]

Purpose: Most patients diagnosed with cancer are administered systemic therapy and these patients are counselled and given printed education (PE) materials. High rates of low health literacy highlight the need to evaluate the quality of these PE materials.Methods: A current state assessment of the quality of PE materials was conducted in Ontario, Canada. Patient education leaders from 14 cancer centres submitted print materials on the topic of systemic cancer therapy to the assessment team. To report adherence to PE quality and health literacy best practices, the following validated measures were used: readability (FRY, SMOG and Flesch Reading Ease), understandability and actionability (Patient Education Materials Assessment Tool (PEMAT)). Materials at grade level 6 or lower and with PEMAT scores greater than 80% were considered to meet health literacy best practices.Results: A total of 1146 materials were submitted; 366 met inclusion criteria and 83 were selected for assessment. Most materials scored below the 80% target for understandability (x̄ = 73%, 31-100%) and actionability (x̄ = 68%, 20-100%), and above the recommended grade 6 readability level (x̄ = grade 9) meaning that the majority did not meet quality standards or best practices.Conclusion: Results suggest that there is significant opportunity to improve the quality of PE materials distributed by cancer centres. The quality of PE materials is a critical safety and equity consideration when these materials convey important safety and self-care directives. [ABSTRACT FROM AUTHOR]

Objective: This study aimed at evaluating the quality and readability of online information about breast cancer written in Chinese.Methods: An Internet search was conducted for "breast cancer" in Chinese using the Baidu search engine. Website quality was evaluated using the DISCERN instrument, and readability was evaluated using the Chinese Readability Index Explorer (CRIE). Higher DISCERN score indicated higher quality of websites, while higher CRIE score indicated lower readability of the content of the websites. We also investigated the effects of website producer category, and the associations of search engine ranking with DISCERN and CRIE scores.Results: A total of 49 websites were included. The mean overall DISCERN score was 50.27 ± 4.14, and the mean CRIE score was 6.78 ± 0.16. Websites produced by non-profit organizations had the highest overall DISCERN scores, while those produced by private individuals had the lowest CRIE scores. Search engine ranking had no significant correlation with website quality or readability.Conclusions: The quality and readability of breast cancer websites in Chinese were not satisfactory, and they varied among different website producer categories.Practice Implications: Website producers should seek to provide more accurate, comprehensive, and easy-to-understand information to better meet the needs of breast cancer patients. In addition, search engines should revise algorithms to promote websites with higher quality and accessibility. [ABSTRACT FROM AUTHOR]

Mayer (2017, 2020) proposed three major design features of computer-assisted instructions (CAI) within the Cognitive Theory of Multimedia Learning: reducing extraneous processing (i.e., excluding irrelevant content), managing essential processing (i.e., focusing on the complex but essential learning materials), and fostering generative processing (i.e., maximizing learner motivation with multimedia features). No study so far has systematically evaluated each design feature, or their combinations for students with reading difficulties. The present study is the first meta-analysis to investigate the optimal design features of CAIs for students with reading difficulties on their decoding/word reading and reading comprehension performance. A total of 49 experimental studies were reviewed with Bayesian network meta-analysis. Results showed that CAI programs with features that reduced extraneous processing were the most effective (g = 0.65) followed by programs that combined reducing extraneous processing, managing essential processing, and fostering generative processing (g = 0.29) as well as programs that combined reducing extraneous processing and managing essential processing (g = 0.27). CAI programs yielded larger effects when they were designed for younger learners with reading difficulties compared to older learners. No significant moderation effects were observed for students' reading difficulty status, reading content, reading outcomes, instruction dosages, control group types, measures, and fidelity checks. These findings suggest that different combinations of design features of CAI programs may generate different effects. Lowering students' cognitive loads by excluding irrelevant content may be the foundation for designing effective computer instructions for students with reading difficulties. • Focus on the design feature of computer assisted instruction on reading difficulties • Network meta-analysis is utilized to explore various combinations of design features • Reducing extraneous processing is an active-ingredient design feature • Different combinations of design features generate different effects on reading [ABSTRACT FROM AUTHOR]

Background: In the context of translational research, researchers have increasingly been using biological samples and data in fundamental research phases. To explore informed consent practices, we conducted a retrospective study on informed consent documents that were used for CARPEM's translational research programs. This review focused on detailing their form, their informational content, and the adequacy of these documents with the international ethical principles and participants' rights.Methods: Informed consent forms (ICFs) were collected from CARPEM investigators. A content analysis focused on information related to biological samples and data treatment (context of sampling and collect, aims, reuse, consent renewal), including the type of consent. An automatic assessment of the readability of the ICFs were performed with the IT program "Flesch Score".Results: 29 ICFs from 25 of 49 studies were analyzed after selection criteria were applied. Three types of consent were identified: 11 broad consents, six specific consents, and two opt-out consents. The Flesch Scores showed that most of the documents were too complex to be fully understood by most of the potential research participants. Most of the biological samples were collected during the healthcare routine, but the information content about secondary use of biological samples varied between ICFs. All documents mentioned personal data treatment but information about their reuse was not standardized in the ICFs.Conclusions: Our review of current IC procedures of CARPEM showed that practices could be improved considering new translational research methods. "Old fashion written ICFs" should be adapted to the translational research approach, to better respect individual rights and international research ethics principles. In this context, theoretically, a digital tool allowing dynamic information and consent of participants, through an electronic interactive platform may be a good way to promote more active participation in research. Nevertheless, its feasibility in the complex environment of biological samples and data research remains to prove. The way of a combination of a broad consent followed by dynamic information may be alternatively tested. [ABSTRACT FROM AUTHOR]