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Patients with generalized myasthenia gravis (gMG) experience functional impairment due to MG symptoms. This study aimed to assess, from the patient perspective, the symptoms, impacts, and treatment goals of individuals diagnosed with gMG.Semi-structured, in-depth concept-elicitation interviews were conducted with 28 individuals diagnosed with gMG in the United States.Participants reported gMG symptoms that affected many body regions and functions, with an average of 16 symptoms per participant. The most frequently reported symptoms were eyelid drooping (93%), physical fatigue (89%), symptoms affecting the legs (82%), difficulty breathing (82%), and difficulty holding head up (82%). Nearly all participants (96%) reported fluctuations in symptoms and severity. Participants' most bothersome symptoms were blurry/double vision (43%), breathing difficulties (36%), all-over fatigue (36%), and swallowing problems (29%). Impacts on physical functioning included an inability to participate in hobbies/sports, need for increased planning, and difficulties performing activities of daily living. All participants reported emotional impacts and impacts on their work and finances. Their treatment goals included reduced fatigue and weakness, improved symptom stability, and minimization of the impact of symptoms, in particular the emotional impact.The fluctuating and unpredictable nature of gMG symptoms was found to have a substantial impact on patients' emotional, social, and economic well-being. Participants' goals for symptom management suggest that greater focus is needed to help them quickly resume a normal lifestyle by achieving symptom stability. Impacts of fluctuating and unpredictable symptoms are difficult to measure, but it is important to consider symptom fluctuation as well as ongoing symptomatology when making treatment decisions, and to recognize the impact of uncontrolled symptoms on patients, their partners/caregivers, and family/friends. These factors are often not reflected in burden/cost-of-illness studies.The aim of this study was to understand—from the patient’s point of view—the range of generalized myasthenia gravis (gMG) symptoms that they experience, which symptoms bother them most, and which symptoms have the greatest impact on everyday life, as well as patients’ treatment goals. Researchers asked these questions in one-on-one interviews with 28 people in the US who have gMG. Study participants reported living with symptoms that come and go, and are sometimes severe, making it difficult to lead a normal life. The most frequently reported symptoms were eyelid drooping (reported by 93% of study participants), physical fatigue (89%), symptoms affecting the legs (82%), difficulty breathing (82%), and difficulty holding head up (82%). The symptoms that bothered patients most were difficulties with vision (43%), problems breathing (36%), all-over fatigue (36%), and trouble swallowing (29%). Participants reported that gMG symptoms affected physical functioning, making it hard to participate in hobbies/sports, increasing the amount of planning needed to conduct their daily lives, and hindering their ability to do day-to-day activities (like driving, eating, and bathing). All participants reported that they were affected emotionally, and that the symptoms of gMG impacted their ability to work and their financial well-being. Participants’ treatment goals included reducing fatigue and weakness, making symptoms more stable, and reducing the impact of symptoms, particularly emotional impacts. These responses reveal the extensive effects of gMG symptoms on patients’ daily lives and highlight that symptom stability is especially important to people with gMG.

Purpose of Review In this review, we aim to summarize the evolution of care for the solid organ transplant recipient (SOTR) with COVID-19 disease, based on the current published guidelines and our center’s experience. Recent Findings Oral antiviral medications and monoclonal antibodies are now used with the goal to prevent severe disease. Immunomodulating drugs in addition to antivirals have been used in the treatment of severe COVID-19. Summary With the ongoing pandemic and unique challenges posed by the SOTR, understanding the risk and advancing management and treatment of COVID-19 infections are imperative to the successful care of a transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel therapeutics towards COVID-19.

Purpose of Review We aim to understand the most common fungal infections associated with the post-lung transplant period, how to diagnose, treat, and prevent them based on the current guidelines published and our center’s experience. Recent Findings Different fungi inhabit specific locations. Diagnosis of invasive fungal infections (IFIs) depends on symptoms, radiologic changes, and a positive microbiological or pathology data. There are several molecular tests that have been used for diagnosis. Exposure to fungal prophylaxis can predispose lung transplant recipients to these emerging molds. Understanding and managing medication interactions and drug monitoring are essential in successfully treating IFIs. Summary With the increasing rate of lung transplantations being performed, and the challenges posed by the immunosuppressive regimen, understanding the risk and managing the treatment of fungal infections are imperative to the success of a lung transplant recipient. There are many ongoing clinical trials being conducted in hopes of developing novel antifungals.

Background Simulation is a useful education tool for high-stakes clinical skills and decision-making. Recommending whether to accept or reject an organ for transplantation based on infection risk is a critical core competency in Transplant Infectious Disease (ID), however there are no published data that learners have opportunities to practice this during training. We created a novel simulation to expose learners to this real-life clinical scenario and evaluated their clinical decision-making in these situations. Methods We created 6 simulations with common ID consult questions about whether to accept or reject an organ for transplant based on infection risk (Table 1). During learners’ Transplant ID rotations, faculty periodically texted or paged them with the simulation cases as though they were the transplant coordinator. Learners had 15 minutes to ask follow up questions before deciding to accept or reject the organ and explain their decision-making process in a survey. Learners completed a survey 1 month after the simulation experience to evaluate its effectiveness. Results Between October 2021 and April 2022, 16 learners from 7 medical centers participated in the simulation (Table 2) and 94% (15/16) completed the follow up survey. Eighty-seven percent (13/15) of ID learners reported that the simulation was effective in teaching them when to accept or reject organs and 80% (12/15) felt more prepared to make these decisions in practice. Most learners correctly identified acceptable organs for transplant during the simulations (Figure 1). Of the 100 clinical reasoning decisions made during the activity, 19% were discordant, where the learner correctly decided to accept or decline the organ but with incorrect or incomplete reasoning for this decision (Figure 2). Conclusion ID learners perceived our transplant ID simulation as an effective educational tool to learn when to accept or reject an organ for transplant. By evaluating the clinical reasoning behind these decisions our simulation provides ID educators with nuanced insight into their learners' thought process and allows for targeted coaching to correct deficits in reasoning. Disclosures Rebecca Kumar, MD, Gilead: Grant/Research Support|Regeneron: Grant/Research Support Jonathan Hand, MD, GlaxoSmithKline: Grant/Research Support|Janssen: Grant/Research Support|Pfizer: Grant/Research Support Roderick Go, DO, Aptose Biosciences: Stocks/Bonds|Bristol Meyers Squibb: Stocks/Bonds|Cytodyn Inc.: Stocks/Bonds|Scynexis: Grant/Research Support Erica J. Stohs, MD, MPH, bioMerieux: Grant/Research Support.

Bacteriophage therapy is the use of viruses to kill bacteria for the treatment of antibiotic-resistant infections. Little is known about the human immune response following phage therapy. We report the development of phage-specific CD4+ T cells alongside rising phage-specific immunoglobulin G and neutralizing antibodies in response to adjunctive bacteriophage therapy used to treat a multidrug-resistant Pseudomonas aeruginosa pneumonia in a lung transplant recipient. Clinically, treatment was considered a success despite the development phage-specific immune responses.

The effectiveness of anti-cyberbullying interventions reported in the literature has been mixed even when the pedagogical organization of the programs were taken into account. To gain deeper insight into the relationship between pedagogical design principles of anti-cyberbullying interventions and their program effectiveness, this study comprises a systematic review and analysis of the pedagogical characteristics and meta-analyses of anti-cyberbullying educational programs for adolescents published up to March 2020. Nineteen independent studies from over 2,700 articles resulting from systematic searches of six database services met the study selection criteria. A detailed integrated socio-ecological framework was constructed to reveal, for each program component in the selected intervention studies, whether intrapersonal learning, interpersonal interactions, or community-oriented events were involved, and the stakeholders targeted. This pedagogical analysis identified five subgroups. Meta-analysis results of the 19 selected programs found small effect sizes overall for cyber-aggression and cyber-victimization. Further explorations showed that the pedagogical design features statistically significantly moderated the effectiveness of the anti-cyberbullying intervention. The subgroup analysis showed that only programs involving interpersonal interactions and stakeholder agency demonstrated superior program effectiveness. Due to the small number of studies that provided data on long-term programs effectiveness, the meta-analysis findings were inconclusive.

Efforts to realize the potential of learning analytics (LA) to contribute to improving student learning and learning design have brought important advances. A review of successful cases of learning analytics applications reveals that 1) there is a tight coupling between the learning outcome (LO) goals, task sequence design, and the learning analytics and feedback in each case, and 2) the learning analytics to be deployed and the feedback to be provided to learners and/or teachers are integral to the learning design (LD) rather than constructed after the LD is completed. Learning design frameworks in the literature have focused on generic learning task taxonomies and are unable to scaffold LA-integrated LD practice. This paper proposes a multilevel framework for LA-integrated LD, which provides a hierarchically nested multilevel structure for the design of LD and LA elements based on 60 STEM curriculum units collected from authentic classrooms. The framework includes a design process model in the form of a Learning Design Triangle and the concept of Learning Analytics integrated Curriculum Component Design Patterns (LA-CCDP). Operationalization of the framework is illustrated using one STEM curriculum unit. This framework can be adopted for professional learning and technology development to support LA-integrated LD practices.

To expand the use of cognitive diagnosis models (CDMs) to longitudinal assessments, this study proposes a bias-corrected three-step estimation approach for latent transition CDMs with covariates by integrating a general CDM and a latent transition model. The proposed method can be used to assess changes in attribute mastery status and attribute profiles and to evaluate the covariate effects on both the initial state and transition probabilities over time using latent (multinomial) logistic regression. Because stepwise approaches generally yield biased estimates, correction for classification error probabilities is considered in this study. The results of the simulation study showed that the proposed method yielded more accurate parameter estimates than the uncorrected approach. The use of the proposed method is also illustrated using a set of real data.

BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is a major limitation in the long-term survival of lung transplant recipients (LTRs). However, the risk factors in the development of BOS remain undetermined. We conducted an international cohort study of LTRs to assess whether Aspergillus colonization with large or small conidia is a risk factor for the development of BOS.METHODS: Consecutive LTRs from January 2005 to December 2008 were evaluated. Rates of BOS and associated risk factors were recorded at 4 years. International Society of Heart and Lung Transplantation criteria were used to define fungal and other infections. A Cox proportional-hazards-model was constructed to assess the association between Aspergillus colonization and the development of BOS controlling for confounders.RESULTS: A total of 747 LTRs were included. The cumulative incidence of BOS at 4 years after transplant was 33% (250 of 747). Additionally, 22% of LTRs experienced Aspergillus colonization after transplantation. Aspergillus colonization with either large (hazard ratio [HR] = 0.6, 95% confidence interval [CI] = 0.3-1.2, p = 0.12) or small conidia (HR = 0.9, 95% CI = 0.6-1.4, p = 0.74) was not associated with the development of BOS. Factors associated with increased risk of development of BOS were the male gender (HR = 1.4, 95% CI = 1.1-1.8, p = 0.02) and episodes of acute rejection (1-2 episodes, HR = 1.5, 95% CI = 1.1-2.1, p = 0.014; 3-4 episodes, HR = 1.6, 95% CI = 1.0-2.6, p = 0.036; >4 episodes, HR = 2.2, 95% CI = 1.1-4.3, p = 0.02), whereas tacrolimus use was associated with reduced risk of BOS (HR = 0.6, 95% CI = 0.5-0.9, p = 0.007).CONCLUSIONS: We conclude from this large multicenter cohort of lung transplant patients, that Aspergillus colonization with large or small conidia did not show an association with the development of BOS.

Infections continue to be a major cause of post-transplant morbidity and mortality, requiring increased health services utilization. Estimates on the magnitude of this impact are relatively unknown. Using national administrative databases, we compared mortality, acute care health services utilization, and costs in solid organ transplant (SOT) recipients to nontransplant patients using a retrospective cohort of hospitalizations in Canada (excluding Manitoba/Quebec) between April-2009 and March-2014, with a diagnosis of pneumonia, urinary tract infection (UTI), or sepsis. Costs were analyzed using multivariable linear regression. We examined 816 324 admissions in total: 408 352 pneumonia; 328 066 UTI's; and 128 275 sepsis. Unadjusted mean costs were greater in SOT compared to non-SOT patients with pneumonia [(C$14 923 ± C$29 147) vs. (C$11 274 ± C$18 284)] and sepsis [(C$23 434 ± C$39 685) vs. (C$20 849 ± C$36 257)]. Mortality (7.6% vs. 12.5%; P < 0.001), long-term care transfer (5.3% vs. 16.5%; P < 0.001), and mean length of stay (11.0 ± 17.7 days vs. 13.1 ± 24.9 days; P < 0.001) were lower in SOT. More SOT patients could be discharged home (63.2% vs. 44.3%; P < 0.001), but required more specialized care (23.5% vs. 16.1%; P < 0.001). Adjusting for age and comorbidities, hospitalization costs for SOT patients were 10% (95% CI: 8-12%) lower compared to non-SOT patients. Increased absolute hospitalization costs for these infections are tempered by lower adjusted costs and favorable clinical outcomes.

This paper reports on a longitudinal study of a network of 10 special education needs schools over a span of 11 years that leveraged the opportunity offered by a government‐funded e‐learning pilot scheme initiative to further their efforts in providing the same educational opportunities to their students as those in mainstream schools. The trajectory of this network's evolution shows that its robustness lies in the joint leadership network among the schools, and the insight and agency that this leadership network exhibited in the intentional exploration and crafting of a social structure and mechanism to support innovative developments in technology and pedagogical innovation, which we refer to as sociotechnical co‐evolution. By adopting a sociotechnical system framework to analyse the changes at the landscape, regime and niches levels, we show that in fact landscape factors play a crucial role in shaping the innovation trajectory through its influence on the niches. Network leadership, within‐school leadership and organizational infrastructures evolve and play an important role in the co‐construction of the sociotechnical regimes needed to bring about deep and widespread changes in pedagogical practice. [ABSTRACT FROM AUTHOR]

International audience; Download PDFPDFNeurologyProtocolPatient-reportedimpact of myasthenia gravis in the real world: protocol for a digital observational study (MyRealWorld MG) Sonia Berrih-Aknin1, Kristl G Claeys2,3, Nancy Law4, Renato Mantegazza5,6, Hiroyuki Murai7, Francesco Saccà8, Sarah Dewilde9, Mathieu F Janssen10, http://orcid.org/0000-0001-7208-1303Emma Bagshaw11, Hara Kousoulakou11, Mark Larkin11, Jon Beauchamp12, Trevor Leighton12, Sandra Paci12 INSERM, Institute of Myology, Center of Research in Myology, Sorbonne Université, Paris, France Department of Neurology, University Hospitals Leuven, Leuven, Belgium Laboratory for Muscle Diseases and Neuropathies, Department of Neurosciences, KU Leuven, Leuven, Belgium Myasthenia Gravis Foundation of America Inc, Westborough, Massachusetts, USA Fondazione IRCCS, Istituto Nazionale Neurologico Carlo Besta, Milan, Italy Associazione Italiana Miastenia e Malattie Immunodegenerative, Milan, Italy Department of Neurology, International University of Health and Welfare, Narita, Japan DNSRO Department, University of Naples Federico II, Naples, Italy Services in Health Economics, Brussels, Belgium Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, Netherlands Vitaccess Limited, London, UK argenx BV, Ghent, BelgiumIntroduction Myasthenia gravis (MG) is a rare, chronic, autoimmune disease, mediated by immunoglobulin G antibodies, which causes debilitating muscle weakness. As with most rare diseases, there is little patient-reported data with which to understand and address patient needs. This study explores the impact of MG in the real world from the patient perspective.Methods and analysis This is a 2-year prospective, observational, digital, longitudinal study of adults with MG, resident in the following countries: the USA, Japan, Germany, France, the UK, Italy, Spain, Canada and Belgium. The planned sample size is 2000. Recruitment will be community based, via patient advocacy groups, social media and word of mouth. Participants will use a smartphone application (app) to check eligibility, provide consent and contribute data. Planned data entry is as follows: (1) personal profile on enrollment—covering demographics, MG characteristics and previous care; (2) monthly event tracker—current treatments, healthcare visits, treatment-related adverse events, productivity losses; (3) monthly selection of validated generic and disease-specific patient-reported outcomes instruments: EQ-5D-5L, Myasthenia Gravis Activities of Daily Living, Myasthenia Gravis Quality of Life 15-item revised scale, Hospital Anxiety and Depression Scale and Health Utilities Index III. Analyses are planned for when the study has been running in most countries for approximately 6, 12, 18 and 24 months.Ethics and dissemination The study protocol has been reviewed and granted ethics approval by Salus IRB for participants resident in the following countries: Germany, the UK and the US. Local ethics approval is being sought for the following study countries: Belgium, Canada, France, Italy, Japan and Spain. Study results will be communicated to the public and participants via conference presentations and journal publications, as well as regular email, social media and in-application communication.

Infections are a common cause of morbidity and mortality in patients with lymphoid cancer. Because cancer therapeutics, including new targeted therapies and immunotherapies, are evolving, clinicians need to be aware of additional risk factors and infections that may arise in patients treated with these agents. This article highlights fundamental issues in treating patients with lymphoid cancer, including risk factors for infection, screening for infectious diseases, and recommendations for antimicrobial prophylaxis in patients with lymphoid cancers. We present 4 scenarios of patients with lymphoid cancers who have various infections, and we describe a treatment approach based on a combination of evidence-based data and experience because objective data are limited regarding infections, especially with newer agents. The goal of this discussion is to provide a framework for institutions and health care providers to help them develop their own approach to preventing and treating infections in patients with lymphoid cancer.

Organ and stem cell transplantation has been one of the greatest advances in modern medicine, and is the primary treatment modality for many end-stage diseases. As our population ages, so do the transplant recipients, and with that comes many new challenges. Respiratory viruses have been a large contributor to the mortality and morbidity of solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Respiratory viruses are generally a long-term complication of transplantation and primarily acquired in the community. With the emergence of molecular methods, newer respiratory viruses are being detected. Respiratory viruses appear to cause severe disease in the older transplant population. Influenza vaccine remains the mainstay of prevention in transplant recipients, although immunogenicity of current vaccines is suboptimal. Limited therapies are available for other respiratory viruses. The next decade will likely bring newer antivirals and vaccines to the forefront. Our goal is to provide the most up to date knowledge of respiratory viral infections in our aging transplant population.

BACKGROUND: Despite increased utilization of hepatitis C virus-infected (HCV+) organs for transplantation into HCV-uninfected recipients, there is lack of standardization in HCV-related patient education/consent and limited data on financial and social impact on patients. METHODS: We conducted a survey on patients with donor-derived HCV infection at our center transplanted between 4/1/2017 and 11/1/2019 to assess: why patients chose to accept HCV+ organ(s), the adequacy of their pre-transplant HCV education and informed consent process, financial issues related to copays after discharge, and social challenges they faced. RESULTS: Among 49 patients surveyed, transplanted organs included heart (n = 19), lung (n = 9), kidney (n = 11), liver (n = 4), heart/kidney (n = 4), and liver/kidney (n = 2). Many recipients accepted an HCV-viremic (HCV-V) organ due to perceived reduction in waitlist time (n = 33) and/or trust in their physician’s recommendation (n = 29). Almost all (n = 47) felt that pre-transplant education and consent was appropriate. Thirty patients had no copay for direct-acting antivirals (DAA) for HCV, including 21 with household income $1000. Two patients reported feeling isolated due to HCV infection and eight reported higher than anticipated medication costs. Patients’ biggest concern was potential HCV transmission to partners (n = 18) and family/friends (n = 15). Overall almost all (n = 47) patients reported a positive experience with HCV-V organ transplantation. CONCLUSION: We demonstrate that real-world patient experiences surrounding HCV-V organ transplantation have been favorable. Almost all patients report comprehensive HCV-related pre-transplant consent and education. Additionally, medication costs and social isolation/exclusion were not barriers to the use of these organs.

In this issue of the journal, we have several new initiatives that we want to promote. The four articles consist of a new review study, a conceptual discussion with critical responses about the concept of scripts in Computer-Supported Collaborative Learning (CSCL), and two articles with new insight about designs for low achievers and learning with epistemic games. We will also share some of the ideas, reflections, and stances in our field from the invited symposium that we organized at the 12th International Conference of the Learning Sciences in Singapore in June. Finally, the journal will launch a new format for contributions called Squibs (see the description at the end of this editorial). The intention with this format is that we as a community can engage in writing shorter contributions that raise awareness of competing theoretical or methodological developments, shortcomings, or new and emerging topics or issues in our field that we should address. As you see in the list of authors for this editorial, the former president of ISLS and associate editor in this journal, Carolyn P. Rose, has become one of the executive editors. We warmly welcome her in this position. The expertise that she brings to the Intern. J. Comput.-Support. Collab. Learn (2016) 11:255–262 DOI 10.1007/s11412-016-9242-6

Crisis management in law enforcement contexts is considered to be a kind of Naturalistic Decision-making (NDM). In a NDM situation, crisis management personnel usually have to tackle highly fluid situations under great stress and uncertainty. It has been observed that a major challenge to the effective handling of crisis situations is the tendency for the personnel involved to ignore alternatives and make irrational decisions that, a phenomenon that the psychologist Janis (1972) refers to as Groupthink. This paper reports on the design of an online Role Play Simulation (RPS) for crisis management training and its implementation in in-service police training. The interactions of participants recorded during the RPS training were categorized using Bales' Interaction Process Analysis (IPA). The results show that participation in the RPS has positive effect on the reduction of Groupthink tendency.

Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug-resistant (MDR) infections. Experience in solid organ transplant is limited. We describe BT in 3 lung transplant recipients (LTR) with life-threatening MDR infections caused by Pseudomonas aeruginosa (n=2) and Burkholderia dolosa (n=1). For each patient, lytic bacteriophages were selected against their bacterial isolates. BT was administered for variable durations under emergency Investigational New Drug applications and with patient informed consent. Safety was assessed using clinical/laboratory parameters and observed clinical improvements described, as appropriate. All patients received concurrent antibiotics. Two ventilator-dependent LTR with large airway complications and refractory MDR P.aeruginosa pneumonia received BT. Both responded clinically and were discharged from the hospital off ventilator support. A third patient had recurrent B. dolosa infection following transplant. Following BT initiation, consolidative opacities improved and ventilator weaning was begun. However, infection relapsed on BT and the patient died. No BT-related adverse events were identified in the 3 cases. BT was well tolerated and associated with clinical improvement in LTRs with MDR bacterial infection not responsive to antibiotics alone. BT may be a viable adjunct to antibiotics for patients with MDR infections.

Pedagogy is at the heart of teaching and learning. Preparing young people to meet new contemporary challenges means to review and update the pedagogies teachers use. However, despite the increased reporting of teachers and schools that are innovating, schools remain largely seen as very resistant places for innovation. To address the importance and challenges of implementing new pedagogies, this paper brings together leading experts to reflect on key areas of pedagogy. In particular, each chapter addresses a pedagogical dimension that together offers a conceptual framework for action. This framework moves beyond a fragmented focus on specific innovations. In doing so, it helps explain how innovative pedagogies may be developed, applied and scaled. Amelia Peterson’s first contribution shows how fundamental purpose is to pedagogy, while Hanna Dumont’s section explores adaptive teaching as a cross-cutting concept over a range of different pedagogical approaches. Then the paper moves to discuss the importance of understanding pedagogies as combinations, which Amelia Peterson defines as two layers: one combining discrete teaching practices and another that combines approaches to meet long-term educational goals. Marc Lafuente looks first at content domains (mathematics, non-native languages, and socio-emotional learning) and how they relate to pedagogies. He then contributes to the thinking on “new learners” and technology, as important context influencing pedagogical choices and implementation. The final section by Nancy Law is focused on change, through the particular prism of technology-enhanced pedagogical innovations. Her analysis moves towards a theory of change that takes account of the need for alignment at the different levels of the educational system.

To learn in our knowledge-oriented society often involves a deep engagement with knowledge artifacts—objects that combine material and semiotic aspects. This is particularly true in CSCL contexts. Knowledge can be formed and shared in different ways and within different formats. Through advances in computer-supported collaborative learning technologies and pedagogies, we can create, shape and present knowledge in new ways. Intersubjective meanings can be developed and shared as virtual and/or physical artifacts. The nature of the collaboratively formed knowledge artifacts create specific opportunities for students or community participants to engage in certain types of interaction, both with the artifacts themselves and through them in collaborative efforts with peers, teachers and other actors. One way to express how knowing can be materially mediated is to state how the relationship between a conceptual structure and its material anchors creates special conditions for participant interaction and learning (Hutchins 2005). Focus on the interpenetration of semantics and materiality is at the heart of the CSCL community’s mission. We need to understand and explain how participants can become deeply engaged with mixes of conceptual and physical structures in their activities. In this issue of ijCSCL, these matters are addressed from the perspectives of several different theoretical frameworks. We introduce these articles by raising some overall themes about the formation of new knowledge artifacts in collaborative contexts. Artifacts have been conceptualized within the CSCL community from cognitive, sociocognitive and socio-cultural stances. The term artifacts is often substituted with tools or

The papers in this issue present innovative approaches to analyzing the roles of individuals in small-group collaborations supported by computer technologies. In reading these articles, you may find it interesting to consider the ways in which their methods conceptualize the relationship of collaborative group learning to the roles of its individual participants. Taken together, these studies envision and explore a space of possible strategies for analyzing the multi-level phenomena of collaborative learning, sometimes coding utterances of individuals and at other times characterizing group trajectories. They each push the boundaries of CSCL research in various ways. Although they can be read as primarily proposing analytic procedures, they also contribute to theory and technology. Perhaps highlighting their nuanced stances on the issue of unit-of-analysis in probing learning data can help to reveal their contributions to the advance of CSCL as a vision and as a field. It is often difficult to determine where overall progress is being made in CSCL research and practice. Statistical indicators in comparative reviews tend to be overwhelmed by the diversity of theories and methodologies applied in research and by the variety of pedagogies adopted in practice. In both researcher and teacher communities, there are new participants entering with training in traditional disciplines as well as long-time participants still working within old paradigms. Folk theories derived from common sense linger on and may obscure the visibility of innovations in scientific theory, methodology or pedagogy. Folk theories of minds and learning still influence classroom practice. According to Bruner (1996) and Bereiter (2002), teachers’ pedagogy is often deeply affected by everyday intuitive Intern. J. Comput.-Support. Collab. Learn. (2014) 9:365–370 DOI 10.1007/s11412-014-9204-9

The dialogical perspective provides an important theoretical framework for CSCL. The strain of this approach most influential in CSCL arose in the throes of the Russian revolution. In the social and intellectual ferment of revolutionary Russia—during the decades preceding and following 1917—groups turned to the theories of Marx (1867/1976) not only to leave behind feudal relationships, but also to leap over the capitalist stage of economic development. While the official soviet philosophy developed a dogmatic version of Marxism-Leninism and even Stalinism, theoreticians like Vygotsky (1930/1978) and Bakhtin (1986) remained true to the social impetus of Marx’ thought. They provided social, developmental, dialectical approaches to psychology (Vygotsky, 1934/1986) and linguistics (Voloshinov, 1973) that complemented Marx’ revolutionary philosophy, history, economics and politics. In particular, these two authors—and the circles of researchers around them—pioneered dialogical outlooks that overcame the ideology of individualism, which is associated with capitalist culture. Philosophies propounded in the early days of the bourgeois era, like reflections by Descartes (1633/1999) of an isolated mind or the social contract among individual citizens postulated by Rousseau (1762) led to views in which (i) minds are possessions of individuals and (ii) communications are exchanges between individuals. Vygotsky countered the first of these views (i) by demonstrating how the higher psychological faculties of human cognition develop historically and evolve culturally through discourse and labor by groups of people; the mind is not innate to isolated individuals, but is an evolving composite of skills and practices developed through social interaction. Bakhtin opposed the second view (ii) by analyzing the dialogical character of communication; ideas are not first produced in self-contained individual minds, but emerge from multi-vocal discourse, whether in conversation, in self-talk or in novels. This is a developmental outlook, which views the nature of things as the result of their history— propounded by philosophers like Hegel, Nietzsche, Wittgenstein and Heidegger as well as scientists like Darwin, Marx and Freud. For both of the Russian researchers, language—a thoroughly social product and essential mediator of cognition—is the focal phenomenon. According to Vygotsky, thinking is a mediated and internalized form of self-talk, a dialog with oneself. In Bakhtin's writings, the cultural and historical forms of language speak through us: The voices of countless social groups are sedimented in the words, phrases and genres of our speech. For an individual to “have an idea” is for meanings which have previously been incorporated in a community's language to be brought together in a multi-vocal and dialogical interaction. Although an adult can formulate new meaning, develop an idea or elaborate an argument as an individual achievement, such abilities are originally learned in small groups or dyads. Even as an individual act, the

Background Early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) remain the most important factor to reduce mortality. Diagnosis remains a challenge, however, due to unspecific clinical presentation and radiological findings. Only very recently rapid tests for IPA have been developed. The objective of this study was to evaluate the performance of the new CE-marked Aspergillus Galactomannan Lateral Flow Assay (LFA; IMMY, Oklahoma, USA; figure) for IPA in patients with and without hematological malignancies. Methods The Aspergillus Galactomannan LFA was retrospectively performed according to the manufacturer’s instructions in 106 previously frozen bronchoalveolar lavage fluid (BAL) samples from 106 patients at risk for IPA (23% with underlying hematological malignancies). Samples were collected between September 2016 and September 2018 at the University of California, San Diego. Performance of the LFA was compared with Galactomannan, BAL culture and the Aspergillus-specific LFD (another rapid test for IPA). IPA was classified according to revised EORTC/MSG criteria. Results Overall, 22 patients met criteria of probable or proven IPA, 9 possible IPA, while 75 patients did not fulfill criteria of IPA. Sensitivity of the Apergilllus Galactomanann LFA for probable/proven IPA was 77% (17/22). Sensitivity was similar to BAL GM (77% with a cutoff of 1.0 ODI), but higher compared with the Aspergillus-specific LFD (59%), and BAL culture (23%). The LFA resulted negative in 7/9 cases with possible IPA and 47/73 cases without IPA (overall specificity 66%, 54/82). The less than perfect specificity was driven particularly by non-neutropenic patients (specificity 62%, 43/69), while specificity was 85% among patients with underlying hematological malignancies. Lower specificity among non-neutropenic patients was also observed for the BAL GM (overall 77%, non-neutropenic patients 72%), the Aspergillus-specific LFD (overall 70%, non-neutropenic patients 67%) and BAL culture (overall 90%, non-neutropenic 88%). Conclusion Our study indicates that the LFA may be useful for rapid diagnosis of IPA in BALF when IPA is clinically suspected. The lower specificity in non-neutropenic patients may be explained by limited applicability of the EORTC/MSG criteria in those patients. Disclosures All authors: No reported disclosures.

This year’s International Conference of the Learning Sciences (www.isls.org/icls2014) will feature the theme of “practices encompassing the range of contexts and processes in which people learn.” In this first issue of 2014 of ijCSCL, we present four explorations of that theme. We begin with a consideration of Activity Theory as a framework for analyzing the systemic contexts of CSCL practices. This is followed by detailed qualitative and quantitative analyses of knowledge building across the age spectrum of schooling: from primary school (4th and 5th grade) to tertiary school (first year college). Finally, the collaborative construction of knowledge is studied at the global level of adults posting to Wikipedia. In preparation for last year’s CSCL conference, a series of editorial introductions to ijCSCL raised the issue of the interrelationships among individual, small-group, and community learning (Stahl 2012, 2013a, b). It is interesting to read the articles in this new issue as in part investigations of such interrelationships. The notion that “interactional resources” such as geometric objects in mathematical problem solving can be seen to be bridging levels of analysis was recently elaborated in (Oner 2013; Stahl 2013c, esp. Ch. 6; Zemel and Koschmann 2013). This notion of resources plays a theoretical role similar to that of artifacts in Activity Theory and appears, for instance, in the scaffolds of epistemic games, the notes of knowledge-building forums and the pivotal-knowledge postings of Wikipedia in the papers of the current issue. Intern. J. Comput.-Support. Collab. Learn. (2014) 9:1–6 DOI 10.1007/s11412-014-9189-4

This journal promised 6 years ago to publish studies on what it termed “CSCL and its flash themes” (Stahl 2007). Rather than devoting single issues to specific topics of timely prominence, we decided to welcome submissions about selected emerging themes of CSCL research on an on-going basis. Accordingly, we set aflame again in the current issue discussion of the topics of argumentation, scripting, and tabletop interfaces. These three areas of computer support for collaborative learning continue to be active foci of CSCL research. To begin the issue, we spark a new theme with a paper on the use of eye-tracking technology to support and to research collaboration, an approach that has not previously been discussed in this journal but has been gathering attention at the ISLS conferences recently. It is noteworthy that research in these flash themes is still not merely a matter of refining the details of well-established findings, but continues to raise fundamental and controversial theoretical and methodological issues from a CSCL perspective. In introducing their study of gaze perception among dyads of students, Bertrand Schneider and Roy Pea begin with an extended discussion of joint attention. As they document, joint attention is foundational to collaborative interaction and, indeed, to human sociality. From infancy on, people learn to take advantage of different forms and media of joint attention to make intersubjective sense. Any mode of intentionality (whether individual, group, or collective) involves an orientation to some subject matter; communication accordingly requires a coordinated orientation to a shared object, with the understanding that this orientation is shared and with a shared sense of the object’s meaning. For two people to solve a problem together—e.g., in a CSCL setting like answering questions about diagrams—the participants must take (or enact) the problem as the same problem and they must see (and describe) the object as the same object (Stahl 2013, Chapter 8; Zemel and Koschmann 2013). This requirement of successful collaboration is complex, multi-modal, subtle, and learned over a lifetime. It involves discourse, gesture, gaze, cognition, social skills, Computer-Supported Collaborative Learning DOI 10.1007/s11412-013-9185-0

The Editors are pleased to announce that the International Journal of Computer-Supported Collaborative Learning was again highly ranked by ISI’s annual “Impact Factor” report released several days ago. IjCSCL ranks #11 of the 203 journals ranked by ISI in the field of Education and Educational Research and it ranks #6 of the 83 journals ranked by ISI in the field of Information Science & Library Science. IjCSCL is the #1 journal published by Springer and ranked by ISI in each of these categories. IjCSCL has an impact factor of 2.243 for last year and a 5-year impact factor of 3.000. The impact factor for 2011 is the number of citations of the journal’s 2009 and 2010 articles cited during 2011 in ISI-ranked journals, divided by the number of the journal’s 2009 and 2010 articles. That is, articles printed in ijCSCL during 2009 or 2010 were cited in ISIranked journals on average 21⁄4 times during 2011. The ISI impact factor (published annually by the Institute for Scientific Information at Thomson Reuters) is widely considered the most important ranking of academic journals. In many universities, it is considered in evaluating authors for tenure and promotion. IjCSCL supports an international research community. It receives submissions from 53 countries. About 7,000 universities and research institutions around the world subscribe to it, making its content available to millions of people through the Springer website. We also maintain the ijCSCL.org website with the full text of all articles freely available to the whole world; there have been two million hits to this site so far. Several thousand articles are downloaded every month from the Springer.com and ijCSCL.org websites. This indicates that ijCSCL continues to be read and cited by many researchers in the active computer-supported collaborative learning Computer-Supported Collaborative Learning (2012) 7:341–345 DOI 10.1007/s11412-012-9155-y

This paper aims to study the relationship between questioning and the quality of knowledge constructed in a CSCL context. In previous studies, different units of analysis are employed and the patterns of relationships are not consistent for different age groups. The analytic units of a thread, an individual, and a group are employed in this study, and two grades of students (grade 6 and grade 10) are investigated. At the thread level, we aim to examine to what extent questioning can be a mechanism for knowledge advancement, and we find that the tenth-graders are capable to advance knowledge through questioning, while for the sixth-graders, more facilitation seems to be needed. At the individual level, we find that for the sixth-graders, those asking good questions are likely to express high-level explanations, suggesting that individual competence plays an important role in advancing knowledge among these younger students. For the tenth-graders, a “division of labor” is observed that good questions are generated by some students while high-level explanations by others. At the group level, a high and positive correlation is found for both grades. The findings suggest further research is needed to examine other possible mechanisms for knowledge advancement in online collaborative discourse.