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Introduction Learning disability has a significant relevance and can generate negative social impacts on the future of an individual if not corrected in time. Phoniatrics is an area of otorhinolaryngology responsible for evaluating, diagnosing, and referring these cases for therapy and/or complementing the multidisciplinary diagnosis. Objective To evaluate in school-aged children the association between the application of a set of tests used in the phoniatric assessment and complaints of academic difficulties. To identify which tests would show the main association with academic performance when applied individually. Methods Blind, cross-sectional study, subdivided into 4 stages. In the 1st stage, 66 children in the third year of elementary school were submitted to the set of tests of skills applied by the phoniatrician; in the 2nd stage, the physician asked the educators about complaints of academic difficulties regarding the students; in the 3rd stage the students’ Portuguese language school grade was obtained and in the 4th stage an analysis was made between the data. Results The educator identified complaints of academic difficulties in 27.2% of the 66 students. There was a statistically significant association between academic difficulties and the following tests of skills: dictation of words and pseudowords, dictation of words, dictation of pseudowords, rhyming, phonemic synthesis, and in the reading test; fluency, intonation and comprehension of the text and morals were analyzed in the reading test. In the multivariate logistic regression analysis, the tests selected to comprise the final model, showing greater association with the academic difficulty complaint were: dictation of words, intonation in reading and comprehension of the morals of the story. Conclusion The tests identified as the most relevant in identifying academic difficulties were dictation of words, intonation in reading and comprehension of the morals of the story. However, the other tests that were part of the phoniatric consultation allowed the observation of the individual and their functioning abilities, leading to a better assessment of the case, regarding aspects not directly related to the pedagogical one.

Modern patients use the internet more frequently for their health information. Our aim was to assess the quality and readability of online patient education materials relating to revision knee arthroplasty. We hypothesised that this information would be too difficult to read for the average patient and of a lesser quality than desired.A search of the top 50 results on 3 search engines (Google, Bing, Yahoo) was completed (MeSH "revision knee arthroplasty", "revision knee replacement"). Readability of these websites was calculated using a specialised website, www.readable.com to produce 3 scores (Gunning-Fog (GF), Flesch Reading Ease (FRE), Flesch-Kincaid Grade (FKG). Quality was assessed using the Journal of American Medical Association (JAMA) benchmark criteria and the Health On the Net (HON) code toolbar extension.89 unique websites were identified. Mean FRE was 44.01 ± 11.05. The mean GF was 12.01 ± 2.94. The mean FKG level was 10.06 ± 1.95. As per the FRE score, no webpage was pitched at or below a sixth grade reading level. The GF index identified only 3 websites (3.4%) at 6th grade reading level. As per FKG score, most webpages (n = 58, 65.2%) found themselves in the 10th grade reading level and above. Four websites (4.5%) displayed a HONcode certificate. However, all had expired. Most websites (n = 34, 38.2%) didn't meet any of the JAMA criteria.The reading level of these materials is too high for the average patient and of a low quality. Given what we know about levels of health literacy and their relationship with patient outcomes, it is vital that we address these deficiencies promptly.

ObjectiveOnline resources can be a valuable source of information for patients and have been shown to result in more inquiry during medical office visits, following physician medical recommendation more closely, and making self-directed lifestyle changes. The accessibility to these resources is limited by the readability level of the article and the literacy level of the population. Peripheral artery disease (PAD) is estimated to affect between 8 and 12 million people in the United States with greater disease severity among under insured or uninsured populations. As PAD continues to increase in prevalence, it is imperative that patients have access to comprehensible patient-centered health information. This study aims to evaluate the readability of online PAD patient education materials.MethodsThe search engine Google was used to collect the first 25 patient-accessible online articles pertaining to the search term "peripheral artery disease." Articles were then categorized by source type: hospital, professional society, or other. Readability was measured using the following tests: Automated Readability Index, Coleman-Liau Index, Flesch-Kincaid Grade Level, Gunning Fog, Linsear Write Formula, and the SMOG Index. Statistical analyses were performed using Statistical Analysis Software, with P values less than .05 being statistically significant.ResultsTwenty-five articles were categorized by source and statistically analyzed. The average readability of PAD patient education materials was 10.8 and significantly above the American Medical Association, National Institutes of Health, and US Department of Health and Human Services recommended reading level of sixth grade. Readability scores among source categories were not significantly different.ConclusionsCommonly available online PAD resources are written at a grade level above that currently recommended by medical societies. Hospitals, professional societies, and other stakeholders in PAD patient education should take into consideration the readability of their materials to make medicine more accessible. Readable articles may combat the historic and structural racism often found in our health care system that marginalizes those with lower health literacy. It is imperative to develop patient education at an appropriate level to enrich patient autonomy.

Background Three-dimensional (3D) models improve the comprehension of renal anatomy. Objective To evaluate the impact of novel 3D-derived parameters, to predict surgical outcomes after robot-assisted partial nephrectomy (RAPN). Design, setting, and participants Sixty-nine patients with cT1-T2 renal mass scheduled for RAPN were included. Three-dimensional virtual modeling was achieved from computed tomography. The following volumetric and morphological 3D parameters were calculated: VT (volume of the tumor); VT/VK (ratio between tumor volume and kidney volume); CSA3D (ie, contact surface area); UCS3D (contact to the urinary collecting system); Tumor-Artery3D: tumor’s blood supply by tertiary segmental arteries (score = 1), secondary segmental artery (score = 2), or primary segmental/main renal artery (scoren = 3); ST (tumor’s sphericity); ConvT (tumor’s convexity); and Endophyticity3D (ratio between the CSA3D and the global tumor surface). Intervention RAPN with a 3D model. Outcome measurements and statistical analysis Three-dimensional parameters were compared between patients with and without complications. Univariate logistic regression was used to predict overall complications and type of clamping; linear regression was used to predict operative time, warm ischemia time, and estimated blood loss. Results and limitations Overall, 11 (15%) individuals experienced overall complications (7.2% had Clavien ≥3 complications). Patients with urinary collecting system (UCS) involvement at 3D model (UCS3D = 2), tumor with blood supply by primary or secondary segmentary arteries (Tumor-Artery3D = 1 and 2), and high Endophyticity3D values had significantly higher rates of overall complications (all p ≤ 0.03). At univariate analysis, UCS3D, Tumor-Artery3D, and Endophyticity3D are significantly associated with overall complications; CSA3D and Endophyticity3D were associated with warm ischemia time; and CSA3D was associated with selective clamping (all p ≤ 0.03). Sample size and the lack of interobserver variability are the main limits. Conclusions Three-dimensional modeling provides novel volumetric and morphological parameters to predict surgical outcomes after RAPN. Patient summary Novel morphological and volumetric parameters can be derived from a three-dimensional model to describe surgical complexity of renal mass and to predict surgical outcomes after robot-assisted partial nephrectomy.

OBJECTIVE: To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. METHODS: This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. RESULTS: Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. CONCLUSIONS: Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. PRACTICE IMPLICATIONS: Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.

The burden of peripheral artery disease is significant for public health but the readily available on-line information on the disease is poorly studied. This study seeks to evaluate the quality and readability of patient resources and identify gaps that appear in the top search results for peripheral artery disease.Internet searches were performed for "PAD" and "Peripheral Artery Disease" and "PVD" on three search engines and two metasearch engines. The top 30 websites from each search engine were compiled, screened, and evaluated across four categories of information to assess overall quality: accountability, interactivity, structure, and content. Four indices were used to evaluate readability of the text for the viewer. Statistical analyses was performed using Rstudio with ANOVA.Sixty-three websites met inclusion criteria, of which 25 were open access (34.9%), 30 were from hospital/healthcare organization (48%), 5 were from a governmental agency (8%), 4 were industry sponsored (6%), and 2 were from professional medical societies (3%). Median total quality score was 19 out of 47 (IQR, 15 -30): of the components of this score, accountability was 5 out of 17 (2 -10), interactivity was 2 out of 5 (2.0 -2.0), site structure was 3 out of 4 (2.5 -3.0), and site content was 11 out of 21 (7 -14). Total score varied significantly by organization type (P = 0.007). Open access (30, 17 -34, median, IQR) and governmental agency (30, 29 -31) websites scored the highest while hospital/healthcare organization (16, 14v21) websites scored the lowest. Overall readability was low with a median Flesch-Kincaid Grade Level Score of 10.7 (IQR, 10 -12). Using this index, only one website (1.6%) was written below the recommended 6th grade reading level.Freely available online patient education materials for peripheral artery disease are poor, have varying quality, and are largely written at a level higher than that of an average US adult thus depriving the patient from understanding the existing information. We recommend that the vascular surgery community re-examine the current offering and provide improved readable websites to patients to facilitate patient education and shared decision making.

To measure the accessibility of Australian web-based health information for midlife women including those from culturally and linguistically diverse (CALD) backgrounds or with low health literacy.Search terms relating to midlife health were entered into Google Australia to identify health information websites. The content of the first two results pages was assessed using the European Commission's quality criteria for health websites. Readability was assessed using the Flesch Readability Ease Score with Grade 8 accepted as the average Australian reading level.Sixteen websites were evaluated. Accessibility scores ranged between 0 and 8. The Victorian Government's health website Better Health Channel and the Jean Hailes for Women's Health website contained the most accessible information, each scoring 8, but were both 'difficult to read' on the readability test. Four websites included written resources in languages other than English and two had information in audio-visual format in languages other than English.There is a gap in accessible online health information for Australian women from CALD backgrounds or those with low health literacy.Healthy behaviour changes in midlife may lead to better health in older age. More accessible health information resources are needed for women in midlife from CALD backgrounds and those with low health literacy.

International audience; Conversation represents a considerable amount of the daily language usage and plays an important role in language acquisition. In conversation, listeners simultaneously process their interlocutor's turn and prepare their own next turn. As such the turn-taking dynamics heavily relies on prediction. In other words, listeners avail prior knowledge to constrain both speech perception and production. Here we explored the relation between prediction and comprehension while watching two interlocutors having a conversation. We capitalize on gaze switch as a proxy of predictive behaviour to class dialogue turns as more or less well predicted and explore how this affects dialogue comprehension. Moreover, we study the extent to which speech degradation, by increasing the global uncertainty of the context, affects the relation between predictions, brain correlates of prediction errors (N400) and 2 global comprehension. Results show that 1) listeners direct gaze to the current speaker, in particular in challenging conditions, 2) gaze behaviour possibly affects the semantic processing of the upcoming turn (N400), 3) participants with a more efficient gaze predictive behaviour better solve semantic uncertainties at the turn onset, in particular in the most challenging listening condition. Our findings contribute to a better understanding of the relation between predictions, neural predictions errors and speech comprehension under challenging conditions.

Objectives Consent forms that are difficult to understand may jeopardize informed consent. The aim of this study was to determine whether consent documents for cardiology-related procedures could be easily read and understood by patients with low health literacy. Methods All 37 cardiology-related consent forms with patient information material were retrieved from a publicly available suite of documents from one state in Australia. Two raters independently assessed documents and resolved discrepancies through discussion. Understandability was assessed using the Patient Education Materials Assessment Tool for Printed materials (PEMAT-P). Readability was assessed using the Gunning Fog Index, SMOG and Flesch Reading Ease formulas. Images were assessed using the 5C Image checklist. Results were analyzed descriptively. Results Only 1 of 37 forms met the general PEMAT-P threshold (70%) for being ‘understandable’. The average readability score was high, requiring a grade 10–12 level of education to understand. Most images lacked useful captions, had low visual clarity, and were not purpose-designed for the material. Conclusions The current format for cardiology consent forms does not meet recommended standards for understandability and readability. Practice implications Development of consent forms would benefit from taking health literacy principles into account with patient input, and purpose-designed images should be included in all forms to reinforce text.

More than 130 million individuals in the United States have now received at least one dose of a COVID-19 vaccine. Currently, all adults in the Unites States now have access to one of three COVID-19 vaccines. As part of the vaccination procedure, Emergency Use Authorization (EUA) fact sheets, which contain information regarding the vaccine, are provided. The purpose of this study was to analyze the ease of reading (i.e., readability) of the EUA-approved fact sheets for the vaccines currently available in the United States, the V-Safe adverse event survey script, and the Centers for Disease Control and Prevention (CDC) website information on COVID-19 vaccines designed for the general public in the United States.We acquired the Pfizer, Moderna, and Janssen EUA fact sheets, as well as the V-Safe survey script and the CDC website information regarding COVID-19 vaccines. These documents were analyzed for their complexity regarding the following readability factors: average length of paragraphs, sentences, and words; font size and style; use of passive voice; the Gunning-Fog index; the Flesch Reading Ease index; and the Flesch-Kincaid Grade Level index.Only the V-Safe adverse-event survey script met readability standards for adequate comprehension. The mean readability scores of the EUA fact sheets and the CDC website were as follows: Flesch Reading Ease score (44.35 avg); Flesch-Kincaid Grade Level (10.48 avg); and Gunning-Fog index (11.8 avg).These scores indicate that at least a 10th-grade level education would be required to understand these reading materials.The average person in the United States would have difficulty understanding the information provided in the EUA fact sheets and CDC COVID-19 vaccine website documents; however, the V-Safe survey was written at an adequate reading level. To ensure that the general public fully understands information regarding COVID-19 vaccines, greater care and effort should be given to the development of simplified information material.

Objective To assess the presentation of risk information in American College of Obstetricians and Gynecologists (ACOG) obstetrical Practice Bulletins. Methods We reviewed B- and C-graded recommendations in Practice Bulletins published from January 2017 to March 2020. We calculated the proportion of recommendations and outcomes that were presented numerically and, of these, the proportion that were presented in accordance with best practices of risk communication – in absolute formats, or as absolute changes in risk from baseline risks. We categorized outcomes as harms or benefits to compare their risk presentation. Results In 21 obstetrical Practice Bulletins, there were 125 recommendations, with 46 (37%) describing risks numerically. Sixteen of these 46 recommendations (35%) presented an absolute change in risk from a baseline risk. For harms, 65% were presented as absolute risks and 25% as relative risks. For benefits, this was 55% and 48% respectively. Conclusion Most recommendations do not present numeric risk information. Of those that do, most do not use absolute risk measures. Practice implications Obstetrical practice guidelines should present numerical risk information wherever possible to support recommendations, increasing the use of absolute risk formats and absolute changes from baseline risks to increase risk comprehension.

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.

The purpose of this paper is to contribute to advancements in the knowledge management domain by exploring knowledge sabotage as the most extreme counterproductive behaviour that hinders knowledge sharing. Through a painstaking analysis of the literature, we developed nine original propositions which shape an innovative framework of individual-, group-, and organisational-level factors influencing this phenomenon. The proposed framework offers the identification and conceptual development of several antecedents, which promote a better comprehension of the sabotage of knowledge towards practitioners and scholars. Since the recent formalisation of “knowledge sabotage”, this is the first work that comprehensively presents the inherent literature and posits such influencing factors, by laying the first stone to obtain a better understanding of antecedents that may hinder or foster intra-organisational knowledge sharing.

Purpose To evaluate the readability, understandability, and actionability of online patient education materials (OPEM) related to breast cancer risk assessment. Material and methods We queried seven English-language search terms related to breast cancer risk assessment: breast cancer high-risk, breast cancer risk factors, breast cancer family history, BRCA, breast cancer risk assessment, Tyrer-Cuzick, and Gail model. Websites were categorized as: academic/hospital-based, commercial, government, non-profit or academic based on the organization hosting the site. Grade-level readability of qualifying websites and categories was determined using readability metrics and generalized estimating equations based on written content only. Readability scores were compared to the recommended parameters set by the American Medical Association (AMA). Understandability and actionability of OPEM related to breast cancer high-risk were evaluated using the Patient Education Materials Assessment Tool (PEMAT) and compared to criteria set at ≥70%. Descriptive statistics and inter-rater reliability analysis were utilized. Results 343 websites were identified, of which 162 met study inclusion criteria. The average grade readability score was 12.1 across all websites (range 10.8–13.4). No website met the AMA recommendation. Commercial websites demonstrated the highest overall average readability of 13.1. Of the 26 websites related to the search term breast cancer high-risk, the average understandability and actionability scores were 62% and 34% respectively, both below criteria. Conclusions OPEM on breast cancer risk assessment available to the general public do not meet criteria for readability, understandability, or actionability. To ensure patient comprehension of medical information online, future information should be published in simpler, more appropriate terms., Highlights • The average grade readability score of breast cancer risk assessment online education materials was 12.1 • No website met the AMA recommendation of a sixth-grade reading level. • To ensure patient comprehension, future information should be published in simpler, more appropriate terms.

The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices.A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later.Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P 0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge 20% was common.Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Objective Vaccine hesitancy is a problem attracting growing attention and concern. Communication can be an effective tool to counteract vaccine hesitancy and promote optimal vaccine uptake. Readability has been recognized as one of the more important aspects of health communication for achieving good health literacy. We reviewed studies of readability assessment in the area of vaccine communication. Methods We conducted a systematic literature search in September 2020, using four online databases (Medline, CINAHL, PsycArticles, and PsycINFO). We included studies that assessed the readability level of online and offline vaccine information materials. Results We found 12 articles that were appropriate for inclusion. Ten of the studies were published after 2016. The readability levels of the majority of the materials assessed were found to be difficult and higher than 8th-grade level. Conclusion Readability assessments of vaccine information are scarce. The limited evidence shows that the readability level of vaccine information supplied by health care providers is more difficult to read than recommended. More studies on the readability of vaccine information are recommended. Practice implications Difficulty reading vaccine information may influence attitudes toward acceptance of or hesitancy to take vaccines. It is recommended that health care professionals use guidelines and tools to create easy-to-read vaccine information.

Objectives With an increase in globalization, the number of non-native-speaking citizens and tourists visiting local pharmacies is rapidly growing worldwide, creating linguistic and sociological problems. The aim of this study is to compare the effect of adding our original method, Original MethOd at pharmacy To ENhAnce Support for Health Improvement (OMOTENASHI), to the conventional medication counselling method (CMC) when counselling non-Japanese patients at the pharmacy. Methods The OMOTENASHI consists of tools written in multiple languages and illustrations to clarify the effects and side effects, and to confirm patients’ understanding. 71 non-Japanese patients were recruited and randomly assigned to the OMOTENASHI or to the CMC in a 1:1 ratio. Comprehension and satisfaction level were evaluated. Results The overall comprehension level was significantly higher in the OMOTENASHI than in the CMC (75% vs 38%, p = 0.002), with a prominent difference in the recognition of the name, effects, side effects, precautions, and how to deal with side effects of the prescribed medication. Conclusion The OMOTENASHI to be a helpful tool in providing essential information to non-native-speaking patients. Practice implication The study highlighted the need to ensure every patient’s safety and interests, and to avoid disadvantages caused by limited language proficiency in the globalization era.

This study intended to compare the effectiveness of thematic maps with that of tabular data in comprehension and memory of risk magnitudes, with Zika virus (ZIKV) disease outbreaks in the United States as the subject matter. The study also aimed to examine the effects of data presentation format and past occurrence information on risk perception and risk avoidance intention.This study used an experiment.Each participant was randomly assigned to view ZIKV disease 2017 incidence data presented in one of the three formats: a choropleth map, a graduated-circle map, and a table, after which they answered questions about comprehension and memory of risk magnitudes. Each participant was then randomly assigned to view or not to view incidence data of the previous occurrence of ZIKV outbreaks in 2016, after which they answered questions about risk perception and risk avoidance intention.The results revealed the effectiveness of thematic maps over tabular data in comprehension, risk perception, and risk avoidance intention. Compared to tabular data, the choropleth map led to a better comprehension of relative risk magnitudes, the graduated-circle map led to higher risk perception, and both thematic maps led to greater risk avoidance intention. In contrast, tabular data led to better recognition of absolute risk magnitudes than both thematic maps. In addition, past occurrence information enhanced risk perception and risk avoidance intention.The findings reveal the importance of data presentation format in comprehension and memory of risk magnitudes. This can be attributed to the cognitive match between the information emphasized in the presentation and that required by the tasks. The findings also suggest that data presentation format and past occurrence information are important judgmental heuristics that help to form risk perception and risk avoidance intention.

Structural competency is the trained ability to discern and respond to the impact of social, political, and economic structures on health. This article discusses a new online standardized patient simulation method that enhances the structural competency of nurses and nursing students. This method has been used to train nurse practitioner students. The article suggests that simulation-based learning can help nurses translate the theoretical comprehension of macro-level forces into clinical practices. This method expands the nurses' perspective, develops their social-political awareness, and encourages them to lead interventions. This simulation can contribute to dismantle structural racism and reduce health inequities.

In this paper, I am going to cast doubt on an idea that is shared, explicitly or implicitly, by most contemporary pragmatic theories: that the inferential interpretation procedure described by Grice, neo-Griceans, or post-Griceans applies only to the interpretation of ostensive stimuli. For this special issue, I will concentrate on the relevance theory (RT) version of this idea. I will proceed by putting forward a dilemma for RT and argue that the best way out of it is to accept that the relevance-theoretic comprehension procedure applies to certain non-ostensive stimuli, contrary to what is generally claimed within RT. In particular, I will argue that relevance theorists should accept that (ceteris paribus) non-ostensive emotional expressions in interactions guarantee a presumption of relevance such that they are interpreted through the relevance-theoretic comprehension procedure. This leads me to propose what I call 'the expressive principle of relevance'.

Purpose School attainment has increased and gender gaps narrowed in many settings without commensurate declines in child marriage and with persistent gender gaps in work. This paper investigates whether child marriage changes young people’s ability to translate education into paid work in rural Malawi. Methods Using data from a longitudinal study of adolescents in rural Malawi followed through young adulthood, individual-level fixed-effects regressions that account for time-invariant factors were used to investigate differences in child marriage status on the extent to which grade attainment, reading, and numeracy skills lead to higher participation in paid work and reduce participation in unpaid work. Gender differences in these relationships were explored. Results Prevalence of child marriage is high for young women (53% vs. 6% for men), and participation in paid work low (7% vs. 42% for men). Attainment of six grades among young married women and nine grades among young married men was associated with paid work irrespective of child marriage. Reading with comprehension in two languages was associated with paid work for young men married as adults (coefficient = .27, p ≤ .01). Numeracy was associated with paid work among unmarried young women (coefficient = .04, p ≤ .01). Negative associations between grade attainment and unpaid work were found for young women married at ages 16–17 and unmarried, while positive associations were found for young unmarried men. Conclusions The relationship between education and work among young people in Malawi is compromised by related challenges of poor learning and continued high levels of child and young adult marriage.

This article encourages the obstetrician-gynecologists to use social media platforms to share their wealth of clinical expertise and experience with the public in an engaging and empowering way. Social media is a powerful tool that increases communication, education, and support that can be leveraged to increase comprehension of women's health topics and advocate for our patients, both inside and outside the examination room. Included are tips for physicians on how to harness their social media superpower to connect with patients on social media, build a brand, and network in a meaningful and authentic way.

Background Trauma patients often have complex injuries treated by multidisciplinary providers with wide-ranging expertise. We hypothesized that trauma patients would frequently incorrectly identify both their injuries and care teams. We also hypothesized that low health literacy level would be correlated with low levels of comprehension about injuries or care teams. Materials and methods We performed a prospective study of adult trauma inpatients >18 years. Participants were surveyed to report on 1) injured body regions 2) their care teams, and 3) health literacy via a validated survey. Self-reported injuries and care teams were compared to the patient's medical record. We also studied whether health literacy was associated with patient knowledge of injuries and care teams. Results Fifty participants were surveyed; thirty-two percent could not identify ≥50% of their injuries. Patients reliably identified injuries to the head, but injuries to other body areas were often misidentified. Forty-two percent of patients were not able to identify ≥50% of their medical teams, and 28% could not identify ≥75% of their medical teams. Patients often did not recognize teams such as nutrition, physical/occupationalt, or social work as part of their care. Thirteen participants reported adequate health literacy. Health literacy was not related to participant knowledge of injuries or care teams (both P = 0.9). Conclusion Many trauma inpatients were unable to correctly identify their injuries and care teams despite a range of self-reported health literacy scores.

Difficulty in acquiring object clitics (OCs), and the omission of OCs more specifically, is used as a marker of developmental language disorder (DLD) in children learning French. Research also suggests that OCs are a complex morphosyntactic property of French and, as such, they could be particularly taxing for working memory (WM) resources. In light of previous research, it seems more likely that difficulties with OCs could be a marker for atypical early language acquisition. Children receiving a cochlear implant (CI) represent a case of delayed language exposure linked to a lack of early auditory exposure. Few studies have investigated the production of clitics in children with CIs. Studies suggest that children with CIs make significantly more clitic omissions on tasks of clitic production than typically-developing (TD) children. To our knowledge, no study has looked at clitic comprehension in children with CIs learning French or at the relationship between WM and performance on tasks of OCs in this population. The present study aimed at examining the production and comprehension of OCs, as well as the relationship between clitic omission and WM, in both typically-developing monolinguals children and CI recipients learning French. Children with CIs performed significantly lower than the control group on both comprehension and production tasks. Clitic omission was significantly related to WM, but only in the CI group suggesting a differential relationship between early auditory experience, WM, and language acquisition.

Previous studies indicate that adults show specialized syntactic and semantic processes in both the temporal and frontal lobes during language comprehension. Neuro-cognitive models of language development argue that this specialization appears earlier in the temporal than the frontal lobe. However, there is little evidence supporting this proposed progression. Our recently published study ( Wang, Rice, & Booth, 2020 ), using multivoxel pattern analyses, detected that children as young as 5 to 6 years old exhibit specialization and integration in the temporal lobe, but not the frontal lobe. In the current study, we used the same approach to examine semantic and syntactic specialization in children ages 7 to 8 years old. We found support for semantic specialization in the left middle temporal gyrus (MTG) for correct sentences and in the triangular part of the left inferior frontal gyrus (IFG) for incorrect sentences. We also found that the left superior temporal gyrus (STG) played an integration role and was sensitive to both semantic and syntactic processing during both correct and incorrect sentence processing. However, there was no support for syntactic specialization in 7- to 8-year-old children. As compared to our previous study on 5- to 6-year-old children, which only showed semantic specialization in the temporal lobe, the current study suggests a developmental progression to semantic specialization in the frontal lobe. This project represents an important step forward in testing neuro-cognitive models of language processing in children.

Abstract thinking is a cognitive process that involves the assimilation of concepts reduced from diffuse sensory input, organized, and interpreted in a manner beyond the obvious. There are multiple facets by which abstraction is measured that include semantic, visual-spatial and social comprehension. This study examined the prevalence and course of abstract and concrete responses to semantic proverbs and aberrant abstraction (composite score of semantic, visual-spatial, and social comprehension) over 20 years in 352 participants diagnosed with schizophrenia, affective psychosis, and unipolar non-psychotic depression. We utilized linear models, two-way ANOVA and contrasts to compare groups and change over time. Linear models with Generalized Estimation Equation (GEE) to determine association. Our findings show that regardless of diagnosis, semantic proverb interpretation improves over time. Participants with schizophrenia give more concrete responses to proverbs when compared to affective psychosis and unipolar depressed without psychosis. We also show that the underlying structure of concretism encompasses increased conceptual overinclusion at index hospitalization and idiosyncratic associations at follow-up; whereas, abstract thinking overtime encompasses increased visual-spatial abstraction at index and rich associations with increased social comprehension scores at follow-up. Regardless of diagnosis, premorbid functioning, descriptive characteristics, and IQ were not associated with aberrant abstraction. Delusions are highly and positively related to aberrant abstraction scores, while hallucinations are mildly and positively related to this score. Lastly, our data point to the importance of examining the underlying interconnected structures of ‘established’ constructs vis-a-vis mixed methods to provide a description of the rich interior world that may not always map onto current quantitative measures.

Brain tumors cause local structural impairments of the cerebral network. Moreover, brain tumors can also affect functional brain networks more distant from the lesion. In this study, we analyzed the impact of glioma WHO grade II-IV tumors on grey and white matter in relation to impaired language function. In a retrospective analysis of 60 patients, 14 aphasic and 46 non-aphasic, voxel-based lesion-symptom mapping (VLSM) was used to identify tumor induced lesions in grey (GM) and white matter (WM) related to patients' performance in subtests of the Aachen Aphasia Test (AAT). Significant clusters were analyzed for atlas-based grey and white matter involvements in relation to different linguistic modalities. VLSM analysis indicated significant contribution of a posterior perisylvian cluster covering WM and GM to AAT performance averaged across subtests. When considering individual AAT subtests, a substantial overlap between significant clusters for analysis of the token test, picture naming and language comprehension results could be observed. The WM-cluster intersections reflect the overall importance of the perisylvian area in language function, similarly to GM participations. Especially the constant high percentages of Heschl's gyrus, superior temporal gyrus, inferior longitudinal and middle longitudinal fascicles, but also arcuate and inferior fronto-occipital fascicles highlight the importance of the posterior perisylvian area for language function. Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Findings from corpus (e.g. Diessel, 2004) and comprehension (e.g. De Ruiter et al., 2018) studies show that children produce the adverbial connectives because and if long before they seem able to understand them. However, although children's comprehension is typically tested on sentences expressing the pragmatic relationship which Sweetser (1990) calls “Content”, children also hear and produce sentences expressing “Speech–Act” relationships (e.g. De Ruiter et al., 2021; Kyratzis et al., 1990). To better understand the possible influence of pragmatic variation on 2- to 4- year-old children's acquisition of these connectives, we coded the because and if Speech–Act sentences of 14 British English-speaking mother-child dyads for the type of illocutionary act they contained, as well as the phrasing following the connective. Analyses revealed that children's because Speech–Act sentences were primarily explanations of Statements/Claims, while their if Speech–Act sentences typically related to permission and politeness. While children's because-sentences showed a great deal of individuality, their if-sentences closely resembled their mothers’, containing a high proportion of recurring phrases which appear to be abstracted from input. We discuss how these patterns might help shape children's understanding of each connective and contribute to the children's overall difficulty with because and if.

Machine reading comprehension (MRC) is a challenging task in natural language processing (NLP), which requires machine to determine the corresponding answer to a given passage and question. Whereas, there always exist unanswerable questions in the real world, which poses a new challenge to MRC tasks. Abundant research work has been carried out on the verification mechanism for the answerability of passage-question pairs. However, these researches only focus on its design and implementation, which has limitations in real-world scenarios. Thus, the method proposed in this paper not only verifies the answerability, but also validates and adjusts the predicted answer to obtain an elaborate answer span. Using powerful pre-trained model as encoder block, this paper explores a more comprehensive verification mechanism. Similar to how humans read passages and give answers, we propose a three-stage mechanism called ”Verification for an Elaborate Span” (V4ES): 1) sketchy reading that the model briefly browses the overall information of the passage and question, and then generates an initial answer; 2) intensive reading that it reads the passage and question again, judges the answerability of the question and gives an answer at this stage; 3) verification that it verifies these two answers produced at the previous two stages, and then gives the final prediction. Moreover, the proposed model is evaluated on two MRC challenge datasets: SQuAD2.0 and CMRC2018, and the experiment results show that our model has achieved great improvement compared with the ALBERT and BERT baselines. In conclusion, our proposed verification mechanism has demonstrated its effectiveness through a series of experiments and analysis.

Patients often utilize the internet to vlearn about retinal diseases. Our results demonstrate that online patient education materials related to common retinal diseases are often written at higher than recommended reading levels and lack accountability.

Researchers tend to rely on metaphors to gain initial comprehension of complex systems. However, literature offers little guidance for this strategy. This paper presents criteria for using metaphors responsibly in this arena by applying them to evaluate ecological metaphors related to innovation systems. We develop the idea of innovation ecotone as the boundary between the knowledge ecosystem and the business ecosystem. We demonstrate why this ecotone better meets the criteria for a valuable metaphor for understanding innovation systems than the “innovation ecosystem” metaphor. This novel approach resolves many ambiguities and provides new implications for policymakers, particularly regarding the nature of innovation policy agencies.

Objective Persons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI). Methods A digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions. Results PWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information. Conclusion By combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis). Practice Implications The current study’s AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA’s access to health information.

Children with asthma grow to become adults with asthma. Adolescents are not simply older children and do not automatically transform into independent adults, nor do they become proficient in self-management of their condition overnight. Adolescence is a high-risk time for many people with asthma, with increased risk of asthma-related morbidity and mortality. Children with high-risk asthma attend hospital-based asthma clinics with their parents until they reach young adulthood, and parents usually take on the significant burden of disease management on behalf of their children. Once patients are transferred to adult medical teams, many will continue to have limited knowledge about their asthma, limited understanding of how to manage their symptoms and comorbidities, and limited comprehension of how and why to take their regular medication. Adolescence is a critical time of change during which young people yearn for autonomy. Effective transition gives young people the skills and knowledge necessary to manage their health independently and provides the substrate for autonomous care, the bed rock of long-term conditions. This review focuses on the challenges of adolescent health care and provides guidance on how to take a planned, patient-centered approach to ensure each transition is effective and safe.

Background Prior studies showed the association between inadequate health literacy (HL) and poor medication-related skills, while none of the published studies have reviewed and compared the existing instruments used to measure medication-related HL. This systematic review comprehensively summarizes the existing instruments that assess medication-related HL. Objectives To identify appropriate HL instruments related to medication use as screening tools for enhancing patients’ ability to use medications correctly. Methods This review retrieved medication-related HL instruments that were published between 2000 and 2019 from three databases (i.e., PubMed, Scopus, EMBASE) and by hand-searching. The PRISMA procedure was followed as well as the SURGE guideline to assess the quality of studies. Psychometric properties, HL dimensions, and types of medication information gleaned from the items in three types of HL instruments (i.e., general, disease-specific, medication-specific) were compared to identify appropriate medication-related HL instruments. Result Forty-eight instruments were identified from 44 studies, whereas 70.8% instruments were either disease- or medication-specific HL instruments. Most instruments with different sample sizes showed certain an extent of reliability and validity. The distributions of HL dimensions and types of medication information among the relevant items were varied across different types of instruments. The five instruments (named as the 16SQ, AKQ-CQ, DHLKI, AKT, and ChMLM) were identified as the most appropriate instruments for three types of medication-related HL, respectively. These appropriate instruments consistently covered items related to HL dimensions of literacy and comprehension and medication-related information regarding dosing, treatment indication, and side effects/precautions. Conclusion Of 48 identified instruments mainly derived from disease- or medication-specific studies, the five most appropriate medication-related HL instruments were identified to support clinicians in facilitating patients' correct medication use. Further confirmation to explore the usefulness among these instruments are needed.

Background Informed consent forms consist of large blocks of written information that may be difficult for patients to understand. Visual teaching aids are promising, however, they have not been studied as a pre-operative educational tool for common surgical procedures. We pilot tested the use of a visual teaching aid during the informed consent process for a colectomy. Methods A randomized pilot study was performed. Participants were randomized into the visual teaching aid group or standard care. Following the consent process, participants were questioned about potential surgical complications, anxiety, satisfaction, and understanding. Results 30 participants were enrolled. Potential complication recall and patient-reported understanding were improved in the visual group (p = 0.01, p = 0.03). Anxiety levels were reduced in the visual group (p = 0.02). No statistically significant data were found for satisfaction (p = 0.75). Conclusions Utilizing a visual teaching aid during the consent process for colectomy increases patient recall of risks, reduces anxiety, and improves understanding.

Expectations are a critical factor in determining actions in a great variety of economic interactions. Hence, being able to measure beliefs is important in many economic environments. In this article, we review the approaches that have been used to measure beliefs and make comparisons of their effectiveness. We also discuss belief elicitation when the truth is not verifiable. We find that introspection (non-incentivized responses) seems to do as well as rather complex incentivized methods. We conjecture that simple and easy-to-comprehend incentivized methods are superior to introspection, in fact there are very few studies making such comparisons; this is an avenue for future research. We also discuss ways in which relatively complex methods could be made easier for usage in experimental work.

Objective Traumatic brain injury (TBI) is a global public health problem, causing long-term burden to patients and caregivers. Patients and their families often resort to seeking online information regarding TBI management while awaiting formal health care consultations. Although this information is accessible and immediately available, little is known about the quality of online resources. We evaluated the accessibility, relevance, and readability of information regarding TBI from major online search engines. Methods TBI-related search terms were entered into 2 online search engines (Google and Yahoo), and the first 30 websites per search were assessed for eligibility. Quality (DISCERN score, JAMA Benchmark score) and readability (Flesch–Kincaid Grade Level, Flesch Reading Ease Score) were assessed. Associations between search ranking, quality, and readability were evaluated. Results In total, 202 websites were evaluated with mean DISCERN score 36.5 ± 9.9/80, signifying poor global quality, and mean JAMA Benchmark score 2.8 ± 1.1/4. The majority required 9–12 years of education (113/202; 55.9%) according to Flesch–Kincaid Grade Level and categorized as “Difficult” on Flesch Reading Ease Score (94/202; 46.5%). Website quality was not associated with search ranking or readability. Conclusions There is a paucity of high-quality online resources for patients with TBI. Herein, we highlight: 1) the importance of guidance from healthcare professionals regarding online-information seeking; and 2) recommendations for the most useful online resources available.

Background Catheter-associated urinary tract infections (CAUTIs) are detrimental to health and are largely preventable with adherence to CAUTI prevention guidelines. Patient and family engagement in CAUTI prevention is often encouraged in these guidelines; however, little is known about how this engagement is operationalized in practice. A systematic review was conducted to synthesize the content, format, and outcomes of interventions that engage patients and/or families in CAUTI prevention. Methods Two reviewers independently screened records from four databases up to March 2021 and searched reference lists of final articles. Included articles were primary research, tested an intervention, involved indwelling urinary catheters, and described at least one patient and/or family engagement method. Articles were appraised for quality using the Downs and Black checklist. Results After 720 records were screened, 12 were included. Study quality ranged from good to poor, scoring lowest in internal validity. The most common formats of patient/family engagement were flyers/handouts (83.3%) and verbal education (58.3%). Common content areas were urinary catheter care and maintenance strategies. Most study outcomes (83.3%) measured CAUTI rates, and half measured patient/family-related outcomes. Improvements were seen in at least one outcome across all studies, but less than half (41.7%) showed statistically significant results. Conclusion The researchers found that most interventions lacked sufficient detail on the content, delivery, and/or outcome measurement of patient/family engagement, which limits transferability. More high-quality, generalizable trials are warranted in this area. Future research should focus on integrating publicly available resources into practice that can be tested for comprehension and revised based on feedback from target audiences.

Purpose To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia. Design and methods A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2–4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge. Results Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2–19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency. Conclusion The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience. Practice implications Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information.

Spurred by federal legislation, professional organizations, and patients themselves, patient access to data from electronic cardiac devices is increasingly transparent. Patients can collect data through consumer devices and access data traditionally shared only with health care providers. These data may improve screening, self-management, and shared decision-making for cardiac arrhythmias, but challenges remain, including patient comprehension, communication with providers, and sustained engagement. Ways to address these challenges include leveraging visualizations that support comprehension, involving patients in designing and developing patient-facing digital tools, and establishing clear practices and goals for data exchange with health care providers.

Driver comprehension is a substantial component of situation awareness that involves the ability of an individual to understand the significance of an object, traffic sign, or hazard while driving. An increase in crashes related to autonomous driving systems has raised a concern regarding the safety of other roadway users due to the diminishing accountability resulting from a general lack of understanding of the limitations or disregard of the safety protocols by users. To keep drivers vigilant when engaged in partial automated systems, a methodology to monitor real-time driver comprehension was proposed. A driving simulator study consisting of 90 participants, equally split between males and females, was executed to establish driver comprehension in six different variations of driving difficulty. Joint probability density functions were created by considering percent time spent gazing, answers to probe questions, and driving performance. Based on these density functions, five levels of comprehension were devised and assigned thresholds. Overall, as task difficulty increased, a non-linear deterioration in driving speed along with an increase in total gaze duration was observed before comprehension was attained. A two-step validation protocol was also proposed to ensure similar levels of comprehension to non-automated driving from the human driver, when engaged in early forms of automation. The proposed real-time driver comprehension monitoring constitutes a first step toward developing a methodology to reinstate the accountability of safety of other roadway users when engaged in driver-in-the-loop automation systems.

Objective To assess the readability of the informed consent forms from the phase 3 COVID-19 vaccine trials conducted in the United States. Patients and Methods English consent forms were used for patients in phase 3 COVID-19 vaccine clinical trials. Consent forms were obtained in October 2020. Using Microsoft Word tools, we analyzed the readability (ie, the ease of reading) of written consent forms and informational documents from phase 3 COVID-19 vaccine clinical trials in the United States from the following manufacturers: AstraZeneca, Moderna, Pfizer, Johnson & Johnson, and Novavax. Results Owing to low readability and several format factors, this study determined that none of the consent forms or informational documents from the recent phase 3 COVID-19 vaccine clinical trials conducted in the United States met readability standards at the recommended 7th grade readability level for the average vaccine research volunteer in any readability category. The average English-speaking vaccine trial volunteer would have great difficulty comprehending the information provided in the consent forms and informational documents. To ensure that study subjects receive and fully comprehend information regarding a clinical study and can provide reliable consent, greater attention should be given to the development and use of simplified consent forms, multimedia formatting, personal discussion, and comprehension assessments.

Objective To evaluate the readability, quality, and accuracy of pelvic organ prolapse (POP) YouTube transcripts. Methods We analyzed the readability of written transcripts for the first 100 YouTube videos about “Pelvic Organ Prolapse.” Transcripts were excluded if they lacked narration in English or contained both no text and no audio. Readability was evaluated using an online software ( www.readabilityformulas.com ) to determine reading grade levels. The quality of videos was scored using the DISCERN quality criteria and the Patient Education Materials Assessment Tool. Accuracy was assessed by comparing content to accepted POP treatment guidelines. Results The median grade level of all 100 videos was 12.6. High quality transcripts or transcripts that discuss the benefits, risk, alternative treatments, and quality of life had a median readability score of 12.5. Transcripts with low misinformation (85%) had a higher median readability index (12.6), than transcripts containing high misinformation (12.2). More than 20% of transcripts discussed shared decision-making. The median readability index for videos with a high Patient Education Materials Assessment Tool score (>75%) for understandability and actionability were both 12.6. Conclusion Transcripts of POP YouTube videos are written at difficult levels with many transcripts exceeding the reading capabilities of the American population. The majority of good transcripts or transcripts with high quality content, low misinformation, shared decision-making, no commercial bias, and understandable and actionable content were written at a high school level or above. Efforts should be made to avoid complex terms when creating patient focused content and helping patients navigate to content of appropriate literacy online.

Objective The American Medical Association and National Institutes of Health have recommended that patient education materials should be written at the sixth-grade reading level to maximize patient comprehension. The objective of the present study was to evaluate the readability of Internet information for the 9 most common spinal surgeries. Methods We reviewed 90 online patient educational materials regarding the 9 most common spinal surgeries as reported by the North American Spine Society. A Google search was performed on March 23, 2019 for each surgery, and the top 10 most visited websites for each surgery were assessed for reading level using the Flesch-Kincaid formula. Results Using the Flesch-Kincaid formula, the average grade reading level of the 90 websites included was 12.82, with a reading ease of 37.04 (“difficult college”). Only 6 websites relayed information to patients at or below the national average of an eighth-grade reading level. The websites for bone morphogenic protein had the highest average grade reading level at 15.88 ± 2.6. Lumbar microscopic discectomy had the lowest average grade reading level at 10.37 ± 2.89. All surgical options discussed had an average readability above the recommended sixth-grade reading level. Conclusions The most accessed online materials for common spinal surgeries, not only exceeded the readability limits recommended by both the American Medical Association and the National Institutes of Health, but they also exceeded the average reading ability of most adults in the United States. Patients, therefore, might not fully comprehend the information from commonly accessed websites regarding surgical spine treatment options.

The brain establishes relations between elements of an unfolding sentence in order to incrementally build a representation of who is doing what based on various linguistic cues. Many languages systematically mark the verb and/or its arguments to imply the manner in which they are related. A common mechanism to this end is subject-verb agreement, whereby the marking on the verb covaries with one or more of the features such as person, number and gender of the subject argument in a sentence. The cross-linguistic variability of these features would suggest that they may modulate language comprehension differentially based on their relative weightings in a given language. To test this, we investigated the processing of subject-verb agreement in simple intransitive Arabic sentences in a visual event-related brain potential (ERP) study. Specifically, we examined the differences, if any, that ensue in the processing of person, number and gender features during online comprehension, employing sentences in which the verb either showed full agreement with the subject noun (singular or plural) or did not agree in one of the features. ERP responses were measured at the post-nominal verb. Results showed a biphasic negativity−late-positivity effect when the verb did not agree with its subject noun in one of the features, in line with similar findings from other languages. Crucially however, the biphasic effect for agreement violations was systematically graded based on the feature that was violated, which is a novel finding in view of results from other languages. Furthermore, this graded effect was qualitatively different for singular and plural subjects based on the differing salience of the features for each subject-type. These results suggest that agreement features, varying in their salience due to their language-specific weightings, differentially modulate language comprehension. We postulate a Salience-weighted Feature Hierarchy based on our findings and argue that this parsimoniously accounts for the diversity of existing cross-linguistic neurophysiological results on verb agreement processing.