English-speaking Adults Research Articles

Measuring symptom burden in patients with cancer during a pandemic: the MD Anderson symptom inventory for COVID-19 (MDASI-COVID)

BackgroundSymptom expression in SARS-CoV-2 infection (COVID-19) may affect patients already symptomatic with cancer. Patient-reported outcomes (PROs) can describe symptom burden during the acute and postacute stages of COVID-19 and support risk stratification for levels of care. At the start of the COVID-19 pandemic, our purpose was to rapidly develop, launch through an electronic patient portal, and provide initial validation for a PRO measure of COVID-19 symptom burden in patients with cancer.MethodsWe conducted a CDC/WHO web-based scan for COVID-19 symptoms and a relevance review of symptoms by an expert panel of clinicians treating cancer patients with COVID-19 to create a provisional MD Anderson Symptom Inventory for COVID-19 (MDASI-COVID). English-speaking adults with cancer who tested positive for COVID-19 participated in the psychometric testing phase. Patients completed longitudinal assessments of the MDASI-COVID and the EuroQOL 5 Dimensions 5 Levels (EQ-5D-5L) utility index and visual analog scale, which were presented through an electronic health record patient portal. To test the validity of the MDASI-COVID to distinguish between known groups of patients, we hypothesized that patients hospitalized, including having a hospitalization extended, for COVID-19 versus those not hospitalized would experience higher symptom burden. Correlation of mean symptom severity and interference scores with relevant EQ-5D-5L scores tested concurrent validity. The reliability of the MDASI-COVID was evaluated by calculating Cronbach alpha coefficients and test-retest reliability was evaluated by calculating Pearson correlation coefficients between the initial assessment and a second assessment no more than 14 days later.ResultsThe web-based scan found 31 COVID-19-related symptoms; rankings of a 14-clinician expert panel reduced this list to 11 COVID-specific items to be added to the core MDASI. Time from literature scan start in March 2020 to instrument launch in May 2020 was 2 months. Psychometric analysis established the MDASI-COVID’s reliability, known-group validity, and concurrent validity.ConclusionsWe were able to rapidly develop and electronically launch a PRO measure of COVID-19 symptom burden in patients with cancer. Additional research is needed to confirm the content domain and predictive validity of the MDASI-COVID and define the symptom burden trajectory of COVID-19.

Exploring the Impact of Two Feedback Types on Speech Intelligibility, Precision, and Naturalness.

This pilot study examined the impact of feedback type on learning a novel speech task, as measured by listener ratings, and will inform procedures for future investigations within a larger sample size. Twenty-four native monolingual English-speaking college-aged adults participated in a single training session to learn novel Hindi phrases. Participants were randomly placed into one of three feedback groups: knowledge of performance (KP), knowledge of results (KR), or a combined KP + KR condition. Participant performance was assessed at 1 day and 1 week post-training. Participant responses were audio recorded and judged for intelligibility, precision, and naturalness by native Hindi speakers, blind to the feedback conditions, via rating scales. At 2 days post-training, participants in the KP and KP + KR feedback conditions were rated as performing better than participants in the KR condition on all three perceptual measures. At 1 week post-training, participants in the KP feedback condition were judged to be superior across all three perceptual measures. Preliminary findings suggest that augmented feedback enhances learning, especially when skills are considered novel and learners are unable to rely on their own internal feedback. These results may have implications for the application of motor learning principles into clinical practice for persons with motor speech disorders.

Does Musicality Assist Foreign Language Learning? Perception and Production of Thai Vowels, Consonants and Lexical Tones by Musicians and Non-Musicians.

The music and spoken language domains share acoustic properties such as fundamental frequency (f0, perceived as pitch), duration, resonance frequencies, and intensity. In speech, the acoustic properties form an essential part in differentiating between consonants, vowels, and lexical tones. This study investigated whether there is any advantage of musicality in the perception and production of Thai speech sounds. Two groups of English-speaking adults-one comprising formally trained musicians and the other non-musicians-were tested for their perception and production of Thai consonants, vowels, and tones. For both groups, the perception and production accuracy scores were higher for vowels than consonants and tones, and in production, there was also better accuracy for tones than consonants. Between the groups, musicians (defined as having more than five years of formal musical training) outperformed non-musicians (defined as having less than two years of formal musical training) in both the perception and production of all three sound types. Additional experiential factors that positively influenced the accuracy rates were the current hours of practice per week and those with some indication of an augmentation due to musical aptitude, but only in perception. These results suggest that music training, defined as formal training for more than five years, and musical training, expressed in hours of weekly practice, facilitate the perception and production of non-native speech sounds.

Pragmatic effects on semantic learnability: Insights from evidentiality

Cross-linguistically prevalent semantic distinctions are widely assumed to be easier to learn because they reflect natural concepts. Here we propose an alternative, pragmatic perspective that links both the cross-linguistic prevalence and the learnability of semantic distinctions to communicative pressures. We focus on evidentiality (the encoding of the speaker’s information source). Across languages, grammatical evidential systems are more likely to encode indirect sources (especially, reported information) compared to direct sources (e.g., visual perception). On a conceptual account, this seems puzzling, since humans reason naturally about how seeing connects to knowing. On a pragmatic account, however, the predominant encoding of the speaker’s reportative compared to visual information sources can be explained in terms of informativeness (visual access is ubiquitous and potentially more reliable, hence less marked). We tested the pragmatic account in four experiments. Adult English speakers exposed to novel miniature evidential morphological systems consistently showed higher learning rates for systems with a single indirect (reportative) compared to a single direct (visual) evidential morpheme (Experiment 1). This pattern persisted even when participants were given specific cues to the target meanings (Experiment 2) and partly extended to cases where evidential meanings were conveyed through visual, not linguistic, means (Experiment 3). It also persisted when the evidential morphemes had to be learned from different materials (Experiment 4). We conclude that the cross-linguistic bias to mark reportative/indirect over visual/direct sources of information has pragmatic roots that also shape the learnability of evidential semantic distinctions.

Patient preferences and willingness-to-pay for community pharmacy-led Medicare Part D consultation services: A discrete choice experiment.

Community pharmacies currently offer Medicare Part D consultation services, often at no-cost. Despite facilitating plan-switching behavior, identifying potential cost-savings, and increasing medication adherence, patient uptake of these services remains low. To investigate patient preferences for specific service-offering attributes and marginal willingness-to-pay (mWTP) for an enhanced community pharmacy Medicare Part D consultation service. A discrete choice experiment (DCE) guided by the SERVQUAL framework was developed and administered using a national online survey panel. Study participants were English-speaking adults (≥65 years) residing in the United States enrolled in a Medicare Part D or Medicare Advantage plan and had filled a prescription at a community pharmacy within the last 12 months. An orthogonal design resulted in 120 paired-choice tasks distributed equally across 10 survey blocks. Data were analyzed using mixed logit and latent class models. In total, 540 responses were collected, with the average age of respondents being 71 years. The majority of respondents were females (60%) and reported taking four or more prescription medication (51%). Service attribute levels with the highest utility were: 15-min intervention duration (0.392), discussion of services+a follow-up phone call (0.069), in-person at the pharmacy (0.328), provided by a pharmacist the patient knew (0.578), and no-cost (3.382). The attribute with the largest mWTP value was a service provided by a pharmacist the participant knew ($8.42). Latent class analysis revealed that patient preferences for service attributes significantly differed by gender and difficulty affording prescription medications. Quantifying patient preference using discrete choice methodology provides pharmacies with information needed to design service offerings that balance patient preference and sustainability. Pharmacies may consider providing interventions at no-cost to subsets of patients placing high importance on a service cost attribute. Further, patient preference for 15-min interventions may inform Medicare Part D service delivery and facilitate service sustainability.

Willingness to participate in entheogen use research in naturalistic settings

AbstractBackgroundEntheogen use is becoming increasingly popular and a potential option for treatment or adjuvant treatment for various medical conditions. Clinical studies are needed to determine the efficacy, safety, and possible role of these traditional medicines in the context of modern society and the Western medicine paradigm. The willingness of patients to participate in such studies is currently unknown.Materials and MethodsIn September 2021 we implemented an anonymous, observational pilot survey to determine the general public's willingness to participate in future entheogen research. All participants were English-speaking adults and had participated in therapy or a retreat utilizing entheogens in a naturalistic setting in the last five (5) years. Participants were recruited through community outreach via email.ResultsThe response rate for this data set was estimated to be 48.3% (n = 84/174). Nearly all (95.5%) participants believed this research should be done and 86.9% said they would participate in entheogen research that lasted longer than one year. A greater proportion of participants were willing to participate in remote interviews (73.5%) rather than in-person surveys (64.7%). A majority of participants (78%) also noted the importance of financial compensation for their time influencing the willingness to participate in future entheogen studies.ConclusionsThe willingness to participate in research involving traditional entheogens is not the limiting factor in facilitating further studies. Participants held overwhelmingly positive perceptions indicating that they believed this research should be done. Future longitudinal clinical studies with financial compensation and controlled set and settings will be necessary to expand the evidence base for naturalistic entheogen use.

Patient Perspectives of Skeletal Muscle Cramping in Dialysis: A Focus Group Study.

Skeletal muscle cramping is a common, painful and debilitating symptom experienced by people receiving dialysis. Neither a standardized, patient-endorsed definition of skeletal muscle cramping nor full understanding of patients' perspectives of skeletal muscle cramping exist. We conducted focus groups, within a Kidney Health Initiative (KHI) project, to elicit skeletal muscle cramping experiences of people receiving dialysis as the basis for patient-reported outcome measure (PROM) development. Eligible participants (English-speaking adults aged 18-85 treated by dialysis and a skeletal muscle cramping episode within 30 days) were purposively recruited from a panel (L&E Research) of people receiving dialysis at home or in-center. Standard qualitative methods were used to conduct virtual 90-minute sessions discussing: skeletal muscle cramping clinical characteristics; participants' skeletal muscle cramping experiences; and feedback on a draft skeletal muscle cramping definition and a patient-facing conceptual model developed by the KHI project workgroup. We used qualitative thematic analysis. There were 20 diverse participants in three focus groups. Universally-experienced skeletal muscle cramping attributes differed by dialysis setting in onset, worst pain rating, duration and timing. Variably-experienced attributes (applied to home and in-center dialysis) were: gross and fine motor impact, sleep disruption, mood-related themes of fear and annoyance/frustration/irritability. Avoidance/adaptive behaviors included reluctance or avoiding movement; adjusting what they ate or drink (e.g., yellow mustard, pickles, pickle juice, tonic water); heat application; massage; and cannabidiol use. The skeletal muscle cramping definition was endorsed and insightful suggestions for conceptual model collected. This qualitative study of in-center and home patients' skeletal muscle cramping experiences identified universally- and variably-experienced attributes. The patient-endorsed skeletal muscle cramping definition can serve as a standard for assessment. These results provide the foundation to develop a PROM for regulatory use with people receiving maintenance dialysis who experience skeletal muscle cramping.

How Does English Encode ‘Tight’ Vs. ‘Loose-fit’ Motion Events? It’s Complicated

ABSTRACT Linguistic encoding of spatial events has long provided a forum for examining how languages encode space, how children learn their native encodings, and whether cross-linguistic differences affect non-linguistic representations of space. One prominent case concerns motion events in which objects are moved into tight or loose-fit relationships of containment or support. Seminal findings from Bowerman showed that young children learning Korean regularly use specific verbs to encode tight/loose fit across containment and support relationships, whereas children learning English use prepositions to encode containment or support (e.g. in/on) across the tight/loose fit distinction. Others have asked how these early-acquired differences affect non-linguistic encoding of similar events. Many of these studies have focused on the lexical differences between the two languages – verbs (in Korean) and/or prepositions (in English). Here, we ask whether this focus might underestimate how English encodes these events by closely examining the range of options used by English speakers to encode loose and tight-fit motion events. In Experiment 1, 3-year-old and adult English speakers described joining and separating events which culminated in loose or tight-fit end-states. Participants’ use of lexical verbs together with their syntactic frames differentiated among the event types, especially between “loose-fit” events with asymmetric motion between objects (e.g. a block being put into a bowl) vs. “tight-fit” events with symmetric motion (e.g. two Legos being brought together at the same time). In Experiment 2, we replicated the basic findings using events portrayed with more complex of objects. Our findings show that English affords both children and adults rich resources to encode motion events culminating in tight and loose fit end-states; these devices include both lexical items and syntactic frames. The findings raise important questions about how to examine effects of language on non-linguistic spatial cognition in children and adults.

Smartphone intervention to optimize medication-assisted treatment outcomes for opioid use disorder: study protocol for a randomized controlled trial

BackgroundOpioids accounted for 75% of drug overdoses in the USA in 2020, with rural states particularly impacted by the opioid crisis. While medication-assisted treatment (MAT) with Suboxone remains one of the more efficacious treatments for opioid use disorder (OUD), approximately 40% of people receiving Suboxone for outpatient MAT for OUD (MOUD) relapse within the first 6 months of treatment. We developed the smartphone app-based intervention OptiMAT as an adjunctive intervention to improve MOUD outcomes. The aims of this study are to (1) evaluate the efficacy of adjunctive OptiMAT use in reducing opioid misuse among people receiving MOUD and (2) evaluate the role of specific OptiMAT features in reducing opioid misuse, including the use of GPS-driven just-in-time intervention.MethodsWe will conduct a two-arm, single-blind, randomized controlled trial of adults receiving outpatient MOUD in the greater Little Rock AR area. Participants are English-speaking adults ages 18 or older recently enrolled in outpatient MOUD at one of our participating study clinics. Participants will be allocated via 1:1 randomized block design to (1) MOUD with adjunctive use of OptiMAT (MOUD+OptiMAT) or (2) MOUD without OptiMAT (MOUD-only). Our blinded research statistician will evaluate differences between the two groups in opioid misuse (as determined by quantitative urinalysis conducted by clinical lab staff blinded to group membership) during the 6-months following study enrolment. Secondary analyses will evaluate if OptiMAT-usage patterns within the MOUD+OptiMAT group predict opioid misuse or continued abstinence.DiscussionThis study will test if adjunctive use of OptiMAT improve MOUD outcomes. Study findings could lead to expansion of OptiMAT into rural clinical settings, and the identification of OptiMAT features which best predict positive clinical outcome could lead to refinement of this and similar smartphone app-based interventions.Trial registrationClinicalTrials.govidentifier: NCT05336188, registered March 21, 2022.

Role of perceived discrimination and anxiety sensitivity in cigarette smoking among english-speaking latinx adults living in the United States.

The Latinx/Hispanic (hereafter, Latinx) population in the United States (US) experiences significant tobacco-related health disparities. Extant work suggests social determinants of health (SDoH) such as perceived discrimination is an individual differences factor for cigarette smoking behavior among Latinx individuals who smoke cigarettes. Other research has suggested sensitivity to internal cues, referred to as anxiety sensitivity, is related to smoking among Latinx adults, but this work has not explored whether anxiety sensitivity may moderate the association between perceived discrimination and smoking behavior. Therefore, the present investigation sought to explore the main and interactive association of perceived discrimination and anxiety sensitivity in relation to cigarettes smoked per day, severity of problems experienced when quitting, and perceived barriers for smoking cessation among 338 English-speaking Latinx individuals living in the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female) who smoke cigarettes. Results supported statistically significant main effects for perceived discrimination and anxiety sensitivity in relation to increased severity of problems experienced when quitting and perceived barriers for smoking cessation. These associations were evident after adjusting for a sociodemographic covariates. Overall, the present investigation suggests that both perceived discrimination and anxiety sensitivity are important constructs relevant to understanding smoking processes among Latinx adults who smoke cigarettes and should be integrated in theoretical models of smoking among this population.

Practices, knowledge, and concerns for out-of-home firearm storage among those with access to firearms: results from a survey in two states

BackgroundTemporary, voluntary storage of firearms away from the home is a recommended option for individuals with risk of suicide, but it may also be used in other situations (e.g., long trips). Prior work has explored the availability of storage options and the views of storage locations. Little is known about out-of-home storage practices among those who live in homes with firearms (including owners).MethodsWe surveyed English-speaking adults (18 or older) in two states (Colorado and Washington) living in a home with a firearm (June–July 2021).ResultsAmong the final sample of 1029, most respondents were white (88.1%) and non-Hispanic (85.0%); half were female (50.8%), and the most common age group was ages 35–44 (25.5%). Just over one quarter (27.3%) of respondents indicated they had stored a firearm away from their home/car/garage in the last 5 years. The place most respondents said they were somewhat or very likely to consider was at a family members home (62.7%) or at a self-storage facility (52.5%).ConclusionOut-of-home firearm storage is a relatively common practice and endorsed by many gun-owners, suggesting out-of-home storage is feasible for firearm owners as an approach to suicide prevention.

The Impact of COVID-19 on Access to Resources among Individuals Experiencing Homelessness and Traumatic Brain Injury

The rates of traumatic brain injury (TBI) are higher among individuals experiencing homelessness compared with the general population. Individuals experiencing homelessness and a TBI may experience barriers to care. COVID-19 may have further impacted access to basic resources, such as food, shelter, and transportation for individuals experiencing homelessness. This study aimed to answer the following research question: What is the impact of COVID-19 on access to resources among individuals experiencing homelessness and TBI? A cross-sectional study design and purposive sampling were utilized to interview 38 English-speaking adults experiencing homelessness and who had sustained a TBI (ages 21–73) in one Colorado city. Qualitative questions related to the impact of COVID-19 were asked and qualitative analysis was used to analyze the responses. Three primary themes emerged regarding the types of resources that were restricted by COVID-19: basic/biological needs, financial needs, and a lack of connection. COVID-19 has shown the social work field the need for continued innovation and better practice standards for individuals who are not housed. For those living with a reported TBI history and experiencing homelessness, COVID-19 made it difficult to access basic services for survival.

Technical profiles of child sexual exploitation material offenders

The idiographic technical profiles of child sexual exploitation material (CSEM) offenders provide insight into their behaviours and context for their interactions with technology, but minimal quantitative work has been done to evaluate their sociability, technical ability and technophilia compared to non-offenders. This work used an online survey to compare an offender group consisting of English-speaking adults previously convicted of CSEM offenses (N = 78) with a reference population of non-offenders (N = 254). The survey assessed sociability, technical ability and technophilia through self-rating and information on occupation, level of education and device ownership. The study found that CSEM offenders had slightly lower sociability than non-offenders, though not at a level of clinical interest. Additionally, CSEM offenders had no statistically significant difference in technical ability and lower overall technophilia when compared to non-offenders. This study fails to support popular perceptions of CSEM offenders being technically savvy loners who are early adopters of new technologies.

Latinx Individuals Who Smoke Daily with and without a Probable Anxiety Disorder: Differences in Smoking Behavior and Beliefs about Abstinence.

There is a well-established relation between anxiety psychopathology and smoking in the general population. However, little work focuses on Latinx/Hispanic (hereafter Latinx) persons who smoke from this comorbidity perspective. The present investigation aimed to explore differences among English-speaking Latinx adults who live in the United States (US) and smoke cigarettes with and without a probable anxiety disorder in terms of cigarette dependence, perceived barriers for quitting, severity of problems when quitting, and smoking abstinence expectancies. The sample included 338 adult Latinx daily cigarette smokers (Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female) who identified as Latinx and were recruited nationally throughout the US. Results indicated that among Latinx persons who smoke, those with a probable anxiety disorder (compared to those without) were more likely to demonstrate higher levels of cigarette dependence, severity of problems when trying to quit, perceived barriers for quitting, and negative abstinence expectancies after adjusting for key variables linked to smoking and anxiety (e.g., hazardous drinking, education). The current findings are the first to document probable anxiety disorder status as a clinically relevant factor for a wide range of smoking variables and beliefs about abstinence among Latinx persons who smoke.

Updating the Aesthetic Fluency Scale: Revised long and short forms for research in the psychology of the arts.

People's knowledge about the arts shapes how they experience and engage with art. Since its introduction, the 10-item Aesthetic Fluency Scale has been widely used to measure self-reported art knowledge. Drawing from findings and researchers' experience since then, the present work develops and evaluates a Revised Aesthetic Fluency Scale using item response theory to broaden its scope (36 items) and refine its response scale. In a large sample (n = 2,089 English-speaking adults), Study 1 found strong evidence for unidimensionality, good item fit, and a difficulty level suitable for its targeted population; Study 2 (n = 392) provided initial evidence for score validity via relationships with art engagement, Openness to Experience, and aesthetic responsiveness; and Study 3 derived a brief, 10-item form for time-constrained projects. Taken together, the revised scales build upon lessons learned from the original and appear promising for the next generation of research.

Voice Assistants' Responses to Questions About the COVID-19 Vaccine: National Cross-sectional Study.

Artificial intelligence-powered voice assistants (VAs), such as Apple Siri, Google Assistant, and Amazon Alexa, interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information. In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed was conducted online from April 22 to 28, 2021. The primary outcomes were the VAs' responses to 2 questions: "Should I get the COVID vaccine?" and "Is the COVID vaccine safe?" Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi-square or Fisher exact test for categorical variables. Of the 466 survey respondents included in the final analysis, 404 (86.7%) used Apple Siri, 53 (11.4%) used Google Assistant, and 9 (1.9%) used Amazon Alexa. In response to the question "Is the COVID vaccine safe?" 419 (89.9%) users received a direct response, of which 408 (97.3%) had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3% (11/207) had a positive connotation and 94.7% (196/207) had a neutral connotation. In response to the question "Should I get the COVID vaccine?" 93.1% (434/466) of users received a list of websites, of which 91.5% (1155/1262) had a neutral connotation. For both COVID-19 vaccine-related questions, there was no association between the connotation of a response and the age, gender, zip code, race or ethnicity, and education level of the respondent. Our study found that VAs were much more likely to respond directly with positive connotations to the question "Is the COVID vaccine safe?" but not respond directly and provide a list of websites with neutral connotations to the question "Should I get the COVID vaccine?" To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination.

Exploring Autistic adults’ perspectives on genetic testing for autism

PurposeThis study aimed to investigate the perspectives of Autistic adults regarding genetic testing for autism. Although previous studies have explored the perceptions of genetic testing for autism among a variety of different stakeholders, to our knowledge, none have explored the perceptions of Autistic adults. MethodsWe distributed a web-based survey via social media to English-speaking Autistic adults. The survey assessed individuals’ experiences with, attitudes toward, and interest in genetic testing for autism and their perceptions of its potential benefits and harms. ResultsIn total, 461 respondents completed the survey: 27% would have wanted genetic testing during childhood, 74% felt that it should only be offered if the Autistic individual is able to consent, and 49% felt that genetic testing for autism should not be done at all. Smaller proportions felt testing should be routinely offered to Autistic adults and children (35% and 26%, respectively). A total of 40% felt that genetic testing was only harmful, and 15% felt it was only beneficial. ConclusionAutistic adults have concerns about genetic testing for autism. Additional work is required to bridge the divide between the Autistic community and health care providers and families to identify if and when genetic testing should be offered.

The Multiple Meanings of Discrimination

Discrimination is one of the most important concepts for understanding, analyzing, and addressing social inequality. It is a term with many meanings, however, and existing research tells us little about how people understand and use the term. This study analyzes data from interviews with 38 English-speaking adults in the southeastern United States to examine how people use and make sense of the term discrimination. In structured interviews, participants described their experiences of mistreatment, reflected on whether their experiences were instances of discrimination, and explained their reasoning. Many participants expressed uncertainty about the meaning of discrimination and were unsure if it applied to particular situations. When asked to explain why they thought particular situations were or were not instances of discrimination, some participants relied on a legalistic framework, drawing from knowledge they had gained in their formal educational and training. Others foregrounded issues of inequality and social justice, explicitly invoking racism, sexism, and social class when explaining why something was or was not discrimination. A third group of participants, disproportionately but not exclusively White and non-Latinx, considered discrimination to be synonymous with “differential treatment” and unrelated to social inequality. Analyses suggest that these interpretive frameworks reflect participants’ legal consciousness, political consciousness, and their ability to read particular situations as connected to specific systems of inequality—that is, their literacies of particular inequalities.

Assessing patient-level knowledge of precision medicine in a community health center setting.

As precision medicine approaches are implemented, cancer treatment decisions have come to require comprehension of genetic tests and their role in risk stratification and treatment options. Acceptance and implementation of precision medicine requires patient understanding of numeracy, genetic literacy, health literacy, and medical trust. Implementing precision medicine in a US federally qualified community health center (FQCHC) setting has received little attention. Using a mixed-methods approach, we sought to identify patient-level factors influencing the understanding of cancer risk and precision medicine among FQCHC patients. We enrolled 26 English-speaking adults aged 40-79years. Participants enrolled in focus groups and completed surveys to assess patient-level understanding of precision medicine, numeracy, and health literacy. The majority of participants were female (77%) and self-identified as African American (89%). Approximately one-third reported having a high school degree or less. While health literacy was generally high, 42% felt that genes or genetics had little impact on health and most (69%) reported little familiarity with precision medicine. Many participants reported that trust in their providers was extremely or very important when receiving genetic tests. Numeracy levels were moderate, with nearly half reporting some discomfort working with fractions and 38% finding numerical information only occasionally useful. Findings suggest that patients may lack familiarity with precision medicine concepts relevant for understanding cancer treatment decisions. Future educational efforts may help bridge the gap in patient understanding and facilitate equitable opportunities for precision medicine for all patients, including those seeking care from community health centers.

Universal Constraints on Linguistic Event Categories: A Cross-Cultural Study of Child Homesign

Languages carve up conceptual space in varying ways—for example, English uses the verb cut both for cutting with a knife and for cutting with scissors, but other languages use distinct verbs for these events. We asked whether, despite this variability, there are universal constraints on how languages categorize events involving tools (e.g., knife-cutting). We analyzed descriptions of tool events from two groups: (a) 43 hearing adult speakers of English, Spanish, and Chinese and (b) 10 deaf child homesigners ages 3 to 11 (each of whom has created a gestural language without input from a conventional language model) in five different countries (Guatemala, Nicaragua, United States, Taiwan, Turkey). We found alignment across these two groups—events that elicited tool-prominent language among the spoken-language users also elicited tool-prominent language among the homesigners. These results suggest ways of conceptualizing tool events that are so prominent as to constitute a universal constraint on how events are categorized in language.