教師の成長に関する一考察 \\n―奈良女子大学附属小学校の教師の姿に学ぶ―

要約\n　奈良女子大学附属小学校（以下奈良女付属小）の教育は，「奈良の学習法」として，\n日本の教育界に大きな学びの場を提供し続けている。その背景には，大正自由教育で\n活躍した木下竹次の『学習原論』１に学び，「成長し続ける」教師の存在があるのでは\nないかと考えた。\n奈良女付属小の教師がなぜ成長し続けているのか。代表的な教師の実践を，昨年度\nに引き続き，さらに掘り下げ，木下竹次の教師論と比較，考察しながら「奈良女付属\n小を学ぶ」意義を考えた

Changes in Quality of Life in Older Hemodialysis Patients: A Cohort Study on Dialysis Outcomes and Practice Patterns

Background: Despite improvements in dialysis treatment, mortality rates remain high, especially among older hemodialysis patients. Quality of life (QOL) among hemodialysis patients is strongly associated with higher risk of death. This study aimed to describe the health-related QOL and its change in older maintenance hemodialysis patients and to demonstrate characteristics associated with health-related QOL. Methods: Data on 892 maintenance hemodialysis patients aged 60 years or older who were surveyed using the Kidney Disease Quality of Life Short Form at baseline and 2 years after study enrollment in phases 4 (2009–2011) and 5 (2012–2014) of the Japanese Dialysis Outcomes and Practice Patterns Study were analyzed. We categorized participants into 3 age groups (60–69, 70–79, and ≥80 years) and described baseline physical component summary (PCS) and mental component summary (MCS) scores, as well as their distribution of changes after 2 years across each category. Results: Hemodialysis patients aged 70–79 years and ≥80 years had lower PCS scores than those aged 60–69 years (median: 70–79 years = 43.1; interquartile range [IQR], 35.2–49.4; ≥80 years = 38.8; IQR, 31.6–43.8; 60–69 years = 45.4; IQR, 37.5–51.4; p < 0.001). In contrast, MCS scores did not significantly differ by age category (70–79 years = 45.6; IQR, 38.4–53.7; ≥80 years = 45.4; IQR, 36.9–55.1; 60–69 years = 46.8; IQR, 39.5–55.7; p = 0.1). As dialysis vintage lengthened, the PCS score significantly became lower, whereas no association was found with change in the MCS score. The MCS score declined over time in older patients, especially among those aged 80 years and older after 2 years’ follow-up. Conclusions: Physical QOL became worse as dialysis vintage lengthened. In contrast, mental QOL declined over time within a relatively short period among older maintenance hemodialysis patients

Biological Dose Evaluation Of Radiotherapy By Equivalent Dose In 2Gy Fractions (EQD2) In Recurrent Glioblastoma.

The standard treatment for glioblastoma is surgery followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy. A total dose of 60 Gy given in 2 Gy fractions (fr) with concurrent and adjuvant TMZ has been recommended; however, local recurrences are frequent and the prognosis remains very poor. In this study, the equivalent dose in 2Gy fr (EQD2) at the recurrent site of glioblastoma was assessed to evaluate the biological effect of RT on glioblastoma considering that α/β ratios might vary from 1 to 10 Gy. Recurrences were found in gross tumor volume (GTV) areas in all 11 patients, and 8 of them also showed recurrence in clinical target volume (CTV). Differences in EQD2 according to α/β ratios were relatively small in high-dose areas around 60 Gy; however, low-dose areas often showed significant differences of EQD2 according to the α/β ratios. In patients that received 60 Gy in 2 Gy fr, EQD2 was less than the original physical dose and became smaller as the α/β ratio became smaller. The comparison of the dose distribution of EQD2 and dose volume histogram (DVH) of EQD2 between α/β ratios 1 and 10 suggested that little difference was found in relatively high-dose areas but a significant difference was found in low-dose areas. In contrast, if the fraction size was larger than 2 Gy, EQD2 was greater than the original physical dose and it became larger as the α/β ratio became smaller. In conclusion, this study showed that the standard RT 60 Gy in 2 Gy fr is insufficient for glioblastoma, and it suggested that biological effects might differ significantly according to each fraction size of radiation and α/β ratio of the linear quadratic (LQ) model

中枢神経系原発悪性リンパ腫の放射線治療個別化の妥当性と有用性：画像評価を用いた治療効果に基づく放射線治療計画

Background: To assess the feasibility and efficacy of individualized treatment selection in radiation therapy (RT) for primary central nervous system lymphoma (PCNSL) according to treatment response by radiographic assessment. Methods: The details of recurrence and change in performance status (PS) were assessed in 31 patients with histologically confirmed PCNSL treated between 2000 and 2016. During the treatment period, radiographic assessment was conducted, and RT planning (RTP) was determined individually by treatment response. Results: At a median follow-up of 28.2 months, 9 patients were alive and 7 of whom were relapse-free. Two-year overall survival (OS) and progression-free survival (PFS) rates were 69.3% and 52.7%, with median survival times (MSTs) of 36.5 months and 24.4 months, respectively. Two-year local recurrence rate was 40.5% and the median time to local recurrence from treatment initiation was 27.9 months. All patients were scheduled to receive whole-brain RT (WBRT) and subsequent partial-brain RT(PBRT), with a median total dose to the tumor bed of 46 Gy and median WBRT dose of 30 Gy. Eight patients received reduced-dose WBRT (rd-WBRT) (<30 GY), and 13 patients who could not achive a complete response (CR) during the RT period received additional boost radiation after WBRT and PBRT, with a median dose of 6 Gy. Over 70% of local recurrence occurred within areas in which only WBRT was conducted (median dose of 30.3 Gy). Two-year occurrence rate of neurotoxicity over grade 2 was 49.5%. PS at 24 months after RT was maintained in 12 patIents. Conclusions: lndividual RTP using radiographic assessment led to reasonable survival and disease control rates with mild treatment-related toxicity. For patients not receiving chemotherapy or lacking a CR after chemotherapy and WBRT, WBRT followed by PBRT and additional boost radiation for poor RT responders might be effective. However, even for patients with CR after chemotherapy, a WBRT dose of 30 Gy or higher might be necessary for local control.博士（医学）・甲第705号・平成31年3月15

学習を通した児童理解における教師の視点を探る : 奈良女子大学附属小学校の実践から

奈良女子大学附属小学校（以下，奈良女附属小）の教育は，大正期新教育運動の指導理念である児童中心主義に基づいた教育であり，大正期新教育運動の中心的人物であった木下竹次（以下，木下）の『学習原論』1　に学び，児童理解の確かな方法論を持つ教師達の存在がある。これまでの研究（「書くことによる児童理解」2　以下「前稿」とする）で，奈良女附属小の教師達の優れた児童理解は，「日記指導」や自由研究などの「書くこと」を奨励し，その内容を日々丹念に読み解く指導を中心とした教師の労作業，確かな方法論に基づいているということを教師の実践事例より考察した。奈良女附属小の「児童理解」の中核に「書くこと」を中心にした実践があるということを，代表的な教師の事例で確かめることが出来たことから，今回の研究では，奈良女附属小の教師達の学習・児童理解の視点がどこにあるのか，前稿で探った「児童理解」に加え，大正期以来発行し続けている「学習研究」や保護者に出されている「学年便り」などの中に現れている教師の視点を実践事例から探ってみた。そこから，日記指導や自由研究，ノート指導など児童に「書くこと」を推進しながら，その内容を読み解く学習・児童理解の幾つかの視点，例えば，教師と子どもの思考のずれを意識することや，経験や観察を詳しく説明させたり書かせたり，楽しく取り組ませることを重視することなどが浮かび上がってきた。そして，それは，いわゆる単純な児童理解の枠を超え，「学び」に取り組む児童自身を教師がどう理解しているかという学習の視点であることも分かってきた。研究ノー

成長し続ける奈良女子大学附属小学校の教師達

奈良女子大学付属小学校には，大正期自由教育，児童中心主義の教育が今に生き生きと受け継がれ，「確かな学び」の道を子どもたちに示し，そして，その学びを支えている素晴らしい「教師」の存在がある。その教師に着目した研究をすることは，最大の教育環境としての教師自身の成長を促すことになる。今回は，奈良女子大学付属小学校の代表的な教員2名の実践を事例研究として取り上げ，教師の成長が子どもの成長と密接に関わっていることを考察した。In this elementary school, “free education” from the Taisho period and children-centered education have been inherited and kept fresh to this day. Children are cultivated a firm foundation of learning. In addition, there are great “teachers” who support that learning. As teachers, doing research that focus on those “teachers” would advance the growth of ourselves, who are the most important element in an educational environment. Through education and practice of two teachers, it was found that the growth of children is closely linked to the growth of teachers