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Search for "Jennifer H Mabry"

Sidney, OH Lawyer
613 S Miami Ave
Sidney, OH 45365
Bob Mabry
Claimed Lawyer ProfileSocial Media
Conroe, TX Lawyer with 28 years experience
(832) 226-6985 Bob Mabry Attorney at Law PLLC
704 North Thompson St., Ste. 157
Conroe, TX 77301
Free ConsultationAppeals, Criminal and White Collar Crime
South Texas College Of Law
Admitted to practice before the Supreme Court of the United States, the Texas Supreme Court and all inferior Texas state courts, the Northern District of Texas and the Bankruptcy Court for the Northern District of Texas.
Admitted to the State Bar of Texas November 3, 1990.
Have won appeals, trials, and a probation revocation in Texas state courts, have undone criminal convictions with Texas state postconviction writs of habeas corpus.
Former Matagorda County Assistant District Attorney, Section Chief of State Counsel for Offenders forAppeals and Sexually-Violent-Predator Civil Commitment and also former criminal trial lawyer at State Counsel for Offenders.
Lifelong domiciliary of Texas, born...
Washington, DC Attorney with 13 years experience
(202) 662-6480 1801 K Street Northwest
Washington, DC 20006
University of Richmond School of Law
Waco, TX Lawyer with 24 years experience
(254) 753-6437 4125 W Waco Dr
Waco, TX 76710
Personal Injury
Chicago, IL Attorney
(312) 840-7670 330 North Wabash Avenue
Chicago, IL 60611
Business, Personal Injury and Products Liability
University of Michigan Law School
Houston, TX Lawyer with 46 years experience
(281) 496-9498 16000 Barkers Point Ln
Houston, TX 77079
Real Estate
Stonewall, TX Attorney with 43 years experience
(830) 609-8818 Stonewall, TX 78671
Los Angeles, CA Lawyer
1801 Century Park E
Los Angeles, CA 90067
San Luis Obispo, CA Attorney with 22 years experience
(213) 239-9009 PO Box 1690
San Luis Obispo, CA 93406
Marquette Univ Law School
GREENVILLE, SC Attorney with 38 years experience
Antitrust, Business and Personal Injury
COLUMBIA, SC Lawyer with 40 years experience
Civil Rights, Medical Malpractice and Personal Injury
ORLANDO, FL Lawyer with 17 years experience
(407) 841-1200 ORLANDO, FL 32802
Business, Employment and Health Care
Las Vegas, NV Lawyer with 41 years experience
(702) 383-8888 300 S 4th St
Las Vegas, NV 89101
ABILENE, TX Attorney with 37 years experience
(915) 672-4233 ABILENE, TX 79604
Divorce and Family
TEXAS CITY, TX Attorney with 56 years experience
(409) 948-4466 TEXAS CITY, TX 77592
Business and Employment
South Texas College Of Law
Beaumont, TX Lawyer with 21 years experience
(409) 981-1190 595 Orleans St
Beaumont, TX 77701
Insurance Defense and Personal Injury
South Texas College Of Law
FORT WORTH, TX Lawyer with 23 years experience
(817) 223-9294 FORT WORTH, TX 76185
IP and Real Estate
Houston, TX Lawyer with 53 years experience
(713) 524-4648 3701 Kirby Dr
Houston, TX 77098
Business and Estate Planning
Atlanta, GA Lawyer with 46 years experience
(404) 687-8898 692 Clifton Rd NE
Atlanta, GA 30307
University of North Dakota
Dade City, FL Attorney with 14 years experience
(352) 521-4388 38053 Live Oak Ave
Dade City, FL 33523
Orlando, FL Lawyer with 28 years experience
(407) 428-5116 800 N Magnolia Ave
Orlando, FL 32803
Lewis And Clark College - Northwestern School of Law
Louisville, KY Lawyer
(502) 589-5400 Louisville, KY 40202
Family and Health Care
Philadelphia, PA Lawyer with 27 years experience
(215) 564-8011 Philadelphia, PA 19103
Phoenix, AZ Lawyer with 25 years experience
(602) 640-2160 2600 N Central Ave
Phoenix, AZ 85004
Flint, MI Attorney
(810) 257-3250 900 S Saginaw St
Flint, MI 48502
Washington, District of Columbia Lawyer
(202) 828-5875 2000 K Street NW
Washington, DISTRICT OF COLUMBIA 20006
Washington, DC Lawyer with 36 years experience
(202) 806-8067 2900 Van Ness St NW
Washington, DC 20008
New York, NY Attorney with 14 years experience
(212) 301-6979 New York, NY 10036
COLUMBIA, SC Lawyer with 48 years experience
Simpsonville, SC Lawyer with 31 years experience
402 W Fernwood Rd
Simpsonville, SC 29681
Lexington, SC Lawyer with 35 years experience
Lexington, SC 29072
Washington, DC Lawyer with 30 years experience
(202) 616-0326 1100 L St NW
Washington, DC 20005
Alameda, CA Attorney
(415) 995-5189 3351 Fernside Blvd
Alameda, CA 94501
(704) 982-5600 ALBEMARLE, NC 28002
Silver Spring, MD Lawyer with 13 years experience
2133 Elm Tree Ln
Silver Spring, MD 20906
Conshohocken, PA Lawyer
(610) 828-4977 2009 Spring Mill Road
Conshohocken, PA 19428
Las Vegas, NV Attorney
(702) 486-2850 2030 E Flamingo Rd
Las Vegas, NV 89119
Jennifer J. Corcoran
Claimed Lawyer ProfileLII GoldSocial Media
Albany, NY Attorney with 20 years experience
(518) 218-7100 441 New Karner Road
Albany, NY 12205
Divorce, Estate Planning, Family and Real Estate
Albany Law School
As a Partner and Consult Attorney at Tully Rinckey PLLC, Jennifer performs initial consultations for a wide range of legal matters, including those relating to family and matrimonial law, trusts and estates, civil litigation, real estate law and private sector employment law.

When performing consultations, Jennifer pulls from over 20 years of legal experience to assess potential and existing clients’ unique situations and provide guidance on how to move forward. At Tully Rinckey PLLC, she has concentrated her practice on family and matrimonial law, elder law, estate planning and real estate law. She has also handled bankruptcy, business law and private...
Jennifer M. Erlinger
Claimed Lawyer ProfileLII GoldSocial Media
(888) 962-4453 100 N Laura St
Jacksonville, FL 32202
Free ConsultationJacksonville, FL Lawyer with 14 years experience
Criminal, Divorce, Family and Traffic Tickets
Stetson University College of Law
Jennifer Erlinger moved to Jacksonville in 2009, after growing up in the Tampa Bay area. Ms. Erlinger received her Bachelor's of Arts from the University of Florida. She went on to achieve both her Juris Doctor, where she focused her study on Trial Advocacy, receiving a Certificate of Concentration in Advocacy for the top ranked advocacy center of Stetson College of Law. She also received her Master's in Business Administration from Stetson University. Prior to joining Wood, Atter, & Wolf, Ms. Erlinger has worked as an Assistant State Attorney, Assistant Attorney General both in child support enforcement and in the...

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The Justia Lawyer Directory is a listing of lawyers, legal aid organizations, and pro bono legal service organizations. Whether you were injured, are accused of a crime, or are merely engaging in everyday affairs that affect your legal rights or property, an attorney can help you resolve problems or prevent new ones from arising.

Here are just a few situations where you might want to seek the advice of an attorney:

  • You were injured in a car or truck accident
  • You have been arrested and charged with a crime, such as DUI or shoplifting
  • You are considering separating from your spouse
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Use Justia to research and compare attorneys so that you can make an informed decision when you hire your counsel.

It is important to research an attorney before hiring him or her. Be sure to evaluate an attorney's experience (types of cases handled, prior results obtained, etc.). Although prior results are not indicative of the likelihood of success in your case, they can help you make an informed decision.

Also worth serious consideration is the attorney's location, particularly if you will be traveling to visit him or her for consultations.

Finally, research an attorney to see whether he or she has ever been subject to discipline. Although disciplinary actions do not necessarily impact the attorney's competence to handle your case, they may affect your decision whether to hire.


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Inspire great performance with teams that are strategically aligned and focused.

The LCP Team Alignment Program is a breakthrough experience for senior leaders and managers whose priorities are continually being challenged by organizational growth, significant enterprise change, mergers and acquisitions, and leadership changes.

Designed for organizations and their leaders that may be in a C-level leader transition or enduring other leadership changes such as a new management team altogether or significant organizational or structural changes.

The LCP Team Alignment Program explores individual goals that are in conflict with other team members or organizational priorities and helps them to leverage their strengths to achieve breakthrough alignment and success.

Who it's for.

Ideal for organizations and leadership teams focused on:

  • Growing through market share and acquisitions.
  • Managing geographically dispersed leadership teams.
  • Adding new members to the leadership team.
  • Experiencing a founder or significant leadership transition.
  • Managing the fall-out from multiple changes to the organizational structure.

Program approach.

The LCP Team Alignment Program is underpinned by LCP’s unique evidence-based approach where leaders gain a deeper awareness of self and their personal strengths. Based on the 5 Leadership Anchors™, leaders discover the power of aligning the energy and focus of a team around shared priorities.

Participants explore individual goals that are in conflict with other team members, identify perceived roadblocks, and leverage strengths for breakthrough results in 6-month or 12-month programs.

The program is designed for C-Suite executives and senior leadership teams, including general management, divisional and regional leadership (minimum of 6 participants).

Participants will engage in live “forum” workshops, individual coaching (in-person and virtual), group coaching, and in topical webinars featuring guest experts.

In addition, they will create and maintain an online leadership journal and engage each other, their leadership coach, and program experts in a secure, interactive online forum.

Program benefits.

Through coaching and peer-to-peer engagement, participants will:

  • Develop strong collaborative behaviors.
  • Discover a commitment to shared success (“winning is not a zero-sum game”).
  • Achieve focused momentum that increases leadership capacity for achieving results.
  • Experience positive employee engagement.
  • Communicate with clear, concise, consistent messages that are always on-brand.
  • Address conflicting priorities and remove roadblocks to individual and shared success.

Organizations will:

  • Gain a cohesive and collaborative leadership team.
  • Develop leaders who have a strong commitment to good governance.
  • Retain key leadership talent.
  • Achieve momentum for sustainable results even within volatile markets and uncharted territory.
  • Inspire teams toward greater performance and better results.

Want to learn more? Contact us.

LCP Global helps leaders to increase their capacity to lead and drive a culture of lasting performance throughout the organization.

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When my husband Scott and I were asked in November of 2014 to share our journey as Mormon parents with a gay son, we never dreamed we’d be speaking so publically about this subject, but we both felt strongly it was a story we needed to share.

We invite you to watch our video(s) and ask that you please share in hope to help individuals, parents and families navigate their journey of understanding and loving their children.

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The Marketing Idea Through Text
Content Strategy and Copywriting
LeadVy Copywriting

What is Content Strategy?

It is basically the approach of adding unique and practical content to a website to make it more meaningful and interactive. Having a powerful content strategy is more likely to help improve the marketing plan of a business that will use quality content strategy to promote its website. LeadVy ensures that we deliver high quality content strategy and make sure we apply this to our business.

SEO Friendly

Link Building

Trust Brand

Quality Traffic

What is Copywriting?

It is the method of conceptualizing and advertising of services, brands or events we see in brochures, websites, emails, television and many more. Our company will be responsible in putting the marketing idea through text. We write, research, proofread, plan and implement marketing campaigns with our creative and descriptive way to endorse the service and product of our partners. With our effective copy and content, We are confident that our Partners’ business will have successful conversion.

Our Keys in Achieving Quality Content Strategy

Remember, good content means good business. To achieve a high quality content, the strategy should be intact. A website with a good quality content will certainly enjoy good conversion rates and high-rank search engine position, and that’s what LeadVY is aiming for.

Develop a Plan

Creating a marketing plan is the key to start building a quality content for the website. LeadVy categorize what our partners want to get on the website and will ensure to apply it according to our partners’ requests.

Choosing a Target

The content of the website should target the ideal audience since this will give an identity to the business. LeadVy provides quality content to meet the expectation that our client desires.

Owning The Website

We will design and input all the necessary contents to make the website attractive and dynamic. Our service will help boost website ranking appropriately by collating significant contents.


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Conquering Nematodes in Cannabis Organically

cannabis nematodes

A variety of tiny creatures can infest even the most meticulously groomed cannabis garden. From fungus gnats (which damage the roots) to spider mites (which coat plants in a fine web), experienced pot cultivators strive to exclude such pests from their gardens.

One of the most troublesome infestations that can strike a cannabis garden is nematodes. These small roundworms (also called “eel worms”) can cause considerable damage to plants, including severe stunting and wilting—both of which can significantly reduce yields.

Six Species of Nematodes

Of the six species of nematodes that are known to infest cannabis plants, five attack the root system. One variety, the root knot nematode, embeds itself in roots and forms giant cells that further expand into galls, which are basically areas of abnormal swelling.

The stem nematode is the one species that lives above the dirt surface and does not infest roots. It does, however, cause swelling—only in the stems, branches, and leaves of the plant. Stem nematodes also cause plants to be chlorotic, meaning that healthy green plant tissue becomes yellow or white due to a lack of chlorophyll.

A troublesome cannabis garden infestation, nematodes that can cause considerable damage to plants, including severe stunting and wilting—both of which reduce yields.

If not dealt with in a timely manner, this type of nematode can cause stems to twist and distort because of how it shortens the internodes between branches. The bad news for commercial growers: This results in stunted growth and reduced yields.

Enter PathogenZERO

A recent press release from Steep Hill Labs frightened cannabis cultivators and consumers alike. The nation’s leading pot testing company announced that it found 84 percent of medical cannabis in the San Francisco Bay Area to contain unsafe levels of a residual pesticide that’s commonly used to treat infestations like nematodes and diseases like gray mold.

The chemical discovered, myclobutanil, is better known as the brand Eagle 20. While approved by many government bodies for human ingestion (eating), inhalation of this fungicide is a very different story. This is because, when heated sufficiently (such as when smoked), myclobutanil breaks down into a very dangerous and infamous poison: Hydrogen cyanide.

Cannabis gardeners wishing to not only avoid pests like nematodes, but also to prevent poisoning patients with cyanide, obviously must seek alternatives to conventional fungicides that, when smoked, are blatantly toxic. One new alternative is PathogenZERO from California’s CaliCropDoc.

PathogenZERO is a broad-spectrum fungicide/pesticide solution that is formulated from natural ingredients and certified organic. This product can protect a cannabis garden against more than 150 different pathogens, including pests such as fungus gnats and nematodes and common diseases like powdery mildew and gray mold (bud rot).

Because it is organic and fully biodegradable, the application of PathogenZERO involves no masks or hazmat suits. It is safe for the environment and all parties in the cannabis supply chain. Gardeners can ethically use it with reckless abandon to achieve the goal of optimized yields and potency.

About Gooey Rabinski 17 Articles
Gooey Rabinski is a technical writer, instructional designer, and photographer who has been covering the cannabis culture since 2004. His work has appeared in High Times, Cannabis Culture, WoahStork, SKUNK, The Emerald Magazine, MERRY JANE, Weed World, Grow Magazine, Whaxy, Green Flower Media, and Cannabis Health Journal. Rabinski crafts compelling educational media that focuses on the science of the cannabis herb, patient advocacy, and eliminating the social stigma that has existed for more than a century in the United States. His photography is available on Instagram at gooey_rabinski and he Tweets from @GooeyRabinski.

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Breaking News

Healthcare Workers Contain Ebola Outbreak

A World Health Organization (WHO) worker vaccinates a man during a campaign aimed at beating an outbreak of Ebola in Democratic Republic of Congo, May 21, 2018.
Healthcare Workers Contain Ebola Outbreak
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From VOA Learning English, this is the Health & Lifestyle report.

Ebola is back in Africa -- this time in the Democratic Republic of Congo (DRC).

On its website the World Health Organization (WHO) states that, as of June 9, at least 28 people have died in the DRC after they had contact with Ebola virus disease. This is out of 66 confirmed, probable or suspected Ebola cases.

Health workers in the DRC are working quickly to stop the virus from spreading. They are using a new vaccine to protect people.

Wangui Nondi says his body temperature rose after he cared for his brother, who died from Ebola. But Nondi is better now after receiving the Ebola vaccine.

The vaccination campaign began in the middle of May in two countryside communities. But there is a limited supply of the vaccine. So, health care workers were the first to be vaccinated.

World Health Organization official Tarik Jasarevic told VOA that only people who have been in contact with an infected person get the vaccine. He said this helps to form a kind of ring around the patient.

"This is not a general mass immunization, as is being done for some other diseases. We are looking into people who have been in contact with those who tested positive for Ebola, and their contacts. So, we make a ring around the person who contracted the virus."

The vaccine they are using was developed a few years ago during the Ebola outbreak in West Africa. The experimental vaccine has proven to be safe and effective in human testing.

Doctor Tarit Mukhopadhyay is a vaccine expert with the University College, London. He leads the Vaccine Development Working Group for the UK Vaccine Network. He explains how the vaccine works.

This colorized image of an Ebola virus virion comes from the U.S. Centers for Disease Control and Prevention.
This colorized image of an Ebola virus virion comes from the U.S. Centers for Disease Control and Prevention.

"What it does, it teaches the immune system to recognize those Ebola proteins on the surface of this modified virus, and in doing so, create a protective response against that."

Scientists can only test the vaccine when there is an Ebola outbreak. Dr. Mukhopadhyay says he and other researchers have many questions.

"What we're trying to do now is to establish how effective is this vaccine? Do you need one dose, or two doses to be protected? And once you've been injected or vaccinated with this, how long does that protection last for, as well?"

Containing Ebola virus disease may be a problem in the DRC. The areas affected by this outbreak are close to heavily-used waterways. It started in an area called Bikoro, and then moved to Mbandaka, a busy port along the Congo River.

People use the river to bring produce to the country's capital, Kinshasa. Health workers say keeping Ebola out of heavily populated areas is critical to containing this outbreak.

Another critical part of containing the outbreak is cooperation.

Jasarevic said that to defeat an Ebola outbreak, the whole community needs to cooperate. The most important thing, he said, is that infected people receive treatment in a hospital where they can be separated from others, or isolated. They must not remain at home.

"It is only human, that people who have their relatives in isolation units want them to be at home, want them to be with their family at home in what could be the last moments of their lives. But we need really to explain to everyone that is how disease is being transmitted. If a person who is sick is in an isolation unit, it not only increases the chance of survival for this patient, but it will also prevent the spread of the virus to the family."

Brief history of Ebola

WHO officials say Ebola virus disease first appeared in 1976. That is when medical experts confirmed cases in what is now South Sudan and the DRC.

Scientists say they think the virus comes from wild animals. The disease can be transmitted from person to person through direct contact with the blood or other fluids from an infected person. For that reason, Ebola patients must be kept away from other people.

The virus destroys cells that control blood pressure and then causes organ failure. Signs of the disease include high body temperature, vomiting, diarrhea, and bleeding. Once infected, patients have a very low chance of surviving.

Health workers carry the body of an Ebola victim for burial at a cemetery in Freetown, December 17, 2014.
Health workers carry the body of an Ebola victim for burial at a cemetery in Freetown, December 17, 2014.

The worst Ebola outbreak in history took place between 2014 and 2016. It killed more than 11,000 people in West Africa. The WHO and international health experts have since been criticized for not doing a better job in fighting the disease.

And that's the Health & Lifestyle report. I'm Anna Matteo.

VOA’s Anita Powell reported on the efforts of Tarik Jasarevic, while VOA’s Carol Pearson reported on the work of Tarit Mukhopadhyay. Anna Matteo adapted their reports for Learning English. Her story also uses information from the WHO website.

Quiz - Health Workers Stop Ebola From Spreading

Quiz - Health Workers Stop Ebola From Spreading

Start the Quiz to find out

Words in This Story

outbreak - n. a sudden start or increase of fighting or disease

dose - n. to have the food, liquid, etc., that is in your stomach come out through your mouth because you are sick

response - n. something that is done as a reaction to something else

modify - v. to change some parts of (something) while not changing other parts

immunization - n. the act of protecting someone from a disease

vomit - v. to have the food, liquid, etc., that is in your stomach come out through your mouth because you are sick

diarrhea - n. an illness that causes you to pass waste from your body very frequently and in liquid rather than solid form

transmit – v. to cause (a virus, disease, etc.) to be given to others

ring – n. something that forms a circle around something else

positive – adj. good or useful

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Learning assessments

Last update 19 Jul 18

In order to improve students’ learning, we need to know more about how much students are learning now and where improvement is most needed. The assessment of learning is therefore a crucial issue that countries will need to strategically address as they develop education sector monitoring plans.

Learning assessments for diverse contexts and purposes

There are multiple kinds of assessments of students’ learning, used in different contexts and for different purposes. Often we differentiate between two major categories: 1) individual assessments for pupils, and 2) system level assessments or evaluations for schools, regions, or national education systems.

Individual assessments

Individual assessments for pupils can be formative and give feedback to pupils and teachers on their skills and progression, or they can be summative, in the form of final grades or examination results.

In classrooms, teachers may design formative or summative tests to evaluate whether students are following the curriculum. Formative tests are diagnostic in nature: teachers want to know if learning is taking place and, if it is not, to provide appropriate interventions. Formative tests are also important for feedback to pupils and parents about the pupils’ progression. Tests can also be summative, conducted at the end of the unit, term, or year, to determine whether students have acquired the required knowledge and skills. Teacher-designed tests are generally used as an assessment tool within a classroom or grade. They do not compare student learning across schools.

Public examinations have different aims to class-based tests. The results are typically used to certify that individual students have attained a certain level in their studies. An examination can also be used to assess whether or not schools are implementing the curriculum and whether teachers are delivering appropriate instructions. They may also be used to select students for further education. When the student’s educational or professional future is dependent on their performance in an examination, it is referred to as a ‘high-stakes’ assessment.

System level assessment and evaluation

Large-scale regional, national, and international assessments are used to evaluate the output of a school system. These are instruments designed to provide evidence about the levels of student achievement in specific learning domains. Unlike examinations, which focus on individuals’ results and determine certification or selection, assessment results have no consequences for individual students. Rather, the purpose is to assess how well students within the system are learning, and explain why some students are performing better than others. A variety of background information about students’ teachers and learning environments are collected, along with data on students’ learning outcomes. These are then analysed and linked together so as to provide informed policy suggestions that can be used by policy-makers.

Incorporating assessment data into a monitoring framework

Assessment data can play a key role in a country’s overall monitoring framework, as part of the analysis of issues in an education system, and in order to monitor plans for improvement. In general, assessment data is most useful for monitoring purposes when the assessment has been rigorously designed for comparing different students, achievement levels, and time periods. National and regional examinations data may also be incorporated into a monitoring system through inclusion in the Education Management Information System (EMIS) or by making this information public via school report cards—though some caution must be exercised in using this information to analyse trends over time, since such examinations are usually not designed with that purpose in mind.

Available international assessment tools

Various international initiatives have created tools for education assessment in learning and education/school management. These international assessment tools are sample based, and are designed to provide evidence-based feedback to inform better education policy-making, leading, in turn, to improved learning and teaching. Broadly we differentiate between internationally developed tests to be used for system level analyses within countries, and large-scale international tests used for comparative assessment across countries. The large-scale comparative assessments are designed for comparing results on a common scale across countries, and they can also measure trends in learning outcomes over time.

It is important to note that the tools described below are not mutually exclusive. Some tools are multifaceted, generating data that can be analysed for various purposes. For example, SACMEQ data can be used for education planning, as well as for monitoring.

Assessments for Use at the Country Level

For use at country level, there are two internationally recognized assessment tools for testing of early reading and mathematics skills. These are the Early Grade Reading Assessment (EGRA) and Early Grade Mathematics Assessment (EGMA), developed by RTI International and funded by USAID. In addition, there are citizen-led initiatives such as UWEZO that carry out learning assessments at the household level.

EGRA – Early Grade Reading Assessment

This is an oral assessment tool designed to measure basic skills for literacy in children in early grades. It focuses on the individual child and is a one-to-one assessment. The tool measures recognition of letters, reading simple words, understanding sentences and paragraphs, and comprehension. The assessment is adopted for use by a particular country in a given language. EGRA helps to establish national reading performance and the level of children’s reading skills at an early stage, data which then feed into measures for improvement and policy-making.

EGMA – Early Grade Mathematics Assessment

This tool is the maths and numeracy equivalent of EGRA. It measures children’s skills in numeracy and mathematics. It focuses on the foundations of maths, such as number identification, quantity discrimination (larger and smaller), missing-number identification, word-problem solving, addition and subtraction, shape recognition, and pattern extension. The assessment is crucial for determining ability for further numeracy tasks. It helps teachers to establish students’ level of understanding of foundational skills and to identify areas of improvement towards further tasks in upper grade.

UWEZO – A civil society assessment tool used in Kenya, Tanzania, and Uganda

Uwezo, which means ‘capability’ in Swahili, is an initiative that carries out an annual household survey to assess whether children aged between 6 and 16 years have the standard literacy (reading) and numeracy (maths) skills required at Level 2. The assessment is regional, covering Kenya, Tanzania, and Uganda. The survey’s assessment tools capture other demographic data, such as household income, location, and schools. They thus provide results that are broad and can be used in various education policy areas, giving room for robust analysis of, for example, schooling status, enrolment, attendance and teacher-student ratios. Also see ASER (India and Pakistan), Beekungo (Mali), Jangandoo (Senegal), MIA (Mexico), and PAL (the People's Action for Learning Network).

International large-scale assessments

Large-scale international assessments are designed to give relevant policy information on learning outcomes in a way that is comparable across educational systems. Typically these tests are sample based and consist of written or computer based cognitive tests, accompanied by surveys to pupils and principals. Some studies also include surveys to teachers and parents as well. Large-scale international assessments give countries and education systems the opportunity to benchmark against each other because results are presented on a common scale across countries. In addition they are designed to give reliable trend data for learning outcomes over time. This enables participating countries to assess strengths and weaknesses in their education system, and to judge the impact over time of reforms and education policy decisions.

A number of different international large-scale assessment tools exist, developed by different international organisations:

The Organisation for Economic Co-operation and Development (OECD) is responsible for PISA and PISA for Development, which are tests of learning outcomes. In addition the OECD also organises TALIS, which is an international survey directed to teachers and principals. The OECD has a broad mission to promote policies that will improve economic and social well-being, including through generating comparative data about different countries’ education systems.

PISA – Programme for International Student Assessment

The Programme for International Student Assessment (PISA) is a triennial international survey run by the OECD. PISA aims to evaluate education systems worldwide by testing the skills and knowledge of 15-year-old students. Every three years students from randomly selected schools worldwide take tests in the key subjects: reading, mathematics and science, with a focus on one subject in each year of assessment. To date, students representing more than 70 economies have participated in the assessment. PISA tests are not directly linked to the school curriculum. The tests are designed to assess to what extent students at the end of compulsory education, can apply their knowledge to real-life situations and be equipped for full participation in society. The information collected through background questionnaires also provides context which can help analysts interpret the results.

PISA for Development

This initiative aims to increase developing countries’ use of PISA assessments for monitoring progress towards nationally set targets for education improvement, with a focus on student learning outcomes. It is also designed for tracking international education targets in the post-2015 framework. A pilot study is currently underway. The results will contribute to the post-2015 education-related development agenda.

TALIS was established in 2008 as an international, large-scale survey of the teaching workforce, the conditions of teaching, and the learning environments of schools in participating countries. The study aims to provide timely, comparable, and useful policy information regarding the conditions of teaching and learning environments to participating countries.

The International Association for the Evaluation of Educational Achievement (IEA) is an independent, international association of national research institutions and governmental research agencies. IEA conducts large-scale comparative studies of educational achievement and other aspects of education, with the aim of gaining in-depth understanding of the effects of policies and practices within and across systems of education.

TIMSS (Trends in International Mathematics and Science Study) measures trends in mathematics and science achievement at the fourth and eighth grades. TIMSS has been conducted every four years since 1995. TIMSS reports overall achievement as well as results according to four international benchmarks (advanced, high, medium, and low), by major content domains (e.g., number, algebra, and geometry in mathematics, and earth science, biology, and chemistry in science. In addition the study collects information about curriculum and curriculum implementation, instructional practices, and school resources.

For countries where students are still developing fundamental mathematics skills, IEA's new TIMSS Numeracy assessment (designed to be administered at the fourth, fifth, or sixth grade) concentrates on measuring children's numeracy learning outcomes, including fundamental mathematical knowledge, procedures, and problem-solving strategies. There is also an advanced tool (TIMSS Advanced) that measures trends in advanced mathematics and physics for final-year secondary-schools students.

PIRLS and PIRLS Literacy

PIRLS (Progress in International Reading Literacy Study) is an assessment of pupils’ reading comprehension and provides internationally comparative data about how well children read at the end of grade four. PIRLS has been conducted at five-year intervals in countries around the world since 2001. In addition the study also collects information about home support, instructional practices and school resources in each participating country. Initiated in 2011, PIRLS Literacy (earlier known as prePIRLS) is based on the same view of reading comprehension as PIRLS, but is designed to test basic reading skills for countries where most children are still developing fundamental reading skills. PIRLS Literacy can be administered at the fourth, fifth, or sixth grade, and gives countries the opportunity to benchmark against the regular PIRLS test.

The International Civic and Citizenship Education Study (ICCS) investigates the ways in which young people are prepared to undertake their roles as citizens. The study assesses pupils at the end of grade eight, and was last conducted in 2009. The study is again planned in 2016. ICCS reports on students' knowledge and understanding of concepts and issues related to civics and citizenship, as well as their beliefs, attitudes, and behaviours.

The International Computer and Information Literacy Study (ICILS) is an international comparative study which is designed to evaluate students’ ability to use computers to investigate, create, and communicate in order to participate effectively at home, at school, in the workplace, and in the community. The study is aimed at students at the end of grade eight, and was first established as a baseline study in 2013 with 21 participating education systems around the world. The next round of ICILS is planned in 2018.

There are a number of regional assessment programmes, such as SAQMEC and PASEC in Sub-Saharan Africa, and LLECE in Latin America, and other newer initiatives. These programmes aim to monitor and evaluate school systems and to provide evidence-based information that can be used by policy-makers to plan and improve the quality of basic education.

SACMEQ – The Southern and Eastern Africa Consortium for Monitoring Education Quality

This is an umbrella organization for 16 education ministries in Southern and Eastern Africa. The organization brings these ministries together to share experiences and expertise with a view to the scientific monitoring and evaluation of education policies on school conditions and the quality of education. SACMEQ carries out training programmes to equip education planners with technical skills, including data collection and analysis for monitoring and evaluation purposes. In addition to its focus on monitoring and evaluation, SACMEQ also occasionally carries out reading and math assessments in member countries to assess sixth-grade students’ abilities in mathematics and reading English.

PASEC – Programme for the Analysis of Education Systems

PASEC is a regional assessment tool for Francophone countries in West Africa and Asia, conducted by CONFEMEN (La Conférence des ministres de l’Éducation des pays ayant le français en partage). It provides information about the performance of education systems, which contributes to the development and monitoring of education achievement in member countries. In addition, PASEC carries out comparative evaluations across its member countries. The objectives of PASEC are to: assess pupils’ performance and identify efficiency and equity issues for basic education; provide national policies with indicators that will allow them to make relevant comparisons; foster, at national level, the development of an internal and permanent capacity for the evaluation of the education system; disseminate evaluation results at international level to contribute to reflections and discussions on factors determining education quality. The overall aim is to contribute to effective evaluation methods that will enhance the capacity of national ministries to evaluate learning achievement at primary-school level.

LLECE – Latin American Laboratory for Assessment of the Quality of Education

LLECE is a network of national units focusing on the assessment of education quality. It was initially created with 15 members—Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, Dominican Republic, Uruguay and Venezuela, coordinated by the Regional Bureau of Education of UNESCO for Latin America and the Caribbean. The network arose in with objectives of providing more information for designing appropriate educational reforms, sharing and developing the expertise necessary for conducting educational assessments, and having a more open orientation toward the sharing of assessment data with the public. So far, three regional assessments have been conducted: PERCE (1997-98), SERCE (2006-8), and TERCE (2013-15). From the initial focus on only reading and mathematics, the approach has grown to also include writing and the natural sciences (the latter only for pupils in the sixth year of primary school). It also aims to identify the factors associated with different levels of achievement, such as the socio-economic context, family life and personal issues, educational policies, and school processes.

As the importance of rigorous learning assessments gains increased recognition, other new regional and international assessment programmes may emerge. As one example, the Southeast Asia Primary Learning Metric (SEA-PLM) was recently inaugurated, in association with the Learning Metrics Task Force (LMTF), a global initiative that is working to improve the measurement of learning around the world.

Key considerations in designing national learning assessments

Reliable information on pupil performance is the key to the successful implementation of targeted education policies. In the past two decades, national assessments have emerged as an important tool for providing a measure of educational achievement. There exist a great variety of national assessment programs with different aims and purposes. Broadly, one can differentiate between assessments that are designed for accountability at all levels, and assessments that are designed for system evaluation and development. In both cases, the desire to measure change in achievement over time will imply specific requirements to the test design.

When designing a national assessment system, there are some key initial considerations that will guide all further choices for the development of the system:

  • What is the intended purpose of the assessment?
  • Which competencies do we want to test?
  • Which are the main target groups to be tested?
  • How can validity and reliability be ensured?
  • Which format should the tests have?
  • Is it important to measure trends, and if so how can this be done accurately?
  • How should the results be reported and to whom?
  • Do we have the necessary expertise?

These aspects are typically defined within a national assessment framework. Following are some further considerations regarding each issue:

Purpose of the national assessment

A national assessment program can serve multiple purposes, and the main purpose should determine the design of the assessment. It is therefore very important to be clear from the beginning about the main purpose. The use of one single test for several purposes might be inappropriate as the information ideally required in each case is not the same. Therefore, education authorities are advised to rank the different purposes in order of priority and adjust test designs accordingly. (See Standards, Accountability, and Student Assessment Systems, Canadian Education Association (CEA))

There are three general purposes for most national assessments. The first group consists of tests which summarize the achievement of individual pupils at the end of a school year or at the end of a particular educational stage, and which have a significant impact on their educational careers. These are high stakes tests, which are often referred to as summative. Second are assessments intended to monitor and evaluate schools and/or the education system as a whole. In this case, test results are used as indicators of the quality of teaching and the performance of teachers, but also to gauge the overall effectiveness of education policies and practices. A third category is composed of assessments that are mainly for the purpose of assisting the learning process of individual pupils by identifying their specific learning needs and adapting teaching accordingly.

Competencies to be tested

The assessment domains can either be based on particular subjects in the curriculum, or can test key competencies for learning across subjects, such as numeracy, literacy, problem solving, or information and communication skills. The assessment of key competencies will be most relevant for formative assessment programs designed to monitor education systems and/or identify individual learning needs. All national assessments measure cognitive skills in the areas of language/literacy and mathematics/numeracy, a reflection of the importance of those outcomes for basic education. In some countries, knowledge of other areas, such as science, social studies, particular languages or other domains, are also included in an assessment.

Whatever the domain of the assessment, it is important to develop an appropriate framework that clearly defines the competencies and skills to be tested, and a test specification. This is necessary both for constructing assessment instruments and afterward for interpreting results.

Target groups and Sampling strategy

The selection of target groups for the assessments is dependent on the purpose of the test. If the purpose is mainly formative, the tests should be administered at stages where the acquired competencies are crucial for further learning and development. Examples can be the beginning and end of primary and towards the end of lower secondary education. If the main purpose of the assessment is summative, it would typically be performed at the end of an education level, such as upon the completion of primary school, lower secondary, or upper secondary.

Examinations and tests to monitor schools are often compulsory for all pupils, while tests that concentrate on evaluation of the educational system as a whole are often administered to a representative sample. If a test is sample based, it is necessary to consider how the results are to be reported when the sample is defined. If results are to be broken down by regions, school types, gender, language of instruction etc., one has to make sure that the sample is representative at all those levels.

Validity and Reliability

Test validity is the extent to which a test actually measures what it is intended to measure. Validity is generally considered the most important issue in educational testing because it concerns the meaning placed on test results, and the extent to which the results of the test can be trusted to have measured the right competencies. A highly valid assessment ensures that all relevant aspects of student performance are covered by the assessment. There are statistical methods to calculate a test’s validity.

Test reliability is the degree to which an assessment produces stable and consistent results. Adequate reliability is a necessary condition for the validity of a test. This means that if the measurement is not reliable it cannot be valid either. Newer scaling methods (Item Response Theory or IRT) have resulted in a different understanding of test reliability, due to the recognition that individual items may differ in their difficulty level. When using IRT methods, test reliability roughly means the precision of the measurement at different levels of the competency measured. The converse of reliability is measurement error and therefore it is of utmost importance to ensure the best possible reliability of the test as a whole.

Test design

To ensure the validity of the test, it must consist of test items representing the whole range of the test domain described in the framework. The test must also contain enough items for each proficiency level. Items can be either multiple-choice or open ended, or a combination of both. Open ended questions require a very strict scoring manual and schooling of scorers, however. In many countries there is now a rapid movement from paper based towards computer based testing. This opens up the possibility of adaptive testing, where the test is automatically adjusted to the student’s proficiency level. This method allows for more precise measurement of the whole competency and more targeted testing.

A rotated test design (matrix sampling) is often used for sample based tests to monitor a whole education system. In a rotated design, the test is constituted on a set of booklets or in blocks each representing only a part of the whole test. Each student only answers one booklet, which can contain different blocks of material. This enables testing of a large set of items without making the test too long for each student. However, with this method it is not possible to deliver individual results for students.

All test items for any of these types of tests must be piloted and analysed using psychometric methods before they are used in the final test, in order to make sure that the test meets all requirements for validity and reliability.

Measuring trends

To measure development of learning achievement over time, the test must contain a set of anchoring items, which are repeated every cycle. The anchoring items will be used to make sure the reported proficiency levels represent the same level of difficulty over time. In other words that the numerical results always represent the same level of competency. Anchoring items must be kept confidential to ensure the same test conditions over time. Only by using a test design of this type can trends be monitored.

Reporting results and using scaled scores

Ideally, assessment results should be reported both to decision-makers and to the general public. The public sharing of such information helps ensure that all stakeholders can help hold educational institutions accountable. However, the public sharing of data that has been disaggregated down to the school level can raise many controversies and is not always beneficial; in some cases higher levels of regional aggregation may be more appropriate. Additionally, if school-level reports are made public, extra care must be taken to ensure that individual students cannot be identified.

It is often necessary to prepare more than one type of report—some more detailed than others—in order to ensure that key findings are accessible to different audiences. Depending on the test design and the purpose of the test, the results can be reported either as one total test score, or be broken down in sub-scales representing different sub-domains and proficiency levels.

To achieve comparability, standardized testing programs most often report the outcomes as scaled scores. The reported scaled scores are obtained by scaling the raw scores (percentages or score points) onto a common scale to account for differences in difficulty across different forms.

Test expertise

Development of national tests requires high expertise, both curricular and content specific expertise and high psychometric competence. An important consideration is how to ensure relevant expertise during the whole process. In some countries there are national institutes or test centres that contribute the necessary expertise, but often this is not the case. There are, however, a number of national and international test institutes that will be able to support countries and provide important capacity building.

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Introductory Pharmacy Practice Experiences (IPPE)

Introductory Pharmacy Practice Experiences (IPPE)

IPPE Manual Downloads:

Erie — Click here to Download the IPPE Manual

Bradenton — Click here to Download the IPPE Manual

IPPE Training — Click Here for the IPPE Preceptor Training

Thank you for continuing the circle of mentorship by being an IPPE preceptor for our program! The Introductory Pharmacy Practice Experience (IPPE) is meant to give each student an opportunity to gain an understanding regarding how institutional and community practice settings operate. The student should be encouraged to begin to assume patient care responsibilities to the level possible in your facility/state and your comfort level. The focus is to learn the foundations of the distributive process from order interpretation to product delivery. We also want the student to acquire a basic understanding of how each setting differs administratively and the many aspects involved from inventory management through advanced clinical services. Please refer to our Learning Objectives for a complete list of rotation goals. Also see our Preceptor Training page for additional information. Refer to the IPPE Rotation Manual as a resource to guide you through the student’s time with you. You will find some required and some optional assignment suggestions enclosed. There are also instructions regarding the evaluation process which should occur at the end of the 2nd week and at the end of the 4th week, as the rotation concludes, through the use of PharmAcademic. We invite your feedback and ask that you contact the Experiential Office at any time if you require ANY additional support. We want this IPPE to be an enjoyable experience for you, as well as for the student. Thank you for all that you do to assist us in each student’s development. We could not do it without you!

IPPE Learning Objectives:

The goal of IPPE rotations is to have the students become competent in the daily practice of pharmacy operations. The student will:

1. Describe the structure, the organization, and chain of command within the organization.
2. Describe the roles and responsibilities of the diverse personnel working in the pharmacy.
3. Become familiar with the workflow in the pharmacy.
4. Handle the processing of prescriptions or physician’s orders from their initial receipt in the pharmacy to the dispensing of the product to the patient or to the patient’s floor/bedside.
5. Gain experience handling parenteral medications as well as other types of formulations.
6. Document and/or file orders or other documents pertaining to the daily work in the pharmacy.
7. Use pharmacy technology pertaining to the site and understand the technologies’ impact on the practice of pharmacy.
8. Communicate efficiently with patients (if appropriate) and members of the health care team.
9. Be professional at all times.

This list is not intended to be exhaustive. The preceptor has the authority to adapt and to add other experiences that he/she feels the student will benefit from.


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Lee Odden Skydiving

Skydiving with the Army Golden Knights

Yesterday I had the chance of a lifetime: To go skydiving for the first time in my life. Not only would I have the opportunity to do jump out of a perfectly good airplane, but I’d get to do it with the best of the best when it comes to skydiving: The Army Golden Knights.

Lee Odden Skydiving

2 1/2 Miles Up & Skydiving with Army Golden Knights

The backstory to this skydiving experience is that I was asked by Greg Swan from Weber Shandwick (who does PR for the Army) if I’d like to go skydiving as part of a pre-conference event outside of Dallas Texas.  After looking deciding there was an interesting social media SEO story to tell and feeling somewhat of a connection to the military because of my previous active duty service in the Army many years ago, I decided to do it.

Here’s a quick video interview in the hangar before getting on the plane:

Here are my last words before the jump. I love you mom!

Video of my actual jump 2 1/2 miles above Dallas with the U.S. Army Golden Knights

Here’s a video with my Army story:

New York Video 050109

View from the 23rd floor balcony in Soho of uptown and downtown Manhattan in New York.

Day Two New York Trip

Dominic Central Park

On the second day of our trip, we slept in a little, having stayed up a bit late after a late dinner. After getting coffee and water, we walked approximately 14 blocks to Central Park and then walked across the park to the (other side) to meet another New Yorker friend of mine, Rebecca, at a restaurant near Lincoln Center that she had picked for us.

Dominic Central Park

We had a very nice lunch and Rebecca made some additional recommendations for things we hadn’t thought of. After lunch Dominic and I went back into Central park, walking by a pond seeing the Hans Christen Anderson and Alice in Wonderland statues.

Dominic Central Park Alice in Wonderland

It was strikingly hot but we continued to walk up the park noticing various musicians playing for tips along the way.

We were looking for the Central Park Zoo but were not paying much attention. Dominic picked up a few sticks which he proceeded to use to “play” an empty water bottle located in his messenger bag.

Dominic at the MET Museum

The heat was intense, so we decided to take a break from it by entering the Metropolitan Museum ??? MET. There was a Superheroes exhibit, although, we were not sure exactly what that would be. Dominic put his sticks in his bag, worried they might not let him have them. They didn’t notice the sticks when the bag was inspected.

The AC in the museum was a welcome relief to the sweltering heat outside. We checked out some Greek artifacts and then a Medieval exhibit before finding the Superheroes exhibit. It was a combination of movie props from Spiderman, Batman and Iron Man plus fashion designer interpretations of various Superhero themes in clothing designs.

After the MET, we wandered outside where the sun dropped enough to be blocked by many of the taller buildings. It was still very hot and humid though and by the time we finally made our way to the Central Park Zoo (which just closed) it had taken it’s toll on Dom. we rested for a while and then made our way back to the hotel.

NYC Birthday Trip Day One

Technically, our first day in New York was Wednesday night when we flew in, but we didn’t get into the hotel (Grand Hyatt at Grand Central Station) from JFK until midnight or so. Dominic enjoyed some late night cookies before we hit the sack for our first real day in New York.

I’ve been to the big apple about 10 times for work, but never for play. This is Dominic’s first trip to the city.

Day One:

After getting in so late, we slept in a little bit but managed to get going and over to Grand Central Station which was on the same block as our hotel, the Grand Hyatt. Grand Central has been in so many movies I we had to check it out. I liked the Grand Central Market and Dom liked the constellations in the ceiling.

After Grand Central, we walked over to Bryant Park a few blocks away to meet Matt M. for lunch. I know Matt through the conferences I speak at and thought it would be good for Dom to meet a few New Yorker friends of mine while we were here. As a native New Yorker, Matt provided a number of great suggestions for things to do.

After lunch we headed over to Times Square where we got on one of the touristy City Sights buses. For a first time look at New York, sitting on the top of one of these double decker buses is a quick way to see some of the city. We got off at the Empire State Building and bought express tickets for the 102nd floor. That was nice not having to wait in line, although the ticket line was about 20 min. Not bad.

The view from the 86th floor is great because you’re outside but it’s packed with people. The view from the very top at floor 102 is pretty cool because few people pay the extra $15 but it’s in a room with windows that are smudged and marked up so photos are not so great.

We got on the City Sights bus for a while going through Soho and Greenwich Village finally getting off in China Town. I had been there before, but it seemed so different this time. We walked around a bit looking for Little Italy and decided not to have a late lunch there in favor of a walk back to our hotel on 42nd street, about 40 blocks.

On the way, we passed by Union Square where a number of chess games were going on. We watched one where they used a timer and it was pretty intense at the end. I’d not seen that kind of play before and as a chess fan, Dominic followed right along.

In Grammercy we came upon a Lowes Theater and decided to take a break and see “Indiana Jones and the Kingdom of the Crystal Skull”. Armed with popcorn and nachos, we watched with different perspectives. I’d seen all of the Indiana Jones movies previous and this one was pretty much a repeat with a modified story angle. Dominic might have seen one other Indiana Jones movie and thought it was fantastic. I’m glad he had fun.

Nachos and a movie were followed by a strong urge to walk the calories off. Fortunate for us, we had 20 blocks to go to our hotel. It was dark and a nice way to see part of the city. We ended up at the Grand Hyatt around 10:30 pm and decided to catch a late dinner at one of the hotel restaurants, “The Commodore Grill” which was a gross disappointment. They took my order and Dominic’s then claimed he didn’t order anything. When we “re-ordered” his grilled cheese, it took 25 minutes. They didn’t charge for the grilled cheese, which was sub-par by the Dominator’s standards, but it was lame all the same.

A spot of TV and we were soon asleep. That concluded day one of the Dominator Birthday trip to New York. For Day Two, we planned some time in Central Park, the zoo, lunch with another New Yorker friend and possibly some time in a museum and FAO Schwartz.

Trip to New York July 2008

Dominator and I will be on our way to NYC tomorrow afternoon with plenty planned. A co-birthday gift, we will be doing plenty of touristy things including the Stature of Liberty, Ellis Island, Central Park, seeing a Yankees game, MOMA, Empire State Building, walking the Brooklyn Bridge, seeing Wicked or Lion King plus many wild card activities.

I have 3 meetings during this time, but they are lunch so it should not be too much.

Dom will be shooting photos and some video for posting to his blog and Flickr account. It should be a great experience.

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text:
So Alone.

Our block in San Francisco could start its own cancer support group! Within 100 yards of sidewalk, we’ve got two breast cancer survivors, one lung cancer patient and one bile duct cancer patient.

A couple days ago, I noticed all three of the other cancer patients chatting on the sidewalk. After a few minutes, one of them came up to me. He’s a retired dentist and used to be friendly with my Dad before he died of lung cancer almost 16 years ago. We’ve never actually spoken, but he came up to me that day with a smile, and said, “We have something in common.”

“Yes, I’ve heard that you have cancer,” I said. “How are you?”

“Not good,” he said in a very tired voice. “They only gave me a few months to live, but it’s been three years. My cancer is very rare, but I went back to China to get both traditional Chinese medicine treatment, and modern treatment.”

We chatted for about half an hour. He’s never been in a support group. He doesn’t really have many people to talk to about his disease. As he continued on his daily walk, I noticed how gingerly he stepped down the sidewalk, how washed out he seemed. And yet, he must have steel within to survive so long.

How different it is to have had an obscenely common cancer. Here we are in the Pink Month of Breast Cancer Awareness and everyone is walking, running, signing petitions and making symbolic gestures of support. The teenage daughter of an old friend shaved her head in solidarity this month. As cynical as I am about pink ribbons, I think that’s pretty cool.

But no one is running for bile duct cancer, this neighbor’s affliction. I can’t imagine anything more isolating than having a rare form of cancer: Little research, no community, only your own strength to sustain you.

I suggested he look for an on-line community, but he said most people with his kind of cancer don’t live more than a year. Not much time to link up on the Internet.

How alone my neighbor is. I hope we talk again soon.

Posted in We Gotta Talk | Tagged , , | 5 Comments

The Hardest Idea: Less is More

When I was first diagnosed, my response—other than to turn the whole cancer nightmare into a research project—was to cry, “Nuke it! Nuke it! Nuke It!”

I had the Valkyrie response: “Kill the wabbit! Destroy that cancer! Do everything!”

I wanted, want, to survive for my kid, my husband, my pets, my family, my friends, and yes, myself.

And yet, on the other side of what I hope is my first and last go-round with cancer treatment, I have a more mature appreciation for all the side effects that cancer treatment inflicts. The mouthsores and chemobrain are gone, but I still have less energy than I used to have. I need more sleep, 9 or 10 hours a night, to function effectively. I’m done by 9 p.m. I know that both the Herceptin and the radiation that I received may lead to heart damage down the line (though my echocardiograms have been good so far). Every day, I have cramps caused by the Tamoxifen that blocks my body’s ability to use the estrogen that was candy for my tumor.

One of the things that I think patients find the most frustrating is that, while we’ve come a long way, much of our treatment decision process comes down to the culture of our hospital and our doctors, and our personality, our tolerance of risk. It’s all an educated guess. There’s data, sure, but not nearly enough.

So it was interesting to note a “Science Daily” story today that suggests that, in some cases, less may be more when it comes to breast cancer.

Here is a summary of the main points, from research at the Seattle Cancer Care Alliance:

• Spare the chemo but not the cancer.
Thanks to the Oncotype DX test, which analyzes a panel of genes linked to tumor recurrence, nearly 50 percent of women with early stage, estrogen-reactive cancer can skip the chemo and go straight to hormone therapy. Alas, my Oncotype score was too high to get a pass, but I’m happy for the half of my fellow pink sisters who avoided chemo.

• Use PARP Inhibitors for triple negative cancer.
For the 15 to 18 percent of women who have “triple negative” disease—that is, it doesn’t react to estrogen or progesterone and it doesn’t express the Her-2 protein—there may be hope for treatment with PARP Inhibitors. These drugs prevent the tumor DNA from repairing itself, leading to cell death.

• Spare the radiation but not the cancer.
If the cancer recurs in my left breast, the standard treatment would be a mastectomy, because I’ve reached my lifetime limit of radiation in that breast. SCCA is experiment with another solution: a second lumpectomy followed by five days of radiation delivered only to the tumor bed.

• Spare the lymph nodes but not the cancer.
Today, if they find cancer cells in the lymph nodes under your arm, they usually remove a lot of them. This can lead to painful lymphedema, or swelling of the arm. But SCCA did a study that showed that early-stage patients who had only only one or two positive lymph nodes removed did just as well five years out as those patients who had many nodes removed.

If I ever face a recurrence, it will probably be difficult for me to resist responding aggressively. And yet, what’s the point in using a sledgehammer that knocks me out? What do you think?

Posted in Cancer Research | Tagged , , , , , , , | 9 Comments

Eat Junk as a Kid? That might increase your breast cancer risk

Indiscretions of youth…

Every time I turn around, there seems to be another study showing that diet and lifestyle influence your risk of dread diseases. We have known that about heart disease for a while, and to that we can now add: diabetes, Alzheimer’s, liver disease, kidney disease, metabolic syndrome and a spectrum of cancers, including, of course, breast cancer.

Every time one of these studies comes out, it’s greeted with a chorus of “Gee, whiz!” I’ve long wondered why everyone finds these results at all surprising. I mean, garbage in, garbage out, right?

This week, another such study came out in the Proceedings of the National Academy of Sciences. This time, there’s an interesting wrinkle: What you eat as a kid may influence your risk of breast cancer later in life.

A team lead by scientists at University of California at Davis tested mice by feeding them a certain kind of “conjugated fatty acid” (the geek name for polyunsaturated fat, those found in plant oils) that has been linked to metabolic syndrome, diabetes and other problems of obesity.

The thought behind the study: Early breast development heightens breast cancer risk. Could dietary fat influence breast development? Apparently, epidemiological studies—number crunching Centers for Disease Control statistics and other data—have suggested this link. But no one had shown this hunch to be true in a biological system, i.e. a mouse or a human.

So what did the UC Davis team find? Mice fed these special fats did indeed start to develop breasts and, here’s the kicker: They did so even if their ovaries had been removed! Why is this important? Well, breast growth and puberty have long been thought to start up in reaction to an increase in estrogen produced by the ovaries. Now, this study seems to suggest, it turns out that just eating a lot of fat can kick start breast development, increasing breast cancer risk by increasing the amount of time that breasts are on the scene.

Apparently, according to coverage in the journal Oncology, this is the first direct evidence that dietary fat can act like estrogen, and lead to breast development.

There’s nothing I can do about the Fritos corn chips and Hostess fruit pies that I consumed as a kid, but now I’ve got one more reason to hold my ground during food battles with my own daughter.

Posted in Cancer Research | Tagged , , | Leave a comment

Pretty Bras After Surgery? Wish I’d Known…

File this under the “wish I’d known” category:

Hy husband Pete has a colleague whose wife has just been diagnosed with breast cancer. She sent me an email yesterday, or rather, her husband forwarded an email to me. She’s not feeling too well.

But here’s the thing: She alerted me to the fact that Nordstrom, the Seattle-based luxury department store known for its service, has a free, in-store prosthesis program. You an make an appointment with a prosthesis fitter who will sew a pocket into any bra that strikes your fancy. She’ll do the same with a post-surgery camisole, or enhancer/equalizer post-mastectomy. She’ll help you navigate the strange world of “breast forms.”

You can see a video about the service here:

I am the most boring lingerie person in the world. I’ve worn the same two Warner’s bras and the same briefs for decades. Well, not the same ones, but the same styles! In the run-up to my lumpectomy, I completely forgot about the need for a post-surgery bra. If memory serves, I sent Pete down to the hospital gift shop to pick something up as I was being wheeled into the OR.

It was comfortable. Pretty? Um, no. It looked like something my great-grandmother would have worn 100 years ago before Lycra and elastic were invented. The post-surgery weeks are not exactly a time when you’re feeling sexy, but a more attractive bra would have made me feel a little better, especially since it took me two months to recover.

This does not have to be your fate. Check out Nordstrom’s service. It looks pretty sweet.

Posted in Uncategorized | 4 Comments

Not so Fast

You’d have had to be mostly asleep during the last couple days to miss the news that a big breast cancer study has come out of the National Institutes of Health’s Cancer Genome Atlas Project, a government effort that has already analyzed the genomes of certain ovarian, colorectal, lung, and brain cancers.

The traditional press and the blogosphere have been all a-twitter about how the several hundred researchers involved in the breast cancer study analyzed the genome of the breast cancer tumors from about 800 women and that they’ve “identified four genetically distinct types of breast cancer.”

I wondered about that when I first heard it. When I was first diagnosed—thrown into the deep end of the pool—that was one of the first things that I learned: There are four basic types of breast cancer:
1) Estrogen-reactive (me).
2) Progesterone-reactive (not me).
3) Her-2 positive (me).
4) “None of the above” Formally known as “triple negative” (not me).

As I followed the news coverage, it seemed to me that the big deal was not that they’d “discovered” four new types of breast cancer, but that they’d been able to analyze those four types in stunning depth and that that has revealed some surprises. For instance, they found that some breast cancers seem to have the same genetic mutations as ovarian cancers, opening up the possibility that ovarian cancer drugs might be useful in breast cancer cases. They also identified many, many genetic targets that might lead—someday—to better drugs.

Then, today, I came across a post from MIT’s Knight Science Journalism center that echoed the questions that had been rolling around in my head.

We’ve known since about 2006 that there are four broad sub-types of breast cancer; we just haven’t analyzed the full genomes of those subtypes until now.

The more I follow cancer news, the more it seems that we’re constantly setting ourselves up for disappointment. “Fill-in-the-blank just discovered! Cancer cure on horizon!” We want the cure so badly that we go nuts over every step forward.

Alas, it’s unlikely that there will ever be a single “cure.” It’s more likely that we’ll find a constellation of different targets for drugs, and different constellations for each kind of cancer, and for each subtype of cancer.

This new study is amazing work. It will undoubtedly lead to more research, and, in a few years, new drugs. But it’s not the end to the fight against breast cancer, just one step toward that goal.

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Help Wanted: Medical Planning Project

The days and weeks just after diagnosis can be some of the most confusing and terrifying. There’s so much to learn, so many feelings, so many reactions, so many appointments!

You don’t have to spend much time on cancer websites and message boards to learn that it’s important to bring someone along with you to those myriad medical meetings and procedures.

Alas, there is far, far less help out there when it comes to planning for those medical appointments. How do you decide what’s most important to you as you face treatment? What questions do you want to ask your doctor? How do you identify the key decision points?

At UCSF, I was blessed to be able to take advantage of the pioneering Breast Cancer Decision Services program. The medical center had a recent pre-med graduate call me to discuss my priorities and concerns. She came to my major appointments, taped them, and then provided me with a CD recording and a summary of the information discussed and the decisions that I needed to make. I don’t know what I would have done without Decision Services, and I don’t know why this sort of service isn’t standard.

But it’s not.

Studies are just beginning to show that patients who are more involved in medical decision-making have better outcomes, both medically and psychologically, according to Jeff Belkora, Ph.D, the director of UCSF’s Decision Services. Belkora and the leaders of the UCSF program are helping to start a similar program at Dartmouth University in New Hampshire. The Informed Medical Decision Making Foundation
is funding shared decision making initiatives in Maine, Massachusetts, Iowa, Oregon and several other states. The foundation’s website also offers decision aids for various conditions, including breast cancer.

Yet this sort of doctor-patient-facilitator partnership remains far from common. A couple of Stanford University grads are working to solve this problem by creating an on-line tool that guides breast cancer patients and helps them to prepare for major medical appointments, identifying their priorities and their questions. The program, AVVA, is still in development. But breast cancer patients in the San Francisco and Boston areas can sign up to help work the kinks out of the program so that it can be released to the general public. Just send an email to

If I were still in active treatment, and if I wasn’t a UCSF patient, I’d do it in a heartbeat.

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Freckles are awesome

Today, I go to the UCSF dermatology department to check out this itchy spot on my left breast, the one that’s been there for more than two months, the one the oncology NP wants me to check out, just to be safe.

All week leading up to this appointment, I feel an overwhelming sense of foreboding and anxiety. I find myself so freaked that I fall off the “no drinks during the week” wagon and have a cognac nightcap once or twice just to stop the spiraling panic so that I can sink into sleep’s oblivion. Earlier in the week, I think that I’m just stressing about the usual things: career, kids, the fact that there’s never an excess of money.

Then last night, I get honest. I am scared, scared, SCARED of metastasis. I’m just feeling that life is getting back to normal, just beginning to feel strong again, just finding a new work rhythm. I’m terrified that this little spot, this probably insignificant little spot may be a skin melanoma something that will suck me back into the exhausting, scary halls of Cancerland.

Late last night, talking to my husband Pete about it, the fear feels huge. It is a cold thing. Perhaps because I’ve allowed myself to relax in the last few month, I feel this fear more sharply than I felt it while in active treatment. Pete hugs me and tells me. “It’s OK, go get a small cognac, or you’ll never get to sleep.” Drat that all those sleeping pills I had during chemo are gone.

I oversleep and cycle like a maniac to the dermatologist’s office. He’s very tall, and handsome. He looks at my spot and feels it. Then he puts on magnifying glasses and looks at it more closely. “Don’t worry,” he says. “It’s a lentigo.”

Apparently, that’s a fancy name for a big freckle. It can get irritated and stay around for a while. I can opt to have it frozen off with liquid nitrogen or I can do nothing.

Thanks, I say, I’ve had enough unpleasant medical procedures for a lifetime. I’ll skip the liquid nitrogen. It’s not like I’m going to be posing for Playboy with my lumpectomy-ed left breast. The freckle can stay as long as it’s not cancer.

As I cycle home, the sun seems brighter, the spring flowers more beautiful, the bird song more melodic. Big exhale.

Posted in Day By Day | Tagged , , | 5 Comments