Monthly Archives: April 2012

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Commonly used medications, both prescription and OTC, may have deleterious effects on vision

When we refer to adverse events with medications, we usually focus on systemic consequences. However, we rarely address the fact that eyes can be adversely affected by medications. There have been several studies recently that illustrate this very important point.

It is vital that we recognize the symptoms of eye distress. Some of these may indicate ophthalmic emergencies. The medications recently studied include common therapeutics, such as bisphosphonates, aspirin, a class of antibiotics called fluoroquinolones and a migraine therapy. I will explain the symptoms to be cognizant of with each.

The impact of bisphosphonates

The class of drugs known as bisphosphonates is the mainstay for the prevention and treatment of osteoporosis. Recent adverse news focused on atypical femur fractures and osteonecrosis (death of part of the jawbone), not on an ocular effect. However, in a large retrospective study (looking at past data), oral bisphosphonates were shown to increase the risk of uveitis and scleritis, both inflammatory eye diseases, by 45 percent and 51 percent respectively (CMAJ. 2012 Apr 2. [Epub ahead of print]). One out of every 1,100 patients treated with the drugs suffered from uveitis, and one out of every 370 patients treated suffered from scleritis.

Why is this important? The consequences of not treating uveitis can lead to complications, such as glaucoma and cataracts. The symptoms of uveitis typically include eye redness, pain, light sensitivity, decreased vision and floaters (

For scleritis, the symptoms are severe pain that radiates to the face and around the orbit, with worsening in the evening and morning and with eye movements ( Uveitis affects the iris and ciliary body (fluid inside the eye and muscles that help the eye focus), while scleritis affects the sclera, or white part of the eye.

These adverse eye events occurred only in first-time users. The authors believe the mechanism of action may involve the release of inflammatory factors by the bisphosphonates.

Aspirin yet again?

It seems aspirin can never get a break. It has been implicated in gastrointestinal bleeds and hemorrhagic (bleeding) strokes. Now the European Eye Study suggests that aspirin increases the risk of age-related macular degeneration (Ophthalmology. 2012;119:112-118). The primary effect is seen, unfortunately, with wet AMD, which is the form that leads to central vision loss. The risk of wet AMD is directly related to the frequency of aspirin use. When aspirin is used at least once a week, but not daily, the risk is increased by 30 percent. When it is used daily, the risk of wet AMD jumps to 226 percent. Aspirin also increased the risk of early AMD.

This study was large and retrospective in design, and it included fundoscopic (retinal) pictures, making the results more reliable. The authors recommend that AMD patients not use aspirin for primary prevention, meaning without current cardiovascular disease. However, aspirin use for secondary prevention — for those with heart disease or a previous stroke — the benefits of the medication outweigh the risks.

The role of antibiotics: fluoroquinolones in retinal detachment

Fluoroquinolones may have toxic effects on the synthesis of collagen and on connective tissue, potentially resulting in retinal detachments and Achilles tendon rupture. This is a common class of antibiotics used to treat acute diseases, such as urinary tract infections and upper respiratory infections.

In a recent epidemiologic study, these drugs were shown to increase the risk of retinal detachment by 4.5 times (JAMA. 2012;307:1414-1419). Common fluoroquinolones include ciprofloxacin (Cipro), levofloxacin (Levaquin) and gatifloxacin (Tequin).
Although it sounds like an impressive number, it’s not a common occurrence. It takes the treatment of 2,500 patients before one patient is harmed. Also, this was only noticed in current users, not in recent or past users. However, it is a serious condition.

Retinal detachment is an ophthalmic emergency, and patients need to be evaluated by an ophthalmologist urgently to avoid irreparable damage and vision loss. Retinal detachments are treatable with surgery. Best results are seen within 24 hours of symptoms, which include many floaters, bright flashes of light in the periphery and a curtain over the visual field ( Fortunately, retinal detachments usually only affect one eye.

Migraine medication

Topiramate (Topomax) is a drug used to treat and prevent migraines. In a recent case-control (with disease vs. without disease) study, topiramate increased the risk of glaucoma in current users by 23 percent. The risk more than doubled to 54 percent in first-time users (Am J Ophthalmol. 2012 May;153(5):827-30). The mechanism of action may be related to the fact that topiramate increases the risk of intraocular pressure.

It is important to be aware that medications not only have systemic side effects, but ocular ones as well. Many of these medications cause adverse effects that require consultation with an ophthalmologist. If you have ocular symptoms related to medications, contact your physician immediately.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website and/or consult your personal physician.

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Former Suffolk County Executive Steve Levy. File photo

By Elana Glowatz & Rachel Shapiro

Suffolk County officials, including former County Executive Steve Levy, “intentionally corrupted and undermined” the Ethics Commission and contributed to its disbandment, according to a special grand jury report released April 19.

Testimony in the report by unnamed county officials alleges that County Official E, who worked in the county executive’s office, attempted to influence ethics commissioners’ decisions; tried to use an ethics complaint as leverage against a legislator to influence his vote; and had not received proper authorization to file financial disclosure forms, among other offenses.

Based on previous reporting, this newspaper determined that County Official E is Levy.

Testimony in the report alleges that other county officials colluded with Levy in these actions as well as committed separate offenses. County Official H, the report said, was an Association of Municipal Employees worker who filled out his time sheets and calculated his accruals as a management employee, leading to him receiving more than $14,000 in health benefits he did not earn.

This newspaper, also based on previous reporting, has determined County Official H to be Alfred Lama, the former executive director of the Ethics Commission.

No charges have been filed against the officials, as testimony did not reveal any illegal activity. The grand jury instead made recommendations to the executive and legislative branches — including creating penalties for ethics violations such as improperly influencing the members of an ethics board or commission — and future county ethics bodies, such as enacting procedural guidelines regarding complaints, hearings and decisions.

Levy took issue with the report. It was “based in large part on testimony from political detractors of the county executive,” he said in a statement shortly after it was released Thursday.

He said seeking the commission’s opinion on a potential conflict of interest, as he did in the case of the legislator, “is not an abuse of the Ethics Commission, it’s the very reason you have one,” and that he did not tell Ethics Commission members how to vote on any issue.

The former county executive also took issue with the report saying that while, for a time, he only filed state financial disclosure forms, he was obligated to file county forms, which the report said were more thorough.

Mark Davies, a former executive director of the Temporary State Commission on Local Government Ethics who drafted state ethics law, said in written testimony to the Suffolk County Legislature in September 2010 that “on the whole, the state form is more extensive than the county form.” He argued that because the county form lacked certain categories, such as offices in political parties and organizations and agreements for future employment, it was not in compliance with state law. Legislation has since been introduced to bring the local form into compliance with state law.

Levy also said that state law mandated the county to accept the state form over the county form, something the grand jury report said “remains an open question with advocates on both sides publicly arguing their positions.” Lama advised the former county executive without a ruling from the entire Ethics Commission, saying Levy could file the state form instead of the county form.

The grand jury report also discussed the findings of an audit by the county comptroller. Lama, who was the ethics commission’s executive director from 2004 until it was abolished, was audited last year. According to the document from Comptroller Joe Sawicki’s office, the investigation was to determine whether the director’s hours worked from 2004 to 2011 had been logged correctly, and whether he was given appropriate pay and health benefits according to the hours he had worked.

The grand jury report said Lama, an AME union employee, had filled out his time sheets as if he were a management employee. It also said there was no evidence of fraud on Lama’s part.

Sawicki said in an interview that he began reviewing Lama’s time sheets and found that the director had often worked less than 50 percent of the work week. The audit states, “[Lama] worked 84 percent of the required full-time hours in 2005 and only 49 percent of the required full-time hours in 2010.” The audit states the county attorney did not change the position to part-time so the director would have the flexibility to work full-time if needed.

The comptroller’s audit found that Lama had been overpaid more than $8,000 in wages and had received more than $14,000 in health insurance coverage premiums that he did not reimburse to the county — from periods when he worked less than 50 percent of the work week and therefore, the audit stated, was not entitled to the premiums.

According to the Suffolk County AME contract, part-time employees “must work greater than 50 percent of the established work week to be entitled to benefits.” Those who fall below that mark, the contract says, may purchase health insurance on a pro rata basis.

Lama said in a phone interview Tuesday that he did not know he was a union employee, and filled out his time sheets for the 7.5-hour day of a management employee.

The grand jury report said Lama signed a “new employee orientation” document, acknowledging his “receipt of the collective bargaining agreement for his AME position and his AME enrollment card.” However, Lama said he went to an orientation when he was hired and “they handed me a piece of paper and I signed it. I wasn’t aware that they were going to put me into the union.”

He added that he always tried to be “as truthful as possible” when filling out his logs, and questioned why it took so long for someone to tell him he was filling in his time sheets incorrectly. “Don’t wait until the end of the rainbow and tell me I made a mistake,” he said.

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Recent research suggests how the brain puts together multisensory information

Rats are not only capable of learning a maze to get to a reward (the coveted cheese, for example), but they also have the ability to process a combination of slow or fast flashes and clicks to learn whether their prize will be on the left or right side of a cage.

Cold Spring Harbor neuroscientist Anne Churchland recently published a paper in the Journal of Neuroscience that shows that rats are capable of putting together combinations of sights and sounds and changing their behavior to fill their rat stomachs.

The results suggest rats may prove to be effective mammalian models for understanding the neuronal circuitry that other mammals (namely, say, humans) use to process information around them and make decisions about courses of action.

“Very little is known about how the brain puts together multisensory information,” Churchland said. “It’s a mystery how neural circuits of the brain make this happen. An animal model can really get at the neural mechanism that underlies multisensory integration.”

While Churchland’s study was a behavioral one — flash the lights, make the sounds and see where the rat goes — she also plans to add electrophysiological data. That means she will study the neurons that are active as a rat combines pieces of information. Neurons are cells that transmit information through chemical and electrical signals.

By looking closely at the responses of rats, she hopes to figure out how these signals come together.

For some people, reacting to and processing a combination of sights and sounds is sometimes “impaired when compared to typically developing peers,” Churchland explained. Some people, for example, struggle when they go into a multisensory environment, like a grocery store.

“If we understand the sensory side more, we’ll be in a better position to treat those aspects of the disorder,” she explained.

Some people with autism spectrum disorders have a hard time interpreting cues such as a tone of voice, body posture, or the look on someone’s face.

Understanding the sensory side of some of these disorders can put scientists and doctors “in a better position to treat” people, Churchland said.

The Cold Spring Harbor neuroscientist works much more on basic research and is not directly involved in clinical applications.

“I hope that our work might inform the ongoing foundation of knowledge that the community is starting to have about autism spectrum disorders,” she expounded.

Some of Churchland’s passion for addressing autism comes from her experience as a camp counselor and as a babysitter, where she took responsibility for a child with autism. While earning her undergraduate degree at Wellesley College, she took courses in child and cognitive development, even as she was earning a degree in math.

After college, she worked at the University of California at San Francisco, where she “fell in love with lab work,” she recalled. “Doing science captured my imagination. The big questions are so exciting.”

Aside from babysitting and camp, Churchland had plenty of opportunities to think about development and, specifically, neuroscience. Her parents, Anne and Paul Churchland, are neuroscientists and philosophers. Indeed, they met in a philosophy class.

“Their enthusiasm for the field was contagious, not just for me, but it inspired many people,” Churchland said. They addressed questions, she explained, such as, how our brains make us who we are, and how we navigate through the world.

She said her parents didn’t encourage her and her brother Mark to pursue careers in neuroscience.

“When we were undergraduates, NIH [National Institutes of Health] funding was at a low level, as it is now,” she explained.

Still, that didn’t keep either her or her brother Mark away, as both of them have now developed careers in experimental neuroscience.

“I feel really lucky to have a family with so many shared interests,” she said. Some day, she hopes to collaborate with her brother, who works at Columbia University.

As for her immediate family, Churchland is married to Michael Brodesky, who works at Bookish in Manhattan, lives at Cold Spring Harbor, and has two children who are in the early stages of primary school.

In her first experience of living in New York, she lauded Long Island for its hiking and biking trails and kayaking opportunities.

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Rheumatoid arthritis is one of many autoimmune diseases, where the body’s immune system begins to attack the body’s own tissue. RA results in systemic (throughout the body) inflammation which initially affects the synovium (lining) of the small joints in both the hand and the feet bilaterally, as well as the wrists and ankles ( It causes pain, stiffness and swelling of the joints.

RA, like most autoimmune diseases, affects significantly more women than men ( and can be incredibly debilitating. It affects approximately 1 percent of the U.S. population (Arthritis Rheum. 2008;58:15-25). Fortunately, treatments have helped to significantly improve sufferers’ quality of life.

RA may be treated initially with acetaminophen and NSAIDs (such as ibuprofen), depending on its severity. To help stop progression and preserve the joints, disease modifying anti-rheumatic drugs (known as DMARDs) may be used. They are considered the gold standard of treatment for RA and include methotrexate, which has been around the longest and is a first-line therapy; plaquenil (hydroxycholorquine); and TNF inhibitors, such as Enbrel (etanercept), Humira (adalimumab) and Remicade (infliximab).

DMARDs work by reducing inflammation and acting as immunosuppressives, basically tamping down or suppressing the immune system. These drugs have helped RA patients improve their quality of life, preserving joint integrity and causing RA to go into remission.

The downside of using immunosuppressive drugs

Unfortunately, DMARDs have significant adverse effects. They include black-box warnings of serious or life-threatening side effects, such as opportunistic infections — more likely in combination with other immunosuppressives — and malignancy.

Anecdotally, I recently had a patient who had previously developed pneumonia twice, multiple basal-cell carcinomas and one episode of melanoma. These were attributed to use of a TNF inhibitor.

Skin cancer risk

In 2009, the FDA warned that there is an increased risk of cancer after about 30 months of treatment, especially with TNF inhibitors. A 2011 meta-analysis (a group of 28 studies) found that TNF inhibitors may increase the risk of cancers, including skin cancers (Ann Rheum Dis. 2011 Nov;70(11):1895-904). In four of the studies, there was a 45 percent elevated risk of developing skin cancer other than melanoma. However, in data pooled from two of the studies, there was a 79 percent greater chance of developing melanoma. All the studies in this analysis were observational studies, and the absolute risk of developing cancer is small. The good news is that this analysis did not appear to show increased risk of lymphoma.

Complications from RA

RA can also affect organs and the surrounding tissue. Thus, complications from RA include heart disease, stroke, atrial fibrillation, chronic obstructive pulmonary disease, fracture risk, as well as uveitis and scleritis (inflammatory disorders of the eye).

Cardiovascular disease

Patients with RA are at a threefold increased risk of developing coronary artery disease, compared to the general population (Ann Rheum Dis. 2007;66(1):70). Those RA patients who stopped taking statins for high cholesterol and/or heart disease, had a 60 percent increased risk of cardiovascular mortality and a 79 percent increased risk of all-cause death after three months (Arthritis Care Res [Hoboken]. 2012 Mar 29). Though statins have their pitfalls, they can be potentially lifesaving in the right context. Don’t discontinue statins before consulting your physician.

Non-pharmacologic approaches

Exercise and fish oil have shown reductions in symptomatology and joint inflammation. In a meta-analysis (a group of 17 trials), omega-3 fish oil reduced joint pain intensity, as reported by patients, minutes of morning stiffness, number of painful joints and NSAID use significantly (Pain. 2007 May;129(1-2):210-23). The dose was at least 2.7 g of EPA plus DHA in the omega-3 fish oil and took at least 12 weeks of treatment to see a benefit.

Exercise is also important to relieve joint pain and stiffness. In a meta-analysis of 14 studies, there was a 69 percent reduction in pain with aerobic exercise (Br J Sports Med. 2011;45(12):1008-1009). Understandably, however, a study found that 42 percent of RA patients don’t work out at the recommended minimum of 10 minutes of moderate exercise daily (Arthritis Care Res [Hoboken]. 2012 Apr;64(4):488-93). The reasons were that half were either not motivated or believed that exercise had no benefit.


In the Iowa Women’s Health Study, results showed that supplemental vitamin D decreased the risk of RA by 34 percent (Arthritis Rheum. 2004 Jan;50(1):72-7). This study involved almost 30,000 women followed over an 11-year period.

The best way to treat an autoimmune disease like rheumatoid arthritis is to prevent it with an anti-inflammatory diet, exercise and omega-3 fish oil. Barring that, however, it is encouraging that DMARD treatments may be effective at half the dose once the disease has been suppressed significantly. Therefore, a low-dose pharmacological approach coupled with non-pharmacological lifestyle adjustments may produce the best outcomes with the fewest adverse reactions.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website and/or consult your personal physician.

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Donald Porter, recipient of NSF Career Award, works on ‘cloud’ computing

Donald Porter was such a childhood fan of Sesame Street that he named his computer lab at Stony Brook OSCAR (for Operating System Security Concurrency and Architecture). His desktop is Kermit and his favorite 48-core test machine is Miss Piggy.

An assistant professor who joined Stony Brook just over a year ago, Porter, like the charming Muppets of his youth, is driven by a desire to teach.

Indeed, his promising research and dedication to teaching recently helped him win a prestigious Career award from the National Science Foundation, which recognizes promising junior faculty members around the country. The NSF will give his lab $400,000 over the course of five years.

“It’s very exciting,” he said. “This will give me funds to hire graduate research assistants, buy computing equipment and do other things that will help me get my research agenda going.”

Porter, who teaches a graduate course on operating systems, said when he explains something to students, it often winds up helping him with his research by forcing him to distill his thoughts.

“If you can’t teach someone else why things are the way they are, it may be hard to make them better in a clear way,” he suggested.

He said his teaching philosophy is to “demystify the computer, so people can really understand what’s going on.”

In a graduate-level operating systems course, he gives students a system developed at MIT in which there are “holes” in a source code. The students have to write the key pieces of the software themselves, including memory management, switching one running program to another, a network-card driver and the file system.

“There is no better way to understand how operating systems perform these central tasks than to write them yourself,” he advocates.

Associate professor Erez Zadok, who has been at Stony Brook for over a decade and has been teaching the popular graduate operating systems course since he arrived, applauded his colleague.

“There’s a small window when you can win this very prestigious award,” Zadok said. “We were delighted to hear he’d won it on the first shot, no less. It’s quite an achievement.”

As for his research, Porter works in an area called cloud computing, where a single computer can use several operating systems at the same time. The technique allows Apple computer users, for example, to run a Windows program at the same time they are also using a Mac operating system.

The process involves sharing resources, software and information. The concept not only allows those who own different hardware to use the software from other computers, but also allows businesses to adjust their technology resources to meet unpredictable demand.

“You can think of the cloud as very cheap, short-term computer rentals,” Porter said. “If you were launching a new product you could temporarily and affordably rent extra servers in the cloud to help meet peak demand for extra orders.”

Porter thinks about ways to divide the labor among the various parts of a computer functioning at the same time. He explained that the numerous systems — the hardware, the operating system, the language system, and the application library, to name a few — work at the same time and may interfere with each other. He wants to look closely at whether there are “better interfaces that make common problems less common.”

Porter hopes his research has a practical impact on industry and on the ways people use and interact with computers.

Porter doesn’t have a statue of Oscar or a puppet in his lab yet. If he needed one, he might borrow something from his wife, Lindsay Porter, a first- and second-grade teacher at Love of Learning Montessori School in Centerport.

“I owe a certain amount of my success to the support of my wife,” Porter acknowledges. “She put up with long hours and flak under deadline and also provided emotional and spiritual support.”

The Porters live in Setauket, an easy ten-minute bike ride to OSCAR and friends at his computer science lab. They moved just over a year ago after he earned his doctorate from the University of Texas at Austin.

“It’s easy to feel like this is home,” offered Porter.

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Dehydration is a topic that is often overlooked or is given only cursory thought, but it’s very important. Dehydration is simple to avoid, right? Not necessarily. We may be dehydrated prior to experiencing symptoms of thirst. With summer right around the corner, especially with this year’s above-average temperatures, this seems an appropriate topic. Complications and symptoms of dehydration can be mild to severe, ranging from constipation, mood changes, headaches and heart palpitations to heat stroke, migraines and heart attacks.

Effect on headaches and migraines

Temperature is a potential trigger for headaches and migraine. As the temperature rises by intervals of 9 degrees, the risk for headache and migraines increases by 8 percent (Neurology. 2009 Mar 10;72(10):922-7). This study involved 7,054 participants from one emergency room site. Warmer temperatures can potentially reduce blood volume in the body, causing dilation of the arteries, resulting in higher risk of headaches and migraines.

In another study, those who drank four cups more water had significantly fewer hours of migraine pain than those who drank less (Handb Clin Neurol. 2010;97:161-72). Headache intensity decreased as well. Anecdotally, I had a patient recently who experienced a potentially dehydration-induced migraine after playing sports in the sweltering heat of Florida. He had the classic aura and was treated with hydration, tylenol and caffeine, which helped avoid much of the suffering.

The impact on heart palpitations

Heart palpations are very common and are broadly felt as a racing heart rate, skipped beat, pounding sensation or fluttering. Dehydration and exercise are contributing factors ( They occur mainly when we don’t hydrate prior to exercise. All we need to do is drink one glass of water prior to exercise and then drink during exercise to avoid palpitations. Though these are not usually life threatening, they are anxiety producing for patients.

Heart attacks

The Adventist Health Study, an observational study, showed a dose-response curve for men (Am J Epidemiol 2002 May 1; 155:827-33). In other words, group one, which drank more than five glasses of water daily, had the least risk of death from heart disease than group two, which drank more than three glasses of water daily. Those in group three, which drank less than two glasses per day, saw the least amount of benefit, comparatively. For women, there was no difference between groups one and two; both fared better than group three.

The reason for this effect, according to the authors, may relate to blood or plasma viscosity (thickness) and fibrinogen (a substance that helps clots form).

Mood and energy levels

In a recent study, mild dehydration resulted in decreased concentration, subdued mood, fatigue and headaches in women (J. Nutr. February 2012 142: 382-388). In this small study the mean age of participants was 23, and they were neither athletes nor highly sedentary. Dehydration was caused by walking on a treadmill with or without taking a diuretic (water pill) prior to the exercise. The authors concluded that adequate hydration was needed, especially during and after exercise.

I would also suggest, from my practice experience, hydration prior to exercise.

Different ways to remain hydrated

Now we realize we need to stay hydrated, but how do we go about this? How much water we need to drink depends on circumstances, such as diet, activity levels, environment and other factors. It is not true necessarily that we all should be drinking eight glasses of water a day. In a recent review article, the authors analyzed the data, but did not find adequate studies to suggest that eight glasses is supported in the literature (AJP – Regu Physiol. 2002;283:R993-R1004). It may actually be too much for some patients.

You may also get a significant amount of water from the foods in your diet. Nutrient-dense diets, like the Mediterranean or DASH, have a plant-rich focus. A study mentions that diets with a focus on fruits and vegetables increases water consumption (Am J Lifestyle Med. 2011;5(4):316-319). As you may know, 95 percent of their weights are attributed to water. An added benefit is an increased satiety level without eating calorically dense foods.

The myth: Coffee is dehydrating

In a recent review, it was suggested that caffeinated coffee and tea don’t increase the risk of dehydration, even though caffeine is a mild diuretic (Exerc Sport Sci Rev. 2007;35(3):135-140). With moderate amounts of caffeine, the liquid has a more hydrating effect than the diuretic effect.

Thus, it is important to stay hydrated to avoid complications — some are serious, but all are uncomfortable. Diet is a great way to ensure that you get the triple effect of high amount of nutrients, increased hydration and sense of feeling satiated without calorie-dense foods. However, don’t go overboard with water consumption, especially if you have congestive heart failure or open-angle glaucoma (Br J Ophthalmol. 2005:89:1298–1301).

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website and/or consult your personal physician.

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Understanding the basic properties of mixing fluids

As a child in France, Thomas Cubaud grew up watching rivers, waves in the ocean, tides, and even the vortex that formed as bathwater ran down a drain.

Fast forward to now and the assistant professor at Stony Brook University has turned his passion for understanding the way fluids move and interact with each other into an award-winning developing career in mechanical engineering.

Cubaud works in a field called microfluidics. That means he mixes tiny amounts of different kinds of fluids (often very viscous or thick liquids with less viscous liquids or solvents). In addition to producing magnificent images, he also tries to understand the nature of the way these liquids mix.

Microfluidics is a relatively new science that was developed about 30 years ago. It has applications in a wide range of fields and helped produce such products as inkjet printheads, DNA chips, and microthermal technologies.

While aware of the potential applications of his research, Cubaud is much more focused on understanding the basic properties of mixing.

When researchers like Cubaud mix a very viscous liquid with a solvent in small amounts, they maximize the surface area (or points of contact) between the two liquids. While that could be an advantage in mixing, they also see what’s called laminar flow, where those two liquids form parallel layers and glide past each other, rather than mixing.

Enter viscous buckling. To picture this, take honey from a pantry and pour it on toast. As it comes out of a jar held a few inches above the toast, the honey falls in lines back and forth, looking like coiled rope. If the honey were falling through another thick liquid instead of air, the buckling back and forth would promote turbulent flow (converting the laminar flow — not good for mixing — into turbulent flow — much better for mixing).

One of the goals of Cubaud’s research is to understand the role of different properties, such as viscosity and surface tension, on the flow of fluids on a small scale.

In his experiments, Cubaud varies the speed at which he injects one fluid into another, the pressure and the thickness of the liquids.

Cubaud’s research showed sufficient promise that he recently won the Career Award from the National Science Foundation, which will give him $400,000 over a five-year period.
The award is given to promising young faculty members at universities around the country to support their teaching and research.

“The challenge is to find the best operating condition. We need to do experiments with different materials and new methods to characterize the flows,” he said.

Jon Longtin, an associate professor at Stony Brook and Cubaud’s mentor, sees considerable promise in his junior colleague.

“He is a genuine top-notch scholar,” Longtin said. “When he gets his arms around an idea, he wrestles it to the ground until he figures out exactly what is going on.”

Longtin said microfluidics has become a hot topic in science, which means there is increased competition for funding.

“He has carved out a niche for himself,” Longtin described. “He’s looking at fluids that have disparities in thickness. He found interesting things that happen that are not necessarily obvious. He’s had a lot of success.”

Cubaud’s research also examines a process called carbon sequestration, where carbon dioxide is removed from the air and absorbed into liquids.

“Injecting carbon dioxide gas with liquids in microgeometries permits us to significantly increase the surface area of contact between the fluids,” he said. “The knowledge that will be gained during the project will help frame future carbon sequestration applications.”

Cubaud pointed to a biological system that already uses microscale interactions between gases and liquids: the lungs, where blood gives up carbon dioxide and takes in oxygen.

Microfluidics allows scientists to achieve a basic understanding of new physical interactions, he said.

“A key aspect of miniaturization technology is that, up until recently, we could only observe phenomena,” he said. “Today, not only can we observe, but we can also directly intervene on small-scale mechanisms.”

Echoing the observations of the young boy in France who watched rivers, oceans and whirlpools in a bathtub, Cubaud said: “When you just do an experiment, you find unexpected results. It’s very exciting to see something possibly unexpected occurring.”

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Alcohol: weighing the risks versus the benefits

There is much confusion over whether alcohol is beneficial or detrimental to your health. The short answer is: It depends on your circumstances, including your family history and consideration of diseases you are at high risk of developing. Alcohol is one of the most widely used over-the-counter drugs.

Several new studies have been published, some touting alcohol’s health benefits with others warning of its risks. The diseases addressed by these studies include breast cancer, heart disease and stroke. It is important that context becomes the determining factor for alcohol intake.

Breast cancer impact

In a meta-analysis (group of 113 studies), there was an increased risk of breast cancer with daily consumption of alcohol (Alcohol and Alcoholism: published online March 29). The increase was a modest but statistically significant 4 percent, and the effect was seen at less than one drink per day. The authors warned that women who are at high risk of breast cancer should not drink alcohol or should drink it only occasionally.

It was also shown in the Nurses’ Health Study (an observational study) that drinking three to six glasses per week increases the risk of breast cancer modestly over a 28-year period (JAMA. 2011;306:1884-1890).

This study involved over 100,000 women. Even a half-glass daily of alcohol was associated with a 15 percent elevated risk of invasive breast cancer. The risk was dose-dependent, with one to two drinks per day increasing risk to 22 percent, while those having more than drinks per day had a 51 percent increased risk.

A drink several times a week may have the least impact on breast cancer, if you are going to consume alcohol. According to an accompanying editorial, alcohol may work by increasing the levels of sex hormones, including estrogen, and we don’t know if stopping diminishes the effect, although it probably does (JAMA. 2011;306(17):1920-1921).

Stroke effects

On the positive side, the Nurses’ Health Study demonstrated a decrease in the risk of both ischemic strokes (caused by clots) and hemorrhagic strokes (caused by bleeding) with low to moderate amounts of alcohol (Stroke: published online March 8). This analysis involved 83,578 women. Those who drank less than 0.5 glasses of alcohol daily were 17 percent less likely than nondrinkers to experience a stroke. Those who consumed 0.5 to 1.5 glasses a day had a 21 percent decreased risk of stroke, compared to nondrinkers.

However, women who consumed more experienced a decline in benefit, and drinking more than three glasses resulted in a nonsignificant increased risk of stroke. The reasons for alcohol’s benefits in stroke have been postulated to involve an anti-platelet effect (preventing clots) and increasing HDL (“good”) cholesterol. Patients shouldn’t drink alcohol solely to get the stroke protection benefits.

Heart effect

In the Health Professionals follow-up study, there was a substantial decrease in the risk of death after a heart attack from any cause, including heart disease, in men who drank moderate amounts of alcohol compared to those who drank more or were nondrinkers (Eur Heart J: published online March 28).

Those who drank less than one glass experienced a 22 percent reduction in risk, while those who drank one to two glasses saw a 34 percent reduction in risk. The authors mention that binge drinking negates any benefits. This study has a high durability spanning 20 years.

Alternative to alcohol for nondrinkers or in addition to alcohol for drinkers

An analysis of the Nurses’ Health Study recently showed that those who consumed more citrus fruits had approximately a 19 percent reduction in the risk of stroke (Stroke: published online Feb. 23). These results were similar to the reduction seen in the Nurses’ Health Study with modest amounts of alcohol.

The citrus fruits used most often in this study were oranges and grapefruits. Of note, grapefruit may interfere with medications such as Plavix (clopidogrel), a commonly used anti-platelet medication to prevent strokes ( Grapefruit inhibits the CYP3A4 system in the liver, thus increasing the levels of certain medications.

Alcohol in moderation

Moderation is the key with alcohol. It is very important to remember that alcohol is a drug that has side effects, such as insomnia. The American Heart Association recommends that women drink up to one glass a day of alcohol.

I would say that less is more. To get the stroke benefits and avoid the increased breast cancer risk, half a glass of alcohol per day may be the ideal amount.

Moderate amounts of alcohol for men are up to two glasses daily, though one glass showed significant benefits. Remember, there are other ways of reducing your risk of these maladies that don’t require alcohol.

If you like to drink, it doesn’t mean you can’t and you can even garner advantages for your health. However, don’t force yourself to drink.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, go to the website and/or consult your personal physician.

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0 2004

Cold Spring Harbor scientist’s discoveries also focus on cancer treatment

One Sunday in the fall of 2010, Alea Mills needed a break from one of her more mundane jobs — writing proposals to get money. She decided to check on her mice.

When she did, she couldn’t contain her excitement. She’d worked with mice for years and yet these were clearly different. She called her husband Ross Maddalena, an actor who doesn’t particularly enjoy visits to her lab — especially during a football Sunday.

“Please, please, please,” she begged. “You have to come. I need somebody else to observe this.”

Maddalena, an extra in movies like “Mr. Popper’s Penguins” and “Salt” who has taken cues from his wife’s career as he followed her from California to Texas to Long Island, drove to her lab at Cold Spring Harbor, where she has conducted research since 2001.

Even without any scientific expertise, Maddalena recognized the changes. Mills had created a mouse model for autism. Using a hand-held video camera, he recorded the mice. Mills said she has watched the movie dozens of times.

A researcher who has made important cancer discoveries, Mills took the unusual step of using her expertise in chromosome engineering — changing the genetic blueprint of an animal — to study autism.

“I saw [autism] as a genetic problem,” Mills said. “We can generate models where we can make the same precise changes as in various diseases.”

By using a form of molecular scissors, Mills took out a 27-gene region on chromosome 16 in mice.

“We didn’t know what to expect,” Mills recalled. “Could we see anything different with respect to the behavior or the brain anatomy of the mice? The answer is yes. Those genes are regulating fundamental processes that are evolutionarily conserved to some degree and are causing the same type of changes.”

Indeed, these genetically altered mice also showed eight regions in their brains that were larger than normal.

Her results, which were published last October in the prestigious journal Proceedings of the National Academy of Sciences, created a buzz in the world of autism research.

At this point, Mills, who is a resident of Lloyd Harbor, is fine-tuning her autism research to look at even smaller areas within that genetic region. She is also looking more closely at the brains of these mice to see if she can connect some of the more severe behaviors to the biggest changes in brain structures.

While extending this research to understanding the development of autism in humans remains a challenge and will require considerably more work, Mills said this could prove an important step in diagnosis and treatment.

People typically show signs of autism at around 2 or 3 years old, Mills said. In mice, Mills and her postdoctoral research fellow Guy Horev can often detect changes in one to two days after birth.

Researchers like Mills need to figure out the mechanism in which these genes might lead to autism and, once they do, work on a potential clinical model to correct it. Mills cautions that there is considerable work left to do to understand the pathways that lead to autism in humans.

While she will continue to oversee autism research, Mills will also direct and conduct studies on cancer, where she discovered Chd5 and p63. Scientists had long sought Chd5, a gene that produces a protein that prevents cancer. Indeed, the amount of Chd5 protein a patient has is a predictor of treatment outcome for cancer patients. The p63 gene, meanwhile, produces some proteins that suppress cancer, while it manufactures others that promote it. The effect of p63 depends on the type of cell.

Perhaps Mills’ upbringing on a 60-acre piece of property in upstate New York made her comfortable looking out to the horizon for answers to a wide range of questions. The only girl in a family of five children, she said she and her siblings “ran rampant.”

At the same time, when Mills was as young as 3, her mother often encouraged her to slow down and look closely at a small piece of grass, where she could study a flower or a worm.

Those days of watching worms brought her to Cold Spring Harbor, where she witnessed the excitement of her own breakthrough with the first mouse model of autism one Sunday in 2010.