The Effect of Schema-Vs-Translation-Based Instruction on Persian Medical Students ’ Learning of General English

This study explored the effect of employing two language teaching approaches, i.e., schema-based instruction (SBI) and translation-based instruction (TBI) on the structure and vocabulary knowledge as well as reading comprehension ability of sixty undergraduate students studying general English in a medical school in Mashhad, Iran. While the SBI approaches the words/phrases comprising texts as schemata having syntactic, semantic and discoursal relationships with each other, the latter considers offering their translation equivalents as the only necessary and sufficient condition to understand texts. After being divided into two groups, the learners in the experimental and control groups were taught via SBI and the TBI, respectively. The administration of a 120-item schema-based cloze multiple choice item test (SBCMCIT) developed on the syllabus and administered as a pretest at the beginning of the term showed that the two groups were homogenous. The administration of an unseen final examination (UFE) consisting of structure, vocabulary and reading comprehension subscales at the end of the term showed that the learners taught via the SBI performed significantly better than those taught via the TBI not only on the UFE and its subscales but also on the SBCMCIT administered as a post test. The findings are discussed within the specified language components and abilities.


Introduction
In the preface of the book Assessing Reading (Alderson, 2000), Bachman asserted that reading comprehension is the most enigmatic and the most extensively researched language skill.With the shifting sands and changing winds of language teaching, this skill has been taught through different approaches ranging from grammar translation to task-based language learning and teaching advocated by Ellis (2003).The present research project was conducted in order to find out whether a new approach based on schema theory could be developed not only to teach but also to test reading comprehension ability within an academic and foreign language context.Schema theory emphasizes what readers know and manipulates it to explain how they understand written texts via two approaches, i.e., macrostructural and microstructural.Schemata in the former approach are viewed as "interlocking mental structures representing readers' knowledge" (Alderson, 2000, p.33) of the texts as a whole.In other words, the readers integrate the information presented in the entire text into their background knowledge by reading their very title or topic and activating their background knowledge to comprehend the text they read.
Over the years the macrostructual approach of schema theory has attempted to explain reading comprehension ability in terms of some broad terms such as scripts and genres, however, it has failed to validate their psychological validity through the initial development of the IELTS modules on texts written for various fields such as engineering, physical and social sciences assumed as different academic genres or schemata.Furthermore, as some critics like Carver (1992) maintained, the approach has not clearly explained how it views the building blocks of texts, i.e., their constituting words.Neither has the macrostructural approach to schema theory explained how reading comprehension ability can be taught.
Instead of using schema as a broad term such as a genre or topic, the microstructual approach adopts the words/phrases comprising written texts as schemata whose individual and collective comprehension determines the reading ability of language learners.This approach explains not only how reading comprehension ability can be tested but also how it must be taught.To achieve this, the macro and micro structural approaches of schema theory will be described and then the latter will be applied to the teaching of general English to the students of medicine.The performance of these students on a schema-based cloze multiple choice item test used as pre-and-post tests as well as on an unseen final examination consisting of the structure, vocabulary and reading comprehension subtests will then be compared with those taught via grammar translation approach to find out which approach brings about significantly higher performance on these tests.

Macrostructural Approach of Schema Theory
Hunt (1982) believed that the ability to comprehend a given text is based on the existence of a schema, i.e., a situation (Anderson, 1980) or a text (Driscoll, 1994;Halliday & Hassan, 1989;Stanovich, 1980;Van Dijk, 1977) dealing with a given field or being narrative, descriptive, explanatory or argumentative in nature (Mc Neil, 1984;Poplin, 1988, Yekovich & Walker, 1988).While both views, i.e., schemata as fields or genres and schemata as text types, have been investigated as constructs, they have never been explored as teaching approaches.
Some language proficiency tests such as the IELTS modules were, however, developed on the assumption that students studying fields as different as humanities, sciences and engineering would have different schemata and thus it would be fairer if their language proficiency would be measured by developing tests on the texts dealing with their own fields (Clapham, 1996;Moy, 1975;Shoham, Peretz &Vorhaus, 1987).Clapham (1996), for example, developed three IELTS modules on the passages related to three broad academic subject areas: life and medical sciences, physical science and technology, and business studies and social sciences and administered them to 842 non-native English speakers preparing to start undergraduate and postgraduate studies at English medium universities.Each student took the test closest to her/his future field of study.Her results did not support the hypothesis that the students schemata of their own field will bring about significant differences in their performance.
Instead of treating schemata as different fields, some scholars have approached them in terms of text types or discourse styles (Meyer, 1975(Meyer, , 1985)).Meyer and Freedle (1984), for example, by employing allegedly identical content wrote passages having the four expository schemata of comparison, causation, problem/solution and collection of description, presented them to 44 teachers enrolled in an educational research methodology class and asked them to recall the content after two weeks.They found that the participants listening to the comparison schema answered significantly more questions correctly one week after hearing the passage than those who listened to the collection/description passage.
The study by Meyer and Freedle (1984) suffers from two major shortcomings which might have contributed to the significant difference in the discourse type, i.e., comparison vs causation, problem/solution and collection of description.First, the texts were written and changed by the researchers themselves and thus their artificiality violates their construct validity.The second and most important shortcoming of Meyer and Freedle's study is that in changing the text to fit discourse styles, they manipulated the content of the passages, i.e., deleted some contextual words such as nouns and verbs and added some others, and thus the listeners to the four versions of the passage received different messages.In other words, the difference found in the performance of the listeners is the result of listening to different content expressed via semantic words/phrases rather than different discourse types or macrostructral schemata.[Interested readers are referred to Khodadady (1997) for a detailed discussion of the study].

Microstructural Approach of Schema Theory
While the macrostructuaal approach to schema theory considers fields, genres and discourse styles as schemata, the microstructural approach views the words and phrases constituting authentic texts as schemata (Khodadady, 1997(Khodadady, , 2004;;Khodadady & Herriman, 2000) and assigns them into three main domains, i.e., semantic, syntactic and parasyntactic (Khodadady 2008a;Khodadady, Pishghadam & Fakhar, 2010).Each domain is hierarchically formed by its genera, which are in turn composed of species and types.The semantic domain, for example, consists of four genera, i.e., adjectives, adverbs, nouns, and verbs.The genus of adjectives in turn contains species such as agentive, comparative, dative and nominal adjectives.And finally each species expressed in texts such as agentive adjectives consist of types such as interesting, fascinating and patronizing, to name a few.
Approaching schemata from a microstructural perspective has provided researchers and teachers alike not only with the ability to choose whatever authentic texts they wish to use in their research projects and classes but also with a sound rationale to develop well functioning multiple choice items (MCIs) objectively.While the texts used in standardized tests such as the TOEFL are written by testing specialists and thus lack construct validity (Khodadady, 1997(Khodadady, , 1999)), many teachers have developed schema-based cloze MCIs on the very texts they teach in their classes (e.g., Fakhar, 2010, Faravani, 2006;Khodadady, Pishghadam & Fakhar, 2010;Khodadady, Shirmohammadi & Talebi, 2011).In addition to being used for developing valid and reliable achievement tests, schema-based cloze MCIs have been employed to measure language proficiency (Gholami, 2006) and translation ability (Khodadady, 2001(Khodadady, , 2008b;;Seif & Khodadady, 2003).

Microstructural Approach of Schema Theory and Foreign Language Teaching
The very premise upon which the schema-based cloze multiple choice item tests (MCITs) are developed can be employed to teach foreign languages.Khodadady (1997), Khodadady and Herriman (2000) argued that for any alternative to compete with the keyed response in being selected in a multiple choice item, there must be semantic, syntactic and discoursal relationships among them.Similarly, the present study is based on the premise that perfect comprehension of a given text will occur if, and only if, language learners understand all the semantic, syntactic and parasyntactic schemata comprising the text and establish the same semantic, syntactic and discoursal relationships among them as the author of the text did.The effectiveness of any foreign language teaching class can, therefore, be determined on the basis of all the activities teachers design and employ in order to help the learners understand not only the schemata comprising the texts by themselves but also the semantic, syntactic and discoursal relationships they hold with each other.In other words, each word/phrase employed in a text, i.e., schema, must activate the readers' personally acquired conventional knowledge of the concept it represents and be understood and interpreted in relation to other words comprising the text.It is, in fact, this very knowledge of a single contextual word/phrase which must be understood as a schema whose proper activation entails its juxtaposition with other schemata forming the text.This very dependence of a schema on a certain context such as a given text distinguishes it from a word as an abstract unit.
The schema-based cloze MCI below was, for example, developed by Khodadady (1997).As can be seen, the alternatives of the item, raid, slander and ambush, are all syntactically related to the keyed response, attack, by being nouns in nature.Because of having a number of relationships with the keyed response, Khodadady refers to schema-based alternatives as competitives.The semantic relationships among the keyed response and comeptitives are shown in Figure 1.
Fears over access to medical records: Privacy campaigners in the US have launched a fierce ... (1) on a bill that they believe will expose medical records to too many prying eyes.The keyed response attack shares the semantic feature of assault with raid, ambush and slander.However, the nature of assault, i.e., physical, acts as a distinctive feature and differentiates slander from the schemata of raid, ambush and attack.While raid and ambush share the feature of physical assault with attack they differ from it in terms of having two specific semantic features, i.e., catching and waiting to attack, respectively.Khodadady (1997) argued that the context of the text, i.e., undeleted schemata, determine the author's choice of a certain schema and must, therefore, act in the same manner for the readers.
Similarly, the present study is based on the hypothesis that the explicit teaching of schema domains, genera, species and types comprising the materials taught in English and presented along with the alternatives sharing semantic features with those schemata will result in significantly better comprehension of the texts on the part of participants taught in the schema-based instruction group and differentiate their performance from the participants taught via the translation-based instruction not only on the schema-based close MCIT administered as a post test but also on the achievement test consisting of structure, vocabulary and reading comprehension sections.

Research Method
The method used was quasi-experimental (two groups -pretest -posttest design).The Design has two groups, an experimental group and control group.An experimental group had pretest, treatment, and posttest.A control group had pretest, without treatment, and Posttest.

Participants
Sixty freshman undergraduate university students of anesthetics whose age ranged between 18 and 19 (Mean = 18.53,SD = .54)took part in this study.They had registered in the course General English for Medical Students as a part of course requirement for their degree.Forty three (71.2%)and 17 (28.8%)were female and male, respectively.They all spoke Persian as their mother language.The majority of participants, i.e., 39 (65%) had learned English only in guidance and high schools as a school subject.Twenty one (35%), however, had also attended various private language institutes to improve their English language proficiency.None were studying English anywhere other than the Medical University of Mashhad while the experiment was conducted.

Materials
Since English for the students of Medicine I (Deedari & Zia Hossaini, 2009) is taught in almost all medical universities in Iran, it was employed as the main textbook in the present study.It consists of 20 lessons each of which is divided into three sections, i.e., pre-reading, reading passage, and homework.In the pre-reading section the readers are presented with a list of key words and their pronunciation in international phonetic alphabets, word definitions and exemplifications, and grammatical points to be explained.In the reading section, a reading passage is followed by true false questions, multiple choice items and open-ended questions.And the last section, homework, provides the readers with a fill-in-the blank vocabulary exercise, a matching test, grammatical exercises, a reading passage, a second passage to be translated into Persian and a list of English words whose equivalents must be found in Persian.Due to the length and diversity of activities to be done both in the class and at home, the first four lessons were taught in the entire general English course offered during the first term of academic year 2010.

Instruments
Two language tests were employed in the study, i.e., a schema-based cloze multiple choice item test and a final test consisting of five subtests.An interview was also held with some participants of both groups at the end of the experiment.

Schema-Based Cloze Multiple Choice Item Test
Following Khodadady, Pishghadam, and Fakhar (2010) and Khodadady, Shirmohammadi, and Talebi (2011), a 120-schema-based cloze multiple choice item test (MCIT) was developed on the first four units of English for the students of Medicine I (Deedari & Zia Hossaini, 2009).In order to develop the competitives of the test, all the schemata comprising the texts were parsed and assigned to semantic, syntactic and parasyntactic domains.Out of 1892 semantic schemata 360 were then chosen on the basis of their common and distinctive semantic features as shown in Figure 1.The test enjoys not only construct validity for being developed on schema theory but also content validity because its competitives were all chosen from the semantic schemata constituting the texts under comprehension.The internal validity of the test was also secured by piloting its items on 16 general English students who were not among the participants of the study.The results showed that items had acceptable indices of difficulty and discrimination and the test itself reached the Alpha reliability coefficient of .83.(The schema-based cloze MCIT is given in Appendix.)

Achievement Test
Over the years, the Department of English Language at Medical University of Mashhad has developed a 96-item high security achievement test whose questions have been piloted through various administrations at the end of several academic semesters.It includes the same types of items through which the learners' mastery of vocabulary, grammatical points and reading passages taught in each unit is measured.It consists of 20 fill-in-the blank items, 34 multiple choice vocabulary items, six multiple choice structural items, 18 traditional cloze multiple choice items, and 18 multiple choice reading items.The results of the present study show that the unseen achievement test employed as final examination is highly reliable (Alpha coefficient = .93)

Interview
An unstructured interview with 10 students of each group was conducted about their opinions, beliefs, and ideas with regard to the teacher's effectiveness in the control group and the treatment they received for the schemata in the experimental group.Each interview took about 15 minutes.The unstructured format for interview was used in this study because it produces a very comfortable atmosphere where the respondents express their views freely with "minimal only interference from the research agenda" (Dörnyei, 2007, p.136).

Procedure
The participants in both control and experimental groups underwent 15 hours of instruction offered in ten sessions.The classes were held twice a week at Medical University of Mashhad, with each session lasting for at least 90 minutes.Both classes were taught by one of the researchers.The participants were informed that the course was conducted as a part of the research project.However, they were kept unaware of the aims of the research so that their awareness of being treated differently would not affect the results of the experiment adversely.Both groups were taught the first four units of English for the Students of Medicine (Deedari & Zia Hossaini, 2009).
The control group learned the keywords and their definitions the same way designed in the book.First, they were presented with the oral and written pronunciation of some words.Then they read their definitions along with the example sentences in which they were used.The Persian equivalents of the words were given whenever they faced problems not only in comprehending the words but also in understanding their definitions and examples.The equivalents were, however, initially elicited from the participants themselves and were given by the teacher whenever they were not appropriate or no participants offered any.Similarly, the reading passages were read by the participants paragraph by paragraph and were translated into Persian and the teacher took over whenever there were no volunteers or there were problems either in reading or translating.The same procedure was followed for the exercises and assignments.Ten of the participants in the control group who were active in the class were chosen for interview at the end of the term.
The experimental group, however, was taught entirely in English and on rare occasions Persian equivalents were offered by the teacher when he felt the explanations offered in English were incomprehensible.For teaching this group, the Schema-Based Instruction (SBI) was adopted in which all the words constituting the reading passages, i.e., schemata, were taught not only by pronouncing them loudly and having the participants repeat after the teacher whenever necessary but also by explaining their syntactic, semantic and discoursal relationships with each other when the participants expressed their inability to do so.
The schema health is, for example, used in the fifth paragraph of the first reading passage called "The Common Cold".Deedari and Zia Hossaini ( 2009) have, however, treated it as a word because its adjectival form, i.e., healthy /'helθi/, has been given in isolation in part A called Pronunciation Practice without offering any definitions or examples as they have done for some other words.In the SBI, nonetheless, the schema health was taught as it appears in the sentence, "… one should avoid unnecessary contact with people who have colds, maintain general good health through adequate rest and nutrition, and …" (p.14).After having the sentence read aloud by a high ability participant, they were asked what type schema was it, an adjective, adverb, noun or verb.They all agreed it was a noun.One of them defined health as "not sick."The teacher immediately used the definition and asked, "Is sick a noun or an adjective?"One of the participants noticed the problem and immediately said, "Healthy."Building on the input, the teacher asked why 'health' was a noun.Another participant offered its being preceded by the adjective schema 'good' as the reason.
Having noticed the participants' structural familiarity with the schema 'health,' the teacher asked whether they could find any sort of semantic relationship between 'health' and other schemata constituting the sentence in which it appeared.One of the participants offered 'touching people with cold' while the other brought up its relationship with 'resting' and 'nutrition.'In order to relate the schema to their personal life the teacher showed Figure 2 and asked, "What else can we do in order to be healthy?"Another participant said, "We can exercise regularly." After directing the participants' attention to Figure 3 the teacher asked, "What will happen if we exercise regularly?"Various answers were offered including "staying healthy and fit".In order to emphasize the discoursal relationship of the schema health with other schemata appearing in the last sentence of paragraph five, it was asked, "What will happen if we put on light clothes in winter?"Among the answers offered, one showed the participants' immediate application of both textual and visual discourse, i.e., "It is unhealthy.We decrease our immune system and viruses can easily attack and make us sick."Similar to the control group, ten of the most active participants in the experimental group were chosen to be interviewed at the end of the term.

Data Analysis
While the internal consistency of the tests designed and employed in the study was assessed via Cronbach Alpha, their internal validity was determined by obtaining item p-values, i.e., the number of correct answers given to an item divided by the total number of answers, and discrimination indices, i.e., point biserial correlations between individual items and the total test score (r pbi ).Following Baker (1989) items having p-values falling between .25 and .75 and the r pbi of .20 and higher were accepted as well-functioning.P-values lower than .25 and higher than .75indicate that a given item is too difficult and too easy, respectively, whereas an item with a r pbi of below .20 fails to discriminate between low and high ability test takers.The one way analysis of variance (ANOVA) was also utilized to determine the difference in mean scores obtained by the control and experimental groups not only on the schema-based cloze multiple choice item test administered as a pre-and-post test but also on the achievement test and its subtests in order to test the three hypotheses below: H1.The mean score of the experimental group on the structure test will be significantly higher than that of the control group.
H2.The mean score of the experimental group on the vocabulary test will be significantly higher than that of the control group.
H3.The mean score of the experimental group on the reading comprehension test will be significantly higher than that of the control group.

Results
Table 1 presents the descriptive statistics of the tests designed and employed in the present study.As can be seen, since the participants lacked the schemata required to comprehend the material-to-be taught, they performed poorly on the pretest, i.e., the mean p-value and r pbi were .29 and .19,respectively.The successful learning of the schemata has, however, brought about not only much acceptable mean p-value and r pbi , i.e., .47 and .41,respectively, on the schema-based cloze MCIT administered as a post test but also higher reliability coefficient, i.e., α = .96,compared to α =.83 (on the pretest).The unseen achievement test administered at the end of the term was also highly reliable, α = .96,and had acceptable item indices, i.e., the mean p-value and r pbi were .71and .36,respectively, and thus enjoyed internal validity.
Table 2 presents the ANOVA analysis of the tests administered in the study.As can be seen, the control and experimental groups were at the same level of language proficiency when the experiment started.However, instructing the experimental group based on the microstructural approach of schema theory has resulted in their superior performance not only on the post test schema-based cloze MCIT (F = 217.451,df =59, p <.001) but also on the achievement test (F = 312.247,df =59, p <.001) and its subtests.The results thus confirm the three hypotheses postulated because the mean score of the experimental group is significantly higher than that of the control group on the structure test (F = 52.852,df =59, p <.001), vocabulary test (F = 96.410,df =59, p <.001) and reading comprehension test (F = 76.177,df =59, p <.001).

Discussion
In spite of being employed in teaching English as a foreign language, the TBI lacks a theory to support it as a language teaching approach (Richards & Rodgers, 2001).Since it is based on faculty psychology (Chastain, 1976) many foreign language teachers have adopted translation as a means to develop learners' knowledge about foreign language competence.However, as Newmark (1988) convincingly argued, this pedagogical application of translation "has to be sharply distinguished from its normal use in transferring meaning and conveying messages" (p.7).The results of the present study support the contention of Newmark regarding the main use of translation as a means of transferring meaning and discourage its application as a teaching approach in foreign language classes.
Between the two components of language, i.e., semantics and syntax, the latter is studied as the most important ability in acquiring first languages so much so that scholars like Atkinson (1992) wrote the book Children's Syntax in order to explain first language acquisition on the basis of theoretical linguistics.The very missing element of teaching structures as it operates in expressing messages in reading comprehension and the inability of TBI to help language learners to master it contextually might be the reason for their dissatisfaction.Eight out of ten participants interviewed in the control group complained that knowing the translation of the words taught was not enough for them to understand the text.The remaining two had nothing to say and simply announced their being comfortable with the way the translation-based teaching was carried out.
The very presentation of a certain schema within a given text and helping the learners in the experimental group comprehend that schema in semantic, syntactic and discoursal relationships it holds with the other schemata comprising the text provides them with the best context not only to master the syntax employed in the text but also apply that mastery to discern the structural relationship presented in the unseen items forming the final examination.For example, Table 3 presents the alternatives, stem, choices and the frequency of times the choices of item 19 on the final examination have been selected by both control and experimental groups.
As can be seen in Table 3, while 90% of the experimental group have chosen the keyed response, i.e., that, the percentage has fallen to 57% for the control group, indicating that the TBI could not pave the way for forty three percent of the learners in the control group to differentiate the relative pronoun that from the three other pronouns as they might appear in the context of an isolated sentence.This noticeable and significant difference is observed in all of the nine syntactic items employed in the unseen final examination.
The SBI brings about significant differences not only in learners' structural knowledge but also in their ability to differentiate unrelated semantic or content words by employing their syntactic knowledge, remember the definition of a given word by choosing its synonym from a list of four, and choose the words which best fit slots in isolated sentences.Items 38, 39 and 11 provide examples for these three types of vocabulary knowledge, respectively.
As can be seen in Table 4, all the participants taught via SBI could pick out the adverb efficiently from the three syntactically unrelated nouns energy, vigor and stamina in item 39 whereas only 63% of control group cold do so.Almost the same percentages appear when the learners are required to pick the synonym of a word such as defect in item 39.Neither could the participants in the control group do better than their experimental counterparts in choosing the keyed word exposure by relating it to the schemata excessive and cancer, implying that knowing the meaning of a given word such as exposure in one's mother language does not necessarily ensure its application in understanding a given message expressed in an isolated English sentence.
And finally, the very focus of the SBI on the syntactic, semantic and discoursal relationships among the schemata comprising the texts brings about significant superiority of this approach over the TBI in learners' reading comprehension ability.The context of item 59, for example reads, "As Pascal climbed up the mountain he saw that the height of the mercury column fell in proportion to the increase in the height of the mountain.This experiment proved Pascal's deduction."Table 5 shows the frequency with which the choices developed on this context have been selected.
As can be seen in Table 5, while 90 percent of learners taught via SBI could choose the sentence paraphrasing the paragraph, only 50 percent of TBI learners could do so.Almost the same amount of difference appears in the percentage of the two groups in all the items comprising the reading comprehension section of the final exam and thus brings about significantly higher performance on the part of SBI group, confirming the fact that translating the passages into the learners' mother language does not result in their better comprehension of texts written in the foreign language.Teaching the schemata comprising the texts in English by employing their meaning, syntactic, semantic and discoursal relationships with each other and presenting them in visual contexts, however, helps learners understand texts significantly better than those taught in their mother language.

Conclusion
The schema-based instruction (SBI) brings about significant improvements in the English learners' structure knowledge, vocabulary knowledge and reading comprehension ability simply because it provides them with a unique opportunity to know, comprehend, apply, analyse and synthesize the concepts represented by the schemata in a given text as they stand by themselves and interact with each other to express the same processes as they originally took place in the author's mind.The SBI provides language learners with an opportunity to experience these processes by establishing syntactic, semantic and discoursal relationships among the schemata and thus consolidates learning within the language of instruction.The translation-based instruction (TBI), however, fails to relate the meaning to the target language by employing the learners' mother language and thus deprives the learners not only of the very the relationships they must discern and internalize in and among schemata but also of the same relationships governing words encountered in traditional vocabulary, structure and reading comprehension tests.
The superiority of SBI over TBI brings about a revival of an ancient perspective on foreign language teaching and once again highlights the important role teachers play in their classes.Although the TBI does place the teachers at the center of the classes and it "has been an indispensable method in English teaching as well as a necessary step in the cultivation of students' communicative ability in a non-English environment" (Kong, 2011), it gives priority to the meaning in the first language and thus yields less not only in learning structure and vocabulary but also reading comprehension ability as the results of the present study reveal.The SBI, however, emphasizes the contribution of teachers to foreign language learning and suggests they take a more active role by providing appropriate visual and textual contexts for the learners to experience the schemata under instruction and their interactions with each other.It remains to be investigated whether modern communicative approaches to foreign language teaching in which the learners are apparently placed in the center of learning activities will produce significant improvements in mastering English as they do in the SBI.
activities.In B. Britton, & S. M. Glynn (Eds.),Executive control processes in reading.Hillsdale, NJ: Lawrence Erlbaum Associate.2) …………from the mosquito salivary glands into the blood system of the host.The sporozoites travel to the liver via the blood system and enter (3) ………… in the liver.After 12 days a new form of the (4) …………called merozoites are (5) ………… and these enter blood cells.At the same time toxins are released.This causes the sweats and (6) ………… that are (7) …………the disease.Some of the merozoites develop into gametocytes and may be sucked up by another mosquito in another blood meal.In the gut of the female mosquito the gametocytes become gametes and are (8) ………… .This forms sporozoites which will travel to the salivary glands of the female mosquito and await the next blood meal to enter another host.
Symptoms of malaria include fever, headache, and vomiting, and usually appear between 10 and 15 days after the mosquito bite.If not (9) …………, malaria can quickly become life-threatening by disrupting the blood supply to vital organs.In many parts of the world, the parasites have developed (10) …………to a number of malaria medicines.Influenza is a respiratory virus that can enter the body through the nose or mouth.When an infected person coughs or sneezes the virus is spread through the air, infecting others.Once a person has been infected with the virus he or she is (11) ………… from the day before they feel sick until (12) ………… are gone.Most cases of seasonal flu occur between November and April.
An influenza virus is generally passed from person to person by airborne (17) ………….This means your child can contract the flu by coming in (18) ………… with airborne viruses from an (19) …………person by way of sneezing and coughing.The virus can also live for a short time on objects such as doorknobs, pens/pencils, keyboards, telephone receivers, and eating or drinking utensils, for example.Therefore, it may also be (20) …………when your child (21) …………something that has been handled by someone ( 22) ………… with the virus and then your child touches his/her own mouth, nose, or eyes.

Cause
Measles is a respiratory disease caused by a virus.The disease of measles and the virus that causes it share the same name.The disease is also called rubeola.Measles (33) ………… normally grows in the (34) ………… that line the back of the throat and lungs.

Complications
About one out of 10 children with measles also gets an ear (36) …………, and up to one out of 20 gets pneumonia.About one out of 1,000 gets encephalitis, and one or two out of 1,000 die.Other rash-causing diseases often (37) …………with measles include roseola (roseola infantum) and rubella (German measles).
While measles is almost gone from the United States, it still kills nearly 200,000 people each year around the world.Measles can also make a pregnant woman have a miscarriage or give birth prematurely.
Friendly bacteria may not harm the digestive system, but it is a surprise that the digestive system does not manage to (87) ………..

Who gets diarrhea?
Anyone can get diarrhea.This (113) ……….. problem can last a day or two or for months or years,

Figure 2 .
Figure 2. The schema healthy and it visually supported context do to protect myself against influenza?According to the CDC, there are steps which can be taken to reduce the risk of contracting and spreading the 'flu virus.Here are some recommendations:1.Keep your distance from and avoid close (26) …………with who are sick.2.If you are sick, stay at home and keep your (27) …………from other people to prevent spreading the 'flu virus.3.Cover your mouth and nose with a tissue and turn your head away from other people when you (28) …………or sneeze.4.Wash your hands often to protect yourself from (29) …………. 5. Avoid (30) ………… your nose, eyes and mouth.6.To keep your immune system (31) …………, get enough sleep, eat plenty of fresh fruit and vegetables, exercise regularly, drink at least 8 glasses of water a day and keep stress levels to the minimum.7.The use of anti-viral drugs can also help to (32) …………you against contracting the 'flu virus.

Table 1 .
Descriptive statistics of the schema-based cloze MCIT (SBCMCIT), achievement test and its subtests

Table 2 .
ANOVA Analysis of schema-based cloze MCIT, achievement test and its subtests

Table 3 .
The choices of the an unseen structure multiple choice item and the frequency of their being chosen

Table 4 .
Three vocabulary items measuring knowledge of unrelated words, definitions and words filling isolated sentences

Table 5 .
Item 59 developed on the first reading passage and the frequency of answers the most contagious with the flu 24 hours before they start having symptoms and during the time they have the most symptoms.That is why it is hard to (23) ………… the spread of the flu, especially among children, because they do not always know they are sick while they are still spreading the (24) ………….The risk of infecting others usually stops around the seventh day of the (25) ………….