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Danny Bluestein and Wei-Che Chiu, a Stony Brook biomedical engineering doctoral student, with ventricular assist devices. Photo from SBU

By Daniel Dunaief

Some day, a doctor may save your life, repairing a calcified heart valve that jeopardizes your health. But then, the doctor may owe his or her latest lifesaving procedure to the work of people like Danny Bluestein, a professor in biomedical engineering and the director of the Biofluids Laboratory at Stony Brook University, and an international team of colleagues.

The group is working on restoring blood flow from the heart to the body using approaches for patients for whom open heart surgery is not an option.

Recently, the National Institutes of Health awarded the research crew a five-year $3.8 million grant to work on a broad project to understand ways to improve transcatheter aortic valve replacements, or TAVR, while reducing or minimizing complications from the procedure.

Danny Bluestein with his wife, Rita Goldstein. Photo from D. Bluestein

The grant is “not just about developing a new device, which we’ve been developing already for several years, but it’s also developing it in such a way that it answers challenges with disease and what clinical problems current technology offers solutions for,” Bluestein said.

TAVR provides a prosthetic valve for high-risk surgery patients. Like stents, TAVR is inserted through an artery, typically near the groin, and is delivered to the heart, where it improves the efficiency of an organ compromised by calcification on a valve and on the aorta itself.

Patients who have been candidates for TAVR are usually over 70 and often struggle to walk, as their hearts are enlarged and lose flexibility.

TAVR surgeries are performed in as many as 40 percent of such operations in some parts of Europe and the United States. The numbers have been increasing in the last couple of years as the technology has improved in different iterations of TAVR.

These valves are not only helping high-risk patients, but they are also assisting moderate and lower risk candidates.

Doctors have used TAVR for off-label uses, such as for people who have congenital difficulties with their valves, and for people who have already had open heart surgeries whose replacement valves are failing and who may be at risk for a second major heart operation.

Recovery from TAVR is far easier and less complicated than it is for cardiac surgery, typically requiring fewer days in the hospital.

Indeed, numerous researchers and cardiologists anticipate that this percentage could climb in the next several years, particularly if the risks continue to decline.

The team involved in this research effort is working with a polymer, hoping to reduce complications with TAVR and develop a way to tailor the valve for specific patients.

“If you’re a polymer person like me, you know we can make this work,” said Marvin Slepian, the director of the Arizona Center for Accelerated BioMedical Innovation at the University of Arizona. Slepian is pleased to continue a long collaboration with Bluestein, whose expertise in fluids creates a “unique approach to making something happen.”

The tandem is working with Rami Haj-Ali, the Nathan Cummings Chair in Mechanics in the Faculty of Engineering at Tel-Aviv University in Ramat Aviv, Israel. “To enable this technology, we need to better understand the current” conditions, said Haj-Ali, who uses computer methods to study the calcium deposited on the valve to understand the stages of the disease.

The valve Bluestein is proposing includes “new designs, new simulations, and new materials” that can create “less reactions with patients and overcome” problems TAVR patients sometimes face, Haj-Ali explained.

One of the significant challenges with TAVR is that it typically only lasts about five to six years.

“The idea of the NIH and this project is to extend the built-in efficiency of such a procedure,” Bluestein said. “TAVR is moving very fast to extend its functionality and durability.”

When the valve is inserted into the body, it is folded to allow it to fit through the circulatory system. This folding, however, can damage the valve, making it fail faster than in the surgical procedure.

As a part of this research, Bluestein and his team will explore ways to change the geometry of the TAVR according to the needs of the patient, which will enhance its functionality for longer. Bluestein and others will test these changing shapes through models constructed on high-performance computers, which can test the effect of blood flowing through shapes with specific physical passageways.

“Eventually, the future would involve custom designed valves, which would be optimal for the specific patient and will extend the lifespan of such a device,” Bluestein said.

A current off-label use of the TAVR valve involves assisting people born with an aortic valve that has two leaflets. Most aortic valves have a third leaflet. People with bicuspid aortic valves develop symptoms similar to those with calcification.

Going forward, Bluestein and his team plan to design valves that are specific for these patients.

A small percentage of patients with TAVR also require pacemakers. The device can interact with the electrophysiology of the heart and impair its rhythm because it creates pressure on the tissue. It is likely pushing against special nodes that generate the heart rhythm.

These studies include exploring the mechanical stress threshold that requires implantation of a pacemaker. By moving the device to a slightly different location, it may not interfere with the heart rhythm.

A resident of Melville and Manhattan, Bluestein is married to Rita Goldstein, who is a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai. 

Bluestein was raised in Israel, where he did his doctoral work. He became intrigued by the study of the flow of blood around and through the heart because he was interested in blood as a living tissue.

As for the ongoing work, Haj-Ali is optimistic about the group’s prospects. The scientists that are a part of this effort “bring something to the table that, in combination, doesn’t exist” elsewhere, he said.

Out-of-date beneficiary designations are a common and costly mistake. Stock photo

By Linda Toga, Esq.

Linda Toga, Esq.

THE FACTS: My brother Joe was dying from cancer and wanted to be sure that all of his assets passed to his wife, Mary, upon his death without the need for court intervention. He mentioned this a number of times, so I assumed he had taken the necessary steps to ensure that his wishes were honored. 

The car Joe drove was in Mary’s name and the house in which he lived was jointly owned with Mary. However, Joe had substantial assets in separate bank and brokerage accounts. After Joe died, Mary was told by the bank and brokerage company that Joe never signed any documents indicating that he wanted his accounts to pass to Mary automatically upon his death. 

THE QUESTION: Is there any way Mary can get access to the funds in Joe’s accounts without getting authority to do so from the Surrogate’s Court?

THE ANSWER: Unfortunately for Mary, she will have to petition the Surrogate’s Court for authority to access Joe’s accounts. If Joe died with a will and the will names Mary as executrix, Mary will need to file a petition seeking letters testamentary. The petition, an original death certificate and a fee based upon the value of the accounts must be filed with the Surrogate’s Court in the county where Joe lived at the time of his death. Once letters testamentary are issued to Mary, she will be able to access the funds and, assuming she is the only beneficiary under the will, do whatever she deems appropriate with the funds. 

If Joe died without a will, Mary will have to petition the court seeking letters of administration. The process and the fees for the administration proceeding are similar to those associated with a probate proceeding. Again, once letters are issued to Mary, she will have the authority to access the funds in the account. Mary will be required to distribute the funds in accordance with the NYS intestacy statute that governs the distribution of estates of people who die without a will. If Joe had children, they will be entitled to a share of the money in the accounts to the extent it exceeds $50,000. 

Based on your description of the assets in the separate accounts as “substantial,” I am assuming there is more than $30,000 at issue. If that is not the case, Mary can file with the Surrogate’s Court an affidavit in relation to a small estate to get authority to access the funds in the accounts. The account numbers and the balance in each account must be provided in the affidavit. Mary will be issued a certificate for each account giving her authority to access the account.

 It is unfortunate that Mary will have to seek court intervention in order to access Joe’s accounts, but she should take some comfort in the fact that the probate/administration proceedings are not burdensome and that her situation is not unusual. Clients frequently find that the steps taken by a decedent were not sufficient to ensure that their estates pass as the decedent wished. 

To avoid this situation, I encourage my clients to periodically review all beneficiary designation and transfer on death forms that have been filed and to review how jointly held property is titled. These steps are critical to ensuring that the client’s estate plan truly reflects the client’s wishes. 

Linda M. Toga, Esq. provides legal services in the areas of estate planning and administration, wills and trusts, guardianship real estate, small business services and litigation from her East Setauket office.

By Barbara Beltrami

What kind of a food columnist would I be if I didn’t write about Christmas cookies every December? And what kind of a Scrooge would you be if you didn’t bake or at least intend to bake Christmas cookies every year? There are times when tradition rules, when you do certain things because you’ve always done them, because your mother and before that your grandmother have always done them and to not do them would be sacrilege. And there is nothing like gathering the kids in the kitchen and making it a tradition that they’ll carry on when it’s their turn. 

So here are some uber traditional Christmas cookie recipes — three different versions — cut, pressed and dropped — of the sugar cookie. I have no idea where or when they originated. I just know they’ve been the go-to recipes in our family for years and years. All are wonderful on their own, particularly when surreptitiously snatched from the voluptuously mounded cookie platter, and they all go well with tea, coffee, milk, hot chocolate, eggnog or any holiday spirits.

Spritz Cookies (Pressed)

Spritz Cookies

YIELD: Makes about 6 dozen

INGREDIENTS:

2 sticks room temperature unsalted butter

2/3 cup sugar

3 egg yolks

1 teaspoon vanilla or almond extract

2½ cups flour

DIRECTIONS:

Heat oven to 400 F. In a large bowl thoroughly combine butter, sugar, egg yolks and extract. Add flour and work in. Divide dough into quarters and place one quarter at a time into cookie press; using desired shapes, force dough onto ungreased cookie sheets. Bake 7 to 10 minutes until set but not brown. Cool on wire rack 30 minutes and decorate as desired.

Drop Sugar Cookies

Drop Sugar Cookies

YIELD: Makes about 3 dozen

INGREDIENTS:

2 eggs, beaten

2/3 cup vegetable oil

2 teaspoons vanilla

1 teaspoon grated lemon zest (optional)

¾ cup sugar

2 cups flour

2 teaspoons baking powder

½ teaspoon coarse salt

DIRECTIONS:

Heat oven to 400 F. In large bowl, thoroughly combine eggs, oil, vanilla and lemon zest (if using); gradually add sugar and beat until mixture thickens. In another bowl, blend flour, baking powder and salt and incorporate mixture into first one. Drop by teaspoonfuls 2 inches apart on ungreased baking sheet, flatten each mound with bottom of glass dipped in sugar. Bake 8 to 10 minutes. Cool immediately on wire rack. Decorate as desired. 

Classic Sugar Cookie Cut Outs

YIELD: Makes 4 to 5 dozen

INGREDIENTS:

1½ cups confectioners’ sugar

2 sticks unsalted butter

1 teaspoon vanilla extract

½ teaspoon almond extract

1 egg

2½ cups flour

1 teaspoon baking soda

1 teaspoon cream of tartar

DIRECTIONS:

In a large bowl thoroughly combine sugar, butter, vanilla and almond extracts and egg. In another bowl, combine flour, baking soda and cream of tartar; then stir that mixture into first one. Cover and refrigerate 4 hours or more. 

Heat oven to 375 F. Divide dough in half and roll out each half to ¼-inch thick on lightly floured cloth-covered surface. Cut cookies and place on ungreased cookie sheets and bake 7 to 8 minutes until light brown. Cool on rack 30 minutes, then decorate as desired. 

Gather unused dough into a ball and refrigerate or place in freezer to chill; then repeat roll out procedure. 

Holiday plants like mistletoe and holly are poisonous to your pets.

By Matthew Kearns, DVM

Dr. Matthew Kearns

Why do pets like holidays? There are many reasons.

Lots of extra attention!!!!! 

Family is home more and friends come over to celebrate. This means lots of extra attention. Most pets enjoy this but some can have some anxiety. Make sure that if your dog or cat tends to get scared with a lot of people around they have a safe haven: a separate room, kennel, etc. 

If your pet tends to get so fearful that they might snap or scratch at a guest, it might be best to find a friend to watch them or consider boarding them for a day or two. We commonly board at our clinic not only for vacations but also for a day or two during the holidays. 

If relatives are visiting, gently remind them of the danger of leaving medications out. Not just prescription medications pose a holiday hazard; over-the-counter medications are dangerous as well. A single ibuprofen or acetaminophen tablet could cause serious illness in a large dog and be potentially fatal to a small dog or cat.

Lights and decorations 

Whether you celebrate the Festival of Lights or “Oh Holy Night,” everyone loves holiday lights and decorations (including dogs and cats). Just make sure that they don’t have access to wires (risk of electrocution), tinsel (GI obstructions) and plants. Plants like mistletoe and holly can cause severe GI problems and sometimes cardiac dysfunction; so make sure they are away from curious paws and mouths. If you have a live tree, the water can become stagnant and bacteria will grow in it; so keep your dog or cat away from it.  

Gifts, gifts, gifts 

Even pets like gifts and, if your cats are like mine, the boxes gifts come in are more fun than the gifts themselves. Check these toys to make sure toys don’t have strings, ribbons or yarn that could come off and potentially be swallowed. If you like to give bones as treats (and what dog doesn’t love bones), make sure they are not turkey, chicken, pork or fish bones. These bones tend to splinter and present choking hazards, as well as perforate the stomach or bowels.

Food, glorious food!!! 

There’s lots of food around and usually on tables within reach of opportunistic dogs and cats. Be careful of leaving food around, especially chocolates. Chocolate has two chemicals: caffeine and theobromine, and both are powerful stimulants. Small amounts cause panting, hyperactivity, increased thirst and urination. Larger exposures of chocolate trigger irregular heart rhythms, seizures, coma and death.  

Chocolate is also very high in sugar and fat. Minimally, this will give your pet a tummy ache, but I have personally seen a few cases of serious gastroenteritis, pancreatitis and liver disease from ingestion of large amounts of chocolate and other candy. Any leftover food will tend to grow bacteria and mold on it if left out. Try to make an effort (even after a long night of reveling) to clean up so that you do not have to worry about your pet ingesting leftover treats.    

I hope everyone has a joyous and safe holiday season and a Happy New Year. Special thanks to Heidi Sutton and all the staff of the Arts and Lifestyle section for making my column possible and another great year. 

Dr. Kearns practices veterinary medicine from his Port Jefferson office and is pictured with his son Matthew and his dog Jasmine.

MEET SUE ELLEN!

This week’s shelter pet is Sue Ellen, a beautiful 2-year-old Lab mix who was rescued from a high kill shelter in Texas and is now safe at Kent Animal Shelter. This holiday season Sue Ellen is thankful to be rescued and would like a loving and forever home of her own. She comes spayed, microchipped and is up to date on her vaccines. Please come down and meet her!

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Sue Ellen and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

Update: Sue Ellen has been adopted!

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Cleary School for the Deaf in Nesconset is the only state-supported school in Suffolk County for more than 50 preschool children who are deaf or profoundly hearing impaired. It has become apparently clear to us the state assistance it does receive doesn’t seem to be nearly enough.

As a parent pointed out, Cleary’s full-time students ages 3 to 7, despite being young, are keenly aware that they are different from their peers. While facing the challenges of learning how to overcome hearing loss, often in combination with visual impairments and other disabilities, they are separated from peers.

This is a classic case of separate but not equal. Cleary School for the Deaf was forced to take down its 30-year-old wooden playgrounds and has taken to GoFundMe to raise the money needed to replace them.

Young children have a natural desire to want to run, jump and play outside. A playground provides them with the opportunity  not only to get exercise and build gross motor skills as they try to negotiate the monkey bars, but a chance for social interaction as well. In taking the risk of asking another child to play, they learn how to negotiate making friends and, unfortunately, deal with rejection. It can also be a chance to be creative by playing make believe.

Parents researching various preschool and kindergarten programs have every reason to want to know what activities and resources will be available to their children — including what opportunities will be available for play.

Katie Kerzner, principal at Cleary, said she’s already faced the difficult questions from parents such as “Will my preschool or kindergarten-aged child have the same opportunity as those at public schools? The opportunity to play on a playground?”

The answer, we all know, should be an unequivocal “Yes.” Unfortunately, the future isn’t so clear. The state-supported school’s staff say enrollment has boomed in the last five years and state aid isn’t keeping up.

Parents of Cleary’s students have launched a GoFundMe campaign in an effort to raise the funds necessary to build a playground. In addition, the school hosted fundraising breakfasts and raffles while local businesses and community members have stepped forward to help, but it’s not yet clear if their fundraising efforts will be enough.

New York State officials need to get on this, provide support and do more. It’s not right to have children who already feel different as they fight to overcome disabilities left out on a fundamental part of growing up.

Our Long Island schools, both public and state-supported, need to receive their fair part of state funding. It’s a battle cry we hear from teachers and school administrators at the start of every budget season in January. This time, we’re sounding the rally cry early for Cleary and its students.

By Daniel Dunaief

Daniel Dunaief

Old school. It’s a phrase that suggests someone, like yours truly, does something one way, even if there might be an easier, more efficient or modern alternative method for doing things.

Take reading a book. My teenage children think nothing of doing their assigned reading for classes on electronic devices.

That just doesn’t work for me. For me, reading has
always been a multisensory experience. I enjoy finishing a page and flipping to the next one, anticipating the next set of words even as I know how many pages are left in the book by the size of the stack to the left and right.

When I was young, I used to figure out the exact middle of a book. I had an understated celebration when I reached the midpoint, even though the prologue, or introduction, often tilted the balance slightly.

Of course, I could do the same thing with an electronic version of a book.

And yet it’s just not the same for me. I also liked to see the names of the people who read the book in school before me. These students had perused the same pages, found the same shocking revelations and associated with the characters as they moved through the same year in their lives.

When I reread a chapter, searched for symbols or literary devices, I could recall exactly where on a page I might have seen something.

In an e-book, every page is the same. None of the pages is slightly darker, has a bent corner where someone might have stopped, or has a slightly larger “e” or a word that’s printed above the others on a line. The virtual pages are indistinct from each other, except for the specific words on the page or the chapter numbers.

I suppose people like me are why a store like Barnes & Noble can still exist, despite the ease and low cost of uploading books. And, yes, I understand when I travel how much lighter my suitcase would be if I uploaded 100 books without lugging the weight of the paper. I also understand that e-books are more environmentally friendly. Once a paper book is produced, however, it no longer requires constant battery recharging.

Passing along books read by earlier generations connects us to our parents and grandparents. We can imagine them holding the book at a distance as their eyes started to change, falling asleep with the book in their laps, or sitting on the couch until late at night, eager to finish a book before going to bed. We can also picture them throwing a book that frustrated them across the room or out the window.

Among the many Titanic stories that sticks out for me is the tale of Harry Elkins Widener, a 27-year-old book collector who boarded the ill-fated ship with his mother and father in Cherbourg, France. Legend has it that he died with a rare 1598 book, “Essays” by Francis Bacon, that he had bought in London. Harry and his father died aboard the ship, while their mother survived the sinking. After her son perished, she donated $2 million — an enormous sum in 1912 — to Harvard to construct a
library which is still on the main campus.

While I’m sure it’s possible to pick a random section of an e-book, I have grabbed books from a shelf and leafed to a random page, trying to figure out where in the story I have landed.

I am delighted to hold children’s books, including many of the Dr. Seuss collection. Also, I remember my children searched each page of “Goodnight Moon,” by Margaret Wise Brown for the mouse. There’s probably a mouse in the virtual version and touching it may even make the mouse grow, scurry across the virtual page or offer lessons about rhyming couplets.

Still, for my reading pleasure, I’m old school: Hand me a book and I’ll carry around a friend.

Evelyn Berezin

By Leah Dunaief

Leah Dunaief

Two exceptional people, Edmunde Stewart and Evelyn Berezin, died this past week, one day apart. The funeral for one was at Bryant Funeral Home in East Setauket on Monday, for the other at Riverside Memorial Chapel in New York City on Tuesday. Although quite different, they were both well known for their talents. I was privileged to know them as friends. Their deaths leave a void for the world and a hole in my heart.

The first was a Scotsman, an orthopedic surgeon who lived for many years in Old Field and whose office was in Port Jefferson. He was 80 years old, and during his half-century of medical practice, he touched the lives of thousands of people. Educated well, he came to the United States to cap off his training, fell in love with one of the first women he met at Stony Brook — and Scotland’s loss was our gain. She was there, at his bedside all those years later, when, struggling to breathe, he finally succumbed to COPD.

Edmunde Stewart

The second was born in the East Bronx and was 93. She was one of three children raised in an apartment under elevated railroad tracks. It was so small that the uncle who boarded with them, while he finished medical school, had to sleep on a mattress under the dining room table. She was bright enough to finish high school at 15 and attended Hunter College at night while she worked. Unusually tall for her generation, she lied about her age in order to get her job. Under a World War II City University program that allowed women to study calculus and other specialized subjects at an all-male school, she then transferred to Brooklyn Polytechnic Institute and ultimately earned a degree in physics from NYU in 1946. Needless to say, she was in a distinct minority in her classes.

He, when not practicing medicine, and as a passionate lover of horses and riding, participated in the Smithtown Hunt for many years and on many wild rides through the neighborhoods. He cut a fine figure in his scarlet hunting jacket at the head of the pack. And he probably broke every bone in his body at least twice in his many falls, always with good humor during the phone calls as he related the latest mishap to his wife on his way to the hospital.

Evelyn Berezin

The other left NYU just shy of a doctorate in 1950 and ultimately found a job in 1951 with the Electronic Computer Corporation, a shop of engineers in Brooklyn. In between she married a tall Brit named Israel Wilenitz, who was a chemical engineer. She figured out how to design various computers including one that made range calculations for the U.S. Defense Department, another that kept accounts in business offices and one for an airline reservations system for United Airlines. She also built and marketed the world’s first computerized word processor. She went on to found her own computer company with two male colleagues, which was located in the Hauppauge Industrial Park, and eventually was bought out by Burroughs Corporation. For fun she loved attending cultural events, especially the American Ballet Theatre in New York City where she held a subscription. Recently she joined us with a subscription to the Metropolitan Opera.

Our best times together were probably on her back deck in Poquott, where she served us elaborate brunches of French toast, bagels and lox from the famous Russ & Daughters on the lower East Side of Manhattan and regaled us with historic events she had witnessed during her long life. She had something interesting to say about every subject, past and present, and was totally engaged in current events right up to the end. The last time I called her, she told me she had to get off the phone because she was watching “60 Minutes.”

He was also my orthopedist and shared with me a precious bit of wisdom: “You Americans feel that there should be a cure for every pain that you may feel. But the body isn’t like that. Pains, minor pains, are a part of life and can be borne without rushing into surgery to have them fixed, which is a risky thing to do in the first place.”

They were companions and their lives were an inspiration for me. I am diminished by the loss of my dear friends.

Violet

MEET VIOLET!

Violet is a 5-year-old Shepherd mix rescued off the streets in Thailand, where she was sure to become part of the meat trade there. She is now safe at Kent Animal Shelter. Violet is a sweet dog and would love to have a family to call her own. She comes spayed, microchipped and is up to date on her vaccines. Please come down and meet her!

Kent Animal Shelter is located at 2259 River Road in Calverton. The adoption center is open from 10 a.m. to 4 p.m. every day. For more information on Violet and other adoptable pets at Kent, call 631-727-5731 or visit www.kentanimalshelter.com.

Update: Violet has been adopted!

From left, Frank Recco, CFO Recco Home Care; Nancy Geiger, director, Gurwin Home Care Agency; Claudia Hammar, president NYS Association of Health Care Providers (NYSHCP); and Taryn Birkmire, executive director of Recco Home Care Photo courtesy of Gurwin Home Care Agency

Nancy Geiger, director of the Gurwin Home Care Agency, recently accepted the Norma Recco Advocate of the Year Award from the Long Island Chapter of the New York State Association of Health Care Providers (NYSAHCP) for her outstanding contributions to public advocacy to advance home and community-based care. 

The award was first presented in 2011 to honor the memory of Norma Recco, a tireless advocate who advanced HCP from a local interest group to a statewide association, and who was the governor’s appointee to the New York State Home Care Council from 1987 to 1997.  

Currently the vice president of the Long Island Chapter of the NYSAHCP, Geiger has specialized in the home care agency field for more than 30 years. She joined Gurwin as director of the Gurwin Home Care Agency in 2007. Under her leadership, the Gurwin agency provides home health aides and companions for Long Islanders who are in need of compassionate care and support.  

“Nancy’s empathy for people is evident, whether she is advocating for her employees or her patients,” said Stuart B. Almer, president and CEO of the Gurwin Family of Healthcare Services. “She is committed to helping to get home care services to those who need them, and we are fortunate to have her leading our Gurwin Home Care Agency.”

Taryn Birkmire, executive director of Recco Home Care, presented Geiger with the award, applauding her for her years in the home care field, her work for the past six years for the chapter and her continued efforts in reaching out to legislators as well as her participation in advocacy events in Albany.  

“I am truly humbled to receive this award and be recognized in the name of Norma Recco,” said Geiger. “Norma was a true pioneer in the home care industry, and she overcame many obstacles back in the early days in the field. Unfortunately, our challenges have become even greater in recent years. Home care plays an important and vital role in the lives of many in our communities, and I am honored to be able to fight for people to continue to receive the services they need to keep them living safely at home.”

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