OBJECTIVE: Concussions are self-limited forms of mild traumatic brain injury (TBI). Gradual return to play (RTP) is crucial to minimizing the risk of second impact syndrome. Online patient educational materials (OPEM) are often used to guide decision-making. Previous literature has reported that grade-level readability of OPEM is higher than recommended by the American Medical Association and the National Institutes of Health. The authors evaluated the readability of OPEM on concussion and RTP.
METHODS: An online search engine was used to identify websites providing OPEM on concussion and RTP. Text specific to concussion and RTP was extracted from each website and readability was assessed using the following six standardized indices: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. One-way ANOVA and Tukey\'s post hoc test were used to compare readability across sources of information.
RESULTS: There were 59 concussion and RTP articles, and readability levels exceeded the recommended 6th grade level, irrespective of the source of information. Academic institutions published OPEM at simpler readability levels (higher FRE scores). Private organizations published OPEM at more complex (higher) grade-level readability levels in comparison with academic and nonprofit institutions (p < 0.05).
CONCLUSIONS: The readability of OPEM on RTP after concussions exceeds the literacy of the average American. There is a critical need to modify the concussion and RTP OPEM to improve comprehension by a broad audience.

Aims/Background Seroma formation is the most common complication following breast surgery. However, there is little evidence on the readability of online patient education materials on this issue. This study aimed to assess the accessibility and readability of the relevant online information. Methods This systematic review of the literature identified 37 relevant websites for further analysis. The readability of each online article was assessed through using a range of readability formulae. Results The average Flesch-Reading Ease score for all patient education materials was 53.9 (± 21.9) and the average Flesch-Kincaid reading grade level was 7.32 (± 3.1), suggesting they were \'fairly difficult\' to read and is higher than the recommended reading level. Conclusion Online patient education materials regarding post-surgery breast seroma are at a higher-than-recommended reading grade level for the public. Improvement would allow all patients, regardless of literacy level, to access such resources to aid decision-making around undergoing breast surgery.

Spelke\'s What Babies Know masterfully describes infants\' impressive repertoire of core cognitive concepts, from which the suite of human knowledge is eventually built. The current commentary argues for the existence of a core concept that Spelke claims preverbal infants lack: social goal. Core social goal concepts, operative extremely early in human development, underlie infants\' basic abilities to interpret and evaluate entities within the moral world; such abilities support claims for a core moral domain.

Central to What Babies Know (Spelke, ) is the thesis that infants\' understanding is divided into independent modules of core knowledge. As a test case, we consider adding a new domain: core knowledge of substances. Experiments show that infants\' understanding of substances meets some criteria of core knowledge, and they raise questions about the relations that hold between core domains.

What is the relationship between language and event cognition? Past work has suggested that linguistic/aspectual distinctions encoding the internal temporal profile of events map onto nonlinguistic event representations. Here, we use a novel visual detection task to directly test the hypothesis that processing telic versus atelic sentences (e.g., \"Ebony folded a napkin in 10 seconds\" vs. \"Ebony did some folding for 10 seconds\") can influence whether the very same visual event is processed as containing distinct temporal stages including a well-defined endpoint or lacking such structure, respectively. In two experiments, we show that processing (a)telicity in language shifts how people later construe the temporal structure of identical visual stimuli. We conclude that event construals are malleable representations that can align with the linguistic framing of events.

A view that has been gaining prevalence over the past decade is that the human conceptual system is malleable, dynamic, context-dependent, and task-dependent, that is, flexible. Within the flexible conceptual representation framework, conceptual representations are constructed ad hoc, forming a different, idiosyncratic instantiation upon each occurrence. In this review, we scrutinize the neurocognitive literature to better understand the nature of this flexibility. First, we identify some key characteristics of these representations. Next, we consider how these flexible representations are constructed by addressing some of the open questions in this framework: We review the age-old question of how to reconcile flexibility with the apparent need for shareable stable definitions to anchor meaning and come to mutual understanding, as well as some newer questions we find critical, namely, the nature of relations among flexible representations, the role of feature saliency in activation, and the viability of all-or-none feature activations. We suggest replacing the debate about the existence of a definitional stable core that is obligatorily activated with a question of the degree and probability of activation of the information constituting a conceptual representation. We rely on published works to suggest that (1) prior featural salience matters, (2) feature activation may be graded, and (3) Bayesian updating of prior information according to current demands offers a viable account of how flexible representations are constructed. This proposal provides a theoretical mechanism for incorporating a changing momentary context into a constructed representation, while still preserving some of the concept\'s constituent meaning.

(1) Background: The wording of informed consent forms could hinder their comprehension and hinder patients\' autonomous choice. The objective of this study was to analyze the readability and comprehension of anesthesia informed consent forms in a Spanish county hospital. (2) Methods: Descriptive and cross-sectional study carried out on patients who were going to undergo anesthetic techniques. The readability of the forms was analyzed using the INFLESZ tool and their subjective comprehension using an ad hoc questionnaire. (3) Results: The analyzed forms presented a \"somewhat difficult\" legibility. A total of 44.2% of the patients decided not to read the form, mainly because they had previously undergone surgery with the same anesthetic technique. The language used in the forms was considered inadequate by 49.5% of the patients and 53.3% did not comprehend it in its entirety. A statistically significant negative correlation of age and INFLESZ readability score with the overall questionnaire score was found. A statistically significant association was observed as a function of age and educational level with the different criteria of the questionnaire. (4) Conclusions: The anesthesia informed consent forms presented low readability with limited comprehension. It would be necessary to improve their wording to favor comprehension and to guarantee patients\' freedom of choice.

UNASSIGNED: The National Institutes of Health (NIH) and American Medical Association (AMA) recommend that online health information be written at a maximum 6th grade reading level. The aim was to evaluate online resources regarding shoulder arthroscopy utilizing measures of readability, understandability, and actionability, using syntax reading grade level and the Patient Education Materials Assessment Tool (PEMAT-P).
UNASSIGNED: An online Google™ search utilizing \"shoulder arthroscopy\" was performed. From the top 50 results, websites directed at educating patients were included. News and scientific articles, audiovisual materials, industry websites, and unrelated materials were excluded. Readability was calculated using objective algorithms: Flesch-Kincaid Grade-Level (FKGL), Simple Measure of Gobbledygook (SMOG) grade, Coleman-Liau Index (CLI), and Gunning-Fog Index (GFI). The PEMAT-P was used to assess understandability and actionability, with a 70% score threshold. Scores were compared across academic institutions, private practices, and commercial health publishers. The correlation between search rank and readability, understandability, and actionability was calculated.
UNASSIGNED: Two independent searches yielded 53 websites, with 44 (83.02%) meeting inclusion criteria. No mean readability score performed below a 10th grade reading level. Only one website scored at or below 6th grade reading level. Mean understandability and actionability scores were 63.02%±12.09 and 29.77%±20.63, neither of which met the PEMAT threshold. Twelve (27.27%) websites met the understandability threshold, while none met the actionability threshold. Institution categories scored similarly in understandability (61.71%, 62.68%, 63.67%) among academic, private practice, and commercial health publishers respectively (p=0.9536). No readability or PEMAT score correlated with search rank.
UNASSIGNED: Online shoulder arthroscopy patient education materials score poorly in readability, understandability, and actionability. One website scored at the NIH and AMA recommended reading level, and 27.27% of websites scored above the 70% PEMAT score for understandability. None met the actionability threshold. Future efforts should improve online resources to optimize patient education and facilitate informed decision-making. Level of Evidence: IV.

UNASSIGNED: Patients often access online resources to educate themselves prior to undergoing elective surgery such as carpal tunnel release (CTR). The purpose of this study was to evaluate available online resources regarding CTR on objective measures of readability (syntax reading grade-level), understandability (ability to convey key messages in a comprehensible manner), and actionability (providing actions the reader may take).
UNASSIGNED: The study conducted two independent Google searches for \"Carpal Tunnel Surgery\" and among the top 50 results, analyzed articles aimed at educating patients about CTR. Readability was assessed using six different indices: Flesch-Kincaid Grade Level Index, Flesch Reading Ease, Gunning Fog Index, Simple Measure of Gobbledygook (SMOG) Index, Coleman Liau Index, Automated Readability Index. The Patient Education Materials Assessment Tool evaluated understandability and actionability on a 0-100% scale. Spearman\'s correlation assessed relationships between these metrics and Google search ranks, with p<0.05 indicating statistical significance.
UNASSIGNED: Of the 39 websites meeting the inclusion criteria, the mean readability grade level exceeded 9, with the lowest being 9.4 ± 1.5 (SMOG index). Readability did not correlate with Google search ranking (lowest p=0.25). Mean understandability and actionability were 59% ± 15 and 26% ± 24, respectively. Only 28% of the articles used visual aids, and few provided concise summaries or clear, actionable steps. Notably, lower grade reading levels were linked to higher actionability scores (p ≤ 0.02 in several indices), but no readability metrics significantly correlated with understandability. Google search rankings showed no significant association with either understandability or actionability scores.
UNASSIGNED: Online educational materials for CTR score poorly in readability, understandability, and actionability. Quality metrics do not appear to affect Google search rankings. The poor quality metric scores found in our study highlight a need for hand specialists to improve online patient resources, especially in an era emphasizing shared decision-making in healthcare. Level of Evidence: IV.

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