Underinvestigation and undertreatment of chronic heart failure persists. Failure to treat elderly patients with ACE-I is associated with a mortality that appears to be greater than that seen in the placebo arms of large clinical trials of ACE-I therapy. Within the population studied, older patients are less likely to be treated. Failure of age to significantly add to prediction of mortality implies that the apparent bias against treating older patients with chronic heart failure with ACE-I is not justified. Because mortality is dependent on provider and site of treatment, further reductions in mortality from chronic heart failure may require intensive and selective local efforts, or development of regional heart failure centers.

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This demonstration of concept applies diagnostic-prescriptive reading instruction, a methodology used in United States developmental education, toward improving reading comprehension and self-regulated comprehension strategy selection in Chinese postsecondary education. A single tutor, also the researcher, works closely with one Chinese university student to develop student-centered comprehension strategies that she can practice on her own. After a battery of formal and informal assessments and interviews, decoding and understanding deficiencies are identified, characterized, and discussed. Both the student and her tutor develop and execute a study plan, which was completed during the spring semester of 2010 at Sha'anxi University of Science and Technology (SUST) in Xi'an, People's Republic of China (PRC). By focusing on the subject's primary decoding deficiency, spelling, and her primary understanding deficiency, lack of background knowledge, the subject and her reading tutor are able to strategically tackle five reading comprehension goals: (1) spelling; (2) phonemic awareness; (3) noticing structural and cohesive elements; (4) comparing argumentative and evaluative texts; and (5) analyzing expository texts in business and economics. A final discussion analyzes both qualitative and quantitative data, including unexpected discoveries such as the salience of cohesion in reading comprehension and the cultural biases of standardized reading assessments.

This study explores the relationships between mixed achievement goals and metacognition in Chinese English major students' in-class listening comprehension and strategy selection, continuing threads of traditional research into the receptive language modalities of reading and listening. Stereotypes of foreign English teachers are also examined for their positive and negative effects on student affect, cognition, and metacognition. Choosing an appropriate achievement goal construct from several paradigms, the researcher chooses a mastery and performance dichotomy, with strong and weak tendencies, to create four achievement goal profiles within a group of 84 sophomore English majors in Mainland China. Methodology is hybrid, with quantitative classroom research data and qualitative teacher reflections. The main findings are that subjects with strong mastery achievement goals measure high on listening comprehension tests and demonstrate heightened competence with top-down listening comprehension strategies. Other findings confirm prior suggestions that students with heightened comprehension may not always use, or be cognizant of, bottom-up learning strategies. Suggestions for foreign and local researchers include the development of socioculturally specific, yet parsimonious, achievement goal constructs for Chinese postsecondary students of English, so that curriculum developers and teachers can simultaneously teach a language of metacognition to all students, while enhancing their listening comprehension.Keywords: listening comprehension, achievement goal profile, metacognition, learning strategies, Chinese students The primary objective of this study was to find out if achievement goal constructs are reliable predictors of listening proficiency, or of student preferences for bottom-up or top-down processing during classroom listening laboratory activities. Based upon research in reading comprehension (He, 2008) and listening comprehension (Shang, 2008) with Chinese students, and the researcher's initial observations as a teacher in China during 2009, it was hypothesized that students with strong mastery achievement goals will prefer using top-down strategies, while those with weak achievement goals, mastery or performance, will be ambivalent about strategy use. It was also predicted that students with a combination of both mastery and performance achievement preferences will trend toward higher scores on proficiency tests. To test these hypotheses, a repertoire of listening strategies, half bottom-up and half top-down, were modeled for 84 students throughout the first semester of their sophomore year at Sha'anxi University of Science and Technology. These students were given opportunities to practice this strategy repertoire every week, and assessed four times throughout their semester-twice in the use of bottom-up listening strategies and twice in the use of top-down listening strategies.A secondary objective of this study was to observe the effects of heightened metacognition on strategy selection and listening p...