Judges wield enormous power in modern society and it is not surprising that scholars have long been interested in how judges think. The purpose of this article is to examine how US judges reason on language issues. To understand how courts decide on comprehension of constitutional rights by speakers with Limited English Proficiency (LEP), I analyzed 460 judicial opinions on appeals from LEP speakers, issued between 2000 and 2020. Two findings merit particular attention. Firstly, the analysis revealed that (...) in 36% of the interrogations, LEP speakers were advised of their rights only in English. This means that two decades after the Executive Order 13166 (2000) _Improving Access to Services for Persons with Limited English Proficiency_, law enforcement still doesn’t have adequate resources to advise LEP speakers of their constitutional rights in their primary languages. Secondly, the analysis revealed that some courts treat second language proficiency as an all-or-none phenomenon. This approach results in linguistic discrimination against LEP speakers who cannot comprehend legal language but are denied the services of an interpreter because they can answer basic questions in English. I end the discusson with recommendations for best practices in delivery of constitutional rights. (shrink)

The relationship between bilingual language control and domain-general cognitive control has been a hot topic in the research field of bilingualism. Previous studies mostly examined the correlation between performances of bilinguals in language control tasks and that in domain-general cognitive control tasks and came to the conclusions that they overlap, partially overlap, or are qualitatively different. These contradictory conclusions are possibly due to the neglect of the moderating effect of second language proficiency, that is, the relationship (...) between bilingual language control and domain-general cognitive control might vary with the L2 proficiency of bilinguals. To examine this hypothesis, we recruited 36 unbalanced Chinese-English bilinguals to perform the Simon task, Oxford Placement Test, and picture naming tasks in single-and dual-language contexts. We find that Simon scores positively predicted switching costs in bilinguals with low L2 proficiency, but not in bilinguals with high L2 proficiency. Furthermore, Simon scores positively predicted mixing costs in bilinguals with high L2 proficiency, but not in bilinguals with low L2 proficiency. These results verify the moderating effect of L2 proficiency on the relationship between bilingual language control and domain-general cognitive control, that is, bilinguals with more proficient L2 rely on domain-general cognitive control less for local language control and more for global language control. This may imply a shift from local to global for the dependency of bilingual language control on domain-general cognitive control during the L2 development of bilinguals. (shrink)

Memory errors and, specifically, false memories in the Deese/Roediger–McDermott paradigm have been extensively studied in the past decades. Most studies have investigated false memory in monolinguals’ native or first language (L1), but interest has also grown in examining false memories in participants’ second language (L2) with different proficiency levels. The main purpose of this manuscript is to review the current state of knowledge on the role of language proficiency on false memories when participants encode and (...) retrieve information in the same language. To do so, a systematic literature search was conducted, and the available studies were reviewed. These studies differed in, for example, age, language proficiency, or material characteristics, including both high and low associative strength lists, and they reported different results. In this review, we attempted to make sense of the apparently contradictory results by carefully identifying participants’ language dominance and L2 proficiency. Specifically, the results indicated that, first, people are more prone to produce false memories in their dominant than in their non-dominant language. This result generalizes to lists with high and low associative strength, as well as to participants of different ages. Second, false memories do not differ between two languages when speakers are equally proficient in both languages. Finally, highly proficient L2 speakers produce more false memories in their L2 than speakers with lower L2 proficiency. The results of this review will be considered in the light of the theoretical frameworks of false memories and bilingual language processing. (shrink)

How learning a second language changes our brain has been an important question in neuroscience. Previous neuroimaging studies with different ages and language pairs spoken by bilinguals have consistently shown plastic changes in brain systems supporting executive control. One hypothesis posits that L2 experience-induced neural changes supporting cognitive control, which is responsible for the selection of a target language and minimization of interference from a non-target language. However, it remains poorly understood as to whether such cognitive (...) advantage is reflected as stronger controlled processing or increased automatic inhibition processing. In this study, using functional MRI we scanned 27 Chinese-English late bilinguals while they performed a Simon task. Results showed that bilinguals with higher L2 vocabulary proficiency performed better in the Simon task, and more importantly, higher L2 vocabulary proficiency was associated with weaker activation of brain regions that support more general cognitive control, including the right anterior cingulate cortex, left insula and left superior temporal gyrus. These results suggest that L2 experience may lead to a more automatic and efficient processing in the inhibitory control task. Our finding provides an insight into neural activity changes associated with inhibitory control as a function of L2 proficiency. (shrink)

Differential academic language proficiency is an issue of major educational concern, bearing on problems varying from pupil performance, to social prospects, and citizenship. In this paper we develop a conception of the language‐acquiring subject, and we discuss the consequences for understanding differential language proficiency in schools. Starting from Wittgenstein's meaning‐as‐use theory we show that learning a language requires an activity that relates the subject both to the community of language users, and to the (...) things language is about. In opposition to Luntley, we contend that this does not mean that linguistic development involves linguistic adjustment to the world ‘as it is’. It is argued that, in as far as linguistic development involves a process of adjustment, this concerns conceptions about the world as it is presupposed to be—a ‘world’ that is subjected to doubt and revision time and again. With respect to dealing with differential academic language proficiency, this approach to linguistic development suggests bringing pupils into situations which require active participation in processes of ‘negotiating meaning’, including negotiating the prevailing presuppositions about what the world is like. This also puts novices in a different position—less assimilatory—recognising their co‐constructive potencies at a more fundamental level. (shrink)

Differential academic language proficiency is an issue of major educational concern, bearing on problems varying from pupil performance, to social prospects, and citizenship. In this paper we develop a conception of the language-acquiring subject, and we discuss the consequences for understanding differential language proficiency in schools. Starting from Wittgenstein's meaning-as-use theory we show that learning a language requires an activity that relates the subject both to the community of language users, and to the (...) things language is about. In opposition to Luntley, we contend that this does not mean that linguistic development involves linguistic adjustment to the world 'as it is'. It is argued that, in as far as linguistic development involves a process of adjustment, this concerns conceptions about the world as it is presupposed to be—a 'world' that is subjected to doubt and revision time and again. With respect to dealing with differential academic language proficiency, this approach to linguistic development suggests bringing pupils into situations which require active participation in processes of 'negotiating meaning', including negotiating the prevailing presuppositions about what the world is like. This also puts novices in a different position—less assimilatory—recognising their co-constructive potencies at a more fundamental level. (shrink)

This study examined the influence of integrative motivation, instrumental motivation and second language (L2) proficiency on socio-cultural/academic adaptation in a sample of two groups of international students studying Chinese in China. Results revealed that the non-Asian student group reported higher levels of integrative motivation, socio-cultural adaptation and Chinese language proficiency than the Asian student group, who reported a higher level of instrumental motivation. No significant difference was found in academic adaptation between the two groups. Moreover, the (...) relationships between study variables are the same across Asian and non-Asian student groups. Further evidence from this research indicated that socio-cultural adaptation was influenced more by integrative motivation and less by L2 proficiency. Integrative motivation was found to be the only significant predictor of academic adaptation. Implications for future research are discussed. (shrink)

The investigation of learners’ interlanguage could greatly contribute to the teaching of English as a foreign language and the development of teaching materials. The present study investigates the collocational profiles of large-scale written production by English learners with varied L1 backgrounds and different proficiency levels. Using the British National Corpus as reference corpus, learners’ collocation use was extracted by corpus query language and further identified by t-score via Python programming language. The collocation list consists of 2,501 (...) make/take + noun collocations. Findings show that proficient learners tend to use collocations containing more semantically complicated and abstract noun elements for varied communication tasks. Moreover, advanced learners are inclined to use collocations comprised of more difficult and longer noun elements. (shrink)

Functional language has been used in many multinational corporations as a way to overcome the problems caused by the coexistence of multiple languages in the workplace. The existing literature has explored the importance, adoption, and effectiveness of functional language. Yet, how functional language shapes host country employees’ moral cognition and behavior is insufficiently researched. Guided by the Social Identity Theory, this manuscript shows that host country employees’ functional language proficiency enhances their unethical pro-organizational behavior through (...) their linguistic group identification and moral disengagement. We tested our predictions using the data collected from 309 full-time host country employees through an online survey, and the results generally supported our hypotheses. The findings make contributions to both international management and language literature and organizational moral behavior literature. (shrink)

Using both quantitative and qualitative approaches, this study investigated the preference of learners of English as a foreign language for four types of written corrective feedback, which are often discussed in the literature, on grammatical, lexical, orthographic, and pragmatic errors. In particular, it concerned whether such preference is influenced by two learner variables, namely, foreign language enjoyment and proficiency level. The preference for selective vs. comprehensive WCF was also examined. The participants in the study were 117 University (...) students in a Thai EFL context. Analysis of questionnaire data revealed a tendency for learners to prefer more explicit types of WCF for most error types, irrespective of their proficiency and FLE level. High proficiency level learners rated less explicit WCF types as useful to some degree, whereas their low proficiency level counterparts did not. Similar results were found for the two FLE groups. Besides, the FLE level seemed to play a role in perceiving the value of WCF in terms of scope. The results of follow-up interviews showed that the linguistic features of learners' first language, existing knowledge of the target language, affective feelings, and teacher's role were the main factors contributing to variation in learners' preferences. Possible pedagogical implications are discussed. (shrink)

This study explored the effect of word knowledge facets on second language Chinese lexical inference by highlighting the moderating effect of language proficiency level and learners’ heritage status. L2 Chinese learners with a mixture of linguistic and cultural backgrounds completed a series of word-knowledge measurements as well as a lexical inferencing task. Through a moderated path model, the study demonstrated that word-general knowledge and word-specific knowledge contributed to L2 Chinese lexical inference. In addition, the study underlined the (...) moderating effect of heritage status on the correlation between word knowledge and lexical inference. Given the distinct patterns between heritage and non-heritage learners, morphological awareness may define the characteristics of reading profiles in the Chinese heritage learner population. (shrink)

The present study aimed at investigating the motivational factors affecting Iranian learners’ learning of English as a Foreign Language across differing levels of language proficiency. To this end, 110 males and 70 females with an age range of 18–31 took part in the study and a mixed-methods approach was adopted. First, the researchers administered Oxford Placement Test to determine the proficiency level of the participants and placed them into three levels of language proficiency. Elementary, (...) intermediate, and advanced. Next, as for the quantitative part of the study, the Attitude/Motivation Test Battery questionnaire was distributed among all the participants to delve into the motivational factors. Finally, a semi-structured interview was conducted to qualitatively probe into EFL learners’ motivational factors affecting their learning of English. It was found that the motivational factors which encouraged EFL learners resulted from either intrinsic or extrinsic tendencies. The recognized intrinsically-based motivational factors were personal enjoyment, social prestige, and being challenged. The extrinsically-oriented factors as the source of motivation to learn English were getting a job, pursuing education, earning more money, traveling to foreign countries, pursuing academic careers, making efficient use of technology, and effectively interacting with native speakers. It was concluded that beginner and intermediate English language learners tended to learn English more based on extrinsic factors whereas advanced learners were found to be more intrinsically motivated. (shrink)

Different disciplines converge to trace language evolution from motor skills. The human ability to use tools has been advocated as a fundamental step toward the emergence of linguistic processes in the brain. Neuropsychological and neuroimaging research has established that linguistic functions and tool-use are mediated by partially overlapping brain networks. Yet, scholars still theoretically debate whether the relationship between tool-use and language is contingent or functionally relevant, since empirical evidence is critically missing. Here, we measured both linguistic production (...) and tool-use abilities in the same participants, as well as manual and linguistic motor skills. A path analysis ruling out unspecific contributions from manual or linguistic motor skills, showed that motor proficiency using a tool lawfully predicts differences in individual linguistic production. In addition, more complex tool-use reveals stronger association between linguistic production and tool mastery. These findings establish the existence of shared cognitive processes between tool-use and language. (shrink)

In the midst of globalization, English is regarded as an international language, or Lingua Franca, but learning it as a second language (L2) remains still difficult to speakers of other languages. This is true especially for the speakers of languages distantly related to English such as Japanese. In this sense, exploring neural basis for translation between the first language (L1) and L2 is of great interest. There have been relatively many previous researches revealing brain activation patterns during (...) translations between L1 and English as L2. These studies, which focused on language translation with close or moderate linguistic distance (LD), have suggested that the Broca area (BA 44/45) and the dorsolateral prefrontal cortex (DLPFC; BA 46) may play an important role on translation. However, the neural mechanism of language translation between Japanese and English, having large LD, has not been clarified. Thus, we used functional near infrared spectroscopy (fNIRS) to investigate the brain activation patterns during word translation between Japanese and English. We also assessed the effects of translation directions and word familiarity. All participants’ first language was Japanese and they were learning English. Their English proficiency was advanced or elementary. We selected English and Japanese words as stimuli based on the familiarity for Japanese people. Our results showed that the brain activation patterns during word translation largely differed depending on their English proficiency. The advanced group elicited greater activation on the left prefrontal cortex around the Broca’s area while translating words with low familiarity, but no activation was observed while translating words with high familiarity. On the other hand, the elementary group evoked greater activation on the left temporal area including the superior temporal gyrus (STG) irrespective of the word familiarity. These results suggested that different cognitive process could be involved in word translation corresponding to English proficiency in Japanese learners of English. These difference on the brain activation patterns between the advanced and elementary group may reflect the difference on the cognitive loads depending on the levels of automatization in one’s language processing. (shrink)

Recent studies have proposed that the executive advantages associated with bilingualism may stem from language-switching frequency rather than from bilingualism per se (see for example, Prior & Gollan, 2011). Barbu, Gillet, Orban and Poncelet (2018) showed that high-frequency language switchers outperformed low-frequency switchers on a mental flexibility task but not on alertness or response inhibition tasks. The aim of the present study was to replicate these results as well as to compare proficient high and low-frequency bilingual language (...) switchers to a control group of monolingual participants. Two groups of proficient bilingual adults (30 high-frequency language switchers and 21 low-frequency language switchers) and a group of 28 monolinguals participated in the study. The results showed superior mental flexibility skills in high-frequency language switchers compared to low-frequency switchers and monolinguals; furthermore, the two latter groups showed no difference in mental flexibility skills. These results provide novel support for the hypothesis that the so-called bilingual advantage is, in fact, a result of language-switching habits. (shrink)

Gaining a high level of proficiency is the ultimate aspiration of all language learners, and the use of apology and politeness strategies is consistently associated with the levels of language proficiency. Owing to the significance of speech acts, politeness strategies, and level of proficiency, this study aimed to investigate the realization of apology speech acts and politeness strategies among Iranian EFL learners to examine and compare the lower-intermediate and advanced learners’ use of apology and politeness (...) strategies. To achieve this goal, 320 learners were selected out of 390 EFL learners who took a test of English language proficiency and were then divided into lower-intermediate and advanced levels. The findings of the study revealed significant differences between lower-intermediate and advanced Iranian EFL learners in the realization of the speech act of apology and politeness strategies. Advanced learners preferred to use more indirect and complicated forms of apology speech acts and tended to apply negative politeness and off-record strategies more than the lower-intermediate learners did. However, lower-intermediate learners preferred to use simple and more direct forms of apology and politeness strategies. It can be concluded that as learners increase their knowledge in the target language, and as their interlanguages get closer to the target language, they tend to apply more complicated and native-like speech acts and strategies . (shrink)

The present longitudinal survey study explored changes in and effects of foreign language classroom anxiety and listening anxiety on Chinese undergraduate students’ English proficiency over a semester in the COVID-19 context. A set of 182 matching questionnaires was collected from first-year undergraduate English as a foreign language learners at two time points of a 16-week semester. Analyses of the data revealed the following major findings: the participants experienced high levels of FLCA and FLLA both at the beginning (...) and end of the semester, neither of which changed significantly during the semester, FLCA and FLLA were highly positively related to each other, FLCA and FLLA significantly predicted students’ self-rated proficiency in listening and speaking English, and confidence in using English, efforts and motivation to learn English and interaction with instructors and peers mediated FLCA and FLLA to exert effects on students’ self-perceived proficiency in listening and speaking English. These findings indicate that the learning environment is critical in influencing the levels of and changes in FLCA and listening anxiety and that these two types of foreign language anxiety are serious issues in the pandemic foreign language learning context. (shrink)

Within the context of China, this study seeks to examine the relationship between English language proficiency, the native dialect of the learner, and the learner’s reason, or motivation for learning English. English language proficiency can be an important vehicle for accessing high quality higher education, for interacting with non-Chinese, and for enhancing employment and career opportunities Data was gathered through an online survey with 985 usable responses recorded. Respondents included a distribution of speakers from five of (...) the major distinct dialects of China. The analysis provides empirical evidence of a diversity of propensities and motivations for English language acquisition among learners from different regions and native dialects. Access to international higher education as a type of motivation is found to have a moderating effect on English proficiency. Other findings suggest that learners in regions with more historic exposure to foreign interaction are more likely to be motivated for social reasons, those from regions with export focused commerce will be motivated for business related reasons. The results of this study may be of interest to policy makers, linguists, educators, and those with an interest in socioeconomic sustainability through language acquisition and education as a method of socioeconomic mobility. (shrink)

This research aims to investigate the impact of learning lexical chunks on the English as a Foreign Language Saudi learners’ speaking fluency. The study uses an intervention with intermediate Saudi learners comprising lexical chunks based upon the books Collocation in Use and Common Idioms in English. Findings obtained from the post-test show that the experimental groups scored significantly better when compared to their performance in the pre-test of speaking fluency. On the contrary, the difference in the performance of the (...) control group between the pre and post-tests is not significant as far as speaking fluency is concerned. The findings also show that the experimental group participants had favorable sentiments regarding explicit lexical chunk training. The research has theoretical and practical consequences in teaching and learning a foreign/second language. (shrink)

Imagine that you possess an indicator for a disease or illness that has nothing to do with your body. It is not a genetic predisposition to acquire cancer or a vice that raises the probability of contracting some dread disease, though estimates of its health risks have placed it on par with having diabetes. It has nothing to do with the environmental pollutants you are exposed to or whether you can afford health care. It is not a physical susceptibility that (...) renders you more easily reachable by the clutches of pathology. No, this indicator of health hinges on certain learned abilities and skills, and it is a barrier to health that is totally within the health field's power and resources to lift.The condition hinted at above is the inability to speak English proficiently in the United States. Today, more than one-sixth of the United States population speaks a language other than English at home, and this number is increasing rapidly. (shrink)

Two meta-analyses of 66 behavioral studies examined variables influencing functional cerebral lateralization of each language of brain-intact bilingual adults. Functional lateralization was found to be primarily influenced by age of onset of bilingualism: bilinguals who acquired both languages by 6 years of age showed bilateral hemispheric involvement for both languages, whereas those who acquired their second language after age 6 showed left hemisphere dominance for both languages. Moreover, among late bilinguals, left hemisphere involvement was found to be greater (...) for those less proficient in their second language, those whose second language was English, and for studies involving dichotic listening paradigms; early bilinguals instead showed bilateral involvement in every condition. Implications of the observed differences in lateralization between early and late bilinguals are explored for existing theories of bilingualism and for neurocognitive models of brain functional organization of language. (shrink)

It can be a great challenge for second language learners to comprehend meanings that are implied in utterances rather than the surface meaning of what was said. Moreover, L2 learners’ attitudes toward pragmatic learning are unknown. This mixed-methods study investigates L2 learners’ ability to comprehend conversational implicatures. It also explores their beliefs about and intentions to develop this ability using Ajzen’s theory of planned behavior. A total of 498 freshmen from a public university in China participated in the study. (...) Data were collected using a web-based test, stimulated recall tasks and semi-structured interviews. Results show that the participants differed in recognizing the intended meanings. Complicated factors account for the variations. In addition to the types of implicature, learners’ beliefs about developing pragmatic comprehension also influence their learning intention, and subsequent performance. These beliefs include learners’ multi-layered, complex attitudes toward the outcomes of pragmatic learning, perceived self-efficacy beliefs regarding language proficiency and L2 cultural knowledge, actual behavioral control over opportunities and resources for pragmatic learning, and perceptions of less social pressure on pragmatic learning. The use of TPB may help language teachers and test designers to understand learners’ beliefs about L2 pragmatic learning in the English as a foreign language context. Understanding the factors influencing learners’ intention will help design more effective teaching curricula that may integrate pragmatic instruction and testing in the future. (shrink)

The present study investigates the relations between L2-English proficiency and L1-Turkish lexical property evaluations. We asked whether L2 proficiency affects lexical properties, including imageability and concreteness ratings of 600 Turkish words selected from the Word Frequency Dictionary of Written Turkish. Seventy-two participants provided ratings of concreteness and imageability for 600 words on a 7-point scale. In order to assess their L2 proficiency, we administered Peabody Picture Vocabulary Test-IV. We divided categories into two subcategories as high and low (...) for the frequency, concreteness, imageability, and age of acquisition. The relationship between these subcategories and imageability-concreteness was examined by mixed effects linear regression analyses. We found that L2 proficiency and imageability ratings were positively correlated and specifically, this positive association was evident for low-frequency words and later acquired words. Results are in line with the interaction of bilingual representation under the dual-coding theory which suggests that bilinguals develop an interconnected imaginal representation for two languages as opposed to separate verbal representations. As L2 proficiency increased, the imageability also increased. These findings have implications for literature investigating the relationship between L2 proficiency and linguistic outcomes. Additionally, findings point to the importance of considering the L2 proficiency of participants when lexical tasks that involve cue words or word lists are used. (shrink)

Foreign-accented speech is generally harder to understand than native-accented speech. This difficulty is reduced for non-native listeners who share their first language with the non-native speaker. It is currently unclear, however, how non-native listeners deal with foreign-accented speech produced by speakers of a different language. We show that the process of language acquisition is associated with an increase in the relative difficulty of processing foreign-accented speech. Therefore, experiencing greater relative difficulty with foreign-accented speech compared with native speech (...) is a marker of language proficiency. These results contribute to our understanding of how phonological categories are acquired during second language learning. (shrink)

First language attrition in adulthood offers new insight on neuroplasticity and the role of language experience in shaping neurocognitive responses to language. Attriters are multilinguals for whom advancing L2 proficiency comes at the cost of the L1, as they experience a shift in exposure and dominance. To date, the neurocognitive mechanisms underlying L1 attrition are largely unexplored. Using event-related potentials, we examined L1-Italian grammatical processing in 24 attriters and 30 Italian native-controls. We assessed whether attriters differed (...) from non-attriting native speakers in their online detection and re-analysis/repair of number agreement violations, and whether differences in processing were modulated by L1-proficiency. To test both local and non-local agreement violations, we manipulated agreement between three inflected constituents and examined ERP responses on two of these. Our findings revealed group differences in amplitude, scalp distribution, and duration of LAN/N400 + P600 effects. We discuss these differences as reflecting influence of attriters’ L2-English, as well as shallower online sentence repair processes than in non-attriting native speakers. ERP responses were also predicted by L1-Italian proficiency scores, with smaller N400/P600 amplitudes in lower proficiency individuals. Proficiency only modulated P600 amplitude between 650 and 900 ms, whereas the late P600 depended on group membership and amount of L1 exposure within attriters. Our study is the first to show qualitative and quantitative differences in ERP responses in attriters compared to non-attriting native speakers. Our results also emphasize that proficiency predicts language processing profiles, even in native-speakers, and that the P600 should not be considered a monolithic component. (shrink)

Defining a nurse as literate is disciplinary and contextual, linked to professional identity formation, and an issue impacting patient safety. Literacy and language proficiency are concepts assessed through examining skills in four pillars: reading, writing, speaking, and listening. This article explores how literacy is not only a practice issue but inextricably intertwined with issues of race, equity, diversity, and inclusiveness in our profession—both in regulatory policy and classroom pedagogy. In making the argument that language is a proxy (...) for race, three cases of language and literacy will be presented. First, the deficit discourse of multilingual student struggle is stereotyped to the presence or absence of an accent, with multilingual student needs often treated homogeneously in disregard of population heterogenous abilities. Second, regulatory policies for language testing internationally educated nurses are discriminatory with testing context bearing little relationship to the language needs of nursing practice. Third, that the myth of “one standard English” results in racist evaluation practices of student academic performance. Recommendations are made for reframing how language and literacy are viewed in nursing education and regulation of practice with a focus on acknowledgment of one's personal relationship to racial issues and emphasizing the need for a change in mindset toward racialized multilingual students and writers. (shrink)

Misuse or misunderstanding of medication information is a common and costly problem in the U.S. The risks of misunderstanding medication information are compounded for the large and growing population of individuals with limited English proficiency that often lacks access to this information in their own language. This paper examines practices related to translation of medication information in the European Union that may serve as a model for future U.S. policy efforts to improve the quality and availability of medication (...) information for individuals with limited English proficiency. (shrink)

Access to clear and concise medication information is essential to support safe and effective use of prescription drugs. Patient misunderstanding of medication information is a common reason for non-adherence to medication regimens and a leading cause of outpatient medication errors and adverse drug events in the U.S. Medication errors are the most common source of risk to patient safety, leading to poor health outcomes, hospitalizations, and deaths. Over half a million adverse drug events occur in the outpatient setting each year (...) at a cost of approximately $1 billion annually.Nearly half of adults in the U.S. experience difficulty understanding and acting upon health information. Even individuals with high levels of general literacy may find medication information difficult to understand or use. The risk of misunderstanding medication information is compounded for patients with limited English proficiency who may not have access to this information in their own language. (shrink)