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Yearly Archives: 2014

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School building has lasted through ups and downs in Port Jefferson Village

Port Jefferson’s old high school on Spring Street, above, was made of wood and burned down on July 4, 1913. Photo from the Port Jefferson Village Digital Archive

A lot has changed in the last century, but Port Jefferson’s Spring Street school building still stands.

BOCES social worker Christian Scott, special education teacher Patricia Dolan and Principal Chris Williams wear period clothing to celebrate the Spring Street school building's 100th birthday. Photo from BOCES
BOCES social worker Christian Scott, special education teacher Patricia Dolan and Principal Chris Williams wear period clothing to celebrate the Spring Street school building’s 100th birthday. Photo from BOCES

Eastern Suffolk BOCES, which leases the school building from the Port Jefferson school district, recently celebrated the building’s 100th birthday, with festivities that included period costumes and popular music from the era — the 1914 hit “By the Beautiful Sea” and a World War I marching song from 1915, “Pack Up Your Troubles in Your Old Kit Bag.” There was also a ribbon-cutting ceremony and lots of cake at the school at Spring and High streets, which is now officially called the Jefferson Academic Center.

Though the mood was light that day, the road leading up to the 100th birthday bash was a rocky one.

Another building, the original Port Jefferson High School, once stood in that same place, but it burned down on Independence Day in 1913.

According to the village’s historical archive, it is still a mystery what caused the fire, which started the night before. At the time, many believed that some young people broke into the building so they could ring the bell at midnight to celebrate July 4. They believed the kids started the fire by accident while using matches to light their way in the dark building.

The Spring Street school building went up in 1914. Photo by Barbara Donlon
The Spring Street school building went up in 1914. Photo by Barbara Donlon

There was also a theory that an arsonist lit up the wooden building, according to the archive. A suspect was presented to a Suffolk County grand jury, but he was not indicted.

The current Spring Street building was erected the following year, with the community laying its cornerstone on May 2.

According to Eastern Suffolk BOCES, $75,000 went toward the new brick and stone structure, which had separate entrances for boys and girls on opposite sides of the building.

“The genders may have been separated by doorways, but their education fell under the doctrine that knowledge is power, a phrase carved into the front of the building for all to see,” a press release from BOCES said.

Though the building was once home to all the grades in the school district, the district expanded and it eventually housed only middle school students. When those kids were moved into the Earl L. Vandermeulen High School building on Old Post Road, where they remain today, the historical building was left behind.

Port Jefferson’s old high school on Spring Street was made of wood and burned down on July 4, 1913. Photo from the Port Jefferson Village Digital Archive
Port Jefferson’s old high school on Spring Street was made of wood and burned down on July 4, 1913. Photo from the Port Jefferson Village Digital Archive

Eastern Suffolk BOCES stepped in during the late 1990s. Sean Leister, Port Jefferson’s assistant superintendent for business, said the school district began leasing the building to BOCES in March 1997. And according to BOCES, it has been providing special education services at the Jefferson Academic Center since 1998.

In 2007, the deteriorating Spring Street building got a little lift — district voters overwhelmingly approved a $5.2 million bond to renovate the building, which came with a renewed 10-year lease, the yearly rent of which covered the cost of the improvements. Those included replacing the gym floor, piping and the boilers; improving site drainage; doing work on the electrical system and the foundation; and making the building more handicapped-accessible with additional toilets, a wheelchair lift and an elevator.

The renovations have kept the Spring Street school going strong — it is the oldest school in Suffolk County that still operates as such.

To 100 years more.

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Sedentary lifestyle contributes

A good follow-up to last week’s acute pancreatitis article is one on gallstones. As I wrote, gallstones are the most significant contributing factor to the development of acute pancreatitis. Like pancreatitis, gallstones are a very common gastrointestinal disease; they affect up to 20 million Americans between the ages 20 of and 74, with a more than two-times increased occurrence in women than in men, according to the NHANES III survey (1). There are two types of gallstones, the majority of which are cholesterol stones — 80 percent occurrence — with pigment stones — 20 percent occurrence — making up the remainder.

Common symptoms

Gallstones may be asymptomatic; however, when gallstones block either the cystic or common bile ducts, symptoms occur. Symptoms include abdominal pain, exacerbated by meals, that is dull or crampy and lasts one to five hours; jaundice, which includes yellowing of skin and eyes; nausea and vomiting; rapid heart rate; hypotension — low blood pressure — and fever (2).

Tests used for diagnosis

Blood tests include complete blood count where there may be a rise in white blood cells; liver enzymes; and pancreatic enzymes — lipase and amylase. In general, diagnostic tests that have more accuracy are the endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). However, these are invasive tests. Less accurate but non-invasive tests include abdominal x-ray, ultrasound and CAT Scan (CT). The tests used also depend on where the stone may be located. Hepatobiliary (HIDA) scans are accurate if the stone is located in the cystic duct. And magnetic resonance retrograde cholangiopancreatography (MRCP) is used if the stone is thought to be located in the common bile duct (2).

What are the risk factors?

There are a multitude of risk factors. Some of these are modifiable, whereas others are not. The modifiable ones include obesity, measured by body mass index (BMI); rapid weight loss; fat consumption; hormone replacement therapy (HRT); oral contraceptives; decreased physical activity; Crohn’s disease and certain drugs. One non-modifiable risk factor is age; the older we get, the higher the risk, with 40 years of age being the demarcation line (3). Other risk factors are gender — females are more predisposed — pregnancy; and family history (4).

Let’s look at the evidence.

Obesity

Again, as with acute pancreatitis, obesity may play an important role. Obesity is not age-discriminant; it can impact both adults and children. The reason obesity is implicated is potentially due to bile becoming supersaturated (5). Bile is a substance produced in the liver and stored in the gallbladder. Bile aids in the digestion or breakdown of fats in the small intestines. Crystals may form, creating cholesterol gallstones from the bile.

Body Mass Index

A body mass index of greater than 30 kg/m2 is considered obese. In a meta-analysis of two prospective, forward-looking observational trials — Copenhagen General Population Study and the Copenhagen City Heart Study — those in the highest quintile of BMI were almost three times as likely to experience symptomatic gallstones compared to those who were in the lowest quintile (6). The highest quintile was those who had a mean BMI of 32.5 kg/m2 and thus were obese, whereas those in the lowest quintile had a mean BMI of 20.9 kg/m2. This is a comparison of ideal to obese BMI. Not surprisingly, since women in general have a higher risk of gallstones, they also have a higher risk when their BMI is in the obese range compared to men, a 3.36-fold increase and 1.51-fold increase, respectively.

Also, the research showed that for every 1 kg/m2 increase in BMI, there was a 7 percent increase in the risk of gallstones. Those who had genetic variants that increased their likelihood of an elevated BMI had an even greater increase in gallstone risk —17 percent —  per 1 kg/m2. In the study population of approximately 77,000, more than 4,000 participants became symptomatic for gallstones.

Gallstones in children

Sadly, obese children are not immune to gallstones, even though they are young. In a prospective observational study based on Kaiser Permanente data from Southern California, children who were overweight had a twofold increased risk of gallstones (7). But if that is not enough, girls who were extremely obese had a higher propensity for gallstones, similar to women in the previous study, with a  greater than sevenfold increase compared to a still very substantial greater-than-threefold increase for obese boys. Hispanic children were affected the most. The age range in this study was between 10 and 19 years old. Obesity is a disease that is blind to age.

Physical activity

We know physical activity is very important to stave off many diseases, but in this case, the lack of physical activity can be detrimental. In the Physicians’ Health Study, a prospective observational trial, those in the lowest quintile of activity between the ages of 40 and 64 had a 72 percent increased risk of gallstone formation, and those 65 and older had a 33 percent increased risk. (8). Also, men who were 65 and older and watched television more than six hours a week were at least three times as likely to have gallstones as those who watched fewer hours. There was a substantial increased risk for those under 65, as well, though to a slightly lesser degree.

Diabetes rears its ugly head

Just like with obesity, diabetes is almost always a culprit for complications. In a prospective observational study, those with diabetes were at a significant 2.55-times greater risk of developing gallstones than those without (9). Again, women had a higher propensity than men, but both had significant increases in the risk of gallstone formation, 3.85-times and 2.03-times, respectively. There were almost 700 participants in this study. The researchers believe that an alteration in glucose — sugar — metabolism may create this disease risk.

Hormone Replacement Therapy

If you needed another reason to be leery of hormone replacement therapy (HRT), then gallstones might be it. In a prospective observational trial, women who used HRT, compared to those who did not, had a 10 percent increased risk in cholecystectomy — removal of the gallbladder — to treat gallstones (10). Though this may not sound like a large increase, oral HRT increased the risk 16 percent, and oral estrogen-only therapy without progestogens increased the risk the most — 38 percent. Transdermal HRT did not have a significantly increased risk.

It is never too early or too late to treat obesity before it causes, in this case, gallstones. With a lack of exercise, obesity is exacerbated and, not surprisingly, so is symptomatic gallstone formation. Diabetes needs to be controlled to prevent complications. HRT, unless menopausal symptoms are unbearable, continues to show why it may not be a good choice. Next week, we will look at the complications of gallstones and how to prevent them.

References:

(1) Gastroenterology. 1999;117:632. (2) emedicine.medscape.com. (3) J Hepatol. 1993;18 Suppl 1:S43. (4) uptodate.com. (5) Best Pract Res Clin Gastroenterol. 2014 Aug;28:623-635. (6) Hepatology. 2013 Dec;58:2133-41. (7) J Pediatr Gastroenterol Nutr. 2012;55:328-333. (8) Ann Intern Med. 1998;128:417. (9) Hepatology. 1997;2:787. (10) CMAJ. 2013;16;185:549-50.

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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For Annie Heroux, it was love at first sight, at least as far as her career was concerned. During her days of studying at the Universite de Montreal, she took a course in crystallography — the study of the structure of small objects by looking at a crystallized arrangement of their atoms.

Even before the class began, she read the entire book. When she saw the professor, Francois Brisse, she said, “This is what I want to do” in graduate school. And so she did.

“I never planned for it,” she said. “It just happened.”

For her graduate work, Heroux performed crystallography work on polymers like kevlar. Eventually, her interest took her to Brookhaven National Laboratory, where she’s been for the last 13 years.

A beamline scientist, Heroux provides a supporting role to many of the users from around the world who come to BNL to see if they can make a link between the structure of something small that often happens inside a cell and its function.

“It is like knowing the shape of the tiny gears in a watch — OK, an antique watch with gears — and then desiring to know how the gears move each other to count down time, or move a muscle or have a thought,” explained BNL colleague and fellow Beamline Scientist Howard Robinson.

Recently, Heroux worked with Scott Bailey, an associate professor in the Johns Hopkins Bloomberg School of Public Health’s Department of Biochemistry and Molecular Biology. Bailey explored how bacteria were able to recognize and destroy viruses.

Heroux helped provide the first picture of the RNA and DNA of a molecular tool called Cascade, which protects the bacteria.

Cascade, an 11-protein genetic security system that can only function if each part is working correctly, uses short strands of bacterial RNA to scan its DNA to see if the genetic blueprints come from something else that might be trying to corrupt its system. If the RNA recognizes something other than its own code, it breaks down the DNA.

Heroux helped explore more conditions to get better crystals with better diffraction qualities — or ways that light bends.

In this research, which was published in August in the journal Science, Bailey and his collaborators found that the RNA scans the DNA in a way similar to how we look through text for a single word. The Cascade has a template to find its compatible counterpart.

In general, Heroux said her role is to make sure that everything works the way it should at the beamline. She “goes through the steps to figure out all the things that can go wrong during an experiment.”

After she helps with experiments, she returns to “crunch the numbers on the computer.”

While she doesn’t have her own lab or pursue her own research agenda, she does have an opportunity to try to figure out new ways to solve the structure of a molecule in a different way.

Heroux is looking forward to the opportunities presented by the NSLS II, the second generation of synchrotron that will open officially in 2015. The beam, which is 10,000 times brighter than the original, will create new opportunities and new challenges.

“The beamline will be so bright that we will modify the way we do experiments,” she said. The X-rays have the potential to destroy the crystals. The experiments will have to occur at a faster speed and may require more crystals to get a full data set.

Heroux enjoys the process of collaborating with scientists on their projects.

“Most scientists are pretty centered over what they want to do,” she said. “What I find interesting is that, by collaborating with all kinds of different groups, I get to see all kinds of different problems. It’s never the same thing.”

A resident of Shirley, which is only seven minutes from the lab, Heroux lives with her partner, Matt Cowan, a computer expert. Heroux, who is originally from Montreal, met Cowan through her work.

The couple have three children: Viviane Trudel, 21, Florence Trudel, 18 and Ethan Cowan, 10.

Heroux enjoys walking through parks with a mycology club, which searches for and identifies mushrooms. She calls cooking her “big relaxation,” and has tried her hand at Indian and Mexican food. She has also made her own sushi.

As for her work, she still is excited about seeing the structure of objects.“You collect data, which are spots on your detector and, if you’re lucky, a couple of hours later, you see the structure popping up,” she said. “That is always exciting, no matter what the structure is.”

 

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Everyone has heard of pancreatic cancer, but pancreatitis is a significantly more common disease in gastroenterology and seems to be on an upward projection. Ironically, this disease gets almost no coverage in the general press. In the United States, it is among the top reasons for patients to be admitted to the hospital (1).

Now that I have your attention, let’s define pancreatitis. A rudimentary definition is an inflammation of the pancreas. There are both acute and chronic forms. We are going to address the acute – abrupt and of short duration – form. There are three acute types: mild, moderate and severe. Those with the mild type don’t have organ failure, whereas those with moderate acute pancreatitis experience short-term or transient (less than 48 hours) organ failure. Those with the severe type have persistent organ failure. One in five patients present with moderate or severe levels (2).

What are the symptoms?

In order to diagnosis this disease, the American College of Gastroenterology guidelines suggests that two of three symptoms be present. The three symptoms include severe abdominal pain; increased enzymes, amylase or lipase, that are at least three times greater than normal; and radiologic imaging (ultrasound, CT, MRI, abdominal and chest X-rays) that shows characteristic findings for this disease (3). Most of the time, the abdominal pain is epigastric, and it may also present with pain in the right upper quadrant of the abdomen (4). Approximately 90 percent of patients may also experience nausea and vomiting (5). In half of patients, there may also be pain that radiates to the back.

What are the risk factors?

There is a multitude of risk factors for acute pancreatitis. These include gallstones, alcohol, obesity and, to much lesser degree, drugs. Gallstones and alcohol may cause up to 75 percent of the cases (2). Many of the other cases of acute pancreatitis are considered idiopathic (of unknown causes). Although medications are potentially responsible for between 1.4 percent and 5.3 percent of cases, making it rare, the number of medications implicated is diverse (6) (7). These include certain classes of diabetes therapies, some antibiotics – Flagyl (metronidazole) and tetracycline – and immunosuppressive drugs used to treat ailments like autoimmune diseases. Even calcium may potentially increase the risk.

Obesity effects

When given a multiple-choice question for risk factors that includes obesity as one of the answers, it’s a safe bet to choose that answer. Pancreatitis is no exception. However, in a recent study, using the Swedish Mammography Cohort and the Cohort of Swedish Men, results showed that central obesity is an important risk factor, not body mass index or obesity overall (8). In other words, it is fat in the belly that is very important, since this may increase risk more than twofold for the occurrence of a first-time acute pancreatitis episode.

Those who had a waist circumference of greater than 105 cm (41 inches) experienced this significantly increased risk compared to those who had a waist circumference of 75 to 85 cm (29.5 to 33.5 inches). The association between central obesity and acute pancreatitis occurred in both gallbladder-induced and nongallbladder-induced disease. There were 68,158 patients involved in the study with a median duration of 12 years. Remember that waistline is measured not from the hips, but rather from the navel. This may be surprising wake-up call for some.

Mortality risks

What makes acute pancreatitis so noteworthy and potentially dangerous is that the rate of organ failure and mortality is surprisingly high. One study found that the risk of mortality was 5 percent overall. This statistic broke out into a smaller percentage for mild acute pancreatitis and a greater percentage for severe acute pancreatitis, 1.5 percent and 17 percent respectively (9). This was a prospective (forward-looking) observational trial involving 1,005 patients.

However, in another study, when patients were hospitalized for this disease, the mortality rate was even higher at 10 percent overall (10).

Diabetes risks

The pancreas is a critical organ for balancing glucose (sugar) in the body. In a recent meta-analysis (involving 24 observational trials), the results showed that more than one-third of patients diagnosed with acute pancreatitis went on to develop pre-diabetes or diabetes (11). Within the first year, 15 percent of patients were newly diagnosed with diabetes. After five years, it was even worse; the risk of diabetes increased by 2.7-fold. This is scary, considering that diabetes has become a pandemic. If we can reduce the risk of pancreatitis, we may also help to reduce the risk of diabetes.

Surgical treatments

Gallstones and gallbladder sludge are major risk factors, accounting for 35 to 40 percent of acute pancreatitis incidence (12). Gallstones are thought to cause pancreatitis by temporarily blocking the duct shared by the pancreas and gallbladder that leads into the small intestine. When the liver enzyme ALT is elevated threefold (measured through a simple blood test), it has a positive predictive value of 95 percent that it is indeed gallstone-induced pancreatitis (13).

If it is gallstone-induced, surgery plays an important role in helping to resolve pancreatitis and prevent recurrence of acute pancreatitis. In a recent study, results showed that surgery to remove the gallbladder was better than medical treatment when comparing hospitalized patients with this disease (14). Surgery trumped medical treatment in terms of outcomes, complication rates, length of stay in the hospital and overall cost for patients with mild acute pancreatitis. This was a retrospective (backward-looking) study with 102 patients.

Can diet have an impact?

The short answer is: yes. What foods specifically? In a large, prospective observational study, results showed that there was a direct linear relationship between those who consumed vegetables and a decreased risk of nongallstone acute pancreatitis (15). For every two serving of vegetables, there was 17 percent drop in the risk of pancreatitis. Those who consumed the most vegetables – the highest quintile (4.6 servings per day) – had a 44 percent reduction in disease risk, compared to those who were in the lowest quintile (0.8 servings per day). There were 80,000 participants involved in the study with an 11-year follow-up. The authors surmise that the reason for this effect with vegetables may have to do with their antioxidant properties, since acute pancreatitis increases oxidative stress on the pancreas.

References:

(1) Gastroenterology. 2012;143:1179-1187. (2) www.uptodate.com. (3) Am J Gastroenterol. 2013;108:1400-1415. (4) JAMA. 2004;291:2865-2868. (5) Am J Gastroenterol. 2006;101:2379-2400. (6) Gut. 1995;37:565-567. (7) Dig Dis Sci. 2010;55:2977-2981. (8) Am J Gastroenterol. 2013;108:133-139. (9) Dig Liver Dis. 2004;36:205-211. (10) Dig Dis Sci. 1985;30:573-574. (11) Gut. 2014;63:818-831. (12) Gastroenterology. 2007;132:2022-2044. (13) Am J Gastroenterol. 1994;89:1863-1866. (14) Am J Surg online. 2014 Sept. 20. (15) Gut. 2013;62:1187-1192.

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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Ominous forecasts start a cascade of reactions, from a race through the supermarket for canned goods and water to trips to the hardware store for batteries and flashlights to a rush to the gas station to fill up before the possibility of an interruption in the supply line.

Stephanie Hamilton is determined to turn predictions of an approaching storm into a new kind of action plan for utilities.

A Smarter Grid R&D Manager at Brookhaven National Laboratory, Hamilton recently received a $336,000 grant from the New York State Energy and Research Development Authority to work with two utilities in upstate New York, Orange and Rockland Utilities and Central Hudson Gas and Electric. She would like to help these utilities gain a better understanding of how to interpret and use weather data to develop a plan for approaching storms.

The elements of new information in the BNL study will include streaming radar that offers forecasts in a range of 1.5 kilometers.

“What this will tell them is where we think the storm is going to be, the volume of the precipitation and how long that might continue,” Hamilton said.

That kind of specific knowledge of a storm will aid companies in understanding where to put reserves in place by reaching out to other companies through a mutual aid assistance program in states that might not be as affected by a storm.

When Hurricane Sandy hit, for example, Orange and Rockland Utilities had over 4,000 workers come to help restore power. Wisconsin Gas and Electric sent crews to Long Island to aid in the storm recovery.

Hamilton and her colleagues are working on building a toolkit that will help utility personnel use weather information they currently don’t have.

“Our expectation is that by having the information and new tools,” these companies will be able to understand “how severe weather will impact their systems.”

— Stephanie Hamilton

Hamilton said she herself isn’t the weather expert: she is relying on the meteorological expertise of BNL scientists Michael Jensen and Scott Giangrande. She is hoping to bring together the skills at understanding severe atmospheric conditions with an awareness of the vulnerable points on an electric grid.

Hamilton’s former supervisor, Gerald Stokes, who is now a visiting professor in the Department of Technology and Society at Stony Brook University, praised her work and her approach. Hamilton is “well regarded in the smart grid and utility community and is seen as one of the pioneers in that area,” he said.

The BNL study is one of seven such efforts NYSERDA is sponsoring with a total of $3.3 million to help utilities prepare for and react to severe weather events.

“As we continue to witness the impacts of extreme weather, it is more important than ever to invest in making our energy infrastructure stronger and smarter,” Gov. Andrew Cuomo said in a statement.

Hamilton hopes this is among the first steps in what could be a lengthy and productive local analysis of the vulnerabilities of the system to various disruptions. Some utility poles might be in areas where the ground becomes saturated with only a few inches of rain, depending on the local conditions and the ability of the vegetation in the area to soak up any accumulations.

When this project ends, the BNL team will try to demonstrate the tool at the utility with their existing procedures to validate the model and see how it can be used, she said.

Down the road, the utilities could integrate this kind of analysis with a pole-by-pole understanding of vulnerabilities to specific weather conditions.

The utilities have a financial incentive to bring systems damaged by a storm back online. Hamilton said a one hour reduction in storm response could save Orange and Rockland Utilities about $100,000 to $200,000.

A resident of Manorville, Hamilton lives with her partner John York, a retired Army lieutenant colonel and an IT expert working with TIAA-CREF in New Jersey as a business analyst for computing systems. Hamilton has enjoyed her three and a half years at BNL after growing up in south Georgia and spending much of her career in western states, including California, Washington and Wyoming.

As for her work, she feels at home at BNL.

“This is really a culmination of all the things I’ve ever wanted to do,” she said. She relishes the opportunity to “move the industry ahead. Making [utilities] more reliable and resilient is the key to our economy.”

 

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Soy may decrease risk if consumed in higher quanitities

NFL players are wearing pink shoes and other sportswear this month, making a fashion statement to highlight Breast Cancer Awareness Month. This awareness is critical, since annual breast cancer incidence in the U.S. is 230,000 cases, with approximately 40,000 patients, or 17 percent, dying from this disease each year (1). The good news is that from 1997 to 2008 there was a trend toward decreased incidence by 1.8 percent (2).

We can all agree that screening has merit. The commercials during NFL games tout that women in their 30s and early 40s have discovered breast cancer with a mammogram, usually after a lump was detected. Does this mean we should be screening earlier?

Screening guidelines are based on the general population that is considered “healthy,” meaning no lumps were found, nor is there a personal or family history of breast cancer. All guidelines hinge on the belief that mammograms are important, but at what age? Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms starting at 50 years old, after which time they should be done every other year (3). The  American College of Obstetricians and Gynecologists recommends mammograms start at 40 years old and be done annually (4). Your decision should be based on a discussion with your physician.

The best way to treat breast cancer – and just as important as screening – is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. We are always looking for ways to minimize risk. What are some potential ways of doing this? These may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer or its recurrence.

Let’s look at the evidence.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials, results showed there was no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The population used in this study involved postmenopausal women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention. The study was prompted by previous studies that have shown antitumor effects with this class of drugs. This analysis involved over 14,000 women ranging in age from 55 to 89. The two trials were FIT and HORIZON-PFT, with durations of 3.8 and 2.8 years, respectively. The FIT study involved alendronate and the HORIZON-PFT study involved zoledronic acid, with these drugs compared to placebo. The researchers concluded that the data were not evident for the use of bisphosphonates in primary prevention of invasive breast cancer.

In a previous meta-analysis of two observational studies from the Women’s Health Initiative, results showed that bisphosphonates did indeed reduce the risk of invasive breast cancer in patients by as much as 32 percent (6). These results were statistically significant. However, there was an increase in risk of ductal carcinoma in situ (precancer cases) that was not explainable. These studies included over 150,000 patients with no breast cancer history. The patient type was similar to that used in the more current trial mentioned above. According to the authors, this suggested that bisphosphonates may have an antitumor effect. But not so fast!

The disparity in the above two bisphosphonate studies has to do with trial type. Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

In a third study, a meta-analysis (group of 36 post-hoc analyses – after trials were previously concluded) using bisphosphonates, results showed that zoledronic acid significantly reduced mortality risk, by as much as 17 percent, in those patients with early breast cancer (7). This benefit was seen in postmenopausal women, but not in premenopausal women. The difference between this study and the previous study was the population. This was a trial for secondary prevention, where patients had a personal history of cancer.

However, in a RCT, the results showed that those with early breast cancer did not benefit overall from zoledronic acid in conjunction with standard treatments for this disease (8). The moral of the story: RCTs are needed to confirm results, and they don’t always coincide with other studies.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In a recent observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (9). These women exercised moderately; they walked four hours a week. The researchers stressed that it is never too late to exercise, since the effect was seen over four years. If they exercised previously, but not recently, for instance, 5 to 9 years ago, no benefit was seen.

To make matters worse, only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. The NFL, which does an admirable job of highlighting Breast Cancer Awareness Month, should go a step further and focus on the importance of exercise to prevent breast cancer or its recurrence, much as it has done to help motivate kids to exercise with its “Play 60” campaign.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a recent meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (10). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg. Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk, when compared to those who consumed the least. Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western versus Mediterranean diets

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (11). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammographies and self-breast exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References:

(1) CA Cancer J Clin. 2013;63:11-30. (2) J Natl Cancer Inst. 2011;103:714-736. (3) Ann Intern Med. 2009;151:716-726. (4) Obstet Gynecol. 2011;118:372-382. (5) JAMA Inter Med online. 2014 Aug. 11. (6) J Clin Oncol. 2010;28:3582-3590. (7) 2013 SABCS: Abstract S4-07. (8) Lancet Oncol. 2014;15:997-1006. (9) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (10) Br J Cancer. 2008;98:9-14. (11) Br J Cancer. 2014;111:1454-1462.

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

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In the 1970s, when he was in graduate school at New York University, Thomas Gingeras said his late mother, Barbara Lammons, described him as a vet for flies. While earning his Ph.D., Gingeras brought home bottles of one of the more common scientific test subject, the fruit fly, and stored them in a bathroom.

Almost four decades later, Gingeras, a professor at Cold Spring Harbor Laboratory, still works with flies, although he doesn’t need to bring any of them to his home on the campus at the laboratory. Instead, he is one of the leaders in a group called Encode, for the encyclopedia of DNA elements.

The Encode project includes scientists from around the world and provides a detailed catalog of genetic elements.

The latest version, called modEncode, for the Model Organism Encyclopedia of DNA Elements, compares genetic elements of humans to those of flies and the roundworm, two of the more actively studied by science.

Using billions of pieces of information including DNA base pairs and messenger RNA, scientists were able to explore the overlap in genetic machinery among members of species with considerably different lives.

“What we see,” Gingeras said, “are patches of things where the sequences that are known to carry out specific functions relate to one another.” These results were recently published in the journal Nature.

He likened the study to an examination of paintings. Looked at from a distance, the way a fly, worm and human might be seen, the end product appears different. “When you look at small areas, you can see” similarities among the paintings.

By finding overlap, scientists can hone in on ways to repair damage and provide additional genetic targets to cure human disease. “This points us in the direction of setting these at the top of the priority list,” said Gingeras. One of the primary paths pharmaceutical companies pursue is that “they look to find a disease state that is closely mimicking what is happening in humans. They look to see if the cause is similar, in their genes and regulatory regions.”

In his lab, Gingeras has five people who do benchwork, producing genetic data. Another five dedicate their time to making sense of that information, plugging bits of data into computers and looking for meaningful overlaps. Gingeras divides his time between analyzing and interpreting the data, writing for grant money and summarizing results in research papers.

Gingeras said the Encode group has been through some battles in the scientific community, especially when they first proposed the idea that the genes that don’t code for a specific element still might have a function for the organism and for the cell.

“The predominant idea when the human genome sequence was deciphered is that only a small fraction of the genome was functional,” about 2 percent, Roderic Guigo Serra, coordinator of the Bioinformatics and Genomics Program at the Center for Genomic Regulation in Barcelona explained in an email. “Gingeras “demonstrated that the fraction of the genome that is transcribed is much larger,” closer to 60 percent or more. Initially, Gingeras’s results were viewed with skepticism; they are now “widely accepted.”

Gingeras admitted that the early criticism bothered him.

“I took it very personally,” he said. “Not too long into this process, it dawned on me that it doesn’t make any difference what anybody thinks. If it’s right, [other scientists] will see it for themselves.”

Serra, who started collaborating with Gingeras more than a decade ago, said his colleague has “amazing energy,” and can call him to discuss their work at almost any hour of the day. This, he said, has been challenging but also motivating for Serra. Gingeras “has the insight to anticipate the questions that will become important before others,” he said.

Gingeras and his wife Hillary Sussman, who is the executive editor of the journal Genome Research at CSHL, have a 12-year-old daughter, Noa Sussman and a 5-year-old, Arie Anna Gingeras.

As for his work, Gingeras said the next steps in the analysis of genomes could include other organisms.

“The intention has been, all along, to provide a blueprint of what you could do on any organism to understand better what the component parts of the organism are,” he said. “This effort is meant to be a model case of what you could do for all organisms. The next step is to do the same thing for other organisms or study systems.”

 

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This is the second article in a two-part series on salt.

Last week, we discussed the potential negative effects of high sodium levels and low sodium levels, or the extremes. As I mentioned in last week’s article, the “extremes” of greater than 6,000 mg and less than 3,000 mg per day may increase the risk of cardiovascular events and all-cause mortality. However, the Prospective Urban Rural Epidemiology study on which these conclusions are drawn was significantly flawed. So don’t start using the salt shaker just yet without impunity. The bigger picture is that high sodium levels are dangerous and the low sodium levels used in this study likely are not.

Ironically, the sodium guidelines from a variety of health organizations range from recommendations of less than 1,500 mg per day to recommendations of less than 2,300 mg per day. Still, the average American takes in over 3,300 mg per day, with potentially disastrous health consequences. Theoretically, very low sodium levels – there’s no consensus on what those levels would be and the previous study does not help to shed light on that level – could potentially be harmful, but less than 1 percent of 100,000 people reached even the strictest of sodium levels (<1,500 mg per day). What we do know is the potential impact of higher levels. This week, we will continue to examine the latest research on sodium intake, in light of recent headlines that highlight disparities in medical opinions on sodium intake.

Blood pressure effect

Last week, we introduced the PURE study, which examined sodium intake by analyzing estimates of daily urinary sodium excretion extrapolated from once-a-day morning excretions. In another analysis involving the PURE study, results showed that those who excreted higher levels of sodium, greater than 5,000 mg a day in this case, had a substantially greater risk of high blood pressure (1).

Meanwhile, those who excreted 3 to 5 grams had a modest risk increase, and those who excreted the lowest amount, less than 3,000 mg, had no increased risk. This also involved over 100,000 participants. Potassium showed a positive impact; the greater amount of excretion, the lower the systolic (top number) blood pressure. The researchers concluded that those who were older, those who consumed more sodium and those with hypertension (high blood pressure) were more likely to experience a rise in their blood pressure.

Cardiovascular impact

However, in the NUTRICODE study, a meta-analysis (a group of 103 studies), results showed that there were over 1.5 million cardiovascular deaths in 2010 that were associated with higher sodium consumption (2). In this study, higher consumption meant greater than 2,000 mg of sodium per day. This number of deaths is based on a global scale involving 66 countries. The reason the cutoff for high sodium was lower than the other studies was that the researchers used the World Health Organization criteria. They calculated that nearly 1-in-10 cardiovascular deaths could be attributed to sodium intake. This is a sobering study that follows others showing similar results with sodium intake and cardiovascular disease.

Effects of reducing sodium

What happens when we reduce salt? Do we have Armageddon? Not quite. In fact, in a recent British analysis of the Health Survey for England, the results showed that reducing sodium by 1,400 mg per day significantly reduced the risk of cardiovascular events (3). The number of deaths from stroke decreased by 42 percent. There were also significant reductions in blood pressure and ischemic heart disease. The term ischemic heart disease is an umbrella term that means reduced blood supply to the heart, usually caused by atherosclerosis, or plaque in the arteries. It is the most common form of heart disease.

This study used 24-hour urinary excretion rates, the gold standard for estimated sodium consumption. Unlike studies mentioned previously, these rates were not estimated. However, there were issues with confounding factors (uncontrolled variables) not being taken into account. This was not a study without flaws, either. Having said this, decreasing sodium intake by a significant amount in the diet might actually have positive benefits. We need a randomized controlled trial to confirm this.

Sodium impact on children

Sodium may have deleterious effects in children. In a recent report from the Centers for Disease Control, 90 percent of kids take in too much salt. These children are between the ages of 6 and 18. Almost 17 percent, or 1 in 6 kids ages 8 to 17, have high blood pressure. This does not mean sodium is directly correlated, since it is not a study. However, it is likely to be a contributor. A handful of foods including chicken nuggets, chips, breads, cold cuts, sauces and soups. contribute 40 percent of our sodium intake. The good news is that the government is going implement sodium reduction in school food 50 percent by the year 2022. However, much of the problem also occurs at home.

Sodium-potassium ratio

You may not be able to look at sodium alone without considering the sodium-potassium ratio. In an observational study, results showed that those with a high sodium-to-potassium ratio had an almost 1.5 times greater probability of all-cause mortality and cardiovascular disease-related death than those with a much lower sodium-to-potassium ratio (5). The group that had higher sodium-to-potassium ratios also had a two-times increased risk of having ischemic heart disease. The duration was a strong point of this study, with almost 15 years of follow-up data. There were over 12,000 patients. It is believed that potassium gets its beneficial effects by activating nitric oxide, which causes vasodilation of arteries and, thus, may lower blood pressure.

While it is possible to get too little salt, it is rather unlikely and rare, especially with a plant-based diet. A diet rich in leafy green vegetables provides about 600-700 mg of sodium by itself, as well as high amounts of potassium. Low sodium is less than 140 mg per serving. But caveat emptor (buyer beware): serving sizes on labels can be deceiving, especially when you might eat more than one serving.

Reducing sodium is an easy way of helping to reduce acute (short-term) symptoms, such as dehydration, bloating and weight gain, while decreasing the risk of many diseases in the long term. Focus on decreasing the sodium, as the British study showed the positive impact on cardiovascular disease. And, if you have adolescents, preteens and teens, try to help reduce their sodium intake as well. Concentrate on increasing potassium intake and decreasing the sodium intake to optimize your sodium-to-potassium ratio.

References:

(1) N Engl J Med. 2014;371:601-611. (2) N Engl J Med. 2014;371:624-634. (3) BMJ Open. 2014;4:e004549. (4) www.cdc.gov. (5) Arch Intern Med. 2011;171:1183-1191.

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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Robert Lofaro drives a Prius, recycles his trash, and uses the air conditioning sparingly during the summer. These decisions reflect not just who he is, but also what he does.

The group leader of the Renewable Energy Group at Brookhaven National Laboratory, Lofaro leads the development of the applied research programs for solar energy. He also was the project manager for the development of the Northeast Solar Energy Research Center, a source of solar energy to the BNL campus that provides field testing and research.

Lofaro’s research addresses questions such as how to deal with the variability in power that comes from the sun due to cloud cover during the day and darkness at night. When solar energy comes to the electrical grid, this inconsistent production can cause problems with controlling the power quality on the grid, which has to supply power at a stable voltage and frequency.

This summer, BNL awarded Lofaro an annual engineering prize. The award, which includes a $10,000 prize, is the highest distinction given to members of the staff at BNL.

“It was quite an honor,” Lofaro said.

Researchers in Lofaro’s group will study energy storage systems, which could provide a buffer between the solar panels and the grid, and the use of “smart inverters,” which can control the grid voltage and frequency. BNL will test these system at NSERC.

“We’re interested in increasing the use of renewable energy throughout the country and in the Northeast,” Lofaro said. The uncertainty in the amount of power can cause problems with control of the grid, he said.

Once any new system is installed and operating, Lofaro seeks to explore how long the system can last.

“That goes towards the cost- effectiveness of installing the technology,” he said. “We’re doing field tests to understand how well they perform.”

Many states have targets for increasing the use of renewable energy. New York plans to increase solar, hydroelectric and wind energy sources to 30 percent of electric generation by next year, up from 22 percent in 2010.

As the cost of solar panels has dropped, the bigger expenses for utilities have been installation, labor, permitting, site preparation, and installation hardware, among others. Researchers are looking to reduce these costs and make solar energy more cost-competitive.

The staff in Lofaro’s department is “focused on grid integration,” he said. “There’s a lot of work to do in helping develop technologies that would enable the next generation” for a system that would enable real-time interactions between pieces of equipment in the grid, coupled with automatic controls, to provide a more efficient, reliable and resilient power delivery system.

Most grids are designed to send energy one way, from a central power station to customers. When some of their customers produce their own solar energy and sell it back to the utility, these two-way energy flows can trigger protective relays that interpret the flow of energy back from the customer as a fault, causing the grids to open the circuit to shut off the power.

New smart grids will need new monitoring, control and communication technologies to operate properly, Lofaro said.

Through automated switching, areas that have lost power through severe weather events, like Superstorm Sandy, might re-establish power more quickly.

Utilities could take portions of the grid and operate them as small parts of the network, with their own supply of power that would operate on its own if necessary, or as an integrated part of the larger grid.

“You’d need a number of control technologies and they’d have to be able to have special switching – through smart switches – that could synchronize” the smaller units with the larger energy source, Lofaro said. He said the grid today will require years to update.

Michael Villaran, who has known Lofaro since they started a month apart at BNL in 1987, describes his group leader as a “hands-on manager” who is “very involved” in the details of his work.

Lofaro is “well thought of in the solar energy research community,” Villaran said. “Getting the NSERC funded and constructed” is a “major accomplishment.”

Lofaro and his wife Nancy, who works in business operations at BNL, live in East Moriches. Lofaro plays on BNL’s golf league. He describes his golf game as “mediocre.”

As for his work, Lofaro is a firm believer of solar energy,

“Renewable energy will play an important part of meeting the nation’s energy needs for many years to come,” he said.

 

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The Facts: I have two dogs that I consider part of my family. I want to be sure they are cared for after I die. Someone suggested that I include a Pet Trust in my Will

The Question: Do you think this is a good approach?

The Answer: Yes, I do. However, in addition to the Pet Trust, which will not exist until after your Will is admitted to probate, it is important to make temporary arrangements for the care of your dogs that can be in place immediately upon your death.

When thinking about the provisions to include in the Pet Trust, you must not only consider who will care for your dogs, but also whether the appointed caregiver has the resources to cover the costs associated with pet ownership. Even if money is not an issue, you need to confirm in advance that the caregiver’s living arrangements are suitable for the dogs. As much as a potential caregiver may want to care for your pets, some apartment buildings and residential communities do not permit residents to own pets. If the caregiver of choice lives in such a community, or lives in a setting that is not large enough for the dogs, it is best to name someone else to adopt your pets after your death.

Once you have settled on a caregiver, you should consider including in your Pet Trust a description of the care you want your pets to receive. For example, if your dogs are groomed once a month, have an annual check-up by the vet and have their teeth cleaned three times a year, this schedule can be set forth in the trust. You can also name the groomer and vet that have taken care of your dogs in the past so that the caregiver can continue to use people with whom your dogs are familiar. Alternatively, you can prepare a letter to the caregiver in which you provide the caregiver with this information.

While the purpose of the Pet Trust is to insure that your dogs will be cared for after you die, it can also serve as a vehicle for providing your caregiver with instructions with respect to the handling your dogs’ remains after they die. This information is important and useful to the caregiver who will certainly want to honor your wishes.

In addition to setting forth in the Pet Trust provision of you Will the name of the caregiver and the type of care you wish your dogs to receive, both during their lives and after their deaths, you will need to allocate a certain amount of money to the trustee of the Pet Trust. The job of the trustee is to distribute the funds to the caregiver as needed to be used for the benefit of your dogs. Some people name the caregiver as the trustee but, you may have different people in those roles if you wish.

A final decision that you will have to make in connection with the Pet Trust is what happens to any of the funds left in the trust after your dogs pass away. Many people who have a Pet Trust direct that any money left in the trust after the death of the pet goes to the caregiver. Another popular arrangement is for the money to be donated to an organization that cares for abandoned and/or abused animals.

In light of the number of issues to be considered when creating a Pet Trust, and the fact that it will be part of your Will, you should discuss your ideas and concerns with an experienced estate planning attorney. That is the best way to insure that your dogs will be cared for in accordance with your wishes.

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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