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This article analyzes the possibility of using the Knowledge Building model in schools to promote the skills and abilities indicated by the LifeComp framework. After placing the LifeComp framework in the current social and cultural context of the knowledge society, the principles of the Knowledge Building model are examined and the technological infrastructure to support it, Knowledge Forum, is presented. A hypothesis on how the design of a Knowledge Building community can promote the competences of the LifeComp Framework is proposed and research evidence to support the hypothesis is provided. Some implications of this analysis and recommended changes for educational institutions to pursue this perspective are then discussed.

Background: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain, tenderness, and fatigue. Patients with FM have no effective medication so far, and their activity of daily living and quality of life are remarkably impaired. Therefore, new therapeutic approaches are awaited. Recently, exercise therapy has been gathering much attention as a promising treatment for FM. However, the underlying mechanisms are not fully understood, particularly, in the central nervous system, including the brain. Therefore, we investigated functional connectivity changes and their relationship with clinical improvement in patients with FM after exercise therapy to investigate the underlying mechanisms in the brain using resting-state fMRI (rs-fMRI) and functional connectivity (FC) analysis. Methods: Seventeen patients with FM participated in this study. They underwent a 3-week exercise therapy on in-patient basis and a 5-min rs-fMRI scan before and after the exercise therapy. We compared the FC strength of sensorimotor regions and the mesocortico-limbic system between two scans. We also performed a multiple regression analysis to examine the relationship between pre-post differences in FC strength and improvement of patients’ clinical symptoms or motor abilities. Results: Patients with FM showed significant improvement in clinical symptoms and motor abilities. They also showed a significant pre-post difference in FC of the anterior cingulate cortex and a significant correlation between pre-post FC changes and improvement of clinical symptoms and motor abilities. Although sensorimotor regions tended to be related to the improvement of general disease severity and depression, brain regions belonging to the mesocortico-limbic system tended to be related to the improvement of motor abilities. Conclusion: Our 3-week exercise therapy could ameliorate clinical symptoms and motor abilities of patients with FM, and lead to FC changes in sensorimotor regions and brain regions belonging to the mesocortico-limbic system. Furthermore, these changes were related to improvement of clinical symptoms and motor abilities. Our findings suggest that, as predicted by previous animal studies, spontaneous brain activities modified by exercise therapy, including the mesocortico-limbic system, improve clinical symptoms in patients with FM.

Abstract Aims Studies detailing endoscopic findings and hemostatic interventions for upper gastrointestinal bleeding after cardiovascular surgery are scarce. We conducted this study to determine the frequency and findings of emergent esophagogastroduodenoscopy (EGD) after cardiovascular surgery and the effect of bleeding requiring hemostatic intervention on clinical outcomes. Methods and Results We retrospectively reviewed records of emergent EGD examinations conducted within 30 days after cardiovascular surgery at a tertiary referral center in Japan from April 2011 to March 2020. Of 1625 patients undergoing cardiovascular surgery, 47 underwent emergent EGD. Sources of bleeding were identified in 30 cases, including transesophageal echocardiogram (TEE)‐related injuries (8 patients), gastric ulcers (7 patients), and duodenal ulcers (7 patients). Patients who required endoscopic hemostatic intervention had more TEE‐related injuries (43% vs 3%, P = 0.005), gastric ulcers (35% vs 6%, P = 0.018), or ulcers in the first part of the duodenum (29% vs 0%, P = 0.006) than those who did not. Intraoperative TEE did not increase the need for endoscopic intervention (71% vs 64%, P = 0.435). Intraoperative TEE and the need for endoscopic intervention did not affect length of stay or all‐cause mortality. Only one death was associated with gastrointestinal bleeding. Conclusion Despite the potential severity of bleeding after cardiovascular surgery, most cases can be managed endoscopically with no increase in hospital stay or mortality.

Background: Spinal anesthesia with intrathecal morphine is widely used for cesarean section (CS), and is associated with nocturnal desaturation. No studies have correlated respiratory depression (RD) in this population with the Mallampati (MMP) classification. We examine the value of MMP for preoperative risk stratification. Method: MMP was assessed preoperatively in patients scheduled for elective CS under spinal anesthesia. We defined RD events as follows within 24 hours postoperatively, measured by mainstream capnometry waveform analysis: 1. Bradypnea (RR ≤ 9 bpm for ≥ 120 seconds); 2. Apnea (PETCO2 < 5 mmHg for ≥ 15 seconds up to 120 seconds); 3. Temporary hypopnea (5 mmHg ≤ PETCO2 < 15 mmHg for ≥ 15 seconds up to 120 seconds); 4. Sustained hypopnea (PETCO2 > 45 mmHg for ≥ 120 seconds). Results: There were 100 patients with MMP 1-2, and 90 patients with MMP 3-4. Bradypnea was observed in 55 patients (MMP 1-2, 55%) vs. 55 patients (MMP 3-4, 61%), p = 0.394. Apnea was observed in 77 patients (MMP 1-2, 77%) vs. 75 patients (MMP 3-4, 83%), p = 0.276. Temporary hypopnea was observed in 68 patients (MMP 1-2, 68%) vs. 76 patients (MMP 3-4, 84%), p = 0.008. No sustained hypopnea events were noted in any patients. Conclusions: Temporary hypopnea was more frequent in patients with MMP 3-4 vs. 1-2, following 0.15 mg intrathecal morphine for CS. The study was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN000031410).

BackgroundFew data are available on the intensity of pain that women experience during the first five days after vaginal childbirth. Moreover, it is unknown if the use of neuraxial labor analgesia has any impact on the level of postpartum pain.MethodsWe performed a retrospective cohort study based on chart review of all women who delivered vaginally at an urban teaching hospital between April 2017 and April 2019. The primary outcome was the area under the curve of pain score on numeric rating scale (NRS) documented in electronic medical records for five days postpartum (NRS-AUC5days). Secondary outcomes included peak NRS score, doses of oral and intravenous analgesics consumed during the first five days postpartum, and relevant obstetric outcomes. Logistic regression was used to examine the associations between the use of neuraxial labor analgesia and pain-related outcomes adjusting for potential confounders.ResultsDuring the study period, 778 women (38.6%) underwent vaginal delivery with neuraxial analgesia and 1240 women (61.4%) delivered without neuraxial analgesia. Median (Interquartile range) of NRS-AUC5days was 0.17 (0.12-0.24) among women who received neuraxial analgesia and 0.13 (0.08-0.19) among women who did not (pConclusionAlthough women who used neuraxial labor analgesia had slightly higher pain scores and increased analgesic requirement during postpartum hospitalization, pain after vaginal childbirth was overall mild. The small elevation in the pain burden in neuraxial group does not seem to be clinically relevant and should not influence women's choice to receive labor analgesia.

There has been growing discourse related to the importance of the scholarship of educational development (SoED), but less discussion related to clearly defining principles for guiding engagement in SoED or contextualizing SoED within literature related to the scholarship of teaching and learning (SoTL). Expanding upon Felten’s (2013) principles for SoTL, as well as evolving discourse related to principles of educational development (e.g., Gibbs, 2013; Taylor & Rege Colet, 2010; Timmermans, 2014), this paper presents seven principles for SoED. Two additional principles (transforming practice and reflective practice) are added to Felten’s principles to further contextualize SoED in relation to educational development and SoTL. Three cases are provided to illustrate educational development, SoTL, and SoED within the context of these principles. The interrelationships between educational development, SoTL, and SoED are complex. While SoED offers many opportunities for further legitimizing the individual and collective practices in educational development, it also presents many additional tensions and questions for further research. On parle de plus en plus de l’importance de l’avancement des connaissances en pédagogie (ACP), mais on parle moins d’une définition claire des principes qui guident l’engagement en ACP ou de la contextualisation de l’ACP dans les publications de la recherche consacrée à l’avancement des connaissances en enseignement et en apprentissage (ACEA). Pour élargir la portée des principes pour l’ACEA présentés par Felten (2013), ainsi que celle du discours évolutif lié aux principes de la pédagogie (voir Gibbs, 2013; Taylor & Rege Colet, 2010; Timmermans, 2014), cet article présente sept principes pour l’ACP. Deux principes supplémentaires (transformation de la pratique et pratique réflective) sont ajoutés aux principes de Felten afin de contextualiser davantage l’ACP par rapport à la pédagogie et à l’ACEA. Trois cas sont présentés pour illustrer la pédagogie, l’ACEA et l’ACP dans le contexte de ces principes. Les relations entre la pédagogie, l’ACEA et l’ACP sont complexes. Alors que l’ACP offre de nombreuses possibilités pour rendre plus légitimes les pratiques individuelles et collectives en pédagogie, il présente également de nombreuses tensions et des questions supplémentaires qui pourront faire l’objet de davantage de recherche.

This study looked at the instructional and assessment effects of using learning journals in three distance asynchronous computer conferencing courses (n=18, n=16, n=17). The instructor used a design-research methodology: each iteration of the course involved modifications to how learning journals were used based on analyses of the responses and results from the preceding course. Modifications included: a) use of orienting questions; b) question content, c) journal assessment and d) amount of scaffolding. Protocols were analyzed with a view to characterizing students’ epistemic cognition from two perspectives: belief mode (rationalist epistemology, self analysis, norms of inquiry to defend competing beliefs) and design mode (knowledge building epistemology, collective responsibility, norms of inquiry to support idea improvement and explanatory coherence). Changes in metacognitive reflection and learning journal activity were related to measures of learning. As a pedagogical tool, learning journals with directed questions (scaffolding) encouraged self-awareness of learning and epistemological reflection. Résumé : La présente étude a examiné les effets de l’utilisation de journaux d’apprentissage sur l’enseignement et l’évaluation dans trois cours à distance asynchrones en téléconférence assistée par ordinateur (n = 18, n = 16, n = 17). L’instructeur a utilisé une méthodologie de recherche-conception : à chaque prestation du cours, des modifications étaient apportées à la manière dont les journaux d’apprentissage étaient utilisés en se basant sur l’analyse des réponses et les résultats obtenus lors de la prestation précédente. Les modifications concernaient : a) l’utilisation de questions d’orientation; b) le contenu des questions; c) l’évaluation du journal; d) la quantité d’échafaudage. Les protocoles ont été analysés de manière à caractériser la cognition épistémique des étudiants à partir de deux points de vue : le mode « croyance » (épistémologie rationaliste, autoanalyse, normes d’enquête pour défendre les croyances concurrentes) et le mode « conception » (épistémologie de coélaboration des connaissances, responsabilité collective, normes d’enquête pour appuyer l’amélioration des idées et la cohérence explicative). Les changements dans la réflexion métacognitive et l’activité des journaux d’apprentissage étaient liés à des mesures de l’apprentissage. En tant qu’outil pédagogique, les journaux d’apprentissage avec questions dirigées (échafaudage) encouragent la prise de conscience de l’apprentissage et la réflexion épistémologique.