Tag Archive for: Covid

How Can Educators Adapt to Distance Learning During a Public Health Crisis?

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Our education system is in a vulnerable state as we continue to battle COVID-19. Many questions are being asked in preparation for the upcoming school year. Is it too soon or even safe to reopen? Is virtual education best for students? There is also an underlying issue of preexisting disparities in education, such as the need for resources like basic learning tools. Educators must consider disparities that also extend into their student’s home life, such as lack of food and the responsibilities of caring for siblings because their parents have multiple jobs.

Teachers across the United States, including Virginia–my home state– are struggling with adapting to virtual teaching in addition to the challenges of preexisting disparities that affect the community of learning.  Loren and Nicole (names changed for discretion purposes), two Virginia educators express their views on the decisions made in their districts for reopening. They share with us their current challenges and their plan of action to prepare for an effective school year. This will require collective effort between teacher, parent, and student as they learn to adapt to the changing landscape of education in the age of the Coronavirus.

The VA District’s Decision

Public health is of the highest concern forcing policy makers to make many considerations regarding the pandemic and reopening of schools. Key federal government officials insist on schools reopening in fall despite the possibility of viral transmission.

Loren, a 24-year-old Special Education teacher stated, “Decisions for the reopening of the school have been heavily influenced by politics such as federal funding and the opinions from state governments on the reopening of school.” Nicole, an educator in mathematics of 39 years stated, “The governor has pretty much left it up to the schools to follow the guidelines that are outlined by the CDC and local health organizations as to whether we reopen schools or what not.”

When asked if educators in their Virginia school district were allowed input in the reopening, they both expressed there was some say in the decision making but ultimately the final decision was left to the school board. In Nicole’s district, surveys for reopening were distributed to parents and educators in June, July, and August to determine if in-person or virtual would be the best practice.  The final decisions were partly determined by the influx of COVID cases in their surrounding communities. The decision for both Nicole and Loren’s district settled on virtual learning.

As Loren and Nicole proceed in the virtual learning direction, their learning communities still have disparities to overcome. These existed pre-COVID era such as minimal resources and little to no experience with online education.

Underlying Conditions

In March, virtual learning was abruptly enforced on students and educators with little to no experience in this method. Prior to COVID, there has been an existing issue regarding the resources to execute work. This includes basic tools like pencils, textbooks, and internet connection. This extends outside of school needs and into the needs of the home as well.

Nicole says, “Thinking about my class, some kids had attendance issues. Some had issues with doing work although they came to school every day. So, lack of motivation for some students.”

Additionally, she brought attention to the challenges that exist in the home such as parental support. “Getting parents to attend conferences to discuss ways to help their child is already tough. So, you can only imagine how the situation will be during virtual.” For some students, outside responsibilities are priorities over their education like the need to tend to siblings in the home. Nicole also stated, “Some other issues were kids not having food or places to stay–shuffling from one family member to the next. Even cases of child neglect or abuse”. These issues take away from the child’s motivation which she noticed in their class participation.

In Loren’s case, parental support is also an issue for her students.  Her concern is if this will be any different virtually. Teaching students with learning disabilities requires a bit of extra attention. Since school will be completely virtual, these students will require the additional assistance from their parents and teachers.

The new direction of virtual education layered with inequitable conditions must be reflected upon. To ensure positive changes are made, educators, parents, and students will need to be equipped with the readiness tools for an effective and engaging school year. How will educators engage and empower students who will now be learning in an unfavorable environment? How can educators cultivate productivity throughout the day?

Tools for Readiness

We can’t move forward with virtual learning if our educators and students are unequipped with stable internet, virtual education training, and the basic tools needed to work.

Since there will be an increase in internet use in the home, the system needs to be stable to handle Zoom or the use of other online platforms. In March, Nicole’s school provided hotspots which were to be returned at the end of the school year. Pre-COVID each student was supplied with Chromebooks.

Virtual Education training is what will teach and empower educators and parents to be competent and successful in virtual learning strategies. Nicole mentioned that her school has been offering training on a learning management system called Canvas which merges assignments to be accessible from one location for easier use. Other outlets offer free resources for educators and students like webinars. Microsoft offers an online teaching guide to prepare educators from Pre-K to PhD with tools for online education. This is a full guide providing tips on making the virtual transition, maintaining engagement with students, and advice on enhancing the social experience for students and their families.

Creativity is needed to spark engagement. For many districts including Nicole and Loren’s, Zoom is being used to conduct the majority of classes. For educators that want a more hands on creative approach, they prefer the use of white boards or chalk boards. These can be mounted on the wall for use during the lesson or prerecorded then discussed during the session.

Creating a conducive work space is important for productivity and maintaining balance between work and life in the home. Educators, parents, and students can all benefit from tools that’ll empower them to minimize stress.

1. Pick the most quiet and productive area in the home for the school day.

  • Minimize distractions by only having the laptop in sight

2. Maintain an organized workspace.

  • Utilize binders and pencil pouches to keep the work area tidy.

3. Keep a bottle of water and a snack nearby.

  • Granola bars, trail mix, even fruit snacks are non-messy treats that’ll help keep you energized.

School districts are determining ways for families to receive resources like childcare and food. For students that need breakfast and lunch provided, Nicole’s district offers Meals-to-Go services at various locations for students to pick up. Parents can contact the school board to determine additional food options for their children. Nicole also stated that some schools may open to allow students that need supervision during the day. Unfortunately, many of Nicole’s students are considered lower income and face challenges that are only intensified by COVID restrictions.

As schools begin to reopen, we will uncover more concerns sparked by the virus. We will continue to learn how to overcome existing disparities among students and educators, and determine if virtual education training and suggested tools are benefiting educators. For vulnerable populations, COVID has only exacerbated existing issues making it more difficult to get through virtual learning. We cannot ignore these issues and hope for students’ success virtually. This change is a collective effort from school boards, educators, parents, and the entire community. We will power through this challenging time of learning to adapt to life during the pandemic that continues to reshape our education system.

Ask Your Doctor About These Essential Genetic Tests for CLL

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Ask Your Doctor About These Essential Genetic Tests for CLL from Patient Empowerment Network on Vimeo.

Genetic testing results can impact a chronic lymphocytic leukemia (CLL) patient’s treatment options and provide a deeper understanding into their disease. Dr. Steven Coutre, a CLL specialist, reviews essential tests and explains their role in CLL care.

Dr. Steven Coutre is a Professor of Medicine in the Hematology Department at Stanford University Medical Center. Learn more about this expert here.

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Transcript:

Dr. Steven Coutre:

In terms of testing for CLL, additional testing, of course, diagnostically, it’s generally not a challenge. It’s very straight-forward. A test that we call Flow Cytometry on a blood sample is usually sufficient to establish the diagnosis. Very, very uncommonly would a bone marrow exam be needed, for example. And in routine practice, also, we don’t necessarily give CT scans to establish a diagnosis or even to, as people say, stage the disease. It really isn’t necessary in most cases.

However, we do have a staging system that correlates with the extent of the disease and that’s simply based on our exam and blood counts, but people also want more information. They wanna know how they’re gonna do, specifically. So, we can add additional tests, genetic testing as people often call it, that can further subdivide individuals into groups that give you additional information on how you might do, meaning if you’re without symptoms, and an observation is recommended, you wanna know, “Well, how long is it gonna be before I need treatment?” Although our staging system gives that information, we can refine that further.

One test is the so-called FISH test, which looks at specific chromosome abnormalities, and the second test that’s generally used is called the IGHV Mutation Assay. That’s really looking at what’s called the mutational status of your immunoglobulin genes. So, it’s really those two broad categories that are most relevant.

Now, we don’t necessarily advocate doing that testing on everyone at the time of diagnosis. Certainly, not everyone who is without symptoms, where we’ve already decided that treatment is not indicated. So, as you can imagine, you can do that testing. You might come up with a profile that’s less favorable. And then, instead of the watch and wait approach, or as folks like to call it, “watch and worry approach,” you worry even more. But then, of course, if you have a favorable profile, then you’re happier. You’re more pleased.

However, we don’t do anything differently regardless of what those tests show, at least at current state. Compared to a decision that’s already been made about treat or not treat. We do, however, strongly advocate getting that testing at the time of treatment, and sometimes, repeating some of the testing with subsequent treatment, when you require treatment, say, a second time, in some cases. So, very important to have a discussion about these tests and what information you will get from them.

Well, we’ll often see patients who are coming for another opinion about their disease. Perhaps they’ve been recently diagnosed, and they have been advised for observation, so, it’s, of course, natural to ask whether that’s a reasonable approach. And in that context, other testing often comes up in the conversation. Perhaps they had the testing done, the FISH, and the mutational testing, and they wanna know what it means, or actually we see some results that have been obtained and we ask them about it. And there’s very often confusion, or really lack of information about what they mean.

So, we really try to discuss that issue. That issue of testing with each and every patient, whether or not they’ve had it done, really trying to let them know what it means. That way they’re fully informed, and in some cases, people feel very strongly that they would like to have it done, even through they realize that we’re not gonna act on it at that point. So, I think pretty much for all patients, it should be part of the initial discussion.

Again, in terms of genetic testing are these tests that I discussed. It’s important to understand what information they give you so you understand why your physician may be making a distinction between one therapy versus another. It is very, very important to get that testing, if somebody is talking about using chemotherapy, for example, hopefully. That’s quite uncommon. But with our newer agents, we know that they work broadly despite those other features.

Nevertheless, I think it’s important for a patient to at least expect the discussion about these tests. We’re not asking you to go to your physician and ask that they be done in all cases, but really understand perhaps why your physician recommended that they not be done at that particular time. 

Advocate for These CLL Genetic Tests

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Advocate for These CLL Genetic Tests from Patient Empowerment Network on Vimeo.

Genetic testing results can influence a chronic lymphocytic leukemia (CLL) patient’s treatment options and provide a more in-depth understanding into their disease. Dr. Philip Thompson, a CLL specialist, reviews key tests that CLL patients should advocate for.

Dr. Phillip Thompson is an Assistant Professor in Medicine in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. Learn more about this expert here.

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Transcript:

Dr. Philip Thompson:

I would say that I see a lot of patients that have previously seen an oncologist closer to home and then traveled to MD Anderson for a second opinion. And so, I can say that over the last three or four years, there’s definitely a significant change in the awareness of physicians in general about doing genetic testing for CLL.

So, in particular, almost everybody will get a FISH test, which I didn’t always see three or four years ago. And more patients are now having IGHV mutation status analysis done. The thing that I see that is very rarely done, though, is what we call next-generation sequencing, or NGS, that looks for mutations in individual genes, and most importantly, in the TP-53 gene that I mentioned.

So, I would – and the other thing that often isn’t done is what we call a carrier tag, which is a routine analysis of the chromosomes of the CLL cells. And it requires some special techniques for the lab to get it to work in CLL. But that can actually provide additional information compared to just FISH.

So, I would suggest to a patient, particularly if they’re gonna do a bone marrow biopsy on you, which is an invasive procedure, that you really try to get some clarity around what tests are going to be ordered on that beforehand. And if you’ve just been diagnosed and you’ve got early-stage CLL, you can make an argument about how many of these tests are absolutely necessary to start with. Because the biggest utility in these tests is in determining what type of treatment you’re going to have.

If you’re not immediately going to have treatment, they don’t necessarily change what your oncologist is going to do. They’re going to monitor you over time and see if your disease is getting worse or not. But I still think they’re useful to have the – a lot of them are useful, particularly the IGHV mutation status and FISH are useful to have at initial diagnosis. Because they give you a really good idea of what the biology of this disease is – this patient’s disease is like and how quickly they’re likely to progress, and that may change how frequently you monitor the patient.

But anyway, I would say it’s important to ask them what genetic testing you are gonna get. And that you ask – have an understanding of what can be ordered.

 And in particular, if you’re going to get treatment, you must ask for TP-53 sequencing, FISH for 17-P deletion, and IGHV mutation status because those three things are essential to determine the optimal treatment that you have. And you shouldn’t feel shy about asking, are those things going to be done.   

What Do Genetic Tests Reveal About My CLL Treatment Options?

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What Do Genetic Tests Reveal About My CLL Treatment Options? from Patient Empowerment Network on Vimeo.

 
Genetic testing results can influence a chronic lymphocytic leukemia (CLL) patient’s treatment options and provide a more in-depth understanding into their disease. Dr. Phillip Thompson, a CLL specialist, reviews three important testing results that can impact treatment timing and approaches.
 
Dr. Phillip Thompson is an Assistant Professor in Medicine in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. Learn more about this expert here.

See More From INSIST! CLL

Related Resources

 

Advocate for These CLL Genetic Tests

  

CLL & COVID 19: What Do Patients Need to Know?

  

How to Learn More About Your CLL

Transcript:

Dr. Philip Thompson:

So, there are three main things we look at before initiating treatment in a patient.

One is what we call the IGHV mutational status of the patient. And this basically splits people into types of CLL. So-called mutated or unmutated. And this is a relatively complex concept. Basically, what happens in normal B-lymphocyte development, so B-lymphocytes are part of your immune system. Their job is they have a probe on the surface of the cell that looks for invading microorganisms. And when they find an invader, this probe binds to the organism. And then the cell actually undergoes, as part of its normal development, a process of mutation so that it makes the best possible antibody to fight that infection. So that’s a normal process that the B-lymphocyte undergoes when fighting infections.

So, CLL can arise from what we call a mature antigen-experienced mutated B-cell, or it can arise from a naive B-cell that has never gone through that process, in which case, it will have an unmutated IGHV. Now, it’s kind of counterintuitive, but the patients with a mutated IGHV generally have better outcomes. That type of CLL is less proliferative, it doesn’t grow as fast, and it also tends to respond better to certain types of treatment. Particularly, it responds better to chemotherapy than patients with unmutated IGHV.

However, the difference between those two is less important if you’re getting some of the newer therapies. Particularly, it seems like if you receive BTK inhibitors, it doesn’t really matter if you have mutated or unmutated IGHV, patients are responding very well. But I like to know whether they have a mutated or unmutated IGHV because it’s helpful for giving the patient an expectation of how their disease is likely to behave biologically.

But also, if they have a mutated they may be a candidate for chemotherapy-based treatment. Whereas if they have unmutated IGHV, I don’t use chemotherapy for those patients.

 

The second thing is a test called FISH. And FISH looks for chromosome abnormalities. So, we have 46 chromosomes, 23 from our mother and 23 from our father. They contain all of our genetic information. And in malignant diseases, you can have major abnormalities in the chromosomes of the cancer cells. Not in the rest of your body, just in the cancer cells. And they happen because of errors that are made when the cells are replicating their chromosomes.                                                                 

So, in CLL, there are four common abnormalities that we look for in a test called FISH, and they tell us a lot about the patient’s prognosis. And there’s one in particular that we look at that has a major impact on our decision making, and that’s a deletion on Chromosome 17.

So, a missing piece of Chromosome 17. And the reason that that’s important is it tends to be an aggressive form of CLL. It also does not respond to chemotherapy, or if it does, the responses are very, very short-lived. So basically, that’s a contrary indication to receiving chemotherapy for your CLL when you should receive another form of therapy if you have a 17-P deletion.

And then, finally, we look at a type of – we look for individual gene mutations in the cells. And that’s different from IGHV mutational status, although the names are kind of similar.

So, in CLL, there are numerous genes that can be affected by mutations that alter the function of the gene. In some cases, it makes the gene non-functional; in some cases, it changes the function in some way that perturbs the normal functioning of the cell and contributes to the malignant transformation of that cell.

So, the most important one, again, relates to a gene called TP-53. So that’s the gene that is deleted if you lose a piece of Chromosome 17. It’s located on the P arm of chromosome 17. If you mutate that gene, it has the same consequences essentially for the cell as if you delete it by deleting a piece of the chromosome. And the two often go together, so you’ll have a 17-P deletion and a mutation of the TP-53 gene on your other Chromosome 17. Because remember, you have two chromosome 17s. So, if you lose both, it may be even worse than only having one. However, it does seem that if you only have a mutation on the TP-53 gene, but you don’t have a deletion on Chromosome 17, that the responses of those patients to chemoimmunotherapy are still really poor.

So, it’s very important to find out, do you have a TP-53 mutation as well as do you have a deletion on Chromosome 17 before you embark on treatment, particularly if that treatment is going to be chemotherapy. So, those are the three things that we look for before    we start any patient on therapy.