This study sought to evaluate the English language coursebooks used at the Turkish public elementary schools. In so doing, a series of coursebooks used in English courses of the curriculum prepared by the Turkish Ministry of National Education were evaluated, using Tomlinson and Masuhara's (2013) set of coursebook evaluation universal criteria. Results indicated that the layout, listening skill, illustrations in use, and affective engagement are the positive traits of the coursebooks, while the negative features outnumber the positive traits. The evaluation indicated that the Turkish public elementary English coursebooks are void of a number of important aspects of language acquisition, including communication-based activities, continuation of using English outside of the classroom, discovery enhancing input and most importantly extensive exposure to English. The central focus of the coursebooks is on the accuracy and repetition rather than effective outcomes, meaningful communication and long term language acquisition. Most activities in all coursebooks contain practice activities, with no place for productivity and autonomy on the part of the students. Additionally, there is no sufficient personalization and the coursebooks fail to make use of what students bring to classroom. Nor are the learners required to think critically, creatively or analytically in most of the activities. The coursebooks do not encourage learners to continue learning English by themselves, thus lacks encouragement for autonomy as well. The activities are designed to practice language items within the classroom environments. Hence, learning does not go beyond the classroom environment with the help of the coursebooks. Nor do the coursebooks guide or encourage learners to make discoveries by themselves. The bombardment of repetitive practice activities that only assess accuracy does not seem to be able to lead to long-term acquisition of English.
Introduction
Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI).
Methods
A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26).
Results
Compared with other groups, the MildPAR-hPWV group was older (
P
<0.001), hypertensive (
P
=0.015), and had a higher pulse pressure (
P
=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (
P
=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (
P
<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843;
P
=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status.
Conclusion
It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI.
Purpose: Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings.Methods: This study was a multicenter, cross-sectional, observational study that included 2,004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association. Results: The median age of the study population was 72 years and 58% were women. Nine hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease, presence of permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants, prescription of edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants. Conclusion: The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.
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