Advertisement International Journal of Emergency Medicinevolume 17, Article number: 189 (2024) Cite this article Metrics details Chenopodium album, commonly known as “lambsquarters,” is a plant consumed as food and used in traditional medicine. Its popularity is increasing due to the belief that it has fewer side effects compared to synthetic drugs. However, its use can lead to acute or chronic poisoning. The growing interest in herbal remedies, along with uncontrolled usage and disregard for expert recommendations, contributes to adverse effects. : A 68-year-old female patient presented to the emergency department with nausea, vomiting, and flank pain following the use of lambsquarters. Impaired kidney function was detected in the patient. A biopsy performed after Chenopodium album usage led to the diagnosis of tubulointerstitial nephritis (TIN). The patient responded positively to corticosteroid and hemodialysis treatment. Caution is necessary in the use of herbal medicines and traditional treatments. A thorough evaluation of factors such as patients’ nutritional status, herbal product usage, medication history, and genetic background is crucial. Chenopodium album can cause tubulointerstitial nephritis, resulting in kidney damage. Similarly, heavy metal poisoning through herbal products can lead to kidney damage. Adopting a multidisciplinary approach in the diagnosis and treatment process can contribute to better patient management. This case presents a rare instance of tubulointerstitial nephritis developed due to the use of herbal products. Physicians should inquire about patients’ history of exogenous substance use and conduct a comprehensive assessment, keeping such situations in mind. Conscious use of herbal medicines and traditional treatments can help prevent serious complications like kidney damage. Chenopodium album, also known colloquially as “lambsquarters” (Fig. 1), is a plant widely consumed as food in many cultures and utilized in certain traditional medical practices. This herbal food has been gaining popularity, attributed to the belief that herbal medicines have fewer side effects compared to synthetic drugs [1]. However, its use can significantly contribute to incidents of acute or chronic poisoning. Poison control centers admit over 100,000 patients exposed to toxic plants, with the majority involving minor toxicities related to the ingestion of medicinal plants in small quantities. In most severe poisoning cases, individuals consume a toxic plant either accidentally or with the intention of utilizing its therapeutic properties [2]. In recent years, the increasing interest in herbal remedies, uncontrolled usage of herbal products, and the disregard for recommendations from healthcare professionals prior to use have exacerbated the negative effects associated with these products [3]. An estimated one-third of adults in developed countries and over 80% of the population in many low- and middle-income countries use herbal and traditional medicines to enhance health or treat common illnesses. Herbal medicines can lead to kidney damage due to toxicity, contamination, misidentification, mislabeling, and adverse plant-drug interactions. The kidneys are particularly sensitive to toxic damage due to their high blood flow, extensive endothelial surface area, high metabolic activity, active uptake by tubular cells, medullary interstitial concentration, and low urine pH. Kidney damage can manifest as nephrolithiasis, chronic interstitial fibrosis, uroepithelial cancer, crystalluria, or hypertension, with some plants increasing potassium levels in those with kidney damage. The regulation of herbal and traditional medicines by global health organizations is critical to reduce the risk of acute kidney injury or chronic kidney disease associated with plant consumption. Nephrologists should be aware of potential nephrotoxicity arising from herbal medicines and supplements [4]. Additionally, some studies indicate that patients using alternative medicines may experience complications such as acute kidney injury (AKI) due to heavy metal poisoning. Defining the use of traditional herbal medicines as a source of toxicity can be challenging [5]. Tubulointerstitial nephritis (TIN) is a condition that can lead to chronic kidney disease (CKD), a common cause of kidney damage. TIN progresses to fibrosis in the renal interstitium through immune-mediated inflammation by inflammatory cells. Patients may present with nonspecific symptoms, and delays in the diagnosis and treatment of the disease can occur if not suspected. Etiologically, drugs, infectious agents, toxins, idiopathic causes, genetic factors, inflammatory bowel disease, or systemic inflammatory conditions associated with immunoglobulin G4 (IgG4) may lead to TIN. Clinical suspicion for TIN is necessary for diagnosis and treatment. Treatment depends on the underlying etiology, with corticosteroids forming the cornerstone of therapy [6]. In this case, a patient who used Chenopodium album for weight loss and experienced impaired kidney function was diagnosed with ATIN following a kidney biopsy. The patient benefited from corticosteroid and hemodialysis treatment. A literature review revealed that this is the first reported case of ATIN following the use of Chenopodium album. Coltsfoot (Chenopodium album) is widely used in alternative medicine A 68-year-old female patient presented to the emergency department with complaints of nausea, vomiting, and flank pain. She reported a history of using lambsquarters for weight loss for seven consecutive days two weeks prior. The patient had no chronic diseases except for diabetes mellitus and was taking metformin 500 mg/day. Upon admission, her vital signs were stable (temperature: 36.2 °C, blood pressure: 129/71 mm Hg, respiratory rate: 18/min, pulse rate: 88/min), and physical examination revealed findings such as arthralgia, edema, and rash. Laboratory investigations showed elevated serum blood urea nitrogen (BUN) at 40.4 mg/dL, creatinine at 2.84 mg/dL, and potassium at 6.1 meq/L. The complete urine analysis indicated leukocytes, leukocyte casts, and erythrocytes (Table 1), (Fig. 2). Two months ago, the serum creatinine was 0.82 mg/dL, and a renal ultrasound showed no abnormalities except for a grade 2 increase in bilateral parenchymal echoes. The patient was admitted to the nephrology clinic for further investigation of the etiology of acute kidney failure and initiation of treatment. On the first day of follow-up, despite medical treatment, hemodialysis was initiated due to persistently high potassium levels (Fig. 3). Following hemodialysis, a kidney biopsy was planned, performed, and pathology consultation was sought. The light microscopy of the kidney biopsy, evaluated with four glomeruli, revealed sclerosis in two glomeruli, thickening of the Bowman capsule in one glomerulus, tubular atrophy, interstitial fibrosis, and mononuclear inflammatory cell infiltration with dense eosinophils in the interstitium. Immunofluorescence showed no deposits (Fig. 3). Given the clinical indications of tubulointerstitial nephritis (TIN), corticosteroid therapy at a dose of 80 mg/day was initiated (Fig. 4). The patient’s metformin, used for diabetes, was discontinued, and insulin therapy was initiated. The patient underwent hemodialysis on the 2nd and 4th days of follow-up, continuing the same dose of steroid therapy. On the fifth day, evaluation revealed a decrease in creatinine levels to 2.33 mg/dL and a reduction in nausea and vomiting symptoms (Fig. 4), (Table 1). The temporary hemodialysis catheter was removed after hemodialysis, and steroid therapy continued at a dose of 64 mg/day. On the 11th day of follow-up, with no remaining complaints, the steroid dose was reduced by 16 mg to 48 mg/day. Linagliptin was initiated for diabetes regulation, and the patient was discharged for outpatient follow-up. Upon returning for a checkup five days later, her creatinine levels had returned to baseline at 0.89 mg/dL (Table 1). Steroid dosage was gradually reduced during follow-ups and discontinued over four weeks. Leukocytes, leukocyte casts, and clusters of erythrocytes in urine sediment under the light microscope Renal function and treatment course. HD: Hemodialysis Black arrows indicate crystals in renal tubules, while blue arrows demonstrate hemosiderin accumulation in renal tubule epithelium under light microscopy. (H&E, × 200) We presented in detail a case of AIN that emerged in a patient who consumed Chenopodium album for one week. To the best of our knowledge, this report represents the first such case in the literature. There are many cases of kidney failure in the clinical setting with unexplained etiology. This case emphasizes the importance of careful use of medications, including herbal medicines and traditional treatments. It highlights the necessity for healthcare professionals to obtain a comprehensive history, including factors such as nutritional status, herbal product usage, medication history, and genetic background, to understand the patient’s condition better. Moreover, it underscores the need for further research on the side effects of herbal products. Chenopodium album is known to be consumed in various regions of the world, believed to have protective effects against hepatotoxicity induced by carbon tetrachloride according to animal experiments [7,8,9]. However, there is insufficient research on its side effects, interactions with drugs, and the potential for contamination with heavy metals. AIN is usually confirmed when histological findings such as interstitial inflammation, edema, and tubulitis accompany acute kidney injury (AKI). The etiology of AIN is diverse, with known causes including drugs, various infections, autoimmune or systemic diseases, and idiopathic conditions. Several studies have shown that drugs are the most common etiology of AIN. Furthermore, AIN reported after the intake of herbal medicines has been documented [10]. In our case, the presence of findings such as tubular atrophy, interstitial fibrosis, and mononuclear inflammatory cell infiltration with dense eosinophils in the interstitium led to the diagnosis of AIN (Fig. 3). The pathogenesis of AIN typically involves allergic reactions triggered by exposure to a specific drug. T-cell-mediated hypersensitivity reactions and cytotoxic T-cell injuries play a role in the pathogenesis of AIN [11]. The exact disease mechanism leading to AIN caused by Chenopodium album is not clear based on the current data. Additionally, the kidneys are a sensitive organ to heavy metal poisoning, which can occur due to both acute and chronic exposure. Heavy metals taken into the body can lead to kidney lesions such as acute tubular necrosis, cortical necrosis, and interstitial nephritis. Exposure to heavy metals, both acutely and chronically, can cause tubulointerstitial injuries without any marked morphological changes, and these can manifest within days after exposure to the toxic substance. Heavy metal exposure constitutes a significant yet inadequately understood cause of kidney damage. The pathology findings, including crystals seen in the tubules, suggest this possibility. However, the absence of symptoms commonly observed in heavy metal poisoning cases, such as encephalopathy, seizures, mental status changes, papilledema, ataxia, and abdominal pain, makes this diagnosis challenging [12, 13]. The cornerstone of AIN treatment is discontinuation of the suspected nephrotoxic agent. There is a general consensus that when there is no evidence of improvement in kidney function after 5–7 days following the discontinuation of the suspected toxin, treatment, especially with steroids initiated promptly, may be beneficial. The rationale for this approach is that early corticosteroids may reduce the inflammatory infiltration of the renal interstitium and thereby prevent later fibrosis risk [11, 14]. In our case, a thorough evaluation of history, physical examination, laboratory, and pathological findings led to the initiation of steroid therapy, combined with hemodialysis due to electrolyte disturbances, acidosis, and uremic symptoms, resulting in a positive outcome. In conclusion, we aimed to provide a multidisciplinary perspective on the diagnosis and management of AIN following the use of herbal products through this case. Physicians should inquire about the history of exogenous substance use and conduct a comprehensive assessment, keeping such situations in mind. Conscious use of herbal medicines and traditional treatments can help prevent serious complications like kidney damage. No datasets were generated or analysed during the current study. Çalka Ö, Akdeniz N, Metin A, Behçet L. Phototoxic dermatitis due to Chenopodium album in a mother and son. Contact Dermat. Jul. 2005;53(1):58–60. https://doi.org/10.1111/J.0105-1873.2005.0456E.X. Froberg B, Ibrahim D, Furbee RB. Plant poisoning., Emerg Med Clin North Am, 25, 2, pp. 375–433; abstract ix, May 2007, https://doi.org/10.1016/j.emc.2007.02.013 Jurčić D, et al. Herbalife® associated severe hepatotoxicity in a previously healthy woman. Acta Clin Croat. Dec. 2019;58(4):771–6. https://doi.org/10.20471/ACC.2019.58.04.26. Del Granado RC, Espinosa-Cuevas M. Herbal Nephropathy, Contrib Nephrol, vol. 199, pp. 143–154, Nov. 2021, https://doi.org/10.1159/000517693 Moorthy S, Samuel AE, Moideen F, Peringat J. Interstitial nephritis presenting as acute kidney Injury following ingestion of Alternative Medicine containing lead: a Case Report. Adv J Emerg Med. 2018;3(1):e8. https://doi.org/10.22114/AJEM.V0I0.100. ArticlePubMedPubMed Central Google Scholar Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring, Pediatr Nephrol, vol. 32, no. 4, pp. 577–587, Apr. 2017, https://doi.org/10.1007/S00467-016-3394-5 Khoobchandani M, Ojeswi BK, Sharma B, Srivastava MM. Chenopodium album prevents progression of cell growth and enhances cell toxicity in human breast cancer cell lines. Oxid Med Cell Longev. 2009;2(3):160–5. https://doi.org/10.4161/OXIM.2.3.8837. ArticlePubMedPubMed Central Google Scholar Chamkhi I, et al. Genetic diversity, antimicrobial, nutritional, and phytochemical properties of Chenopodium album: a comprehensive review. Food Res Int. Apr. 2022;154. https://doi.org/10.1016/J.FOODRES.2022.110979. Hussain S, Asrar M, Rasul A, Sultana S, Saleem U. Chenopodium album extract ameliorates carbon tetrachloride induced hepatotoxicity in rat model. Saudi J Biol Sci. May 2022;29(5):3408–13. https://doi.org/10.1016/J.SJBS.2022.02.014. Krishnan N, Moledina DG, Perazella MA. Toxic nephropathies of the Tubulointerstitium: Core Curriculum 2024. Am J Kidney Dis. 2024. https://doi.org/10.1053/J.AJKD.2023.09.017. ArticlePubMed Google Scholar Ulinski T, Sellier-Leclerc AL, Tudorache E, Bensman A, Aoun B. Acute tubulointerstitial nephritis, Pediatr Nephrol, vol. 27, no. 7, pp. 1051–1057, Jul. 2012, https://doi.org/10.1007/S00467-011-1915-9 Kosiba AA, Wang Y, Chen D, Wong CKC, Gu J, Shi H. Feb., The roles of calcium-sensing receptor (CaSR) in heavy metals-induced nephrotoxicity, Life Sci, 242, 2020, https://doi.org/10.1016/J.LFS.2019.117183 Fowler BA. Mechanisms of kidney cell injury from metals. Environ Health Perspect. 1993;100:57–63. https://doi.org/10.1289/EHP.9310057. ArticleCASPubMedPubMed Central Google Scholar Joyce E, Glasner P, Ranganathan S, Swiatecka-Urban A. Tubulointerstitial nephritis: diagnosis, treatment, and monitoring, Pediatric Nephrology, vol. 32, no. 4, pp. 577–587, Apr. 2017, https://doi.org/10.1007/s00467-016-3394-5 Download references Not applicable. This study received no financial support. Department of Internal Medicine, Faculty of Medicine, Erciyes University, Kayseri, Turkey Alparslan Demiray Department of Pathology, Faculty of Medicine, Erciyes University, Kayseri, Turkey Sevil Demiray & Hülya Akgün Department of Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey Tuğba Yılmaz & İsmail Koçyiğit You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar Author Contributions: Alparslan Demiray (A.D.): Designed the manuscript, followed the patient, and wrote the article. Tugba Yılmaz (T.Y.): Conducted the literature review and contributed to the writing of the article. Ismail Koçyiğit (İ.K.): Contributed to the conceptualization of the article, patient follow-up, and provided assistance in ensuring the academic strength of the manuscript. Pathological evaluation was performed by Sevil Demiray (S.D.) and Hülya Akgün (H.A.). H.A. conducted the examination of the kidney biopsy, and S.D. made significant contributions to this examination process, contributing significantly to the academic richness of the article. Correspondence to Alparslan Demiray. Ethical approval and participant consent not applicable for this case report. Written informed consent was obtained from the patient for the publication of this case report. The authors declare no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. Reprints and permissions Demiray, A., Yılmaz, T., Demiray, S. et al. A case of acute tubulointerstitial nephritis following the use of chenopodium album L. Int J Emerg Med17, 189 (2024). https://doi.org/10.1186/s12245-024-00790-3 Download citation Received: Accepted: Published: DOI: https://doi.org/10.1186/s12245-024-00790-3 Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article.
| Source: BCC Research LLCBCC Research LLC Boston, Dec. 18, 2024 (GLOBE NEWSWIRE) — According to the latest study from BCC Research the “Global Market for Medical Device Technologies” is expected to grow from $810.4 billion in 2024 to $1.3 trillion by the end of 2029, at a compound annual growth rate (CAGR) of 9.8% from 2024 through 2029. This report is relevant due to the rapid advances in technology and the integration of AI in medical devices. As healthcare systems worldwide continue to evolve post-pandemic, the demand for innovative, technology-oriented devices has surged, prompting the need for examine market trends and developments. This report covers not only the current landscape but also anticipates future shifts in this dynamic market. The report analyzes the medical device technology market, focusing on trends and market estimate through 2029. It evaluates the positioning of the major players and their product portfolios while assessing regulatory scenarios and emerging technologies. The market is segmented by device type, including drug delivery devices, in vitro diagnostics (IVD), urology and renal devices, orthopedics and spine, imaging devices, cardiovascular devices, and endoscopy. Imaging devices encompass X-rays, ultrasound and computed tomography. IVDs are categorized into immunochemistry, clinical chemistry and molecular diagnostics. The report also segments the market by end-users, such as hospitals, home healthcare, and diagnostic centers, while providing analysis of the markets North America, Europe, Asia-Pacific, and the Rest of the World, with specific focus on the U.S., Germany, the U.K. and Japan. Click here for more details on the “Global Market for Medical Devices” report. The following factors are driving the global market for medical devices: Aging Population: More elderly people means a higher demand for devices to diagnose and manage age-related health issues. AI Integration: AI enhances diagnostic accuracy and speeds up data analysis. Chronic Diseases: Increasing cases of diabetes, cancer, and heart disease drive the need for advanced monitoring and treatment devices. Public Health Improvement: Better healthcare infrastructure and access boost the demand for essential medical tools. Enhanced Diagnosis: Technological advances make diagnostic devices more precise, faster, and less invasive. Patient Education: Informed patients seek out the best medical technologies for managing their health. Request a sample copy of Medical Devices: Technologies and Global Markets Report Synopsis Interesting facts: The report addresses the following questions: Leading companies in the market include: Related Reports Infusion Pumps and Devices: Technologies and Global Markets: This report provides insights into the infusion pump market, including market projections through 2029 and the market shares of key players. It analyzes the market by products, applications, and end users. Infusion pumps are categorized into general-purpose types, such as large-volume, syringe, electronic ambulatory, and elastomeric pumps, as well as specialty types, including insulin, patient-controlled analgesia, enteral, and implantable pumps. 3D Printing Medical Devices: Global Markets: This report analyzes trends in the global market for 3D printing medical devices. The report highlights emerging technologies and the competitive landscape, providing profiles of the major companies. Purchase a copy of the reportdirectly from BCC Research. For further information or to purchase a report, please contact info@bccresearch.com. About BCC Research BCC Research reports provide objective, unbiased measurement and assessment of market opportunities. Our industry analysts’ goal is to help readers make informed business decisions, free of noise and hype.
Does “Pix or it didn’t happen” apply to traveling to the edge of space on a balloon-lofted solar observatory? Yes, it absolutely does. The breathtaking views on this page come courtesy of IRIS-2, a compact imaging package that creators [Ramón García], [Miguel Angel Gomez], [David Mayo], and [Aitor Conde] recently decided to release as open source hardware. It rode to the edge of space aboard Sunrise III, a balloon-borne solar observatory designed to study solar magnetic fields and atmospheric plasma flows.
To do that the observatory needed a continual view of the Sun over an extended period, so the platform was launched from northern Sweden during the summer of 2024. It rose to 37 km (23 miles) and stayed aloft in the stratosphere tracking the never-setting Sun for six and a half days before landing safely in Canada. Strictly speaking, IRIS-2 wasn’t part of the primary mission, at least in terms of gathering solar data. Rather, the 5 kg (11 pound) package was designed to provide engineering data about the platform, along with hella cool video of the flight. To that end, it was fitted with four GoPro cameras controlled by an MPS340 microcontroller. The cameras point in different directions to capture all the important action on the platform, like the main telescope slewing to track the sun, as well as details of the balloon system itself. The controller was programmed to record 4K video at 30 frames per second during launch and landing, plus fifteen minutes of 120 FPS video during the balloon release. The rest of the time, the cameras took a single frame every two minutes, which resulted in some wonderful time-lapse sequences. The whole thing was powered by 56 AA batteries, and judging by the video below it performed flawlessly during the flight, despite the penetrating stratospheric cold and blistering UV exposure. Hats off to the IRIS-2 team for this accomplishment. Sure, the videos are a delight, but this is more than just eye candy. Seeing how the observatory and balloon platform performed during flight provides valuable engineering data that will no doubt improve future flights. Continue reading Catching The View From The Edge Of Space – Hackaday
VIRAL videos claiming thieves can steal iPhone owners' card details through AirDrop are running rampant online – but none of them are telling the truth. False claims of a new bank-raiding scam targeting iPhone owners have spread like wildfire on social media platform TikTok. The videos claim that “Apple Pay users with AirDrop toggled on are rendering themselves susceptible to financial identity theft," Daily Dot first reported. The theory is that if this setting is switched on, then a stranger in the street could initiate a walk-by tap-attack to transfer your card data to their phone. But it's not true, or even possible. While the AirDrop feature can be toggled on for days at a time, it only really works with nearby devices for 10minutes at a time. Any longer than that and it is limited to your contacts. The cards inside your Apple Wallet or Apple Pay are also not shareable. That data is locked down, and cannot be shared or transferred. Apple Pay is more secure than your real wallet, according to Apple, because it doesn't store or have access to the original card or card numbers. Instead, when you add a card to your Apple Wallet, your bank sends Apple a unique device account number and encrypts it – meaning that code is scrambled for everyone, including Apple. “The Device Account Number in the Secure Element is isolated from iOS, is never stored on Apple servers, and is never backed up to iCloud," Apple says in a support page. In terms of your Apple Wallet, then “iCloud secures your Wallet data — like passes and transaction information — by encrypting it when it's sent over the Internet and storing it in an encrypted format when it's kept on Apple’s servers," according to Apple. While there have been other scams and crimes associated with AirDrop, such as phishing attempts and cyberflashing, your financial details cannot be transferred directly. The false story is thought to date back to the release of the NameDrop feature in 2023, Daily Dot reported. This is a proximity data transfer feature for contact cards only. Yet, TikTok users have created their own narrative on what AirDrop is capable of, which has snowballed across the platform. It comes as the US seeks to ban TikTok over the security of data and its links to China's government. US lawmakers from both political parties have supported a law that would ban the platform for all 170million US users unless TikTok is sold by its Chinese parent company, ByteDance. While TikTok has tried to appeal the law, calling it "unconstitutional", a US court rejected the attempt earlier this month. On Monday, the app, and ByteDance, asked the US Supreme Court to intervene and stop the nationwide ban. “The Act will shutter one of America’s most popular speech platforms the day before a presidential inauguration," TikTok wrote in its filing.
Zero-trust security is essential to enterprises that are converging operational technology (OT) with IT infrastructure. New research from Enterprise Management Associates (EMA) identified how this convergence influences zero-trust strategy and implementation. Companies have historically secured OT systems – which include physical security controls, HVAC systems, industrial control systems like factory automation equipment, and medical scanning equipment – by air-gapping them. Physical isolation from IT networks protects OT systems against threats, but it also prevents companies from driving more automation, efficiency, and intelligence into business operations. Companies want flexibility in how end users and business applications access and interact with OT systems. For instance, air-gapped medical imaging equipment in a hospital requires a doctor to interact physically with the equipment to access their patient’s imagery. IT/OT convergence allows those doctors to access medical imagery from anywhere. Enterprises also want to extract data from OT systems, which requires network connectivity. For example, manufacturers can pull real-time data from their assembly lines so that specialized analytics applications can identify opportunities for efficiency and predict disruptions to production. While converging OT onto IT networks can drive innovation, it exposes OT systems to the threats that proliferate the digital world. Companies often need new security solutions to protect OT. EMA’s latest research report, “Zero Trust Networking: How Network Teams Support Cybersecurity,” revealed that IT/OT convergence drives 38% of enterprise zero-trust security strategies. Zero-trust security is the application of granular authentication, authorization, and segmentation policies and controls to ensure least privilege access to networks. Zero trust often involves continuous verification of authorized access by analyzing behavior and challenging devices and users to reauthenticate themselves. Zero trust is especially valuable to OT convergence because it can authenticate access based on factors other than user identity, and it can apply granular network segmentation to restrict what kinds of communications OT devices can have on an IT network. EMA’s new zero-trust research, based on a survey of 270 IT professionals, found that IT/OT convergence correlates with a different approach to this security model. For instance, the top two guiding principles of zero-trust initiatives in general are (1) preventing unauthorized access and (2) preventing zero trust from negatively impacting network performance and user experience. With OT-focused zero trust, enterprises are less concerned about network performance impacts. Instead, they place a greater premium on management simplicity. OT convergence adds network complexity by expanding the number of devices that need to connect and increasing the amount of segmentation needed to isolate those devices. Zero-trust architectures that are built for management simplicity can mitigate these issues. IT/OT convergence leads enterprises to set different priorities for zero-trust solution requirements. When modernizing secure remote access solutions for zero trust, OT-focused companies have a stronger need for granular policy management capabilities. These companies are more likely to have a secure remote access solution that can cut off network access in response to anomalous behavior or changes in the state of a device. When implementing zero-trust network segmentation, OT-focused companies are more likely to seek a solution with dynamic and adaptive segmentation controls. These companies also perceive a greater need for a network observability tool that can support zero trust. Typically, they want an observability tool that can facilitate access policy design. EMA’s research asked respondents to identify various challenges to their zero-trust projects. Our analysis found that OT-driven projects had a few unique issues. First, we found that these companies are more likely to struggle with adapting legacy secure remote access technologies like VPNs to zero-trust requirements. Moreover, OT-focused companies were more likely to perceive an overall lack of effective zero-trust products on the market. Apparently, most zero-trust solution providers are focused on traditional IT use cases, rather than OT. These companies were also more likely to tell EMA that their network observability tools are failing to support zero trust, suggesting that they need new monitoring tools that can extend their visibility into OT systems. To learn more about EMA’s new zero-trust networking research, check out this free on-demand webinar, which highlights our key findings. Shamus McGillicuddy is the research director for the network management practice at Enterprise Management Associates. He has been covering the networking industry for more than 12 years as an analyst and journalist. Prior to joining EMA, Shamus was the news director for TechTarget’s networking publications. He led the news team’s coverage of all networking topics, from the infrastructure layer to the management layer. He has published hundreds of articles about the technology and competitive positioning of networking products and vendors. He was a founding editor of TechTarget’s website SearchSDN.com, a leading resource for technical information and news on the software-defined networking industry. Sponsored Links
Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Advertisement Humanities and Social Sciences Communicationsvolume 11, Article number: 716 (2024) Cite this article Metrics details The purpose of this study was to analyze text-based comprehension questions asked by fourth-grade teachers in Turkish (L1) lessons in emergency distance education that started during the COVID-19 pandemic and to compare the results with those of other studies conducted in face-to-face educational settings. The text-based comprehension questions were evaluated in terms of different text types (narrative and expository) according to the distribution of the questions in the reading/listening process, answer source (whether the answer to the question was intratextual, extratextual, or intertextual), format, inference type, and teacher specificity. The study was designed to utilize a qualitative description method. Two fourth-grade teachers working in different primary schools were selected as participants. The data were collected through online lesson observations. A total of 56 lesson hours were observed and videotaped. The content analysis technique was applied for the analysis of the data. As in the results of previous studies, the present study, which was conducted in an emergency distance education environment, revealed that the text-based comprehension questions asked by teachers are generally asked after reading/listening, are answered with intratextual and extratextual sources, are prepared only in an open-ended question format, and are mainly of the propositional inference type. Additionally, it was found that teachers do not take the initiative to generate questions themselves and remain primarily dependent on the textbook. In the context of the teaching and learning of reading comprehension, questions play a significant role in developing students’ higher-order thinking skills and ensuring in-depth understanding (Ateş 2011; Durkin 1978–79). They not only provide information to teachers about the academic status of students but also help students construct meaning from the text (Başaran 2019, pp. 295–296). According to Güneş (2021a), the primary function of questions is to inform and to be informed within the scope of learning and teaching (pp. 313–314). Questions can be used to make readers aware of the crucial points of a text (Day and Bamford 1998), to check comprehension (Gerot 2000), to extend the topic, to relate the text to prior knowledge and experiences to improve comprehension (Handsfield and Jiménez 2008) and to serve as an assessment of students’ comprehension of what has been taught (Kintsch 2005). Experts from the National Reading Panel (NRP) (2000) also argue that generating and answering questions effectively develops comprehension. In brief, questions can be considered an auxiliary element of students’ comprehension, meaning-making, and learning (Beck et al. 1996; Duke and Pearson 2002; Durkin 1979). Text comprehension questions can be classified in many different ways using various parameters. For example, the revised Bloom’s taxonomy provides a framework for questions (Anderson et al. 2001). Questions related to the remembering stage of the taxonomy are directed towards recognition and recall. In contrast, questions associated with the understanding stage are directed towards interpretation, sampling, classification, summarizing, inferring, comparing, and explaining. The application stage includes execution and realization questions, while the analysis stage includes parsing, organizing, and examining questions. While questions related to the evaluation stage are about controlling/auditing and criticizing, the creation stage is about creating, planning, and producing (Krathwohl 2002). In Day and Park’s (2005) taxonomy, questions are divided into six comprehension categories. These categories are literal, reorganization, inference, prediction, evaluation, and personal response. Clymer (1968) mentioned that Barrett’s taxonomy puts questions into five categories. These categories are literal comprehension, reorganization, inferential/deep comprehension, evaluation, and appreciation. Furthermore, Akyol (2019) and Başaran (2019) suggested a question classification specifically for language lessons. They stated that it is necessary to classify questions based on their different aspects, including their purposes (questions about text schema and content), the timing of asking (pre-text, during-text, and post-text questions), the format (open-ended, multiple-choice, true-false, fill-in-the-blank, and matching questions), the cognitive processes required (simple comprehension and in-depth comprehension questions), and the answer sources [intratextual (the answer is within the text), extratextual (the answer is outside the text), and intertextual (the answer is between texts) questions]. In the current study, Akyol (2019) and Başaran’s (2019) question classification was preferred because it deals with different aspects of questions and is specific to language lessons. Inference-making is essential for comprehension and is emphasized in the Turkish curriculum beginning at the 3rd-grade level (MoNE 2019). Inference is explained as obtaining the truth from a proposition with the help of other propositions, deducing a new proposition from a proposition (Hançerlioğlu 1989; Timuçin 1994). Questions can be utilized to lead students to make inferences. In this vein, there are various types of inferences that questions serve. Although there are different taxonomies (Nicholas and Trabasso 1980; Pearson and Johnson 1978; Warren et al. 1979) for inference, Chikalanga’s (1992) taxonomy was used in this study since it includes ideas from previous taxonomies and is more comprehensive. Accordingly, inference types are divided into lexical, propositional, and pragmatic inferences. Lexical inferences are aimed at finding the referents of pronouns and the intended meaning of words with multiple meanings (homophones) by using clues in the textual context. Propositional inferences are defined as necessary truths. This is because these inferences are directly derived from the semantic context of the explicit propositions in the text. Finally, pragmatic inferences are usually based on extratextual knowledge, in other words, the reader’s schemas (Chikalanga 1992). Examples of questions related to inference types taken from Kaya et al.’s (2021) study are given below: “Bulut felt a hand touching his right shoulder while he was walking absent-mindedly. At first, he was scared, but when this fear was replaced by curiosity, he turned and looked behind him. It was his favorite friend, Mehmet Ali, whom he had not seen for years, touching his shoulder. As soon as he saw him, an enthusiastic smile covered his face.” – To whom does the underlined word “him” refer in the above text? Answer: Mehmet Ali Inference type: Lexical inference – Why was Bulut happy to see Mehmet Ali? Answer: He was happy to see a friend he had not seen for years. Inference type: Propositional inference – Why do you think Bulut is walking absent-mindedly? Answer: He might be thinking about something he has to do, or Bulut may typically be absent-minded and contemplative. Inference type: Practical inference In the comprehension process, the quality of the questions (type, content, comprehension level, and purpose) is among the factors that affect the construction of meaning (Fordham 2006a). For example, if the objective was to develop students’ in-depth comprehension skills, it would be inappropriate to ask simple comprehension questions (Cerdán et al. 2009; Fordham 2006a). This is because the answers to simple comprehension questions appear directly in the text as words or sentences. Simple comprehension questions require low-level cognitive skills. For in-depth comprehension questions, the answer is not directly mentioned in the text. It is either implied or found by using an individual’s background knowledge. In answering such questions, students need to activate high-level cognitive processes such as analysis, synthesis, and evaluation (Akyol 1997; Başaran 2019, pp. 307–308). Stevens (1912) observed that approximately two-thirds of the questions posed by teachers were based on memorization and recall. Similarly, both Ateş’s (2011) study examined the questions asked to fifth-grade students in Turkish (L1) lessons (Ateş 2011), and Özdemir’s study investigated questions in 1–5 grade level Turkish textbooks (Özdemir 2011) in Türkiye and found that they were mostly simple comprehension questions that require low-level thinking skills. To construct meaning and provide in-depth comprehension, teachers need to model how to make meaning through the questions they ask (Hervey 2006), and students need to be given opportunities to work with question types that engage different comprehension processes (Day and Park 2005). One of the most common methods used in the teaching process is the question-answer method (Parker and Hurry 2007). When the related literature is examined, many studies are found that consider the use of questions in the teaching-learning process and during text-based comprehension activities (Afflerbach 2010; Akyol 1994, 1996, 1997, 2001; Akyol et al. 2013; Applegate and Applegate 2004; Applegate 2007; Applegate et al. 2002; Aslan 2011; Ateş 2011; Aydemir and Çiftçi 2008; Ayvacı and Türkdoğan 2010; Batur et al. 2019; Beck et al. 1996; Boyles 2003; Cerdán et al. 2009; Changpakorn 2007; Cortese 2004; Day and Park 2005; Demirgüneş et al. 2014; Durukan 2009; Eason et al. 2012; Fordham 2006b; Kreiner 1996; Langer 1985; Özdemir 2011; Parker and Hurry 2007; Polat and Dedeoğlu 2020; Raphael 1982; Rosenshine et al. 1996; Stevens 1912; Tuinman 1973; Ülper and Yalınkılıç 2010). In these studies, questions are classified according to their format, the cognitive processes required, the answer sources (whether the answer to the question is in intratextual, extratextual, or intertextual), or various taxonomies. These studies were generally conducted by analyzing documents such as textbooks, student workbooks, teacher guidebooks, or exam papers. In some studies, teachers or preservice teachers were asked to list the questions they would likely ask their students about a particular text through various data collection tools. Research on comprehension questions based on direct classroom observations (Ateş 2011; Durkin 1978–79; Stevens 1912) is quite limited. However, investigating the type, content, and level of comprehension questions through observations has the potential to make essential contributions in terms of revealing the details of the implementation process. To utilize this potential, in this study, the approach employed involved examining the comprehension questions of primary school teachers about the texts they teach in Turkish lessons based on observations. Turkish (L1) lessons are taught based on a thematic approach in Türkiye (MoNE 2019). The thematic approach has emerged as an instruction model that involves students working on a specific theme in detail (Arhan and Gültekin 2013; MoNE 2019). In the thematic approach, themes provide opportunities for students to expand, organize, and structure knowledge and skills in the mind, and to transfer them to daily life (Güneş 2009). Texts are essential elements of the thematic approach (Arhan and Gültekin 2013). There are different types of texts (informative, narrative, poetry) in the Turkish textbook to help students acquire basic language skills. The curriculum predetermines the texts in the book. Eight themes are included in the Turkish textbook for one school year. For each theme, the textbook proposes four texts, three of which are reading texts, and one involves listening/watching (students do not read these texts but listen to audio recordings or watch videos). Each text addresses different subdimensions of a theme. For example, the “Science and Technology” theme is one of the themes in the fourth-grade Turkish textbook (Kaftan-Ayan et al. 2021). The first text in this theme provides examples of technological tools that can be invented. The second text explains how to make an invention. The third text presents examples of the life and inventions of an inventor, and the fourth one describes the characteristics that scientists should have. Thus, the “Science and Technology” theme is taught in different aspects. Various text-based activities are carried out with a student-oriented approach before, during, or after reading or listening to the text. The primary purpose of these activities is to ensure that the students understand the text. Indeed, according to many studies in the literature (Akhondi et al. 2011; Akyol 2018, p. 4; Block and Parris 2008; Duke and Pearson 2002; Durkin 1978–79; Güneş 2021b; Loranger 1997; Pressley 2002; Temur 2001, p. 62), the main purpose of reading and listening is comprehension. One of the crucial factors that affects learning is the learning environment (Özerem and Akkoyunlu 2015). The integration of technology into learning environments and the transformation of educational processes have accelerated in recent years. However, the most rapid change in educational environments in many countries occurred during the COVID-19 pandemic. With the first COVID-19 case in Türkiye, the Ministry of National Education decided to close the schools on March 16, 2020. On March 23, 2020, asynchronous and synchronous distance education was implemented through the Education Information Network (EBA) platform, and applications such as Zoom, Microsoft Teams, Google Meet, and Adobe Connect were used to continue education and training activities when schools were closed due to the COVID-19 pandemic. This sudden and radical transformation in the educational environment due to the COVID-19 pandemic had the potential to affect many variables, such as the teaching process, teacher‒student and student‒student interactions, classroom management, student achievement, and motivation. According to Wong et al. (2022), although the distance education process has shortcomings, it provides certain advantages, such as providing students with a flexible and personalized learning environment, allowing them to progress at their own pace, removing limitations of time and space, and saving money and time. In this context, curiosity arises about how distance education affects the quality of comprehension questions asked by teachers. Thus, this research aimed to investigate comprehension questions about Turkish texts in the emergency distance education process. Addressing comprehension questions in the emergency distance education process can be considered a microlevel investigation focusing on a small part of teaching and learning. Microlevel investigation is an inductive path that focuses on a specific situation and helps researchers reach new ideas. Given that education will become more digitalized in the future, it is essential to consider how microlevel aspects, such as the characteristics and quality of the questions, will affect the teaching and learning process. Therefore, examining questions that have important functions in comprehension in a digital learning environment can provide new data and new perspectives on the subject. Even though the study was conducted during the distance education period, it is expected that the findings will still apply to teaching processes in the future. Accordingly, the main problem of this research is as follows: What are the characteristics of the text-based comprehension questions asked by fourth-grade teachers in emergency distance education Turkish lessons? Based on this main problem, answers to the following subproblems were sought: For Turkish lessons taught under the emergency distance education process, the following questions were considered; What is the distribution of the text-based comprehension questions in the reading/listening process (pre-text, during-text, post-text)? What are the formats of the text-based comprehension questions? What are the answer sources (intratextual, extratextual, intertextual) of the text-based comprehension questions? What are the inference types (lexical, propositional, pragmatic) of the text-based comprehension questions? What is the dependency of teachers on the textbook when asking text-based comprehension questions? In this study, a qualitative descriptive approach was applied. Qualitative description (QD) is a research method that describes experiences or events in a rich and straightforward way without in-depth interpretation (Milne and Oberle 2005; Neergaard et al. 2009; Sandelowski 2000). QD studies have taken a naturalistic perspective and examine phenomena in their natural state (Kim et al. 2017). Basic QD is not as highly interpretive as other qualitative research designs, such as grounded theory and phenomenology (Sandelowski 2000). “The goal is to stay close to the surface of the data while capturing all the elements of that experience, and the inherent scientific rigor is a reflection of a researcher’s ability to achieve that goal” (Milne and Oberle 2005, p. 143). As explained in the introduction, text-based comprehension questions have been analyzed through studies conducted in face-to-face educational environments. This study, which tries to examine how this situation is realized in the online environment, aims to produce a straightforward description and comprehensive summary of the phenomenon of interest. Therefore, the study was designed with a QD approach. Qualitative samples are typically small due to the emphasis on thorough interaction with participants, and the findings are not generalizable. In qualitative research, one of the most effective methods is to select individuals with particular knowledge and experience about the phenomenon being examined (Cresswell and Plano-Clark 2011). In addition, participants’ readiness and willingness to openly share their experiences and ideas are also important (Bernard 2002). In this study, which was conducted during the pandemic, preliminary contact was made with the principals of eight primary schools to arrange the observation of online fourth-grade Turkish lessons. School principals were informed about the purpose of the study, and our request to work with volunteer teachers was conveyed. However, positive feedback was received from only three school principals. The other school principals stated that teachers did not volunteer because of the uncertainties of the pandemic, their unfamiliarity with the online teaching process, or their anxiety. Thus, this study was conducted with three volunteer fourth-grade teachers. A pilot study was conducted in one teacher’s classroom, and the main study was conducted in two classrooms. Accordingly, the participants of this study were selected by convenience sampling. Fluent reading skills are emphasized as a focus on “learning to read” in the first years of primary school. However, there is a shift in focus to reading comprehension skills, or “reading to learn”, at the fourth-grade level. Thus, we decided to conduct this study at the fourth-grade level. Following ethical principles, participant identities were kept confidential, and teachers were given code names. The names given to the teachers were “Teacher A and Teacher B”. Demographic information about the study participants is shown in Table 1. In the present study, video recordings were taken to prevent data loss in the observation of the questions asked by the teachers in the Turkish (L1) lessons for comprehension. In addition, the teacher questions were compared with the textbook questions for the subproblem that assesses the dependency of teachers on the textbook when asking text-based comprehension questions. Accordingly, the questions asked by the teachers were listed first. These questions were subsequently compared with the questions in the Turkish language textbook. The study data were collected in April-May in the second semester of the 2020–2021 academic year. In this period, schools were closed to face-to-face education due to the COVID-19 pandemic, and distance education started. Thus, the observational data of the study were collected during online lessons on the Zoom platform. The data were collected by the first author of the study. First, a pilot study was conducted in a different class from the classes in which the main observations were made, and 16 h of Turkish lesson observations were conducted between January 11 and 22, 2021. Pilot observations were used to develop the observation form for question categorization, and the researchers were also provided with experience in managing the data collection process. Within the scope of the study, the main observation data were collected from the online classes of two fourth-grade teachers (Teacher A and Teacher B). Before the observation, the themes and texts were determined by interviewing the teachers. Both teachers’ online classes related to texts on the same theme were observed. For this purpose, the theme of “Health and Sports” theme was selected. This choice was influenced by the fact that two of the four texts in the theme were expository, and two were narrative texts. The texts in the “Health and Sports” theme were taught in Teacher A’s class between April 22 and May 27, 2021, and in Teacher B’s class between April 30 and May 26, 2021. From the beginning to the end of the process, 34 lesson hours were observed in Teacher A’s class, and 22 lesson hours were observed in Teacher B’s class. However, not all of this time was spent on the texts, and different activities (such as grammar and evaluation) were also carried out. Table 2 presents information about the text taught and the duration of the classes in which only text-based activities were carried out. Non-text activities such as grammar and evaluation activities were excluded. To eliminate the testing/monitoring effect on teachers and students and to accustom them to the process, the researcher attended the classes and took recordings for a week before the main data were collected. These recordings were not used in the analysis. Before collecting the main observation data, teachers were asked about their weekly class schedules, and an observation schedule was created. The researcher recorded the lessons while turning off her video image and sound to avoid distracting the students. The data of the study were analyzed using Weber’s (1990) basic content analysis approach. This approach is deductive. Preliminary codes are developed before data collection. Theoretical and empirical works construct a basis for analysis (Drisko and Maschi 2016). Accordingly, the preliminary codes of this study were developed by drawing on Akyol’s (2019), Başaran’s (2019), and Chikalanga’s (1992) studies prior to data collection and analysis. The “observation form for question classification” was created as the basis for the data analysis. This form consists of two parts. In the first part of the form, some information describing the lesson was recorded. These were the theme, text name, text type, school, class, teacher, and date. In the second part, the five categories in Fig. 1 and their codes were given. Observation form for question classification. As shown in Fig. 1, “the observation form for question classification” was designed to find answers for each subproblem. To develop this form, a literature review was conducted, and a draft form was created. This draft form was subsequently sent to five experts, one of whom was an expert in qualitative research and four of whom were Turkish language field experts. Necessary arrangements were made as a result of the suggestions. For example, the category name, initially “the originality of the teacher question”, was changed to “question source” in line with expert opinions. In addition, the code names in this category were changed from “original” and “textbook-dependent” to “teacher” and “textbook”. The pilot observation data were analyzed with the revised form. During these analyses, some changes were made to the form, and the finalized form was used. The codes used are explained in Table 3. In the data analysis process, video recordings were transcribed first. The transcripts were coded in line with the subproblems. We also examined whether the questions were found in the textbook; thus, we determined whether the teachers depended on the textbook while asking questions. Regarding the four texts analyzed in the textbook, there were two pre-text questions before each text and 4 or 5 post-text questions after each text. Before the observation, the listening text “A Medicine Tale” was also listened to, and it was determined that there were three during-text questions. The researchers first coded the data individually based on the predetermined codes. The coding results were subsequently compared. If there were discrepancies in the coding, they were discussed, and a consensus was reached. The results of the analysis were subsequently defined and interpreted. Rigour can be created in qualitative studies using various strategies (Milne and Oberle 2005; Neergard et al. 2009). This study’s rigour was ensured within the framework of the credibility, confirmability, dependability, and transferability principles of Bradshaw et al. (2017). For credibility (to establish rapport before commencing observation), three volunteer teachers were contacted by telephone. The purpose of the research, the duration of the observation, and the fact that one researcher would be a passive observer during the observation were explained. Additionally, prolonged engagement, data sources, and researcher triangulation were used to ensure credibility. An audit trail technique was used to capture the data collection and analysis process to ensure dependability. Description of demographics of participants, direct quotations from teacher questions, and external expert opinions contributed to confirmability. Sufficient data collection and analysis details were provided for transferability to recreate the study. Within the scope of the research, first, approval was obtained from the *** University Ethics Commission dated November 24, 2020, number ***, stating that the research followed ethical principles. Then, official permission was obtained from the Ankara Provincial Directorate of National Education. After the official procedure, approval was obtained from the school administrators where the research was conducted, the teachers whose classes were observed, the parents of the students in these classes, and the students. While providing consent, the participants were told that participation in the research was completely voluntary and that they could withdraw from the study at any time. It was also stated that their identities would be kept confidential, and the data would not be shared with anyone other than the researchers. In this part of the study, the characteristics of the questions asked by the teachers during the narrative and expository text-based activities are presented. The results that emerged from the analysis of the data are divided into five categories: (1) distribution of the question in the reading/listening process, (2) answer source of the question, (3) question format, (4) question inference type, and (5) teachers’ dependency on the textbook when formulating questions. The questions asked by the teachers within the scope of expository and narrative texts were analyzed in three groups, pre-, during-, and post-text, according to their distribution in the reading/listening process. The analysis showed that the questions teachers A and B asked were similar according to their distribution in the reading/listening process. As shown in Table 4, when evaluated in terms of narrative and expository text types, the timing of the questions asked by both teachers in the reading/listening process was similar. According to the results, teachers mostly asked comprehension questions after the text. Post-text questions served to make inferences and enabled the teacher to assess the extent to which the text had been understood by the students. Some examples of post-text questions are as follows: “When do Nasrettin Hodja’s pains start?” (For Healing – Narrative Text) “How can we see microscopic creatures?” (Mysterious Creatures – Expository Text) Pre-text questions were mostly asked to activate prior knowledge and to make predictions. These questions are generally included in the “preparatory studies” section of the textbook. This section, which consists of two questions, is provided before each text in the textbook. The questions in this section are asked to activate students’ prior knowledge about the text’s subject and enable them to make predictions about the text. For example, the question “What do you understand a balanced diet to mean?” which was posed to the students before reading the text titled “For Healing”, dealing with the subject of healthy nutrition, and the question “Why do plants and food decay?”, which was asked before the text “Mysterious Creatures”, addressing the topic of microscopic organisms, are among those posed to students to activate their prior knowledge. In addition, in the text titled “Our First Wrestler Koca Yusuf and the Secret of His Success” the question “What do you think the subject of this text could be?” was posed to the students based on the title and visuals of the text, was a prediction question. Students were rarely asked questions while reading or listening to the text. As in the pre-text phase, the questions asked during reading were also oriented towards predicting and activating prior knowledge. These kinds of questions were asked only in the listening text “A Medicine Tale”. However, these questions were not directly asked by the teachers; rather, they were found in the audio recording of the text listened to by the students. Within the scope of participatory listening activities, while the students were listening to the text, the text was interrupted at a certain point, and questions were asked to predict what would happen next. For example, after listening to a part of the text titled “A Medicine Tale”, Elif, the main character of the text, asks Uncle Arda, another character, “How do medicines harm people? Why do people use them if medicines are harmful?”. The questions were directed to the students through the question “How do you think Uncle Arda answered this question?”. Thus, a participatory listening activity was carried out, which maintained students’ curiosity and motivation regarding the text. No questions were asked during reading in the other texts analyzed in this study. The questions asked by the teachers during the text-based activities were divided into three groups: intratextual, extratextual, and intertextual. These analyses revealed that both teachers asked questions with similar characteristics in terms of answer sources. The teachers asked intratextual and extratextual questions in approximately equal amounts. However, in our dataset, it was determined that the teachers did not include intertextual questions. Table 5 shows the distribution of the questions asked by the teachers according to the answer sources. The answers to the intratextual questions the teachers asked are directly included in the text. These questions are simple to answer. In the present study, the participants asked intratextual questions after reading/listening but not during participatory reading/listening. Since the questions asked before and during reading/listening in the analyzed texts are aimed at activating prior knowledge and predicting the content of the text, these questions are generally not suitable for answering with intratextual resources. For this reason, all the intratextual questions were post-text questions, as in the examples below. “What do scientists do to find medicines?” (A Medicine Tale – Narrative Text) “What does Mümin’s master, Yolcu Mehmet Pehlivan, say about Koca Yusuf?” (Our First Wrestler Koca Yusuf and the Secret of His Success-Expository Text) On the other hand, teachers asked questions that could be answered with extratextual sources at all stages of the reading/listening process. Although mainly after the text, extratextual questions were also asked before and during the text. Since the entire text had not yet been read, the questions asked before and during the text were mostly answered with extratextual sources. For example, the question “What should we do to protect our health?”, which was asked before the text “Mysterious Creatures”, and the question “How do you think medicines cure diseases?”, which was asked during the text “A Medicine Tale”, are among the questions answered with extratextual sources. The extratextual questions asked after reading/listening are questions whose answers are not directly included in the text and which students can answer using their prior knowledge and experiences. The question “What are the solutions you have found to solve the problem in the text?” was asked after reading the text “For Healing”, which was a question that students could answer based on their prior knowledge and experiences. Therefore, the question could be answered with extratextual answer sources. In addition, neither teacher included intertextual questions in the “Health and Sports” theme that was analyzed within the scope of the research. The questions asked by the teachers were divided into five formats: open-ended, multiple-choice, true/false, fill-in-the-blank, and matching questions. The table below shows the distribution of the questions asked by teachers in this context Table 6. Both teachers included only open-ended questions in both text types. When the questions in the textbook were analyzed, the results were similar. The textbook and teacher-made questions did not include multiple-choice, true/false, fill-in-the-blank, or matching-type questions. The questions asked by the teachers to comprehend the text were categorized into three groups in terms of inference type: lexical, propositional, and pragmatic. Table 7 shows the distribution of the questions asked by teachers to students according to inference type. There were similarities between the number and distribution of inference questions the teachers asked. The teachers did not include lexical inference questions in either text type. It was also found that the textbook did not include such questions. Lexical inference questions are aimed at finding the referents of pronouns and the intended meaning of words with multiple meanings (homophones) by using context clues. Observations show that teachers ask questions that address propositional and pragmatic inference types. In this process, propositional inference questions were used most frequently, as seen in the following excerpt taken from the narrative text “For Healing” in the textbook. “Nasrettin Hodja fell ill for a while. The doctor tells him to abstain for a while and not to eat heavy and spicy food. He gives him medicines. Hodja follows what the doctor says for a few days. He feels improvement in himself. He craves spicy stuffed dishes….” The questions given below for this text are examples of propositional inference: “Why does the doctor ask Nasrettin Hodja to abstain?” (Logical-explanatory inference) “What does Nasrettin Hodja want to eat when he gets better?” (Logical-informational inference) Pragmatic inference questions were also asked by teachers in the text-based activities. The answers to such questions are not directly included in the text but are based on students’ prior knowledge and schemas. Therefore, pragmatic inference questions are similar to extratextual questions in terms of their answer sources. One example of a pragmatic inference question is “What is the importance of nutrition for an athlete? Talk about it as a class.” To answer this question, students need to have some prior knowledge and schemas about the subject. Students who do not have prior knowledge about balanced and regular nutrition, energy requirements, nutritional values of foods, and exercise may not be able to provide a qualified answer to this question. Another example of this type of question concerns a visual activity in the text “For Healing”. In this visual activity, Güven Usta suggests a correct sitting position for a child who is not sitting upright at a desk. In line with this suggestion, students are asked, “How can Güven Usta’s suggestion benefit our health in the future?”. To answer this question, students need to have prior knowledge and schemas on topics such as spinal structure, the muscular system, and the circulatory system. Otherwise, the answers given may not be sufficient. As stated earlier in the present study, intratextual questions according to answer sources were similar to propositional inference questions in the classification made according to inference types, while extratextual questions were similar to pragmatic inference questions. Based on these findings, a detailed analysis was conducted. The code co-occurrence model related to the categories of inference types and answer sources was examined. The connections between the categories are presented concretely with numerical values in Fig. 2. Code co-occurrence model according to the answer sources and inference types of the text-based comprehension questions. As shown in Fig. 2, almost all questions of the propositional inference type can be answered with intratextual sources. On the other hand, all of the questions of the pragmatic inference type can be answered using extratextual sources. The participants in this study did not ask any questions about lexical inference type, which is one of the inference types, or intertextual type, which is one of the answer sources. Therefore, further analysis of these codes could not be conducted. It was determined that both teachers mostly followed the textbook in the text-based activities. In addition, we analyzed whether the teachers created unique questions without being dependent on the textbook. The results are summarized in Table 8. Both teachers asked text comprehension questions based on the textbook without differences in type of text. Although the proportion of unique questions produced by Teacher A was greater than that produced by Teacher B, approximately 90% of the questions were textbook-based. This study aimed to examine the text-based comprehension questions that fourth-year teachers asked in Turkish lessons taught during the period of emergency distance education that was implemented during the COVID-19 pandemic. The first finding of this study is that the participating teachers asked more post-text questions than pre- and during-text questions. This result is similar to those of studies conducted in face-to-face education environments (Akyol 2001; Kaya-Özgül and Çetinkaya-Özdemir 2022; Sunggingwati and Nguyen 2013). This finding implies that teachers’ text-based comprehension questioning did not change during the distance education period. The teachers asked all pre-text questions determined for the texts analyzed in the Turkish language textbook and the questions in the listening text. This behavior of the teachers shows that they tend to adhere closely to the textbook. Teachers’ adherence to the textbook is understandable because textbooks are seen as the primary source of educational material in Türkiye. Another issue addressed in this study is the type of questions asked by teachers in the distance education period, which were categorized by answer source. It was observed that teachers asked intratextual and extratextual questions almost equally in the text-based activities. This result is compatible with previous studies performed in face-to-face teaching (Akyol 2001; Akyol et al. 2013; Kaya-Özgül and Çetinkaya-Özdemir 2022). While the teachers asked extratextual questions to activate prior knowledge and prediction, they did not ask high-level cognitive questions that involved inferring, evaluating, or making connections. The Turkish language curriculum emphasizes the importance of developing higher-order cognitive skills such as inferring, evaluating and making connections from the third grade onwards (MoNE 2019). However, the results of the research conducted in face-to-face settings and this study reveal that teachers do not ask such questions. This important finding suggests that teachers’ awareness of the Turkish language curriculum and the reasons for not asking such questions are issues that need to be investigated. Another result related to the answer source is that the teachers did not include any intertextual questions in text-based activities, as found in other studies (Akyol 1994, 1997; Ateş 2011; Kaya-Özgül and Çetinkaya-Özdemir 2022; Sunggingwati and Nguyen 2013). The reason why teachers do not ask intertextual questions may be that there are no such questions in the Turkish language textbook. However, there are explanations in the Turkish language curriculum that encourage teachers to ask questions that lead students to construct intertextual meaning. According to the curriculum, by studying different types of texts within the scope of a theme, students are expected to construct relationships between these different types of texts (MoNE 2019). As has been found in various studies (Akyol 2001; Fordham 2006a; Kaya-Özgül and Çetinkaya-Özdemir 2022; Sunggingwati and Nguyen 2013; Şengül 2005), both teachers included only open-ended questions in both text types intensively in this study. When the questions in the textbook were analyzed, it is noteworthy that the situation was the same. Multiple-choice, true/false, fill-in-the-blank and matching-type questions were not included in the textbook or teacher-made questions. In some studies (Akyol 2001; Şengül 2005), open-ended questions were called “classical questions”. Hynds (1990) argued that teachers should enable students to construct meaning from texts with open-ended, multifaceted, and student-centered questions. Since closed-ended questions have limited answers (Akyol 2019), if teachers limit meaning-making to short-answer questions, they can limit what their students can learn about literary works and reading texts (Hynds 1990). Thus, teachers’ use of open-ended questions can be considered positive. However, as stated by Şengül (2005), when all questions that are posed are open-ended, as a result, students may be unfamiliar with different question types. When the text comprehension questions asked by the teachers were analyzed in terms of inference type, similar results were obtained regardless of the text type. Propositional inference-type questions were mostly used. These questions included pragmatic inference questions. This result is similar to the results obtained from Demirgüneş et al.’s (2014) study in which the questions in the 8th-grade Turkish (L1) teacher’s guidebook were classified according to inference types. However, it contradicts the results of Kaya et al.’s (2021) study in which questions in middle school textbooks were analyzed according to inference type. According to the results of the mentioned study, mostly pragmatic inference questions were included in the textbooks, followed by propositional inference questions. These results show that as grade level increases, the types of inference can be differentiated and higher level inference questions can be asked. In addition, the difference between the results of Demirgüneş et al. (2014) and Kaya et al. (2021), although both studies were conducted with middle school textbooks, can be attributed to the changes in curricula and textbooks over time, considering the publication years of the studies. In studies examining students’ inference-making skills (Algül and Bozkurt 2021; Bayat and Çetinkaya 2020), it was observed that pragmatic inference-making was the most difficult for students. According to Kaya et al. (2021), such difficulty in pragmatic inference questions shows that students fail to use their world knowledge and experiences to make connections between texts. This finding also suggested that students cannot internalize texts. For this reason, it is essential to include pragmatic inference questions to a sufficient extent. According to the results of this study, more propositional inference questions were asked than other question types in text-based activities. Propositional inference questions are answered by interpreting the semantic content of the text. These questions require logical informational and logical explanatory inferences. To answer such questions, logical-semantic relationships need to be established between the sentences or paragraphs that make up the text. According to the results of the study, lexical inference questions were not included by the teachers, nor were such questions encountered in the relevant sections of the textbook. Lexical inferences serve to identify and monitor pronoun referents and to ensure the continuity of the subject in the text. They are also effective at finding the meaning of words in the text context (Demirgüneş et al. 2014). Given this explanation, teachers’ failure to include such questions was considered a deficiency by the researchers. Another issue the study addressed was teachers’ dependency on the textbook when asking questions about text-based activities. When the questions were analyzed, it was seen that teachers were almost entirely dependent on the textbook when asking questions, regardless of the text type. These findings are similar to those of other studies (Akyol et al. 2013; Alvermann and Phelps 2002; Dillon 1988; Shomoossi 2004; Sunggingwati and Nguyen 2013; Van Der Meij 1994). There may be various reasons why teachers are almost entirely dependent on textbooks when asking questions and rarely ask questions of their own making, and this topic can be explored in new research studies. This study was conducted with two teachers in 56 lesson hours during the COVID-19 pandemic. Therefore, the data are relatively limited. However, this approach also contributes to determining whether there are changes in the characteristics of the text-based comprehension questions teachers ask in distance education. One of this study’s most important results is that teachers depend on the textbook instead of producing text-based questions themselves. In general, further research to discover teachers’ views on why they had chosen to use almost exclusively questions they had not created can be performed to contribute to studies on questioning and comprehension. In addition, additional research should be conducted on why teachers usually ask post-text questions that are to be answered with intratextual and extratextual resources, are prepared only in the open-ended question format, and mainly serve the propositional inference type but not higher-order comprehension. Considering these results, training can be given to teachers on the characteristics of the questions to be asked in text-based activities, asking a variety of questions that address individual differences and issues to be considered in the question-answer method. The question-answer method is but one possibility for comprehension. 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Gazi University, Gazi Faculty of Education, Ankara, Türkiye Ülkü Çoban Sural & Naciye Aksoy You can also search for this author in PubMedGoogle Scholar You can also search for this author in PubMedGoogle Scholar The authors confirm contribution to the paper as follows: study conception and design: [Ülkü Çoban Sural, Naciye Aksoy]; data collection: [Ülkü Çoban Sural]; analysis and interpretation of results: [Ülkü Çoban Sural, Naciye Aksoy]; draft manuscript preparation: [Ülkü Çoban Sural]; review and editing; [Naciye Aksoy]; revision: [Ülkü Çoban Sural, Naciye Aksoy]. All authors reviewed the results and approved the final version of the manuscript. Correspondence to Ülkü Çoban Sural. The authors declare no competing interests. This study was approved by the Ethics Committee at Gazi University on November 24, 2020 with approval number E.126119. Written informed consent was obtained from participants before observations. 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