特別支援学校（病弱）高等部における発達障害のある生徒と社会をつなぐ学校システムの在り方

内容の要約広島大学(Hiroshima University)博士(教育学)Doctor of Philosophy in Educationdoctora

発達障害のある人に対する就労移行支援に関する事例的考察 : A事業所におけるエスノグラフィーに基づく分析

本研究は、就労移行支援事業所を利用する発達障害のある人を企業へ橋渡しするための方法を具体的に明らかにすることを目的とした。A 事業所においてエスノグラフィックな手法を用いた調査を行った結果、発達障害のある人と企業をつなぐ移行支援の実践は、訓練と振り返りの反復による発達障害のある人の自己理解と、支援者による特性理解の深化のプロセスであることが明らかになった。A 事業所では日々の座学や作業、実習などの訓練と、面談による訓練の振り返りが反復的に行われる中で、スタッフによる特性理解と利用者による自己理解を深めることにつながるシステムが構築されていた。また、実践の中で特に重視されていたのは、ストレングス視点に基づき、職場において生かされる長所と捉えることのできる強みを見出すことであり、苦手な部分を補うだけでなく、強みを生かして就労につなげていくことが目指されていた。強みを見出す方法として、様々な訓練によるスキルの習得、情報収集、振り返り、リフレーミング、対話の５つが繰り返し行われる中で、特性が就労に生かせる強みとして共有されていた。This study aimed to explore specific ways of connecting people living with developmental disabilities (PLWDD) to companies by using a work transition support provider. As a result of conducting an ethnographic study at center A, it became clear that the implementation of work transition support that connects companies and PLWDD is a process of deepening the self-understanding of PLWDD through repeated training and reflection, and of deepening supporters’ understanding of this cohort’s characteristics. At center A, through a process of repeated training including daily classroom lectures, work, and practical training, supplemented by a review of training through interviews, a system was built that would deepen the staff’s understanding of PLWDD characteristics, and the cohort’s self-understanding. Further, what was particularly emphasized as part of the implementation was to find strengths, based on the strength perspective, which can be regarded as advantages to be utilized in the workplace. The aim was not only to compensate for weaknesses but also to make use of the strengths to lead to employment. Strengths were identified through repetition of the five methods, namely, acquiring skills, information gathering, reflection, reframing, and dialog, and characteristics were shared as strengths that could be used in employment.本論文は、第一著者が令和２年度、広島大学大学院教育学研究科に提出した博士学位論文の一部を再分析し、大幅に加筆修正したものである

Issues and Practices of Career Guidance for Students Who Have Developmental Disorders at Special Schools

This study aims to clarify the structure of the process and issues surrounding career guidance for students with developmental disorders, who are learning through a high school equivalent curriculum at upper secondary divisions of special schools for students with health impairments. Semi-structured interviews involving seven teachers from upper secondary divisions of special schools were conducted to collect data for qualitative data analysis. Consequently, three categories of issues that affect students’ career decisions were identified: student issues, school system issues, and family and social resources issues. In addition, three categories for practices were generated: guidance policies, guidance and support for realizing their career paths, and building and maintaining connections with local communities. One category for achievement points after graduation was also generated: career paths of upper secondary divisions graduates. Based on these results, this study concluded that the characteristic issues are effects of school refusal, maladaptation on career learning, and the narrowing of career choices due to lack of support from family. Moreover, maintaining a receptive approach and connections that were established during school also identified as characteristic practices

家族介護者の介護負担を客観化する

特別寄稿Special Articles　1965 年から訪問看護に携わってきた。在宅療養は家族の介護によって支えられる場合がほとんどであり、この家族の介護負担を軽減する施策が必要だと考え、介護負担を客観化するために、生活時間調査を行った。生活時間調査は療養者の生活行動と同時に、家族介護者の介護と生活行動の所要時間を調査し、家族介護者が介護の時間を捻出するために、自身の生理的な生活時間まで割いていることを客観的に示した。さらに、介護に携わっていない家族も加えた、それぞれの人生の時間の流れを一覧の図に作成し、その影響を示した。家族介護者の生活時間調査の結果は、スモン裁判や予防接種裁判の証拠としても用いられ、それぞれの裁判において、家族介護者の負担を証明することに成功した

「看護の将来を考える会」の活動報告

紀要委員会企画Special Articles　看護をとりまく環境の激的な変化に関する情報を得て、看護学部教員の有志が領域を超えて看護の将来について自由に語り合う場として、2017 年12 月から「看護の将来を考える会」の活動を開始した。毎月開催し、2018 年12 月で第11 回を数え、延べ115 人が参加した。活動実績と成果について「看護の将来考える会」の世話人として報告する

保健師教育課程の教育評価 : コロナ禍における遠隔（Web）ツールを活用した公衆衛生看護学実習プログラムの実践

報告Reports　世界的パンデミックを引き起こしている新型コロナウイルス感染症の感染拡大により、本学では、本来学生が実習地に赴き、地域住民との関わりの中で修得している保健師の実践力を、従来の自治体などに赴く実習（以下、臨地実習）から「学内実習」によって獲得させるための実習プログラムに急遽修正する事が求められた。　今回の公衆衛生看護学実習では、保健師に求められる実践力と卒業時の到達目標と到達度が獲得できるよう、新たに遠隔（Web）ツールを活用した実習プログラムを開発し実施したので、その取り組み内容の報告及び今後の課題と展望について考察する

特定行為研修における３年間の取り組み

紀要委員会企画Special Articles　2018 年に本学は看護師特定行為研修指定研修機関に指定され、2019 年から研修を開始した。３年間の研修で 14 名の研修生が、総合病院や訪問看護事業所等において適切な医療を提供するために、特定行為を実施する看護師を目指し、指定の講義・演習・実習を履修した。　本報告では、特定行為実施が望まれる社会的背景、医療現場で求められる特定行為、看護師が行う特定行為の意味、そして特定行為研修の今後の発展等について述べる

DOCK2 is involved in the host genetics and biology of severe COVID-19

「コロナ制圧タスクフォース」COVID-19疾患感受性遺伝子DOCK2の重症化機序を解明 --アジア最大のバイオレポジトリーでCOVID-19の治療標的を発見--. 京都大学プレスリリース. 2022-08-10.Identifying the host genetic factors underlying severe COVID-19 is an emerging challenge. Here we conducted a genome-wide association study (GWAS) involving 2, 393 cases of COVID-19 in a cohort of Japanese individuals collected during the initial waves of the pandemic, with 3, 289 unaffected controls. We identified a variant on chromosome 5 at 5q35 (rs60200309-A), close to the dedicator of cytokinesis 2 gene (DOCK2), which was associated with severe COVID-19 in patients less than 65 years of age. This risk allele was prevalent in East Asian individuals but rare in Europeans, highlighting the value of genome-wide association studies in non-European populations. RNA-sequencing analysis of 473 bulk peripheral blood samples identified decreased expression of DOCK2 associated with the risk allele in these younger patients. DOCK2 expression was suppressed in patients with severe cases of COVID-19. Single-cell RNA-sequencing analysis (n = 61 individuals) identified cell-type-specific downregulation of DOCK2 and a COVID-19-specific decreasing effect of the risk allele on DOCK2 expression in non-classical monocytes. Immunohistochemistry of lung specimens from patients with severe COVID-19 pneumonia showed suppressed DOCK2 expression. Moreover, inhibition of DOCK2 function with CPYPP increased the severity of pneumonia in a Syrian hamster model of SARS-CoV-2 infection, characterized by weight loss, lung oedema, enhanced viral loads, impaired macrophage recruitment and dysregulated type I interferon responses. We conclude that DOCK2 has an important role in the host immune response to SARS-CoV-2 infection and the development of severe COVID-19, and could be further explored as a potential biomarker and/or therapeutic target

The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force

「コロナ制圧タスクフォース」COVID-19患者由来の血液細胞における遺伝子発現の網羅的解析 --重症度に応じた遺伝子発現の変化には、ヒトゲノム配列の個人差が影響する--. 京都大学プレスリリース. 2022-08-23.Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection