Monthly Archives: September 2014

Members vote against Heatherwood retirement community

The owner of the Heatherwood golf course wants to build 200 units of retirement housing at the site. Photo by Andrea Moore Paldy

Civic members took a stand Tuesday night against a housing community proposed to be built on the Heatherwood golf course, voting to send a letter of opposition to Brookhaven Town.

The Port Jefferson Station/Terryville Civic Association’s executive board will draft and submit the letter, which carries no legal weight but serves to share the community’s views on a project for consideration.

The official civic vote caps a months-long discussion on the project at the Heatherwood Golf Club, at Arrowhead Lane and Nesconset Highway in Terryville.

Doug Partrick, an owner of both the course and multifamily housing developer Heatherwood Communities, wants to build 200 rental units for people 55 and older, a mixture of town houses, ranches and apartments.

When Partrick gave a presentation on the project at a May civic meeting, he said the retirement housing would be built on 25 acres at the golf course, leaving the remaining 45 acres as open space. The 18-hole golf course currently at the site would be reduced to a nine-hole course that would surround the homes.

The course is zoned A Residence 5, which allows for one housing unit on every 5 acres. Partrick would need a zone change to planned retirement community zoning to proceed with the development.

As they did at previous civic meetings, members spoke against the proposal on Tuesday night, citing quality of life concerns such as traffic congestion.

Civic President Ed Garboski reported that a traffic study of the area found that retirement housing would have little impact on traffic, though some residents scoffed at that notion.

One man who lives near the golf course talked about how busy the adjacent roads are already and said the housing community would make things worse.

And member Don Zaros took issue with the fact that the homes would be rentals, saying people who rent instead of own — whom he called “transients” — do not care about the community as much.

Partrick, who was not at Tuesday’s meeting, said previously that if the housing development does not move forward he might close the club. He said he would think about whether he would be “better off consistently losing money on the golf course or … just shutting the golf course down, leaving it dormant.”

While some residents have been concerned about having a large abandoned property in town that could possibly attract vandalism or homeless people, others were not worried. While one man said on Tuesday that having retirement housing is “better than a blighted, abandoned piece of property” in the neighborhood, another countered that vacant and blighted are not the same thing, and having a large grassy parcel would be better for Long Island’s groundwater than a housing community.

The group voted overwhelmingly to send a letter of opposition to the town, in keeping with an unofficial vote at last month’s meeting that produced the same result.

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Too little salt is unlikely for most of us

This is the first of a two-part series on salt. Salt, or sodium, is one of the most pervasive essential nutrients in our diet. While we need exogenous (external) salt, the debate on the amount we need continues. Are we getting too much or too little? A recently published study would indicate that the extremes – too much and too little – are dangerous. The newspaper headlines from this study suggest that reducing sodium may be harmful.

Is this true or is it hyperbolized? We will investigate this study in much more detail. However, I will say this: Many Americans get far more than the recommended amount of sodium intake, regardless of which guidelines you are using. Very few individuals suffer from dietary sodium deficiency.

So what are the guidelines, and how much are Americans consuming on average? According to the Centers for Disease Control, the U.S. government recommends no more than 2,300 mg of sodium per day (1). But for those who are over 50 years old, are African American or who have high blood pressure, diabetes or chronic kidney disease, then sodium should be restricted to less than 1,500 mg per day. One teaspoon of salt is the equivalent of 2,300 mg of sodium. The World Health Organization recommends less than 2,000 mg per day (2) and the American Heart Association recommends less than 1,500 mg for everyone (3). This is approximately two-thirds of a teaspoon of salt. The average amount Americans consume is 3,300 mg per day.

This is not about the salt shaker, though. Most people protest that they don’t use salt or processed foods, which are notoriously high in sodium. Sodium lurks in many places, though.

What are the potential obscure sources of sodium? Participants in a recent study were able to identify that processed foods were a major source of sodium and its excess; however, less than one-third knew that bread, pasta, cereal and cheese were major sources (4). Other sources include soups (yes, even many “healthy” soups); many frozen foods; condiments, including salad dressings; and sauces, especially spaghetti sauces, regardless of whether or not they are organic. So, if we include bread, sauces and cheese, that makes pizza one of the worst offenders! Also remember that eating out significantly contributes to increased sodium intake.

I had an interesting situation occur recently with a patient. After one month, he came back for a visit. During that month he went on vacation for a couple of weeks. We looked at his body composition. While he gained 5 pounds, what was surprising was that he actually lost 12 pounds of body fat, but gained 17 pounds of water weight. He had said he was eating really well. Unfortunately, he was unable to control for salt intake while eating out. Thus, as a consequence, he had significantly swollen ankles and significantly increased blood pressure that was uncontrolled. Even over a short period of time, salt can have a large impact on the body.

What are the potential short-term symptoms of too much salt? They can include headaches, dizziness, dehydration, edema (swelling), arrhythmias and weight gain.

Too much salt can increase our risk of disease or exacerbate pre-existing diseases. For instance, salt can raise blood pressure and contribute to kidney stones, osteoporosis, diabetes and chronic kidney disease. It can also exacerbate autoimmune disease, such as rheumatoid arthritis and Sjögren’s, and increase the risk of cardiovascular disease and mortality from CVD and all-causes (5). There are several studies that emphasize the impact of sodium on cardiovascular disease globally.

Also, don’t fall for the idea that when we exercise most of us need sodium replenishment. If we exercise strenuously – on the level of football players or marathon runners – then, yes, we need more sodium (6). However, for the rest of us who exercise no more than 90 minutes every day at a vigorous pace, it is unlikely that we require additional sodium.

One of the most frequent questions I am asked is whether there are any benefits from using Himalayan salt, kosher salt or sea salt instead of regular table salt. When we talk about symptoms or disease consequences from excessive salt consumption, it doesn’t matter whether the source is a more sophisticated form of salt. The effects are the same. Salt is salt! Let’s look at the evidence.

Impact of salt extremes

In the Prospective Urban Rural Epidemiology study, an observational study, results showed that participants who were at the “extremes,” those who had high amounts of sodium and those who had low amounts of sodium, all experienced higher risk of cardiovascular events and all-cause death (7). When blood pressure was factored in, those in the higher sodium group did not have significantly increased cardiovascular events.

There were three groups in the study: those who excreted high amounts of sodium, defined as greater than 6,000 mg or the upper “extreme”; moderate amounts, defined as 3,000 mg to 6,000 mg; and low amounts, defined as less than 3,000 mg or the lower “extreme.” There were over 100,000 participants from 17 countries. The duration of the study was approximate 3.5 years. The amounts of urinary sodium excreted were based on an estimated 24-hour urine output, which is a way of measuring sodium intake. The results also showed that increasing potassium levels greater than 1,500 mg had the opposite effect of sodium, decreasing the risk of cardiovascular events and death. The potassium levels were a 24-hour estimate, as well.

A weakness of this study was that data were based on one urinary sodium excretion in the morning and then extrapolated out to 24-hour urine output, which is considered a better biomarker. Nonetheless, there was only one reading per participant and this was not a 24-hour reading. Thus, this is not a very accurate way to measure sodium, since it was a single snapshot view.

Even if one did suffer from not enough sodium, causing hyponatremia (low sodium in the blood), eating more from the diet might perpetuate increased thirst and, thus, potential fluid overload. This could lead to edema and even lower sodium.

Therefore, from this study, we don’t know if sodium of less than 3,000 mg per day is dangerous. There were two times more participants who had high sodium excretion compared to low sodium excretion, and there were seven times as many participants with sodium levels greater than 4,000 mg than those with levels less than 3,000 mg. Granted, low sodium may be an issue, but what is really too low? We don’t know, and it does not happen often.

We as a society consume much more than any of the guidelines suggest. It would be a disservice to believe that adding more salt to your diet would not be harmful or that not reducing your intake is okay. So don’t reach for the salt shaker and read labels carefully. Rather reach for foods that have high levels of potassium and naturally occurring sodium such as green leafy vegetables.

References:

(1) www.cdc.gov. (2) www.who.int. (3) www.heart.org. (4) Appetite. 2014;83C:97-103. (5) www.uptodate.com. (6) Evid Based Nurs. 2014;17:92. (7) N Engl J Med. 2014;371:612-623.

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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SBU’s Hannun works to develop inhibitors for cancer

Yusuf Hannun is building a team where he firmly believes the whole has to be greater than the sum of the parts. The director of the Cancer Center at Stony Brook, Hannun is tackling the prevention, diagnosis and treatment of a disease that is the second highest killer of Americans each year in a way that unites a wide range of expertise, some in relatively new and unexpected areas.

“A team of us is working to bring to the cancer center what may, for most people, look like previously poorly explored areas,” Hannun said, who has been conducting cancer research for over 30 years and became the director of the center at Stony Brook over two years ago.

That includes areas such as applied math and physics, computer science and artificial intelligence. Stony Brook is building a program in cancer metabolism and hopes to extend that to nutrition.

“We want to exploit every resource we can in our battles against cancer,” he said. “We’re building on Stony Brook’s strength in chemistry, drug biology, drug delivery, math and engineering.”

The modern study of cancer involves an analysis of reams of genetic information that is significantly larger than any one clinician can analyze and study, even on a single patient.

“One generates billions of points of data per patient,” Hannun said. “There is an immense need to probe these data sets, simplify them and extract what’s meaningful versus what’s noise” in studying mutations and genetic variants.

With all of the data available, scientists can explore multiple comparisons that might lead to a better understanding of the genetic underpinnings of cancer. They are moving toward an analysis of different types of cancer cells in any one patient, and they also will compare cancer cells in a patient to normal, healthy cells.

They are also heading toward understand the differences between patients with similar cancers, to see if there are genetic patterns that contribute to the onset of a particular type of cancer. When it strikes, cancer is a complex disease, Hannun said, which makes the “task of finding what’s real and what’s noise” challenging. “We have to do multiple analyses.” Each cancer includes a dozen different subtypes, if not more, and each one, he said, has to be treated and defeated differently.

Hannun dedicates a majority of his time working at the Cancer Center. He said he still “protects some parts of the week for lab work,” which includes the weekly Thursday meeting between his team and that of his wife, Lina Obeid, the dean of research at the Medical School.

In his lab, he has new targets for different cancers and is trying to develop inhibitors. He is working to understanding the mechanism by which enzymes regulate tumors.

At the Cancer Center, Hannun has distilled research into several major directions: cancer metabolism and lipids, experimental therapeutics and metastasis, informatics and imaging.

Hannun is focused on the interface between research and the clinical world, where the results of research at Stony Brook and other institutions will help drive clinical cancer medicine for the next few decades.

The Lebanon-born and educated Hannun has set a specific goal for the center as well. He’d like to receive a National Cancer Institute designation. Currently, that is given to only 60 cancer centers across the country.

That designation would not only be a recognition of success and achievement for the Long Island team, but would also enable them to bid for funding for special programs that only those centers can obtain.

The process to receive that designation is “very rigorous and extremely competitive and requires a significant breadth and depth of cancer research and a coordination of clinical research at any one center,” he said.

As a whole, cancer research probably gets about 10 percent of the resources needed to fight the disease, Hannun estimates.

Hannun said the center has hired about eight faculty members over the previous two years and hopes to add more.

The center has made some inroads with three or four promising new targets, he said.

When they can break free from their laboratory and administrative responsibilities, Hannun and Obeid, who live in Setauket, have enjoyed the move to Long Island, where they kayak and bicycle, visit the vineyards and head to the Hamptons.

As for working so closely with his wife, Hannun said, “We share not just family, but we share our professional life.” Their work often comes up when they’re outside the lab, which Obeid said offers another connection for two people whose social circles overlapped starting in high school.

“Sometimes, we say, ‘Let’s not talk about work.’ Inevitably, we come back to the excitement. It’s really unique if you’re able to share something you’re so excited about in your everyday life with your best friend.”

 

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SB’s Obeid sets ambitious goals for medical research

Multitasking has been a necessity for Lina Obeid. The dean for research at the Stony Brook Medical School, Obeid runs a laboratory that focuses on cancer research, advocates for greater resources for other scientists, helps recruit staff members to join the university’s research department, and sees geriatric patients at the Veterans Affairs Medical Center in Northport.

“I’m very efficient,” she said, as she spoke on a car phone on the way back from seeing patients to her lab. She is also ambitious, for herself and for the university.

Currently, Stony Brook ranks about 70th in money directed by the National Institute of Health, one of the main funding agencies for research.

“I would like us to move up to the top 50 and maybe to the top 25 at some point,” said Obeid.

Obeid said she watches over common resources. Recently, she went to bat for a new super-resolution microscope. The NIH had agreed to support 60 percent of the cost, so she asked Stony Brook to step up for the other half.

The microscope, she argued, “would really put us on the map if we had it,” she said.

Ken-Ichi Takemaru, an associate professor at Stony Brook, had led a group of 10 investigators in applying for the microscope.

Obeid “was highly supportive of our grant application from the beginning and immediately acted to secure a matching fund,” he said. “Her generous support was also recognized at NIH and helped our application to receive a high score.”

Obeid and Hannun, who have worked in their labs together for years, created a grant-seminar series two years ago that is designed to improve the approach of Stony Brook staff to finding funding.

The seminars are designed to “get their grants better,” she said. She will be starting a program to provide access to outside experts who can read and evaluate grant proposals.

These efforts help scientists “dot their I’s and cross their T’s to make the grants look tight and clean,” she said.

Obeid is also involved in recruiting scientists to join the university. She chaired the search and advocated strongly for the recruitment of Joel Saltz to become the chair of a new biomedical informatics department last year.

“We were very successful,” Obeid recalled. “Everyone was on board as he is the best possible recruit for this new department.” When she’s tried to lure other scientists to the school, she said she highlights the health sciences and physical mathematics sciences.

To tackle new frontiers in medicine, Stony Brook also has a strong engineering and computer sciences department, which “allows us to do unique things other universities can’t do for cancer and other illnesses. We can really break new ground.”

In her daily responsibilities, Obeid believes her research remains her top priority, where, as is characteristic of her approach to her work and life, she moves in several directions at the same time. She is exploring the role of enzymes that control two molecules that are instrumental for a cell: one of them controls growth and proliferation while the other enhances cell death and differentiation.

“When you have this yin and yang, it’s important to understand the enzymes that make and break them,” Obeid said. These enzymes can become drug targets, turning on or off critical cell signals.

She is also studying how some cancers have mutations that cause them to have an inflammatory response when treated with chemotherapy, instead of dying or going into remission. She is exploring lipids, which were originally thought only to store fat, but, instead, may have a signaling role.

Obeid believes her clinical work with geriatric patients helps inform and direct some of her research, while also allowing her to do something that comes naturally to her. “It’s important for me to be in touch with clinical care,” she said. “I like taking care of people.”

Obeid appreciates the opportunity to work with World War II veterans at the hospital.

The daughter of a retired academic surgeon, Obeid said her father Sami Obeid, whose 90th birthday she and her three brothers recently celebrated in California, has been an inspiration to her.

He is “superb with his hands, very efficient and the kindest person I know,” she said. He was known for walking into a room and lighting it up with his smile. Obeid said she tries to emulate that when she walks around campus.

As for the decision to join Stony Brook, Hannun said he deferred to his wife. “I got engaged by the possibilities here,” Obeid said. “It was a big decision. I said, ‘Let’s do something different.’ He was surprised by my saying that.”

 

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It’s not about the scale

Weight loss should be a rather simple concept. It should be solely dependent on energy balance: the energy (kilocalories) we take in minus the energy (kilocalories) we burn should result in weight loss if we burn more calories than we consume. However, it is much more complicated. Frankly, there are numerous factors that contribute to whether people who want or need to lose weight can.

The factors that contribute to weight loss may depend on stress levels, as I noted in my previous article, “Ways to counter chronic stress.” High stress levels can contribute to metabolic risk factors such as central obesity with the release of cortisol, the stress hormone (1). Therefore, hormones contribute.

Another factor in losing weight may have to do with our motivators. We will investigate this further.

And we need successful weight management, especially when approximately 70 percent of the American population is overweight or obese and more than one-third is obese (2).

Recently, obesity in and of itself was proclaimed a disease by the American Medical Association. Even if you don’t agree with this statement, excess weight has consequences, including chronic diseases such as cardiovascular disease, diabetes, osteoarthritis and a host of others, including autoimmune diseases. Weight has an impact on all-cause mortality and longevity.

It is hotly debated as to which approach is best for weight loss. Is it lifestyle change with diet and exercise, medical management with weight loss drugs, surgical procedures or even supplements? The data show that, while medication and surgery may have their places, they are not replacements for lifestyle modifications; these modifications are needed no matter what route is followed.

But the debate continues as to which diet is best. We would hope patients would not only achieve weight loss, but also overall health.

Let’s look at the evidence.

Low-carbohydrate diets versus low-fat diets

Is a low-carbohydrate, high-fat diet a fad? It may depend on diet composition. In a newly published study of a randomized controlled trial, the gold standard of studies, results showed that a low-carbohydrate diet was significantly better at reducing weight than low-fat diet, by a mean difference of 3.5 kg lost (7.7 pounds), even though calories were similar and exercise did not change (3).

The authors also note that the low-carbohydrate diet reduced cardiovascular disease risk factors in the lipid (cholesterol) profile, such as decreasing triglycerides (mean difference 14.1 mg/dl) and increasing HDL (good cholesterol). Patients lost 1.5 percent more body fat on the low-carbohydrate diet, and there was a significant reduction in inflammation biomarker, C-reactive protein. There was also a reduction in the 10-year Framingham risk score. However, there was no change in LDL (bad cholesterol) levels or in truncal obesity in either group. This study was 12 months in duration with 148 participants, predominantly women, with a mean age of 47, none of whom had cardiovascular disease or diabetes, but all of whom were obese or morbidly obese (BMI 30-45 kg/m2).

Although there were changes in biomarkers, there was a dearth of cardiovascular disease clinical endpoints. This begs the question: Does a low-carbohydrate diet really reduce the risk of developing cardiovascular disease or its subsequent complications? The authors indicated this was a weakness since it was not investigated.

Digging deeper into the diets used, it’s interesting to note that the low-fat diet was remarkably similar to the standard American diet; it allowed 30 percent fat, only 5 percent less than the 35 percent baseline for the same group. In addition, it replaced the fat with mostly refined carbohydrates, including only 15 to 16 g/day of fiber.

The low-carbohydrate diet participants took in an average of 100 fewer calories per day than participants on the low-fat diet, so it’s no surprise that they lost a few more pounds over a year’s time.

Patients in both groups were encouraged to eat mostly unsaturated fats, such as fish, nuts, avocado and olive oil.

As David Katz, M.D., founding director of Yale University’s Prevention Research Center noted, this study was more of a comparison of low-carbohydrate diet to a high-carbohydrate diet than a comparison of a low-carbohydrate diet to a low-fat diet (4).

Another study actually showed that a Mediterranean diet, higher in fats with nuts or olive oil, compared to a low-fat diet showed a significant reduction in cardiovascular events — clinical endpoints not just biomarkers (5). However, both of these studies suffer from the same deficiency: comparing a low-carbohydrate diet to a low-fat diet that’s not really low in fat.

Diet comparisons

Interestingly, in a meta-analysis (a group of 48 RCTs), the results showed that whether a low-carbohydrate diet (including the Atkins diet) or a low-fat diet (including the Ornish plant-based diet), the results showed similar amount of weight loss compared to no intervention at all (6). Both diet types resulted in about 8 kgs (17.6 pounds) of weight loss at six months versus no change in diet. However, this meta-analysis did not make it clear whether results included body composition changes or weight loss alone.

In an accompanying editorial discussing the above meta-analysis, the author points out that it is unclear whether a low-carbohydrate/high animal protein diet might result in adverse effects on the kidneys, loss of calcium from the bones or other potential deleterious health risks. The author goes on to say that for overall health and longevity and not just weight loss, micronutrients may be the most important factor, which are in nutrient-dense foods.

A recent Seventh-day Adventist trial would attest to this emphasis on a micronutrient-rich, plant-based diet with limited animal protein. It resulted in significantly greater longevity compared to a macronutrient-rich animal protein diet (7).

Psyche

Finally, the type of motivator is important in whatever our endeavors. Weight loss goals are no exception. Let me elaborate. A recently published study followed West Point cadets from school to many years after graduation and noted who reached their goals (8). The researchers found that internal motivators and instrumental (external) motivators were very important.

The soldiers who had an internal motivator, such as wanting to be a good soldier, were more successful than those who focused on instrumental motivators, such as wanting to become a general. Those who had both internal and instrumental motivators were not as successful as those with internal motivators alone. In other words, having internal motivators led to an instrumental consequence of advancing their careers.

When it comes to health, an instrumental motivator, such weight loss, may be far less effective than focusing on an internal motivator, such as increasing energy or decreasing pain, which ultimately could lead to an instrumental consequence of weight loss.

There is no question that dietary changes are most important to achieving sustained weight loss. However, we need to get our psyches in line for change. Hopefully, when we choose to improve our health, we don’t just focus on weight as a measure of success. Weight loss goals by themselves tend to lead us astray and to disappoint, for they are external motivators. Focus on improving your health by making lifestyle modifications. This tends to result in a successful instrumental consequence.

References:

(1) Psychoneuroendocrinol Online. 2014 April 12. (2) JAMA 2012;307:491–497. (3) Ann Intern Med. 2014;161:309-318. (4) Huffington Post. 2014 Sept. 2. (5) N Engl J Med. 2014;370:886. (6) JAMA. 2014;312:923-933. (7) JAMA Intern Med. 2013;173:1230-1238. (8) Proc Natl Acad Sci U S A. 2014;111:10990-10995.

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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Like a pit orchestra hidden beneath the stage during a musical, a collection of often unheralded people work for years to make it possible for astronauts to dazzle the world with their journeys further from home than anyone has ever gone.

A physicist at the NASA Space Radiation Laboratory, Michael Sivertz is one of the researchers working behind the scenes to help make those majestic launches that carry astronauts deep into space safer.

Along with other physicists, biologists, and a host of others, Sivertz helps run, maintain and prepare the equipment NASA built in 2003 to test the effects of cosmic radiation on everything from different systems in the human body to the electronics that make space flight possible.

While he doesn’t test the cells themselves, Sivertz helps create and understand the kinds of radiation that enable other scientists to see how these DNA-altering and cell-altering ions might affect people who spend prolonged periods in space. He studies mitigation efforts that include shielding.

“When a proton goes through your DNA, it dislodges an occasional base pair,” Sivertz said. That’s like knocking a piece out of a jigsaw puzzle. The human body then looks for a part that fits in the empty space. “The repair happens trivially.”

When an ion of iron, however, goes through DNA, “it’s like a bomb going off. It quite frequently breaks both legs of DNA, and much damage is done. There is no simple recipe for putting those pieces of DNA back together in a foolproof way. That’s what makes space radiation so different,” he said. Sivertz’s role, he explained, is to develop the instrumentation that makes tests of cellular reactions to different kinds of radiation possible.

Peter Guida, a biologist at BNL who provides a similar expertise at using the NSRL, appreciates his colleague’s work. Sivertz “was chosen in particular because of his background, expertise and work ethic to become part of the NSRL program,” said Guida, who has known Sivertz for more than a decade. “That’s proven to be an extremely wise choice.”

Sivertz is working to understand the beam, its energy, its fragmentation, the way it loses energy and its stopping range — how far it goes through a material before it stops. He recently conducted a series of measurements to study the scattering cross section and charge-changing cross section for a variety of ions, including oxygen, carbon, and helium 3 and helium 4, which are isotopes of helium. “BNL is one of the only places in the world that can accelerate helium ions to produce an ion beam,” he said, while NSRL is the only facility designed to simulate the entire cosmic ray spectrum.

Sivertz also helps make it possible for scientists to test the effect of radiation on electronic devices. “As the characteristic size of electronic devices has shrunk, they have approached the size of cells, and their activation energies are similar to that of cells,” he explained. “Models for electronic behavior are sharing understanding with models for cellular behavior.”

Sivertz recognizes the need to understand how the environment in space might affect expensive systems. “If you’re going to send up a $1 billion satellite, you want to make sure some $5 memory chip doesn’t bring it down when it gets hit” by radiation, he said.

About a quarter of the time, Sivertz gets to pursue his own research, which includes a more precise understanding of the nature of the beams he’s directing toward test samples. Ion beams delivered at NSRL begin as a pure beam. As that beam moves through the air and equipment along the way, some of those ions hit atoms in the air, scatter or break into fragments, he described. For some experiments, researchers need to know exactly what happens to the beam and how it changes.

He is also working with people on helping to build better proton therapy treatment for cancer. Proton therapy may be more targeted toward tumors because the protons move at a slower speed, causing them to distribute all their energy at the site of a tumor rather than in healthy layers of tissue before and after the tumor.

Like members of a pit orchestra, Sivertz and Guida both play the same instrument: the guitar. Guida said Sivertz keeps his nylon-stringed guitar near the beam line, to strum some classical strains during the unusual moments when the beam line isn’t functioning.

In addition to being a talented scientist, Guida said, Sivertz is “a pretty good guitar player.”

 

Civic group does not vote ‘fore’ or against proposal

The Heatherwood Golf Club. File photo by Andrea Moore Paldy

Dozens of community members turned out to a special meeting of the Port Jefferson Station/Terryville Civic Association last Wednesday night, Aug. 27, to oppose a proposed retirement housing project at the Heatherwood golf course.

The owners of Heatherwood Golf Club, located at Arrowhead Lane and Nesconset Highway in Terryville, are looking to build 200 rental units at the site — made up of townhouses, ranches and apartments — for residents 55 and older.

Doug Partrick, an owner of the course and multifamily housing developer Heatherwood Communities, was not at the meeting, but according to a presentation he gave on the project at a May civic meeting, the housing would be built on 25 of the golf course’s 70 acres, leaving 45 acres as open space.

The homes would be surrounded by a nine-hole golf course, down from the 18 holes currently on the site.

Residents at Wednesday’s meeting said they are concerned about the project’s impacts on traffic and quality of life. They were also wary of overdevelopment.

“It takes me 20 minutes to get home and I travel 1.8 miles,” Patricia Higgins, who lives close to the golf course, said in an interview afterward. “I could walk faster.”

Civic President Ed Garboski told the crowd that the golf course would shut down at the end of the season, regardless of whether the housing project is approved.

Partrick had said in May that if the development did not move forward, he would think about whether he is “better off consistently losing money on the golf course or … just shutting the golf course down, leaving it dormant” and paying taxes on the land.

“If he wants to walk, let him walk,” Lou Antoniello, who is the civic treasurer but was speaking just as a Terryville resident, said in an interview. “Have a nice day and don’t let the door hit you on the way out.”

Residents hope they can stop the project from moving forward.

“I am so glad I came to know what’s going on and it’s disappointing,” Port Jefferson Station resident Nancy Farrell said in an interview.

Garboski said during the meeting that results of a traffic study performed on the area found that the proposed Heatherwood project would not have a big impact on traffic.

But residents argued that 200 rented units would bring at least 200 new cars, and said they don’t understand how that wouldn’t affect traffic.

Joe Cannone, a Port Jefferson Station resident, said after the meeting that he isn’t against development at the golf course, but “the golf course should either stay a golf course or develop for what it’s zoned for.”

The course is zoned A Residence 5, which allows one housing unit for every 5 acres.

The civic is expected to vote on whether it supports the project at its next meeting on Sept. 23.

Whatever the group decides, it will have the backing of a neighbor — Shawn Nuzzo, president of the Civic Association of the Setaukets and Stony Brook, attended last Wednesday’s meeting because part of the golf course lies in the Three Village school district, and he assured the crowd that his civic will take the same stand as whatever the Port Jefferson Station/Terryville Civic Association decides.

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The end of the Labor Day holiday represents the unofficial end of summer, the beginning of the academic calendar and noticeably shorter daylight hours. The pace of life tends become more hectic. Although some stress is valuable to help motivate us and keep our minds sharp, high levels of constant stress can have detrimental effects on the body.

It is very likely that there is a mind-body connection when it comes to stress. In other words, it may start in the mind, but it can lead to acute or chronic disease promotion. Stress can also play a role with your emotions, causing irritability and outbursts of anger, and possibly leading to depression and anxiety. Stress symptoms are hard to distinguish from other disorders but can include stiff neck, headaches, stomach upset and difficulty sleeping. Stress may also be associated with cardiovascular disease, with an increased susceptibility to infection from viruses causing the common cold and with cognitive decline and Alzheimer’s (1).

A stress steroid hormone called cortisol is released from the adrenal glands and can have beneficial effects in small bursts. We need cortisol in order to survive. Some of cortisol’s functions include raising the glucose (sugar) levels when they are low and helping reduce inflammation and stress levels (2). However, when cortisol gets out of hand, higher chronic levels may cause inflammation, leading to disorders such as cardiovascular disease, as recent research suggests. Let’s look at the evidence.

Inflammation may be a significant contributor to more than 80 percent of chronic diseases, so it should be no surprise that inflammation is an important factor with stress. In a recent meta-analysis (a group of two observational studies), high levels of C-reactive protein, a biomarker for inflammation, were associated with increased psychological stress (3).

What is the importance of CRP? It may be related to heart disease and heart attacks. This study involved over 73,000 adults who had their CRP levels tested. The research went further to suggest that increased levels of CRP may result in more stress and also depression. With CRP higher than 3.0 there was a greater than twofold increase depression risk. The researchers suggest that CRP may heighten stress and depression risk by increasing levels of different proinflammatory cytokines, inflammatory communicators among cells (4).

In one recent study, results suggested that stress may influence and increase the number of hematopoietic stem cells (those that develop of all forms of blood cells), resulting in specifically an increase in inflammatory white blood cells (5). The researchers suggest that this may lead to these white blood cells accumulating in atherosclerotic plaques in the arteries, which ultimately could potentially increase the risk of heart attacks and strokes. Chronic stress overactivates the sympathetic nervous system — our “fight or flight” response — which may alter the bone marrow where the stem cells are found. This research is preliminary and needs well-controlled trials to confirm these results.

Stress may increase the risk of colds and infection. Cortisol over the short term is important to help suppress the symptoms of colds, such as sneezing, cough and fever. These are visible signs of the immune system’s infection-fighting response. However, the body may become resistant to the effects of cortisol, similar to how a type 2 diabetes patient becomes resistant to insulin. In one study of 296 healthy individuals, participants who had stressful events and were then exposed to viruses had a higher probability of catching a cold. It turns out that these individuals also had resistance to the effects of cortisol. This is important because those who were resistant to cortisol had more cold symptoms and more proinflammatory cytokines (6).

When we measure cortisol levels, we tend to test the saliva or the blood. However, these laboratory findings only give one point in time. Thus, when trying to determine if raised cortisol may increase cardiovascular risk, the results are mixed. However, in a recent study, measuring cortisol levels from scalp hair was far more effective (7). The reason for this is that scalp hair grows slowly, and therefore it may contain three months’ worth of cortisol levels. The study showed that those in the highest quartile of cortisol levels were at a three-times increased risk of developing diabetes and/or heart disease compared to those in the lowest quartile. This study involved older patients between the ages of 65 and 85.

Lifestyle plays an important role in stress at the cellular level, specifically at the level of the telomere, which determines cell survival. The telomeres are to cells as the plastic tips are to shoelaces; they prevent them from falling apart. The longer the telomere, the slower the cell ages and the longer it survives. In a recent study, those women who followed a healthy lifestyle — one standard deviation over the average lifestyle — were able to withstand life stressors better since they had longer telomeres (8).

This healthy lifestyle included regular exercise, a healthy diet and a sufficient amount of sleep. On the other hand, the researchers indicated that those who had poor lifestyle habits lost substantially more telomere length than the healthy lifestyle group. The study followed women 50 to 65 years old over a one-year period.

In another study, chronic stress and poor diet (high sugar and high fat) together increased metabolic risks, such as insulin resistance, oxidative stress and central obesity, more than a low-stress group eating a similar diet (9). The high-stress group was caregivers, specifically those caring for a spouse or parent with dementia. Thus, it is especially important to eat a healthy diet when under stress.

Interestingly, in terms of sleep, the Evolution of Pathways to Insomnia Cohort study shows that those who deal with stressful events directly are more likely to have good sleep quality. Using medication, alcohol or, most surprisingly, distractors to address stress all resulted in insomnia after being followed for one year (10). Cognitive intrusions or repeat thoughts about the stressor also resulted in insomnia.

Psychologists and other health care providers sometimes suggest distraction from a stressful event, such as television watching or other activities, according to the researchers. However, this study suggests that this may not help avert chronic insomnia induced by a stressful event. The most important message from this study is that how a person reacts and deals with a stressors may determine whether they suffer from insomnia.

Constant stress is something that needs to be recognized. If not addressed, it can lead to suppressed immune response or increased levels of inflammation. CRP is an example of an inflammatory biomarker that may actually increase stress. In order to address chronic stress and lower CRP, it is important to adopt a healthy lifestyle that includes sleep, exercise and diet modifications. A good lifestyle may be protective against cell aging when exposed to stressors.

References:

(1) Curr Top Behav Neurosci. 2014 Aug. 29. (2) Am J Physiol. 1991;260(6 Part 1):E927-E932. (3) JAMA Psychiatry. 2013;70:176-184. (4) Chest. 2000;118:503-508. (5) Nat Med. 2014;20:754-758. (6) Proc Natl Acad Sci U S A. 2012;109:5995-5999. (7) J Clin Endocrinol Metab. 2013;98:2078-2083. (8) Mol Psychiatry Online. 2014 July 29. (9) Psychoneuroendocrinol Online. 2014 April 12. (10) Sleep. 2014;37:1199-1208.

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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By Linda M. Toga, Esq.

The Facts: My father has decided to gift his house to me and my brother and to retain a life estate for himself. This is part of his Medicaid planning.

The Question: What are the advantages and disadvantages of making this transfer?

The Answer: The advantages of putting the house in your names now is that it starts the clock running for purposes of Medicaid benefits that will cover nursing home care. As long as five years pass between when the house is transferred and when your father applies for Medicaid, the full value of the house will have no bearing on your father’s eligibility for benefits. In addition, by retaining a life estate in the house, your father will continue to be eligible for real property tax exemptions such as Enhanced Star and veterans exemptions that he may now enjoy. It is important to note that the life estate has a value which will be taken into consideration when he applies for Medicaid. However, the life estate should not cause him to be ineligible to receive benefits.

The disadvantages of transferring the house to you and your brother outweigh the advantages. First, if the house is sold during your father’s life, he is entitled to receive the value of his life estate. While the life estate itself is not considered an available resource for Medicaid purposes, the cash that he receives from the sale of his life estate will be deemed an available resource which may make him ineligible for benefits.

Second, if you and your brother are gifted the house now, your basis in the house for capital gains tax purposes will be the same as your father’s basis. If, on the other hand, you are not gifted the house now but you inherit the house upon your father’s death, you will get a step up in basis. Assuming your father has owned the house for a long time, getting the step up in basis upon his death will likely avoid significant capital gains taxes when you and your brother sell the house.

Third, if you and your brother own the house, your creditors will be able to attach liens and/or judgments to the property. This will not necessarily decrease the value of the property but, those liens and judgments will have to be paid when the house is sold, regardless of whether that is before or after your father’s death. If your father needs to apply for Medicaid in three years, for example, your father will be ineligible for Medicaid for a period of time based upon the value of the gifted house. If you have to sell the house to cover your father’s expenses during the penalty period, the amount of money you and your brother will have to pay those expenses will be decreased by the amount of any judgments and liens that had to be paid off at the time of the sale.

Clearly, the disadvantages of gifting the house now are significant, and individual circumstances and goals may require differing approaches. There are also other options available to your father. For example, rather than transferring the house to you and your brother now, your father can transfer the property into an irrevocable trust. The trust can provide that the house passes to you and your brother when your father dies. While using a trust will not avoid the five year Medicaid look-back period, it will protect the property from your creditors and result in you and your brother getting a step up in basis upon your father’s death.

In light of the number of issues to be considered, it would be important to discuss this matter with an experienced elder law attorney and/or financial/tax advisor before deciding which option is the best one for your father.

Linda M. Toga, Esq. provides legal services in the areas of litigation, estate planning and real estate from her East Setauket office.

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Grigori Enikolopov — or Grisha to his colleagues — is involved in pushing limits. The associate professor at Cold Spring Harbor Laboratory and member of the graduate program at Stony Brook University is developing ways to refine state-of-the-art imaging to see the creation of new brain cells in adults.

The cells he’s seeking to observe are stem cells located primarily in the hippocampus. In animal models, these stem cells have the potential to restore memory after an injury or disease, enhance mood or improve the ability to learn.

“His latest work is very bold in trying to refine imaging” to be able to observe in real time “the generation of new brain cells,” said Dennis Steindler, the Joseph J. Bagnor/Shands Professor of Medical Research in the Department of Neurosurgery at the University of Florida. Steindler, who has known Enikolopov for over a decade, said his Cold Spring Harbor Laboratory colleague is “pushing the limitations of imaging. We’re at the point where we’re going to see what the resolution limit of noninvasive imaging of a brain is, anatomically and molecularly.”

Enikolopov and Steindler also led a study that will help prepare astronauts push the limits of space travel on potential future trips to Mars. The scientists explored the effects of cosmic radiation on these same important stem cells. They discovered that inactive stem cells are vulnerable to the effect of prolonged periods in space.

Working with Marcelo Vazquez at Brookhaven National Laboratory among others, the group discovered that these neural stem cells were sensitive to cosmic radiation. This finding, which was published in 2008, will help NASA with future missions that could involve prolonged exposure to cosmic radiation.

“Space travel in the future will use the data that [Enikolopov] and my collaborators helped develop to provide better protection methods for astronauts taking long space trips,” Steindler said. “It speaks to the breadth and scope of [Enikolopov’s] research” that he could become an instrumental part of this team.

Indeed, Enikolopov is interested in a broad range of areas related to stem cells, including understanding the signals that activate these powerful cells that can become neurons or glial cells, which are critical for the functioning of neurons in the brain.

Up until about 20 years ago, scientists didn’t even know stem cells were located in the hippocampus. Only recently were researchers like Enikolopov able to demonstrate the connection between stem cells and new neurons, learning, memory and mood.

“The idea that new neurons may be important for new memories was a natural and intuitive one, but it took a while to prove that,” Enikolopov said.

Steindler called Enikolopov “a rare scientist who has a grasp on many different complex technological approaches,” and said his Cold Spring Harbor collaborator has helped make important discoveries.

Enikolopov said stem cells are often involved in helping recover from damage to the brain. He and other scientists don’t yet know how these stem cells assess and repair the damage. As people age, the number of new neurons produced decreases, which means each of the stem cells adults have becomes more important at warding off age-related cognitive declines.

“Preventing the birth of new neurons from stem cells in the adult brain causes problems with memory; conversely, increasing production of new neurons enhances memory,” he said.

In animal models, running and living in an enriched environment increases production of new neurons. With humans, scientists still have to prove that, although Enikolopov believes that people should also benefit from exercise and experiencing new environments and ideas.

If Enikolopov and Steindler are effective, they may some day help “make 80 the new 40,” Steindler said.

While Steindler is an enthusiastic supporter and collaborator, he isn’t the first American scientist to appreciate the talents of the Russian-born Enikolopov. James Watson, the Nobel Prize-winning former director of CSHL, was visiting the institute in Moscow where Enikolopov worked. Watson invited him to become a visiting scientist at Cold Spring Harbor Laboratory.

Enikolopov understood his appointment would last around a year. “We thought this would be temporary” when he and his wife, Natalia Peunova, an independent research investigator at Cold Spring Harbor Laboratory, left Russia. That was a quarter of a century ago, as the couple raised three children on Long Island and have two grandchildren.

Enikolopov enjoys driving along the North Shore, where he marvels at the water views.

As for his work, Enikolopov is hoping to unlock the stem cell code. The primary focus is on “understanding how stem cells produce new neurons and how they talk to other types of stem cells,” he explained.

 

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