Monthly Archives: October 2013

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Alistair Rogers left his home in Rocky Point and traveled to Barrow, Alaska, which is above the Arctic Circle and is the northernmost community in the United States, for five weeks this summer. Rogers foregoes the cycling group he enjoys on Long Island and a home with a comfortable bed to live in a dormitory-style room, complete with bunk beds.

Where Rogers works, the mosquitoes can be so aggressive that he wears a full bodysuit, complete with hood and gloves. Any piece of exposed skin becomes a target for bloodthirsty bugs.

For Rogers, a plant physiologist in the Environmental Sciences Department at Brookhaven National Laboratory, Barrow is an ideal location to study how tundra plants, many of which are grasses and small shrubs, take up carbon dioxide. His research will contribute to improving models other scientists have created for the climate in 2050 and beyond. Rogers is a part of a multidisciplinary study called Next-Generation Ecosystems Experiments in the Arctic. The 120 scientists in the study come from Oak Ridge, Lawrence Berkeley and Los Alamos National Laboratories, the University of Alaska, Fairbanks and several other institutions.

The group measures the changes in the physical, chemical and biological response of land-based ecosystems in Alaska. One of the biggest unknowns is how much carbon dioxide some of these plants can take up as a part of photosynthesis.

Rogers’ data, he said, shows that the models’ assumptions were wrong: the models underestimate the capacity for carbon dioxide uptake by three to five times. Armed with a Licor 6400 photosynthesis instrument, Rogers puts a leaf in the chamber and controls carbon dioxide concentration, light intensity, humidity and temperature. The instrument measures the amount of carbon dioxide and water released.

The Arctic is an especially important region to study because the permafrost is beginning to thaw and degrade. Once that happens, dead plants trapped in the ice release their stored carbon dioxide, which has the potential to increase the rate of global climate change, he said.

“The greatest uncertainty surrounds the fate of frozen organic matter that only now is becoming accessible to microbial degradation as permafrost thaws and degrades,” he explained. The thaw also creates opportunities for plants because of the availability of nutrients. The question, he explained is whether the greening of the Arctic will counter the release of old carbon.

Other researchers have appreciated how Rogers has contributed to the group’s understanding of the tundra. “While many scientists classically trained in biochemistry stay in the laboratory and wear a white lab coat, Alistair has taken the sophistication of a modern-day laboratory to the frozen tundra,” said Stan Wullschleger, the projector director for NGEE Arctic from Oak Ridge National Laboratory.

“We have Alistair and a few others to thank for making measurements that show how much more there is to know about the sensitive and poorly understood ecosystems.”

Wullschleger said the soil and plants in the arctic are “critical to our understanding of how our planet works.” The mosquitoes and the separation from Long Island notwithstanding, Rogers described the experience of traveling to Barrow as “a real privilege. Not many people get to go up to the top of the world.”

He said the local Inupiat still hunt whale. He has eaten something called mikiaq, which is raw whale blubber that is fermented in whale blood for a number of weeks. “I bolted it down as quickly as possible,” he said. “Heavy salting improved the flavor” but it most definitely did not “taste like chicken.”

A native of England, Rogers said he enjoys the Long Island weather. He appreciates the proximity to parks and beaches.

Rogers initially started his scientific career with a focus on animals. He transitioned, however, to plants when he “realized as an undergrad that plants determine the rate of global change.”

Rogers has contributed to the development of the next generation of scientists on Long Island. Three times, the Department of Energy has named the BNL scientist an outstanding mentor for undergraduate research programs: in 2009, 2004, and 2002.

“I really enjoy” mentoring, he said. The questions from curious students can “keep you on your toes and that’s a good thing.”

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May reduce the risk of mortality in women

The calcium controversy continues to be a hot topic, with several new studies seemingly contradicting previous studies. The crucial question: Is there any benefit to taking calcium to prevent bone fractures? If so, which demographic benefits most, and how much should be consumed? From what sources should we get calcium: diet, supplement or both?

Recently, the U.S. Preventive Services Task Force took calcium supplementation to task. In February, the USPSTF said that the evidence for both calcium and vitamin D was inconclusive in preventing bone fracture risk in healthy men and in premenopausal and postmenopausal women. Therefore, they do not recommend that postmenopausal women without history of fracture take calcium or vitamin D supplements for bone health (Ann Intern Med. 2013;158:691-696).

In contrast, in 2011, the Institute of Medicine recommended calcium supplements of up to 800 to 1000 mg to reduce the risk of bone fracture in healthy adults (IOM.edu). Both the IOM and the USPSTF based their recommendations on two large systematic reviews that were not without their weaknesses. This implies that further evidence may be needed to determine the best approach.

Calcium supplementation has risks. There are potential increased risks of heart attacks, kidney stones and elevated cholesterol. In one of the most recent randomized controlled trials, postmenopausal women with already elevated cholesterol saw a significant further increase in cholesterol over two years when given 800 mg of supplemental calcium (Am J Clin Nutr. 2013 Nov.;98:1353-1359).

Regardless of the controversy, one thing is clear: postmenopausal women are at the greatest risk of having fractures and developing osteoporosis (clevelandclinic.org). In fact, one in two postmenopausal women will experience a fracture from osteoporosis. For those with hip fractures, there is a 400% increased risk of dying in the first three months, and one in five will lose her independence (Ann Intern Med. 2013;158:691-696, 701-702).

 

Cardiovascular impact

There have been several studies showing that calcium may increase heart attack risk. To read more about these studies, please read my Feb. 26 article entitled, “Calcium’s effect on heart disease and all-cause mortality.”

I will highlight one study I mentioned in that article, the European Prospective Investigation into Cancer and Nutrition study (Heart. 2012; 98:920-925). In this study, researchers found if patients were getting most of their calcium from supplements, they were at a twofold greater risk of a heart attack, compared to those who were not taking supplements.

However, patients who were getting a modest amount of calcium from both dietary sources and supplements actually saw a 30% decrease in heart attacks. The researchers believe that a large bolus (amount delivered at one time) of calcium from supplements may cause blood levels to surge, producing harmful effects on the heart and calcium deposits in the vasculature.

Even within this study, results vary depending on the source of calcium and the amount from each source. The authors suggest if calcium supplementation is needed, such as with postmenopausal women, then no more than 500 mg should be used, and splitting the dose between morning and night may be ideal.

Now let’s fast-forward to two of the most recent studies that question calcium’s relation to heart disease and death. There was a meta-analysis (a group of 19 randomized clinical trials) involving women over the age of 50 presented at the American Society for Bone and Mineral Research 2013 Annual Meeting. Results showed that there were no significant increased risks of heart disease, heart attacks or death from calcium supplementation in women (ASBMR 2013, abstract 1002). This does not necessarily allay fears, but it does call them into question.

At the same conference, a study called the Osteoporotic Fractures in Men study was presented. It implied that calcium supplements do not increase the risk of heart ailments for men (ASBMR 2013, abstract 1002).

 

Mortality

If this were not confusing enough, in the Canadian Multicentre Osteoporosis Study, there was actually a 22% decrease in mortality in women who used calcium supplements, compared to those who did not (J Clin Endocrinol Metab. 2013;98:3010-3018). These results were seen in women who took 500 mg to 1000 mg per day of supplemental calcium, but not in men. Interestingly, women who had significant dietary calcium also saw a mortality reduction. Above 1000 mg calcium intake, the benefit was attenuated. This was an observational study with a 10-year duration.

However, the mortality story may not be the same for men. Results of an observational study showed that a large daily dose of calcium-only supplements (1000 mg per day or more) may actually increase the risk of mortality to 37% for heart disease death (JAMA Intern Med. 2013;173:639-646). The study found that half of men took calcium supplements.

 

Efficacy

When we think of bone health, we typically think of vitamin D supplements, with or without calcium. However, in a recent randomized controlled trial, the gold standard of studies, the opposite was true (J Clin Endocrinol Metab. online Sept. 24). Results showed that in postmenopausal women, calcium with or without vitamin D helped to improve bone health, whereas 4000 IU of vitamin D alone did not reduce osteoporosis risk. The study duration was six months with a population of 120 women.

 

Dietary

Dietary sources of calcium are numerous. Dairy products, such as milk and yogurt, have calcium. Fortified nondairy products, such as soy milk, also do, but fortification is essentially supplementation. Natural forms of calcium include nuts, seeds, beans, dark green leafy vegetables and fish, such as salmon and sardines.

 

Conclusion

The bottom line is: use caution when considering calcium supplements. The appropriate dose may be 500 mg per day at the upper limit, since this is all we absorb at one time, and this should be reserved for postmenopausal women. It might be wise to divide this dose between the morning and evening to minimize a potential bolus effect.

Unfortunately, none of these studies are definitive. However, it is encouraging that postmenopausal women may benefit from calcium supplements and dietary intake rather than be harmed by them. Regardless, it’s best to get most of our intake from dietary sources rather than supplements, since dietary sources are much less likely to cause side effects, such as kidney stones.

 

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 www.medicalcompassmd.com and/or consult your personal physician.

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Hollywood came to Leemor Joshua-Tor’s lab. When actress Rachel Weisz was preparing for her role as a scientist in “The Bourne Legacy,” she and director Tony Gilroy visited Joshua-Tor’s lab at Cold Spring Harbor Laboratory.

Like Weisz’s aunt, Olga Kennard, Joshua-Tor explores the unknown structure of complex molecules. While she may not have a Hollywood pedigree, Joshua-Tor has had a hit of her own, thanks to her research on a protein linked to an important function in biology.

A professor at Cold Spring Harbor Laboratory and an investigator at Howard Hughes Medical Institute, Joshua-Tor was one of many scientists seeking to understand how a gene-regulating mechanism worked. Through a process called RNA interference, a small RNA molecule either enters the cell or is produced from long RNAs in the cell and is cut to pieces. That small piece sticks to an RNA that is normally part of the process of converting DNA to proteins. Once that RNA gets cut, the genetic machinery comes to a stop.

While researchers knew there was a collection of proteins in the silencing signal, they weren’t sure which one was helping to hit the stop button or how that protein might work. A structural biologist, Joshua-Tor took a different approach. She figured she might be able to find the important protein by looking at molecular architecture. What she found was that the small RNA sticks to the Argonaute protein and then “seeks” the larger RNA.

Steve Harrison, a professor at Harvard Medical School and an investigator with the Howard Hughes Medical Institute, called Joshua-Tor’s 2004 discovery of Argonaute’s role an “important contribution. It is a key step for understanding the biochemistry of small RNA-guided gene regulation.”

Joshua-Tor explained that being able to see the molecules provides a better understanding of what is happening and, perhaps, how.

“All RNA interference processes included the Argonaute protein, but no one knew what it did,” she recalled. The protein is “at the heart of the execution phase” of interference.

RNA interference can protect cells against viruses, while it can also help monitor and regulate gene expression.

While the Argonaute protein carries out many processes, it works through other proteins as well, Joshua-Tor said. It plays a role as a tumor suppressor in prostate cancer.

In addition to the work her nine-person lab does on Argonaute, Joshua-Tor’s team is also looking at proteins that are involved in papilloma viruses. These viruses, which can cause benign or malignant tumors in areas like the cervix, use an initiator protein, called E1. Together with a former postdoctoral student, Eric Enermark, who now works at St. Jude Children’s Research Hospital and in collaboration with CSHL’s Arne Stenlund, they discovered how E1 recognizes and binds the start site. Enermark and Joshua-Tor later figured out how the protein uses the energy of adenosine triphosphate to travel on the DNA.

While structural biology involves numerous steps to go from targeting a molecule to seeing how all the parts fit together, the effort can create “an amazing feeling. You put up with a lot of grief in order to relive that rush when you see a structure for the first time. It’s just unbelievable,” Joshua-Tor said.

A resident of Huntington, Joshua-Tor lives with her five-year-old daughter Avery. The mother-daughter team enjoy going to beaches and visiting the Long Island Aquarium and Exhibition Center in Riverhead. Avery also “loves playing with the kids on our block,” which includes an annual fall block party, which has a deejay, races, water-balloon competition and scarecrow making.

Joshua-Tor, who spent part of her childhood in Israel and attended high school in Great Neck during her junior year, also enjoys the wineries and the “amazing” fresh corn of the east end.

Joshua-Tor said she loves the history of science and finds herself thinking about earlier discoveries that used the same technique, X-ray crystallography, that she employs in some of her research.

“Molecular biology is riddled with discoveries in structural biology,” she said, including by researchers like Dorothy Hodgkin, who confirmed the structure of penicillin and of vitamin B12, which helped her win the Nobel Prize in Chemistry in 1964. “We stand on the shoulders of our predecessors.”

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Maria Rivas washes windows at Buffalo Wild Wings as part of a work-study program. Photo by Erika Karp

By Erika Karp

Tyler Butler, a 16-year-old special needs student at Centereach High School, has a plan. He wants to go to Suffolk County Community College, get married and have a family, but he knows he needs a job first. Butler has taken a step in the right direction though, thanks to the life skills’ work-study program at Centereach High School.

Jacob Robinson learns work skills at Buffalo Wild Wings in Centereach. Photo by Erika Karp
Jacob Robinson learns work skills at Buffalo Wild Wings in Centereach. Photo by Erika Karp

On a Thursday morning, hours before Buffalo Wild Wings Grill & Bar in Centereach is crowded with customers, Butler, along with three of his peers, is diligently getting the restaurant ready for business. Butler is laying down mats, while Maria Rivas, 18, washes windows; Anthony Miglino, 20, sets up chairs; and Jacob Robinson, 16, fills Wetnap caddies.

While the students’ disabilities vary, all of them are learning skills to help them become more independent as they enter adulthood.

“They need to experience real-life situations [and] real-life jobs,” said Debbie O’Neill, a 26-year special education teacher in the Middle Country Central School District.

O’Neill, along with Peggy Dominguez, who has been teaching in the district for 27 years, advocated for and initiated the work-study program three years ago.

In the beginning, O’Neill and Dominguez were surprised by how many businesses didn’t want help and that some people felt the students were being taken advantage of. Today, students rotate between different local businesses five days a week visiting places like Old Navy, The Home Depot, Holiday Inn Express and St. Charles Hospital.

Dominguez said that many of the skills people take for granted are ones their students don’t have, but by immersing them in a real job situation, they’re able to work on social skills and become more independent. The program has also grown tremendously this year to more than 50 students, as many who in the past sat for the Regents competency tests have transitioned into the life skills program.

Centereach High School Principal Tom Bell said in a phone interview that the program is beneficial for all students, as the life skills students are more immersed in everyday school life. “They feel more part of the school,” he said.

In addition to the off-campus work-study, younger students, along with those who aren’t ready to work off campus, are working on campus. This year, the students are helping district staff with clerical and custodial tasks, in addition to running a campus store and a café. Students who run the café bake items, take orders, deliver goods and keep inventory.

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Anthony Miglino is part of a work study program at Centereach High School. Photo by Erika Karp

According to special seducation teacher Darla Randazzo who runs the café, the work-study program has helped build the students’ confidence. Randazzo said that by the time a student leaves school, they will have a resume or portfolio that showcases all of their skills.

“When they leave school, they’ll have more skills to bring to the job,” she said.
Superintendent Roberta Gerold said the program is still growing as more students are now opting to participate in work-study instead of attending BOCES programs.
Gerold said it is a wonderful thing that the students are learning to be as independent as possible.

Rivas, who has been participating in the off-campus work-study program for three years and has attended BOCES in the past, said she enjoys the program because she can learn about everything. While she has a part-time job on the weekends, she is hoping she could get another one at Buffalo Wild Wings.

So far, two students have been offered jobs, and while this seems like a small number, Dominguez said it is a major accomplishment. Often times, the small achievements are the best kind.

A few days ago, while working at The Home Depot, Butler correctly directed a customer to the outdoor lighting fixtures. As the students were walking back to the bus, they saw the customer leaving the store with what he was looking for.

“Sometimes the successes are small,” Dominguez said. “But it makes such a difference.”

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Mice rely on their sense of smell for their survival, sniffing out food, finding mates, or scampering away from the butcher’s wife or, more likely, a hungry fox.

Dinu Florin Albeanu wants to understand how the scents in the air translate into signals in a mouse’s brain that cause the animal to understand its environment and react accordingly.

An assistant professor at Cold Spring Harbor Laboratory, Albeanu studies the neurological circuits in mouse brains, trying to figure out how information translates into behavior.He is attempting to understand how the mouse decides what aspects are important and what are not important.Albeanu is excited to ask these kinds of scientific questions at a time when the technology to monitor individual neurons on a real-time basis has taken such enormous strides in recent years.

He is able, for example, to take a thirsty mouse that has smells coming from its right and left. If the mouse licks a port on the left in response to a specific signal, it gets water. While the mouse is considering the smells around it, Albeanu and his colleagues can monitor the specific activity in the brain to see how it is changing.

To check to see how important any neurons are in perception, the CSHL research team can suppress activity in those circuits and see if the mouse reacts to the smell in a different way. The scientists turn off different subsets of neurons, so they can ask “at what point is smell A perceived as something different,” Albeanu said.

Going further than this, Albeanu looks at how altering specific features of activity, such as the timing of when neurons spike or the number of spikes, can alter the circuit and, eventually, the behavior of the animal.

The animals have a neurological feedback loop, where the cortex sends signals back to the olfactory, or smell, area. In one experiment, Albeanu’s crew is monitoring the information from those signals. By doing so, he can determine whether the feedback ensures that there is not an error signal, where the initial reaction to a scent requires reinforcement with additional odor gathering before reacting. He performs similar experiments with the feedback loop, suppressing some of the returning neurological information to determine its role in generating behavior.

In his broad range of research, Albeanu is also interested in how mice process olfactory stimuli with visual information or other types of sensory cues. Would a mouse sooner trust what it sees, if there’s an image of a predator nearby, or what it smells, if that image includes the scent of food or a mate?

“The brain extracts and processes information about the environment combining multiple senses,” he explained. “We’re probing how and where in the brain visual and olfactory cues are compared and integrated, and indeed pursuing a range of experiments along these lines.”

Vivek Jayaraman, a group leader at Janelia Farm Research Campus of the Howard Hughes Medical Institute, called Albeanu “technically gifted and resourceful.” He suggested that the CSHL scientist, whom he’s known for a decade, uses “a powerful combination of techniques to record and stimulate neural activity and, importantly, they’re also busy adding interesting animal behavior tasks to the mix. This makes for a pretty potent cocktail.”

Albeanu, who said he himself has probably an average sense of smell, explained that he is “fascinated by how little is known about how you go from the smells to complex perceptions.”

A resident of Huntington, Albeanu has been at CSHL since 2008. He also rents an apartment in the city. While he’s on the Island, he enjoys running, biking and swimming.

Albeanu spends about a month each year in his native Romania to co-organize a summer course called Transylvanian Experimental Neuroscience Summer School. This past June, the second summer for the course, organizers received applicants from 37 countries.

The course focuses on experimental and theoretical methods to study how the brain operates at the level of neuronal circuits.Albeanu describes his work as basic research, in which he asks questions and seeks answers to understand the way systems like olfaction can generate behavior. He can imagine an extension of this work, in which future research could get at how the human brain operates.

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One-fifth of premature deaths linked to obesity

Have we entered a fourth dimension, where it’s possible to be obese and healthy? Hold on to your seats for this wild ride. This would be a big relief, since more than one-third of Americans are obese, another third are overweight and the numbers are on the rise (CDC.gov). There are several studies that suggest it’s possible to be metabolically healthy and still be obese.

What does metabolically healthy mean? It is defined as having no increased risk of diabetes or cardiovascular disease (heart disease and stroke), because blood pressure, cholesterol levels and inflammatory biomarkers remain within normal limits.

However, read on before thinking that obesity can be equated with health. Though several studies may suggest metabolic health with obesity, there is a caveat: some of these obese patients will go on to become metabolically unhealthy, but even more importantly, obesity will increase their risk significantly for a number of other chronic diseases. These include osteoarthritis, diverticulitis, rheumatoid arthritis and migraine. There is also a higher rate of premature mortality, or death, associated with obesity.

In other words, the short answer is that obesity is NOT healthy. For more information about obesity and its effects on rheumatoid arthritis, read my article entitled “The AMA declares obesity a disease,” published on July 4.

 

Metabolically healthy obese

Several studies published in the last few months imply that a there is such a thing as MHO. In the Cork and Kerry Diabetes and Heart Disease Phase 2 Study, results show that approximately one-third of obese patients may fall into the category of metabolically “healthy” (J Clin Endocrinol Metab online. 2013 Aug. 26). This means that they are not at increased risk of cardiovascular disease, based on five metabolic parameters, including LDL “bad” cholesterol, HDL “good” cholesterol, triglycerides, fasting plasma glucose and insulin resistance. The researchers compared three groups: MHO, metabolically unhealthy obese and nonobese participants. Both the MHO participants and the nonobese patients demonstrated these positive results.

There were over 2,000 participants involved in this study, with an equal proportion of men and women ranging in age from 45 to 75. The researchers believe that a beneficial inflammation profile, including a lower C-reactive protein and a lower white blood cell count, may be at the root of these results.

In the North West Adelaide Health Study, a prospective (forward-looking) study, the results show that one-third of obese patients may be metabolically healthy, but goes further to say that this occurs in mostly younger patients, those less than 40 years old, and those with a lower waist circumference and more fat in the legs (Diabetes Care. 2013;36:2388-2394). The reason for the positive effects may have to do with how fat is transported through the body.

In metabolically unhealthy obese patients, fat is deposited in the organs, such as the liver and heart, potentially leading to cardiovascular disease and type 2 diabetes. A theory is that mitochondria, the cells’ energy source, are disrupted, potentially increasing inflammation.

However, the results also showed that over a 10-year period, one-third of “healthy” obese patients transitioned into the unhealthy category. Over a longer period of time, this number may increase.

 

Premature mortality

To hammer the nail into the coffin, so to speak, obesity may be associated with premature mortality. In a recent study, about 20% of American patient deaths were associated with being obese or overweight (Am J Public Health online. 2013 Aug. 15). The rates were highest among white men, white women and black women. The researchers found this statistic surprising; previous estimates were far lower. Researchers reviewed a registry of 19 consecutive National Health Interview Surveys, from 1986 to 2004, including more than 500,000 patients with ages ranging from 40 to 84.9 years old.

Interestingly, obesity seems to have more of an effect on mortality as we age: obesity raised mortality risk 100% in those who were 65 and over, compared to a 25% increased risk in those who were 45.

 

Osteoarthritis

It is unlikely that any group of obese patients would be able to avoid pressure on their joints. In a recent Australian study, those who were obese had a greater than two times increased risk of developing osteoarthritis of the hip and a greater than seven times increased risk of developing osteoarthritis of the knee (BMC Musculoskelet Disord. 2012;13:254). If this weren’t bad enough, obese patients complained of increased pain and stiffness, as well as decreased functioning, in the hip and knee joints. There were over 1,000 adults involved in this study. Patients were greater than 39 years old, so obesity’s impact on osteoarthritis could affect those relatively young.

There is a solution to obesity and its impact on osteoarthritis of the knees and hips. In a randomized controlled trial of 454 patients over 18 months, those who lost just 10% of their body weight saw significant improvement in function and knee joint pain, compared to those who lost less than 10% (JAMA. 2013;310:1263-1273). So, if you are 200 pounds, this would mean you would experience benefits after losing only 20 pounds.

When diet and exercise together were utilized, patients saw the best outcomes, with reduced pain and inflammation and increased mobility, compared to diet or exercise alone. However, diet was superior to exercise in improving knee joint pressure. Also, inflammatory biomarkers were reduced significantly more in the combined diet and exercise group and the diet alone group, compared to the exercise alone group.

The diet was composed of two shakes and a dinner that was vegetable-rich and low in fat. The exercise component involved both walking with alacrity plus resistance training for a modest frequency of three times a week for one hour each time. Thus, if you were considering losing weight and did not want to start both exercise and diet regimens at once, focusing on a vegetable-rich diet may be most productive.

While it is interesting that some obese patients are metabolically healthy, this does not necessarily last, and there are a number of chronic diseases involved with increased weight. Though we should be careful not to be prejudiced or judgmental of obese patients, this disease needs to be treated to avoid increased mortality risk and of increased risk of developing other diseases.

 

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 www.medicalcompassmd.com and/or consult your personal physician.

Cops call Sarah Strobel's death ‘criminal’

Above, a scene from a candlelight vigil where friends of 23-year-old Sarah Strobel gathered. Photo from Taylor Friedman

Suffolk County police have deemed criminal the death of a 23-year-old Huntington Station woman whose body was found in the Froehlich Farm Nature Preserve last Thursday, police said Monday.

The woman was identified as Sarah Strobel of East 6th Street in Huntington Station. Her body was found just before 9 am in the preserve off West Rogues Path in Huntington Station, according to police.

Detectives from the Suffolk County Police Department’s Homicide Squad started an investigation after a person walking at the preserve noticed the body off the side of the path and called police, the SCPD said last week.

The path was a favorite hiking spot of Strobel’s, according to 22-year-old Taylor Friedman, who said the young woman was one of her best friends. Friedman helped organize a candlelight
vigil with Strobel’s other friends, which was held last Friday.

Taylor Friedman, a close friend of Sarah Strobel’s, remembers the 23-year-old at a candlelight vigil. Photo by J.D. Neek
Taylor Friedman, a close friend of Sarah Strobel’s, remembers the 23-year-old at a candlelight vigil. Photo by J.D. Neek

“It’s still really fresh and raw for all of us,” Friedman said in a phone interview on Monday from Haven Hair Spa, where she works as an assistant manager. “This is my first day back at work, and I feel like I’m in a cloud.”

Friedman and Strobel visited the preserve a handful of times, and they both shared hiking as a favorite hobby, Friedman said.

“Sarah was a free spirit and a wise soul,” the friend said. “She lived her life to the fullest and made the best of any situation whether it was bad or good.”

Rebecca Stander, a childhood friend of Strobel’s, also remembered the 23-year-old fondly. In a statement Stander said Strobel was her “best friend since third grade,” noting how the two would do their homework together. Strobel’s favorite cereal was Fruity Pebbles, she said, and her favorite perfume was Lolita Lempicka.

Strobel, a 2008 Walt Whitman High School graduate, was also remembered by the South Huntington School District.

“We have little additional information at this point but do know that our hearts go out to Sarah’s family during this difficult time,” Superintendent David P. Bennardo said in a statement posted on the district’s website. “The members of our South Huntington learning community join in mourning Sarah’s passing and keep her in our thoughts and prayers during this difficult time.”

Strobel loved music, both Stander and Friedman said. Her favorite bands included Incubus and the Red Hot Chili Peppers, Friedman said.

“I want the world to know how loved she is,” Stander wrote, “and that beautiful rock star will always remain alive in my heart.”

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They ask far-reaching questions, from looking at exactly how fleeting flame is to exploring supernova to studying chemistry and materials for clean energy production to examining the interaction of clouds with aerosols. The eight researchers who conduct a broad range of experiments using computers and a large numbers of data points are part of a growing one-year old group called the Institute for Advanced Computational Science.

A combined effort of Stony Brook University and Brookhaven National Laboratory, the IACS was created to use computers and their applications to solve problems in the physical sciences, life sciences, medicine, sociology, industry and finance.

The analysis of wide-ranging data is “incredibly broad and has a high payoff,” said Robert Harrison, director of the IACS, who moved to Long Island from Tennessee last year.

Funded with a $10 million donation from an anonymous contributor combined with a matching donation from the Simons Foundation, the IACS plans to hire an additional eight researchers over the next few years. Stony Brook is in the process of building a facility in what used to be the north half of the Life Sciences Library.

Harrison described computational sciences as a “very competitive” area for recruiting, which requires state-of-the-art facilities to build the best faculty and student team. The group has already purchased a $550,000 system from IBM.

Harrison, who is also the head of BNL’s Computational Sciences Center, said IACS faculty can contribute to the National Synchrotron Light Source II.

The new facility, which will open in 2015, will produce X-rays that are 10,000 times stronger than the current light source and will allow scientists to look at the molecular structure of anything from batteries as they wear down to the development of marine shells to superconductors.

Once experiments begin at the NSLS-II, the ability to process information will become especially important. The new light source “will create a lot of data at high rates,” said Reinhold Mann, the associate laboratory director for Environmental, Biological and Computational Sciences Directorate. “We need to manage the data and archive and analyze it. That needs to happen on the fly, as the data comes in. It’s a unique challenge [that requires] applied math, networking and connectivity.”

Mann, who is Harrison’s supervisor, has known him for over 10 years. Harrison leads by example and has an engaging vision, Mann said. He has a “good combination of skills on the technical and communication and people side.”

Harrison expects the computational science group to become a part of a team that enables researchers with different expertise to collaborate. “If you want to design a new fuel cell for clean energy production, by turning methanol into energy,” Harrison offered as a possible example, then “you [will work in] chemistry, material sciences and engineering. In order to understand the device, you might need to look inside it by using X-rays from the new light source.”

When he first visited Long Island in February of 2011, Harrison was surprised at how cold, raw and beautiful the area was. He said he marvels at the world around him. People are “surrounded by this miracle” he said. “Pick up a leaf and look under it at the insects or the pores in the leaf. There is all this wondrous stuff.”

Harrison and his three sisters (including a twin sister) are the first generation in their family to attend college. Harrison said he recalls sitting with his father, a World War II veteran who served in the British Army in India and who left school at the age of 14, when he was 17.

“My father didn’t understand what stars in the night sky were,” he said. Harrison suggested that understanding the “world around us” might give people “more confidence that things are okay.”

A resident of Port Jefferson, Harrison said he writes snippets of programs every day. He marvels at the rate of advancement in computers. His $700 cell phone is 10 times faster than the $20 million supercomputer he used for his Ph.D. thesis. He believes he is like many other scientists when it comes to facing an unfamiliar situation. He sees a problem as an opportunity to build knowledge.

“You work your way out of the maze,” he said, “and at each step, you learn. Even the dead ends” can provide information.

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At its root is the doctor-patient relationship

After reading in the New York Times Week in Review that the annual physical exam may have outlived its usefulness, I pondered whether this is actually true. Is it a reflex, or does it have an important role? The answer, I think, depends on how you perceive and utilize this yearly ritual.

If annual medical exams mean lots of expensive diagnostic tests and invasive procedures, it may be time to put it to pasture. However, if it fosters a physician-patient relationship and allows for a partnership in prevention and treatment of diseases, then this alone may be a good reason to keep it. Doctors and patients alike complain there is not enough time spent getting to know or understand each other’s approaches. Eliminating the annual physical would only worsen the situation.

So what are the pros and cons of this time-tested ritual?

Downsides

One of the downsides may be that the yearly ritual does not save lives. According to a Cochrane meta-analysis (a group of 16 studies), an annual physical exam had no benefit of on mortality risk and morbidity (disease) risk (Cochrane Database Syst Rev. 2012 Oct. 17). The report went on to say that it did not have an effect on overall mortality, nor on cancer survival and/or cardiovascular mortality. Nine trials were utilized for mortality data. The study weakness could be that the trials included were old and may not be applicable to more modern approaches. The authors also suggested that primary care physicians may already be treating patients at high risk for diseases.

PSAs

Another potential negative to annual exams is that certain diagnostics, such as prostate-specific antigen screenings to test for prostate cancer, could be harmful. In a recently presented abstract (European Cancer Conference 2013; Abstract 1481), the results of a meta-analysis show that routine screening for prostate cancer in the general, symptom-free male population may have more detrimental effects than benefits — a high PSA may lead to unnecessary invasive procedures, such as biopsies and prostatectomies (removal of the prostate). Side effects could be impotence and infection, and could result in hospitalization. The author acknowledged that there have been two large studies on PSAs, one touting the benefits and the other showing increased harm. This latest assessment may be the tiebreaker. Some urologists may disagree with these newest findings.

Upsides

What are the upsides of an annual medical checkup? Not all diseases show symptoms, especially in the earlier stages. Examples include hypertension (high blood pressure) and chronic kidney disease. This is also an opportunity to discuss mental health — stress levels, depression and anxiety. And, of course, there is the importance of lifestyle discussions, including weight, exercise and diet.

Chronic kidney disease

Though chronic kidney disease does not have an awareness month, it is no less significant than breast cancer or prostate cancer, causing upwards of 90,000 deaths per year. According to the Centers for Disease Control and Prevention, one in five patients with high blood pressure has chronic kidney disease (CDC.gov). Early to moderate stages of the disease may go undetected, since the only way to detect it when it has no symptoms is through blood tests and urinalysis.

If there is protein in the urine and/or reduction in the estimated glomerular filtration rate and creatinine in the blood, this may be a sign of CKD. To learn more about the treatment and prevention of CKD, I encourage you to read my Aug. 13 article. Detecting CKD early may be the key to halting its progress and preventing end-stage kidney disease resulting in dialysis. Without the annual medical exam, we may miss the opportunity to detect this disease in its early stages.

High blood pressure

High blood pressure is known as the “silent killer,” because there are frequently no symptoms until it is too late. According to a study, high blood pressure may be responsible for almost half of all heart attacks and a quarter of premature deaths in the U.S. (BMJ. 2001;322:977-980).

To reduce the risk of this “silent killer,” lifestyle modifications are in order. In a meta-analysis, involving 54 small, randomized controlled trials, aerobic exercise had significant benefits in reducing blood pressure. This was true of patients with elevated and with normal blood pressure, as well as those who were obese and those of normal weight (Ann Intern Med. 2002;136:493-503). Very few lifestyle changes alter blood pressure in “healthy” patients, but ones that do may reduce risk of ever developing the disease. In this trial, the systolic blood pressure (top number) was significantly reduced by a mean of 3.4 mmHg.

Body mass index

The first step toward obesity prevention and treatment is an awareness of the problem. According to a new report by the Institute of Medicine, physicians should regularly monitor patients’ body mass index (Evaluating Obesity Prevention Efforts, National Academies Press, online Aug. 2). This may give patients a sense urgency to lose weight. In my practice, I also assess body composition, which includes fat percent and fat mass. Though someone may not be obese, their fat mass may be higher than normal.

Depression

One of the most effective ways to get to know a patient and recommend effective prevention and treatment is with a thorough discussion of history. This is the art of medicine, and it involves the intangibles that may not show up in numbers, including mental health issues.

A recent abstract showed it is not what patients say, but how they say it that may be most important. Short essays were used to help determine whether patients were sad or actually mildly depressed (26th European College of Neuropsychopharmacology Congress; Abstract P.2.b.060). Those who were mildly depressed used significantly more verbs in the past tense than the present (100% versus 2.6%) and used less complex sentences, compared to the healthy control patients.

Ultimately, I think the success of an annual medical checkup has to do with the approach. If there is a strong focus on a thorough history, rather than a predominance of diagnostic testing leading to invasive procedures, there is very little downside. The yearly medical exam is an opportunity to discuss preventive measures, including lifestyle changes, whether the patients are healthy or have disorders that may be prevented from worsening.

 

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 www.medicalcompassmd.com and/or consult your personal physician.

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As the director of the Research in Interventional Cardiology unit at Stony Brook Medical School, Luis Gruberg does more than 400 procedures a year in which he rebuilds the collapsing or blocked walls that provide blood to the heart.

The professor in the Department of Medicine is screening for as many as 40 candidates who might benefit from a new stent, a device made by a unit of Abbott Laboratories that will open artery walls and, after two years, will dissolve.

“This is a unique new type of stent that is made out of a type of sugar that will be reabsorbed into the body,” Gruberg said. “It will serve as a scaffold” for the heart and will prevent the arteries from “renarrowing or closing.”

The stent, called Absorb, is made of polylactide, which includes corn starch or sugar cane and is commonly used in dissolvable sutures, screws and pins.

Currently, patients who need a stent typically receive one that is made out of metal, Gruberg said. While those stents are durable and are considered safe and reliable, they remain in the body, which may not enable a restoration of the blood vessel function. During the trial, Gruberg will monitor vasomotion, a measure of how much natural motion returns to the blood vessel.

“If the clinical trial proves to show this is as good as or better than the metal stent used today, this will be a significant step forward,” he said. This new stent has a drug coating that prevents an immediate renarrowing of the artery by scar tissue. Stents are often used to treat coronary artery disease, which is the most common type of heart disease. Gruberg, who has been at Stony Brook for seven years, said he has been involved in numerous studies of other novel therapies or approaches to medical care. He participated in the Plato study that led to the approval of ticagrelor. He also contributed to the Champion studies with cangrelor that is being considered at the Food and Drug Administration for approval. These drugs are used in patients that undergo coronary artery interventions.

“When you use these medications or devices, you don’t know” exactly how well they’ll work, he said. “Patients trust you. [The studies] try to improve our medical knowledge. We don’t know until the study comes out.”

William Lawson, the acting chairman of the division of cardiovascular medicine and Gruberg’s supervisor, said it “benefits the university, cardiology and the heart institute to have someone so engaged and productive.”

Lawson described Gruberg’s research as cutting edge and suggested it would “advance what we do clinically in the next couple of years.” Lawson was especially impressed with Gruberg’s ability to engage high school students, medical students and residents, which he said would help develop the next generation of people going into medicine. A native of Bolivia, Gruberg has worked at institutions with strong research programs, including Washington Hospital Center and Rambaum Medical Center in Haifa, Israel.

Gruberg started the Research in Interventional Cardiology unit at Stony Brook when he arrived in August, 2006. He is pleased with the progress of a group that currently has 10 active trials. Stony Brook has been “very successful in establishing a research program,” he said. “We have nothing to envy to those major institutions. We’ve established ourselves in the field.”

Lawson, who has known Gruberg for over five years, said Gruberg’s work has helped accomplish what he set out to do when he arrived, by participating in so many clinical trials and advancing cardiac technology.

Indeed, Gruberg said Stony Brook has conducted more than 70 studies in interventional cardiology. “Since I came here, I’ve been a part of these amazing studies,” he said. “That’s just the proof that Stony Brook is out there, doing great research and trying to help patients.”

Gruberg and his wife Rakefet, whom he met in Israel, live in Setauket. Their older son, Barr, graduated from Ward Melville and is attending Geneseo, while Jonathan is in ninth grade at Gelinas Junior High School.

In his personal decisions, Gruberg said he tries to promote what he tells his patients. “I exercise and try to eat healthy and don’t smoke,” he said. “I try to lead by example.”

 

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