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The incidence of pneumonia is higher in older than younger people, due to both an increase in factors facilitating entry of infectious agents into the lungs, and attenuated functioning of the immune system. Classic features of presentation of pneumonia may be absent. The most common signs of pneumonia in old age are tachypnoea and tachycardia. Aetiology is established in only 50% of older patients. The empirical treatment of community-aquired pneumonia (CAP) should be aimed at its most common cause, Streptococcus pneumoniae. The empirical treatment of health care-associated pneumonia (HCAP) should be targeted at Gram-negative agents. Choice of antibiotic must include consideration of potential drug interactions.
Any teacher or parent can tell you that many students are bored in school. But many of them tend to assume that boredom is not a problem with the best students, and that if students tried harder or learned better they wouldn't be bored. In the 1980s and 1990s, education researchers increasingly realized that when students are bored and unengaged, they are less likely to learn (Blumenfeld et al., 1991). Studies of student experience found that almost all students are bored in school, even the ones who score well on standardized tests (Csikszentmihalyi, Rathunde, & Whalen, 1993). By about 1990, it became obvious to education researchers that the problem wasn't the fault of the students; there was something wrong with the structure of schooling. If we could find a way to engage students in their learning, to restructure the classroom so that students would be motivated to learn, that would be a dramatic change.
Also by about 1990, new assessments of college students had shown that the knowledge they acquired in high school remained at a superficial level. Even the best-scoring students, those at the top colleges, often had not acquired a deeper conceptual understanding of material – whether in science, literature, or math (Gardner, 1991). Educators still face these critical problems today.
When learning environments are based on learning sciences principles (e.g. project, problem, and design approaches), they are more likely to be motivating for students. The principles – such as authenticity, inquiry, collaboration, and technology – engage learners so that they will think deeply about the content and construct an understanding that entails integration and application of the key ideas of the discipline. For a learning sciences approach to work, students must invest considerable mental effort and must persist in the search for solutions to problems. In many ways, newly designed environments based on learning sciences principles require students to be more motivated than do traditional environments (Blumenfeld et al., 1991). Although there is evidence that students respond positively to these learning environments (Hickey, Moore, & Pellegrino, 2001; Mistler-Jackson & Songer, 2000), it remains unclear whether students are willing to invest the time and energy necessary for gaining the desired level of understanding. Many classroom activities in which students enthusiastically participate do not necessarily get students cognitively engaged.
The concept of cognitive engagement couples ideas from motivation research with ideas regarding learning strategy use. It includes students' willingness to invest and exert effort in learning, while employing the necessary cognitive, metacognitive, and volitional strategies that promote understanding (Fredricks, Blumenfeld, & Paris, 2004). The use of strategies can be superficial or deep. Superficial cognitive engagement involves the use of memory and elaboration strategies.
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