The effects of individual differences and linguistic features on reading comprehension of health-related texts

Background. Relatively little attention has been focused on whether or how the effects of reader characteristics, or of the linguistic properties of a text, predict reading comprehension of health-related information. In addition, there is little evidence for the utility of any of the writing guidelines promulgated by the National Health Service (NHS) in order to improve the comprehension of health information. Nonetheless, some previous research suggests that health-related texts could be adapted for different groups of users to optimise understanding. Thus, existing knowledge presents important limitations, and raises concerns with potentially far-reaching practical implications. To address these concerns, I investigated how variation in individual differences and in text features predicts the comprehension of health-related texts, examining how the effects of textual features may differ for different kinds of readers. Method. The focus of this thesis is on Study 3, in which I investigated the predictors of tested comprehension, but I report preliminary studies where I examined the readability of a sample of health-related texts (Study 1), and the perceived comprehension of a sample of health-related texts (Study 2). In the primary study (Study 3), I used Bayesian mixed-effects models to analyse the influences that affect the accuracy of responses to questions probing the comprehension of a sample of health-related texts. I measured variation among 200 participants in their cognitive abilities, to capture the effects of individual differences, as well as variation in the linguistic features of texts, to capture the effects of text structure and content. Results. I found that tested comprehension was less likely to be accurate among older participants. However, comprehension accuracy was greater given higher levels of education, health literacy, and English language proficiency levels. In addition, self-rated evaluations of perceived comprehension predicted comprehension, but only in the absence of other individual-differences-related predictors. Variation in text features, including readability estimates, did not predict comprehension accuracy, and there was no evidence for the modulation of the effects of individual differences by text features. Discussion. Text features did not module the effects of individual differences to influence comprehension accuracy in any meaningful way. This suggests that adapting health-related texts to different groups of the population may be of limited practical value. Implications. Individual differences really matter to comprehension. Thus, optimally, understanding of health-related texts amongst the end-users should be tested, and interventions to aid readers, such as those with relatively low health literacy levels, could be used to improve comprehension of health-texts. In the absence of sensitive measures of reader characteristics, and when testing of understanding is not possible, the use of end-user evaluations of health-related texts may serve as a useful proxy of tested comprehension. However, looking for text effects, and guidance focusing on text effects, seems less useful given the reported evidence. Consequently, the effectiveness of designing health-related texts with the consideration of NHS’s text writing guidelines, is likely to be limited

Psychological inoculation protects against the social media infodemic

Misinformation can have a profound detrimental impact on populations' wellbeing. In this large UK-based online experiment (n = 2430), we assessed the performance of false tag and inoculation interventions in protecting against different forms of misinformation ('variants'). While previous experiments have used perception- or intention-based outcome measures, we presented participants with real-life misinformation posts in a social media platform simulation and measured their engagement, a more ecologically valid approach. Our pre-registered mixed-effects models indicated that both interventions reduced engagement with misinformation, but inoculation was most effective. However, random differences analysis revealed that the protection conferred by inoculation differed across posts. Moderation analysis indicated that immunity provided by inoculation is robust to variation in individuals' cognitive reflection. This study provides novel evidence on the general effectiveness of inoculation interventions over false tags, social media platforms' current approach. Given inoculation's effect heterogeneity, a concert of interventions will likely be required for future safeguarding efforts

Testing the impact of overt and covert ordering interventions on sustainable consumption choices: a randomised controlled trial

Food products have significant impacts on the environment over their life cycle. We investigated whether displaying products in ascending order of carbon footprint in an online supermarket environment can shift consumer choices towards more sustainable options. We examined whether the effect of the ordering intervention differs when the ordering is overt (information about the ordering is explicit), compared to when it is covert (participants not told about the ordering). We conducted a three-arm parallel-group randomised trial using 1842 online participants from England, Wales, and Northern Ireland. Participants shopped for a meal, choosing one product from each of six product categories in a simulated online supermarket. Six products were listed vertically on each product-category page. Products were randomly ordered for the control arm but ordered by carbon footprint in the covert and overt ordering arms. In the overt ordering arm, a statement was displayed at the top of each product page about the ordering of products. The primary outcome was whether one of the three most sustainable products was chosen in each product category. There was no effect of the covert ordering on the probability of choosing more sustainable products compared with the control arm (OR = 0.97, 95% CI 0.88-1.07, p = 0.533). Furthermore, we did not find evidence that the effects of the covert ordering and overt ordering differed (p = 0.594). Within the control condition, products in different positions were chosen with similar frequencies, suggesting that product positioning does not have an impact on choices. This may explain why re-ordering products had no effect. In the overt condition, only 19.5% of people correctly answered that the products were ordered according to sustainability in a follow-up question, suggesting that they didn't notice the statement. Results suggest that choices for grocery products might be too ingrained to be changed by subtle rearrangements of choice architecture like the ordering interventions, and highlight the difficulty of conveying information effectively to consumers in the online grocery shopping environment

The effects of read-aloud assistance, vocabulary and background knowledge on comprehension of health-related texts of Sri-Lankan English as second language speakers

In order to understand the role of the factors that can predict the comprehension of health-related texts in a second language (L2), we conducted a study that examines whether allowing L2 users to listen to a health-related text while reading it affects understanding. We also investigated what role general and health-related vocabulary knowledge play in the comprehension of health-related texts in a silent-reading and reading-while-listening conditions. Our participants were 259 Sri Lankan L2 users who read two health-related texts silently and read two other texts while listening to the text being read out to them. They also completed an L2 vocabulary knowledge and a health-related vocabulary knowledge test. We used Generalized Linear Mixed-Effects Models to predict the effect of text presentation mode, L2 and health-related vocabulary knowledge on comprehension. The results showed no significant effect of text presentation mode. However, both L2 vocabulary knowledge and health-related vocabulary knowledge were found to play a substantial role in text comprehension. Our findings also revealed that Sri Lankan L2 users generally demonstrated inadequate comprehension of health-related texts. To promote a higher level of health-related text comprehension in an additional language, the general and health-specific L2 vocabulary knowledge and language proficiency of the population needs to be improved

Operation of Battery Storage as a Temporary Equipment During Grid Reinforcement Caused by Electric Vehicles

Electric vehicle charging stresses distribution grids significantly with high penetrations of electric vehicles. This will lead to grid reinforcement works in several distribution grids. Battery storage is a possible solution to bypass times of grid reinforcement due to electric vehicle charging. In this paper, different operation strategies for such a battery storage are tested at first in simulations. The main difference between the strategies is the necessary input data. Following the simulations, selected strategies are tested in reality in the project ”Netzlabor E-Mobility-Allee”. It is proved that battery storage is a functioning possibility to bypass times of grid reinforcement

The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice:a national regression discontinuity design

Objectives Unnecessary antibiotic prescribing contributes to antimicrobial resistance. A randomized controlled trial in 2014–15 showed that a letter from England’s Chief Medical Officer (CMO) to high-prescribing GPs, giving feedback about their prescribing relative to the norm, decreased antibiotic prescribing. The CMO sent further feedback letters in succeeding years. We evaluated the effectiveness of the repeated feedback intervention. Methods Publicly available databases were used to identify GP practices whose antibiotic prescribing was in the top 20% nationally (the intervention group). In April 2017, GPs in every practice in the intervention group (n = 1439) were sent a letter from the CMO. The letter stated that, ‘the great majority of practices in England prescribe fewer antibiotics per head than yours’. Practices in the control group received no communication (n = 5986). We used a regression discontinuity design to evaluate the intervention because assignment to the intervention condition was exogenous, depending on a ‘rating variable’. The outcome measure was the average rate of antibiotic items dispensed from April 2017 to September 2017. Results The GP practices who received the letter changed their prescribing rates by −3.69% (95% CI=−2.29 to −5.10; P<0.001), representing an estimated 124 952 fewer antibiotic items dispensed. The effect is robust to different specifications of the model. Conclusions Social norm feedback from a high-profile messenger continues to be effective when repeated. It can substantially reduce antibiotic prescribing at low cost and on a national scale. Therefore, it is a worthwhile addition to antimicrobial stewardship programmes

Testing young foreign language learners’ reading comprehension:Exploring the effects of working memory, grade level, and reading task

Extensive research has demonstrated the impact of working memory (WM) on first language (L1) reading comprehension across age groups (Peng et al., 2018), and on foreign language (FL) reading comprehension of adults and older adolescents (Linck et al., 2014). Comparatively little is known about the effect of WM on young FL readers’ comprehension, and even less within testing contexts. Young FL readers are still developing their L1 reading skills and general cognitive skills (e.g., attentional regulation abilities). Completing FL reading tests might be particularly taxing on their WM, and differences in WM capacity – as well as other learner and task characteristics – might create construct-irrelevant variance in test performance. In this study we investigate the effects of WM, grade level, and reading task on young learners’ FL reading test performances. Ninety-four young English language learners (Grades 6-7) in Hungary completed the TOEFL® Junior™ Comprehensive’s reading test and a WM test battery. Our mixed-effects model predicted significantly higher comprehension accuracy among learners with higher WM capacity, and among learners in Grade 7 compared to learners in Grade 6. Reading task differences were not associated with significant comprehension accuracy differences. We discuss the implications of our findings for testing young learners’ FL reading comprehension

The effect of read-aloud assistance on the text comprehension of dyslexic and non-dyslexic English language learners

One of the special arrangements in testing contexts is to allow dyslexic students to listen to the text while they read. In our study, we investigated the effect of read-aloud assistance on young English learners’ language comprehension scores. We also examined whether students with dyslexia identification benefit from this assistance differently from their peers with no official identification of dyslexia. Our research was conducted with young Slovenian learners of English who performed four language assessment tasks adapted from a standardized battery of Slovenian national English language tests. In a counter-balanced design, 233 students with no identified dyslexia and 47 students with dyslexia identification completed two language comprehension tasks in a reading-only condition, one task with read-aloud assistance and one task in listening-only mode. We used Generalized Linear Mixed-Effects Modelling (GLMM) to estimate accurately the effects of the mode of administration, dyslexia status, and input text difficulty, while accounting for error variance owing to random differences between students, texts, and questions. The results of our study revealed that young L2 learners with no dyslexia identification performed similarly in the three conditions. The read-aloud assistance, however, was found to increase the comprehension scores of dyslexic participants when reading difficult texts, allowing them to perform at the level of their non-dyslexic peers. Therefore, our study suggests that this modification of the test administration mode might assist dyslexic students in demonstrating their text comprehension abilities

Reserves and trade jointly determine exposure to food supply shocks

While a growing proportion of global food consumption is obtained through international trade, there is an ongoing debate on whether this increased reliance on trade benefits or hinders food security, and specifically, the ability of global food systems to absorb shocks due to local or regional losses of production. This paper introduces a model that simulates the short-term response to a food supply shock originating in a single country, which is partly absorbed through decreases in domestic reserves and consumption, and partly transmitted through the adjustment of trade flows. By applying the model to publicly-available data for the cereals commodity group over a 17 year period, we find that differential outcomes of supply shocks simulated through this time period are driven not only by the intensification of trade, but as importantly by changes in the distribution of reserves. Our analysis also identifies countries where trade dependency may accentuate the risk of food shortages from foreign production shocks; such risk could be reduced by increasing domestic reserves or importing food from a diversity of suppliers that possess their own reserves. This simulation-based model provides a framework to study the short-term, nonlinear and out-of-equilibrium response of trade networks to supply shocks, and could be applied to specific scenarios of environmental or economic perturbations

The complement cascade as a mediator of tissue growth and regeneration

Recent evidence has demonstrated that the complement cascade is involved in a variety of physiologic and pathophysiologic processes in addition to its role as an immune effector. Research in a variety of organ systems has shown that complement proteins are direct participants in maintenance of cellular turnover, healing, proliferation and regeneration. As a physiologic housekeeper, complement proteins maintain tissue integrity in the absence of inflammation by disposing of cellular debris and waste, a process critical to the prevention of autoimmune disease. Developmentally, complement proteins influence pathways including hematopoietic stem cell engraftment, bone growth, and angiogenesis. They also provide a potent stimulus for cellular proliferation including regeneration of the limb and eye in animal models, and liver proliferation following injury. Here, we describe the complement cascade as a mediator of tissue growth and regeneration