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Stony Brook University

Bertha Madras will be the keynote speaker at Stony Brook University's 9th annual Meeting of the Minds symposium

By Ernest J. Baptiste

Ernest J, Baptiste

Not a week goes by without a news story referencing the misuse of, addiction to, treatment of and deaths caused by opioids. And it’s no wonder. While the United States accounts for 4.4 percent of the world’s population (per U.S. Census Bureau figures), we consume 30 percent of prescribed opioids worldwide, according to the International Narcotics Control Board. 

Sadly, within New York State, Suffolk County bears the brunt of this notoriety. Based on information from the NYS Department of Health, between 2009 and 2013, the county reported 337 heroin-related deaths — more than any other county in our state. 

As Suffolk County’s only academic medical center, Stony Brook Medicine has the clinical, research and educational expertise to lead our community in the battle against addiction. We have a duty and an obligation to do so. For years we have worked closely with both Stony Brook Southampton Hospital and Eastern Long Island Hospital to help those affected by the opioid crisis. 

In 2017, we took our commitment a step further by launching an Addiction Psychiatry Division. Our team of experts evaluates, diagnoses and treats people who suffer from one or more disorders related to addiction. They also conduct research into the causes and effective interventions for addiction and train our health are professionals in how to better identify and treat addiction.

In addition to treating those affected by the opioid epidemic, it’s also important to have a forum where the physicians and nurse practitioners, who have the authority to dispense prescriptions for pain medication, can explore, and develop, with input from the public, the future of pain management medicine.

This was the premise for a recent conference panel discussion held in August at Stony Brook University Hospital titled, Changing Perceptions About Pain Management and Opioid Use Across the Continuum of Care. During the panel discussion, Stony Brook experts explored current issues in the practice of managing chronic and acute pain. The event was part of our Ethical Decision Making Series and attracted over 100 clinicians and members of the community. 

This month, Stony Brook has two more opioid epidemic-related events planned. 

On Thursday, Oct. 18, Stony Brook Southampton Hospital will present its 5th annual Addiction Medicine Symposium at Stony Brook Southampton University, Avram Theatre, 39 Tuckahoe Road, from 8 a.m. to 5 p.m. The goal is to help increase knowledge and improve performance of medical staff members, residents, nurses and other health care professionals when working with patients who suffer from addiction. To learn more, visit http://cme.stonybrookmedicine.edu.

The following day, Friday, Oct. 19, the opioid epidemic will be the focus when the Stony Brook University Neurosciences Institute hosts its 9th annual Meeting of the Minds symposium at Stony Brook University’s Charles B. Wang Center, 100 Nicolls Road, Stony Brook from 8 a.m. to 1 p.m. The free event is open to physicians and other health care professionals, researchers, students and anyone with an interest in the opioid epidemic.

Experts from Stony Brook Medicine will present, discuss and explore the clinical implications of their scholarly research findings and discuss translational and informatics approaches to the opioid epidemic. This year’s keynote speaker will be Bertha Madras, a prominent psychobiologist, public policy maker and member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Breakfast will be provided and a discussion and Q&A will follow each presentation. To learn more, visit www.neuro.stonybrookmedicine.edu/motm. 

Let’s fight the opioid epidemic together as a community so that our children and future generations of Long Islanders won’t have to.

Ernest J. Baptiste is chief executive officer of Stony Brook University Hospital.

 

Stony Brook University President Dr. Samuel L. Stanley Jr. delivers his ninth state of the university address Oct. 3. Photo from Stony Brook University

As Stony Brook University President Dr. Samuel L. Stanley Jr. looks confidently to the future, the school’s budget deficit is still at the forefront of his mind.

On Oct. 3, Stanley delivered his ninth state of the university address on the Staller Center’s main stage to an auditorium full of faculty, staff, students and elected officials. During the speech, which lasted about an hour, the university president touched on several topics including enrollment growth, Stony Brook Medicine’s future and financial woes and successes — like the university’s positive economic impact on Long Island.

When it comes to tackling the budget deficit, Stanley did not specify the exact amount but said there is more work that needs to be done to lessen the financial shortfall. He said a hiring freeze still holds for 2018-19 because nothing has changed externally as the university has not received an increase of state support since 2010. He said fee increases and enrollment growth has helped alleviate some of the financial burdens, and the university is actively communicating with the state to seek an increase in allocations.

Stanley touted SBU’s presence as a driver for the local economy, citing about $7.2 billion generated from the hospital’s research; people hired and contracted; start-up companies involved with SBU’s incubator; and purchases of students and faculty in the area, the president said.

“We always take these things with a little grain of salt, but I think it’s an important thing that we need to talk about because again the state puts a significant investment into Stony Brook University,” he said. “We appreciate the investment we get from the state, but it’s really nice to talk about the return on that investment from the state.”

The university also saw positive results from The Campaign for Stony Brook fundraising efforts, which raised $630.7 million. He said many people ask him why money can’t be taken from those funds to help with the school’s budget deficit.

“Ninety-eight percent of that money raised is directly allocated to specific goals that our donors have on campus,” he said, adding the funds are usually put toward scholarships, endowed professorship, research projects or a specific campus building.

Stanley said the four-year graduation rate for the class entering in 2014 has reached 62 percent, which signifies a 17-point jump from a 45 percent graduation rate for the class entering in 2007. Among the factors he credited for the success is the Finish in 4 Grants Program. Initiated in spring 2015, the program assists students in good standing who are about to complete their studies but are confronted with personal circumstances that prevent it.

“We want to continue to build on this momentum, but it’s going to be important that we work very hard and continue to find the resources to support this very important program,” he said.

Stanley said a significant part of the university’s budget, $2.28 billion, is for Stony Brook Medicine.

“We are the destination, I believe, for quality care on Long Island,” he said. “We’re the only provider of a level one trauma center for Long Island. We have the only children’s hospital in Suffolk County.”

In the next few months, Stony Brook University Hospital will be opening the Medical and Research Translation building with a state-of-the-art cancer center, Stony Brook Children’s and Hospital Pavilion, and the Phillips Family Cancer Center in Southampton.

Leila Esmailzada, kneeling, with another BeLocal team member Caroline Rojosoa (in the black argyle sweater) distribute trial briquettes. Photo courtesy of BeLocal

By Daniel Dunaief

Leila Esmailzada set out to change the world but first had to perform a task that turns many people’s stomachs: clean someone else’s vomit off the floor.

The Stony Brook University graduate student, who is in the master’s Program in Public Health, traveled to Madagascar for a second consecutive summer with the nonprofit BeLocal Group to help several teams of student engineers put into place projects designed to improve the lives of the Malagasy people.

Before they could help anyone else, however, these students, many of them recent graduates from the College of Engineering, fought off a series of viruses, including a particularly painful stomach bug.

Esmailzada said she saw cleaning the vomit off the floor as part of the big picture.

“Compassion really plays into being abroad for your work and for your team, because you realize that everybody came here for a shared mission,” Esmailzada said. “What happens along the way is sometimes just a result of the path that brought them here.”

Briquettes lay out to dry in Madagascar. Photo courtesy of BeLocal

Indeed, beyond Esmailzada’s compassion, her ability to continue to accomplish tasks in the face of unexpected and potentially insurmountable obstacles encouraged BeLocal, a group started by Laurel Hollow residents Mickie and Jeff Nagel and Eric Bergerson, to ask her to become the group’s first executive director.

“I can’t say enough about [Esmailzada] being so resourceful over there,” said Mickie Nagel, who visited the island nation of Madagascar the last two years with Esmailzada. “She thinks about things in a different way. You can have the best product, but if you can’t connect it to the Malagasy and understand more deeply what they need, what their concerns or wants are” the project won’t be effective.

This past summer BeLocal tried to create two engineering design innovations that had originated from senior projects at SBU. In one of them, the engineers had designed a Da Vinci bridge, borrowing a model from the famous inventor, to help villagers cross a stream on their way to the market or to school. When the makeshift bridge constructed from a log or tree got washed away or cracked, the residents found it difficult to get perishable products to the market.

The first challenge the group faced was the lack of available bamboo, which they thought they had secured months before their visit.

“When the bamboo wasn’t delivered, I figured we were now going to do research on bamboo,” Nagel explained in an email, reflecting the group’s need to react, or, as she suggests, pivot, to another approach.

When they finally got bamboo, they learned that it was cut from the periphery of a patch of bamboo that borders on a national park. Government officials confiscated the bamboo before it reached BeLocal.

“We were happy to see that law enforcement recognized and acted on the ‘gray area rules’ of conserving the national park, which shows that the hard work Madagascar is putting into conservation is actually paying off,” Esmailzada said. She eventually found another provider who could deliver the necessary bamboo a few days later. This time, an important material was cut down from a local farm.

While they had the bamboo, they didn’t know how to cure it to prepare it for construction. Uncured, the bamboo could have become a soggy and structural mess. “We did try to cure [it] a few different ways, but we really didn’t have the time needed to properly treat all of it,” Nagel said. “We didn’t anticipate the bamboo not arriving cured since it was what we had been working on for months.”

Nagel credits the bridge team with adjusting to the new circumstances, constructing two girder bridges over creeks for more market research.

The BeLocal team also worked on a project to create briquettes that are healthier than the firewood the Malagasy now use for cooking. The wood produces considerable smoke, which has led to respiratory diseases and infections for people who breathe it in when they cook.

The group produced briquettes toward the end of their summer trip and presented their technique to an audience of about 120 locals, which reflected the interest the Malagasy had shown in the process during its development.

This fall, BeLocal is working on ways to move forward with sharing the briquette technique, which they hope to refine before the new year. BeLocal wants to develop clubs at Stony Brook and at the University of Fianarantsoa in Madagascar that can work together.

While BeLocal will continue to share senior design ideas on its website (www.belocalgrp.com) with interested engineers, the group is focusing its energy on perfecting the briquettes and getting them to people’s homes in Madagascar.

Nagel admired Esmailzada’s approach to the work and to the people in Madagascar.

Esmailzada said she studied how people in Madagascar interact and tried to learn from that, before approaching them with a product or process. She believes it’s important to consider the cultural boundaries when navigating the BeLocal projects, realizing that “you are not the first priority in a lot of these villagers’ lives in general. You have to understand they won’t meet and speak with you. It’s a reasonable expectation to ask maybe three times for something before you think you can get it done.”

Esmailzada also developed a routine that allowed her to shift from one potential project to another, depending on what was manageable at any given time.

The Stony Brook graduate student is delighted to be an ongoing part of the BeLocal effort.

“I love working with an organization that has the passion and vision as large as BeLocal,” she explained. “This work is fulfilling because you are working toward the chance of improving the well-being of another person or community.”

SBU’s Christopher Gobler, with Dick Amper, discusses alarming trends for LI’s water bodies at a Sept. 25 press conference. Photo by Kyle Barr

Long Island’s water is facing a dangerous threat — not a mythical sea monster, but harmful and poisonous algal blooms. Recently released data showed the problem was more far reaching this summer than years past.

The Long Island Clean Water Partnership, an advocacy collective supported by the Rauch Foundation, that includes members from Stony Brook University and the Long Island Pine Barrens Society headed by Dick Amper, released an annual water status report Sept. 25 that showed new harmful algal blooms in Port Jefferson, Northport and Huntington harbors and in North Shore ponds and lakes.

“Every single water body across Long Island, be it the North Shore or the South Shore, East End, Suffolk County, Nassau County, all had significant water impairments during this time frame,” said Christopher Gobler, endowed chair of Coastal Ecology and Conservation at the Stony Brook University School of Marine and Atmospheric Sciences. “We would call this a crisis.”

“We are the nitrogen pollution capital of America.”

— Kevin McDonald

The Island-wide study, which was conducted from May through September, showed Northport Harbor suffered a bloom of Dinophysis, a type of algae that releases a powerful neurotoxin that can affect shellfish. Both Northport and Huntington harbors showed a rash of paralytic shellfish poisoning in other marine life from eating shellfish.

In May, shellfish fishing was temporarily banned in Huntington and Northport harbors by the New York State Department of Environmental Conservation because of PSP. The harmful poison began to wane in June, Gobler said, and those bans have since been lifted, according to an automatic message put out by the state DEC.

Stony Brook University’s Roth Pond has been experiencing for years summer blooms of poisonous blue-green algae, a type that is harmful to animals. This past summer the researchers saw the algae spread into neighboring Mill Pond in Stony Brook. In 2017, Suffolk County had more lakes with blue-green algal blooms than any other of the 64 counties in New York, according to the report.

The summer also saw the rise of a rust tide in Port Jeff Harbor and Conscience Bay caused by another poisonous algae, which, while not dangerous to humans, is dangerous to marine life. Gobler said while it did not necessarily lead to fish kills along the North Shore, places like Southampton saw the deaths of tens of thousands of oysters and fish due to rust tide. If the problem persists, Port Jeff might start to see a fish die-off, which could have lasting implications to the local ecology.

The algal blooms and hypoxia were both exacerbated by a particularly warm summer, a trend expected to continue due to climate change. In coming years, Gobler said he expects the number of dangerous algae to spread because of this trend.

“We’re expecting that temperatures will rise 5 or 10 degrees this century, so we need to make changes or things will get significantly worse,” Gobler said.

The prognosis looks grim, with multiple other places across Long Island experiencing harmful algal blooms, but the source is already well known. This year’s study cites heavy loads of nitrogen pollution from sewage and fertilizers as the ultimate source of the algal events, particularly the nitrogen waste from old cesspool systems leaking into local waters.

Suffolk County and several state and local politicians have been advocating for changes, either for creating sewer systems — such as Smithtown’s projects in Kings Park, Smithtown Main Street and St. James — or by creating financing programs for property owners to overhaul waste systems.

In 2014 Suffolk County Executive Steve Bellone (D) called nitrogen pollution the county’s “environmental public enemy No. 1.” Since then the county has worked with local scientists and engineers to craft technology that could replace Long Island’s old cesspool and septic tanks, but some of those replacement systems have been very cost prohibitive. Suffolk has made some grant money available to those interested in upgrading.

New York Gov. Andrew Cuomo (D) signed legislation in April that put $2.5 billion toward clean water protection and improving water infrastructure, including $40 million for the new sewer systems in Smithtown and Kings Park, and adding a rebate program for those upgrading outdated septic systems. Suffolk County and scientists from Stony Brook University are currently working on cheaper nitrogen filtration systems, but commercial availability of those systems could be years away.

“Technology and governmental policies are rapidly changing to address our island’s water crisis, but we need to increase our pace of change.”

— Adrienne Esposito

Kevin McDonald, the conservation project director at The Nature Conservancy, said that there is a strong impetus for all of Long Island to change its waste standards.

“We are the nitrogen pollution capital of America,” McDonald said. “We can’t reverse climate change by ourselves, but with the right support and engagement and leadership we can aggressively respond to this problem at a faster pace than at present.”

Many of these areas now experiencing algal blooms were only encountering hypoxia, or a depletion of dissolved oxygen in water necessary for sea life to survive, in the same report released back in summer 2017. Last year Mount Sinai Harbor was spared from severe hypoxia, but now has seen a decrease in necessary oxygen levels this past summer. Gobler said it wouldn’t be out of the question that Mount Sinai Harbor could experience a potentially dangerous algal bloom next summer.

One thing is for sure, according to Gobler: Long Island will experience more hypoxia and harmful algal blooms until new waste systems can catch up to the amount of nitrogen that’s already in the water.

“Technology and governmental policies are rapidly changing to address our island’s water crisis, but we need to increase our pace of change,” said Adrienne Esposito, the executive director of the environmental advocacy group Citizens Campaign for the Environment.

On Sept. 22, Stony Brook University hosted CommUniversity Day. The free event was open to the local community members, employees, friends and neighbors to experience what SBU is all about. Activities included an instrument petting zoo, drowsy and distracted driving simulators, teddy bear clinics, Tai Chi demonstrations, Kazoo-niversity orchestra, rubber duck race and more.

By Daniel Dunaief

We have to walk before we can learn to run. It’s a common metaphor that suggests learning new skills, like playing the bassoon, requires a comfort level with notes and scales before taking on complex compositions.

As it turns out, the expression also applies literally and evolutionarily to the part of our anatomy that is so instrumental in enabling us to walk and, eventually, run — the foot.

Carrie Mongle. Photo courtesy of SBU

Carrie Mongle, a doctoral candidate in the Interdepartmental Doctoral Program in Anthropological Sciences at Stony Brook University, recently joined a host of other researchers, including former SBU scientist Peter Fernandez and current clinical assistant professor in biomedical sciences at Marquette University, in a study on the evolution of bones in the foot that made the transition to a bipedal lifestyle possible.

Published in the journal Proceedings of the National Academy of Sciences (PNAS), the work by Fernandez, Mongle and other collaborators explored the forefoot joints of ancient hominins, looking at primitive primates from as far back as 4.4 million years ago.

By comparing the toe joint shapes of fossil hominins, apes, monkeys and humans, they were able to find specific bony shapes in the forefoot that are important in the development of bipedal locomotion — or walking on two feet.

“This study demonstrates that early hominins must have been able to walk upright for millions of years, since the 4.4-million-year-old fossil Ardipithecus ramidus, but that they did not fully transition to a modern walk until much later, perhaps in closer relatives within our own group, Homo,” Mongle explained in an email.

While modern humans are most pronounced in doming, a few primates that walk on the ground have similar foot biomechanics to bipedalism and have similar morphologies in their toes. Those, however, aren’t expressed exactly the same way because their toe bones look different from hominins generally, she explained.

Like the drawings so often associated with a knuckle-walking ancestor that transition to a familiar outline of a person walking, the foot also went through various stages of development, balancing between the need to grasp onto objects like tree limbs and an efficient ability to walk, and then run.

“The foot is a complex assemblage of bones, so it makes sense that not all of them would have changed at exactly the same time,” Mongle suggested. “Our study supports the hypothesis that the transition to bipedalism was a gradual, mosaic process.”

Mongle got involved in this study after discussions with Fernandez, who was at SBU two years ago when the work began. Fernandez suggested to her that, “If we team up together, we can combine our interests and answer some questions about this feature,” she recalled.

Fernandez and Mongle found this dome shape developed in the foot bone even as this early fossil still maintained the ability to grasp tree limbs or other objects.

Fernandez and several other researchers involved in the study collected the data from the fossils, while Mongle, who focuses on cranial morphology and teeth in her own research, performed the evolutionary modeling. “My role in this research was in analyzing and explaining the evolutionary models, which allowed us to reveal the timing and sequence of events that produced the modern human forefoot,” she explained.

As for her doctoral research, Mongle is broadly interested in updating the hominin family tree. She uses mathematical models to look at variations in the fossil record. She is currently studying a cave in South Africa, where researchers have been recovering fossils since the 1930s.The cave has a considerable number of teeth that are all blended together from a period of between 2.5 million and 3 million years ago.

The teeth could tell a more complete story about how human ancestors divided up the food and local resources available to them. If different species were in the same space, they might have divided up into different groups to relieve competitive stress.

Frederick Grine, the chairman in the Department of Anthropology at SBU, offered a strong endorsement of Mongle’s research.“I have no doubt whatever that her work on the cranium and the dentition will provide invaluable insights into human phylogeny,” he wrote in an email, calling her an “exceptionally gifted research scientist” and described her as having an “extremely keen intellect.”

One of Mongle’s overarching research questions is, “How did we become human?” Reconstructing the phylogenetic tree is an important part of that exploration.

While it isn’t central to her thesis work, Mongle appreciated the opportunity to explore the transition to bipedalism, which is one of the “major turning points” in the development of humans.

Mongle explained that several possibilities exist on why human ancestors might have stood upright and walked on two feet.

“One of the prevailing theories is that upright walking may have evolved because climate change led to a loss of forests,” she wrote in an email. “As a consequence of walking upright, we now have free hands to carry tools.

Bipedalism evolved from a type of locomotion that was already efficient, so the question of its evolution remains open and is “hotly debated,” Mongle explained.

The next steps, literally and figuratively, are to study other bones in the feet. “We only looked at one particular part of the foot,” she said. “We would like to expand these approaches to using other bones in the forefoot,” seeking patterns and changes that would also contribute to a bipedal lifestyle.

Mongle, who started her doctoral research in 2012, hopes to graduate from the program next May, at which point she will be looking for postdoctoral research opportunities.

SUNY students work together with the nonprofit Nechama to repair roofs in Puerto Rico. Photo from Joseph WanderVaag

As Puerto Rico continues to recover a year after Hurricane Maria left devastation in its wake, some college students reflected on lasting memories of their missions to the island to offer help and support.

Joe VanderWaag helps to repair a roof in Puerto Rico. Photo from Joseph VanderWaag

This past summer more than 650 State University of New York and City University of New York students along with skilled labor volunteers helped to repair homes on the island through Gov. Andrew Cuomo’s (D) New York Stands with Puerto Rico Recovery and Rebuilding Initiative, according to the governor’s website. During a 10-week span, five deployments of volunteers worked on the island with the goal of repairing the roofs of 150 homes. By the end of the summer, the volunteers fixed the roofs of 178.

Peter Velz, SUNY assistant vice chancellor for external affairs, said since October 2017 the university system was working on engagement with Puerto Rico. On March 16 students from SUNY Alfred State and Geneseo went down for a week.

He said he believes the interaction with the homeowners was probably the most impactful for the students, and the residents they met in Puerto Rico tried to pay them back the best they could.

“It wasn’t paying them back financially,” Velz said. “Kids would make them bracelets or kids would make them pictures or the families would make them lunch. I really think that was probably the most lasting impact for the students, was working in the homes with the homeowners and providing them shelter.”

Rebecca Mueller, one of 21 Stony Brook University students who volunteered, traveled to the island in July, as did Joseph VanderWaag, who attends Suffolk County Community College’s Ammerman Campus.

“I wish there was more that we could do. But I think that the main goal for the organization, while we were there, was to make it livable at that point.”

— Rebecca Mueller

Mueller, 23, of Coram, a graduate student working toward her master’s in social work, said when she received an email from SBU looking for students to travel to Puerto Rico she knew she had to help.

“I knew things there still weren’t that great from hearing different stories, and I felt like not as much help was given to them as it should have been,” she said. “So, when I saw an opportunity where I could actually help to do something, I knew I couldn’t pass it up.”

VanderWaag, 20, of Smithtown, who is in his last semester at SCCC, echoed those sentiments.

“It was so devastating to see that these were our citizens not really getting any help,” he said.

Traveling to Catano and surrounding towns where her group was working, Mueller said she saw houses with no roofs, windows or doors. She worked on three homes during her stay, and said the students would climb to the top of roofs and roofers with the nonprofit NECHAMA — Jewish Response to Disaster showed them what to do.

Rebecca Mueller, above right, and a friend get ready to patch leaks with cement. Photo from Rebecca Mueller

Two of the buildings she worked on had second stories before Hurricane Maria, but the upper levels were destroyed by the storm, and the volunteers had to turn what was left into roofs by scraping up tiles, finding cracks, grinding them to open them up and then sealing with cement. The volunteers then primed and sealed the new roofs to make them waterproof.

“I wish there was more that we could do,” Mueller said “But I think that the main goal for the organization, while we were there, was to make it livable at that point. Because they couldn’t even live in the houses because every time it rained water was pouring through the ceiling.”

Mueller said she also helped to clean out one man’s bedroom that was unlivable after water damage from the storm. The room had mold and bugs, and his bed, clothes and other items needed to be thrown out.

VanderWaag said the homeowners he met didn’t have a lot of money so whenever there was a leak they would go to the hardware store for a quick fix to patch the roof. When the students weren’t working, he said they would talk to community members about the hurricane’s devastation and the response from the U.S.

“They are a mixture of upset, angry and feeling just almost betrayed,” he said.

VanderWaag said he’ll always remember how appreciative the homeowners were and how one woman cried after they were done. Her husband who was in his 70s would try his best to fix the leaks by carrying bags of concrete up a ladder and patching the leaks.

“It was a huge burden lifted off their shoulders,” VanderWaag said.

“They are a mixture of upset, angry and feeling just almost betrayed.”

— Joseph VanderWaag

Mueller said one family cooked lunch for her group and others working on the house next door every day. She said the students had time to sightsee, and when one tour guide heard what they were doing, he offered to take them on a free tour of the south side of the island. Both she and VanderWaag also visited Old San Juan and saw historic military forts during their trips.

“It really was a life-changing experience,” Mueller said. “Even the people I met from the other SUNY schools, we became so close so quick.”

Pascale Jones, SBU international programs coordinator, joined students for a week to help out. She said when she saw the students in action, she was amazed at how much they already knew about construction and found the whole experience to be humbling.

Originally from Port-au-Prince, Haiti, Jones said she is used to seeing a certain level of devastation but was surprised to see the state of some of the homes.

“It’s Puerto Rico and these are U.S. citizens,” Jones said. “So, I did not expect this devastation so long after the hurricane’s passing. To think, U.S. citizens are living in a way that I would almost equate to a third world country.”

Delaney Unger and her parents, Melissa and Noah, look on at a Sept. 10 press conference as SBU doctors explain the procedure Delaney underwent after doctors diagnosed her with osteosarcoma. Photo by Rita J. Egan

A young dancer has come through a cancer battle with the poise and grace of a prima ballerina.

More than a year ago, 12-year-old Delaney Unger, of Selden, was diagnosed with osteosarcoma, a rare type of bone cancer, in her left distal femur. Now cancer free, she reunited with the Stony Brook University Hospital doctors who provided her a way to dance with her St. James studio again at a Sept. 10 press conference.

Delaney Unger demonstrates how to take off the prosthetic she received after having her knee amputated. Photo by Rita J. Egan

Dr. Fazel Khan, an orthopedic oncologist surgeon, said doctors diagnosed Delaney with cancer above her left knee joint in December 2016. While given a few treatment options, including knee replacement, she and her family decided in order to have an active life she would undergo rotationplasty surgery, also known as the Van Ness procedure, which involves partial amputation followed by use of a prosthesis.

Khan said the operation involved amputating Delaney’s diseased knee, then doctors rotated her ankle 180 degrees and placed it in the position of the knee joint. It was attached to the remaining thigh to create a functional, natural joint. This results in a shorter leg with the foot and toes facing backward.

“The beauty of that solution is that you now control your ankle as if it’s your knee,” Khan said, adding it takes a lot of training and perseverance on the patient’s part to adjust.

Delaney’s mother, Melissa, said when her daughter began experiencing pain in her knee she and her husband, Noah, thought she had overworked it between dancing and gymnastics — maybe pulling a muscle. A pediatrician sent Delaney for an X-ray that showed a mass on her femur and an appointment was made with an oncologist.

“At that point, everything stopped,” Unger said. “Our world would forever be classified as before cancer and after cancer.”

During the press conference, Delaney demonstrated how easy it was to remove and put on her prosthesis that she has worn for the past year. It fits over her backward foot and extends up the thigh.

Khan said while knee replacement works well for people who are older, it may not be the best solution for younger people who are active.

“All my patients inspire me, but I’ve never seen somebody that is 11 years old, and now 12 years old, who has been so strong, so inspiring and so courageous in all of this.”

— Dr. Fazel Khan

“You can wear a prosthesis after [the amputation], and you can jump around or dance on that prosthesis as much as you like, and if it wears out, you can put a new prosthesis in there.” Khan said.

Plastic surgeon Dr. Jason Ganz, who worked with Delaney, said he has kept in touch with the family through emails and videos. He said it was wonderful to see how far she has come since the diagnosis, and she looked incredible.

Khan said he was inspired by Delaney who decided that despite cancer she would not give up on her dancing dreams.

“All my patients inspire me, but I’ve never seen somebody that is 11 years old, and now 12 years old, who has been so strong, so inspiring and so courageous in all of this,” the surgeon said.

Unger said Delaney used crutches for approximately a month after the operation and could walk unassisted after two months. In May 2018, she danced in St. James-based Chorus Line Dance Studio’s annual recital.

“Delaney has always had lots of confidence, drive and determination,” her mother said. “All of these traits have helped her to fight her battle and come through the other side.”

Delaney said she hopes sharing her story will help children going through the same thing. Using social media, she has been able to connect with others who had the same type of cancer and underwent the Van Ness procedure. She said even though having an ankle for a knee and wearing a prosthesis took time adjusting to, now it feels normal and sometimes she forgets she has one.

Delaney Unger dancing in her May 2017 recital. Photo from Stony Brook University

The soon-to-be 13-year-old said she continues to study ballet, tap, jazz lyrical, contemporary and hip-hop, and plans to try out for Selden Middle School’s kickline team. Delaney said sometimes the prosthesis affects her dancing as she can’t balance as well on her left leg; however, its more flexible now, so she choses to do her leg hold with her left side. She also said she can kick fine with both legs.

Delaney thanked the doctors who helped her and had kind words for the Stony Brook hospital staff.

“The child life specialists helped to put a smile on my face every day,” she said, adding Friday was her favorite day because therapy dogs would come to visit.

While dancing still takes up a considerable part of her life, she has new dreams.

“[The doctors] have inspired me to want to become a pediatric oncologist,” Delaney said. “I want to help other children do their treatments, and I want to research causes and new treatments for cancer.”

Her mother said Delaney has already been an inspiration to many.

“People have said that her attitude and outlook on life, even now going through cancer, has helped them,” the mother said. “They’ll stop and think, ‘Say, wait a minute, Delaney is going through this right now, I can handle this problem today.”

This post was updated Sept. 13 to correct the date of Delaney’s performance.

Ute Moll. Photo courtesy of Stony Brook University

By Daniel Dunaief

In the battle against cancer, human bodies have built-in defenses. Cancers, however, can hijack those systems, turning them against us, not only allowing them to avoid these protective systems, but converting them into participants in a process that can often become fatal.

Such is the case for the p53 gene. One of the most closely studied genes among researchers and clinicians, this gene eliminates cells with damaged DNA, which could turn into cancer. Mutations in this genetic watchdog, however, can turn this genetic hero into a villainous cancer collaborator. Indeed, changes in the genetic code for p53 can allow it to produce a protein that protects cancer from degradation.

Ute Moll. Photo courtesy of SBU

Ute Moll, professor and the vice chair for research in the Department of Pathology at the Stony Brook University School of Medicine, has made important strides in studying the effect of mutations in this gene over the last five years, demonstrating how the altered gene and the protein it creates are an important ally for cancer.

Moll published her most recent finding in this arena in the journal Cancer Cell. The Stony Brook scientist, working with an international team of researchers that included collaborators from her satellite lab at the University of Göttingen, advanced the work on previous results.

This research, which is done on mice that develop tumors through a process that more closely resembles human cancer growth, is a “very good mimic in the molecular and clinical features of human colon cancer,” Moll said.

The main research was done on a faithful mouse model of human colorectal cancer that produces mutant p53, Moll explained. She then confirmed key findings in human colon cancer cells and in survival analysis of patients.

This model allowed Moll to “study tumors in their natural environment in the intact organism with its tumor surrounding connective tissue and immune system,” Ken Shroyer, the chairman of the Department of Pathology at SBU School of Medicine, explained in an email.

The tumors that develop in these mice are driven by mutant p53 and are dependent on it for their continued growth. “These tumors overexpress mutant p53 at high levels,” which makes them a “formidable drug target for their removal,” Moll said.

By deleting the mutant p53 gene, she was able to slow and even stop the progression of the cancer. “We can show that when we remove mutant p53 either genetically or pharmacologically, we are cutting down invasiveness.” Mice with deleted mutants had fewer and smaller tumors and showed over a 50 percent reduction in invasive tumor numbers, she explained.

Finding ways to mitigate the effect of mutant p53 is important for a wide range of cancers. The mutated version Moll studied is the single most common p53 mutation in human cancer, which has a mutation that switches an amino acid for an incorrect one. This amino acid change destroys the normal function of the p53 gene.

The mutation she studies represents about 4.5 percent of all cancers. That amounts to 66,000 cancer patients in the United States each year.

More broadly, mutations in p53 in general, including those Moll didn’t study, are involved in half of all human cancers, Shroyer explained, which makes it the “single most common cancer mutation.”

Yusuf Hannun, director of the Stony Brook University Cancer Center, suggested that the work Moll did could have important clinical implications.“The deciphering of this mechanism clearly indicates new cancer therapy possibilities,” Hannun wrote in an email. The models she worked with are “quite promising.”

In addition to finding ways to stop the progression of cancer in mice with this damaged gene, Moll and her colleagues also used an Hsp90 inhibitor, which blocks a protein that protects the mutant protein from being degraded.

Inhibiting this protein has other positive effects, as the inhibitor eliminates other co-mutant proteins that could also drive tumors. “We are hitting multiple birds with one stone,” Moll said.

Hsp90 inhibitors are a “complicated story” in part because they have strong side effects in the liver and the retina. Researchers are working on the next generation of inhibitors.

A class of anti-cholesterol drugs called statins, which Moll called “one of the blockbuster drugs of medicine,” also has mutant p53 degrading effects, which work against some mutants, but not in others. The benefits are inconsistent and involve confounding variables, which makes interpreting their usefulness difficult, she added.

Moll said her recent article in Cancer Cell has triggered a number of email exchanges with a range of people, including with a patient whose cancer involved a different type of mutation. She has also had discussions with researchers on several other possible collaborations and has started one after she published her recent work.

The scientist is hopeful that her studies will continue to contribute to an understanding of the development and potential treatment of cancer.

Degrading mutant p53 has shown positive results for mice, which indicates “in principle” that such an approach could work down the road in humans, she suggested.

Stony Brook University’s Larry Swanson, Malcolm Bowman and Carl Safina have been chosen to be part of the new state Ocean Acidification Task Force. Photo from Stony Brook University

Stony Brook University will be well represented on the new state Ocean Acidification Task Force examining the effect of acidification on New York’s coastal waters. The legislation was drafted by Assemblyman Steve Englebright (D-Setauket), chair of the Assembly Standing Committee on Environmental Conservation.

The university has three representatives on a 14-member team that will explore the impacts of acidification on the ecology, economy and recreational health of the coastal waters, while also looking to identify contributing factors and make recommendations to mitigate the effects of these factors.

“We have some of the best people in ocean acidification science who will be part of the process.”

— James Gennaro

Englebright said he was pleased to have the SBU representatives on the task force.

“We have these extraordinary scholars and researchers at the university who have a lot to contribute, and I hope that we’re able to listen closely to their advice regarding new policy and potentially new law to protect our coastal ecosystem and marine water.”

Larry Swanson, associate dean of the School of Marine and Atmospheric Sciences will join Malcolm Bowman, distinguished service professor and Carl Safina, endowed research chair for nature and humanity, both also from SoMAS. The task force, which will have its first meeting some time in September at SBU, was signed into law in 2016 and is operating under the direction of Gov. Andrew Cuomo (D) and the New York State
Department of Environmental Conservation.

“We will make recommendations to the Department of Environmental Conservation and the Legislature and will share information about what our understanding of the state of knowledge of ocean acidification is, what are the impacts that we know about in New York state waters,” Swanson said, adding the group will suggest factors to monitor for consequences of acidification.

The composition of the group reflects its wide-ranging mandate, with members including Karen Rivara, owner of Aeros Cultured Oyster Company and former president of the Long Island Farm Bureau.

“We have a very significant shellfish industry that’s potentially in jeopardy. We need to understand what ocean acidification is doing to that industry.”

— Larry Swanson

Ocean acidification has been increasing at a rapid pace amid the increasing output of the greenhouse gas carbon dioxide. Since the industrial revolution more than 200 years ago, ocean acidification has increased by about 30 percent, as absorbed carbon dioxide is converted into carbonic acid. The rate of change of ocean acidification is at a historic high and is 10 times faster than the last major acidification, 55 million years ago, according to a press release announcing the formation of the task force.

The task force, which will allow the public to provide input through a website it is developing and at its meetings, will focus on gathering existing data about the waters in and around Long Island, collecting additional information and offering the New York State Legislature suggestions for future policies.

The group will “figure out how to make science into policy-ready proposals,” said James Gennaro, chair of the task force and deputy commissioner at the DEC. Gennaro is pleased with the composition of the group.

“We have some of the best people in ocean acidification science who will be part of the process,” Gennaro said.

Swanson believes it’s important to consider understanding what is going on in the interior bays, including the Great South Bay and the Long Island Sound, as well as the New York Bight which is a curved area from Long Island to the north and east, and includes areas south and west to Cape May, New Jersey.

Some of the questions Swanson said he believes the group will explore include, “Can we measure changes based on what we know from historical information, how bad are those changes and what are the likely consequences?”

“This is very much a local water, coastal water, embayment improvement initiative.”

— James Gennaro

Improving the ecology of the ocean doesn’t have to be at the expense of the local economy, and vice versa, Swanson suggested.

Indeed, New York’s marine resources support nearly 350,000 jobs and generate billions of dollars through tourism, fishing and other business.

“We have a very significant shellfish industry that’s potentially in jeopardy,” Swanson said. “We need to understand what ocean acidification is doing to that industry. We can do things like control effluent going into the Great South Bay and Peconic Bay.”

Protecting and preserving the environment will “have a payoff” for the economy, Swanson added.

While the problem is global, monitoring agencies should oversee local impacts, Swanson and Gennaro agreed.

“This is very much a local water, coastal water, embayment improvement initiative,” Gennaro said, who added he is “eager” to get started.

The task force will meet no less than four times. The public will be able to follow the task force on the website that SBU and the DEC
are creating.

It is “imperative to do all we can to make sure we stay ahead of [and] act on” ocean acidification, Gennaro said.

Swanson suggested that local action can have consequences. People sometimes suggest that whatever policymakers do in New York will be a drop in the bucket compared to the overall problem of ocean acidification.

“If that’s the drop that causes the bucket to overflow, that’s an important drop,” Swanson said. “We can certainly make suggestions that we ought to do things on a national and global level.”

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